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Biomedical subjects

O Yuge

Publications and source records attributed to O Yuge.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Risk of bradycardia after endoscopic electrocautery of the upper thoracic sympathetic ganglia].

We evaluated risk of bradycardia after endoscopic electrocautery of the upper thoracic sympathetic ganglia (ETS). Enrolled in this study were 24 patients. Bradycardia, defined as heart rate below 50 beats per min continuing for more than 5 min, was found in 12 patients (50%). All patients were divided into two groups; bradycardia group and non-bradycardia group. Age, sex, region of electrocautery, fentanyl dosage, and operation time were not different between the two groups. Power spectral analysis of heart rate variability revealed that sympathetic activity decreased after ETS. Multivariate analysis indicates that postoperative-minimal heart rate depends upon preoperative heart rate at rest. We conclude that careful monitoring after ETS is necessary in a patient with heart rate below 60 bpm preoperatively.

Aged↗
PubMed2000

[Pain management for patients with cancer--current problems in a pain clinic].

One hundred and twenty-three patients with early or advanced cancer who had been referred to our pain clinic were studied retrospectively to investigate current problems with pain management for cancer patients. Pain due to advanced cancer and prolonged post-thoracotomy pain were two major reasons for referral. It was found that 51.7% of the patients with advanced cancer had not been treated appropriately with the WHO protocol for cancer pain relief before referral; however, increased administration of morphine did not necessarily relieve cancer pain, and in fact decreased the QOL of some patients; and 47.7% of patients with cancer pain were effectively treated with nerve block therapy. The present investigation also indicates that many patients who had undergone thoracotomy suffered prolonged post thoracotomy pain. Although post-thoracotomy pain was refractory to NSAIDs, trigger point injections with or without intercostal nerve block were effective in 65.4% of such patients. We conclude that further propagation of the WHO protocol for cancer pain relief, appropriate use of nerve block and establishment of practical guidelines for multidisciplinary management of pain are mandatory for improving the QOL of patients with cancer.

Aged↗
PubMed2000

[Left lung lavage affected the cardiac autonomic nervous activity more than right lung lavage during one lung ventilation in a patient with pulmonary alveolar proteinosis].

A 31-year-old man with pulmonary alveolar proteinosis underwent whole lung lavage using differential lung ventilation under general anesthesia with propofol and fentanyl. Left lung lavage was performed under the differential lung ventilation using extracorporeal lung assist. A month later, right lung lavage was performed under the differential lung ventilation alone. We compared left lung lavage with right one in the effects on heart rate variability and relationships between heart rate and arterial pressure. In the left lung lavage compared with the right one, arterial pressure was maintained higher; sympathetic nervous activity was kept tonic as shown in the power spectral analysis of heart rate variability; coherency showed lower; and a phase relationship analysis indicated a delay of almost 180 degrees. Therefore, we conclude that left lung lavage affected the cardiac autonomic nervous activity more than right one in differential lung ventilation.

Adult↗
PubMed1999

Perioperative blood transfusion as a prognostic indicator in patients with hepatocellular carcinoma.

We studied the relation of perioperative blood transfusion and the outcomes in 175 patients with hepatocellular carcinoma (HCC) who underwent hepatic resection from 1986 to 1994 in our hospital. Hepatectomy was performed in 23 (13.1%) patients with and 152 (86. 9%) without blood transfusions. The cumulative cancer-free survival rates for patients who had received blood transfusion was significantly lower than that for patients who had not received blood transfusions (p = 0.003). Further examinations revealed a significant difference in cancer-free survival rates for stage I-II patients (n = 75) of HCC (p = 0.02) but not for stage III-IV patients (n = 56) (p = 0.06). Cox regression analysis for recurrence revealed that blood transfusion was the most significant prognostic indicator (p = 0.001) for recurrence in stage I-II patients but not in stage III-IV patients (p = 0.99). These results suggest that a perioperative blood transfusion may be a significant prognostic indicator for patients with HCC who had underwent hepatectomy, especially in stage I-II patients of HCC.

Adult↗
PubMed1999

Topographical features of cutaneous tactile hypoesthetic and hyperesthetic abnormalities in chronic pain.

Tactile sensory abnormalities, such as tactile hypoesthesia and mechanical allodynia, are frequently present in patients with chronic pain. A growing body of evidence indicates that hyperesthetic phenomena, like mechanical allodynia, are at least in part due to altered processing by neurons in the CNS. We propose that the hyperesthesia is associated with a functional tactile hypoesthesia that is similarly mediated by altered processing by CNS neurons, and that this association is characterized by a particular topography that may be related to the receptive field organization of somatosensory CNS neurons. Moreover, we propose that the hyperesthetic-hypoesthetic association is dynamically modulated in tandem by pain input.

Chronic Disease↗
PubMed1999

Cytosolic Ca2+ movements of endothelial cells exposed to reactive oxygen intermediates: role of hydroxyl radical-mediated redox alteration of cell-membrane Ca2+ channels.

1. The mode of action of reactive oxygen intermediates in cysosolic Ca2+ movements of cultured porcine aortic endothelial cells exposed to xanthine/xanthine oxidase (X/XO) was investigated. 2. Cytosolic Ca2+ movements provoked by X/XO consisted of an initial Ca2+ release from thapsigargin-sensitive intracellular Ca2+ stores and a sustained Ca2+ influx through cell-membrane Ca2+ channels. The Ca2+ movements from both sources were inhibited by catalase, cell-membrane permeable iron chelators (o-phenanthroline and deferoxamine), a *OH scavenger (5,5-dimethyl-1-pyrroline-N-oxide), or an anion channel blocker (disodium 4, 4'-diisothiocyano-2, 2'-stilbenedisulphonic acid), suggesting that *O2- influx through anion channels was responsible for the Ca2+ movements, in which *OH generation catalyzed by intracellular transition metals (i.e., Haber-Weiss cycle) was involved. 3. After an initial Ca2+ elevation provoked by X/XO, cytosolic Ca2+ concentration decreased to a level higher than basal levels. Removal of X/XO slightly enhanced the Ca2+ decrease. Extracellular addition of sulphydryl (SH)-reducing agents, dithiothreitol or glutathione, after the removal of X/XO accelerated the decrement. A Ca2+ channel blocker, Ni2+, abolished the sustained increase in Ca2+, suggesting that Ca2+ influx through cell-membrane Ca2+ channels was extracellularly regulated by the redox state of SH-groups. 4. The X/XO-provoked change in cellular respiration was inhibited by Ni2+ or dithiothreitol as well as inhibitors of Haber-Weiss cycle, suggesting that Ca2+ influx was responsible for *OH-mediated cytotoxicity. We concluded that intracellular *OH generation was involved in the Ca2+ movements in endothelial cells exposed to X/XO. Cytosolic Ca2+ elevation was partly responsible for the oxidants-mediated cytotoxicity.

Animals↗
PubMed1999

Protamine induces elevation of cytosolic free Ca2+ in cultured porcine aortic endothelial cells.

To test the hypothesis that protamine influences calcium movement in endothelial cells, we measured the concentration of intracellular free calcium ([Ca2+]i) in cultured porcine aortic endothelial (PAE) cells in Krebs solution (2.5mM Ca2+, pH 7.4) at 37 degrees C, by fura-2 fluorimetry. The basal [Ca2+]i of PAE cells was 113+/-18 nM (n=6). Protamine increased [Ca2+]i in a concentration-dependent manner (EC50, the concentration having 50% of the maximum effect, 1.4+/-0.3 microg mL(-1), n=6). The response of PAE cells to 100 microg mL(-1) protamine (330+/-80 nM, n=6) was blocked by a Ca2+ chelator, 5 mM glycoletherdiaminetetraacetic acid (EGTA; 131+/-16 nM, n=6), and by a non-selective Ca2+ channel blocker, 3 mM Co2+ (134+/-14 nM, n=6). These results suggest that Ca2+ influx through cell-membrane Ca2+ channels is mainly responsible for the protamine-induced Ca2+ elevation.

Animals↗
PubMed1999

Genetic analysis with calcium-induced calcium release test in Japanese malignant hyperthermia susceptible (MHS) families.

Some genetic studies have shown a linkage between malignant hyperthermia susceptibility (MHS) and chromosome 19q or the skeletal muscle ryanodine receptor (RYR1) gene. Some types of MHS seem to be caused by an abnormality of calcium-induced calcium release (CICR). We analyzed the linkage of RYR1 gene polymorphisms in Japanese MHS families and investigated the correlation between genetic evidence of RYR1 gene mutations and an accelerated rate of CICR. We studied 63 subjects who were referred to our institute for investigation of MHS. CICR rates were measured by the skinned fiber method in 23 subjects. DNA samples were collected from 63 individuals belonging to 22 unrelated families. Restriction fragment length polymorphism (RFLP) analyses on the RYR1 locus and hypervariable microsatellite analysis were performed. We found one family with a linkage between acceleration of the CICR mechanism and a group of RFLPs. In CICR tests, ten of the 11 patients who had presented with fulminant MH showed accelerated rates of CICR. Analysis for the mutation C1840T, which was performed in 63 samples, did not demonstrate an alteration in any of the patients. Although we found heterozygotes in RFLP studies, we did not recognize a specific relationship between the acceleration of CICR and the RFLPs. We suggest a linkage between the acceleration of CICR and an abnormal human RYR1 gene in MHS. These results also suggest that heterogeneity exists for MH. We conclude that genetic tests cannot replace CICR tests or caffeine-halothane contracture tests with muscle biopsy as a diagnosing test for MH in the near future.

Calcium↗
PubMed1999

Brain metastasis from hepatocellular carcinoma after radical hepatectomy.

Brain metastasis from hepatocellular carcinoma (HCC) is a rare, yet perplexing problem in patients with cancer. We report on 5 patients with metastasis of HCC to the brain after radical hepatectomy. Intrahepatic recurrence occurred in 3 patients, and distant metastasis to sites other than the brain was observed in 3 patients (lung, 2; bone, 1). The symptoms for brain metastasis included headache, hemiparesis, and vomiting. Hemorrhage was found in 4 of 5 patients. All patients had a single nodular lesion in the brain. The alpha-fetoprotein levels were more than 10,000 ng/ml in 4 patients. Two patients underwent surgical resection, 1 received cranial irradiation, and 2 were administered corticosteroids. The interval between diagnosis of the primary cancer and detection of brain metastasis ranged from 2 to 54 months. The mean survival period was only 3 months after diagnosis of brain metastasis. All 5 patients died of neurologic causes. Because no effective treatment for brain metastasis from HCC is available, further study is needed.

Adult↗
PubMed1998

Isolated caudate lobectomy by anterior approach for hepatocellular carcinoma originating in the paracaval portion of the caudate lobe.

We aimed to assess isolated caudate lobectomy by the anterior approach for the treatment of large hepatocellular carcinomas originating in the paracaval portion of the caudate lobe. The surgical procedures consisted of ligation and dissection of the caudate branch of the portal vein and short hepatic veins from the right side of the hepatic hilum; liver resection cranially from the right side of the process portion; ligation and dissection of the short hepatic veins from the left side; hepatic resection between the lateral segment and Spiegel lobe; and, finally, dissection of the liver at the right of the Cantlie line, reaching the tumor in the paracaval portion of the caudate lobe. The important point in this procedure was the appropriate management of the short hepatic veins, the branches of the hepatic vein, and the glisson's vessels of the paracaval portion. The operative times for the three patients reported here were 430, 355, and 575 min, with blood loss of 1100, 1180, and 2000 ml, respectively. The duration of the operation was short and blood loss was minimal; severe complications were not observed. Complete recovery of liver function after this surgery tended to be slow. Early recurrence was observed during long-term follow-up. This procedure is considered to be a safe method, with optimal surgical vision for caudate lobe tumors of a relatively large size. However, adjuvant therapy to prevent recurrence is required.

Aged↗
PubMed1998

Parasympathetic activity in brain death: effect of apnea on heart rate variability.

BACKGROUND: Power spectral analysis of heart rate variability is a useful monitoring of brain-damaged patients. However, the effect of artificial ventilation is not clearly demonstrated in assessing vagal activity because the locus of its activity is originated close to the respiratory center in the brain stem. We studied heart rate variability during artificial ventilation and apnea test as part of an assessment of brain death. METHODS: Ten adult patients with severe brain damage were studied. Power spectral analysis of heart rate variability from electrocardiographic R-R intervals was integrated to compare spectral components before, during and after the apnea test. Before the test, circulatory and blood gas variables and electrocardiographic recording were obtained under controlled mechanical ventilation at a rate of 12 and 18 (/min), each for 5 min. Measurements were made for 10 min during the apnea test, and repeated thereafter as before the test. Power spectral analysis based on fast Fourier transformation was made by integrating each low- (LF: 0.04-0.15 Hz) and high- (HF: 0.15-0.40 Hz) frequency band areas. LF was assessed as sympathetic and parasympathetic nervous activity, and HF as respiratory-related parasympathetic vagal activity. The HF/LF ratio showed sympathovagal balance. RESULTS: All patients were assessed as brain dead. During apnea, PaCO2 (P<0.01) and LF (P<0.05) increased, and pH (P<0.01) and HF/LF ratio (P<0.05) decreased. Heart rate, mean arterial pressure, PaO2 and HF remained consistent throughout. CONCLUSION: It was shown that sympathovagal balance was inclined to be sympathotonic during apnea, and that there were no changes in the respiratory-related vagal activity in spite of stopping artificial ventilation.

Adolescent↗
PubMed1998

Living related partial liver transplantation for primary biliary cirrhosis--a case report.

An adult living related partial liver transplantation was performed on a 49 year old female with terminal hepatic failure due to primary biliary cirrhosis (PBC). The donor was her 53 year-old sister. A sufficient volume of graft tissue was obtained, which comprised 1.5% of the body weight of the recipient. The recipient had an excellent recovery without any major complications, and was discharged 35 days after the operation. At 15 months after the operation, the patient has shown no signs of rejection while using FK506 and prednisolone as immunosuppressants. The progression of symptomatic PBC can be predicted, and the timing of the transplantation can be easily determined. In addition, the results of liver transplantation for PBC are good. Therefore, adult living related partial liver transplantation is an excellent treatment for primary biliary cirrhosis.

Bilirubin↗
PubMed1998

Indications for palliative reduction surgery for hepatocellular carcinoma with multiple intrahepatic metastases.

We evaluated the efficacy of and the indications for palliative reduction surgery as a procedure to improve the prognosis of hepatocellular carcinoma (HCC) patients with multiple intrahepatic metastases. From January 1986 to October 1997, 25 HCC patients with multiple intrahepatic metastases who underwent necessary palliative reduction surgery due to advanced disease, were participated in the study. The 1-, 3-, 5-year survival rates of 25 patients with reduction surgery were 54.7%, 29.9%, 22.4%, respectively. Moreover, the 1-, 3-, 5-year survival rates of patients with some postoperative supplemental treatment were 68.8%, 41.2% and 30.9%, respectively. All 6 patients who had been alive for more than 3 years had had primary tumors with diametric sizes of approximately 5 cm and had undergone, at most, one segmentectomy. These patients received postoperative supplemental treatments. The indication for palliative reduction surgery for HCC patients with multiple intrahepatic metastases was patients with a relatively small primary tumor (around 5 cm) which could be removed by one segmentectomy or less.

Aged↗
PubMed1998

Thoracoscopic microwave coagulation therapy for hepatocellular carcinoma.

Thoracoscopic microwave coagulation therapy (MCT) is a new therapeutic approach for hepatocellular carcinoma (HCC) in segments VII and VIII, which allows minimal access to the tumor and complete tumor ablation. In this study, four patients with HCC in segments VII and VIII underwent thoracoscopic MCT as a less invasive therapeutic option due to advanced liver cirrhosis and/or severe complications. Tumor sizes ranged from 15 to 30 mm in diameter and the tumors were well differentiated in 2 patients, moderately in one and poorly in one patient. Microwave irradiation was performed at an 80 W output with a 60-sec duration via a thoracoscopic route and the total duration ranged from 4 to 24 min (mean: 17 min). Patients recovered rapidly to preoperative conditions and no mortality was occurred. Complications were observed in one patient, including pleural effusion and fever elevation, but were cured conservatively. Postoperative computed tomography (CT) showed complete tumor ablation with a cancer-free margin, which is thought to be equivalent to a limited hepatic resection. This preliminary study suggests that thoracoscopic MCT might be a new, less invasive option providing a cure for HCC in segments VII and VIII in patients with advanced liver cirrhosis and severe complications.

Aged↗
PubMed1998

Continuous monitoring of jugular bulb venous oxygen saturation for evaluation of cerebral perfusion during carotid endarterectomy.

In this study we examined whether continuous monitoring of jugular bulb venous oxygen saturation (SjO2) is applicable for the evaluation of cerebral hypoperfusion during carotid endarterectomy (CEA). The subjects were 25 patients who underwent elective CEA under general anaesthesia. After the carotid stump pressure (SP) was measured, SjO2 and the somatosensory evoked potentials (SEP) were monitored during the carotid test clamping for 10 min. There was no alteration in cardiovascular and respiratory status during the test clamping. No correlation was observed between SEP amplitude and SP (r = 0.16, p = 0.25). However, at clamping, SjO2 decreased from 70 to 64% (p < 0.01) with a reduction in SEP amplitude from 2.0 to 1.6 microV (p < 0.01). After declamping, SjO2 increased from 65 to 70% (p < 0.01) with a recovery in SEP from 1.6 to 1.9 microV (p < 0.01). The changes in SEP amplitude and SjO2 correlated (r = 0.66, p < 0.001). These results suggest that continuous monitoring of SjO2 is superior to SP measurement in the prediction of cerebral hypoperfusion caused by carotid clamping and applicable to CEA.

Cerebrovascular Circulation↗
PubMed1998

Hepatic resection for cavernous hemangiomas of the liver.

In this report, we evaluate the indications of, and present our recent strategy for, cavernous hemangioma of the liver. Seven patients with cavernous hemangiomas of the liver, who underwent hepatic resection were enrolled in this study. The lesions were located in the right lobe in 3 patients, the left lobe in 2, and in both the right and left lobes in 2. The longest diameter of the lesions ranged from 1.4 to 14.5 cm (mean, 8.2 cm). The indications for hepatic resection were symptomatic lesions in 3 patients, lesions suspected to be hepatocellular carcinoma in 2, and symptomatic and growing lesions during follow-up in 2. Right lobectomy was performed in 2 patients, left lobectomy with caudate lobectomy in 1 patient, and minor hepatic resection in the other 4 patients. One of the patients who underwent minor hepatic resection had recently received laparoscopy-assisted hepatic resection and one of the three patients who received transfusion during surgery was given an autotransfusion. There were no mortality, and morbidity was minimal. In conclusion, hepatic resection, including laparoscopy-assisted procedures, was considered a safe treatment. Hepatic resection for cavernous hemangioma should be performed only in patients with moderate to severe symptoms, complicated lesions or both, because most benign lesions have a good natural course. Furthermore, in the future, less invasive surgical procedures should be used whenever possible to treat these benign liver tumors.

Digestive System Surgical Procedures↗
PubMed1997

Neuropathic pain and prolonged regional inflammation as two distinct symptomatological components in complex regional pain syndrome with patchy osteoporosis--a pilot study.

To reappraise symptomatology of complex regional pain syndrome (CRPS), we investigated the clinical symptoms of seven patients with CRPS who showed associated patchy osteoporosis. The incidence of moderate to severe spontaneous pain, burning pain, mechanical allodynia was higher in patients with significant nerve injury than in those without. Periarticular tenderness adjacent to osteoporotic bones, abnormalities of blood flow, edema and impairment of motor function were seen in both groups of patients. Our clinical observations of patients with CRPS associated with patchy osteoporosis suggest that CRPS may have the following two distinct components: (1) neuropathic pain that includes severe spontaneous pain or severe persistent mechanical allodynia and (2) prolonged regional inflammation, the early phase of which could be indicated by positive inflammatory symptoms of pain (tenderness), heat, redness, swelling and loss of function and their alleviation with corticosteroids.

Adult↗