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Biomedical subjects

R Okutani

Publications and source records attributed to R Okutani.

At least 37 records · Page 2Linked to original sources
PubMed1996

[The dual effect of ketamine on dopamine release from rat pheochromocytoma (PC-12) cells].

Ketamine is known to increase arterial pressure and heart rate with its sympathomimetic action. However, it also relaxes vascular smooth muscle and causes hypotension. We studied such a bipartite effect in terms of ketamine induced changes of dopamine (DA) release from rat pheochromocytoma (PC-12) cells as a model of sympathetic nervous system. Without KCl stimulation, ketamine increased the DA release from PC-12 cells in a dose-related fashion (10(-4)M: 2.6 +/- 0.4, 10(-3)M : 7.5 +/- 0.3, 10(-2)M: 27.1 +/- 3.2%). The similar increase of DA release was observed with absence of extracellular Ca2+. Exposure of KCl (50 mM) to PC-12 cells increased the DA efflux from 1.7 +/- 0.4 to 14.2 +/- 0.8% (P < 0.001). The release of DA stimulated by KCl (50 mM) was reduced to 9.0 +/- 1.0% and 11.4 +/- 0.3% in the presence of ketamine 5 x 10(-4)M and 10(-3)M respectively, and increased with the ketamine concentration of 10(-3)M. These findings indicate that ketamine depresses DA efflux related to membrane depolarization (K+) but it promotes a number of spontaneous DA efflux.

Adrenal Gland Neoplasms↗
PubMed1995

[Perioperative management of a patient with severe bronchial asthma attack].

We report an anesthetic management for Miles' operation in a 50-year-old female who had frequent severe bronchial asthmatic attacks prior to surgery. Because the surgical field was in the lower abdomen, we selected spinal anesthesia combined with epidural anesthesia. For spinal anesthesia, 15 mg of hyperbaric tetracaine with epinephrine was used. Moreover, 3 ml of 2% mepivacaine with epinephrine was injected via an epidural catheter, and then analgesia up to Th 6 was obtained. In order to prevent an asthmatic attack during surgery, the following cares were taken: (1) administration of moisturized oxygen by nebulizer via a nasal canula, (2) intravenous administration of steroid, (3) addition of epinephrine to the local anesthetics, and (4) sedation by music. The surgery was completed safely without asthmatic attacks. Postoperatively, pain control with buprenorphine was managed with a continuous extradural infusion. The patient was discharged 50 days after surgery, and was in a favorable condition without bronchial asthmatic attacks.

Anesthesia, Epidural↗
PubMed1994

Sex-associated differences in protein 1 values in urine: immunochemical detection of protein 1 in genital tissues.

Immunochemical methods were used to analyse sex-associated differences in urinary protein 1 concentration. Spot urine from seven normal men and seven women of reproductive age was collected in four sequentially divided fractions, and protein 1 concentration in each fraction was measured by an enzyme immunoassay using the sandwich method: protein 1 values in the first of the sequential urine samples from the male subjects were remarkably high (81.4 +/- 80.4 micrograms/l; mean +/- 1 SD), but were much lower in the remaining three fractions. In females, on the other hand, protein 1 values were low (0.7 +/- 0.4 microgram/l), were uniform in all four sequential fractions, and were close to those of the last three fractions of urine from male subjects. Based on this finding, protein 1 concentration was measured in 14 specimens of seminal plasma, where concentration of protein 1 was high (1259.1 +/- 1716.5 micrograms/l; range, 201.9 to 6580.0 micrograms/l). On Western blotting, protein 1 in seminal plasma had a molecular mass of M(r) 14,000, the same as that of protein 1 purified from the urine of patients with chronic renal failure of probable plasma origin, and of concentrated male urine collected at the initiation of voiding, which is thus thought to come mainly from genital tissue. Protein 1 was found to be in high concentration (434.8 +/- 504.6 micrograms/l) in five aspirated fluids collected at the ejaculatory duct after squeezing the prostate. Three prostate tissue extracts contained protein 1 concentrations ranging from 8.6 to 50.1 micrograms/l. Protein 1 is also present in seminal vesicle fluids (7.1 +/- 2.8 micrograms/l; range, 2.3 to 9.5 micrograms/l).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Anesthetic management in a patient with Beckwith-Wiedemann syndrome].

Beckwith-Wiedemann syndrome has three major symptoms, exomphalos, macroglossia and giantism. We report the anesthetic management of a 2-year-old male, weighing 16.1 kg and with a height of 94.6 cm, associated with bilateral retention testis. The anesthesia was maintained with oxygen, nitrous oxide, and sevoflurane. The surgery was completed safely without adverse events such as difficulty in tracheal intubation or refractory hypoglycemia. The anesthetic management of this syndrome requires: an assessment of difficulty in tracheal intubation and treatment, an understanding of the capacity of the patient's glucose metabolism, and assessment of complicated deformities. In particular, it is necessary to carry out a preoperative examination of the cardiovascular system.

Anesthesia, Inhalation↗
PubMed1994

[Anesthesiological management of a patient with primary aldosteronism complicated with hypertrophic cardiomyopathy].

A 49-year-old male with primary aldosteronism, accompanied by hypertrophic cardiomyopathy (HCM), underwent our anesthesiological management for resection of a left adrenal tumor. The preoperative examination revealed hypertension, mild nephropathy and hypokalemia. Spilnolactone treatment was discontinued 3 days before surgery. In the operating room, a Swan-Ganz catheter was inserted for monitoring hemodynamic parameters. Anesthesia was maintained with nitrous oxide-oxygen-isoflurane and vecuronium. During the surgery, prostaglandin E1 and nitroglycerin were used as vasodilators. During surgery, the patient was successfully managed, anesthesiologically. In anesthesiological management of patients with primary aldosteronism, care is needed regarding changes in blood pressure and electolyte levels during adrenalectomy. In cases where aldosteronism is accompanied by HCM, as in the present case, hemodynamic changes can cause a fatal outcome, and hence, carefulness is needed in using anesthetics and drugs which act on the circulatory system.

Adrenalectomy↗
PubMed1993

Protein 1: its purification and application in clinical medicine.

Protein 1 (P1) is a low-molecular-weight protein recently isolated from the urine of patients with chronic renal failure. Its molecular weight is 14 kDa on sodium dodecyl sulfate polyacrylamide gel electrophoresis and pI 4.7 on isoelectric focusing. We purified this protein, characterized its physicochemical properties, and analyzed its amino acid sequences to show that it is probably identical to human lung Clara cell 10 kDa protein. Its monoclonal antibody was prepared, and a reliable enzyme-linked immunosorbent assay employing the sandwich method was developed and used to investigate distribution and variation in concentration of P1 in various body fluids under an array of physiologic and pathologic conditions. Clinical studies indicated that, as is the case with other proteins of low molecular weight, the main catabolic site of P1 of plasma origin is the kidney: P1 is filtered by the renal glomeruli and reabsorbed by the renal tubules. Unabsorbed P1 is thus excreted into the urine. This protein is also synthesized in the genital tissues of males, however, from which it is also excreted into the urine. Clinical data obtained in our study of this protein is summarized here, and an attempt is made to determine the potential value of this protein in laboratory medicine.

Adolescent↗
PubMed1993

[Anesthetic management of a patient with polyarteritis nodosa who suddenly developed cardiac rupture after valve replacement].

We recently encountered a patient with mitral insufficiency, accompanied by PN (polyarteritis nodosa), who developed a cardiac rupture immediately after a mitral valve replacement. The patient was a 60-year-old woman. After she was diagnosed as having mitral stenosis and insufficiency in 1968, the patient developed congestive heart failure and underwent repeated hospital admissions and discharges. In 1989, she was diagnosed as having PN and began to receive a high-dose steroid therapy (prednisolone; total dose 5245 mg). Because of transient brain ischemia and exacerbation of the symptoms of heart failure, the patient underwent mitral valve replacement on December 19, 1991. For anesthesia, oxygen, fentanyl, midazolam and vecuronium were administered. During surgery, catecholamine, nitroglycerin and prostaglandin E1 were continuously infused intravenously. The patient was weaned smoothly from the cardiopulmonary bypass. The operation was completed in about 6 hours. Her postoperative course was satisfactory until she suddenly developed left ventricular rupture and died 6 hours after surgery. The rupture seemed to be attributable to a weakening of the myocardial wall following long-term, high-dose steroid therapy, and to myocardial degeneration caused by PN-associated necrotizing vasculitis of myocardial arterioles.

Female↗
PubMed1993

[Anesthetic management for cesarean section of a patient with transient diabetes insipidus and acute severe liver dysfunction].

A 26-year old woman presented with acute hepato-renal dysfunction, coagulation abnormalities and diabetes insipidus associated with hypernatremia in the latter term of pregnancy (39 weeks). Such transient diabetes insipidus during pregnancy as in this case has been reported to be resistant to AVP, but to respond to DDAVP. Because of fetal compromise, an urgent cesarean section was performed. Spinal anesthesia was chosen because of the possible deleterious effects of general anesthesia on liver function. After delivery of twin babies, her symptoms recovered gradually. In conclusion, diabetes insipidus during pregnancy as in this case is transient and disappear after delivery. However, multiple organ dysfunction may become worse and cause fetal death, unless surgical procedure with appropriate anesthetic management is performed.

Acute Disease↗
PubMed1993

[Successful anesthetic management of a patient with a giant mediastinal tumor].

Because of its anatomical location, mediastinal tumor is frequently accompanied by airway stenosis and signs indicating compression of the heart and large vessels. For this reason, a patient with this tumor often requires an urgent operation. We recently conducted such an operation on a girl 2 year and 7 month old in whom a giant tumor originating from the posterior mediastinum had caused dyspnea. In this case, anesthesia was induced with ketamine. Intubation was carried out while the girl was semiawake. No muscle relaxants were used, and spontaneous ventilation was partially preserved. During the operation, anesthesia was maintained with oxygen, nitrous-oxide and halothane, without using muscle relaxants. Although intratracheal bleeding, caused by manipulation of the tumor, aggravated the blood gas data, this could be coped with by elevating the oxygen concentration in the inspired gas. During the operation, respiratory control with 10cmH2O PEEP was carried out to cope with atelectasis from lung compression by the tumor. The postoperative course was excellent. From anesthetic management of this case we emphasize the following points: (1) preoperative assessment of the relationship between posture and dyspnea and assessment of the locational relationships of the tumor, heart, vessels and trachea, using CT, ultrasonography, bronchoscopy, etc; (2) utilizing a pulse oximeter, monitoring CO2 in expired gas and monitoring CVP during operation; (3) avoidance of the use of muscle relaxants before the improvement of the symptoms arising from tumor-caused compression; and (4) close respiratory care after operation.

Anesthesia↗
PubMed1992

Simple and high-yield purification of urine protein 1 using immunoaffinity chromatography: evidence for the identity of urine protein 1 and human Clara cell 10-kilodalton protein.

A simple and high-yield purification procedure for urine protein 1 (UP1) using anti-UP1 immunoaffinity chromatography is described. Pure UP1 was obtained in a final yield of 60.2%, and observed as a single electrophoretic band and as a single peak on reversed-phase high-performance liquid chromatography. The N-terminal amino acid residue of UP1 was found to be glutamic acid, contrary to what was reported previously. Furthermore, the N-terminal sequence of UP1 up to 53 amino acids was confirmed to be identical with that of mature human Clara cell 10-kilodalton protein, which inhibits phospholipase A2 activity.

Amino Acid Sequence↗
PubMed1992

[Perioperative management of a patient with transient polyuria].

Perioperative and anesthetic management of a patient with a diabetes insipidus is reported. A 33 year old man was followed by physical therapy after spinal cord injury. At that time polyuria (4300-8600 ml.day-1) and polydipsia developed. His urine output was controlled by DDAVP (desmopressin) preoperatively. As the result of water restriction test and Carter-Robbins test the diagnosis of complete central diabetes insipidus was doubted preoperatively. We investigated the changes of his perioperative body fluids and endocrine responses. The following conclusions are made: 1) The diagnosis of this case is not renal and true diabetes insipidus, but is probably partial or transient diabetes insipidus. 2) These results indicate that endocrine examinations related to AVP secretion are essential.

Adult↗
PubMed1991

Hemodynamics in the prone jackknife position during surgery.

We examined the hemodynamic changes occurring with prone jackknife positioning during colorectal surgery. The operative procedure was restorative proctocolectomy with ileal J-pouch anal anastomosis in five patients with adenomatosis coli and six patients with ulcerative colitis and anoabdominal resection of the rectum with colonic J-pouch anal anastomosis in eight patients with rectal cancer. Nineteen patients (10 men and 9 women aged 41 +/- 19 years) were monitored with arterial and Swan-Ganz catheters during positioning. Measurements were obtained in the supine and prone positions (1 minute, 3 minutes), and the jackknife position (1, 3, 5, and 10 minutes), as well as before and after adoption of the Lloyd-Davies position (1, 3, 5, and 10 minutes). Turning the patient from the supine position to the prone position resulted in a significant decrease in the cardiac index (CI). However, following head-down rotation, the CI increased and returned to the value seen in the supine position (p less than 0.05). Heart rate (HR) slowed and mean arterial pressure (MAP) increased in the prone jackknife position. We concluded that the extent of the changes in cardiac function presented no serious problems.

Adenoma↗
PubMed1990

[Platelet catecholamine changes in patients with pheochromocytoma].

In patients with adrenal tumor, the importance of platelet catecholamine was examined. In patients with pheochromocytoma, not only preoperative catecholamine concentrations in blood and urine but also platelet catecholamine content were abnormally high as compared to patients with other adrenal tumors (pheochromocytoma for NE 3383 and E 311, no pheochromocytoma for NE 235 and E 24 pg.mg-1 protein). In the patient with pheochromocytoma, plasma catecholamine concentration showed its peak during the manipulation of the tumor during operation, and it decreased rapidly and returned to normal level the day after operation. On the other hand, platelet catecholamine content showed its peak after operation and returned to normal range on the 7th postoperative day. These results suggest that determination of platelet catecholamine content is useful for pre-operative diagnosis of pheochromocytoma, and that catecholamine in platelet modulates sudden fluctuation in plasma catecholamine concentration.

Adrenal Gland Neoplasms↗