Biomedical subjects

R Shimizu

Publications and source records attributed to R Shimizu.

At least 181 records · Page 10Linked to original sources

PubMed1994

[Failures of lumbar epidural analgesia caused by transforaminal passage of an epidural catheter in two cases].

In one case, analgesia level obtained with a 20 ml of 1.5% mepivacaine was unilateral and inadequate. In the other case, an epidural catheter was inserted after a 20 ml of 2% mepivacaine was injected through a Tuohy needle. Toxicity by local anesthetic was induced by an overdose of local anesthetic through the catheter. In both cases, transforaminal passage of a catheter was confirmed by epidurogram with iohexol. If an epidural catheter is advanced beyond 5 cm into the epidural space, it may migrate outwards through the intervertebral foramen. Therefore, the insertion of an epidural catheter should be limited to 3-4 cm.

Adult↗

PubMed1994

[Meralgia paresthetica after spinal anesthesia].

A 27-year-old man underwent appendectomy under spinal anesthesia with 0.3% dibucaine 2.7 ml. The perioperative course was uneventful. The surgical procedure, however, lasted for 1.5 hours in the supine position. On the second postoperative day, a postspinal headache occurred and lasted for 18 days. On the seventh postoperative day the patient complained of numbness along the anterolateral aspect of the left thigh innervated by the lateral cutaneous nerve. There was no reflex or motor deficit indicative of the involvement of other nerves. The disorder was diagnosed as meralgia paresthetica caused by the surgical procedures. The numbness disappeared after the oral administration of mecobalamin in several days. In the treatment of a case like this, it is important to exclude neurological complications caused by spinal anesthesia.

Administration, Oral↗

PubMed1994

[Continuous epidural buprenorphine for postoperative pain relief in upper abdominal surgery].

To evaluate postoperative analgesia and side effects of epidural buprenorphine, 100 patients who underwent upper abdominal surgery were divided into 5 groups. All patients were given initially 0.1 mg of buprenorphine in 8 ml of 0.25% bupivacaine in bolus. Following an epidural bolus, 20 patients in each group were given 0.25% bupivacaine alone (group A), 5 micrograms buprenorphine in 1 ml of 0.25% bupivacaine (group B), 8 micrograms buprenorphine in 1 ml of 0.25% bupivacaine (group C), 12 micrograms buprenorphine in 1 ml of 0.25% bupivacaine (group D), or 15 micrograms buprenorphine in 1 ml of 0.25% bupivacaine (group E) with a portable disposable device at a rate of 1 ml.h-1 for 48 h. The analgesic efficacy in group E was superior to that in groups A, B, C and D. No significant difference was found in the incidence of side-effect among 5 groups. Therefore, epidural buprenorphine 15 micrograms in 1 ml of 0.25% bupivacaine given to patients at a rate of 1 ml.h-1 was thought to be optimal for postoperative pain relief in upper abdominal surgery in terms of its efficacy and side effects. However, 35% of these patients required supplementary systemic analgesics in the early postoperative period.

Abdomen↗

PubMed1994

[Comparison of intraoperative complications between laparoscopic cholecystectomy by intraperitoneal insufflation and abdominal wall lifting].

We compared intraoperative circulatory and respiratory complications and changes in body temperature during laparoscopic cholecystectomy by intraperitoneal insufflation of carbon dioxide gas (24 cases) with those by abdominal wall lifting (16 cases). The abdominal wall lifting method tended to produce fewer complications than the intraperitoneal insufflation method, but not significantly. In conclusion, the former was thought to be safer than the latter.

Abdominal Muscles↗

PubMed1994

[Spinal anesthesia for open reduction of tibial fracture in a patient with late cerebellar cortical atrophy].

We could successfully perform spinal anesthesia with bupivacaine for open reduction of tibial fracture in a patient with late cerebellar cortical atrophy (LCCA). LCCA is a very rare neurologic degenerative disorder localized chiefly in the cerebellum, and it may be followed by various complications. His postoperative course was uneventful, followed by no neurological complication. Regional anesthesia including spinal anesthesia seems to be safe for operations in patients with LCCA.

Anesthesia, Spinal↗

PubMed1994

[Intravenous lidocaine in the treatment of post treatment neuropathy].

A 46-yr-old man with a 3-month history of post treatment neuropathy following insulin treatment for diabetes mellitus was suffering from severe pain and dysesthesia in his bilateral feet and legs. The patient described his pain as constant burning sensation which was severest in the soles and extended circumferentially over the legs. Previous trials of tricyclic antidepressants and nonsteroidal antiinflammatory drugs were uneffective. The patient received a trial dose of intravenous lidocaine (200mg), which markedly decreased his pain. Subsequently, mexiletine was administered orally in a dose of 300 mg a day and the dose was increased up to 450 mg a day, by which a severity of pain was halved and anxiety was relieved one month later. In conclusion, intravenous lidocaine and oral mexiletine may be useful drugs for post treatment neuropathy.

Administration, Oral↗

PubMed1994

[Atropine has little significance as a premedication for spinal anesthesia].

Intramuscular atropine 0.5 mg as an anticholinergic premedicant for spinal anesthesia was studied in 14 patients. Twelve patients of a control group did not receive atropine. No significant difference was found between the groups with regard to changes in blood pressure during spinal anesthesia whose analgesic level reached T4. A significant difference was found between the groups with regard to changes in heart rate during spinal anesthesia, but the incidence of bradycardia below 60 beats.min-1 was similar between the groups. Intramuscular atropine 0.5 mg as a premedicant offered little vagal blockade of the heart during spinal anesthesia.

Adult↗

PubMed1994

[Responses of arterial pressure and heart rate to epidural anesthesia in controlled hypertensive patients].

We have compared the responses to thoracic epidural anesthesia in 14 controlled hypertensive patients with those in 36 normotensive patients. Arterial pressure and heart rate were measured on the day before surgery, before and after the establishment of the epidural anesthesia, during light general anesthesia combined with epidural anesthesia, and after extubation. No significant difference in systolic, diastolic and mean arterial pressures were found between hypertensive and normotensive patients on the day before surgery. Changes in systolic and mean arterial pressures were greater in hypertensive patients than in normotensive ones, but absolute values of systolic, diastolic and mean arterial pressures after the establishment of the epidural anesthesia were similar between hypertensive patients and normotensive ones. Although no significant difference was found between the groups with respect to the highest and lowest systolic arterial pressure during operation, systolic arterial pressure after extubation was significantly higher in hypertensive patients than in normotensive ones. These suggest that the combination of epidural and general anesthesia is a safe technique for patients with medically controlled hypertension.

Aged↗

PubMed1994

[Cardiac arrests probably induced by hypermagnesemia during anesthesia for caesarean section].

A 24-year-old pregnant woman was scheduled for Caesarean section during the 31st week of pregnancy. The patient had been treated with MgSO4 for premature labor and toxemia. During anesthesia, cardiac arrest occurred twice. The first cardiac arrest occurred immediately after induction of anesthesia and seemed to be due to combined effects of hypermagnesemia, thiopental and supine hypotensive syndrome. Three babies were delivered during cardiac massage. The second one occurred immediately after administration of methyl-ergometrine malate and seemed to be due to combined effects of hypermagnesemia and methyl-ergometrine malate. The patient and three babies did not develop any complication. In giving anesthesia for patients with hypermagnesemia, anesthetists should take account of interactions between magnesium, anesthetics and other drugs.

Adult↗

PubMed1994

[A method of tracheal intubation tried in a patient with multicentric reticulohistiocytosis].

A 48-year-old woman had suffered from multiple destructive arthritis, skin nodules and skin ulcer of bilateral legs caused by multicentric reticulohistiocytosis for 16 years. Skin transplantation and total hip joint replacement were scheduled. Tracheal intubation was anticipated to be difficult because of destructive arthritis of the temporomandibular joint. We tried a new method to intubate the trachea through a laryngeal mask. After topical application of 8% lidocaine to the oropharynx, a size 4 laryngeal mask was inserted and its cuff was inflated by 20 ml of air. Anesthesia was induced with 4% sevoflurane in 50% nitrous oxide via laryngeal mask. A fiberscope through a tracheal tube was inserted through the laryngeal mask into the trachea. A tracheal tube with the internal diameter of 6.5 mm, was successfully intubated. This method gave little discomfort to the patient.

Female↗

PubMed1994

Reconstruction of the hepatic vein to the prosthetic inferior vena cava in right extended hemihepatectomy with ex situ procedure.

BACKGROUND: Ex situ procedure permits complete resection of a tumor involving the confluence of the three main hepatic veins, which is difficult when conventional technique is used. METHODS: We report treatment of a patient with intrahepatic cholangiocellular carcinoma involving this confluence of the three main hepatic veins and the retrohepatic inferior vena cava (IVC) by using right extended hemihepatectomy and resection of the retrohepatic IVC with ex situ procedure. Reconstruction of the left hepatic vein required anastomosis of the left hepatic vein and a polytetrafluoroethylene (PTFE) replacement for the IVC. To our knowledge this is the first report of reconstruction of the hepatic vein by use of a PTFE prosthesis. RESULTS: Anastomosis of the left hepatic vein to the PTFE graft was successfully performed during extracorporeal liver operation. The patient has had no recurrence during 8 months since the operation. Neither torsion nor obstruction of the hepatic vein and the graft has been observed. CONCLUSIONS: Reconstruction of main hepatic veins and the PTFE graft as the replacement of the IVC under extracorporeal liver operation may be useful in improving the cure rate and resection rate for liver cancer that is unresectable by the conventional technique.

Anastomosis, Surgical↗

PubMed1994

Elevation of transforming growth factor alpha in cat aqueous humor after corneal endothelial injury.

PURPOSE: To determine if a scrape injury to cat corneal endothelial cells increases the level of mitogenic proteins such as transforming growth factor alpha (TGF alpha) in aqueous humor. METHODS: Aqueous humor of cats was collected at 0, 2, 6, and 24 hours after wounding the endothelium by contact with a cannula tip. Aqueous humor samples collected from sham-wounded cats served as controls. Aqueous humor samples were analyzed for levels of protein, for mitogenic activity using incorporation of tritiated thymidine by cultures of bovine corneal endothelial cells, and for immunoreactive TGF alpha protein using a specific radioimmunoassay. RESULTS: The average protein level in aqueous humor obtained before wounding was low (0.5 mg/ml), increased 26-fold at 2 hours after injury (13 mg/ml), then progressively decreased at 6 hours (8 mg/ml) and 24 hours (2 mg/ml). Levels of mitogenic activity of aqueous humor samples collected 2, 6, and 24 hours after wounding were 2-fold, 2.5-fold, and 0.6-fold higher, respectively, compared to the level of mitogenic activity measured in aqueous humor collected before wounding (0 hours) or in aqueous humor collected from sham-wounded eyes. TGF alpha concentration in aqueous humor collected before endothelial wounding was low (6.8 ng/ml), increased 14-fold 2 hours after wounding (97.4 ng/ml), then progressively decreased at 6 hours (63.3 ng/ml) and 24 hours (35.5 ng/ml) after wounding. TGF alpha concentrations in aqueous humor collected from sham-wounded eyes at 2 hours (9.5 ng/ml) and 6 hours (5.3 ng/ml) were not significantly different from prewound levels. Detergent extracts of bovine corneal endothelial cells contained substantial levels of TGF alpha immunoreactive protein (20 ng/mg protein). CONCLUSIONS: Wounding of cat endothelium causes a rapid increase in mitogenic proteins in aqueous humor including TGF alpha, which may act by an autocrine mechanism to stimulate endothelial wound healing.

Animals↗

PubMed1993

New degradation product of spiradoline mesylate in aqueous solution: formation of an imidazolidine ring.

A new degradation product of spiradoline mesylate was recognized in aqueous solution stored at 80 degrees C for 10 days. The structure of the degradation product was elucidated with spectroscopic data and a synthetic method as (1RS,3RS,8RS,10RS)-2-methyl-2,7-diazatricyclo - [6.4.0.0(3,7)]dodecane-10-spiro-2'-tetrahydrofurane by several two-dimensional NMR spectra. The fused imidazolidine ring system was synthesized from (5RS,7RS,8RS)-N-methyl-8-(7-pyrrolidino-1-oxa spiro-[4.5] decane)amine reacted with mercuric acetate. Because the degradation was promoted by bubbling air or oxygen gas into the solution or by adding alpha,alpha'-azobisisobutylonitrile for radical initiation, and the reaction was suppressed by bubbling nitrogen gas or deaerating, the reaction mechanism of the degradation was considered to be oxidation caused by an oxygen radical.

Chromatography, High Pressure Liquid↗

PubMed1993

Structures of mucin-type sugar chains on human erythropoietins purified from urine and the culture medium of recombinant Chinese hamster ovary cells.

Less is known about the mucin-type sugar chains attached to human erythropoietin as compared with N-linked sugar chains which structures and function have been well studied. In this study, we purified urinary human erythropoietin from three independent groups of aplastic anemia patients, and analyzed the structures of mucin-type sugar chains as well as that obtained from recombinant human erythropoietin produced by Chinese hamster ovary cells. Unlike the N-linked sugar chains, the mucin-type sugar chains are totally different between the urinary and the recombinant erythropoietins. All of the three independent samples of urinary erythropoietin contained oligosaccharides with the structures of +/- Neu5Ac alpha 2-->6GalNAc, while recombinant human erythropoietin contained those with the structures of Neu5Ac alpha 2-->3Gal beta 1-->3(Neu5Ac alpha 2-->6)GalNAc, Neu5Ac alpha 2-->3Gal beta 1-->3GalNAc, and Gal beta 1-->3(Neu5Ac alpha 2-->6)GalNAc.

Anemia, Aplastic↗

PubMed1993

The surgical management of synchronous hepatocellular carcinoma and thoracic esophageal carcinoma.

A 73-year-old man was hospitalized with pathologically documented hepatocellular carcinoma and cirrhosis, and a 5.0-cm tumor located in the left lobe was resected by a left lateral segmentectomy. At the same time, metastatic squamous cell carcinoma was identified by frozen section in a perigastric lymph node in the lesser omentum. Intraoperative endoscopy revealed a 1.0-cm erosive lesion in the thoracic esophagus that was subsequently found to be primary squamous cell carcinoma. Seven weeks later, a transthoracic subtotal esophagectomy with substernal, cervical esophagogastrostomy was performed. Twenty-two months after these resections there has been no recurrence of either the hepatocellular or esophageal carcinomas.

Aged↗

PubMed1993

Stress hormone responses to major intra-abdominal surgery during and immediately after sevoflurane-nitrous oxide anaesthesia in elderly patients.

We studied the responses of plasma epinephrine, norepinephrine, adrenocorticotropic hormone (ACTH), cortisol, and antidiuretic hormone (ADH) during and immediately after sevoflurane-nitrous oxide anaesthesia supplemented with vecuronium in seven elderly patients (mean 76.6 +/- 1.7 SEM) who underwent major intra-abdominal surgery. The plasma concentrations of norepinephrine, ACTH, cortisol, and ADH increased in response to surgical procedures (P < 0.05). The plasma concentration of ADH increased to a peak concentration of 189.1 +/- 20.7 pg.ml-1 30 min after skin incision (P < 0.05). The plasma concentrations of epinephrine, norepinephrine, ACTH, and cortisol increased to peak concentrations of 408.6 +/- 135.5 pg.ml-1, 635.7 +/- 167.8 pg.ml-1, 222.6 +/- 48.0 pg.ml-1, and 113.6 +/- 67.5 micrograms.dl-1, respectively immediately after tracheal extubation (P < 0.05). We conclude that, in the elderly patients, the responses of stress hormones to major intra-abdominal surgery were preserved during sevoflurane-nitrous oxide anaesthesia sufficient to prevent increases in arterial pressure and heart rate. The strongest responses of epinephrine, norepinephrine, ACTH, and cortisol were elicited immediately after tracheal extubation.

Abdomen↗

PubMed1993

The intrathecal spread of hyperbaric dibucaine in adolescents.

We investigated the spread of spinal anesthesia with hyperbaric dibucaine in 20 adolescents aged 9-18 yr and 20 adults aged 23-53 yr. No significant difference was found between the two groups with regard to height, whereas a statistical significant was found between the two groups with regard to weight. Spinal anesthesia was conducted with Neo-Percamin S injected at the L3-L4 interspace through a 25-gauge spinal needle. Injected volumes of the anesthetic solution were calculated from the patients' height at 0.01 ml.cm(-1). In adolescents, 1.6 +/- 0.1 ml (mean +/- SD) of the anesthetic solution produced 19.4 +/- 1.5 spinal segments blocked. In adults, 1.6 +/- 0.1 ml of the solution produced 13.4 +/- 1.6 spinal segments blocked. A high spinal anesthesia above T5 was achieved in 17 (85%) patients in adolescents, whereas such a high level of spinal anesthesia was not experienced in adults. These results suggest that the hyperbaric dibucaine solution for spinal anesthesia in adolescents may have a tendency to produce an unexpectedly extensive spread of anesthesia.

Journal Article↗

PubMed1993

Evaluation of histamine-releasing property of propofol in whole blood in vitro.

We examined the property of emulsion form of propofol (ICI 35 868) to release histamine in whole blood in vitro. Heparinized whole blood from 10 healthy volunteers were incubated with medium and propofol at the final concentration of 0, 1, 10 and 100 microg.ml(-1). The concentration of histamine in supernatant fluid after incubation was measured by radioimmunoassay. Histamine release was expressed as the percentage of the concentration of histamine released into supernatant fluid relative to the total cellular histamine content, which was yielded by destroying cell components in the whole blood. Histamine release in the presence of propofol at the concentrations of 1, 10 and 100 microg.ml(-1) were almost the same as histamine release in the absence of propofol. We conclude that emulsion form of propofol has no property to release histamine in whole blood in vitro.

Journal Article↗