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Biomedical subjects

S Dohi

Publications and source records attributed to S Dohi.

At least 145 records · Page 8Linked to original sources
PubMed1993

[Investigation of meropenem levels in the human bone marrow blood, bone, joint fluid and joint tissues].

A solution of 0.5 g of meropenem (MEPM) in 100 ml of saline was administered to adult patients before the orthopaedic surgery via intravenous drip infusion for 30 minutes. Eleven samples of bone marrow blood, 13 bone, 8 joint fluid and 8 joint tissues obtained from 15 clinical cases were analyzed for MEPM levels. At the same time, blood samples were taken from peripheral veins and serum served as control was analyzed. The concentration of MEPM in the marrow blood at 30 minutes after administration of MEPM reached 15.4 micrograms/ml, which was above 50% of the maximum concentration in serum. Ratios of concentration in bone marrow to that in serum were between 93% and 105% at that time. MEPM levels were 5.74-0.40 micrograms/g in bones, 20.3-4.55 micrograms/ml in joint fluid and 18.2-4.05 micrograms/g in joint tissues at 30 to 75 minutes after administration. In joint fluid and joint tissues, the concentration above 50% of maximum level in serum were maintained for more than an hour. MEPM is thought to be useful for the treatment of bone and joint infections and also prophylaxis of infections in cases of major surgery of skeletal tissue in the field of orthopaedic surgery.

Adult↗
PubMed1993

[Perioperative pulmonary thromboembolism. A clinical study].

Pulmonary embolism (PE) is a major catastrophe during postoperative period. We had six patients who developed PE after surgery and one during anesthesia and surgery. Severe arterial hypoxemia (PaO2 41 +/- 14 mmHg) occurred in all six postoperative patients, but not in a patient who developed PE under anesthesia. In 3 patients with pulmonary artery catheter in place, pulmonary arterial pressure (PAP) increased significantly during the embolic events. PAP tended to decrease before the apparent improvement of PaO2 in each patient. This suggests that increases in anastomotic bronchial blood flow occurred following the events. In a patient who developed PE under enflurane-N2O-O2 anesthesia, neither hypoxemia nor hypotension occurred despite significant increase in PAP. All patients received heparin and urokinase intravenously, which caused persistent bleeding in two patients. It remains for further investigations to study the mechanisms of serious hypoxemia in postoperative patients with PE as well as those of favorably maintained pulmonary oxygenation in a patient with PE under general anesthesia.

Adult↗
PubMed1992

Age-related increase in systolic fraction of pulmonary vein flow velocity-time integral from transesophageal Doppler echocardiography in subjects without cardiac disease.

The pulmonary vein flow velocity-time profile would be equivalent to the pulmonary vein flow volume-time profile, provided that the cross-sectional area of the pulmonary vein remains unchanged during 1 cardiac cycle. The systolic fraction of the pulmonary vein flow velocity-time integral, a ratio of velocity-time integral of the S wave to the sum of velocity-time integrals of the S and D waves, represents the ratio of left atrial storage volume to left ventricular stroke volume. This systolic fraction may help early filling of the left ventricle through an appropriate storage of blood and generation of driving pressure in the left atrium. Because early filling of the left ventricle is progressively impaired with age, it was hypothesized that this systolic fraction is increased with age. Forty-four noncardiac surgical patients (age range 17 to 70 years) who underwent transesophageal Doppler echocardiography under general anesthesia were studied, and left upper pulmonary vein flow and mitral inflow velocities were recorded. The ratio of peak velocity of the E wave to that of the A wave of mitral inflow velocity-time profile (y) decreased with age (y = -0.0245 x age + 2.41; r = -0.672, p < 0.01). Systolic fraction (y) increased with age (y = 0.00373 x age + 0.514; r = 0.656, p < 0.01). The age-related increase in the systolic fraction of pulmonary vein flow velocity-time integral may account for the compensation for impaired early filling of the left ventricle in elderly patients.

Adolescent↗
PubMed1992

Distribution patterns and frequency of proliferating cells in cutaneous keratinocytic neoplasms. Immunohistochemical study with a monoclonal antibody (TOB7) used against proliferating cell nuclear antigen.

BACKGROUND: Almost all markers for proliferating cells need freshly frozen tissues for evaluation; therefore retrospective study is impossible. OBJECTIVE: In the present study, a murine monoclonal antibody (TOB7) against the proliferating cell nuclear antigen (PCNA) was used for the analysis of cell kinetics of cutaneous keratinocytic neoplasms. The antibody is applicable to formalin-fixed, paraffin-embedded tissues. METHODS: The frequency of PCNA-positive cells and their distribution patterns were immunohistochemically investigated in various cutaneous keratinocytic neoplasms. RESULTS: Squamous cell carcinoma and Bowen's disease showed significantly increased numbers of PCNA-positive cells when compared with other keratinocytic neoplasms. A characteristic marginal or random distribution pattern of PCNA-positive cells was observed in the lesions of each disease category. CONCLUSION: Important information on the growth dynamics of keratinocytic neoplasms was obtained in this retrospective immunohistochemical study.

Antibodies, Monoclonal↗
PubMed1992

Haemodynamic changes associated with thermodilution cardiac output determination during myocardial ischaemia or pulmonary oedema in dogs.

Since the technique of thermodilution (TD) cardiac output measurements per se causes haemodynamic alterations, the authors examined whether the alterations elicited by iced injectate are augmented in the presence of myocardial ischaemia (MI) or pulmonary oedema (PE), compromised conditions frequently associated with critically ill patients. MI (N = 7) or PE (N = 7) was induced by clamping the anterior descending coronary artery or by a slow infusion of oleic acid into the right atrium, respectively, in anaesthetized dogs. Injection of iced injectate, 3 ml, caused similar changes in heart rate, mean systemic and pulmonary arterial pressures, pulmonary blood flow, right ventricular dP/dt, and right atrial pressure in dogs with and without MI or PE. Cardiac output estimated by TD correlated closely with pulmonary blood flow measured by electromagnetic flowmeter in both MI and PE (r > 0.9). No profound alterations in haemodynamics were observed at any injection during TD cardiac output measurements under MI or PE. These results indicate that TD cardiac output determination does not cause serious haemodynamic alterations, and can estimate right ventricular output accurately under MI and PE.

Animals↗
PubMed1992

[Anaphylactoid reactions to contrast media which occurred during cholecystectomy and subsequent disseminated intravascular coagulation--a case report].

A 67-year-old woman without any history of allergic episode developed severe hypotension (40 mmHg) without skin rash one minute after the administration of amidotrizoic acid for intraoperative cholangiography during thoracic epidural and light general anesthesia. Although ephedrine, methoxamine, dopamine and norepinephrine were administered, severe hypotension persisted for three hours and epinephrine was only effective. Marked elevations of serum levels of histamine, leukotriene D4 and leukotriene E4 were noted after the episode, suggesting the occurrence of the anaphylactoid reaction to amidotrizoic acid and the activation of the immunological complement system. After the recovery from the anaphylactoid reaction, the patient developed disseminated intravascular coagulation (DIC) and severe bleeding around the wound for which reoperation was needed. It is necessary to consider some prophylactic treatments against DIC when severe anaphylactoid reaction occurred.

Aged↗
PubMed1992

[The relation between upper respiratory tract infection and mild hypoxemia during general anesthesia in children].

Anesthesiologists often face the problem of a child with symptoms of an acute upper respiratory infection (URI) presenting for surgery. Anesthesia in the presence of uncomplicated URI may not be contraindicated. However, we experienced three cases of such children in which lung atelectasis developed after the induction of general anesthesia. Because continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) was useful for detecting mild hypoxemia in these patients, we retrospectively examined the possible association between URI symptoms and SpO2 in 63 children. Patients with symptoms of URI showed a significantly high incidence of decreased SpO2 to below 95% for 5 minutes. Our results suggest that, with URI symptoms even uncomplicated, symptomatic patients have increased risks for the development of mild hypoxemia during anesthesia.

Anesthesia, General↗
PubMed1992

[Anaphylactic shock with ventricular fibrillation induced by chlorhexidine].

We experienced a case in which a 66 year-old male patient developed anaphylactic shock followed by ventricular fibrillation, possibly due to intravenous aspiration of chlorhexidine used for topical application when right internal jugular vein was punctured. He was successfully resuscitated without any sequelae. Although lymphocyte transformation test failed to identify the specific allergen, IgE antibodies against chlorhexidine in the patient's serum were detected by radioallergosorbent technique. Chlorhexidine is an extensively used antiseptic, but there have been many reports regarding severe adverse reactions associated with its use. Chlorhexidine does not seem to be a safe antiseptic.

Aged↗
PubMed1991

Detection of heat-stable enterotoxin in a cholera toxin gene-positive strain of Vibrio cholerae O1.

DNA colony hybridization with a polynucleotide clonal DNA probe for heat-stable enterotoxin of Vibrio cholerae non-O1 (NAG-ST) was used to screen 197 isolates of V. cholerae O1. Under stringent hybridizing and washing conditions, one strain (GP156) reacted with the probe. The concentrated supernatant from V. cholerae O1 GP156, heated at 100 degrees C for 5 min, elicited fluid accumulation in the suckling mice and that could be completely neutralized by an anti-NAG-ST monoclonal antibody (mAb2F). The preparation from V. cholerae O1 GP156 also inhibited the binding of mAb2F to NAG-ST in a competitive ELISA. V. cholerae O1 GP156 was confirmed to possess a gene encoding cholera toxin (CT). These results indicate that a heat-stable enterotoxin is produced by certain strains of CT-producing V. cholerae O1.

Animals↗
PubMed1991

Pulmonary oedema after airway obstruction due to bilateral vocal cord paralysis.

We report a case of pulmonary oedema which developed after airway obstruction due to bilateral vocal cord paralysis. The patient was a 52-yr-old woman undergoing craniotomy for an acoustic neuroma. Anaesthesia was uneventful. Spontaneous ventilation resumed after reversal of neuromuscular blockade. Following extubation she showed signs of airway obstruction and dyspnoea. The trachea was reintubated but she became hypoxic, PaO2-36 mmHg, produced pink frothy secretions and the x-ray was typical of pulmonary oedema. The oedema cleared within 24 hr. Tracheostomy was performed one week later as the cords were still fixed, but the latter had recovered by three months and the tracheostomy was closed. The cause of the cord paralysis is unknown but probably was a result of surgical trauma to the brain stem.

Airway Obstruction↗
PubMed1991

Haemodynamic and cerebral blood flow alterations after reduction of increased cerebrospinal fluid pressure in dogs.

To clarify some of the mechanisms for the hypotension that may occur after cranial decompression, the authors examined alterations in cerebral blood flow (CBF) and systemic and pulmonary haemodynamic variables when cerebrospinal fluid (CSF) pressure was increased and then suddenly reduced in eight anaesthetized dogs. After CSF pressure was elevated to 50-85 mmHg for two hours, CBF decreased from 46.3 +/- 4.4 to 31.6 +/- 8.5 ml.100 g-1.min-1 (mean +/- SD, P less than 0.01). Mean systemic arterial pressure (MAP), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), and systemic vascular resistance index (SVRI) increased by 20 +/- 11 mmHg, 3.9 +/- 2.5 mmHg, 5.2 +/- 3.3 mmHg, and 1448 +/- 1377 dynes.sec.cm-5.m2 from baseline values, respectively (P less than 0.01). Rapid reduction of increased CSF pressure caused CBF to increase to 61.5 +/- 19.1 ml.100 g-1.min-1, whereas MAP, MPAP, PAWP, and SVRI decreased by 22 +/- 11 mmHg, 2.4 +/- 0.9 mmHg, 2.3 +/- 2.0 mmHg, and 1289 +/- 1237 dynes.sec.cm-5.m2 from previous values (P less than 0.01) at 30 min following the decompression. However, cardiac index and pulmonary vascular resistance index remained unchanged during the study period. The present animal data indicate that the decrease in MAP after decompression is mainly a result of a reduction in systemic vascular resistance.

Animals↗
PubMed1991

Oral clonidine preanesthetic medication augments the pressor responses to intravenous ephedrine in awake or anesthetized patients.

To evaluate the possible interaction between clonidine and ephedrine, the authors studied hemodynamic responses to intravenous ephedrine in 80 patients who received either clonidine pre-anesthetic medication of approximately 5 micrograms.kg-1 orally (n = 40) or no medication (n = 40). The patients were studied while they were either awake (n = 40) or anesthetized with enflurane and nitrous oxide in oxygen (n = 40). Hemodynamic measurements were made at 1-min intervals for 10 min after ephedrine 0.1 mg.kg-1 was injected as a bolus. Although the responses to ephedrine were always greater in anesthetized patients, the magnitudes of mean blood pressure increases in patients who received clonidine (10 +/- 8% for awake and 27 +/- 11% for anesthetized subjects, mean +/- standard deviation [SD]) were significantly greater (P less than 0.05) than in patients not receiving clonidine (4 +/- 5% for awake and 17 +/- 11% for anesthetized subjects). The enhanced pressor responses to ephedrine observed in both awake and anesthetized patients in the presence of clonidine may be attributed to increased catecholamine storage at sympathetic nerve endings due to clonidine, enhanced sensitivity of tissue receptors to which ephedrine binds, potentiation of alpha-adrenoceptor mediated vasoconstriction of both agents, or all of these. It is concluded that oral clonidine preanesthetic medication of 5 micrograms.kg-1 does augment rather than attenuate the pressor responses to intravenous ephedrine in patients both prior to and during general anesthesia.

Administration, Oral↗
PubMed1991

Oral clonidine blunts the heart rate response to intravenous atropine in humans.

Clonidine, recently introduced into anesthesia practice, may cause bradycardia. Whether this bradycardia is reversible with atropine is not known. Accordingly, we studied heart rate (HR) responses to intravenous atropine in 80 patients assigned randomly to either a control group, who received no medication (n = 20), or a clonidine group, who received oral clonidine of approximately 1.2 micrograms.kg-1 (n = 20), 2.5 micrograms.kg-1 (n = 20), or 5 micrograms.kg-1 (n = 20). All patients received incremental doses of atropine, 2.5, 2.5, and 5 micrograms.kg-1, at 2-min intervals (total dose 10 micrograms.kg-1). Positive chronotropic response to the cumulative atropine dose of 10 micrograms.kg-1 was attenuated significantly only in patients given clonidine 5 micrograms.kg-1 (7 +/- 1 beats per min, mean +/- standard error) when compared with those given smaller doses of clonidine (15 +/- 2, 16 +/- 2 beats per min) or no clonidine (19 +/- 2 beats per min) (P less than 0.05). To determine whether HR hyporesponsiveness to atropine induced by clonidine can be overcome by a larger dose of atropine, the authors studied 30 additional patients given clonidine 5 micrograms.kg-1 or no medication. In all patients not receiving clonidine (n = 15), HR increased by more than 20 beats per min when atropine of 15 micrograms.kg-1 was administered, whereas in only 5 patients (33%) receiving clonidine did the HR increase by 20 beats per min after atropine 15 micrograms.kg-1 (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1991

[Midazolam as a premedicant for trigeminal nerve blocks].

Although patients with trigeminal neuralgia can be treated satisfactorily with nerve blocks, the block procedure is sometimes very painful and uncomfortable for them. To investigate the efficacy and adverse effects of midazolam as a premedicant for trigeminal nerve blocks, 19 patients were randomly assigned to receive either midazolam (0.05 mg.kg-1, n = 6), midazolam (0.1 mg.kg-1, n = 7), or saline/placebo (n = 6) before the block. The patients given midazolam (0.1 mg.kg-1) had a significantly lower incidence of recalling the block procedure and had complained of less discomfort when interviewed the following day. No serious adverse effects were observed in any patient given midazolam. Midazolam can be used safely as an effective premedicant for potentially uncomfortable procedures such as trigeminal nerve blocks.

Aged↗
PubMed1991

[Subendocardial infarction on recovery from anesthesia].

A 57-year-old man without any history of coronary artery disease underwent total hip replacement for which a continuous lumbar epidural analgesia combined with general anesthesia was used. During the recovery from anesthesia, the patient developed sudden hypotension and ventricular fibrillation (Vf), followed by ST elevation (I, II, III, aVF and V2-V6) on ECG. A coronary angiography, which was performed 30 min after the onset of Vf, revealed both the total occlusion of proximal left anterior descending artery (LAD) and 25% stenosis of proximal right coronary artery. It seemed that coronary artery spasm had occurred during the emergence from anesthesia, and then the coronary spasm ceased in a minute or two, while thrombus was produced in proximal LAD. The patient recovered from the episode of myocardial ischemia after percutaneous transluminal coronary recanalization and intraaortic balloon pumping. This patient was operated again on 4th and 8th postoperative days uneventfully under general anesthesia (enflurane and nitrous oxide in oxygen).

Anesthesia Recovery Period↗