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Biomedical subjects

S Endo

Publications and source records attributed to S Endo.

At least 847 records · Page 47Linked to original sources
PubMedDate not supplied

Head injuries in snowboarders compared with head injuries in skiers. A prospective analysis of 1076 patients from 1994 to 1999 in Niigata, Japan.

We investigated snowboarding-related head injury cases and skiing-related head injury cases during five ski seasons at one resort area. There were 634 snowboarding-related head injuries and 442 skiing-related head injuries. The number of snowboarding head injuries increased rapidly over the study period. More male snowboarders than female snowboarders suffered head injuries. For both snowboarders and skiers, head injuries frequently occurred on the easy and middle slopes. Falls were the most frequent causes of injury in both groups. Jumping was a more frequent cause of injury in the snowboarders (30%) than in the skiers (2.5%). Injury to the occipital region predominated in the snowboarders as compared with the skiers. There were 49 organic lesions in 37 snowboarders and 46 organic lesions in 33 skiers. Subdural hematoma was frequent in the snowboarding head injury group, and fracture was frequent in the skiing head injury group compared with the snowboarding group (not significant). Subdural hematoma was likely to be caused by a fall rather than by a collision, and bone fracture was likely to be caused by a collision rather than by a fall. Four snowboarders and one skier died as a result of their head injuries. Our data suggest that snowboarding head injuries may be prevented by protection of the occipital region and refraining from jumping by beginners.

Accidental Falls↗
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Plasma type II phospholipase A2 levels in patients with acute pancreatitis.

Changes in the blood levels of type II phospholipase A2 (PLA2) were investigated over time in patients with acute pancreatitis from an early stage after manifestation of the disease. The serum level of type II PLA2 at the first examination and the maximum level during the course of illness were both correlated with the severity of the disease. Serum levels of type II PLA2 were significantly higher in patients with acute pancreatitis complicated by multiple organ failure (349.1 +/- 146.6 ng/ml) than in those with acute pancreatitis not complicated by multiple organ failure (66.9 +/- 50.1 ng/ml). The serum levels of type II PLA2 were also significantly higher in patients who eventually died (316.8 +/- 150.5 ng/ml) than in those who survived (148.9 +/- 167.9 ng/ml). There was a significant correlation between the serum levels of type II PLA2 and those of TNF-alpha during the course of illness (r = 0.8037, p < 0.0001). The serum levels of type II PLA2 reliably reflected the severity of acute pancreatitis even in the early stages of the disease. These results suggest that type II PLA2 may be closely involved in the pathophysiology of acute pancreatitis.

Acute Disease↗
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The effects of immune globulin on endotoxemia.

Ten patients (mean age, 40 years; 2 women) with endotoxemia received 2.5 gm of immune globulin daily for 4 days or 5 gm daily for 2 days. In all patients, plasma endotoxin levels decreased to normal levels (< or = 9.8 pg/ml) within a mean of 3.2 days after starting immune globulin treatment, and body temperatures decreased to < 37 degrees C within 4.5 days. In 10 antibiotic-treated (control) patients with endotoxemia who did not receive immune globulin, plasma endotoxin levels declined to normal levels in 6 and their body temperatures dropped to normal levels within 5.0 days; no changes in body temperature were noted in the 4 patients whose plasma endotoxin levels did not decrease.

Adult↗
PubMedDate not supplied

Treatment of endotoxemia with low-dose intramuscular injections or oral administration of polymyxin B.

Thirty patients with sepsis received 50,000 U of polymyxin B intramuscularly per day (n = 22) or 3 million U orally per day (n = 8). Plasma endotoxin levels were measured by the Endospecy test after treating the plasma with a new perchloric acid method. Plasma endotoxin levels were reduced to normal values (less than 9.8 pg/ml) in all the injected patients within two days and in all the orally treated patients within three days. Clinical symptoms were also ameliorated. No treatment side effects were reported. It is concluded that polymyxin B is a safe and effective treatment against endotoxemia.

Administration, Oral↗
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Intracranial dural arteriovenous fistulas with retrograde cortical venous drainage: assessment with cerebral blood volume by dynamic susceptibility contrast magnetic resonance imaging.

BACKGROUND AND PURPOSE: Retrograde cortical venous drainage (RCVD) is the most major risk factor for aggressive behavior of intracranial dural arteriovenous fistulas (DAVF). The purpose of this study was to assess the efficacy of relative cerebral blood volume (rCBV) map for RCVD in patients with DAVF. METHODS: Ten patients with angiographically proven DAVF with RCVD, 2 reference patients with DAVF without RCVD, and 10 control subjects underwent examinations with dynamic susceptibility contrast (DSC)-MR imaging. Four patients with DAVF with unilateral RCVD were evaluated, before and after treatment. The calculation of mean rCBV ratio was performed on a hemispheric basis. The mean rCBV ratio was defined as the value on one side (higher value side) divided by that on the other side (lower value side). RESULTS: In all patients with DAVF with RCVD, the rCBV map showed an increase in rCBV of the angiographically proved affected hemisphere. In 2 reference patients with DAVF without RCVD and all control subjects, the rCBV map showed no increase of rCBV. The mean rCBV ratio in patients with DAVF with RCVD was significantly higher than that of control subjects (P = .0002). Treatment response for RCVD was indicated by a decrease of CBV on the rCBV map and by a decrease of 22% in the mean rCBV ratio. CONCLUSIONS: Increased rCBV by DSC-MR correlated with RCVD in patients with DVAF. The assessment with rCBV for RCVD may be more quantitative than that with angiogram.

Aged↗
PubMedDate not supplied

Perchloric acid, toxicolor, endospecy, and miconazole in the early diagnosis and treatment of fungemia.

As a procedure for the diagnosis of fungemia, Toxicolor and Endospecy (limulus tests using a synthetic chromogenic substrate) were used to measure (1----3)-beta-D-glucan (beta-glucan), which is a membranous component of fungus. The plasma samples were pretreated with a new perchloric acid method. These methods permit measurement of the beta-glucan within about two hours. Patients in whom fungemia was diagnosed were effectively treated with miconazole.

Adult↗
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Inhibitory effects of ulinastatin on the production of cytokines: implications for the prevention of septicemic shock.

The study was designed to determine whether ulinastatin can be used as a biological response modifier for the prevention of septicemic shock. Monocytes from heparinized blood of three healthy volunteers were incubated with 0.125 or 1.25 U/ml of ulinastatin, and then endotoxin (Escherichia coli lipopolysaccharide) was added at concentrations of 0.1, 1.0, and 10.0 micrograms/ml. A dose-dependent increase in the production of tumor necrosis factor alpha, interleukin-1 alpha, and interleukin-1 beta was noted after endotoxin stimulation. Production of these cytokines was inhibited by the addition of ulinastatin in a dose-dependent manner. The results indicate that ulinastatin could be useful in the prevention of septicemic shock.

Cytokines↗
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Evaluation of IPM/CS in gram-negative bacillus infections: use of an endotoxin-specific assay.

The subjects were 26 patients hospitalized with severe trauma or burns. Twice daily for seven to 14 days, 1 gm of IPM/CS (a 1:1 combination of imipenem and cilastatin sodium) was administered by intravenous drip infusion to each patient. Clinical outcome was rated excellent in nine patients, good in 12, and fair in five. Bacteria, isolated in 21 of the 26 patients, were eliminated in 18 and decreased in three. Mean endotoxin levels, assessed by the Endospecy method, were reduced from 167.8 pg/ml before treatment to 5.1 pg/ml after treatment. No treatment side effects were noted.

Adult↗
PubMedDate not supplied

Prevention by ulinastatin of decreased carbonic anhydrase activity induced by PMN elastase in vitro.

Disturbed carbon dioxide (CO2) elimination in adult respiratory distress syndrome (ARDS) has been considered to result from the dead space created by microthrombosis and vasoconstriction. However, another disturbance factor in CO2 elimination has been reported; the chemical dead space resulting from the inhibition of carbonic anhydrase (CA). This experiment was conducted to quantify the inhibition of CA activity by polymorphonucleocyte (PMN) elastase, which increases in ARDS. Different flasks containing solutions of CA, buffer, elastase, ulinastatin (an elastase antagonist), CA with PMN elastase, and CA with both PMN elastase and ulinastatin were prepared. Each flask was injected with sodium bicarbonate labeled with radioactive carbon (14C) and was shaken for 20 minutes; CA activity in each flask was measured by calculating the decrease in the coefficient (K) of 14C. It was observed that CA activity was inhibited dose-dependently by PMN elastase and that the inhibited activity was recovered by ulinastatin, which can inhibit PMN elastase. These findings indicate that CA activity in vitro could be inhibited by PMN elastase, which increases in ARDS, and suggests that disturbance of CO2 elimination could be reduced by using ulinastatin. It was concluded that ulinastatin could prevent the CA activity induced by PMN elastase in vitro.

Carbonic Anhydrase Inhibitors↗
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Levels of soluble adhesion molecules and cytokines in patients with septic multiple organ failure.

Multiple organ failure (MOF) is a common complication of sepsis or septic shock. In this condition, it is believed that activated neutrophils adhere to the vascular endothelium and induce various mediators and tissue damage, leading to organ damage. We investigated the plasma levels of inflammatory cytokine activating neutrophils, soluble adhesive molecules, and endotoxin in 8 patients with septic MOF, 15 patients with sepsis but without MOF, and in 5 patients with MOF unrelated infection. The soluble intercellular adhesion molecule-1 (sICAM-1) concentration in sepsis-complicated groups was significantly higher than that in the multiple organ failure (MOF) group without infection. Of sepsis-complicated groups, the sICAM-1 value in the MOF group was significantly higher than that in the sepsis group without MOF. In sepsis-complicated groups, both soluble endothelial-leukocyte adhesion molecule-1 (sELAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) concentrations were significantly higher than those in the MOF group without infection. However, there was no significant difference between the septic MOF group and the sepsis group without MOF. In patients showing high levels of soluble adhesion molecule, prognosis was poor, and the concentration of soluble adhesion molecules rapidly decreased during recovery from MOF. It is speculated that endotoxin and inflammatory cytokines damage vascular endothelium as well as various other cells and produce, a large number of adhesion molecule, especially in patients with septic MOF, causing leakage of adhesion molecules into blood.

Adult↗
PubMedDate not supplied

Hemodynamic and humoral conditions in stepwise reduction of pulmonary blood flow during venoarterial bypass in awake goats.

The effects of reduced pulmonary arterial blood flow (PAF) during venoarterial bypass (VAB) on hemodynamic and humoral conditions were investigated in a series of experiments in a chronic animal model. A biventricular bypass system was installed in five adult goats weighing 49.8 +/- 1.1 kg. Two weeks later, the extracorporeal circuitry was changed to VAB without anesthesia. The PAF was reduced stepwise from 100% to 50, 25, 10, and 0% of total systemic flow. The mean aortic pressure and systemic vascular resistance decreased from 110 +/- 14 to 66 +/- 3 mmHg and from 1,288 +/- 77 to 740 +/- 73 dyne.sec/cm5, respectively, in proportion to the decrease in PAF from 100 to 0%. The prostaglandin E2 concentration increased from 1.5 +/- 0.6 to 8.8 +/- 0.6 pg/ml following the decrease in PAF from 100 to 0%. The renin-angiotensin system increased in proportion to the decrease in PAF. In contrast, the epinephrine and norepinephrine concentrations (60 +/- 10 and 227 +/- 80 pg/ml, respectively, at 100% PAF) did not change appreciably even at 10% PAF, but were markedly elevated to 335 +/- 117 and 2,088 +/- 1,503 pg/ml at 0% PAF. The antidiuretic hormone level similarly changed. In conclusion, decrease in PAF during VAB exerts significant effects on hemodynamics in a proportional manner and on vasoactive humoral factors in a diverse manner.

Animals↗
PubMedDate not supplied

In vitro and in vivo heat dissipation of an electrohydraulic totally implantable artificial heart.

The authors evaluated the heat transfer characteristics of an electrohydraulic totally implantable artificial heart (EH-TAH) developed at our institute. In three in vitro experiments, the heat dissipation of the EH-TAH was investigated. First, the EH-TAH was connected to a closed mock circuit filled with 1 L of saline, and driven at an input power of 20 W. The estimated heat conducted to the blood was approximately 10.3 W, which was almost half of the input power. Second, we simulated heat transfer with the circulation of a calf by using a heat exchanger. The amount of heat dissipating directly from the EH-TAH surface was calculated to be 10 W. Third, the temperature of the actuator examined with thermography was found to be almost uniform, and no prominent high temperature area was observed. In an in vivo study, the EH-TAH was implanted for 10 days in a calf weighing 62 kg. The input power was 18 +/- 2 W, the temperature of the actuator-tissue contacting surface was 39.4 +/- 0.8 degrees C, and that of the pump blood chamber was 39.8 +/- 0.4 degrees C. This slight temperature elevation was thought to be attributable to heat dissipation to the blood. On histologic study of the chest wall and the lung in contact with the actuator, vascularized connective tissue envelopes were observed, but unfavorable side effects, such as tissue necrosis, were not observed. These results suggest that the thermal effect of this system is acceptable at the input power used.

Animals↗
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Development of an implantable centrifugal blood pump for circulatory assist.

An implantable centrifugal pump (ICP) for prolonged circulatory assist has been developed, at 320 ml and 830 g. A central balancing hole was made in its impeller for better antithrombogenicity. Waterproofing and histocompatibility were supported by a silicone seal and a casing made of titanium and acrylic resin. Overall efficiency was 30% and normalized index of homolysis was 0.003 mg/dl, the same value as the BP-80, at a flow rate of 5 L/min and a head of 100 mmHg. Antithrombogenicity and hemolytic properties of the ICP were investigated in paracorporeal implantation in three goats (61-71 kg). Exothermicity, anatomic fit, and water tightness of the ICP were evaluated in intrathoracic implantation in an adult goat (66 kg). The ICP could run paracorporeally for 50, 200, and 381 days. There was no thrombus in the ICP after 381 days' pumping, and the ICP could run in the chest cavity for 40 days. The temperature of the motor rose 1.8 +/- 0.3 degrees C from that of the pleura. Moisture content of the seal remained normal. The ICP was completely covered with smooth fibrous tissue. Although a small area of atelectasis was found in the lingula, neither lung adhesion nor necrosis of the chest wall was observed. The ICP has satisfactory antithrombogenicity, hemolytic property, water tightness, anatomic fit, and exothermicity for use as an implantable circulatory assist device.

Animals↗
PubMedDate not supplied

In vitro and in vivo evaluation of a left-right balancing capacity of an interatrial shunt in an electrohydraulic total artificial heart system.

The authors evaluated the basic performance of an interatrial shunt (IAS) made by punching a hole in the atrial septum, in accommodating the left-right imbalance in our electrohydraulic total artificial heart (EHTAH) system. In an in vitro study conducted in a closed mock circuit connected with the EHTAH, the interatrial pressure gradient changed in compliance with the amount of bronchial flow and the size of the IAS. The IAS of 4.4 mm diameter or larger maintained the interatrial pressure gradient within physiologically permissible limits when the amount of bronchial flow was 5% of cardiac output or less. A left-to-right one-way valve made of a piece of pericardium, a possible option in this IAS method, successfully prevented right-to-left reverse shunt flow through the IAS. In a chronic in vivo study using a calf implanted with the EHTAH for 10 days, a 4.5 mm IAS without the one-way valve demonstrated satisfactory dynamic left-right balancing capacity with a stable interatrial pressure gradient of 4 +/- 1 mmHg over a wide range of atrial pressures. No thrombus was found in or around the IAS at autopsy. The authors conclude that the IAS is a simple and promising means of left-right balancing in the EHTAH system.

Animals↗
PubMedDate not supplied

Pulmonary microcirculation during pulsatile and non pulsatile perfusion.

During development of a rotary blood pump as an assist device, the efficacy of non pulsatile perfusion to the end organ has to be verified. However, there are few evaluations of two different perfusion mechanisms through the tissue microcirculation. In this study, the pulmonary microcirculation was analyzed by vital microscopic observation. Wistar rats weighing 400-500 g were anesthetized and ventilated by a respirator. After establishing right heart bypass from the right atrium to the pulmonary artery using a roller pump, the pulmonary microcirculation was observed during intravenous infusion of bovine albumin tagged with fluorescein isothiocyanate. The images were recorded on a videotape through an ultra-sensitive SIT TV camera. Initially, the pulmonary circulation was pulsatile, produced by the native heart, and the pulmonary capillary network was evenly perfused by the blood. After starting the pump, the flow became non pulsatile and the distribution of capillary perfusion was displaced to the short circuit connecting the pulmonary arterioles and venules. Flow distribution during non pulsatile perfusion was heterogeneous compared with pulsatile perfusion. This result suggests that non pulsatile flow may lead to the deterioration of function. Further investigation is necessary to evaluate the relationship between the microcirculation and organ function.

Animals↗