The origin and clinical significance of thyroid murmur.
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Adult↗
Biomedical subjects
S Shimazaki
Publications and source records attributed to S Shimazaki.
Radiation dose-tumor control assays for irradiation through a sieve.
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Animals↗
Antioxidant therapy using high dose vitamin C: reduction of postburn resuscitation fluid volume requirements.
Twenty-four guinea pigs with third degree burns over 70% of the body surface area were divided equally into four groups. At 0.5 hours postburn, all groups received Ringer's lactate solution (R/L) according to the Parkland formula. The infusion rate was then reduced to 25% of the Parkland formula at 1.5 hours postburn. Group 1 received only R/L, and groups 2, 3 and 4 received adjuvant vitamin C (14.2 mg/kg/hr) until 4, 8, and 24 hours postburn, respectively. The volume of R/L was reduced by that of vitamin C solution so that the hourly sodium and fluid intake in each group was the same. Groups 1 and 2 demonstrated higher hematocrit and lower cardiac output values than did group 3, suggesting hypovolemia and hemoconcentration in these groups. Group 3 showed hematocrit and cardiac output values equivalent to those in group 4. We conclude that high dose vitamin C infusion maintains hemodynamic stability in the presence of a reduced resuscitation fluid volume provided vitamin C is administered for a minimum of 8 hours postburn.
Animals↗
Multicore myopathy associated with multiple pterygium syndrome and hypertrophic cardiomyopathy.
A boy with multicore myopathy associated with multiple pterygium syndrome and hypertrophic cardiomyopathy is described. Light microscopy of biopsy samples from the skeletal muscle and myocardium revealed multiple cores in the muscle fibers in the former but their absence in the latter. These results suggest that the pathogenesis of the histologic changes might differ between skeletal muscle and myocardium, and that further electron microscopic examination be done on both types of specimen. The prognosis of multicore myopathy is not usually good when cardiac involvement is present.
Abnormalities, Multiple↗
Delayed hemorrhage following transcatheter arterial embolization for blunt hepatic injury.
This is the first report of delayed hemorrhage (21 days after the injury) following transcatheter arterial embolization (TAE) for severe hepatic injury. The first TAE was performed about 2 h after admission on a 21-year-old man with severe blunt hepatic injury. Three bilomas were detected by cholescintigraphy 19 days later. The patient's status had been eventless until the occurrence of a delayed hemorrhage with hypotension. Angiography was repeated and three pseudoaneurysms were detected in the same areas as the bilomas. With repeated TAE, pseudoaneurysms disappeared and hemorrhage could be controlled. Intrahepatic biloma may be related to pseudoaneurysms and delayed hemorrhage in severe hepatic injury.
Adult↗
Enzyme-free method for cultured skin grafting.
Cultured skin autografting has promise to improve the prognosis of severe burn injury. Established methods for cultured epithelial cell autografting need enzymatic proteolytic reaction that have potential risks of losing cell surface structures and causing allergic reactions in the recipients. Therefore, we have developed an enzyme-free method of cultured skin autografting. Donor skin was obtained in 0.2-0.3 mm thickness during an operation of debriding burned eschar. The skin was cut into pieces and spread on removable soft culture surface membrane in culture plates. Modified MCDB 153 medium with 10 microg/L epidermal growth factor and 150 mg/L bovine pituitary extract was used. The tissues were incubated at 37 degrees C in a water-saturated atmosphere of 5% CO2 in air. After 3 weeks, the cultured tissue on the membrane was removed mechanically from the bottom of the plates and implanted on granulated recipient sites in upside down manner. The cultured auto-skin grafting was successfully performed in two patients with severe burn. The recipient sites were partially epithelized in 2 weeks and maintained thereafter. Our method is performed easily using partial thickness donor skin without enzymatic processes.
Adult↗
How long do we need to give antioxidant therapy during resuscitation when its administration is delayed for two hours?
Twenty-four guinea pigs with third-degree burns over 70% of the body surface area were divided equally into four groups. All animals received Ringer's lactate (R/L) beginning 30 minutes after burn injury. Group 1 received R/L without vitamin C beginning 2 hours after burn injury. Groups 2, 3, and 4 received R/L with vitamin C until 4, 8, and 24 hours after burn injury, respectively. Beginning 3 1/2 hours after burn injury the hourly fluid volume was reduced to 25% of the Parkland formula calculation. The hourly sodium and fluid intake in each group was the same. Groups 1 and 2 demonstrated higher hematocrit and lower cardiac output values as compared with those values for group 3, indicating hypovolemia and hemoconcentration in these groups. Group 3 showed hematocrit and cardiac output values equivalent to those values for group 4. We conclude that high-dose vitamin C must be given until 8 hours after burn injury to maintain adequate hemodynamic stability in the presence of a reduced resuscitation fluid volume.
Analysis of Variance↗
Hemodynamic effects of delayed initiation of antioxidant therapy (beginning two hours after burn) in extensive third-degree burns.
The hemodynamic effects of the delayed initiation of antioxidant therapy with high-dose vitamin C were studied in 12 guinea pigs with third-degree burns over 70% of their body surface area. All animals were resuscitated with Ringer's lactate solution (RL) according to the Parkland formula (4 ml/kg/% burn during the first 24 hours) from 1/2 to 2 hours after burn, and the infusion rate was reduced thereafter to 25% of that of the Parkland formula. The vitamin C group (n = 6) received RL with vitamin C (14 mg/kg/hr), and the control group (n = 6) received RL only. The 24-hour fluid intake for each group was 32.5% of the Parkland formula volume. Burn wound edema in the vitamin C group was significantly less than that in the control group. The vitamin C group maintained adequate hemodynamic stability as determined with hematocrit and cardiac output values, but the control group did not. Even though the initiation of the vitamin C administration is delayed until 2 hours after burn, the hourly infusion rate of the resuscitation fluid can be reduced to 25% once it is started. Thus antioxidant therapy with adjuvant vitamin C administration may be applicable to the clinical setting in which a patient with burns arrives at the burn care facility a few hours after the burn injury occurred.
Analysis of Variance↗
Comparison of hemodynamic changes resulting from toxic shock syndrome toxin-1-producing Staphylococcus aureus sepsis and endotoxin-producing gram-negative rod sepsis in patients with severe burns.
Five patients with burns and toxic shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus sepsis (TSS group) were treated in a 5-year period at Kyorin University Hospital's Traumatology and Critical Care Center Burn Unit. Hemodynamic and metabolic differences in these patients were compared retrospectively with those in another five patients who were matched by burn index and age and in whom endotoxin-producing gram-negative rod sepsis developed (End group). Both groups showed hypermetabolic and hyperdynamic changes at the point sepsis developed. There were no significant differences between the two groups in any parameter. At the point septic shock developed, the TSS group showed significantly lower mean (+/- SD) arterial pressure (TSS vs End group, 64 +/- 5 vs 74 +/- 5 mm Hg; p < 0.05), significantly lower systemic vascular resistance index (TSS vs End group, 579 +/- 62 vs 729 +/- 75 dynes.sec.cm-5/m2; p < 0.05), and higher oxygen consumption (TSS vs End group, 190 +/- 7 vs 163 +/- 11 L/min/m2; p < 0.05) compared with the End group. This is the first clinical report that asserts that TSST-1-producing gram-positive sepsis may result in more hypermetabolic and hyperdynamic differences than does endotoxin-producing gram-negative rod septic shock. These responses may indicate a stronger stimulation of cytokine and nitrous oxide synthetic activity by TSST-1 than by endotoxin.
Adult↗
Mild hypotension and body burns synergistically increase bacterial translocation in rats consistent with a "two-hit phenomenon".
Wistar rats were burned over 15% of their total body surface area and suffered hemorrhagic hypotension (mean blood pressure 80 mm Hg) 72 hours after the thermal injury (burn + hypotension group). Rats in other groups were treated in the same way except sham hypotension in burn group, sham burn in hypotension group, and sham hypotension and sham burn in control group. At the end of the study period, the mesenteric lymph nodes (MLN), liver, and spleen were cultured for translocated bacteria. The cecal bacterial burden was not affected by the insults. The number of bacteria translocated to the MLN after the thermal injury was much greater in the burn + hypotension group (156.19 +/- 42.29 colony-forming units [CFUs]/gm tissue) rather than in the other groups (5.24 +/- 8.34, 9.86 +/- 16.56, 40.21 +/- 45.8 in the control, hypotension, and burn groups, respectively). This indicates that bacterial translocation (BT) is the result of a two-hit phenomenon. The gut-MLN BT ratio, obtained by dividing the bacterial CFUs in the MLN by those in the cecum, was higher in the burn + hypotension group than in the other groups (p < 0.01). This ratio allows standardized measurements of BT to the MLN despite differences in the absolute bacterial load in the gut, and the elevated gut mesenteric lymph nodes BT ratio of the burn + hypotension group suggests that the two-hit phenomenon of BT may be the result of alterations in the gut mucosal barrier function.
Animals↗
[A patient with facioscapulohumeral muscular dystrophy accompanied by myasthenia gravis].
A patient was a fifty-year-old man, who had a 35 year-history of facioscapulohumeral muscular dystrophy (FSHD). He was admitted to our hospital because of acute progressive weakness involving his lower extremities without any fluctuation in the recent 3 weeks. We clinically followed him for 30 years and he was able to do all daily activities, walked alone, drove a car and climbed stairs with a handrail. His 76-year-old mother had about 60 year-history of FSHD and could walk with support. On admission, neurological examination revealed moderate to marked muscle weakness and atrophy of the face, limb-girdle and all extremities, predominantly in the upper proximal limbs. He could hardly stand and needed a stick for walking. He had no blepharoptosis or ocular movement disturbance, and did not complain of difficulties in swallowing and chewing. CK values and other laboratory data were normal, and serum anti-Jo-1 antibody, anti-SSA/Ro antibody and anticardiolipin IgG antibody were negative. Because EMG examination revealed myopathic changes and an X-ray examination of the lumbar spine was normal. Thus, polymyositis and neurologenic disorders were ruled out. Disturbance in chewing and swallowing, that were uncommon in FSHD, appeared about a month after admission. Repetitive stimulation test revealed typical waning pattern. Edrophonium chloride injection was effective for decreased waning and the clinical symptoms. The titer of serum anti-ACh receptor antibody was 97 nmol/l, confirming the diagnosis of myasthenia gravis. Because of fluctuated dyspnea, thymectomy was done and his condition gradually relieved after administration of corticosteroid and choline esterase inhibitor. From this experience, we learned that we have to consider other neuromuscular disorders, even rare ones, if there existed unusual weakness of underlying muscular dystrophy.
Aged↗
Efficacy of endoscopic hemoclipping for GI bleeding in relation to severity of shock.
BACKGROUND/AIMS: To examine the efficacy of prospectively performing endoscopic hemoclipping in patients with severe gastrointestinal bleeding by assessing in relation to the severity of the case. METHODOLOGY: Endoscopic hemoclipping was performed in 44 patients in shock caused by severe gastrointestinal bleeding. The level of severity was categorized using two factors. One factor was the presence or absence of severe shock, and the other was the presence or absence of active bleeding at endoscopy. Age, blood transfusion volume, APACHE III score, coagulopathy, initial hemostatic, rebleeding and mortality rate were recorded in relation to those four subsets. If rebleeding occurred, the systolic blood pressure, heart rate and serum hemoglobin concentration were compared between the initial time of bleeding and rebleeding. RESULTS: Initial hemostasis was successfully achieved in all cases. The severe shock group required significantly more blood transfusions. The most severe subset had the highest APACHE III score, and coagulopathy. Rebleeding occurred in seven cases in the severe shock group only. In the rebleeding group, the systolic body pressure was lower, heart rate was higher, and serum hemoglobin concentration was lower than the non-rebleeding group. Four patients, all in subset 1, died, but no patient died due to gastrointestinal bleeding. CONCLUSIONS: The endoscopic hemoclipping method is very effective for severe gastrointestinal bleeding in shock. The severity of shock was a more important risk factor than the presence of active bleeding. Our category of severity is simple, it reflects the patients' clinical condition accurately, and is very useful for patients with gastrointestinal bleeding.
APACHE↗
(1-Sar, 8-Ile) angiotensin II in the treatment of inhalation injury: a pilot study.
The patients were three men and two women with moderate to severe inhalation injury. Each patient received immediate fluid therapy and all required intubation for respiratory management. At some time between 24 and 72 hours after the injury, the synthetic angiotensin analogue (1-Sar, 8-Ile) angiotensin II was infused at a rate of 100 ng/kg/min for 10 minutes, 200 ng/kg/min for another 10 minutes, and 300 ng/kg/min for 30 minutes. The mean (+/- SD) PaO2 increased from 80.8 +/- 26.9 mmHg before to 89.8 +/- 27.3 mmHg after the infusion (P < 0.05) and the PaCO2 decreased from 42.4 +/- 8.3 to 39.6 +/- 7.9 mmHg (P < 0.05). A transient pressor response was noted in all patients. The results suggest that this angiotensin II analogue may be of benefit in the treatment of inhalation injury and other types of acute lung injury.
1-Sarcosine-8-Isoleucine Angiotensin II↗