Biomedical subjects

T Kitano

Publications and source records attributed to T Kitano.

At least 55 records · Page 3Linked to original sources

PubMed1998

[The relationship between maintenance dose of vecuronium and the recovery time from the muscle relaxation].

We investigated the relationship between maintenance bolus dose of vecuronium bromide (Vb) and the recovery time measured by TOF Guard in patients anesthetized with isoflurane (1.2-2.0%)-N2O-O2 (GOI group, n = 19) and epidural anesthesia (2% mepivacaine) plus isoflurane (0.5%)-N2O-O2 (EPI group, n = 14). In both groups, anesthesia was induced with propofol 2 mg.kg-1 and Vb 0.1 mg.kg-1 and ventilation was controlled to keep end tidal CO2 between 35-40 mmHg. When the muscle relaxation recovered to 25% of train-of four ratio (TOFR), doses of Vb 0.06, 0.04 or 0.02 mg.kg-1 were administered. Recovery time to TOFR 25% at each Vb dose (T 0.06, T 0.04 and T 0.02 respectively) was observed. T 0.02, T 0.04 and T 0.06 in GOI group were 36.7 +/- 3.2, 50.7 +/- 4.3 and 60.7 +/- 5.02 min (mean +/- SE), respectively and those in EPI group were 42.6 +/- 2.53, 52.2 +/- 2.51 and 59.9 +/- 3.22 min, respectively. There were no significant differences in the recovery time between these two groups. In both groups, although the recovery time to TOFR 25% was prolonged significantly in proportion to the increasing doses of Vb, the increase did not correlate with the dose of Vb. We suggest that frequent administration of Vb 0.02 mg.kg-1 decreases the total amount of Vb to keep TOFR within 25%.

Aged↗

PubMed1998

Effect of additional general anesthesia with propofol, midazolam or sevoflurane on stress hormone levels in hysterectomy patients, receiving epidural anesthesia.

Hormonal responses after surgery are characterized by increased pituitary-adrenal axis hormones. We undertook this study to determine whether the choice of anesthesia influences stress hormone levels. Twenty-three adult females scheduled for hysterectomy for benign disease under general anesthesia were randomly assigned to one of three groups: epidural/propofol anesthesia (Group P), epidural/midazolam anesthesia (Group M), and epidural/sevoflurane anesthesia (Group S). The concentrations of ACTH and cortisol in group P and group M were significantly less than that of group S at 60 min after the incision. The concentrations of beta-endorphin and aldosterone in group P and group M were significantly less than that of group S at 60 min after the incision and after extubation. We conclude that combined epidural and general anesthesia with propofol or midazolam has a greater suppressive effect than sevoflurane on the stress response of the pituitary-adrenal axis during hysterectomy.

Adrenal Cortex Hormones↗

PubMed1997

Long-term follow-up (8 to 17 years) after thromboexclusion operation for thoracic aortic aneurysms.

BACKGROUND: It has been reported that the thromboexclusion operation is a good method for managing certain difficult thoracic aortic aneurysms. METHODS: Forty-four patients underwent graft replacement (group 1) and 14, the thromboexclusion operation (group 2). We reviewed the long-term results of the thromboexclusion operation and compared them with those of graft replacement in our institutions. RESULTS: The hospital mortality rate in groups 1 and 2 was 29.5% (13 patients) and 35.7% (4 patients), respectively. In group 1, the one late death (2.3%) was due to heart failure and in group 2, three of the four late deaths (28.6%) were due to rupture of the excluded thoracic aorta, and one late death was due to heart failure. Long-term follow-up was possible for 23 patients in group 1 and 5 patients in group 2. Survival 3 years after operation was significantly better in group 1 than in group 2 (p < 0.05). Long-term follow-up with blood pressure measurements, chest roentgenograms, electrocardiograms, and echocardiograms showed no significant differences between the preoperative and postoperative findings. However, in group 2, left ventricular hypertrophy and hypertension, which had not been present preoperatively, were found in all of the patients. Also, 1 patient has had persistent hemoptysis. CONCLUSIONS: The thromboexclusion operation has introduced unanticipated problems that were recognized at long-term follow-up.

Adult↗

PubMed1997

Phylogenetic relationship of the genus Oncorhynchus species inferred from nuclear and mitochondrial markers.

The phylogenetic relationship among the salmonid fishes of the genus Oncorhynchus has been analyzed using various kinds of markers for a long time. However, there are three major disagreements among those studies; (1) the authenticity of the Pacific salmon group as a monophyletic cluster, (2) the phylogenetic relationship among three Pacific salmons (pink salmon, sockeye salmon, and chum salmon), and (3) the phylogenetic position of masu salmon. We used allozyme electrophoresis to clarify the phylogenetic relationship between the Pacific salmon group and the Pacific trout group. Furthermore, we reanalysed published mitochondrial DNA D-loop sequences (Shedlock et al., 1992). Allozymic data and mtDNA data indicated the following consistent results; (1) all Pacific salmons formed a monophyletic cluster, (2) chum salmon and pink salmon were clustered within those Pacific salmons, (3) masu salmon formed a cluster with other Pacific salmons and diverged first in this group.

Animals↗

PubMed1997

Iodine-123-BMIPP myocardial washout and cardiac work during exercise in normal and ischemic hearts.

UNLABELLED: Iodine-123-BMIPP washout at rest and after exercise was investigated in relation to cardiac work in normal and ischemic myocardium. METHODS: Sixteen healthy volunteers and 10 patients with ischemic heart disease were examined. After injection of 111 MBq of 123I-BMIPP, successive SPECT imaging was performed to evaluate washout ratio (WR) at rest and after mild and maximal exercise. RESULTS: In the healthy volunteers, the mean WR was 3.3 +/- 3.5% after 1 hr of rest and increased during both mild and maximal exercise. The WR showed a better correlation with net pressure rate product (PRP) than with the peak PRP. After maximal exercise, the WR showed a distinct correlation with the net PRP in the range from 200-300 x 10(3) mmHg/min and then showed a plateau greater than 10%. In five ischemic heart disease patients with the net PRP > or = 300 x 10(3) mmHg/min, the exercise WR values were significantly elevated in normal segments relative to ischemic segments. CONCLUSION: BMIPP washout increased with the increase in cardiac work during exercise in normal myocardium but not in ischemic myocardium. A certain amount of exercise is necessary to evaluate fatty acid metabolism in normal and ischemic myocardium.

Adult↗

PubMed1997

[Postoperative electroencephalographic change in old patients with cardiac surgery].

The purpose of this study was to evaluate cerebral dysfunction in aged patients associated with cardiac surgery using quantitative electroencephalograph (QEEG). Seventeen consecutive patients undergoing cardiac surgery were investigated. There were nine males and eight females whose ages ranged from 65 to 77 years (mean 70.6 years). The cardiac procedures consisted primarily of coronary artery bypass (eleven patients) and valve replacement (six patients). They had good postoperative course, no complications were recognized. Each patient had an EEG examination using digital EEG equipment in first day before operation. Follow up investigations were repeated three times (first day, fifth day and one month after operation). QEEG analysis consisted of fast Fourier transform method was performed in each record. A fall in the peak frequency at basic rhythm was seen in 1st and 5th postoperative day. A power spectra corresponding to slow wave showed an increase at parieto-occipital area in 1st and 5th postoperative day. Alpha activity at occipital area was increased in one month after operation. The EEG change in first or fifth postoperative day suggested the patients had cerebral dysfunction without clinical findings.

Age Factors↗

PubMed1997

[Effects of loprinone hydrochloride on hemodynamics and respiratory oxygenation in patients after cardiac surgery].

Loprinone hydrochloride (Lop), a phosphodiesterase fraction III inhibitor and positive inotrope, was recently released in Japan. We evaluated its dose-related effects on hemodynamics and oxygenation as as well as on plasma levels of Lop in ten patients after cardiac surgery. Immediately after admission to the intensive care unit, baseline hemodynamics and arterial blood gas data were obtained; patients with inotropic support, were given 0.1, 0.2, 0.3 microgram.kg-1.min-1.lop over 1 hour incrementally, and additional data were obtained. CI increased significantly from baseline (2.1 +/- 0.3 l.min-1.m-2) to 3.2 +/- 0.8 at 0.3 microgram.kg-1.min-1. Systemic vascular resistance decreased significantly from baseline (2853 +/- 439 dynes.sec.cm-5.m-2) to 1554 +/- 440 at 0.3 micrograms. kg-1.min-1, and mean arterial pressure also decreased significantly from baseline. There were no significant changes in heart rate (HR), central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), or PaO2.FIO2(-1) in patients over the period evaluated. Plasma levels of Lop rapidly increased to 27.8 ng.ml-1 (effective level; 20 ng.ml-1) at 0.3 microgram.kg-1.min-1. In this study, Lop was shown to effectively increase CI in patients after cardiac surgery with no significant changes in HR, CVP, PAOP or PaO2/FIO2. Thus, Lop has a beneficial effect in the treatment of patients with low cardiac output immediately after cardiac surgery.

Aged↗

PubMed1997

[Successful operation on giant solitary fibrous tumor of the pleura].

A 68-year-old man began complaining of dizziness and dyspnea on exertion 2 months ago. Chest X-ray and CT scan taken on admission revealed a giant tumor occupying almost all of the right thoracic cavity. The mediastinum, especially RA and IVC, was markedly oppressed and shifted by the tumor. MRI showed no invasive lesions of the tumor into adjacent organs. An operation was performed under the tentative diagnosis of solitary fibrous tumor (SFT) of the pleura by transcutaneous needle biopsy. The tumor was encapsulated and resected from the lower lobe of the right lung using a surgical stapler. Then the tumor was carefully dissected from the chest wall, pericardium and diaphragma, and removed completely. It weighed 3920 g and measured 22 x 20 x 20 cm. Various immunohistochemical properties of the specimen were morphologically compatible with SFT. The postoperative course was uneventful and the patient is now free of complaints. Because malignant cases of SFT have been reported a careful follow-up will be performed.

Aged↗

PubMed1997

[Effects of olprinone on IL-6 and IL-10 production during and after cardiac surgery].

Phosphodiesterase inhibitor (PDEI) has been accepted as an inodilator with positive inotoropic and vasodilating actions. Recently many new PDEIS have been available for the treatment of heart failure. We investigated the effect of a new PDEI-III agent, olprinone, on IL-6 and IL-10 production during and after coronary bypass graft surgery (CABG). Twelve patients scheduled for CABG were assigned to 2 groups. In 6 patients (Group-O), olprinone was administered continuously for 30 minutes at a rate of 0.3 micrograms.kg-1.min-1 (gamma) after the anesthesia induction. Then, the infusion rate of olprinone was decreased to 0.2 gamma and it was kept until the 3rd post-operative day. In another 6 patients (Group-C), phentolamine was used for vasodilator instead of olprinone. The plasma levels of IL-6 in Group-O did not show any significant change during perioperative period, whereas those in Group-C reached the peak at the end of extracorporeal circulation and did not recover to control level until the 3rd post-operative day. The plasma levels of IL-10 in Group-O increased to the maximum level at the end of extra-corporeal circulation and were significantly higher than those in Group-C. It is suggested that olprinone has not only inodilating action but also anti-inflammatory action at therapeutic concentrations used for heart failure.

Cardiac Surgical Procedures↗

PubMed1997

Functional evaluation of flail hip joint after periacetabular resection of the pelvis.

Five patients subjected to flail hip joint after resection of primary bone tumor of the pelvis involving acetabular region were examined with respect to function. When a thick portion of the supraacetabular pelvic neck was left in place, the operated legs functioned well regardless of whether the head of the femur was placed anterior or posterior to the iliac wing. In a patient who had only a thin portion of the iliac wing left in place and in those who underwent total excision of the ilium or hemiresection of the pelvis, the function of operated legs was poorer than with a thick portion of the supraacetabular pelvic neck left in place, but still more than 50% of leg function remained. Although flail hip joint results in a larger leg-length discrepancy than do other techniques, it enables favorable healing of the operative wound. Therefore, this method should be considered for women or sedentary patients with primary bone tumor of the pelvis involving acetabular region.

Acetabulum↗

PubMed1996

Continuous monitoring of ventilatory mechanics during one-lung ventilation.

OBJECTIVE: The Ultima SV respiratory monitor can be used to monitor the intraoperative effects of the lateral decubitus position and one-lung ventilation on ventilatory mechanics. METHODS: Eight patients with esophageal cancer who required one-lung ventilation for esophagectomy and reconstruction were enrolled in the study. We monitored pressure-volume or flow-rate-volume loops continuously throughout the operation. Respiratory parameters were evaluated closely during five conditions of ventilation: two-lung ventilation in the supine position, two-lung ventilation in the lateral decubitus position, dependent one-lung ventilation in the lateral decubitus position, nondependent one-lung ventilation in the lateral decubitus position, and dependent one-lung ventilation in the lateral decubitus position with the chest opened. Respiratory rate was controlled at 10 breaths/min, and tidal volume was kept constant (10 ml/kg) during surgery. RESULTS: Peak inspiratory pressure increased to 29.0 +/- 9.0 (mean +/- SD) cm H2O in the dependent one-lung in the lateral decubitus position with the chest opened (p < 0.01). Dynamic compliance decreased to 29.4 +/- 4.9 ml/cm H2O in the dependent one-lung in the lateral decubitus position with the chest opened (p < 0.01). The changing configuration of the loops also offered additional and instantaneous information during one-lung ventilation. CONCLUSIONS: One-lung ventilation caused several changes in the whole respiratory system (lung, thorax, and endotracheal tube). Continuous monitoring of flow-rate-volume or pressure-volume loops with in-line spirometry provided comprehensive information regarding parameters in one-lung ventilation.

Aged↗

PubMed1996

Respiratory mechanics and arterial blood gases during and after laparoscopic cholecystectomy.

PURPOSE: The purpose of this study was to assess the effects of increased intra-abdominal pressure due to CO2 insufflation on the mechanical characteristics of the respiratory system and arterial blood gases during and after laparoscopic cholecystectomy. METHODS: Respiratory mechanics and arterial blood gases were examined in 12 patients undergoing laparoscopic cholecystectomy with CO2 insufflation. Respiratory mechanics were continuously monitored with in-line spirometry. In the recovery room, PaCO2 was measured in this group at 30 min and compared with PaCO2s in 23 patients who had undergone open cholecystectomy retrospectively, to evaluate the effects of insufflation on CO2 elimination. RESULTS: Minute ventilation was decreased by about 500 ml.min-1 during abdominal insufflation. Dynamic lung compliance decreased from 49.6 +/- 4.7 to 30.7 +/- 2.3 (mean +/- SEM) ml.cmH2O-1 with abdominal insufflation (P < 0.005), and returned to 45.1 +/- 3.1 after the release of pneumoperitoneum. Peak inspiratory pressure increased from 15.9 +/- 0.9 to 18.9 +/- 1.0 cmH2O with abdominal insufflation (P < 0.05). Arterial blood gas determinations indicated a decrease in arterial pH, with CO2 retention during insufflation and in the recovery room (P < 0.05). PaCO2 of the laparoscopic patients was higher than that of the open patients in the recovery room. CONCLUSION: The results indicate that respiratory acidosis was caused during CO2 insufflation for laparoscopic cholecystectomy, that was due to (1) decreased compliance, (2) increased CO2 load and (3) insufficient ventilation. Accumulated CO2 during laparoscopic cholecystectomy increased PaCO2 level in the recovery room.

Adult↗

PubMed1996

Glucose intolerance during prolonged sevoflurane anaesthesia.

PURPOSE: The effects of prolonged sevoflurane anaesthesia on insulin sensitivity were investigated by two successive intravenous glucose tolerance tests (IVGTT) in eight patients who underwent prolonged surgery. METHODS: The first IVGTT was administered (25 g glucose as 20% dextrose in water iv) over two minutes 35 min after initiation of surgery. Arterial blood samples were obtained at 0, 5, 10, 30, 60, and 120 min after glucose administration for blood glucose and plasma insulin determination. A second IVGTT was performed six hours following the initiation of surgery. RESULTS: The disappearance rate of glucose (k-value) for the first IVGTT was 0.887 +/- 0.436 (mean +/- SD) %.min-1, and 0.784 +/- 0.289 for the second IVGTT. Both k-values are lower than the normal value. The maximum insulin response to glucose (delta IRI-delta BS-1) of the second IVGTT was lower than the first IVGTT (0.124 +/- 0.092 vs 0.071 +/- 0.056, P < 0.05). The total insulin output of the first IVGTT was higher than the second IVGTT (1.161 +/- 830 vs 568 +/- 389 microU.min.ml-1, P < 0.05). CONCLUSION: Glucose intolerance is enhanced by diminished insulin output in response to blood glucose elevation during prolonged anaesthesia and surgery.

Aged↗

PubMed1996

[Laboratory virological diagnosis of imported dengue cases].

Suspected dengue cases in Japan during the period of 1985-1995, 173 cases with unknown febrile illness entering or returning from mostly southeast Asia, were tested by serology and RT-PCR gene amplification. Seventy seven cases were confirmed by a significant rise of dengue 2 (Den 2) HI antibody in paired sera or by detection of HI antibody titer higher than 1:320 in single serum. The other 3 cases with antibody levels not higher than 1:80 in paired sera and 12 cases with an antibody 1:160 in single sera were positively suspected of dengue infection but were not confirmed. Countries of origin of confirmed cases were Thailand (39 cases), Philippinse (15), India (13), and Indonesia (9). Sera of dengue cases showed high degrees of cross reactivity of Japanese encephalitis virus (JEV) in HI test but not in IgM capture ELISA. Sera of confirmed JEV-infected cases, however, showed practically no cross reactivity to Den 1 4 in HI test, suggesting unilateral cross reactivity of HI antibody. RT-PCR detected the Den 1 genome in sera of 3 cases obtained within 3 days after onset and the Den 2 genome in serum of case 4 days after onset. Although the number is limited, 92 (53%) out of 173 cases of febrile illness of unknown etiology entering Japan from tropical countries were either confirmed or positively suspected to be dengue fever. Considering possibilities of under reporting, importations of tropical viral infections should be bigger in number and will necessitate our intensified alertness.

Asia, Southeastern↗

PubMed1996

An epidemiological study on diabetes mellitus in the population living in a methyl mercury polluted area.

The aim of this study was to determine the actual prevalence of diabetes mellitus and to investigate the contribution of various risk factors to the diabetes mellitus among the population in a methyl mercury polluted area. The study was a population based cross sectional mass screening survey. A case-control study was designed to estimate the role of various risk factors including methyl mercury exposure for diabetes mellitus. The study was confined to a small rural town 10 km north of Minamata City; 1,087 persons older than 40 years were examined. Measurement of glucose metabolism was made on the basis of urine and haematological examinations. Data on risk factors were collected by questionnaire, and by measurement of body height and weight (obesity). The prevalence rate of the diabetes mellitus was 8.4% in males and 5.3% in females. The odds ratio of family history was significantly higher, 4.63. The odds ratio of residential history in a methyl mercury high polluted area was 0.58. The prevalence of the diabetes mellitus in this methyl mercury polluted area was not increased, contrary to what was expected based on the pathological findings.

Aged↗

PubMed1996

[Presurgical evaluation of cerebral perfusion reserve in patients for cardiovascular surgery using 99mTc-ECD SPECT with diamox enhancement].

Cerebrovascular stroke is one of the major complications in cardiovascular surgery with cardiopulmonary bypass. The purpose of this study was to evaluate the usefulness of preoperative 99mTc-ethyl cysteinate dimer (ECD) SPECT and acetazolamide (diamox) enhancement to predict neurological complications in cardiovascular surgery. Eighteen patients with coronary disease, valvular disease or aortic aneurysm were studied before the operations. Regional cerebral blood flow and perfusion reserve were evaluated using ECD SPECT before and after the intravenous administration of diamox (1 g). Three cases with moderate to severe baseline abnormalities and poor perfusion reserve had cerebral infarction postoperatively. Twelve cases with good to fair perfusion reserve had no neurological complication. Three cases having poor perfusion reserve had the operations with more intensive brain protection, in which higher perfusion pressure to the brain was maintained during cardiopulmonary bypass, and no neurological complication was observed. In conclusion, patients who have moderately or markedly abnormal baseline flow with poor perfusion reserve may have some risk of neurological complications in cardiovascular surgery. ECD SPECT with diamox enhancement may give information useful for selection of operation procedures.

Acetazolamide↗

PubMed1996

[Stress hormone response during midazolam/fentanyl anesthesia combined with epidural anesthesia for abdominal total hysterectomy].

Stress hormone response was investigated during midazolam/fentanyl/oxygen/air anesthesia combined with epidural anesthesia in six patients undergoing abdominal total hysterectomy (group MF). A control group of six patients received nitrous oxide/oxygen/sevoflurane anesthesia combined with epidural anesthesia (group C). We evaluated plasma concentrations of ACTH, cortisol, aldosterone and beta-endorphin during the control period, 10 min, 60 min after incision, and in the recovery room. In group C, plasma concentrations of ACTH, cortisol, aldosterone and beta-endorphin increased significantly 60 min after incision compared with control concentrations. But in group MF, they did not increase significantly during anesthesia. In the recovery room there were significant differences compared with preinduction concentrations in both groups. It is concluded that midazolam/fentanyl anesthesia combined with epidural anesthesia is more effective than nitrous oxide/oxygen/sevoflurane anesthesia combined with epidural anesthesia to control the stress response to surgery.

Adrenocorticotropic Hormone↗

PubMed1996

The role of physicochemical properties of biomaterials and bacterial cell adhesion in vitro.

This study was undertaken to investigate the physicochemical aspects of the interaction between the surface of biomaterials and bacterial cell membranes in vitro, aimed at studying the mechanisms of bacterial adhesion to biomaterials. Correlations were made between the number of adherent bacterial cells (S. aureus) and each of the calculated components of surface free energy (i.e., dispersion, polarity and hydrogen bond) of biomaterials. The effect of antibodies to cell-adhesion molecules on bacterial adhesion was also studied using monoclonal antibodies to vitronectin receptor, fibronectin receptor and CD44. This study indicates the polarity component of surface free energy plays a dominant role in the process of bacterial adhesion at least in vitro. The number of cells adherent to materials decreased to 44-73% of the control value in the presence of antibodies tested, showing that cell adhesion molecules affect adherence to biomaterials. Moreover, the results suggested that bacterial adhesion was prevented by specific blockade of cell adhesion molecule receptors.

Antibodies, Monoclonal↗