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Biomedical subjects

T Kugimiya

Publications and source records attributed to T Kugimiya.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Anesthetic problems in a very low birth weight infant with Kasabach-Merritt syndrome].

Kasabach-Merritt syndrome is characterized by thrombocytopenia and bleeding tendency leading to disseminated intravascular coagulation with giant hemangiomas. We present a very low birth weight infant with this syndrome who underwent four operations. A male baby (1179 g, 37 cm) was born at a gestational age of 28 weeks and 6 days by caesarean section. A large hemangioma, 7 x 8 cm in size, was recognized on the left thigh. As associated consumption coagulopathy (Kasabach-Merritt syndrome) was diagnosed with platelet count 5.1 +/- 10(4) mm-3 and fibrinogen 49 mg.dl-1. Despite treatment with liniac X-ray radiation, systemic steroid and component transfusion, coagulopathy became worse with extremely low platelet count of 1.1 x 10(4) mm-3. Infusion of dopamine and dobutamine was necessary for high output cardiac failure. On day 9, PDA ligation was performed. Cerebro-ventricular drainage, ventricuro-peritoneal shunt and shunt revision were required on day 15, 49 and 88, respectively, for hydrocephalus due to intraventricular hemorrhage. Main anesthetics used were fentanyl and sevoflurane. Major problems encountered by anesthetists were: bleeding tendency, water and electrolyte management, body temperature control, and immaturity and fragility of premature infant. Coagulopathy in Kasabach-Merritt syndrome must be a risk factor for intraventricular hemorrhage, which is a characteristic complication of a very low birth weight infant.

Anesthesia, General↗
PubMed1996

[Anesthetic problems in a 480 g infant for ventriculo-peritoneal shunt surgery].

A 480 g, 38-day-old female infant underwent ventriculo-peritoneal shunt surgery for hydrocephalus after intra-ventricular hemorrhage. The patient was born at a gestational age of 25 weeks and 5 days, weighing 600 g, as one of twins by a cesarean section. Although respiratory distress syndrome developed, it was relieved with surfactant. The esophagus was easily perforated by a gastric tube. At the age of 7 days, PDA was closed conservatively with indomethacin. Anesthesia was induced and maintained with fentanyl (induction dose 4 micrograms.kg-1, total dose 6 micrograms.kg-1) and vecuronium. Ventilation was controlled with oxygen and air (FIO2 0.21-0.25). The main problems encountered by anesthetists in the perioperative period were; fluid management (hyperkalemia, hyponatremia, infusion volume), bradycardia due to increased intracranial pressure, body temperature control (hypothermia), and transport to the operating room. In anesthesia for extremely low birth weight (extremely premature) infants, utmost care and proficient procedure are required because of their immaturity, fragility and smallness.

Adjuvants, Anesthesia↗
PubMed1996

[Simultaneous mitral valve replacement and splenectomy in a patient with chronic idiopathic thrombocytopenic purpura].

A 57-year-old female with valvular heart disease and chronic idiopathic thrombocytopenic purpura (ITP) underwent successful open-heart surgery. Preoperative administration of steroids and high-dose gamma-globulin increased the platelet count from 3 x 10(4)/microgram at admission to 10 x 10(4)/microgram before the operation. Splenectomy followed by mitral valve replacement (SJM 27M) were performed simultaneously. No platelet transfusion needed during and after the operation owing to rapid increase in platelets that would occur following splenectomy. The postoperative course was uneventful. The present simultaneous splenectomy and open-heart operation appears to be a safe and effective procedure for minimizing perioperative blood loss in patients with ITP and heart disease.

Chronic Disease↗
PubMed1995

Changes in cerebral blood flow estimated after stellate ganglion block by single photon emission computed tomography.

The validity of the hypothesis that the cerebral vasculature is under the control of sympathetic innervation was investigated using brain scintigraphy imaging before and after stellate ganglion block (SGB). The experiment with HM-PAO showed a definite increase in the blood flow of the brain on the block side on both by the dynamic images and the SPECT images. The tympanic temperature (Tty) of the block side decreased significantly after SGB, compared to the unblock side in this study, as had been reported before. This change in Tty coinsided with the increase in cerebral blood flow as mentioned above. This study demonstrated that the cerebral vasculature is under the control of sympathetic innervation, the pathway of which is relayed and/or passes through the stellate ganglion. We conclude that SGB increases intracerebral blood flow and can also exert secondary effects systemically due to CNS blood flow changes as have been previously reported.

Adult↗
PubMed1995

Myocardial recovery during post-ischemic reperfusion: optimal concentrations of Na+ and Ca2+ in the reperfusate and protective effects of amiloride added to cardioplegic solution.

The effects of Na+ and Ca2+ concentrations in the reperfusate on post-ischemic myocardial recovery were examined. Also, the myocardial protective effects of amiloride, an inhibitor of the Na+/Ca2+ and Na+/H+ exchange systems, added to cardioplegic solutions were assessed, using an isolated working rat heart perfusion system. Global myocardial ischemia was induced by 30-min normothermic cardioplegic arrest, using St. Thomas' solution. The concentration of Na+ in the reperfusate varied, stepwise, from 75 to 145 mM/l, and that of Ca2+, from 0.1 to 2.5 mM/l. In this study post-ischemic functional recovery was best at 110mM/l Na+ and 1.2-1.8 mM/l Ca2+ in the reperfusate. A significantly greater post-ischemic functional recovery and a lower creatine kinase release were observed when amiloride was added to the cardioplegic solution. Ca2+ overload via Na+/Ca2+ and Na+/H+ exchange systems would, thus, appear to be due, at least in part, to post-ischemic reperfusion injury.

Amiloride↗
PubMed1993

[Axillo-femoral bypass for adult form of extreme coarctation of the aorta--the long term prognosis].

A 33-year-old female with adult form of extreme coarctation underwent axillo-femoral bypass grafting. The postoperative hemodynamic improvement was remarkable. The patient spent excellent quality of life without any hypotensive drug or anticoagulant agent for 14 years until pseudoaneurysms of the bypass graft ruptured. The patient was saved by an emergency operation with 2 steps of surgical procedures. The first step was making the new axillo-femoral bypass at the contralateral side, then the diseased graft was replaced by a new graft as the second step. The postoperative catheterization revealed no pressure gradient between the upper and lower extremities, and the bilateral API's were over 100%. The pseudoaneurysm of the graft seemed to be caused by the stabbed needle holes for the dearing of the graft and the instrument for the partial occlusion of the graft. We learned from this experience that the needle holes of the graft should be repaired by plegeted sutures, and Fogarty clamp or the clamp with rubber sheath should be used for clamping graft. The axillo-femoral bypass is, of course, not a first choice procedure for extreme coarctation, but the hemodynamic improvement was achieved in our case. Therefore, it may be still useful for the compromised host as an alternative procedure to the radical correction.

Adult↗
PubMed1989

Laboratory evaluation of heat-and-moisture exchangers.

We conducted a laboratory study on six commercially available heat and moisture exchangers in order to determine and compare their water retaining efficiency and their contribution to airway resistance. The Gambro-Engström Edith Flex device was the most desirable of the six devices we evaluated in terms of its water retaining efficiency. The NMI Pneumoist 1 and the Siemens Servo Humidifier 153 units had good water retaining capacity but their higher airflow resistance need close monitoring, especially after prolonged clinical use. The Pall HME 15-22 and the Portex Humid-Vent 1 devices were also efficient in water retaining capacity. The Pall also demonstrated low airflow resistance and the minimum increase in airflow resistance after water immersion. The pathogen filtering capacity of the Pall should also be considered an additional advantage, especially in infected patients. The Terumo Breathaid device performed worst of all six devices, but it was still better than no HME at all.

Journal Article↗
PubMed1984

Effects of drug-induced reduction in oxyhemoglobin affinity on survival time of mice in severe hypoxic conditions.

We studied the effect of ortho-iodo sodium benzoate (OISB) given intraperitoneally to mice. 300 and 600 mg/kg of OISB increased P50 from the control value of 41.2 mmHg to 42.7 mmHg and 45.7 mmHg, respectively. The mice were then exposed to two experimental hypoxias, namely, hypobaric hypoxia and carbon monoxide hypoxia. Mean survival time was prolonged from 67.8 (control saline) to 94.8 sec (OISB 300 mg/kg) and 112.2 sec (OISB 600 mg/kg) in the hypobaric hypoxia, and from 201.3 sec (control saline) to 329.7 sec (OISB 300 mg/kg) and 407.7 sec (OISB 600 mg/kg) in the carbon monoxide hypoxia. We concluded that OISB had prolonged survival time by reducing oxyhemoglobin affinity, thus facilitating oxygen release in severe hypoxic conditions.

Animals↗
PubMed1983

Myonephropathic-metabolic syndrome as a complication of cardiopulmonary bypass.

We encountered eight rare cases of myonephropathic metabolic syndrome (MNMS) which developed as a complication of the femoral arterial cannulation (FAC) during cardiopulmonary bypass (CPB). Seven were boys ranging in age from 4-17 years, and all had undergone open heart surgery using CPB with a hemodilution technique. These eight corresponded to 1.9 per cent of the 420 patients treated with CPB before June, 1974. The pump priming fluid used was either Ringer's lactate solution alone or that containing a small amount of colloidal solution. Duration of CPB ranged from 52 min to 2 hrs and 42 min, but the FAC period was more than 3 hrs in each case. Acute renal failure occurred in 3 and 2 required peritoneal dialysis. Severe respiratory insufficiency occurred in 2 and one died 3 months after the operation. The most effective means to prevent the development of MNMS seems to be the local cooling of the cannulated limb during FAC. MNMS did not occur in 444 cases of CPB with FAC after July 1974, and here local cooling was applied in all cases.

Adolescent↗