[Body temperature control in Perioperative period].
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Anesthesia, General↗
Biomedical subjects
T Matsukawa
Publications and source records attributed to T Matsukawa.
Simultaneous determination of the enantiomers of leucine and [2H7]leucine in plasma by capillary gas chromatography-mass spectrometry.
A method for the stereoselective assay of D- and L-enantiomers of both leucine and [2H7]leucine in rat plasma was developed using gas chromatography-mass spectrometry-selected-ion monitoring. DL-[2H3]leucine was used as an internal standard. The method involved purification by cation-exchange chromatography using BondElut SCX cartridge and derivatization with hydrochloric acid in methanol to form methyl ester followed by subsequent chiral derivatization with (+)-alpha-methoxy-alpha-trifluoromethylphenylacetyl chloride to form diastereomeric amide. The derivatization made the separation of the leucine enantiomers possible with good gas chromatographic behavior. Quantitation was performed by selected-ion monitoring of the quasi-molecular ions of the diastereomers on the chemical ionization method. The sensitivity, specificity, accuracy and reproducibility of the method were demonstrated to be satisfactory for application to pharmacokinetic studies of leucine enantiomers.
Animals↗
Dual-mode EPR study of new signals from the S3-state of oxygen-evolving complex in photosystem II.
The light-induced new EPR signals at g = 12 and 8 were observed in photosystem II (PS II) membranes by parallel polarization EPR. The signals were generated after two flashes of illumination at room temperature, and the signal intensity had four flashes period oscillation, indicating that the signal origin could be ascribed to the S3-state. Successful simulations were obtained assuming S = 1 spin for the values of the zero-field parameters, D = +/-0.435 +/- 0. 005 cm-1 and E/D = -0.317 +/- 0.002. Orientation dependence of the g =12 and 8 signal intensities shows that the axial direction of the zero-field interaction of the manganese cluster is nearly parallel to the membrane normal.
Chloroplasts↗
Fast and slow recovery phases of goldfish behavior after transection of the optic nerve revealed by a computer image processing system.
As the goldfish is a common experimental animal for vision research, including psychophysical behavior, it is very important to quantitatively score fish behavior. We have previously developed a computer image processing system which can acquire the positional coordinates of goldfish moving freely in an aquarium and determine turning directions (go straight, right or left turn). In the present study, an algorithm to determine tilting angles of moving goldfish was constructed. We also made histograms for quantifying the interaction between pairs of goldfish (two-point distance). By using these histograms, we estimated the time-course of behavioral regeneration after optic nerve transection in goldfish. Control goldfish showed an equal percentage of right or left turns and maintained an upright position in a dorsoventral axis. When the optic nerve of a goldfish was unilaterally sectioned, the goldfish showed predominant turning and slight tilting toward the intact eye. The abnormal turning and tilting behaviors lasted for 10-14 days and then gradually decreased, returning to control behaviors by one month after the unilateral transection. When the optic nerve of a single goldfish was bilaterally sectioned, it did not show any preferential turning and tilting behavior, which is similar to what was observed in control goldfish. However, the trace maps showed that, after bilateral sectioning, fish preferred to cross the center of the tank, which was unlike control fish. In control pairs, one goldfish chased the other with a fixed small range of two-point distances. However, in pairs of goldfish with bilateral transection of the optic nerve, the blind goldfish behaved independently of each other, with a long two-point distance. The long two-point distance of the blind goldfish lasted for at least two months and then slowly returned to control two-point distance by four months after bilateral transection. Such fast and slow recovery in goldfish behaviors evoked after unilateral and bilateral transection of the optic nerve is discussed with respect to reconnection of regenerating optic nerves in the fish central nervous system. This computer image processing system is a useful tool with which we can quickly and easily quantify fish behavior.
Algorithms↗
Optimal length and angle of a new lightwand device (Trachlight).
STUDY OBJECTIVE: To investigate the effects of angle and length of the Trachlight lightwand and the effect of obesity on transillumination of the neck and difficulty of intubation. DESIGN: Prospective, randomized study. SETTING: Operating room of a university hospital. PATIENTS: 270 patients, aged 30 to 70 years, requiring anesthesia. INTERVENTION: Three different studies were performed. 1) One hundred twenty adults for general anesthesia to test the effect of the angle, 2) 120 patients for the length of the extrusion, and 3) 30 patients with body weight > or = 120% of the standard (Broca's formula) versus 30 with body weight < 120% of the standard to test the effect of the obesity. 1) The lightwand was bent at 20 degrees, 40 degrees, 60 degrees, or 80 degrees with 0 cm extruded from the endotracheal tube; 2) the lightwand was exposed from the endotracheal tube with -0.5, 0, 1, 2, 3, or 4 cm with 40 degrees angle; and 3) the effect of obesity was tested with 40 degrees angle and 0-cm extrusion. Endotracheal intubation was performed using the lightwand. Transillumination of the light at neck and the difficulty of intubation were assessed. MEASUREMENTS AND MAIN RESULTS: 1) A 20 degrees angle decreased the transillumination and an 80 degrees angle increased the number of difficult intubation. 2) Transillumination decreased with -0.5 cm and 0 cm extrusion. Difficult intubation increased with the extrusion > or = 3 cm. 3) Transillumination decreased and difficult intubation increased in the patients with body weight > or = 120% of the standard. CONCLUSIONS: To increase the success rate of tracheal intubation using the lightwand, the lightwand should be bent in 40 degrees to 60 degrees, with the extrusion of 1 to 2 cm from the tracheal tube. For obese patients with body weight > or = 120% of the standard, the lightwand was not useful.
Adult↗
Continuous epidural administration of midazolam and bupivacaine for postoperative analgesia.
BACKGROUND: Midazolam has been reported to have a spinally mediated analgesic effect. Clinically, single-shot epidural or spinal administration of midazolam has been shown to have an analgesic effect on perioperative pain. In this study, we investigated the analgesic effect of continuous epidural administration of midazolam with bupivacaine on postoperative pain. METHODS: Four groups of 20 patients who underwent gastrectomy or cholecystectomy were studied. Continuous epidural infusion of bupivacaine 100 mg (Group C), bupivacaine 100 mg + midazolam 10 mg (Group M10), or bupivacaine 100 mg + midazolam 20 mg (Group M20) in 40 ml per 12 h was started after surgery using the balloon infuser. Group I received intermittent epidural bupivacaine (2.5 mg.ml-1) 6 ml every 2 h. When necessary, an indomethacin suppository and then a single epidural shot of bupivacaine (2.5 mg.ml-1) 6 ml was administered. Blood pressure, heart rate, respiratory rate, analgesic area, analgesia score, and sedation score were monitored for 12 h postoperatively. Memory and frequencies of supplemental analgesia (indomethacin suppositories and epidural bupivacaine) were also checked. RESULTS: Group M20 showed a significantly wider area of pinprick analgesia and better analgesia scores than other groups. The need for rescue analgesics were significantly less in Group M20. Sedation and amnesia were more pronounced in Group M20 than the other groups. CONCLUSION: Adding midazolam (10 to 20 mg per 12 h) to continuous epidural infusion of bupivacaine for postoperative pain can provide a better analgesia, amnesia and sedation than bupivacaine alone.
Adjuvants, Anesthesia↗
Acute phase histopathological study of spinally administered midazolam in cats.
UNLABELLED: Midazolam may be a useful analgesic when administered intrathecally. However, neurotoxicity must be excluded. The purpose of this study was to investigate whether spinally administered midazolam induces acute-phase histopathological or inflammatory reactions of the spinal cord. A lumbar laminectomy was performed on 40 cats, and their spinal cords were exposed. Midazolam 10 mg (2 mL, n = 20 cats) or saline 2 mL (20 cats) was administered directly to the spinal cord. At 1, 2, 4, or 6 h after the administration, cats were killed, and the lumbar spinal cord was removed and fixed in 10% formalin. Histology was examined using light microscopy with hematoxylin and eosin staining. Both groups showed slight to moderate changes in the spinal cord, but no severe damage was observed. Inflammatory reactions were seen in only one cat in the saline group with slight neutrophil infiltration. These changes were not different between the midazolam group and the saline group. In conclusion, up to 6 h after direct exposure to midazolam, no acute histological damage or inflammatory reaction of the spinal cord was seen in cats. IMPLICATIONS: Spinally administered midazolam, even in large doses, does not cause acute neurotoxicity or inflammation of the spinal cord.
Acute-Phase Reaction↗
Cerebrovascular carbon dioxide reactivity during general anesthesia: a comparison between sevoflurane and isoflurane.
UNLABELLED: We compared cerebrovascular carbon dioxide reactivity during the administration of sevoflurane and isoflurane anesthesia by measuring cerebral blood flow velocity (CBFV) as an indirect measurement of cerebral blood flow. Thirty patients, 20-70 yr old, undergoing lower abdominal surgery and without known cerebral or cardiovascular system disease, were randomly assigned to either sevoflurane or isoflurane treatment groups. Anesthesia was induced with thiopental 5 mg/kg IV and maintained with either sevoflurane or isoflurane in 67% nitrous oxide and oxygen. The CBFV and pulsatility index (PI) of the left middle cerebral artery were monitored with transcranial Doppler. The P(ETCO)2 was increased stepwise from 20 to 50 mm Hg by changing the respiratory rate with a constant tidal volume. At every 5-mm Hg stepwise change in P(ETCO)2, CBFV and PI were recorded. CBFV increased with increasing P(ETCO)2. CBFV was significantly smaller in the isoflurane group at P(ETCO)2 = 20-40 mm Hg than in the sevoflurane group. The rate of change of CBFV with changes in CO2 was larger in the isoflurane group than in the sevoflurane group. PI was constant over time and was not different between groups. In conclusion, hypocapnia-induced reduction of intracranial pressure might be more effective during the administration of isoflurane than sevoflurane. IMPLICATIONS: Changes in cerebral blood flow caused by the changes of carbon dioxide tension are greater during the administration of isoflurane anesthesia compared with sevoflurane anesthesia. Attempts to decrease intracranial pressure by decreasing carbon dioxide tension may be more successful during isoflurane than sevoflurane anesthesia administration.
Adult↗
Thermoregulatory thresholds for vasoconstriction in patients anesthetized with various 1-minimum alveolar concentration combinations of xenon, nitrous oxide, and isoflurane.
BACKGROUND: Nitrous oxide limits intraoperative hypothermia because the vasoconstriction threshold with nitrous oxide is higher than with equi-minimum alveolar concentrations of sevoflurane or isoflurane, presumably because of its stimulating actions on the sympathetic nervous system. Xenon, in contrast, does not cause sympathetic activation. Therefore, the authors tested the hypothesis that the vasoconstriction threshold during xenon-isoflurane anesthesia is less than during nitrous oxide-isoflurane anesthesia or isoflurane alone. METHODS: Fifteen patients each were randomly assigned to one of three 1-minimum alveolar concentration anesthetic regimens: (1) xenon, 43% (0.6 minimum alveolar concentration) and isoflurane, 0.5% (0.4 minimum alveolar concentration); (2) nitrous oxide, 63% (0.6 minimum alveolar concentration) and isoflurane 0.5%; or (3) isoflurane, 1.2%. Ambient temperature was maintained near 23 degrees C and the patients were not actively warmed. Thermoregulatory vasoconstriction was evaluated using forearm-minus-fingertip skin temperature gradients. A gradient exceeding 0 degrees C indicated significant vasoconstriction. The core-temperature threshold that would have been observed if skin had been maintained at 33 degrees C was calculated from mean skin and distal esophageal temperatures at the time of vasoconstriction. RESULTS: The patients' demographic variables, preinduction core temperatures, ambient operating room temperatures, and fluid balance were comparable among the three groups. Heart rates were significantly less during xenon anesthesia than with nitrous oxide. The calculated vasoconstriction threshold was lowest with xenon (34.6+/-0.8 degrees C, mean +/- SD), intermediate with isoflurane alone (35.1+/-0.6 degrees C), and highest with nitrous oxide (35.7+/-0.6 degrees C). Each of the thresholds differed significantly. CONCLUSIONS: Xenon inhibits thermoregulatory control more than isoflurane, whereas nitrous oxide is the least effective in this respect.
Adult↗
[Cesarean section in a patient with severe diabetic ketoacidosis associated with intracranial hemorrhage of the fetus].
A patient at 33 weeks of pregnancy with diabetic ketoacidosis was transferred to our hospital. Despite intensive medical treatment, fetal state deteriorated and fetal distress was documented. A decision was made to deliver the fetus immediately. An asphyxial neonate was delivered by cesarean section under spinal anesthesia. The neonate was resuscitated in the operating room and intensively managed at the pediatric ward. CT scan revealed the multiple intracranial hemorrhage in the neonate on the fifth day of the birth. Stringent glucose control during pregnancy is crucial for the health of both the mother and fetus.
Adult↗
[Anesthetic management of cesarean section for conjoined twins].
A 31-year-old female patient underwent cesarean section for conjoined twins under general anesthesia. In the 33rd week of pregnancy, MRI showed the twins to be a thoracopagus, whose hearts and livers are combined. The patient was not informed that her fetus combined. General anesthesia was induced with thiamylal 200 mg and vecuronium 8 mg in the presence of two pediatricians. Anesthesia was maintained with 66% nitrous oxide in oxygen until the delivery. Just after the delivery, methylergometrine maleate 0.2 mg, midazolam 5 mg, and fentanyl 100 micrograms were administered intravenously. PGF2 alpha was administered in the uterus because of inadequate contraction of the uterus. Apgar score was 0 point at both 1 minute and 5 minutes. Autopsy showed their hearts and livers combined. Conjoined twins tend to die early after birth because of abnormality in their hearts. We selected general anesthesia for this case considering mother's feeling, and we successfully held intraoperative bleeding down with methylergometrine maleate and extra PGF2 alpha.
Adult↗
Comparison [correction of Compariso] of sympathetic nerve response to head-up tilt in summer [correction of sumer] and winter.
The seasonal adaptation of humans is accomplished metabolically by increased or decreased body heat production and by cardiovascular adjustments which result in decreased or increased heat loss from the body. The sympathetic nervous system plays an important role in thermoregulation and in blood pressure regulation. Muscle sympathetic nerve activity (MSNA) has an essential role in blood pressure regulation in humans. However, it has not yet been clarified how the MSNA changes during seasonal adaptation or how these changes may contribute to long-term thermoregulation in relation to blood pressure regulation. The purpose of the present study was to elucidate if seasonal variations exist in responses of the sympathetic nervous system in humans for gravity-dependent blood pressure regulation.
Acclimatization↗
Baroreflex control of muscle sympathetic nerve activity is attenuated in the elderly.
To determine whether the baroreflex control of sympathetic nerve activity is attenuated in the elderly, muscle sympathetic nerve activity (MSNA) from the tibial nerve was monitored using microneurography, and heart rate and blood pressure were recorded during the depressor (phase II) or pressor (phase IV) period to Valsalva's maneuver in 10 younger subjects and 7 aged subjects. The baroreflex slope for heart rate showed attenuation in the aged subjects during the pressor phase but not during the depressor phase, the baroreflex slope for MSNA was also attenuated in the aged subjects during the pressor and tended to be attenuated during the depressor phases. These data suggest impaired baroreflex function for both heart rate and sympathetic nerve activity in the elderly.
Adult↗
A Case of Sclerosing Lymphocytic Lobulitis of the Breast Associated with Diabetes Mellitus.
BACKGROUND: The benign breast disease sclerosing lymphocytic lobulitis is thought to result from autoimmune diseases causing insulin-dependent diabetes mellitus (IDDM) due to insulinitis. In cases of sclerosing lymphocytic lobulitis accompanied by IDDM, the clinical term gdiabetic fibrous breast disease hhas been proposed. METHODS: A case of sclerosing lymphocytic lobulitis of the breast is described RESULTS: The patient was a 43-year-old woman diagnosed with non insulin-dependent diabetes mellitus (NIDDM) 8 years previously. Insulin therapy was thought to be necessary because treatment with glibenclamide was not effective. She visited our facility complaining of a lump in her right breast that was 5 cm in diameter, painless, rock-hard, discrete, and irregularly outlined. Biopsy was performed because breast cancer was strongly suggested by its hardness and its irregular internal echo on ultrasonography. Histopathological findings demonstrated marked stromal sclerosis and lymphocyte infiltration in the perivascular and perilobular areas. Sclerosing lymphocytic lobulitis was diagnosed. CONCLUSION: Referring physicians should avoid performing unnecessary repeated biopsies by recognizing this disease entity, which often occurs bilaterally.
Journal Article↗
Performance of the YB(66) soft X-ray monochromator crystal at the wiggler beamline of the UVSOR facility.
Soft X-ray spectra have been measured using a pair of YB(66)(400) monochromator crystals at the double-crystal monochromator beamline BL7A of the UVSOR facility, where the wiggler radiation has a magnetic field of 4 T. Deformation of the YB(66) crystal due to heat load from the synchrotron radiation is almost negligible. The photon flux is about 10(8) photons s(-1) (100 mA)(-1) in the energy region 1.2-2 keV and the energy resolution is 0.7 +/- 0.1 eV around hnu = 1.5 keV. These results show that the YB(66) crystal is suitable for use as a monochromator crystal. Its application to soft X-ray spectroscopy is discussed.
Journal Article↗
Light-induced high-spin signals from the oxygen evolving center in Ca2+-depleted photosystem II studied by dual mode electron paramagnetic resonance spectroscopy.
Illuminating Ca2+-depleted photosystem (PS) II membranes generated two new EPR signals at g = 11 and 15 by perpendicular and parallel polarization modes, respectively. Two turnovers of the oxygen evolving center (OEC) beyond the modified S2' state are required for the appearance of these signals. The formation of the signals correlated with that of an asymmetric (singlet-like) EPR signal observed at g approximately 2. Spectral simulation indicated that both signals arose from a transition between |2(+/-)> levels with intradoublet splitting of Delta = 0.276 cm-1 in an S = 2 spin system. Furthermore, the two signals in parallel and perpendicular modes were formed at the same time, indicating that the same metal center was responsible. The molecular z-axis of the S = 2 spin system for the signals was almost parallel to the plane of thylakoid membranes. These results indicate that the Mn cluster in the photosynthetic oxygen evolving center is the source of the new EPR species which may be a Mn(IV)-Mn(IV) or Mn(III)-Mn(III) dimer or a Mn(III) monomer. Redox events of the Mn cluster in the Ca2+-depleted PS II are discussed based on these observations.
Calcium↗
Unusual gastric polyp showing submucosal proliferation of glands: case report and literature review.
We report an unusual pedunculated polyp in the stomach in a 41-year-old woman. She was hospitalized because of epigastric discomfort. Endoscopy revealed a polyp with a long stalk in the fundus of the stomach. The polypectomyzed polyp measured 23 x 18 x 9 mm and was characterized by submucosal proliferation of glands and cystic dilatation. The surface of the polyp was covered with gastric mucosa of fundic or pyloric gland type. The glandular structures consisted of various types of lining cells, including pyloric or mucous-neck cell type, surface mucous (foveolar) cell type, parietal-like cells, and somatostatin-positive cells. The submucosal glandular or cystic elements were connected with the overlying gastric mucosa through a defect of the muscularis mucosa, suggesting that this polyp may have been formed by the heterotopic inverted downgrowth of mucous glands into the submucosa. We discuss the histogenesis of this rare polyp and present a review of the literature.
Adult↗
Comparative effects of Ringer's acetate and lactate solutions on intraoperative central and peripheral temperatures.
STUDY OBJECTIVES: To compare the effects of Ringer's lactate (LR) and Ringer's acetate (AR) solutions on core body and peripheral temperatures during isoflurane or sevoflurane anesthesia. DESIGN: Prospective, randomized study. SETTING: Operating rooms of a university hospital. PATIENTS: 60 ASA physical status I and II patients undergoing general surgery. INTERVENTIONS: Following induction with 5 mg/kg of thiamylal and 0.1 mg/kg of vecuronium, patients were randomly assigned to one of four groups (15 patients per group). They received inhalation anesthetics (66% nitrous oxide [N2O] and 1.0% to 2.0% isoflurane or 1.3% to 2.6% sevoflurane) and LR or AR. MEASUREMENTS AND MAIN RESULTS: Tympanic membrane (central) temperatures, forearm temperatures, and fingertip temperatures were recorded during surgery every 30 minutes. Tympanic membrane temperatures in the patients given AR were significantly higher than those given LR during isoflurane anesthesia 5 and 30 minutes after induction of anesthesia. However, this was not the case for sevoflurane anesthesia. There were no significant differences in forearm and fingertip temperatures or fingertip bloodflow among the four groups. CONCLUSION: There was no significant difference between AR and LR in the preservation of heat during either sevoflurane or isoflurane anesthesia. However, AR may be superior to LR for maintaining central temperature during the early period of isoflurane anesthesia.
Acetates↗