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Biomedical subjects

T Matsukawa

Publications and source records attributed to T Matsukawa.

At least 73 records · Page 4Linked to original sources
PubMed1998

Propofol anesthesia for cesarean section successfully managed in a patient with moyamoya disease.

We report a case of general anesthesia in a 25 year-old female patient with moyamoya disease who presented for cesarean section. General anesthesia was induced with propofol 100 mg, succinylcholine 50 mg, and nicardipine 1 mg intravenously (i.v.), and maintained with 60% nitrous oxide in oxygen. Just after the clamp of the umbilical cord, propofol 10 mg/kg/hr following propofol 50 mg pentazocine 15 mg vecuronium 8 mg, and methylergometrine maleate 0.2 mg were given i.v. The rate of infusion of propofol was reduced to 8 mg/kg/hr 10 minutes after the clamp and reduced to 6 mg/kg/hr 20 minutes after the clamp. Additional pentazocine 15 mg was given i.v. Blood pressure was maintained between 110 and 145 systolic, and 50 and 85 diastolic mmHg, and end-tidal carbon dioxide was between 34 and 36 mmHg. No postoperative deterioration of the patient's neurologic findings occurred. For the anesthetic management of moyamoya disease patients, especially in delivery, it is important to avoid hemodynamic changes and to maintain cerebral blood flow (CBF). We used propofol for hemodynamic stability and avoided hyperventilation so as to maintain CBF. We successfully managed the patient perioperatively.

Adult↗
PubMed1998

Interpleural misplacement of an epidural catheter.

We report a case of interpleural misplacement of an epidural catheter possibly caused by inappropriate angle of the Tuohy needle. A 71-year-old man was scheduled for left lower lobectomy of the lung with general and epidural anesthesia. A 18-gauge Tuohy needle was introduced into the Th5-Th6 interspace with a right paramedian approach. The direction of the epidural needle was at an angle of about 30 degrees from the skin directed cephalad. The needle was advanced 8 cm from the skin, where loss-of-resistance feeling was evident, and an epidural catheter was easily inserted 5 cm beyond the needle tip. Administration of 7 ml of 1.5% lidocaine given 20 minutes before skin incision did not alter arterial blood pressure or heart rate. Thoracotomy was performed via the fifth intercostal space. The surgeon then found the epidural catheter to be in the left pleural cavity. The catheter was immediately withdrawn. It is, therefore, necessary to employ the appropriate angle of the Tuohy needle on attempting epidural anesthesia to avoid the complication that we experienced.

Aged↗
PubMed1998

Stellate ganglion block does not change the tympanic membrane temperatures of either block or unblock sides in male volunteers.

STUDY OBJECTIVES: To test the effect of stellate ganglion block on tympanic membrane temperatures. DESIGN: Prospective, observational study. SETTING: Department of Anesthesia, Yamanashi Medical University, Yamanashi, Japan. SUBJECTS: 7 healthy male volunteers. INTERVENTIONS: Stellate ganglion block, 6 ml of 1% mepivacaine hydrochloride, was administered. MEASUREMENTS AND MAIN RESULTS: Application of temperature probes (right and left tympanic membranes, eight adhesive right skin-surface temperatures at the chest, upper arm, digital fingertip, lateral calf, thigh, and great toe) was followed by a 30-minute control period. Temperatures were recorded every 15 minutes for 30 minutes before stellate ganglion block and every 5 minutes for 40 minutes after the block. The right tympanic membrane temperature increased slightly but not significantly compared with the left tympanic membrane temperature 10 minutes after stellate ganglion block and subsequently. Right skin-surface temperature gradients at the upper limb decreased slightly but not significantly after stellate ganglion block. Similarly, right skin-surface temperature gradients at the lower limb decreased slightly but not significantly after stellate ganglion block. CONCLUSIONS: Stellate ganglion block does not change the tympanic membrane temperatures of either block or unblock sides.

Adult↗
PubMed1998

Helium gas microbubbles. Experimental study on a new ultrasound contrast material.

PURPOSE: To evaluate histological changes and duration of enhancement after the intra-arterial injection of helium gas microbubbles in comparison with conventionally used carbon dioxide (CO2) microbubbles at US. MATERIAL AND METHODS: Four different doses of helium gas microbubbles (0, 0.1, 0.2 and 0.5 ml/kg) mixed with normal saline and own blood were injected into the celiac artery of 8 rabbits. After one week, autopsies were performed on all animals and histological changes in the liver, stomach and spleen were studied on hematoxylin-eosin stains. In addition, VX-2 tumor strains were transplanted into the femoral muscle in 5 other rabbits. Four weeks after transplantation, we catheterized the femoral artery and either CO2 or helium gas microbubbles were injected under US observation. We evaluated the duration of enhancement in the tumors with the two types of microbubbles. RESULTS: On histological evaluation, damage in hepatic cells as well as multiple areas of gastritis in the stomach were seen when a dose of 0.5 ml/kg of helium gas was used. Damage in the liver and stomach was slight at a dose of 0.2 ml/kg. The spleen was not damaged at doses of under 0.5 ml/kg. In the evaluation of tumor enhancement, the duration of enhancement with helium gas microbubbles ranged from 28 to 45 min (average 36 min) while that with CO2 ranged from 4 to 12 min (average 9 min) (p<0.01 at paired t-test). CONCLUSION: Intra-arterial injection of helium gas should not exceed 0.2 ml/kg: a dose of 0.5 ml/kg may cause damage to the liver and stomach. The duration of enhancement with helium gas microbubbles is significantly longer than that with CO2 microbubbles.

Animals↗
PubMed1998

Thyroid hormone, all-trans retinoic acid, and 9-cis retinoic acid functioned as negative modulators of the effect of glucocorticoid on induction of alpha 1-acid glycoprotein mRNA in RLN-10 cells.

The expression of acute-phase protein genes is controlled by many factors, such as IL-1, IL-6, glucocorticoids, thyroid hormone (T3), and retinoic acids. We studied the interaction of T3, glucocorticoids, all-trans retinoic acid (RA), and 9-cis retinoic acid (9cRA) on the expression of the rat alpha 1-acid glycoprotein (AGP) gene in vitro. Dexamethasone (Dex) activated AGP gene expression in a rat liver derived cell line, RLN-10. Although T3, RA, and 9cRA by themselves had no effect on AGP production, they reduced the response to Dex of the AGP gene.

Alitretinoin↗
PubMed1998

Accuracy and precision of "deep sternal" and tracheal temperatures at high- and low-fresh-gas flows.

The accuracy of tracheal temperature as a measure of core temperature is relatively poor during high-flow ventilation (6 litre min-1 fresh-gas flow). It is unknown if accuracy improves when lower fresh-gas flow rates are used. We tested the hypothesis that tracheal temperature accuracy would improve with low-flow ventilation (1 litre min-1). We studied 20 ASA Physical Status I and II patients undergoing general anaesthesia for lower abdominal surgery. Deep body temperatures were measured at the middle of the sternum using a Coretemp "deep-tissue" thermometer. Tracheal temperatures were monitored from thermistors incorporated into the tracheal tube cuffs. Oesophageal temperatures were measured from thermocouples incorporated into stethoscopes positioned at the point of maximal heart sounds. Sternal temperature correlated reasonably well with distal oesophageal temperatures, both being within the 0.5 degree C cut-off for accuracy and precision. Tracheal temperatures were lower than oesophageal temperatures during both high- and low-flow ventilation. Tracheal temperatures were 0.7 degree C less during high-flow ventilation and 0.9 degree C less during low-flow ventilation. The precision in both cases was adequate. We conclude that tracheal temperatures were insufficiently accurate for routine clinical use, even when fresh- gas flow was restricted to 1 litre min-1. In contrast, the deep temperatures were sufficiently accurate and precise for routine clinical use.

Adult↗
PubMed1998

The effects of age and gender on the optimal premedication dose of intramuscular midazolam.

UNLABELLED: We conducted a double-blind study on the effects of age and gender on the optimal premedication dose of i.m. midazolam. We randomly divided 100 male and 100 female patients in each of three age groups: A = 20-39 yr, B = 40-59 yr, and C = 60-79 yr (total 600 patients) into five groups according to midazolam dosage: 0.04, 0.06, 0.08, 0.10, and 0.12 mg/kg. Midazolam was injected i.m. with atropine 0.01 mg/kg 15 min before the induction of anesthesia. Blood pressure (BP), heart rate, respiratory rate, oxygen saturation (SpO2), sedation level, tongue root depression, eyelash reflex, and anterograde amnesia were monitored. There were no significant differences between male and female patients in any variables in any age. Decrease of SpO2 and loss of eyelash reflex were seen with midazolam 0.10 mg/kg in Group A, and with 0.08 mg/kg in Group B. In Group C, decreases in BP and SpO2, loss of eyelash reflex, and depression of the tongue root were observed with midazolam 0.06 mg/kg. In conclusion, the optimal doses of i.m. midazolam administered 15 min before the induction of anesthesia in male or female patients were 0.08, 0.06, and 0.04 mg/kg for Groups A, B, and C, respectively. IMPLICATIONS: Midazolam is the most widely used preoperative anxiolytic drug. Our purpose was to evaluate the optimal dose of i.m. midazolam that would maximize the desired effects and minimize the side effects in a common clinical setting. Results indicate that age, but not gender, should affect the i.m. midazolam dose selected for premedication.

Adult↗
PubMed1998

Hypoxemia decreases the shivering threshold in rabbits anesthetized with 0.2 minimum alveolar anesthetic concentration isoflurane.

UNLABELLED: Shivering has been proposed as an etiology of postoperative hypoxemia. The difficulty with this theory is that hypoxemia inhibits shivering in unanesthetized cats, rats, and humans. However, anesthesia inhibits many protective reflexes, including the ventilatory response to hypoxemia. We therefore tested the hypothesis that arterial hypoxemia fails to inhibit shivering in lightly anesthetized rabbits. Rabbits were intubated and instrumented during exposure to surgical concentrations of anesthesia, and anesthesia was then maintained with 0.2 minimum alveolar anesthetic concentration isoflurane. The core was cooled at a rate of 2-3 degrees C/h by perfusing water at 10 degrees C through a colonic thermode. Core temperatures were recorded from the distal esophagus. Sustained, vigorous shivering was considered physiologically significant. The core temperature that triggering significant shivering identified the thermoregulatory threshold for this response. Arterial blood was sampled for gas analysis at the shivering threshold in each rabbit. Hypoxemia linearly reduced the shivering threshold from 36.7 degrees C at 130 mm Hg to 35.4 degrees C at 50 mm Hg (threshold = PaO2.0.019 + 34.3; r2 = 0.49). We failed to confirm our hypothesis: instead, even mild hypoxemia reduced the shivering threshold >1 C. A 1 C decrease in the shivering threshold is likely to prevent or stop most postoperative shivering because it exceeds the reduction produced by many effective anti-shivering drugs. These data do not support the theory that shivering causes postoperative hypoxemia. IMPLICATIONS: Shivering has been proposed as an etiology of postoperative hypoxemia. Our data, in contrast, show that mild hypoxemia inhibits shivering. Shivering is thus unlikely to be a cause of postoperative hypoxemia.

Anesthesia, Inhalation↗
PubMed1998

Tissue heat content and distribution during and after cardiopulmonary bypass at 31 degrees C and 27 degrees C.

BACKGROUND: Afterdrop following cardiopulmonary bypass results from redistribution of body heat to inadequately warmed peripheral tissues. However, the distribution of heat between the thermal compartments and the extent to which core-to-peripheral redistribution contributes to post-bypass hypothermia remains unknown. METHODS: Patients were cooled during cardiopulmonary bypass to nasopharyngeal temperatures near 31 degrees C (n=8) or 27 degrees C (n=8) and subsequently rewarmed by the bypass heat exchanger to approximately 37.5 degrees C. A nasopharyngeal probe evaluated core (trunk and head) temperature and heat content. Peripheral compartment (arm and leg) temperature and heat content were estimated using fourth-order regressions and integration over volume from 19 intramuscular needle thermocouples, 10 skin temperatures, and "deep" foot temperature. RESULTS: In the 31 degrees C group, the average peripheral tissue temperature decreased to 31.9+/-1.4 degrees C (means+/-SD) and subsequently increased to 34+/-1.4 degrees C at the end of bypass. The core-to-peripheral tissue temperature gradient was 3.5+/-1.8 degrees C at the end of rewarming, and the afterdrop was 1.5+/-0.4 degrees C. Total body heat content decreased 231+/-93 kcal. During pump rewarming, the peripheral heat content increased to 7+/-27 kcal below precooling values, whereas the core heat content increased to 94+/-33 kcal above precooling values. Body heat content at the end of rewarming was thus 87+/-42 kcal more than at the onset of cooling. In the 27 degrees C group, the average peripheral tissue temperature decreased to a minimum of 29.8 +/-1.7 degrees C and subsequently increased to 32.8+/-2.1 degrees C at the end of bypass. The core-to-peripheral tissue temperature gradient was 4.6+/-1.9 degrees C at the end of rewarming, and the afterdrop was 2.3+/-0.9 degrees C. Total body heat content decreased 419+/-49 kcal. During pump rewarming, core heat content increased to 66+/-23 kcal above precooling values, whereas peripheral heat content remained 70+/-42 kcal below precooling values. Body heat content at the end of rewarming was thus 4+/-52 kcal less than at the onset of cooling. CONCLUSIONS: Peripheral tissues failed to fully rewarm by the end of bypass in the patients in the 27 degrees C group, and the afterdrop was 2.3+/-0.9 degrees C. Peripheral tissues rewarmed better in the patients in the 31 degrees C group, and the afterdrop was only 1.5+/-0.4 degrees C.

Adult↗
PubMed1998

The accuracy and precision of four infrared aural canal thermometers during cardiac surgery.

BACKGROUND: Four infrared aural canal thermometers are currently available in Japan: Genius, Thermoscan, Quickthermo, and Thermopit. We therefore tested the hypothesis that each is sufficiently accurate and precise for clinical use. METHODS: For the purpose of this investigation, we considered accuracy to be the mean difference between the test thermometers and the reference thermocouple. Precision was considered to be the standard deviation of the difference between the test and reference values. We evaluated ten patients undergoing cardiopulmonary bypass with moderate hypothermia (approximately 30 degrees C). Aural canal temperatures were measured in random order with each infrared thermometer, and compared with readings from a thermocouple positioned at the contralateral tympanic membrane. RESULTS: Compared to the thermocouple, the Genius and Thermoscan both had regression slopes > 0.85 and correlation coefficients near 0.87; in contrast, slopes of the Quickthermo and Thermopit regressions were 0.68 and 0.53, respectively. The correlation coefficients for each were < 0.65. The accuracy (offset, or bias) was near 0 degree C with both the Genius and Thermoscan thermometers. In contrast, it was 1.1 degrees C with the Quickthermo and a full 2.3 degrees C with the Thermopit. The precision (standard deviation) of the measurements, however, was approximately 0.8 degree C in each case. CONCLUSION: We conclude that none of the tested aural canal infrared thermometers was sufficiently accurate and precise for perioperative use.

Aged↗
PubMed1998

The effects of transjugular intrahepatic portosystemic shunt on portal hypertensive gastropathy.

In addition to variceal bleeding, haematemesis may occur due to haemorrhagic gastritis in patients with portal hypertension. This has been known as portal hypertensive gastropathy (PHG). We have evaluated the effects of the transjugular intrahepatic portosystemic shunt (TIPS) on portal venous pressure (PVP) and endoscopic gastric mucosal changes observed in patients with portal hypertension. We performed TIPS in 12 patients with complications due to portal hypertension as follows: variceal bleeding in nine patients (bleeding from oesophageal varices in seven and gastric varices in two), refractory ascites in three and haemorrhage from severe PHG in one. Endoscopic examinations were performed before and after TIPS for all patients. Changes of PVP and gastric mucosal findings on endoscopy were analysed. Before TIPS, PHG was seen in 10 patients. Portal venous pressure decreased from an average of 25.1+/-8.8 to 17.1+/-6.2 mmHg after TIPS (P<0.005). On endoscopy, PHG improved in nine of 10 patients. Oesophagogastric varices improved in eight of 11 patients. In one patient with massive haematemesis, haemorrhage from severe PHG completely stopped after TIPS. Because TIPS effectively reduced PVP, this procedure appeared to be effective for the treatment of uncontrollable PHG.

Endoscopy, Gastrointestinal↗
PubMed1998

Sonographic comparison of intraarterial CO2 and helium microbubbles for detection of hepatocellular carcinoma: preliminary observations.

PURPOSE: To evaluate the usefulness of helium gas microbubbles in the detection of small hepatocellular carcinoma (HCC) lesions relative to that of CO2 microbubbles. MATERIALS AND METHODS: Ultrasonography (US) enhanced with both CO2 microbubbles and helium microbubbles was performed in 15 patients. CO2 microbubbles were injected into the proper hepatic artery under US observation. Next, helium microbubbles were injected. Duration and degree of enhancement with the two types of microbubbles were compared. Ten minutes after helium injection, the whole liver was examined with US to detect additional tumors. When new lesions were detected, biopsy was performed. RESULTS: Duration of enhancement with the helium microbubbles (mean, 37.2 minutes) was significantly longer than that with the CO2 microbubbles (mean, 3.6 minutes; P < .001). The degree of enhancement with helium was greater than that with CO2. Thirteen additional lesions were detected after injection of helium gas. All these lesions proved to be HCC at biopsy. CONCLUSION: The duration of enhancement is significantly longer with helium than with CO2 microbubbles. Therefore, helium microbubbles can be used for examination of the whole liver for detection of additional tumors.

Carbon Dioxide↗
PubMed1998

Gender difference in age-related changes in muscle sympathetic nerve activity in healthy subjects.

Muscle sympathetic nerve activity (MSNA) was measured directly along with blood pressure at rest in 69 healthy women (20-79 yr old) and 76 age-matched healthy men (16-80 yr old). All were nonobese and normotensive. In the women and men the MSNA was positively correlated with age (women: y = 0.788x - 5.418, r = 0.846, P < 0. 0001; men: y = 0.452x + 12.565, r = 0.751, P < 0.0001). The regression intercept of y was significantly lower (P < 0.0001) in the women than in the men, and the regression slope was significantly steeper (P < 0.0001) in the women. The MSNA was lower in women than in men among those <30 (P = 0.0012), 30-39 (P = 0. 0126), and 40-49 yr old (P = 0.0462) but was similar in women and men among those 50-59 (P = 0.1911, NS) and >/=60 yr old (P = 0.1739, NS). The results suggest that MSNA increases with age in women and men and that the activity is markedly lower in young women than in men but is markedly accelerated with age.

Adolescent↗
PubMed1998

CT appearance of hepatic tumors after microwave coagulation therapy.

OBJECTIVE: The purpose of this study was to evaluate the changes in treated lesions and surrounding parenchyma of the liver as well as associated findings on CT in patients who underwent microwave coagulation therapy for hepatic tumors. MATERIALS AND METHODS: We retrospectively reviewed the findings on helical dynamic CT scans obtained before and after percutaneous or intraoperative microwave coagulation therapy for 74 lesions in 63 patients with hepatocellular carcinoma or metastatic hepatic tumors. Indications for microwave coagulation therapy included primary hepatic tumors in 54 patients and hepatic metastasis in nine patients. Sixty percent nonionic contrast material, infused at 3 ml/sec, was followed by sequential arterial phase, portal venous phase, and equilibrium phase helical CT of the entire liver in all patients. RESULTS: All lesions were hypodense and extended to the liver capsule. The lesions treated with percutaneous microwave coagulation therapy were teardrop-shaped, whereas those treated with intraoperative microwave coagulation therapy were round. Peripheral enhancement was seen on contrast-enhanced CT in 93% of the treated lesions immediately after microwave coagulation therapy; however, such enhancement disappeared on follow-up CT. Hemorrhage within the lesions and pleural effusion were found in nine patients. Complications detected on CT included intratumoral abscess (n = 4), subcapsular hematoma (n = 2), tumor dissemination (n = 3), ascites (n = 5), and portal vein thrombosis (n = 1). CONCLUSION: CT of the liver in patients undergoing microwave coagulation therapy showed findings that were dependent on the technique of therapy. Thus, CT scans must be carefully analyzed to avoid confusing results of therapy with findings that indicate complications requiring further treatment.

Aged↗
PubMed1998

[PARAGRAPH as a neuromuscular blockade monitor].

To assess the clinical performance of a new neuromuscular blockade monitor "PARAGRAPH", we studied adults and pediatric patients during general anesthesia. PARAGRAPH enables anesthesiologists to perform various types of assessment of neuromuscular blockade, including TOF, DBS and single twitch even with children. The most remarkable point is its capability for analysis and printing by personal computer. We conclude this device is portable and easy to use, as well as a clinically reliable neuromuscular blockade monitor.

Adult↗
PubMed1998

[Comparative effect of tranexamic acid on the reduction of bleeding during and after cardiac surgery].

The administration of tranexamic acid (TA), an antifibrinolytic agent, prior to cardiopulmonary bypass (CPB) has been reported to reduce bleeding after cardiac surgery. In a retrospective clinical trial, 99 adults patients undergoing open heart surgery received TA (CABG, TA (+): n = 20; Valve replacement, TA (+): n = 20) or did not receive TA (CABG, TA (-): n = 20: Valve replacement, TA (-): n = 19). In the TA group, just after induction of general anesthesia, a 160 mg.kg-1 dose of TA was administered intravenously. In each group, bleeding volumes during operation, and at 6 and 24 hours after operation, were compared. Patients of [CABG, TA (+)] group had significantly less intraoperative and total blood loss [total blood loss 608 g : 313 g, intraoperatively, 134 g at 6 hours, and 296 g at 24 hours] compared with [CABG, TA (-)] group (total blood loss 1043 g: 640 g, intraoperatively, 232 g at 6 hours, and 403 g at 24 hours). Additionally, in patients of Valve replacement, TA (+) group had less but not significant total blood loss (total blood loss 903 g: 523 g, intraoperatively, 173 g at 6 hours, and 380 g at 24 hours) compared with TA (-) group (total blood loss 1237 g: 863 g, intraoperatively, 214 g at 6 hours, and 374 g at 24 hours). TA administered prior to CPB may reduce the amount of bleeding during and after cardiac surgery.

Adult↗
PubMed1998

[A case of air embolism during tubal insufflation].

Air embolism occurred immediately after tubal insufflation in a 40-yr-old female patient following abdominal total hysterectomy under general anesthesia. Abrupt decreases in Etco2, Spo2, and blood pressure were observed. Blood gas analysis revealed a marked difference between PaCO2 and EtCO2. The patient recovered soon and was extubated in the operating room. The post operative course was uneventful. Monitoring of EtCO2 was effective for early detection of air embolism.

Adult↗