Absence of reflex tachycardia after spinal anesthesia in the elderly.
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Aged↗
Biomedical subjects
T Nishikawa
Publications and source records attributed to T Nishikawa.
The recovery profile of baroreflex control of heart rate after isoflurane or sevoflurane anesthesia in humans.
UNLABELLED: Volatile anesthetics attenuate baroreflex function in a concentration-dependent manner. This study was designed to determine how long full recovery of baroreflex control of heart rate takes after isoflurane or sevoflurane anesthesia in healthy volunteers. We assessed baroreflex sensitivity in 20 subjects randomized to receive either isoflurane or sevoflurane (n = 10 each). After an 8- to 10-h fast and no premedication, mea- surements of R-R intervals obtained from the electrocardiogram (lead II) and systolic blood pressure (SBP) measured through a radial artery catheter were made at conscious baseline and 20, 60, and 120 min after the induction during end-tidal isoflurane 1.3% or sevoflurane 2.0% in air and oxygen, and 20, 60, 120, and 180 min after the emergence from general anesthesia. Baroreflex responses were triggered by bolus IV injection of phenylephrine and nitroprusside to increase and decrease SBP by 15-30 mm Hg, respectively. The linear portions of the baroreflex curves relating R-R intervals and SBP were determined to obtain baroreflex sensitivity. During anesthesia, baroreflex sensitivities of both the pressor and depressor tests were decreased by 50%-60% compared with conscious baseline values in both groups (P <0.05). Pressor test sensitivities returned to the baseline values at 120 min, whereas depressor test sensitivities returned to the baseline values at 60 min, after general anesthesia in both groups. There were no significant differences in baroreflex sensitivities between groups at any interval. Our results indicate that the recovery characteristics of baroreflex sensitivity are similar after isoflurane and sevoflurane anesthesia and that the depressor test sensitivity is restored more rapidly than the pressor test sensitivity after both anesthetic techniques. IMPLICATIONS: Arterial baroreflex function is an important neural control system for maintaining cardiovascular stability. The authors found that 2 h was required for full recovery of baroreflex function and that recovery characteristics were similar after isoflurane and sevoflurane anesthesia in healthy volunteers not undergoing surgery.
Adult↗
T-wave amplitude as an indicator for detecting intravascular injection of epinephrine test dose in awake and anesthetized elderly patients.
UNLABELLED: Aging is associated with reduced heart rate (HR) responsiveness to a simulated IV test dose containing epinephrine. We tested the hypothesis that a more contemporary T-wave criterion (positive if there was a > or = 25% decrease in T-wave amplitude) was applicable in both awake and anesthetized older patients. Sixteen healthy patients > or = 65 yr old first received 3 mL of normal saline IV, followed 4 min later by 1.5% lidocaine 3 mL containing 15 microg epinephrine (1:200,000) IV in the supine position when awake, and they were anesthetized with stable 2% end-tidal sevoflurane and 67% nitrous oxide. HR, systolic blood pressure (SBP) determined invasively, and lead II of the electrocardiogram were continuously recorded for 4 min after the IV injections of saline and the test dose. A sensitivity of 88% and a negative predictive value of 89% were obtained in awake patients on the basis of the conventional HR criterion (positive if there was a > or = 20 bpm increase), whereas a sensitivity of 81% and a negative predictive value of 84% were obtained during sevoflurane anesthesia on the basis of the modified HR criterion (positive if there was a > or = 10 bpm increase). However, sensitivities, specificities, and positive and negative predictive values were all 100% on the basis of the SBP (positive if a > or = 15 mm Hg increase was recorded with an arterial line) and the T-wave criteria for both awake and anesthetized conditions. These results suggest that the SBP and T-wave criteria should be applied in awake and anesthetized elderly patients for detecting accidental intravascular injection of the epinephrine-containing test dose. IMPLICATIONS: To determine whether an epidural catheter is in a blood vessel, an epidural test dose containing 15 microg epinephrine is often used. We found that an increase in systolic blood pressure and a decrease in T-wave amplitude, but not an increase in heart rate, seem to be reliable indicators for detecting accidental intravascular injection in both awake and sevoflurane-anesthetized patients > or = 65 yr old.
Age Factors↗
Rectal S(+)-ketamine for pediatric premedication.
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Administration, Rectal↗
The efficacy of simulated intravascular test dose in sedated patients.
UNLABELLED: Sedation usually decreases the reliability of subjectively detecting an intravascular test dose, but the efficacies of objective hemodynamic and T-wave criteria remain undetermined. Sixty healthy patients were randomly assigned to receive IV midazolam in 1-mg increments until they were lightly sedated, fentanyl 2 microg/kg followed by incremental midazolam until they were similarly sedated, or no sedative (n = 20 each). Then, normal saline 3 mL was administered IV, followed 4 min later by 1.5% lidocaine 3 mL plus epinephrine 15 microg (1:200,000) in all subjects. Heart rate (HR), systolic blood pressure (SBP) measured by a radial arterial catheter, and lead II of the electrocardiogram were continuously recorded for 4 min after the saline and test dose injections. An IV test dose produced significant increases in HR and SBP and decreases in T-wave amplitude in all subjects. However, the mean maximum increase in HR in patients sedated with midazolam plus fentanyl (31 +/- 14 bpm [mean +/- SD]) was significantly less than in those administered midazolam alone or no sedative (42 +/- 12 and 44 +/- 10 bpm, respectively; P < 0.05). A sensitivity of 100% was obtained on the basis of the traditional HR criterion (positive if > or =20 bpm increase) in patients sedated with midazolam or no sedative, but it was 70% in those with midazolam plus fentanyl (P < 0.05 versus the other two groups). Irrespective of the treatment, sensitivities and specificities of 100% were obtained according to the SBP (positive if > or =15 mm Hg increase) and T-wave (positive if > or =25% decrease in amplitude) criteria. An increase in SBP and a decrease in T-wave amplitude are more reliable than an HR response for detecting accidental intravascular injection of the epinephrine-containing test dose in subjects sedated with midazolam and fentanyl. IMPLICATIONS: To determine whether an epidural catheter is in a blood vessel, an epidural test dose containing 15 microg epinephrine is used. We found that an increase in systolic blood pressure and a decrease in T-wave amplitude seem to be more reliable than a heart rate change for detecting inadvertent intravascular injection of an epinephrine-containing test dose in patients sedated with midazolam and fentanyl.
Adult↗
Decrease in T-wave amplitude without hemodynamic changes after intravascular injection of an epinephrine test dose.
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Aged↗
Moderate hypothermia depresses arterial baroreflex control of heart rate during, and delays its recovery after, general anesthesia in humans.
BACKGROUND: Effects of hypothermia on arterial baroreflex function during, and on its recovery after, general anesthesia were examined in humans. METHODS: Twenty healthy volunteers were randomly assigned to a normothermic group (n = 10 each, active forced-air warming) or to a hypothermic group (no active warming) during anesthesia. Measurements of R-R intervals and systolic blood pressure were made at conscious baseline and at 20, 60, and 120 min after the induction and 20, 60, 120, and 180 min after emergence from general anesthesia with sevoflurane for 2 h. Ventilation was mechanically controlled, and end-tidal sevoflurane concentration was maintained at 2% during anesthesia. Baroreflex responses were triggered by bolus intravenous injections of phenylephrine and nitroprusside. The linear portions of the baroreflex curves relating R-R intervals and systolic blood pressure were determined to obtain baroslopes. RESULTS: During anesthesia, the mean lowest tympanic temperature of the hypothermia group (33.9+/-0.5 degrees C [mean +/- SD]) was significantly lower than that of the normothermia group (36.1+/-0.7 degrees C, P < 0.001). The baroslopes of the pressor and depressor tests were decreased by 19-39% during and by 27-53% after general anesthesia in the hypothermia group, compared with the normothermia group (P < 0.05). The baroslopes of the normothermia group returned to the baseline values at 60 min after anesthesia, whereas the pressor test sensitivity of the hypothermia group was significantly less than that of the normothermia group for the entire course of recovery. CONCLUSIONS: The results indicate that moderate hypothermia enhances anesthesia-induced depression of baroreflex function in anesthetized humans and delays its recovery after general anesthesia.
Adult↗
Synchronous double cancer of the stomach and rectum with situs inversus totalis and polysplenia syndrome.
Situs solitus refers to the normal arrangement of body organs. Situs inversus totalis is a complete mirror image or reverse isomeric form of the thoracic and abdominal viscera. Any arrangement of organs between these two extremes is designated by heterotaxia. Several patterns of vascular and visceral abnormalities are associated with heterotaxia, and two loosely defined syndromes of splenic anomalies (asplenia and polysplenia) are most common. We present the case of a 71-year-old woman with situs inversus totalis and polysplenia syndrome who developed synchronous double cancer originating from the stomach and rectum. Abdominal manifestations were situs inversus totalis combined with multiple lobulated spleen, azygous continuation of the interrupted inferior vena cava, direct drainage of hepatic vein to left atrium, preduodenal portal vein, short pancreas, incomplete rotation of the colon, and malrotation of the intestine. Histologically, gastric cancer was diagnosed as papillary adenocarcinoma and rectal cancer, as moderately differentiated adenocarcinoma. The patient was successfully treated with total gastrectomy for gastric cancer and low-anterior resection of the rectum for rectal cancer.
Adenocarcinoma↗
Ulnar bursa distention following volar subluxation of the distal radioulnar joint after distal radial fracture: a rare cause of carpal tunnel syndrome.
This report describes an eighty-four-year-old woman with persistent carpal tunnel syndrome attributable to an ulnar bursa distention associated with the subluxation of the distal radioulnar joint after distal radial fracture. During surgery, when the forearm was placed in supination, the ulna head with a sharp osteophyte was found to be displaced into the carpal tunnel through a defect of the ruptured capsule of the wrist joint. This volar subluxation of the ulnar head had caused distention of the ulnar bursa, causing compression of the median nerve, which resulted in carpal tunnel syndrome. In addition to reduce displaced fractured segment to obtain anatomic articular surface, original radial length and tilt, the anatomic restoration of the distal radioulnar joint is essential to maintain better long-term function after fracture of the distal radius.
Accidental Falls↗
Conflict of intentions due to callosal disconnection.
OBJECTIVES: Three patients with callosal syndrome manifested a peculiar symptom in that they were unable to perform intended whole body actions because another intention emerged in competition with the original one. Attempts were made to clarify the symptomatology of this manifestation and its possible mechanism is discussed. METHODS: The three patients are described and previous reports on patients with callosal damage were reviewed. Four additional patients with similar symptoms were found and the clinical features common to all seven patients were examined. RESULTS: This symptom could not be attributed to unilateral movement disorders such as unilateral apraxia, intermanual conflict, or compulsive manipulation of tools. The manifestations included marked hesitation in initiating actions, interruption of actions, repetitive actions, and performance of unintended actions with difficulty in correcting them. All patients, except one, had a lesion in the posterior half of the body of the corpus callosum, and there was no significant involvement of the cerebral cortex. The symptom became manifest later than 4 weeks after callosal damage. It occurred during spontaneous actions, but not during well automated actions nor when following instructions. CONCLUSION: This symptom, tentatively named "conflict of intentions", can be regarded as a fragment of diagonistic dyspraxia originally described by Akelaitis, although it can occur independently of intermanual conflict. Normally, the right and left cerebral hemispheres may be complementarily modifying automated whole body actions in order to adapt behaviour to changes of the environment as well as to the intention. Partial callosal disconnection without significant cortical involvement would exaggerate the disparity between the role of each hemisphere through the reorganisation of neural systems after callosal damage. Such double, often contrary, behavioural tendencies may sometimes simultaneously enter the patient's awareness.
Adult↗
A Case of pemphigus foliaceus which occurred after five years of remission from pemphigus vulgaris.
A 77-year-old Japanese female developed pemphigus foliaceus (PF) after 5 years of remission from pemphigus vulgaris (PV). The patient had painful erosions in her mouth and flaccid blisters of the skin and was diagnosed as having PV, which responded well to corticosteroid treatment. She was then free from any lesion of PV for 5 years with a low dose of corticosteroid. Then she developed scaly erythematous lesions on the skin and was diagnosed as suffering from PF. Enzyme-linked immunosorbent assay (ELISA) using recombinant desmoglein 1 (Dsg-1) and Dsg-3 revealed that she had anti-Dsg-3 IgG in the PV stage, no antibodies during remission and anti-Dsg-1 IgG in the PF stage. These findings indicate that the target antigen was shifted from Dsg-3 to Dsg-1 along with the phenotype after a 5-year interval in this patient.
Adrenal Cortex Hormones↗
Somatic mutations of the MEN1 gene and microsatellite instability in a case of tertiary hyperparathyroidism occurring during high phosphate therapy for acquired, hypophosphatemic osteomalacia.
Somatic mutations of the MEN type 1 (MEN1) gene were recently shown to be responsible for tumorigenesis in 13-26% of sporadic, nonfamilial primary hyperparathyroidism. However, it is unknown whether these mutations are also involved in tumorigenesis of parathyroid glands occurring during high phosphate therapy for hypophosphatemic rickets or osteomalacia. A male patient with adult-onset, hypophosphatemic osteomalacia had been treated with 1alpha-OHD3 and oral phosphate for 13 yr when tertiary hyperparathyroidism developed. After total resection of four enlarged parathyroid glands and autotransplantation of a hyperplastic gland, the patient has continued to do well for the last 2 yr. Sequence analysis of the coding exons of MEN1 gene revealed a 36-bp deletion with a 2-bp insertion (exon 2) in the right upper parathyroid gland accompanied with loss of heterozygosity at 11q13 locus and a heterozygous mutation of 2-bp deletion (AG) in exon 10 in the right lower gland, in which microsatellite instability was also found. No MEN1 gene mutation was detected in the other two hyperplastic parathyroid glands or in the peripheral blood. These findings indicate that MEN1 gene mutations contributed to tumorigenesis of the right upper parathyroid gland in this case of phosphate-induced tertiary hyperparathyroidism. Very recently a bone tumor was found in the right femoral neck, and the tumor (chondroblastoma) was resected.
Adult↗
Protective effect of ajoene on acetaminophen-induced hepatic injury in mice.
Ajoene, a garlic-derived sulfur-containing compound, exhibited a hepatoprotective effect against acetaminophen-induced liver injury in mice. A pretreatment with ajoene suppressed the rise in serum glutamic-pyruvic transaminase activity and the reduction in the hepatic reduced glutathione level. These effects of ajoene were observed dose-dependently (20-100 mg/kg). The pretreatment by ajoene also suppressed the decrease in hepatic protein thiol content resulting from acetaminophen administration.
Acetaminophen↗
Ectopic adrenocorticotropin syndrome exhibiting paradoxical adrenocorticotropin responsiveness to gonadotropin-releasing hormone.
In a 37-year-old man who had Cushing's syndrome, investigations, including overnight dexamethasone suppression test, corticotropin-releasing hormone (CRH) test, pituitary MRI and inferior petrosal sinus sampling suggested the presence of ectopic adrenocorticotropin (ACTH) production. Interestingly, gonadotropin-releasing hormone (GnRH) increased plasma ACTH from 73 pg/ml to 708 pg/ml at 15 min. Furthermore, desmopressin also increased plasma ACTH whereas CRH and thyrotropin-releasing hormone (TRH) had no effect. Such paradoxical responses of plasma ACTH were observed repeatedly. A thoracic CT scan revealed a right anterior mediastinal mass, which was surgically resected. Histological and immunohistochemical examination confirmed that the tumor was an ACTH-producing carcinoid. ACTH and cortisol decreased immediately following surgery. Neither desmopressin nor GnRH administration resulted in elevation of plasma ACTH while ACTH-responsiveness to dexamethasone and CRH was restored. To our knowledge, this is the first report documenting GnRH responsiveness in ectopic ACTH syndrome.
ACTH Syndrome, Ectopic↗
Homology study of two polyhydroxyalkanoate (PHA) synthases from Pseudomonas aureofaciens.
Recently, we have cloned and analyzed two polyhydroxyalkanoate (PHA) synthase genes (phaC1 and phaC2 in the pha cluster) from Pseudomonas aureofaciens. In this report, the deduced amino acid (AA) sequences of PHA synthase 1 and PHA synthase 2 from P. aureofaciens are compared with those from three other bacterial strains (Pseudomonas sp. 61-3, P. oleovorans and P. aeruginosa) containing the homologous pha cluster. The level of homology of either PHA synthase 1 or PHA synthase 2 was high with each enzyme from these three bacterial strains. Furthermore, multialignment of PHA synthase AA sequences implied that both enzymes of PHA synthase 1 and PHA synthase 2 were highly conserved in the four strains including P. aureofaciens.
Acyltransferases↗
Genotypes at SAA1 locus correlate with the clinical severity of AA-amyloidosis.
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Adult↗
[A case of trichophytia profunda acuta of the glabrous skin].
We report the case of a 68-year-old man with eruption on his left arm in the lesion where he wore his wrist watch. He was treated with topical steroid ointment at another clinic. He also suffered from tinea pedis. Examination of the scale and hair showed hyphal elements. Histopathological examination revealed granulomatous reaction around the hair follicles. We found no fungal elements in the tissue in spite of detecting serial sections of them. Trichophyton rubrum was cultured from tissue and scale, and the case was diagnosed as Trichophytia profunda acuta of the glabrous skin. Spontaneous remission was shown only by topical treatment for tinea pedis. A therapy of "wait and see" may be one choice.
Aged↗
[One-week application of terbinafine cream compared with four-week application in treatment of Tinea pedis].
The possibility of one-week application of terbinafine cream for tinea pedis was studied in a double-blind test at four institutes, comparing four-week application as a control. Of a total of forty-three patients studied, nineteen were randomized into a four-week application group, Group I, and twenty into a one-week application group, Group II. Group I was evaluated as moderate to extremely useful in twelve (63.2%) of the nineteen patients and Group II in twelve (60.0%) of the twenty patients. No statistical differences were observed between two groups. These findings appeared to indicate that the short term, one-week application of terbinafine cream had results equivalent to the four-week application. This short-term treatment which aids in improving patient compliance and reducing the total amount of drug applied, thus lowering drug cost, is viewed as a useful way of treating tinea pedis.
Administration, Cutaneous↗