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Biomedical subjects

T Yukioka

Publications and source records attributed to T Yukioka.

35 records · Page 2Linked to original sources
PubMed1995

Effect of mild hypothermia on the coefficient of oxygen delivery in hypoxemic dogs.

Hypothermia is one of therapeutic options in patients with severe acute respiratory failure. This study was designed to determine the optimum core temperature during hypoxemia by analyzing oxygen delivery (DO2) and consumption (VO2). Six dogs were ventilated using a mixed gas of N2 and air (fractional concn of O2 in inspired gas = 0.12) with total muscle relaxation under general anesthesia. Hypoxia (arterial PO2 approximately 35 Torr) was maintained during the experimental period. The core temperature was reduced progressively from 37 to 30 degrees C by surface cooling. The coefficient of oxygen delivery was defined as DO2 divided by VO2. In each animal, the DO2/VO2 was calculated by altering the core temperature by 1 degrees C, and its relative value was a third-order polynomial function of core temperature having a maximum value at a core temperature of 32.1 +/- 0.46 degrees C. At a core temperature of 32 degrees C, the blood lactate level was significantly lower than that at a core temperature of 37 degrees C (6.3 +/- 1.3 vs. 12.2 +/- 1.6 mg/dl; P < 0.05). The relative value of the DO2/VO2 was highest with limited lactate elevation at a core temperature approximately 32 degrees C. Under the condition of hypoxia, mild hypothermia approximately 32 degrees C may be optimal to improve oxygen demand-supply balance.

Animals↗
PubMed1991

Fluid distribution and pulmonary dysfunction following burn shock.

Respiratory function and body fluid changes were measured in 46 burned patients for up to 7 days postburn (DPB). The patients in this prospective study were divided into an HLS group [n = 17, burn size 61 +/- 0.5% BSA (mean +/- SEM), resuscitated with hypertonic lactated saline] and an iso-Na group (n = 29, burn size 60 +/- 4.5% BSA, resuscitated with lactated Ringer's solution). During DPB 3 to 5, the Respiratory Index (A-aDO2/PaO2), functional extracellular fluid volume (f-ECFV), an ratio of plasma volume to interstitial fluid volume (PV/ISFV) were increased in the iso-Na group compared with the HLS group. During the same period, the Respiratory Index and PV/ISFV correlated significantly; respiratory dysfunction was less in the HLS group. Nearly 50% of the iso-Na group required endotracheal intubation. Sodium loads were the same in both groups; the HLS group required less water. These results suggest that extracellular fluid distribution differs between the two treatments; HLS may be associated with ameliorated respiratory function not only because of less volume loading during resuscitation, but also because the PV/ISFV ratio is less than when lactated Ringer's is administered.

Adult↗
PubMed1987

A dose-responsive model of smoke inhalation injury. Severity-related alteration in cardiopulmonary function.

The dose responsiveness of selected physiologic indices was studied in a sheep model of smoke inhalation injury. In this model, graded severity of injury was achieved by changing the contact time with smoke (defined by "unit"), whereas other variables were kept constant. Blood gas and cardiopulmonary indices were measured in 70 sheep, including 12 controls, either 24 or 72 hours after exposure to 3, 6, 9, 12, 15, or 18 units of smoke. A 12-unit dose of smoke was fatal within 72 hours and an 18-unit dose was fatal within 24 hours. The best correlation between smoke dose and response was observed in arterial oxygen tension 24 hours after exposure. At 24 hours, most of the cardiopulmonary indices showed significant change only after a 12-unit exposure. Although the exact shape of the dose-response curve could not be defined, sigmoid or curved linear shape was suggested, reflecting the progressive deterioration.

Animals↗
PubMed1986

Evaluation of (1-sarcosine, 8-isoleucine) angiotensin II as a therapeutic agent for oleic acid-induced pulmonary edema.

(1-Sarcosine, 8-isoleucine) angiotensin II was assessed as a therapeutic agent for acute respiratory distress syndrome with oleic acid pulmonary edema in sheep used as an experimental model. Under general anesthesia with controlled mechanical ventilation with 100% oxygen, 32 sheep received oleic acid (0.075 ml/kg) intravenously. After oleic acid infusion, 20 animals were treated with continuous intravenous infusion of the angiotensin II analogue; nine received 300 ng/kg/min, six received 600 ng/kg/min, and five received 2000 ng/kg/min. Cardiopulmonary measurements were repeated every 30 minutes for 270 minutes. According to time-integrated PaO2, six of 15 animals of the groups given 300 and 600 ng/kg/min (43%) did not respond to the treatment. All animals responded in the group given 2000 ng/kg/min. Animals in the latter group had lower Qs/Qt, PaCO2, and airway resistance than had the control animals. Elevation of pulmonary vascular resistance was limited and mean arterial blood pressure was well maintained. These results reveal that (1-Sar, 8-Ile) angiotensin II is effective in the treatment of oleic acid-induced pulmonary edema.

1-Sarcosine-8-Isoleucine Angiotensin II↗
PubMed1985

[Chloride and lactate composition of hypertonic sodium solution for fluid resuscitation of burn injury].

This study was performed to determine the appropriate anion composition of hypertonic sodium solution for fluid therapy of severely burned patients. Two different solutions with equal sodium concentration (Na 300 mEq/1) were prepared. The first one, low chloride solution (C1 88 mEq/1), was used for ten patients (group I); the second, high chloride solution (C1 244 mEq/1), for other ten patients (group II). Two groups had the same severity of burn injury. The infusion rate was controlled to achieve an adequate urine output (1.0 ml/kg/hour). The observation period was eight hours after injury and water and sodium intake and renal function were measured. Ccr and FENa were identical in two groups. Although both had same urine output, CH2O of group I increased. Water and sodium intake of group I were lower than those of group II. Water diuresis was related with limited chloride intake in group I and this suggested the relation between urine concentration and chloride loading in kidney. conclusively, hypertonic sodium solution with low chloride concentration requires less volume for resuscitation and may be preferred to high chloride solution in the initial therapy of burn injury.

Acid-Base Equilibrium↗
PubMed1983

Computed tomography for diagnosis and assessment of cerebral fat embolism.

A patient with cerebral fat embolism was followed by computed tomography (CT). For the first few days after injury, CT revealed no abnormality. About a week later, multiple low density areas appeared in the white matter of the frontal region. They disappeared within the subsequent 2 weeks while subdural effusions developed in the fronto-parieto-temporal regions. As neurologic recovery progressed, the subdural effusions gradually diminished and cerebral atrophy was seen.

Adolescent↗
PubMedDate not supplied

Delayed hemorrhage following transcatheter arterial embolization for blunt hepatic injury.

This is the first report of delayed hemorrhage (21 days after the injury) following transcatheter arterial embolization (TAE) for severe hepatic injury. The first TAE was performed about 2 h after admission on a 21-year-old man with severe blunt hepatic injury. Three bilomas were detected by cholescintigraphy 19 days later. The patient's status had been eventless until the occurrence of a delayed hemorrhage with hypotension. Angiography was repeated and three pseudoaneurysms were detected in the same areas as the bilomas. With repeated TAE, pseudoaneurysms disappeared and hemorrhage could be controlled. Intrahepatic biloma may be related to pseudoaneurysms and delayed hemorrhage in severe hepatic injury.

Adult↗
PubMedDate not supplied

A new surgical procedure for aged burn victims: applications of dermolipectomy for burn wounds and donor sites.

A new surgical method for use on both burn wounds and donor sites of elderly patients with burns is presented. This procedure is based on dermolipectomy. During the period from January 1985 to December 1988, 20 operations were performed on 18 patients. This procedure was applied to 39 donor sites and to four burn wound sites. The most common donor site was the lateral trunk. There was only one postoperative death. Actual survival rates and predicted survival rates were compared, and in those patients with burns over 21% to 40% of total body surface area actual survival rates were better than the predicted rates.

Aged↗
PubMedDate not supplied

Comparison of hemodynamic changes resulting from toxic shock syndrome toxin-1-producing Staphylococcus aureus sepsis and endotoxin-producing gram-negative rod sepsis in patients with severe burns.

Five patients with burns and toxic shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus sepsis (TSS group) were treated in a 5-year period at Kyorin University Hospital's Traumatology and Critical Care Center Burn Unit. Hemodynamic and metabolic differences in these patients were compared retrospectively with those in another five patients who were matched by burn index and age and in whom endotoxin-producing gram-negative rod sepsis developed (End group). Both groups showed hypermetabolic and hyperdynamic changes at the point sepsis developed. There were no significant differences between the two groups in any parameter. At the point septic shock developed, the TSS group showed significantly lower mean (+/- SD) arterial pressure (TSS vs End group, 64 +/- 5 vs 74 +/- 5 mm Hg; p < 0.05), significantly lower systemic vascular resistance index (TSS vs End group, 579 +/- 62 vs 729 +/- 75 dynes.sec.cm-5/m2; p < 0.05), and higher oxygen consumption (TSS vs End group, 190 +/- 7 vs 163 +/- 11 L/min/m2; p < 0.05) compared with the End group. This is the first clinical report that asserts that TSST-1-producing gram-positive sepsis may result in more hypermetabolic and hyperdynamic differences than does endotoxin-producing gram-negative rod septic shock. These responses may indicate a stronger stimulation of cytokine and nitrous oxide synthetic activity by TSST-1 than by endotoxin.

Adult↗
PubMedDate not supplied

Mild hypotension and body burns synergistically increase bacterial translocation in rats consistent with a "two-hit phenomenon".

Wistar rats were burned over 15% of their total body surface area and suffered hemorrhagic hypotension (mean blood pressure 80 mm Hg) 72 hours after the thermal injury (burn + hypotension group). Rats in other groups were treated in the same way except sham hypotension in burn group, sham burn in hypotension group, and sham hypotension and sham burn in control group. At the end of the study period, the mesenteric lymph nodes (MLN), liver, and spleen were cultured for translocated bacteria. The cecal bacterial burden was not affected by the insults. The number of bacteria translocated to the MLN after the thermal injury was much greater in the burn + hypotension group (156.19 +/- 42.29 colony-forming units [CFUs]/gm tissue) rather than in the other groups (5.24 +/- 8.34, 9.86 +/- 16.56, 40.21 +/- 45.8 in the control, hypotension, and burn groups, respectively). This indicates that bacterial translocation (BT) is the result of a two-hit phenomenon. The gut-MLN BT ratio, obtained by dividing the bacterial CFUs in the MLN by those in the cecum, was higher in the burn + hypotension group than in the other groups (p < 0.01). This ratio allows standardized measurements of BT to the MLN despite differences in the absolute bacterial load in the gut, and the elevated gut mesenteric lymph nodes BT ratio of the burn + hypotension group suggests that the two-hit phenomenon of BT may be the result of alterations in the gut mucosal barrier function.

Animals↗
PubMedDate not supplied

Efficacy of endoscopic hemoclipping for GI bleeding in relation to severity of shock.

BACKGROUND/AIMS: To examine the efficacy of prospectively performing endoscopic hemoclipping in patients with severe gastrointestinal bleeding by assessing in relation to the severity of the case. METHODOLOGY: Endoscopic hemoclipping was performed in 44 patients in shock caused by severe gastrointestinal bleeding. The level of severity was categorized using two factors. One factor was the presence or absence of severe shock, and the other was the presence or absence of active bleeding at endoscopy. Age, blood transfusion volume, APACHE III score, coagulopathy, initial hemostatic, rebleeding and mortality rate were recorded in relation to those four subsets. If rebleeding occurred, the systolic blood pressure, heart rate and serum hemoglobin concentration were compared between the initial time of bleeding and rebleeding. RESULTS: Initial hemostasis was successfully achieved in all cases. The severe shock group required significantly more blood transfusions. The most severe subset had the highest APACHE III score, and coagulopathy. Rebleeding occurred in seven cases in the severe shock group only. In the rebleeding group, the systolic body pressure was lower, heart rate was higher, and serum hemoglobin concentration was lower than the non-rebleeding group. Four patients, all in subset 1, died, but no patient died due to gastrointestinal bleeding. CONCLUSIONS: The endoscopic hemoclipping method is very effective for severe gastrointestinal bleeding in shock. The severity of shock was a more important risk factor than the presence of active bleeding. Our category of severity is simple, it reflects the patients' clinical condition accurately, and is very useful for patients with gastrointestinal bleeding.

APACHE↗
PubMedDate not supplied

(1-Sar, 8-Ile) angiotensin II in the treatment of inhalation injury: a pilot study.

The patients were three men and two women with moderate to severe inhalation injury. Each patient received immediate fluid therapy and all required intubation for respiratory management. At some time between 24 and 72 hours after the injury, the synthetic angiotensin analogue (1-Sar, 8-Ile) angiotensin II was infused at a rate of 100 ng/kg/min for 10 minutes, 200 ng/kg/min for another 10 minutes, and 300 ng/kg/min for 30 minutes. The mean (+/- SD) PaO2 increased from 80.8 +/- 26.9 mmHg before to 89.8 +/- 27.3 mmHg after the infusion (P < 0.05) and the PaCO2 decreased from 42.4 +/- 8.3 to 39.6 +/- 7.9 mmHg (P < 0.05). A transient pressor response was noted in all patients. The results suggest that this angiotensin II analogue may be of benefit in the treatment of inhalation injury and other types of acute lung injury.

1-Sarcosine-8-Isoleucine Angiotensin II↗