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Biomedical subjects

Y Kosaka

Publications and source records attributed to Y Kosaka.

At least 109 records · Page 6Linked to original sources
PubMed1995

Interaction of extradural morphine and lignocaine on ventilatory response.

We have evaluated the effects of lumbar extradural morphine and lignocaine on the ventilatory response to carbon dioxide. Twenty-four female patients were allocated randomly to receive extradural morphine 2 mg (group M), 2% lignocaine 10 ml (group L) or a combination of morphine 2 mg and 2% lignocaine 10 ml (group ML). On the day before surgery, resting ventilatory values including minute volume (VE) and tidal volume (VT), and ventilatory response to progressive hyperoxic hypercapnia (VE/PE'CO2) were measured. On the day of surgery, the same measurements were repeated 30 min after extradural injection. Ventilatory values at rest were not altered after extradural injection. Mean VE/PE'CO2 decreased significantly after extradural morphine (P = 0.002) and increased (P = 0.011) after extradural lignocaine. Mean VE 7.3 (VE at PE'CO2 7.3 kPa) decreased significantly after extradural morphine (P < 0.001) and increased after extradural lignocaine (P = 0.047). Extradural morphine and lignocaine did not significantly alter mean VE/PE'CO2 and mean VE 7.3: 14.6 (95% confidence intervals 12.1-17.1) to 15.3 (13.1-17.6) litre min-1 kPa-1 and 22.8 (18.1-27.5) to 22.8 (17.3-28.3) litre min-1, respectively. We conclude that extradural co-administration of morphine and lignocaine did not increase the risk of respiratory depression associated with morphine.

Adult↗
PubMed1995

[A new protein titrator tape for self-assessment by outpatients with proteinuria].

ł- have invented a new dipstick (protein titrator tape) for measuring the volume of protein excreted in the 24-hour urine. The principle of the method is based on the protein error of indicators with the modification of a conventional dipstick test. The dipstick consists of two thick filter papers, containing differently adjusted pH indicators of tetrabromphenol blue, making it possible to detect a wide range of protein concentrations in the urine using a standard color chart that includes twenty color blocks. Two hundred and ninety outpatients had their urine samples assessed with this method as well as with the pyrogallol red test as a comparative study for quantitative measurement of protein concentrations. The new-type dipstick method exhibited good correlation with the results of the pyrogallol red test, especially in the range of protein concentrations from 50 mg/dl to 400 mg/dl, showing the linear equation of "y (Pyrogallol red) = 10.5 + 0.99 x (Dipstick) (r = 0.91, P < 0.01)". Although there was good correlation with the pyrogallol red test at higher concentrations from 400 mg/dl to 1,000 mg/dl, the dipstick method tended to exhibit lower concentrations than those indicated by the counterpart method. The rate of consistency between observers was quite high. This new-type dipstick method will offer a reliable method for patients or their family to assess their protein excretion in the urine every 24 hours at home using a portable urine sampling device.

Adult↗
PubMed1995

A clinical study of lectin-reactive alpha-fetoprotein as an early indicator of hepatocellular carcinoma in the follow-up of cirrhotic patients.

Levels of two types of lectin-reactive alpha-fetoprotein (AFP), designated AFP-L3 and AFP-P4+P5, were analyzed with Lens culinaris agglutinin A and AFP-P4+P5 with erythroagglutinating phytohemagglutinin, respectively, in an attempt to determine the utility and significance of these macromolecules as early indicators of hepatocellular carcinoma during the periodic follow-up of cirrhotic patients. The subjects were 51 of 190 consecutive cirrhotic patients in whom hepatocellular carcinoma developed during a 6-year follow-up period and 21 cirrhotic patients without hepatocellular carcinoma. Serum AFP levels were of limited value to diagnose and predict hepatocellular carcinoma. The relative levels of AFP-L3 and AFP-P4+P5 in patients with hepatocellular carcinoma at the time of tumor detection were significantly higher than those in patients with cirrhosis. The sensitivity was 61%, and the specificity was 90%. Fourteen patients (48%) of 29 patients with small hepatocellular carcinomas less than 2 cm in diameter showed elevated percentage of lectin-reactive AFP. Retrospective examination of 21 patients who were positive for lectin-reactive AFP at diagnosis of hepatocellular carcinoma showed that 41% of them had already expressed lectin-reactive AFP 12 months before the direct detection of hepatocellular carcinoma by diagnostic imaging. These results lead us to conclude that the level of lectin-reactive AFP is a suitable predictive marker for the early recognition of hepatocellular carcinoma in the follow-up of patients with cirrhosis, and that measurements of the level of lectin-reactive AFP should be added to the screening methods that are now in use.

Biomarkers, Tumor↗
PubMed1995

[Acute pancreatitis associated with acute intermittent porphyria].

Pancreatic involvement associated with acute intermittent porphyria is rare. There were only nine cases reported until now which have pancreatic disease and AIP, one case with chronic pancreatitis, one with cystadenocarcinoma and chronic pancreatitis, one with transient macroamylasemia and the others with acute pancreatitis. The cause of these complications in these patients is uncertain. However, in our case, it is possible that AIP might have caused the acute pancreatitis, since this patient developed acute pancreatitis following the attack of AIP. It seems to be necessary to pay attention to the combination of these diseases.

Acute Disease↗
PubMed1995

[Serum cardiac troponin-T in coronary artery bypass graft and mitral valve replacement].

Serum cardiac troponin-T was measured to evaluate perioperative myocardial injury in heart surgery. Twelve patients of coronary artery bypass graft (CABG) and nine of mitral valve replacement (MVR) were selected and the measurements were performed at 3 points-before, as well as after the surgery and on the first postoperative day. Elevated serum levels of troponin-T were observed in postoperative measurement in both groups (CABG 2.98 +/- 1.44, MVR 2.57 +/- 0.52 ng.ml-1), where all the preoperative values were less than 0.1 ng.ml-1. On the first postoperative day, CABG group showed a higher serum level of troponin-T than MVR group (6.05 +/- 4.16 vs. 2.57 +/- 2.12 ng.ml-1, P < 0.05 respectively). Taking another myocardial marker, such as CK-MB or myosin light chain I, into consideration, these data indicate that myocardial injury occurs during heart surgery and the grade of injury is severer in CABG than in MVR.

Aged↗
PubMed1994

Two-color analysis of peripheral lymphocyte surface antigens in inherently healthy adults.

We studied 134 "healthy persons" with no past history of any serious or latent diseases, and observed differences in their 25 lymphocyte subsets by conducting two-color analyses using 12 useful combinations of dye-labeled monoclonal antibodies. CD4+Leu8+ cells and CD25+CD3+ cells were significantly higher in males than in females, whereas CD4+Leu8- cells and CD23+CD19+ cells were significantly higher in females. In comparison of the 25 lymphocyte subsets among four age groups, CD45RA-CD4+ cells and CDw29+CD4+ cells significantly increased with age, and CD8+ CD11b- cells and CD57-CD8+ cells significantly decreased with age. In females, helper T cells significantly increased and helper inducer T cells increased, while cytotoxic T cells decreased with age. These are important findings that should be considered in studies of immune function and autoimmune disorders.

Adult↗
PubMed1994

High-dose chemotherapy and blood stem cell autografts for children with first relapsed acute lymphoblastic leukemia: a pilot study of the Children's Cancer and Leukemia Study Group of Japan (CCLSG).

This study was performed to determine the value of high-dose chemotherapy and peripheral blood stem cell autografts (PBSCT) in the treatment of children with first relapsed acute lymphoblastic leukemia (ALL). Eighteen children underwent PBSCT during the second complete remission (CR) and had a minimum 10 month follow-up. The median age of the patients was 11 yr (range, 2-17 yr). Fifteen patients received the "MCVAC" regimen, one received high-dose MCNU+busulfan therapy, one received high-dose melphalan+VP-16, and one received melphalan+carboplatin+cytosine arabinoside+MCNU. None of these regimens included total body irradiation. Eight patients developed recurrence of the disease at 1 to 19 mo (median, 3 mo) after PBSCT. Patients in whom the first relapse occurred sooner, that is, within 16 mo of initial therapy, tended to have a better survival rate than those who developed relapse after 30 mo (six of seven survived versus four of 11; not significant). Although the preliminary data provided little conclusive information, it did suggest that incorporation of PBSCT in the salvage protocol of relapsed childhood ALL can be justified.

Adolescent↗
PubMed1994

Pregnancy enhances the antinociceptive effects of extradural lignocaine in the rat.

We have compared the antinociceptive effect of extradural lignocaine on somatic and visceral nociception in pregnant (n = 11) and non-pregnant rats (n = 9). Colorectal distension (CD) threshold and tail flick (TF) latency were measured as visceral and somatic nociception, respectively, for 60 min after extradural injection. On days 19, 20 and 21 of pregnancy, rats received lignocaine 200, 400 or 800 micrograms or normal saline via a chronically implanted lumbar extradural catheter. Extradural lignocaine produced dose-dependent antinociceptive effects on TF latency and CD threshold. Lignocaine 200 or 400 micrograms produced significantly greater peak effects in pregnant than in non-pregnant rats. Although the peak effects with lignocaine 800 micrograms were not different between groups, the duration of the effects were longer in pregnant compared with non-pregnant rats. We conclude that both somatic and visceral antinociceptive effects of extradural lignocaine were potentiated in pregnant rats near term compared with those in non-pregnant rats.

Analgesics↗
PubMed1994

Synergistic antinociceptive interaction after epidural coadministration of morphine and lidocaine in rats.

BACKGROUND: Clinically, epidural coadministration of opioids and local anesthetics has provided excellent analgesia for various types of pain. However, information about the interaction of these drugs when administered epidurally is limited. Therefore, we evaluated the antinociceptive interaction between morphine and lidocaine on both somatic and visceral noxious stimuli in the rat. METHODS: Male Sprague-Dawley rats weighing 300-350 g had epidural catheters implanted at T13-L1. Every rat was tested with both the tail flick test, a somatic noxious stimulus, and the colorectal distension test, a visceral noxious stimulus. In the colorectal distension test, the response threshold was defined by the pressure within the intracolonic balloon required to trigger abdominal contraction. Tail flick latency and colorectal distension threshold were measured before and for 180 min after the administration of morphine, lidocaine, or combinations of those drugs. To characterize the interaction, isobolographic analysis was performed with a fixed morphine: lidocaine dose ratio of 1:1,000. RESULTS: Epidural morphine (0.1-10 micrograms) and lidocaine (100-800 micrograms) increased the tail flick latency and colorectal distension threshold in a dose- and time-dependent fashion. The epidural injection of morphine (0.1-1 microgram) mixed with lidocaine (100 or 200 micrograms) significantly increased the peak effect and prolonged the duration of effects compared with each drug alone in both nociceptive tests. Areas under the curves, calculated to express overall magnitude and duration of antinociceptive effects, were significantly increased by combinations as compared with each drug alone, especially with morphine 0.1 microgram and lidocaine 100 or 200 micrograms, each of which alone produced no change in the area under the curve. Isobolographic analysis revealed that epidural morphine and lidocaine interact synergistically at 10, 20, and 30 min after injection in both somatic and visceral nociception tests. Both potency ratio analysis and fractional analysis confirmed the finding of the isobolographic analysis. Epidural naloxone antagonized the antinociceptive effects produced by the combination. CONCLUSION: These data demonstrate that epidurally coadministered morphine and lidocaine produce synergistic analgesia and prolong the duration of analgesia in tests of somatic and of visceral nociception.

Analgesia↗
PubMed1994

Comparison of continuous epidural infusion of morphine/bupivacaine with fentanyl/bupivacaine for postoperative pain relief.

The efficacy and safety of postoperative analgesia with continuous epidural infusion of either morphine or fentanyl in combination with bupivacaine were evaluated in 85 patients, ASA physical status I or II, undergoing thoracic and/or upper abdominal surgery. Patients were treated with one of the combinations for 48 h after surgery. The morphine/bupivacaine group (MB; n = 45) received morphine at the rate of 0.2 mg.h-1, and bupivacaine at the rate of 10 mg.h-1 for the first 24 h or 5 mg.h-1 for the second 24 h; the fentanyl/bupivacaine group (FB; n = 40) received fentanyl at the rate of 20 micrograms.h-1, and bupivacaine at the rate of 10 mg.h-1 for the first 24 h or 5 mg.h-1 for the second 24 h. The degree of pain relief assessed by the visual pain scale and the modified Prince Henry pain scale was satisfactory in most patients in both groups. In group MB 74% and in group FB 76% of patients did not need any supplementary analgesics. No significant differences were observed between the groups in assessment of pain. The incidence of hypotension (P < 0.05) and pruritus (P < 0.05) was higher in group MB than in group FB. None of the patients developed respiratory depression in either group.

Abdomen↗
PubMed1994

[Clinical significance of determination of anti-HCV antibodies].

This study was conducted to evaluate the clinical significance of assays of hepatitis C virus (HCV) antibodies to manage the liver diseases due to HCV. To detect HCV infection accurately, the second-generation anti-HCV assays such as EIA, PHA and TND-2 were more useful than other assays such as anti-C100-3 antibody, anti-GOR antibody, and anti-JCC-2 antibody, because the second generation anti-HCV assays showed positive rates in over 90% of the cases with positive HCV-RNA. Although in some patients the determination of anti-GOR, anti-JCC-2, IgM anti-HCV and their titrations revealed the severity of liver disease and were useful to predict the effects of interferon therapy, measurements of these antibodies were not considered so useful as clinical parameters for management of patients with liver disease due to HCV. However, the fact that the changes of serum titer of anti-JCC-2 correlated well to the changes of serum transaminase levels in a few patients with IFN suggests that the clinical significance of anti-HCV core antibodies should be further discussed.

Adult↗
PubMed1994

[Epidural anesthesia with high dose fentanyl for a patient with dilated cardiomyopathy].

Dilated cardiomyopathy is defined as a syndrome of dilated ventricles with gross impairment of ventricular systolic function. Recently, there are several anesthetic reports regarding this syndrome. But any appropriate anesthetic method has not been established. A 59-year-old man with dilated cardiomyopathy underwent low anterior resection of rectum. We employed the technique of high dose epidural fentanyl anesthesia as the anesthetic method. During surgery, mild hypotension developed, but other cardiovascular abnormalities were not observed during and after the operation. Based on this result, the authors recommend that high dose epidural fentanyl anesthesia is an anesthetic method of choice for patients with dilated cardiomyopathy.

Anesthesia, Epidural↗
PubMed1994

[Sevoflurane anesthesia in a patient with multiple sclerosis].

Multiple sclerosis (MS) is a disorder of the nervous system in which myelin breakdown is a prominent feature. We report a 65-yr-old woman scheduled for femoral neck prosthetic replacement under sevoflurane anesthesia, who had been suffering from a progressive type of MS for 27 years. Previously she had a history of exacerbation of symptoms after caudal block done for sciatic neuralgia. Stress such as surgery, anesthesia, emotional distress and variable body temperature can exacerbate the disease. Spinal and epidural block are relatively contraindicated in MS. Thiopental was reported to worsen MS. But there is no evidence that any of the volatile anesthetic agents has a deleterious effect on MS. Sevoflurane can be used to induce anesthesia quickly. To avoid thiopental, we chose slow induction with sevoflurane (GOS). Anesthesia was maintained with GOS. It seems that intraoperative hypotension which resists to ephedrine administration is partly due to autonomic abnormality. Yet, there is no report of sevoflurane anesthesia in MS patient. We consider that in this case sevoflurane is a safe anesthetic because of its less effect on postopreative neurological symptoms than that of epidural block.

Aged↗
PubMed1994

[The difficulties in communication through RS-232C interface between monitor devices and a personal computer--the difference of data output format and transmit mode].

We investigated data output format and transmit mode of communication through RS-232C interface between monitor devices and a personal computer. The baud rate, start bit, data bits, parity bit and stop bits are listed with transmit mode of six companies' monitor devices which are now widely sold in Japan. Each monitor device has its own data output format and transmit mode, which are quite different from the others and make it somewhat difficult to import data from different monitor devices to a personal computer. We suggest that, because two or three different monitor devices are commonly used during anesthesia, some general standard should be established to make an easy communication between monitor devices and a personal computer for ordinary users.

Anesthesia↗
PubMed1994

[Anesthetic management of a patient with abdominal aortic aneurysm (AAA) with giant bulla].

We report a case of abdominal aortic aneurysm with giant bulla in a 58-year-old man who had an elective abdominal aortic reconstruction surgery. Preoperative chest x-ray showed a giant bulla in the right lung and small bullae in the left. General anesthesia was induced with midazolam 0.5 mg, fentanyl 0.2 mg and succinylcholine chloride 80 mg. After tracheal intubation, anesthesia was maintained under spontaneous breathing with halothane 0.5-1% in a mixture of air and oxygen (FIO2 0.4-1.0) supplemented with continuous epidural mepivacaine from the catheter inserted the day before surgery. Since satisfactory analgesia and muscle relaxation were achieved by epidural mepivacaine, no analgesics and muscle relaxants were administered during the operation. Postoperatively, no complications occurred and the patient was extubated and transferred to the intensive care unit. We emphasize that combined epidural and light general anesthesia with spontaneous respiration might be ideal for the safe anesthetic management of a patient with a giant bulla.

Anesthesia, Epidural↗