Importance of machine perfusion flow in kidney preservation.
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Adult↗
Biomedical subjects
Y Narumi
Publications and source records attributed to Y Narumi.
Relationship between stimulating current and accelographic train-of-four response at the great toe.
We investigated the accelographic train-of-four response evaluated at the great toe at varying stimulating currents. Fifteen adult patients undergoing elective general anaesthesia were studied. The mean current at which a supramaximal T1 value could be elicited was > 49 (9) mA [mean (SD)]. Ratios of accelographic T1 values at 50, 40, 30, 20 and 10 mA to accelographic T1 value at 60 mA were 0.90 (0. 18), 0.58 (0.37), 0.38 (0.37), 0.19 (0.26) and 0.00 (0.00), respectively [mean (SD), p < 0.05 for 50 mA vs. 30, 20 and 10 mA, p < 0.05 for 40 mA vs. 20 and 10 mA, and p < 0.05 for 30 vs. 10 mA]. Threshold currents for train-of-four (the lowest currents at which any train-of-four response could be elicited) before and after induction of anaesthesia were 30 (10) and 31 (10) mA, respectively. The train-of-four ratio (T4/T1) measured at varying currents did not differ significantly. However, in the patients in whom threshold currents for train-of-four were 40, 30 and 20 mA, the train-of-four ratio recorded at the threshold current was significantly less than at 50 mA. We conclude that at the great toe, the mean current at which a supramaximal response to train-of-four can be yielded is as high as > 49 mA. The mean threshold currents for TOF before and after induction of anaesthesia were 30 and 31 mA, respectively. Train-of-four ratio measured at the threshold current is less than that at 50 mA.
Anesthesia, General↗
MR evaluation of the articular cartilage of the femoral head during traction. Correlation with resected femoral head.
OBJECTIVE: The purpose was to evaluate the articular cartilage of the hip joint with MR during traction and compare the findings with the resected specimen or arthroscopic findings. MATERIAL AND METHODS: Eight healthy volunteers, 5 patients with osteonecrosis, 5 with acetabular dysplasia, and 5 with advanced osteoarthrosis underwent MR imaging to evaluate the articular cartilage of the hip joint. Coronal fat-suppressed 3D spoiled gradient-echo (SPGR) images were obtained during traction. Identical imaging was performed of all the resected femoral heads of the osteonecrosis and advanced osteoarthrosis patients, and was correlated with the macroscopic pathological findings. RESULTS: The traction was effective and the femoral articular cartilage was clearly identified in all 8 control subjects, and in all cases of osteonecrosis and acetabular dysplasia. In 4 cases of osteonecrosis, chondral fracture was identified in the boundary between the necrosis and the normal area. In all cases of advanced osteoarthrosis, cartilage was identified only at the medial side. The MR images of osteonecrosis and advanced osteoarthrosis corresponded well with the MR images of the resected femoral heads and the macroscopic findings. CONCLUSION: Fat suppressed 3D-SPGR during continuous leg traction was useful in detecting cartilage abnormalities.
Adult↗
Electromyographic assessment of neuromuscular block at the gastrocnemius muscle.
We have assessed neuromuscular block electromyographically at the gastrocnemius muscle and compared it with that at the abductor digiti minimi muscle in 60 adult patients undergoing cervical spine surgery under general anaesthesia. All patients were in the prone position. After vecuronium 0.2 mg kg-1, times to onset of neuromuscular block at the gastrocnemius and abductor digiti minimi muscles were mean 147 (SD 24) and 145 (14) s, respectively (ns). Times to return of the first response of the post-tetanic count (PTC1) at the gastrocnemius and abductor digiti minimi muscles were 27.7 (5.6) and 37.0 (5.9) min, respectively (P = 0.0001). Times to return of the first response of the train-of-four (TOF) at the gastrocnemius and abductor digiti minimi muscles were 41.0 (9.1) and 49.9 (8.7) min, respectively (P = 0.01). Recovery of PTC, T1/T0 and TOF ratio at the gastrocnemius muscle were significantly faster than at the abductor digiti minimi muscle.
Adult↗
Tactile evaluation of fade of the train-of-four and double-burst stimulation using the anaesthetist's non-dominant hand.
We have studied detection of fade in response to train-of-four (TOF), double-burst stimulation3,3 (DBS3,3) or DBS3,2, assessed tactilely by the anaesthetist using the index finger of the non-dominant hand and the thumb of the patient, compared with that assessed when the index finger of the dominant hand was used. The probability of detection of any fade in response to TOF or DBS3,3 using the non-dominant hand was significantly less than when the dominant hand was used (P < 0.05). The probability of identification of fade in response to DBS3,2 assessed using the non-dominant hand was comparable with that evaluated using the dominant hand when TOF ratios were 0-0.9, but when TOF ratios reached 0.91-1.00, detection using the non-dominant hand was significantly less common than with the dominant hand (12% vs 33%; P < 0.05). Using the non-dominant hand, the probability of detection of fade in response to ulnar nerve stimulation was less than that with the dominant hand and only the absence of DBS3,2 fade ensured sufficient recovery of neuromuscular block.
Adult↗
Post-tetanic count and train-of-four responses during neuromuscular block produced by vecuronium and infusion of nicardipine.
We have examined onset and recovery of neuromuscular block produced by vecuronium using either post-tetanic count (PTC), or the first twitch of the train-of-four (TOF) (T1/T0) and TOF ratio (T4/T1) during continuous infusion of nicardipine. Sixty adult patients were allocated to one of four groups of 15 patients each: nicardipine-PTC, nicardipine-TOF, control-PTC and control-TOF. In the nicardipine-PTC and nicardipine-TOF groups, nicardipine 0.03 mg kg-1 was given before vecuronium 0.1 mg kg-1 and a continuous infusion of nicardipine was started immediately at a rate of 2 micrograms kg-1 min-1. Mean time from administration of vecuronium to onset of neuromuscular block in the nicardipine-PTC and nicardipine-TOF groups was significantly shorter than in the control-PTC and control-TOF groups (166 (SD 39) vs 220 (28) s; P < 0.05). There was no significant difference in recovery of PTC between the nicardipine-PTC and control-PTC groups or in recovery of TOF ratio in the nicardipine-TOF and control-TOF groups. However, during recovery, T1/T0 in the nicardipine-TOF group was significantly less than that in the control-TOF group, 60-100 min after administration of vecuronium.
Adult↗
Pancreatic CT imaging: effects of different injection rates and doses of contrast material.
PURPOSE: To assess the effects of the intravenous injection rate and dose of contrast material on pancreatic computed tomography (CT). MATERIALS AND METHODS: A total of 126 patients were divided at random into four groups with different injection rates and doses. Groups 1 and 2 underwent injection of 2 mL per kilogram of body weight of 300 mg of iodine per milliliter of contrast material, and groups 3 and 4 underwent injection of 1.5 mL/kg. The injection rate was 5 mL/sec for groups 1 and 3 and 3 mL/sec for groups 2 and 4. Single-level serial CT scanning was performed at the level of the pancreatic head, and the pancreatic enhancement value was calculated. RESULTS: The maximum pancreatic enhancement value was 99 HU +/- 18 (mean +/- SD) for group 1, 90 HU +/- 18 for group 2, 86 HU +/- 15 for group 3, and 74 HU +/- 13 for group 4. There were significant differences in the maximum pancreatic enhancement value between groups 1 and 2 (P = .045), between groups 3 and 4 (P = .001), between groups 1 and 3 (P = .016), and between groups 2 and 4 (P = .001). CONCLUSION: Both a higher dose and a faster injection rate increased the maximum pancreatic enhancement value.
Adult↗
Comparison of CT angiography with MR angiography in the living renal donor.
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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↗
Sensitivity in detection of hypervascular hepatocellular carcinoma by helical CT with intra-arterial injection of contrast medium, and by helical CT and MR imaging with intravenous injection of contrast medium.
PURPOSE: To determine the effectiveness of i.a. contrast-enhanced helical CT and of i.v. contrast-enhanced helical CT and MR imaging, in detecting hypervascular hepatocellular carcinoma (HCC). MATERIAL AND METHODS: Fifty patients with 125 hypervascular HCC nodules underwent helical CT both during arterial portography (CTAP) and during hepatic arteriography (CTHA). Helical CT and MR imaging of the entire liver with i.v. administration of contrast medium were also performed. Helical CT images were obtained at 30-33 s (arterial-phase CT) and at 5 min (equilibrium-phase CT) after the initiation of an i.v. bolus injection of contrast medium. After T1- and T2-weighted spin-echo MR imaging, gradient-echo images during breath-holding were obtained prior to and 20 s, 1 min, and 2 min after the bolus administration of 0.1 mmol/kg of gadopentetate dimeglumine (dynamic MR). The sensitivity and positive predictive value of the various techniques were evaluated and compared. RESULTS: In terms of sensitivity for hypervascular HCC nodules of less than 1 cm in diameter, CTAP (90%) and CTHA (88%) were significantly superior to dynamic MR imaging (44%), arterial-phase CT (39%), spin-echo MR imaging (20%), and equilibrium-phase CT (7%) (p < 0.001). However, there was no significant difference in the techniques with regard to the detection of lesions equal to or more than 2 cm in diameter. CONCLUSION: For detecting small hypervascular HCCs, helical CT with i.a. contrast enhancement is superior to helical CT and MR imaging with i.v. enhancement.
Adult↗
Time course of a new ultrashort-acting beta-adrenoceptor-blocking drug, ONO-1101: comparison with those of esmolol and propranolol by using the canine isolated, blood-perfused heart preparations.
Time courses of beta-adrenoceptor-blocking actions of ONO-1101, a new cardioselective beta-blocker, were compared with those of esmolol and propranolol by using the isolated, blood-perfused sinoatrial node (SAN) and papillary muscle (PM) preparations of dogs. ONO-1101 per se given intraarterially (i.a.) in each nutrient artery did not affect basal sinoatrial rates (SARs; 99 +/- 2 beats/min, n = 7) in the SAN and developed tension (DT; 3.2 +/- 0.7 g, n = 7) of the PM preparations. Norepinephrine (NE) injected i.a. into the each artery induced increases in SAR (42 +/- 6 beats/min at 0.051 +/- 0.014 microg) and PMDT (2.9 +/- 0.4 g at 0.048 +/- 0.011 microg). The i.a. injections of NE were repeated every 3 min after i.v. bolus injections of ONO- 1101 into the support dog. NE-induced increases in SAR and PMDT were maximally inhibited 3 to 6 min after the i.v. injections of ONO-1101. Maximal percentage inhibitions by ONO-1101 of NE-induced increases in SAR were 54 +/- 6, 78 +/- 3, and 96 +/- 2% at 0.01, 0.1, and 1 mg/kg of the drug, respectively. Similarly, maximal percentage inhibitions by ONO-1101 of NE-induced increases in PMDT were 50 +/- 12, 93 +/- 2, and 100% +/- 0, respectively. The inhibition was quickly recovered; times required for 50% recovery (RT1/2) were 12 +/- 3. 17 +/- 3, and 32 +/- 10 min in the SAN preparation, and 13 +/- 3, 16 +/- 2, and 39 +/- 11 min in the PM preparations, after i.v. injections of 0.01, 0.1, and 1 mg/kg of ONO-1101, respectively. In comparison, maximal percentage inhibitions by esmolol of NE-induced increases in SAR were 45 +/- 5, 79 +/- 6, and 96 +/- 2%, and those in PMDT were 34 +/- 4, 75 +/- 5, and 97 +/- 1%, whereas the RT1/2 values were 11 +/- 2, 15 +/- 4, and 40 +/- 12 min in the SAN preparation, and 10 +/- 2, 16 +/- 7, and 27 +/- 6 min in the PM preparations, after i.v. injections of 0.01, 0.1, and 1 mg/kg of esmolol, respectively. In contrast, the maximal percentage inhibitions by an i.v. bolus injection of 0.1 mg/kg of propranolol of NE-induced increases in SAR and PMDT were 77 +/- 18% and 87 +/- 13% (n = 4). respectively. The maximal inhibitions were obtained 6-15 min after injections of propranolol and then slowly recovered only by 21% in the SAN and 8% in the PM preparations, even after 60 min. These results clearly demonstrate that ONO-1101 is an ultrashort-acting beta-blocker, but the recovery time is dose dependent, and that the beta-blocking action of ONO-1101 is almost similar to or slightly more potent (or both) than esmolol.
Adrenergic beta-Antagonists↗
Preoperative staging of endometrial carcinoma: diagnostic effect of T2-weighted fast spin-echo MR imaging.
PURPOSE: To evaluate the usefulness of T2-weighted fast spin-echo magnetic resonance (MR) imaging with a 512 x 256 matrix for assessment of the preoperative stage of endometrial carcinoma. MATERIALS AND METHODS: Twenty-eight women with histopathologically proved endometrial carcinoma underwent preoperative T2-weighted fast spin-echo, dynamic T1-weighted fast spin-echo, and postcontrast T1-weighted spin-echo MR imaging with a phased-array surface coil. The uterine long-axis planes in each sequence were reviewed at separate sessions by three radiologists blinded to the histopathologic data. RESULTS: For the diagnosis of myometrial invasion, no statistically significant differences were found among T2-weighted imaging, dynamic imaging, and postcontrast T1-weighted imaging. For the diagnosis of deep myometrial invasion, T2-weighted and dynamic images showed higher specificity than postcontrast T1-weighted images (T2-weighted, 89%; dynamic, 88%; and postcontrast T1-weighted, 80%). For cervical invasion, T2-weighted and dynamic images showed larger areas under receiver operating characteristic curves than did postcontrast T1-weighted images (T2-weighted, 0.78; dynamic, 0.71; and postcontrast T1-weighted, 0.67). CONCLUSION: T2-weighted imaging is useful for identifying the stage of endometrial carcinoma.
Carcinoma↗
Effects of injection rates of contrast material on arterial phase hepatic CT.
OBJECTIVE: Our goal was to assess the effects of the i.v. injection rate of contrast material on arterial phase hepatic CT. SUBJECTS AND METHODS: One hundred patients were randomly divided into four groups of 25 with different injection rates of 90 ml of contrast material: 2, 3, 4, or 5 ml/sec. Single-level serial CT was performed at the level of the middle section of the main portal vein before injection and every 2 sec from 12 sec to 60 sec after injection of contrast material. The enhancement value was calculated as the difference in attenuation value between the unenhanced and contrast-enhanced images for the aorta and liver parenchyma. The duration of the arterial phase was defined as the interval beginning when the enhancement value for the aorta reached 100 H and ending when the value for the liver parenchyma reached 20 H. RESULTS: Faster injection rates increased the maximum enhancement of the aorta. Although faster injection rates decreased the time from injection to the beginning and the end of the arterial phase, faster injection rates did not decrease the duration of the arterial phase itself. CONCLUSION: A faster injection rate increases arterial enhancement of the liver, and the duration of the arterial phase remains the same as that occurring with a slower injection rate. We hypothesize that faster injection rates can provide better results using CT to reveal hypervascular liver tumors.
Adult↗
[Three-dimensional gadolinium-enhanced dynamic MRI of whole liver using spectrally selected enhanced fast gradient recall sequence].
Three-dimensional gadolinium-enhanced dynamic MRI of whole liver using the spectrally selected enhanced fast gradient recall sequence (spec IR-efgre3d) was performed in five patients with HCC. Ten HCC nodules were confirmed by CTA, CTAP and Lipiodol CT, and all of them were detected with dynamic MRI. MIP images reconstructed from 3D gadolinium-enhanced dynamic MR studies clearly showed the main portal vein and its branches in all cases. Portal vein thrombosis was also demonstrated with the MIP images.
Carcinoma, Hepatocellular↗
[Gd-DTPA enhanced multi-shot echo-planar MRI: improvement of contrast between metastatic liver cancer and liver parenchyma].
In six patients with metastatic liver cancer, spin-echo multi-shot echo-planar MR imaging 8/2000/80/1 (shot/TR/TE/excitation) of the liver was performed before and 30, 60, 90 and 120 sec after the intravenous injection of Gd-DTPA. Signal-to-noise ratios (SNR) of the liver tumor and liver parenchyma were measured in each phase. The contrast-to-noise ratios (CNR) between the tumor and liver parenchyma were also calculated. While the SNR of the tumor did not change after the injection of Gd-DTPA, the SNR of the liver parenchyma decreased and the CNR between the tumor and liver parenchyma increased.
Adult↗
MRI of normal anterior cruciate ligament (ACL) and reconstructed ACL: comparison of when the knee is extended with when the knee is flexed.
The purpose of this study was to evaluate, using MRI, the morphology of normal anterior cruciate ligament (ACL) and ACL grafts when the knee was extended compared with when the knee was flexed. Eighteen normal controls and 22 ACL graft patients were studied. Spin-echo (SE) T1-weighted images (TR 330 ms/TE 15 ms, NEX 1) were obtained with a slice thickness of 3 mm. Oblique sagittal images parallel to the ACL were obtained at various flexed angles of the knee joint. In 12 of the 18 normal controls the ACL appeared convex toward the posterior side when the knee was extended and gradually became straight when the knee was flexed. In 15 of the 22 ACL graft patients the grafts appeared straight when the knee was extended and became convex toward the anterior side when the knee was flexed. It is concluded that the morphological changes seen on MR images of ACL grafts from when the knee is extended to when the knee is flexed are different from those in the normal ACL.
Adolescent↗
CT arterial portography and CT arteriography with a triple-lumen balloon catheter.
PURPOSE: To evaluate the usefulness of the triple-lumen balloon catheter in the serial performance of CT arterial portography (CT-AP) and CT arteriography (CT-A). MATERIAL AND METHODS: A combined CT-AP and CT-A examination of 58 patients was carried out in which a cobra-type triple-lumen balloon catheter was used. CT-AP was performed by injecting contrast medium either into the splenic artery through a side-hole in the catheter proximal to the balloon inflated in the common hepatic artery, or into the superior mesenteric artery through an end-hole in the catheter. Then CT-A was serially performed by delivering contrast medium either to the common hepatic artery or the proper hepatic artery from the end-hole, or to the accessory right hepatic artery through a side-hole proximal to the inflated balloon. RESULTS: Sufficient CT-APs were obtained in 53 of the 58 patients (91%), CT-A in 42 (72%), and both in 42 (72%). Incomplete CT-AP was due to technical failure or anatomical anomaly, as was incomplete CT-A. No complications were seen. CONCLUSION: The triple-lumen balloon catheter technique is useful and convenient in the serial performance of CT-AP and CT-A.
Carcinoma, Hepatocellular↗
Superparamagnetic iron oxide enhanced magnetic resonance imaging of rat liver with hepatocellular carcinoma and benign hyperplastic nodule.
RATIONALE AND OBJECTIVES: The authors assess the potential of a new superparamagnetic iron oxide (SPIO) in grading hepatocellular carcinoma (HCC) histologically and in differentiating HCC from benign hyperplastic nodule (HPN). METHODS: Nine Wistar rats (with poorly to moderately differentiated HCC, well-differentiated HCC, and HPN) received drinking water containing N-nitrosomorpholine, and were examined by magnetic resonance imaging (4.7 tesla). Spin-echo images (repetition time/echo time, 600/24.5 mseconds) were obtained before and 15 minutes after intravenous administration of 10 mumol Fe/kg of SH U 555A. RESULTS: Poorly to moderately differentiated and well-differentiated HCC showed no significant change in signal-to-noise ratio (SNR) 15 minutes after contrast, whereas HPN showed a significant decrease in SNR. The contrast-to-noise ratio (CNR) between each kind of tumor and adjacent liver parenchyma showed a significant increase at 15 minutes after contrast. CONCLUSIONS: The SPIO discussed in this article may help to differentiate HCC from HPN, but it remains difficult to grade hepatocellular carcinoma histologically.
Animals↗