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ABSTRACT: Three hundred and thirty-four pediatric patients less than 4 years old who underwent surgery for congenital heart disease were retrospectively studied to devise a practical formula for predicting the appropriate size for an uncuffed endotracheal tube for pediatric cardiac anesthesia. Furthermore, this formula was compared with that for non-cardiac anesthesia obtained from 409 patients without congenital heart disease. A simple regression equation between tube size and body length resulted in the simple predictive formula: "tube size = 0.04 x body length + 1.6" for pediatric cardiac anesthesia. This formula had the same slope and an approximately 0.3 mm larger intercept on the Y-axis compared with that for pediatric non-cardiac anesthesia. Therefore, a one-size larger endotracheal tube is more suitable for use in pediatric cardiac anesthesia than in pediatric non-cardiac anesthesia for the same body length.
Hiroshima journal of medical sciences 01/2002; 50(4):97-9.
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ABSTRACT: We evaluated the validity of Cole's formula (tube size = 0.25 x age + 4) for the estimation of uncuffed endotracheal tube size, and devised new formula with a statistical method on the basis of the ages of 217 pediatric patients with congenital heart disease. The sizes of the tubes actually used for these patients were 0.5 mm or larger than those estimated by Cole's formula in 29% of patients with congenital heart disease. Only one patient with cyanotic heart disease required a tube that was more than 0.5 mm smaller than that estimated by Cole's formula. The regression formula representing the relationship between the tube size and age was "tube size = 0.316 x age + 4.135". In conclusion, tube size estimated by Cole's formula tends to be smaller than practically appropriate tube size for pediatric cardiac anesthesia, and therefore we suggest new formula to estimate the tube size.
Masui. The Japanese journal of anesthesiology 04/2001; 50(3):284-6.
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ABSTRACT: Whether or not to apply nutritional pretreatment and how to do so are controversial issues with respect to the liver about to undergo aggressive intervention. We studied the effects of glucose loading on the viability of hepatocytes that were subsequently exposed to the inhibitors of carbohydrate metabolism, potassium cyanide (KCN) and iodoacetic acid (IAA). After rat hepatocytes were cultured for 24 hours in Leibovitz's L-15 medium containing 0, 10, 20, and 30 mmol/L glucose, the medium was replaced with modified Hanks-HEPES buffer with or without 2.5 mmol/L KCN or 0.5 mmol/L IAA. Lactate dehydrogenase (LDH) activity, lactate concentration, and pH of the supernatant were measured after 0, 2, 4, and 6 hours of exposure to KCN and after 0, 20, 40, and 60 minutes of exposure to IAA. Glycogen and adenosine triphosphate (ATP) contents in the hepatocytes were measured simultaneously. Hepatocytes cultured with various concentrations of glucose for 24 hours stored levels of glycogen in proportion to the glucose concentration in the culture medium without any significant difference in viability. The hepatocytes cultured with higher glucose concentrations maintained a higher ATP content and released less LDH and more lactate, and the pH decreased in the supernatant during exposure to KCN. Conversely, hepatocytes cultured with lower glucose concentrations maintained a higher ATP content and released less LDH during exposure to IAA. In conclusion, prior glucose loading appears to be beneficial for hepatocytes if oxidative phosphorylation is to be inhibited, whereas withholding glucose appears to be beneficial if glycolysis is to be inhibited.
Metabolism 04/2001; 50(3):342-8. · 2.66 Impact Factor
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T Asahara,
K Dohi,
H Nakahara,
K Katayama,
T Itamoto,
K Sugino,
K Moriwaki, K Shiroyama,
K Azuma,
K Ito,
F Shimamoto
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ABSTRACT: We performed a laparoscopy-assisted hepatectomy on a 52-year-old woman with a large hepatic cavernous hemangioma (longest diameter, 8.5 cm). With the use of Pringle's maneuver, the left lateral segment of the liver was resected with a Cavitron ultrasonic surgical aspirator (CUSA) while lifting the abdominal wall. Postoperative hepatic dysfunction was mild and transient, resolving spontaneously early after surgery. We intend to expand the indications of this minimally invasive procedure for hepatic resection.
Hiroshima journal of medical sciences 01/1999; 47(4):163-6.
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T Asahara,
K Katayama,
T Itamoto,
Y Okamoto,
H Nakahara,
S Yoshioka,
E Ono,
K Dohi,
M Kitamoto,
T Nakanishi,
K Moriwaki, K Shiroyama,
O Yuge
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ABSTRACT: Thoracoscopic microwave coagulation therapy (MCT) is a new therapeutic approach for hepatocellular carcinoma (HCC) in segments VII and VIII, which allows minimal access to the tumor and complete tumor ablation. In this study, four patients with HCC in segments VII and VIII underwent thoracoscopic MCT as a less invasive therapeutic option due to advanced liver cirrhosis and/or severe complications. Tumor sizes ranged from 15 to 30 mm in diameter and the tumors were well differentiated in 2 patients, moderately in one and poorly in one patient. Microwave irradiation was performed at an 80 W output with a 60-sec duration via a thoracoscopic route and the total duration ranged from 4 to 24 min (mean: 17 min). Patients recovered rapidly to preoperative conditions and no mortality was occurred. Complications were observed in one patient, including pleural effusion and fever elevation, but were cured conservatively. Postoperative computed tomography (CT) showed complete tumor ablation with a cancer-free margin, which is thought to be equivalent to a limited hepatic resection. This preliminary study suggests that thoracoscopic MCT might be a new, less invasive option providing a cure for HCC in segments VII and VIII in patients with advanced liver cirrhosis and severe complications.
Hiroshima journal of medical sciences 10/1998; 47(3):125-31.
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ABSTRACT: Blood flow velocity in the vertebral artery was measured using transcranial Doppler sonography during sevoflurane anesthesia in 12 patients in the knee-chest position. The correlation between mean arterial blood pressure (MBP) and mean blood flow velocity in the vertebral artery (Vmean) was significant in each patient. Normalized data expressed as a percentage of the individual arithmetic means permitted a composite analysis of data from all patients. Linear regression of normalized MBP (%MBP) on normalized Vmean (%Vmean) showed %Vmean = 24.8 +/- 0.75 %MBP (r = 0.78, P < 0.01). The results of the present study suggest that fluctuations in systemic blood pressure may lead to fluctuations in cerebral blood flow. Therefore, the use of sevoflurane anesthesia must be accompanied by careful management of blood pressure during surgery.
Masui. The Japanese journal of anesthesiology 11/1994; 43(10):1515-9.
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ABSTRACT: A retrospective study was conducted on the cause of hypotension during spinal anesthesia and also on the relation between the level of anesthesia and the hypotension. Two hundred twenty three patients who had received spinal anesthesia for gynecological surgery were divided into two groups. Group I consisted of 87 patients with a significant decrease in blood pressure, while group II consisted of 136 patients with no significant decrease in blood pressure. First, the age, dosage of spinal anesthesia, amount of preoperative transfusion, and level of spinal anesthesia were reviewed and compared between the group I and II. Next, all the patients were classified by the level of spinal anesthesia, and the degree of decrease in blood pressure and the frequency of a significant decrease in blood pressure were examined by each level of spinal anesthesia. Only the level of spinal anesthesia was found to differ significantly between the group I and II. The degree of hypotension was greater at higher levels of spinal anesthesia. More than 50% of the patients with T5 or higher levels of anesthesia had a significant decrease in blood pressure. We conclude that the cause of the significant decrease in blood pressure during high spinal anesthesia is in most part due to the blockade of the cardiac sympathetic nerve.
Masui. The Japanese journal of anesthesiology 06/1994; 43(5):697-701.
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ABSTRACT: We experienced a case of intermittent Wolff-Parkinson-White (WPW) syndrome following spinal anesthesia. This patient had neither any past history of cardiac symptoms nor any abnormal finding in the preoperative electrocardiogram. Soon after spinal anesthesia, the level of anesthesia spread to C6. Both abbreviated PR intervals and delta waves characteristic of WPW syndrome appeared on the electrocardiogram monitor. These abnormal wave-forms continued throughout the operation, but disappeared after three days. This case was diagnosed as intermittent WPW syndrome based upon these observations. High spinal anesthesia effectively blocks the cardiac sympathetic nerve and suppresses the normal atrioventricular conduction. Further, conduction by the accessory pathway is facilitated by the relative excitement of parasympathetic nerve. In the present case, the conduction by the accessory pathway, which had originally been very poor, was transiently promoted by the above-mentioned mechanism, and abnormal wave-forms characteristic of WPW syndrome appeared temporarily in the electrocardiogram.
Masui. The Japanese journal of anesthesiology 05/1994; 43(4):584-8.
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ABSTRACT: This study was undertaken in order to clarify the influence of acute hepatic blood flow occlusion on arterial blood ketone body ratio (AKBR) and systemic hemodynamics. Ten patients for hepatectomy were divided into two groups. Group I was composed of five patients who had clamping of total hepatic blood flow (Pringle's method), and Group II was composed also of five patients who had clamping of the right hepatic artery and portal vein during operation. Ten minutes after clamping blood flow, AKBR decreased significantly in both groups, and a marked reduction in AKBR was observed in group I. During occlusion, cardiac output was reduced significantly, and immediately after declamping, mean arterial blood pressure and systemic vascular resistance index (SVRI) decreased significantly. These changes in hemodynamics in group I were larger than those of the other group. A larger reduction in AKBR was observed during occlusion, and the greater change in SVRI appeared after declamping blood flow. These findings suggest that in the cases with hepatic blood flow occlusion, especially total occlusion, a special attention should be paid to mitochondrial liver dysfunction and hemodynamic changes associated with acute hepatic blood occlusion.
Masui. The Japanese journal of anesthesiology 04/1993; 42(3):382-6.
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ABSTRACT: Postthoracotomy pain syndrome is generally considered to be neuropathic pain due to intercostal nerve injury. However, nonneuropathic pain can also occur following thoracic surgery. We present a series of cases with postthoracotomy pain syndrome in which myofascial pain was thought to be a causative component of postthoracotomy pain syndrome.
Twenty-seven patients (17 men and 10 women) were treated with trigger point injections, intercostal nerve blocks, and/or epidural blocks. Clinical criteria were used to diagnose the myofascial pain. A visual analogue scale was used, and sensory disturbances were recorded before and after treatment. A trigger point in a taut muscular band within the scapular region, which we diagnosed as myofascial pain, was observed in 67% of the patients. The existence of this trigger point significantly increased the rate of success for the treatments.
Postthoracotomy pain may result, at least in part, from a nonneuropathic origin (myofascial pain). It is recommended that each patient be examined in detail to determine whether there is a trigger point in a taut muscular band within the scapular region. If found, this point is suggested as a good area for anesthetic injection.
Regional Anesthesia and Pain Medicine 25(3):302-5. · 4.08 Impact Factor
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ABSTRACT: BACKGROUND-MATERIALS: Dopamine is known to induce hyperglycemia in both animals and man, but the precise mechanism by which this occurs has not yet been fully clarified. We investigated whether dopamine has any direct effect on glucose release from hepatocytes through the glycogenolytic and/or gluconeogenic pathways, and at the same time determined the main type of adrenergic receptor involved in glucose release, using primary cultured rat hepatocytes. METHODS-RESULTS-CONCLUSIONS: Glycogen-rich and glycogen-depleted hepatocytes were prepared in order to study glycogenolytic and gluconeogenic glucose release, respectively. After exchanging the culture medium for Hanks-HEPES buffer containing no glucose (but with fructose for the glycogen-depleted hepatocytes), dopamine was added to these two groups of hepatocytes at final concentrations of 0, 10(-7), 10(-6), 10(-5), and 10(-4) M. The amount of glucose released from the hepatocytes 30 minutes after adding dopamine at concentrations of 10(-5) and 10(-4) M were significantly higher than those obtained at dopamine concentrations of 0, 10(-7) and 10(-6) M. Tne increase in glucose release at the dopamine concentration of 10(-5) M was inhibited by 10(-5) M propranolol, but not by 10(-5) M phentolamine. Our findings suggest that dopamine has a direct effect on hepatocytes, increasing glucose release via both the glycogenolytic and gluconeogenic pathways and mediated by beta-adrenergic receptors.
In vivo (Athens, Greece) 12(5):527-9. · 1.17 Impact Factor
