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H Hirasawa

Publications and source records attributed to H Hirasawa.

At least 19 recordsLinked to original sources
PubMed1992

An initial comparison of intensive care in Japan and the United States.

OBJECTIVE: The objective of this study was to compare the utilization of, and outcome from, critical care services in selected medical centers providing secondary and tertiary care in the United States and Japan. DESIGN: Prospective data collection on 1,292 patients from each of the participating Japanese study hospitals in 1987 to 1989 and compared with the 5,030 patients in the United States 1982 Acute Physiology and Chronic Health Evaluation (APACHE II) database used to develop the APACHE II equation. Detailed organizational characteristics of the participating ICUs and hospitals were also obtained. SETTING: Data collection took place in the ICUs of 13 U.S. hospitals and six Japanese hospitals. PATIENTS: Data were collected on consecutive, unselected patients from medical, surgical, and mixed medical/surgical critical care units, with a spectrum of medical and surgical diagnoses. MEASUREMENTS AND MAIN RESULTS: U.S. and Japanese ICUs have a similar array of diagnostic and therapeutic modalities. Only 2% (range 0.6 to 3.5) of beds in Japanese hospitals were designated to intensive care. The organization of the Japanese and U.S. ICUs varied by hospital. There were significantly fewer women admitted to Japanese ICUs and a substantially lower proportion of low-risk-of-death patients. Despite a rapidly aging population, there were relatively fewer elderly patients with chronic health ailments in the Japanese ICU population (8%) compared with the U.S. cohort (18%). CONCLUSIONS: In this sample of hospitals, similar high-technology critical care is available in the United States and Japan. Variations in utilization between the two countries represent differences in case mix and bed availability. The APACHE II equation stratified patients in the Japanese patient cohort across the full spectrum of increasing severity of illness.

Chi-Square Distribution↗
PubMed1992

[Amino acids metabolism and nutritional support in acute renal failure].

It has been claimed that conventional essential amino acid (EAA) solution may give rise to adverse effects such as hyperammonemia, in acute renal failure (ARF). On the other hand the majority the ARF treated recently have been complicated by multiple organ failure (MOF). These data indicate that a new regimen in nutritional support should be applied to those patients. A new amino acid solution for renal failure, containing not only EAA but also branched chain and non-essential amino acids, has been developed. We administered this solution as total parenteral nutrition (TPN) to ARF patients complicated by MOF. Continuous hemodiafiltration is simultaneously applied to remove excess water. The nutritional status and the deranged aminogram are improved by this treatment. We believe that an ARF patient complicated by MOF should be nutritionally supported with this new regimen.

Acute Kidney Injury↗
PubMed1991

Assortment of posthepatectomy hyperbilirubinemia by the occurring time with reference to indication of plasma exchange.

This study was undertaken to assort the group of posthepatectomy hyperbilirubinemia by occurring time for helping elucidate its indication of plasma exchange (PE). PE was carried out for 14 cases among 198 hepatectomized patients. The 14 cases were classified for 3 groups due to the period between operation and PE. 1: Early type (less than 2 weeks), 2:Intermediate type (2 less than-less than 8 weeks), 3: Late type (greater than 8 weeks). The results were as follows. Number (liver cirrhosis (LC)) [table: see text]. The effect was expected for the early groups since PE would remove overload against the regenerating residual liver. However, there were no survival cases among the early group or LC group. These results suggest that PE may be effective for the slowly increasing hyperbilirubinemia in not cirrhotic patients and that the state of hyperbilirubinemia is the terminal stage for LC patients even under the particular situation such as posthepatectomy.

Hepatectomy↗
PubMed1991

[Hemopurification in the management of ARDS complicating multiple organ failure].

In the field of critical care medicine, it has been claimed that ARDS often develops as a part of multiple organ failure (MOF). Since multi-modality therapy is necessary in the management of MOF, it is also mandatory even in the management of ARDS. Among the various therapeutic approaches for patients with MOF, hemopurification is one of the most effective therapeutic tools. Various hemopurification methods such as hemodialysis, peritoneal dialysis, hemoadsorption, hemofiltration and plasma exchange have been applied in the management of MOR. However, our recent experiences suggest that continuous hemofiltration (CHF) and/or continuous hemodiafiltration (CHDF) are safest, most easily performed and effective hemopurification in the management of ARDS/MOF. The efficacy of hemopurification in the management of ARDS is summarized as follows. 1) Removal of humoral mediators and causative substances of ARDS following insults such as sepsis and trauma. 2) Treatment of pulmonary interstitial permeability edema which has been claimed to be one of the most important pathological conditions in ARDS. 3) Removal of excess water given as carrier in IVH solution and accumulating in the body. 4) Immunomodulation which has also been considered to be necessary in the treatment or prevention of ARDS.

Hemofiltration↗
PubMed1990

[A study on the utility of flumazenil for patients in the ICU].

Flumazenil, a specific antagonist of benzodiazepines, was administered to adult patients receiving treatment at ICU, and its utility to hasten recovery from sedation was evaluated in 40 patients and its usefulness for differential diagnosis of sedated conditions was also evaluated in 5 patients. The efficacy rate for recovery from sedation induced by benzodiazepines was 85.0%. Moreover, flumazenil was considered to be useful for differentiation of sedated conditions when causes were unknown. Depression of respiration improved in association with improvement of consciousness level. In some patients an elevation in blood pressure was also observed with improved consciousness.

Adult↗
PubMed1990

[Clinical study of postoperative delirium in the elderly].

It is said that the surgery is often followed by a delirious state (postoperative delirium) in the elderly, but there are few reports on detailed studies of this condition. To determine the frequency with which postoperative delirium occurs in the elderly, its main causes and clinical characteristics, etc., the author made a clinical study of 127 patients, aged 60 years and over, who were about to undergo operations. In this study, polygraphy was used in a postoperative electrophysiological study. Of the 127 patients, delirium was noted in 20 (15.7%), there being little difference according to age or sex in the rate of occurrence, but in patients with malignancy, the rate was appreciably higher. Delirium became apparent between one day and two days after the operation and lasted for up to 6 days. We classified the types of delirium into the following three on the basis of clinical symptoms: hallucination type (5 cases), confusion type (8 cases) and hallucination-confusion type (7 cases). The possible causes of postoperative delirium include the patient's condition as shown in the pre and postoperative polygrams, the invasive effects of anesthesia and surgery (surgical procedures, length of time under anesthetic, time required for the operation, amount of blood lost and amount of blood received by transfusion, etc., the serum albumin before surgery, WBC after surgery, %delta PaO2, and whether ICU was used or not, and so on. Quite often in patients with postoperative delirium, the pre and postoperative polygrams show slow abnormality in the EEGs before surgery, and the eye movements of R(++)/RS pattern in the EOGs before and after surgery. Slow abnormality in the EEGs was much more frequently seen in the confusion type and hallucination-confusion type patients than in the hallucination type. In view of these results, we feel that any consideration of the occurrence of delirium must include the following factors. In cases where the effects of surgical invasion and metabolic disorder are greater, quite often consciousness is clouded following surgery. If the eye movements of R(++)/RS pattern is shown in the EOGs before surgery, as the clouding of consciousness is alleviated after the operation, considerable activity takes place in some of the brain's functions (those related to anxiety and tension, etc.) and a state of dissociation occurs in brain functions which would normally undergo integrated changes. It was thought that this dissociated state is manifested as the delirium.

Age Factors↗
PubMed1990

[Parasomnia associated with abnormal REM sleep in the aged].

Three aged patients (age 63-78 years) had 3-15-year histories of abnormal behaviors during nocturnal sleep. These three patients presented no other psychiatric problems. Polysomnographic recordings were carried out from 1-3 nights after adaptation. The patients were simultaneously monitored via a video system during the recording period. Various nocturnal behaviors, including laughing, weeping, the shaking of arms and getting up were detected during these recordings. These behaviors appeared exclusively during REM periods which were associated with a large amount of abnormal REM sleep lacking muscle atonia (d-STREM with EMG). NREM sleep architecture was intact and %SWS was within the normal limits per age for all the patients. The patients, manifesting such abnormal behaviors during sleep, could be aroused completely with awakening stimuli, and could recall in detail their unpleasant dreams. Two of the three were treated with clonazepam (0.5-1 mg/day) which immediately decreased the abnormal behaviors during sleep. Polysomnographic studies after the treatment showed a marked decrease in the d-STREM with EMG. The above results indicate that these abnormal behavior during nocturnal sleep were closely linked to d-STREM with EMG. And the administration of clonazepam not only led to an amelioration in the abnormal behaviors but also in the polysomnographic pathology. It is concluded that parasomnia in the aged is characterized by behavioral manifestations of the dreaming due to dysfunctions of the muscle atonia system.

Aged↗
PubMed1990

Hydrostatic pressure versus osmotic pressure in the development of vasogenic brain edema induced by cold injury.

The role of hydrostatic pressure and osmotic pressure gradient in the development of vasogenic brain edema induced by cold lesion made in the parietal cortex was studied in cats under ketamine anesthesia and blood pressure monitoring. The animals were divided into a hypertensive group and a normotensive group and were kept alive for 6 hr. The brain was removed and cut coronally at the lesion for tissue sampling from various areas of edematous white matter to measure both the SG and the amount of extravasated serum albumin in the same samples. Our result showed that the edema confined in the area containing extravasated serum albumin and the increase of water content correlated linearly with the amount of extravasated serum albumin both in the normotensive group and hypertensive group. However, the slope of the regression line indicated albumin content in the edema fluid was significantly different between the two groups. The slope became lower as the MABP during the experiment became higher, indicating that protein concentration in the edema fluid became lower when hypertension sustained. Thus, both hydrostatic and osmotic pressure gradient regulate the extravascular accumulation of edema fluid in the cold lesion edema.

Albumins↗
PubMed1989

[Cellular metabolic consideration in the pathophysiology and the treatment of shock].

Shock is defined as the summation of cellular dysfunction and resultant impairment of the function in various organs. The typical such condition can be observed in shock-induced multiple organ failure (MOF). Therefore, the most effective and fundamental management against shock should be the improvement of such cellular dysfunction. The present study was undertaken to investigate the cellular metabolic abnormalities and their treatment in shock-induced MOF patients. The severity of cellular damage was evaluated with cellular injury score (CIS), which can be calculated by scoring the values of osmolality gap, arterial ketone body ratio and blood lactate. The CIS correlated significantly with the outcome and the number of failing organs in the MOF patients. Since tissue hypoxia and humoral mediator have been considered to play a key role in the development of such cellular dysfunction, protease inhibitor was administered to such patients and oxygen metabolism was improved with catecholamine. The CIS improved among survived MOF patients following those treatments. These results suggest that the shock-induced MOF is the summation of the cellular dysfunction which can be assessed with the CIS, and that such cellular dysfunction could be improved through the therapeutic approach to the humoral mediators and/or tissue oxygen metabolism.

Humans↗
PubMed1989

46,XY pure gonadal dysgenesis with gonadoblastoma.

A case of gonadoblastoma on one side in streak gonads in a phenotypic female with chromosomal 46,XY pattern is described. The histopathological resemblance between gonadoblastoma and sex cord tumor with annular tubules is discussed. The high serum testosterone level, being unrelated to the administration of human chorionic gonadotropin is valuable for the diagnosis of gonadoblastoma in an individual with dysgenetic gonads. Gonadoblastoma is frequently very small in size and is located in ectopic regions, so that laparotomy with biopsy has been stressed. The hormonal supplement for a postgonadectomized girl is also discussed.

Adolescent↗