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Biomedical subjects

K Shingu

Publications and source records attributed to K Shingu.

At least 55 records · Page 3Linked to original sources
PubMed2001

[A case of atropine-resistant bradycardia in a patient on long-term lithium medication].

A 44-year-old woman was scheduled for laparoscopic cholecystectomy and partial thyroidectomy. She had received lithium, 400-1200 mg daily, and other antidepressants for 10 years for her depressive disorder. Preoperative examination revealed a swelling of the right thyroid associated with hypothyroidism. Her heart rate was in the range of 45-70 min-1 preoperatively. After induction of anesthesia with propofol 50 mg, and fentanyl 100 micrograms, heart rate decreased to 36 min-1 and remained low after tracheal intubation. Atropine sulfate 1.1 mg in divided doses, and ephedrine 4 mg i.v. did not change the heart rate. However, a bolus of isoproterenol 0.02 mg i.v. increased the heart rate to 95 min-1. We suspect that atropine-resistant bradycardia was due to sinus node dysfunction produced by interaction of chronic lithium treatment, fentanyl and propofol. Therefore, an intractable sinus node dysfunction may occur in a patient in whom lithium is given chronically, particularly in whom hypothyroidism is associated. In such a patient, a beta-adrenergic stimulant may be effective in treating bradycardia.

Adult↗
PubMed2000

The effect of ketamine isomers on both mice behavioral responses and c-Fos expression in the posterior cingulate and retrosplenial cortices.

Ketamine, a non-competitive NMDA receptor antagonist, is a racemic mixture. S(+) ketamine is presumed to be more potent as an anesthetic than R(-) ketamine, and causes less postanesthetic stimulation of locomotor activity than R(-) ketamine in animals at equihypnotic doses. In the present study, we investigated the effect of S(+), R(-), and racemic ketamines on mice behavioral responses and c-Fos expression in the posterior cingulate and retrosplenial cortices (PC/RS), which are suggested to be the brain regions responsible for NMDA-receptor-antagonist-induced psychotomimetic activity. Ataxia and head weaving and c-Fos expression in the PC/RS were significantly more induced by both S(+) and racemic ketamines than by R(-) ketamine at the same dose. S(+) ketamine induced significantly more potent ataxia than racemic ketamine at the same dose. Ketamine-induced c-Fos expression in the PC/RS correlated well with the intensity of behavioral responses. These results imply that R(-) ketamine is weaker than both S(+) and racemic ketamines in a psychotomimetic effect. Also, S(+) ketamine is more potent than racemic ketamine in a psychotomimetic effect and possibly in an anesthetic effect. They also indicate that PC/RS is at least one of the specific brain regions responsible for ketamine-induced behavioral responses in animals and a psychotomimetic activity in humans.

Animals↗
PubMed2000

Intubating laryngeal mask for fibreoptic intubation--particularly useful during neck stabilization.

PURPOSE: To assess the ease of fibrescope-assisted tracheal intubation while the patient's head and neck were placed in the neutral or the manual in-line position, and to determine if the intubating laryngeal mask facilitated fibreoptic intubation in these positions. METHODS: In 84 patients, the patient's head and neck were placed in the neutral position (pillow placed under occiput), and in another 40 patients the head and neck were stabilized by the manual in-line method (no pillows under occiput). In both groups, after induction of anesthesia with 2.0-2.5 mgxkg(-1) propofol, 50-100 microg fentanyl and 1.0 mgxkg(-1) vecuronium, patients were allocated randomly into two groups: in Group C tracheal intubation was attempted using only a fibrescope, whereas in Group L fibreoptic intubation through the intubating laryngeal mask was attempted. RESULTS: In group C the success rate of fibreoptic tracheal intubation within two minutes was higher in the neutral position (31 of 42 patients (73%)) than in the manual in-line position (8 of 20 patients (40%)). In contrast, in group L the success rate was similar between the two positions. Tracheal intubation was easier in group L than in group C (P < 0.01 or 0.001) and the time for intubation was shorter in group L than in group C in both head and neck positions. CONCLUSIONS: Fibreoptic tracheal intubation was more difficult in the manual in-line position than in the neutral position. The intubating laryngeal mask facilitated fibreoptic intubation in both positions.

Anesthesia, Inhalation↗
PubMed2000

Failed tracheal intubation using a laryngoscope and intubating laryngeal mask.

PURPOSE: To report unexpected failed tracheal intubation using a laryngoscope and an intubating laryngeal mask, and difficult ventilation via a facemask, laryngeal mask and intubating laryngeal mask, in a patient with an unrecognized lingual tonsillar hypertrophy. CLINICAL FEATURES: A 63-yr-old woman, who had undergone clipping of an aneurysm seven weeks previously, was scheduled for ventriculo-peritoneal shunt. At the previous surgery, there had been no difficulty in ventilation or in tracheal intubation. Her trachea remained intubated nasally for 11 days after surgery. Preoperatively, her consciousness was impaired. There were no restrictions in head and neck movements or mouth opening. The thyromental distance was 7 cm. After induction of anesthesia, manual ventilation via a facemask with a Guedel airway was suboptimal and the chest expanded insufficiently. At laryngoscopy using a Macintosh or McCoy device, only the tip of the epiglottis, but not the glottis, could be seen, and tracheal intubation failed. There was a partial obstruction during manual ventilation through either the intubating laryngeal mask or conventional laryngeal mask; intubation through each device failed. Digital examination of the pharynx, after removal of the laryngeal mask, indicated a mass occupying the vallecula. Lingual tonsillar hypertrophy (1 x 1 x 2 cm) was found to be the cause of the failure. Awake fibrescope-aided tracheal intubation was accomplished. CONCLUSIONS: Unexpected lingual tonsillar hypertrophy can cause both ventilation and tracheal intubation difficult, and neither the laryngeal mask nor intubating laryngeal mask may be helpful in the circumstances.

Anesthesia, Inhalation↗
PubMed2000

The likely transformation of papillary thyroid carcinoma into anaplastic carcinoma during postoperative radioactive iodine-131 therapy: report of a case.

We report herein a case of papillary carcinoma which appeared to transform into anaplastic carcinoma during postoperative radioactive iodine-131 (131I) therapy. A 67-year-old man who was diagnosed as having papillary thyroid carcinoma with bilateral neck lymph node involvement and multiple lung metastases underwent total thyroidectomy prior to 131I therapy. Immediately after a second course of 131I therapy, the patient complained of right neck pain and swelling, and a biopsy of the swollen neck lymph node was taken. Histologic examination of this biopsy specimen revealed anaplastic carcinoma. With p53 immunohistochemical staining, both the primary tumor and the biopsy specimen were positive. We speculate that first, some DNA damage in tumor cells was induced by the initial 131I therapy, but neither DNA repair nor cell apoptosis occurred because the p53 gene was already mutated; then further DNA damage was induced by the second 131I therapy, leading to anaplastic transformation.

Aged↗
PubMed2000

Solitary brain metastasis from papillary thyroid carcinoma in a patient with depression: report of a case.

Papillary carcinoma of the thyroid is a common thyroid malignancy with a relatively good prognosis. However, distant metastases may develop and become threatening, particularly to older patients, in a more aggressive manner. We report herein the clinical, radiological, and pathological findings of a patient with papillary thyroid carcinoma who had a solitary cerebral metastasis. The patient had been suffering from depression and had already undergone a hemithyroidectomy for primary thyroid carcinoma, and was known to have metastatic thyroid carcinoma of the lungs and bone. After the removal of the remnant thyroid gland prior to radioiodine (131I) therapy, he developed additional problems related to depression. Electroencephalography played an important role in identifying suspected brain metastasis and computed tomography demonstrated a space-occupying lesion in the left cerebral hemisphere. Consequently, an early removal of intracranial mass could be performed without any further life-threatening complications. Moreover, after removal of the brain mass the patient's depression improved immediately without the use of any antidepressants. This case report indicates the possibility that a patient's depression might be associated with brain metastasis from papillary thyroid carcinoma, and also suggests that an early diagnosis with the appropriate surgical management of a brain metastasis followed by radioiodine therapy could be valuable for achieving a prolonged disease-free period.

Bone Neoplasms↗
PubMed2000

Microcapsulated parathyroid tissue in vitro.

Ideally, microcapsules will make it possible to transplant parathyroid tissue for allo- and xenotransplantation in hypoparathyroid patients. In this study, parathyroid tissues capsulated by polyelectrolyte complex were evaluated in vitro. Hormone secretion ability was significantly (P < 0.001) greater in sediment than in supernatant. There was no difference in hormone secretion ability between the parathyroid tissue thawed at room temperature and the tissue thawed in a bath at 37 degrees C. Both non-capsulated and capsulated parathyroid tissues were incubated for three weeks. The ability of capsulated parathyroid to secrete hormones in vitro was reduced gradually and disappeared within three weeks. There are still several problems to be solved before the clinical application of parathyroid allotransplantation using microcapsulation.

Cryopreservation↗
PubMed2000

Ease of tracheal intubation through the intubating laryngeal mask during manual in-line head and neck stabilisation.

We studied 40 anaesthetised and paralysed patients, in a randomised manner, to compare the ease of tracheal intubation either using a Macintosh laryngoscope and gum elastic bougie (group C) with the ease of tracheal intubation through the intubating laryngeal mask using a fibreoptic bronchoscope (group L), during manual in-line stabilisation of the patient's head and neck. In both groups, a maximum of 120 s was allowed for attempts at tracheal intubation. The ease of placement of the intubating laryngeal mask or tracheal intubation was assessed using a 100-mm visual analogue scale (VAS). In patients in whom tracheal intubation succeeded, time for intubation was measured. The intubating laryngeal mask was placed successfully in 19 of 20 patients, with the median VAS of 18 mm (95% CI: 13-32 mm). The success rate of tracheal intubation in group L (17 patients) was significantly higher than in group C (nine patients) (p < 0.01), tracheal intubation in group L was significantly easier than intubation in group C (p < 0.001; 95% CI for difference in VAS: 18-68 mm) and time taken for tracheal intubation was significantly shorter in group L than in group C (95% CI for difference: 8-50 s).

Adult↗
PubMed2000

Efficacy of the laryngeal tube during intermittent positive-pressure ventilation.

We studied the efficacy of the laryngeal tube (VBM, Germany) during intermittent positive-pressure ventilation in 50 patients. After induction of anaesthesia and neuromuscular blockade, a size 4 laryngeal tube was inserted for patients of height 155 cm or greater. After insertion of the laryngeal tube, its pharyngeal and oesophageal balloons were inflated to an intracuff pressure of 60 cmH(2)O. An Ambu self-inflating bag was attached to the laryngeal tube and the lungs were ventilated manually at 15 breath.min(-1). It was possible to ventilate the lungs at the first attempt in 47 patients (94%). The airway pressure at which air leaked around the laryngeal tube exceeded 18 cmH(2)O in 41 patients (82%), and was > 30 cmH(2)O in 25 (50%). Median [interquartile range (range)] leak pressure was 30 [20-30 (6 to > 30)] cmH(2)O. Median [interquartile range (range)] tidal volume was 587 [533-653 (133-800)] ml or 8.8 [8.2-10.6 (1.9-12.6)] ml.kg(-1). We conclude that the laryngeal tube has a potential role in airway management during intermittent positive-pressure ventilation for anaesthesia or cardiopulmonary resuscitation.

Adult↗
PubMed2000

Clinicopathological characteristics of atypical cystic duct (ACD) of the breast: assessment of ACD as a precancerous lesion.

To clarify the clinicopathological features of an atypical cystic duct (ACD) as defined by Tsuchiya's criteria as a precancerous lesion of the breast, we used 200 whole mammary gland serial sections of breast cancer. Forty-four (22%) of the 200 breast cancer patients had ACD breast lesions. The frequency of patients with ACD increased in premenopausal women (P = 0.001). There was no correlation between the ACD-present group and the ACD-absent group for immunohistochemical status of the estrogen receptor (ER), progesterone receptor (PgR), p53, or c-erbB2; Ki-67 labeling index of cancer tissues; size of tumor, or lymph node metastases. A number of ACD lesions displayed continuity to cancer lesions. In 500 serial sections of a paraffin-embedded tissue of a ACD case at 3 microm intervals, an apparent transition from ACD into ductal carcinoma in situ was observed. Immunohistochemical analysis using alpha-smooth muscle actin showed that myoepithelial cells of ACD stained strongly, and their nuclei and cytoplasm were thinning. In 16 of the 44 (36%) ACD-present patients, carcinoma cells stained positive for p53. Within those 16 cases, 12 cases (75%) were positive for p53 in ACD lesions. There was a significant correlation between the expression of p53 protein in malignant cells and ACD (P = 0.001). All 44 ACD lesions had no staining of c-erbB2, regardless of staining in malignant lesions. The mean Ki-67 labeling index of ACD lesions was low (0.3%), suggesting that ACD had a low proliferative rate. We suggest that ACD is the precancerous breast lesion because of a histologic continuum between ACD and malignancy, and because of p53 protein expression in ACD.

Adult↗
PubMed2000

Increased chromatid-type chromosomal aberrations in mouse m5S cells exposed to power-line frequency magnetic fields.

PURPOSE: To investigate the induction of chromosomal aberrations in mouse m5S cells after exposure to power-line frequency magnetic fields (extremely low frequency magnetic fields; ELFMF) at high-flux densities. MATERIAL AND METHOD: m5S cells were either untreated or pretreated during the G1 phase with mitomycin C (MMC, 1 microM) for 1 h or 3 Gy X-rays, and then exposed to ELFMF at three different flux densities (5 and 50 mT at 60 Hz, 400 mT at 50 Hz) for 40 h. Unexposed control cells were incubated for the same period in a conventional CO2 incubator. Chromosomal aberrations were analysed in the first post-treatment metaphases. Cell kinetics were assessed by DNA flow cytometry and the mitotic index. RESULTS AND CONCLUSIONS: ELFMF enhanced the formation of spontaneous and MMC- or X-ray-induced chromosomal aberrations, in a flux-density-dependent manner. Statistically significant increases in the frequency of chromosomal aberrations were observed in cells exposed to 400 mT ELFMF with respect to unexposed controls. The aberrations induced by ELFMF were mostly chromatid-type, not chromosome-type. The cells exposed to 400 mT ELFMF exhibited a three-fold higher level of chromatid-type aberrations than did the unexposed cells. Flow cytometric and mitotic index analyses revealed that the S or G2 arrest following MMC or X-irradiation was more profound in ELFMF-exposed cells than in unexposed cells. Our results suggest that ELFMF can interfere with post-replication repair, resulting in increased levels of chromatid-type chromosomal aberrations induced spontaneously and by DNA damaging agents.

Animals↗