Delayed kinking of the tracheal tube during neck flexion in a paediatric neurosurgical patient.
Explore the source record for details and available documents.
Child↗
Biomedical subjects
K Shingu
Publications and source records attributed to K Shingu.
Anaesthesia in a child with deletion 13q syndrome.
Explore the source record for details and available documents.
Abnormalities, Multiple↗
Difficult airway management in a baby with Axenfeld-Rieger syndrome.
Explore the source record for details and available documents.
Abnormalities, Multiple↗
[Total intravenous anesthesia with propofol is advantageous than thiopental-sevoflurane anesthesia in the recovery phase].
A randomized, prospective and multi-institutional study was performed to investigate whether different anesthetic methods affected differently the quality of recovery from anesthesia. Two hundred and eleven patients were allocated to one of two groups; total intravenous anesthesia (TIVA) with propofol and fentanyl (group P, n = 107) and general anesthesia with thiopental, sevoflurane and nitrous oxide (group TS, n = 104). The rapidity of emergence from anesthesia and postoperative incidence of nausea, vomiting, and headache were compared between the two groups. The group P showed significantly shorter emergence times for verbal command responses (7.4 +/- 5.6 min), extubation (10.0 +/- 6.0 min) and orientation (13.1 +/- 7.8 min) than the group TS (9.1 +/- 5.0 min, 11.7 +/- 6.2 min, 16.4 +/- 7.9 min, respectively). The postoperative incidence of vomiting was not significantly different between the two groups (3.7% in the group P and 9.6% in the group TS), but the postoperative incidences of nausea and headache were significantly lower in the group P compared with the group TS (10.3%, 17.8%, respectively in the group P and 34.6%, 29.8%, respectively in the group TS). We conclude that TIVA with propofol is advantageous than thiopental-sevoflurane anesthesia in the recovery phase.
Adult↗
Hoarseness after cardiac surgery.
OBJECTIVE: To investigate the incidence, severity, and duration of hoarseness after adult cardiac surgery and to examine movement of the endotracheal tube (ETT) during neck extension for sternotomy. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Seventy-two adults undergoing elective cardiac surgery (assessment of hoarseness was completed in 68). INTERVENTIONS: An ETT with an internal diameter of 8.0 mm and 7.5 mm was used for men and women, respectively. After surgical positioning, the ETT was placed with its tip about 3 cm above the carina. MEASURES: ETT migration during positioning for sternotomy was measured using a fiberoptic bronchoscope. Hoarseness was examined at 6-12 hrs after extubation. RESULTS: The ETT moved away from the carina during surgical positioning and the migration was 11+/-6 (1-27) mm [mean+/-SD (range)]. Hoarseness occurred in 32% of the patients (22/68), of whom five (23%) were grade 1 on a four-point scale (0-3), 14 (64%) were grade 2, and three (14%) were grade 3 (aphonic). The duration of hoarseness was 4+/-3 (1-14) days, except in one patient with left vocal cord paralysis (60 days). When this patient was excluded, intubation time was an independent predictor of the severity of hoarseness (p=0.0001). CONCLUSIONS: Hoarseness after cardiac surgery is common. Most hoarseness is transient and its severity is predicted by duration of intubation. Positioning for sternotomy displaces the ETT cuff away from the carina. This may cause persistent hoarseness because displaced cuff from trachea to larynx may damage the recurrent laryngeal nerve or vocal cords.
Cardiac Surgical Procedures↗
A Case of Occult Breast Cancer With Paraneoplastic Polyneuropathy.
We encountered a very rarc case of occult breast cancer associated with paraneoplastic sensory polyneuropathy. A 59-year-old woman was admitted to our hospital complaining of numbness in all extremities, ataxia of left extremities and a tumor in the left axilla. From the neurological findings, a malignant tumor was suspected. The immunohistochemical analysis of the axillar swollen lymph node revealed metastasis from breast cancer and confirmed the primary lesion. On a preoperative diagnosis of suspected occult breast cancer, left mastectomy and resection of left axillar lymph nodes were performed. Furthermore, immunohistochemical staining of sural nerves and Western blot analysis of the serum of this patient showed the loss of axons and the presence of antineural antibody in the seurm. Immunological response was considered to be the remote effector system between the breast cancer and sensory polyneuropathy in this disorder.
Journal Article↗
Postoperative outcome of insufficient surgery for small differentiated thyroid carcinoma.
We performed conservative surgery for small differentiated thyroid carcinoma, but also inadvertently carried out minimal insufficient surgery, such as enucleation (Ex) or partial lobectomy (pLx) without regional node dissection for malignant thyroid nodules. In this study, the long-term postoperative outcome after such insufficient surgical treatment was evaluated. Of 348 patients with differentiated thyroid carcinoma who underwent initial surgery between 1953 and 1976, 84 underwent either Ex or pLx and their records are herein reviewed. The frequency of recurrence from the remnant gland or regional lymph nodes was examined in relation to the tumor diameter (< or = 1.0 cm, tis; 1.0 cm-2.0 cm, t1; > 2.0 cm, t2). After Ex/pLx, the recurrence rate in the tis group was 13.3% and not significantly different from that (13.6%) in the t1 group. The recurrence rate was notably increased in the t2 group. Moreover, there was no significant difference between the recurrence rate in the tis and t1 groups after Ex/pLx and that after lobectomy with nodal dissection. These results suggest that a reoperative procedure with a more extensive thyroidectomy and neck dissection might not necessarily be required immediately after minimal insufficient surgery is inadvertently carried out in patients with small differentiated thyroid carcinoma measuring 2.0 cm in diameter or less.
Adolescent↗
Germline mutations of the APC gene in two Japanese adenomatous polyposis patients.
Germline mutations of the adenomatous polyposis coli (APC) gene have been reported in patients with familial adenomatous polyposis (FAP) and are believed to be an early event in colorectal carcinoma. We report the results of screening for germline mutations of the APC gene in 4 cases of 2 kindreds using non-radioactive PCR-SSCP (polymerase chain reaction-single strand conformation polymorphism) analysis. The mutation in kindred 1 was a 4 bp deletion at codon 849 in exon 15, resulting in a frameshift leading to truncation of the APC gene product. In kindred 2, a transversion of C to G at codon 2038 was observed, resulting in an amino acid change from leucine to valine. In this case, it is possible to screen presymptomatic diagnosis easily and quickly by digestion with restriction enzyme EcoNI.
Adenomatous Polyposis Coli↗
Characterization of nociceptin hyperalgesia and allodynia in conscious mice.
1. Intrathecal (i.t.) administration of nociceptin and high doses of morphine induced allodynia in response to innocuous tactile stimuli, and i.t. nociceptin evoked hyperalgesia in response to noxious thermal stimuli in conscious mice. Here we have characterized the nociceptin-induced allodynia and compared it with the morphine-induced allodynia and the nociceptin-evoked hyperalgesia. 2. Nociceptin-induced allodynia was evoked by the first stimulus 5 min after i.t. injection, reached a maximum at 10 min, and continued for a 50 min experimental period. Dose-dependency of the allodynia showed a bell-shaped pattern from 50 pg to 5 ng kg-1, and the maximum effect was observed at 2.5 ng kg-1. 3. Morphine-induced allodynia reached the maximum effect at 15 min and declined progressively until cessation by 40-50 min. The dose-response curve showed a bell-shaped pattern, similar to that induced by nociceptin, with a maximum effect at 0.5 mg kg-1, five orders of magnitude higher than that of nociceptin. 4. The allodynia evoked by nociceptin and morphine were dose-dependently blocked by glycine, D(-)-2-amino-5-phosphonovaleric acid (D-AP5, an N-methyl-D-aspartate (NMDA) receptor antagonist), gamma-D-glutamylaminomethyl sulphonic acid (GAMS, a non-NMDA receptor antagonist) and methylene blue (a soluble guanylate cyclase inhibitor), but were not affected by muscimol (a gamma-aminobutyric acidA (GABAA) receptor agonist) and baclofen (a GABAB receptor agonist). 5. Morphine did not inhibit forskolin-stimulated cyclicAMP formation in cultured cells expressing the nociceptin receptor. 6. Nociceptin-induced hyperalgesia was evoked 10-15 min after i.t. injection. Nociceptin produced a monophasic hyperalgesic action over a wide range of doses from 5 fg to 50 ng kg-1. The nociceptin-induced hyperalgesia was blocked by glycine only among the agents examined. 7. None of the pain responses evoked by nociceptin and morphine were blocked by naloxone. 8. These results demonstrate that, whereas the mechanisms of the nociceptin-induced allodynia and hyperalgesia are evidently distinct, they involve a common neurochemical event beginning with the disinhibition of the inhibitory glycinergic response. Morphine may induce allodynia through a pathway common to nociceptin, but the nociceptin receptor does not mediate the action of high doses of morphine.
Animals↗
Stimulative effects of saponin from kikyo-to, a Japanese herbal medicine, on pancreatic exocrine secretion of conscious rats.
Our previous report stated that kikyo-to, a Japanese herbal medicine, consisting of the roots of Platycodon grandiflorum and Glycyrrhiza sp., stimulates the pancreatic exocrine secretion of conscious rats. The present study focused on the effective components of kikyo-to and the mechanism of stimuli to pancreatic secretion of rats. When 10 to 100 mg of platycodin D, a saponin from the root of Platycodon grandiflorum, was intragastrically administered, the pancreatic secretion of rats was stimulated. At the same time, the plasma CCK concentration increased. On the other hand, the stimulative effects of glycyrrhizin, a saponin from the root of Glycyrrhiza sp. were weak compared to platycodin D. The effects of 10 mg/kg of platycodin D on pancreatic secretion were inhibited by loxiglumide (50 mg/kg, i.g.), a CCK receptor antagonist. In contrast, the suppressive effect of atropine (300 micrograms/kg/h, i.v.) on pancreatic secretion was reduced by administering 10 mg/kg of platycodin D. In addition, up to 1 mM of platycodin D did not inhibit the trypsin activities in vitro. In conclusion, kikyo-to serves to stimulate pancreatic exocrine secretion mainly because platycodin D causes gastrointestinal hormones, particularly, CCK to be released from the duodenum.
Animals↗
The effects of atrial natriuretic peptide infusion on hemodynamic, renal, and hormonal responses during gastrectomy.
UNLABELLED: Atrial natriuretic peptide (ANP) antagonizes the reninangiotensin-aldosterone, adrenocorticotropic hormone-cortisol, vasopressin, and endothelin systems. Surgical injury stimulates these systems and causes vasoconstriction and antidiuresis. We assessed the hemodynamic, renal, and endocrine effects of continuous intravenous infusion of ANP in patients anesthetized with sevoflurane undergoing gastrectomy. ANP (0.1 microgram.kg-1.min-1; ANP group, n = 9) or saline (control group, n = 9) was infused continuously for 3 h from the start of the operation. The ANP group showed much higher urinary volume and sodium, potassium, and chloride excretion than the control group, although the former had lower arterial blood pressure. ANP infusion slightly inhibited aldosterone secretion and initially tended to inhibit renin secretion stimulated by surgery, but it did not affect surgery-induced increases in the plasma concentrations of vasopressin, adrenocorticotropic hormone, cortisol, or endothelin. Two patients in the ANP group experienced excessive hypotension, one experienced bradycardia, and two experienced mild hypoxemia, which required treatment but were resolved easily. These findings suggest that ANP infusion may be used with caution for controlling renal function and arterial blood pressure during surgery. IMPLICATIONS: Continuous intravenous infusion of atrial natriuretic peptide, 0.1 microgram.kg-1.min-1, during gastrectomy was associated with higher water and sodium excretion and lower arterial blood pressure. It tended to inhibit the renin-angiotensin-aldosterone system compared with saline infusion, which suggests that atrial natriuretic peptide may be useful for intraoperative circulation control.
Adrenocorticotropic Hormone↗
Development of Graves' disease after surgical treatment for thyroid nodules: report of four cases.
We report herein rare cases who developed hyperthyroid Graves' disease after surgical treatments for thyroid nodules. We have seen only 4 such cases in the course of 1680 consecutive cases (0.24%) of thyroidectomies in which partial thyroidectomy was carried out from 1966 to 1993. It is of interest that because 2 of these three cases (67%) were associated with positive TGHA and/or MCHA at the time of surgery, the presence of autoimmune thyroiditis may predispose to Graves' disease, but surgical treatment of the thyroid glands may not be related to the development of Graves' disease, because the hyperthyroid symptoms appeared 2 to 27 years (mean: 12 years) after the surgery.
Adult↗
[Involvement of enhanced glutamate release in halogenated volatile anesthetic-induced excitation in mouse brain].
The present experiments aimed to elucidate the mechanisms of excitatory effects of volatile anesthetics. In ddN mice, enflurane (2% in air), sevoflurane (2%) or isoflurane (1.2%) induced opisthotonus. In ddY mice, a halogenated ethane, tetrachlorodifluoroethane (CCl2FCCl2F:DF-112, 2%) induced tonic-clonic convulsion. These CNS excitatory effects were suppressed by pretreatment with an N-methyl-D-aspartate antagonist, MK-801 (0.5mg.kg-1). Halogenated volatile anesthetics (enflurane, sevoflurane, isoflurane and halothane) increased glutamate release from synaptosomes of the mouse cerebral cortex at concentrations corresponding to those used clinically. The convulsive gas, DF-112, released glutamate more potently than the anesthetics. These data suggest the involvement of enhanced glutamate release in the mechanisms of excitatory effects of halogenated volatile anesthetics.
Anesthetics, Inhalation↗
Thoracic duct cyst in supraclavicular region.
A 28-year-old female attended an outpatient clinic in October, 1989, because of a tumor in the left supraclavicular fossa, detected in a health examination. Following exploratory puncture of the tumor which yielded milky-white fluid, suggesting a cyst in the thoracic duct, she was admitted to our department. The cyst was unilocular measuring about 6 cm in diameter, and the fluid content was chyle-rich in lipids. Lymphography demonstrated a lymphatic structure adjacent to the lesion and scattered lymph vessels on the cyst surface. On November 16 the cyst was resected. A restiform structure was observed between the cyst and the thoracic duct, but the presence or absence of communication was unclear. The histological diagnosis was thoracic duct cyst. Thoracic duct cyst occurring in the cervical region is very rare. Our case may provide useful information as to its pathogenesis and the mode of retention of cyst fluid.
Adult↗
Changes in the cerebral arteriovenous oxygen content difference by surgical incision are similar during sevoflurane and isoflurane anaesthesia.
PURPOSE: To investigate changes of cerebral arteriovenous oxygen content difference (AVDO2) induced by surgical incision and to determine carbon dioxide (CO2) reactivity of the cerebral circulation during sevoflurane and isoflurane anaesthesia. METHODS: Twenty-one ASA 1-2 patients undergoing elective surgery for supratentorial tumours were randomly allocated to receive either 1.3 MAC sevoflurane/N2O anaesthesia (n = 10) or equi-MAC isoflurane/N2O anaesthesia (n = 11). Before and after incision, haemodynamic measurements and AVDO2 determinations were performed. After opening the dura, AVDO2 was determined before and after the respiration rate was increased by 50%. RESULTS: Incision produced an increase in mean arterial pressure from 69 +/- 11 to 97 +/- 22 mmHg (mean +/- SD) (P < 0.0005) and from 71 +/- 6 to 89 +/- 12 mmHg (P < 0.0001) in the sevoflurane and isoflurane groups, respectively, whereas the heart rate increased from 60 +/- 9 to 72 +/- 8 bpm (P < 0.001) and from 65 +/- 6 to 70 +/- 7 bpm (P < 0.001), respectively. Arterial carbon dioxide tension (PaCO2) was increased from 33.6 +/- 2.3 to 34.6 +/- 1.8 mmHg (P < 0.05) with incision in the sevoflurane group. The AVDO2 was decreased from 6.5 +/- 1.6 to 5.3 +/- 1.6 vol% (P < 0.0005) in the sevoflurane group and from 6.7 +/- 1.1 to 6.0 +/- 1.1 vol% (P < 0.01) in the isoflurane group. The % change of AVDO2 was larger in the sevoflurane group than in the isoflurane group (-18.3 +/- 8.4% vs -9.1 +/- 9.0%; P < 0.05) but no difference remained after the post-incisional AVDO2 value of the sevoflurane group was corrected for pre-incisional PaCO2. Carbon dioxide reactivity, calculated as the percent change in AVDO2 per mmHg change in PaCO2, was 6.1 +/- 3.0%.mmHg-1 in the sevoflurane group and 5.9 +/- 2.4%.mmHg-1 in the isoflurane group (P = NS). CONCLUSIONS: Sevoflurane and isoflurane are associated with similar impairment of cerebral flow-metabolism coupling at incision, while CO2 reactivity is maintained during both anaesthetics.
Adult↗
Antifungal activity from Alpinia galanga and the competition for incorporation of unsaturated fatty acids in cell growth.
An antimicrobial diterpene was isolated from Alpinia galanga in the screening for potentiators of phytochemical antibiotic action. The structure was elucidated by spectral data and identified as (E)-8 beta, 17-epoxylabd-12-ene-15, 16-dial (1). Diterpene 1 synergistically enhanced the antifungal activity of quercetin and chalcone against Candida albicans. Antifungal activity of 1 was reversed by unsaturated fatty acids. Protoplasts of C. albicans were lysed by 1. These results suggest that antifungal activity of 1 is due to a change of membrane permeability arising from membrane lipid alternation.
Antifungal Agents↗
Perioperative plasma concentrations of endothelin and natriuretic peptides in children undergoing living-related liver transplantation.
To investigate the clinical significance of endothelin (ET), natriuretic peptides, and the renin-angiotensin-aldosterone system in pediatric liver transplantation, we measured plasma levels of ET, atrial and brain natriuretic peptides (ANP, BNP), aldosterone, and plasma renin activity in 18 patients (aged 0.5-12 yr; median 1 yr) undergoing living-related liver transplantation due to congenital biliary atresia and severe liver cirrhosis. Before transplantation, the plasma ET level (28.9 +/- 2.5 [mean +/- SEM] pg/mL) was increased compared with that of healthy children (10-18 pg/mL), but decreased during the anhepatic phase (22.5 +/- 1.6 pg/mL). It increased again after reperfusion and remained at high levels in the early postoperative period (postoperative day 3, 27.8 +/- 3.0 pg/mL). Plasma levels of ANP and BNP and aldosterone and plasma renin activity were also high before surgery. Plasma ANP and BNP did not change significantly during surgery. After transplantation, plasma BNP significantly increased, and plasma ANP tended to increase. Plasma aldosterone increased markedly during the anhepatic phase, although plasma renin activity decreased. After transplantation, plasma aldosterone and plasma renin activity both decreased to within normal levels. Mean arterial blood pressure increased gradually after reperfusion and surgery (postoperative day 3, 35.7 +/- 5.2% increase). No substantial differences in these variables occurred between the younger (< or = 1.0 yr, n = 9) and older patients (> 1.0 yr, n = 9). These results suggest that ET production in the cirrhotic liver is augmented and ET, natriuretic peptides, and the renin-angiotensin-aldosterone system all play some role in the circulatory regulation during perioperative periods of pediatric liver transplantation.
Aldosterone↗
Percutaneous chronic epidural catheterization in the rabbit.
BACKGROUND: Although several epidural catheterizations in small animals have been reported, all of them were performed surgically and no percutaneous method has been reported. We have established a technique for percutaneous chronic epidural catheterization in rabbits. METHODS: Following pentobarbital anesthesia, the animals (n = 15) were fixed in a prone position using a fixing apparatus. A 19-gauge Tuohy needle was inserted in the lumbar region at an angle of about 30 degrees to the skin with the paramedian approach and advanced into the epidural space with the loss-of-resistance method. A 23-gauge Nylon catheter was advanced cephalad in the epidural space and the distal tip was extruded from the neck following the subcutaneous tunnelling. The effects of 0.5 ml of 1% lidocaine injected through the catheter were observed for 10 days. RESULTS: No behavioral or neurological abnormalities were observed after the catheterization except for one case of catheterization in the epidural vessel. Motor paralysis of hind-limbs became manifest at 1-2 min after injection of 0.5 ml of 1% lidocaine through the catheter, and lasted 15-25 min. Autopsy revealed that the catheter was located in the lumbar epidural space in all animals and the distribution of methylene blue was consistent with that of lidocaine. CONCLUSION: This rabbit model can be used to investigate the effects of epidurally administered drugs.
Animals↗