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Biomedical subjects

K Shingu

Publications and source records attributed to K Shingu.

At least 145 records · Page 8Linked to original sources
PubMed1996

Respiratory effects of CO2 pneumoperitoneum during transperitoneal laparoscopic urological surgery.

OBJECTIVE: To evaluate the effects of CO2 pneumoperitoneum on respiratory function during urological laparoscopic surgery with exposure of the retroperitoneal space in the lateral decubitus position. METHODS: Arterial blood gas analysis and measurements of the partial pressure of CO2 in exhaled gas (PetCO2) were performed during CO2 pneumoperitoneum in 12 patients who underwent transperitoneal laparoscopic surgery for the retroperitoneal organs (the retroperitoneal group): the results were compared to those of 11 patients who underwent laparoscopic varicocelectomy (the varicocele group) with the same anesthesia and intra-abdominal pressure. RESULTS: The increase in PaCO2 and PetCO2 and the decrease in arterial pH during CO2 insufflation were significantly greater in the retroperitoneal group than in the varicocele group. PaCO2, PetCO2 and arterial pH continued to change in the retroperitoneal group, whereas these values reached a plateau at 30 min after the beginning of CO2 insufflation in the varicocele group. CONCLUSIONS: The respiratory effects of CO2 pneumoperitoneum are more pronounced during laparoscopic urological surgery with opening of the retroperitoneum. It is possible that exposure of the retroperitoneal space increased CO2 absorption during insufflation.

Adult↗
PubMed1996

Development of Graves' disease from asymptomatic autoimmune thyroiditis: a case report.

We report herein a case of hyperthyroid Graves' disease developed from asymptomatic autoimmune thyroiditis (AAT). A 25-year-old single female with AAT was followed up for over 3 years. Thereafter her condition progressed to hyperthyroidism with both positive TSH receptor antibodies (TRAb) and an increase in antithyroidal antibodies. It is possible that there was continuous destruction of thyroid epithelial cells without a hyperthyroid state, followed by production of TRAb, although Graves' disease very rarely develops from destructive thyroiditis including AAT.

Adult↗
PubMed1996

Catecholamine release caused by carbon dioxide insufflation during laparoscopic surgery.

PURPOSE: We evaluated plasma catecholamine levels during pneumoperitoneum in laparoscopic surgery. MATERIALS AND METHODS: Plasma epinephrine and norepinephrine were evaluated in 29 patients who underwent laparoscopic retroperitoneal surgery in a half lateral decubitus position (group 1) or laparoscopic varicocelectomy in a Trendelenburg position (group 2). RESULTS: The levels of epinephrine and norepinephrine increased significantly 5 minutes after carbon dioxide insufflation compared to levels after Veress needle insertion and just before insufflation. The elevation of catecholamine levels during laparoscopic procedures was greater in group 1. CONCLUSIONS: Our results indicate that carbon dioxide insufflation may cause catecholamine release during laparoscopic surgery. Careful monitoring of hemodynamics is mandatory at the beginning of the procedure.

Adolescent↗
PubMed1995

Effects of anesthesia and surgery on plasma endothelin levels.

To investigate the clinical significance of endothelin (ET), a potent and long-acting vasoconstrictor peptide in anesthesia and surgery, we measured plasma ET-like immunoreactivity (ET-LI) levels by using radioimmunoassay in patients undergoing various kinds of surgery under general anesthesia. No significant changes in plasma ET-LI levels were observed in patients undergoing relatively minor surgery under general anesthesia with nitrous oxide and halothane (n = 6), enflurane (n = 6), or isoflurane (n = 5). Although plasma ET-LI levels after surgery in patients undergoing total knee replacement (12.4 +/- 0.9 [mean +/- SEM] pg/mL, n = 7), hysterectomy (11.4 +/- 0.6 pg/mL, n = 8) or cholecystectomy (14.8 +/- 1.2 pg/mL, n = 9) were no different from those before surgery, plasma ET-LI levels after surgery in patients undergoing gastrectomy (20.4 +/- 1.9 pg/mL, n = 15), esophagectomy (24.7 +/- 2.5 pg/mL, n = 12), hepatectomy (27.5 +/- 3.4 pg/mL, n = 12), or heart surgery (43.1 +/- 4.1 pg/mL, n = 18) were higher than those before surgery (P < 0.05). Changes in plasma ET-LI levels during surgery had positive correlations with the duration of the operation (n = 100, r = 0.51, P < 0.01) and intraoperative blood loss (n = 100, r = 0.30, P < 0.01). In patients undergoing subtotal esophagectomy, the plasma ET-LI level did not increase during the initial 2 h, but increased gradually during surgery, reached a peak within a few hours after surgery, and declined slowly thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Orotracheal intubation through the laryngeal mask airway in paediatric patients with Treacher-Collins syndrome.

The laryngeal mask airway (LMA) is useful as an airway intubator (conduit) for an intubating tracheal bougie or fibreoptic bronchoscope, over which a tracheal tube is passed. However, in our paediatric patients with Treacher-Collins syndrome, only the latter technique was successful. This was attributed to the fact that a posteriorly protruded tongue displaced the LMA, made the glottis move considerably anterior and interfered with the attempts to enter the trachea with a bougie. Downward displacement of the epiglottis, which can sometimes impair the intubation technique through the LMA, was not observed in our patients. Partial obstruction of a tracheal tube within the LMA occurred in one of the patients.

Airway Obstruction↗
PubMed1994

Ergostane glycosides from Petunia hybrida.

Six new ergostane glycosides, designated as petunioside A, petunioside B, 24-epipetunioside B, petunioside C, 24-epipetunioside C and petunioside D, were isolated from the methanolic extract of the fresh aerial parts of Petunia hybrida. Their structures were determined by means of spectroscopic analysis and single crystal X-ray analysis.

Carbohydrate Conformation↗
PubMed1994

Changes of endothelin concentration in cerebrospinal fluid and plasma of patients with aneurysmal subarachnoid hemorrhage.

To investigate the clinical significance of endothelin (ET), a potent vasoconstrictor peptide, in subarachnoid hemorrhage (SAH) and SAH-related cerebral vasospasm, we measured the ET-like immunoreactivity (ET-LI) in plasma and cerebrospinal fluid (CSF) obtained serially from patients with SAH due to ruptured cerebral aneurysm who underwent aneurysmal surgery. The normal ET-LI levels in plasma and CSF (n = 24) were 12.4 +/- 2.0 (mean +/- s.d.) and 9.1 +/- 1.2 pg.ml-1, respectively. Plasma ET-LI levels in patients with SAH before surgery (16.8 +/- 7.8 pg.ml-1, n = 8) were higher than the normal values (P < 0.05), and became further elevated after surgery (22.5 +/- 9.4 pg.ml-1). ET-LI levels in plasma and CSF one day after surgery were 18.7 +/- 5.5 and 18.4 +/- 6.8 pg.ml-1 (P < 0.01 vs. normal values), respectively, and declined thereafter. The plasma and CSF ET-LI levels in patients who showed symptomatic vasospasm became concomitantly elevated again. These results suggest that ET is involved in SAH-related vasospasm and raise the possibility that surgical stress influences the vasospasm.

Adult↗
PubMed1994

Activation of the cortical and medullary dopaminergic systems by nitrous oxide in rats: a possible neurochemical basis for psychotropic effects and postanesthetic nausea and vomiting.

To provide a neurochemical basis for the central nervous system actions of nitrous oxide, the changes of brain dopamine (DA), serotonin (5-HT), norepinephrine (NE), and metabolites of DA and 5-HT were studied in rats. Thirty male Wistar rats were assigned to one of five groups according to the type of gas and the duration of gas exposure. The rats in one group, which served as control, were exposed to air for 30 min, and the rats in four other groups were exposed to 75% nitrous oxide in oxygen for 0.5, 1, 2, and 4 h, respectively. Animals were killed with microwave irradiation, and the brains were divided into seven sections: the cerebral cortex, cerebellum, striatum, hippocampus, midbrain-thalamus, hypothalamus, and medulla-pons. The contents of NE, DA, 3,4-dihydroxyphenyl-alanine (DOPAC), homovanillic acid (HVA), 5-HT, and 5-hydroxyindoleacetic acid (5-HIAA) in each discrete area were measured with high-performance liquid chromatography. Nitrous oxide had no significant effect on the contents of NE, 5-HT, nor 5-HIAA, but decreased that of DA in the striatum and midbrain-thalamus after 4 h of exposure (P < 0.05). Levels of DOPAC, but not DA, in the cerebral cortex and medulla-pons were increased significantly at exposures up to 2 h (P < 0.05), but were not significant from control levels after a 4-h exposure. Increased levels of DOPAC indicate that nitrous oxide increases dopaminergic neuronal activities in the mesocortical projection and the medullary network.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1994

Effects of sevoflurane on central nervous system electrical activity in cats.

We analyzed the effect of a new volatile anesthetic, sevoflurane (2%-5% in oxygen) on the electroencephalogram (EEG) of the neocortex, amygdala, and hippocampus, cortical somatosensory evoked potential (SEP), and brainstem reticular multiunit activity (R-MUA) in cats. Sevoflurane suppressed the background activity of the neocortex more than the amygdala and hippocampus. With increasing concentration of sevoflurane, the cortical EEG progressed from high-amplitude slow waves to a suppression-burst pattern, which was followed by an isoelectric pattern and then spikes with isoelectricity. The amplitude of the SEP was augmented and the R-MUA was suppressed by sevoflurane in a dose-related manner. Repetitive peripheral electrical stimulation induced generalized seizures at 5% sevoflurane in 2 of 13 cats. These results suggest that sevoflurane suppresses the background central nervous system electrical activities in a dose-related manner, leaving the reactive capabilities facilitated at deep anesthesia.

Anesthetics↗
PubMed1994

[Influence of age on cardiac pump function during laparoscopic cholecystectomy--measurements by ear densitography].

Using ear densitography, consisting of photoelectric plethysomography and Holter electrocardiography, we measured systolic time intervals (STI) in 21 patients, ASA class 1 and 2, undergoing laparoscopic cholecystectomy using CO2 insufflation under general anesthesia (neuroleptanesthesia with isoflurane in air, FIO2 0.5). The patients were divided into two groups: Y-group (10 patients under 59 years of age) and O-group (11 patients over 60 years of age). We investigated the influence of age on cardiac pump function during pneumoperitoneum non-invasively. Y-group showed improvement of cardiac pump function (reduction of PEP/LVET) from 30 minutes after the beginning of insufflation and quick recovery of cardiac function immediately after deflation. O-group showed a tendency of increasing PaCO2 and arterial diastolic pressure, and delayed recovery of cardiac function (elongation of PEP at 60 minutes, and increase of PEP/LVET at 60 and 90 minutes, respectively, after insufflation). Hypertension and tachycardia were apparent immediately after pneumoperitoneum in the O-group. We conclude that special care and monitoring are mandatory for the aged patients with impaired cardiac or respiratory function during laparoscopic surgery.

Aged↗
PubMed1994

[The function of neologism in relation to the precipitating process of psychosis].

Based on clinical observations, the author presented his reflections on the function of neologism appearing during the initial phase of psychosis. When the patient feels he is being interrogated as to his membership in certain groups significant to him, the neologism becomes manifest; neologism keeps him in touch with the group in that its content reflects how the patient feels he is viewed by the group; the patient, however, is not able to question his membership on a conscious level, but receives all at once, through auditory hallucinations, an affirmative answer in neologism. Why does neologism assume those idiosyncratic forms of language? There seem to be logical necessities. When a subject belongs to a group, he needs to speak a metalanguage that is richer than the language proper to it, in order to convey "It is true that I belong to this group." This is required because he must avoid the Russel type paradox of self-reference. For example, in order for a Japanese to say, "It is true that I am Japanese", he ought to express it in a metalanguage that is richer than his mother tongue. Scientific languages, such as those of anthropology or linguistics, may seem appropriate. However, as Wittgenstein and Lacan have pointed out, such a metalanguage does not really exist. Notwithstanding, it remains the goal of psychotic neologism and is the reason that psychotic neologism is destined to impossibility or dissolution of actual sense. On the other hand, it is conjectured that in normal subjects, group membership is not effectuated by such a metalanguage, but by fragmental and insignificant phonetic element that he incorporates at the earliest phase of development.

Adult↗
PubMed1994

Significance of values of thyrotropin binding inhibitor immunoglobulins and appearance of intrathyroidal lymphocytes at subtotal thyroidectomy for Graves' disease.

This study was undertaken to investigate whether thyrotropin binding inhibitor immunoglobulins (TBII) values at and after subtotal thyroidectomy correlated with the outcome or the histologic grade applied to the appearance of intrathyroidal lymphocytes at the time of surgical treatment. In addition, the main reason for the study was to determine whether or not it was possible to predict the outcome after the operation by the data obtained. There was no relation between the TBII results and the grade of the appearance of intrathyroidal lymphocytes at the time of operation or the TBII postoperative results (whether positive or negative) and the final outcome. However, it was of interest that patients with a recurrence of hyperthyroidism had the TBII values of more than 50 percent at the time of surgical treatment, and also manifested continuously positive TBII values after the operation. They also had moderate grades of lymphocytic infiltration and lymph follicle formation in the surgical specimen. It seemed impossible to predict the outcome of each instance in accordance with TBII values and the grade of the appearance of intrathyroidal lymphocytes at the time of the operation. However, it might be possible to predict at least the recurrence of hyperthyroidism by the consideration of changes of TBII values postoperatively.

Adolescent↗
PubMed1994

Effects of nitrous oxide on the brain catecholamines in rats.

The effects of nitrous oxide on the brain norepinephrine (NE), dopamine (DA), and metabolites of DA were studied in rats. Forty-eight male Wistar rats were divided into 2 groups and exposed to gas in Plexiglas tubes: compressed air or 75% nitrous oxide in oxygen. Each group was further divided into 4 subgroups, consisting of 6 rats each, according to the duration of exposure: 0.5, 1, 2 and 4 hours. The control group of 6 rats were kept in rat cages and exposed to room air. The animals were sacrificed with microwave irradiation after the exposure. Brain contents of NE, DA, 3,4-dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) were measured with high-pressure liquid chromatography. Exposure to compressed air in the tube did not affect NE, DA, DOPAC nor HVA. Nitrous oxide did not change the brain content of NE or DA. Metabolites of DA increased with nitrous oxide: DOPAC and HVA increased after 0.5 h exposure (from 105 +/- 8 to 152 +/- 38 ng/g brain, from 120 +/- 9 to 175 +/- 27 ng/g brain, respectively, P < 0.05). Increased levels of DA metabolites indicate that nitrous oxide increases dopamine turnover. However, these increases attenuated during exposure. The attenuation indicates that the decline of DA turnover may correlate with a development of acute tolerance to nitrous oxide action(s) in the central nervous system.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1993

Comparison of CNS effects of propofol and thiopentone in cats.

Using cats with chronically implanted brain electrodes, we have compared the effects of propofol on CNS electrical activities with those of thiopentone. Ten cats were allocated to receive either propofol (n = 5) or thiopentone (n = 5). Cats were anaesthetized initially with 4% halothane in oxygen. The trachea was intubated and the lungs ventilated mechanically. A femoral artery and a vein in a forepaw were cannulated for arterial pressure monitoring and fluid infusion. After the inspired concentration of halothane was maintained at 0.5%, EEG in the cortex, the amygdala and the hippocampus, somatosensory evoked potential (SEP) and reticular multi-unit activity (R-MUA) were recorded. Incremental doses of propofol or thiopentone were administered i.v. at 5-min intervals during 0.5% halothane anaesthesia. The cumulative doses of propofol and thiopentone were 2, 5, 10 and 20 mg kg-1, and 4, 10, 20 and 40 mg kg-1, respectively. Arterial pressure was maintained in excess of 100 mm Hg systolic by infusion of phenylephrine. All cats in the propofol group survived, but two in the thiopentone group died after the administration of thiopentone 40 mg kg-1. Changes observed in CNS activity were dose-related in all cases. The EEG changed with the increments of doses of propofol or thiopentone, from fast, small amplitude to complexes of fast and slow, large amplitude activities, burst suppression and flat EEG. SEP latency was prolonged by both agents: the peak latency of N1 changed from 15 (SD 2) ms to 20 (5) ms with propofol 20 mg kg-1, and from 14 (1) ms to 27 (2) ms with thiopentone 40 mg kg-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1993

Positive end-expiratory pressure ventilation decreases plasma atrial and brain natriuretic peptide levels in humans.

To investigate the possible role of atrial and brain natriuretic peptides (ANP and BNP) in the renal effects of mechanical ventilation with positive end-expiratory pressure (PEEP), we measured changes in plasma ANP and BNP levels during PEEP in patients undergoing subtotal esophagectomy. Application of 15 cm of H2O PEEP for 1 h decreased the levels of plasma ANP and BNP from 24.4 +/- 5.5 (mean +/- SEM) and 19.0 +/- 3.5 fmol/mL to 14.4 +/- 2.1 and 15.3 +/- 3.0 fmol/mL, respectively (P < 0.05). The level of plasma cyclic guanosine monophosphate, an intracellular second messenger of ANP and BNP, also decreased from 8.4 +/- 1.5 to 5.7 +/- 0.8 pmol/mL (P < 0.05). PEEP increased the levels of plasma arginine vasopressin from 2.0 +/- 0.5 to 4.2 +/- 1.2 pg/mL, aldosterone from 36.1 +/- 4.9 to 65.3 +/- 12.7 pg/mL, and plasma renin activity from 1.4 +/- 0.5 to 2.7 +/- 0.7 ng.mL-1.h-1. During PEEP ventilation, urine output, urinary sodium and potassium excretion, osmolar clearance, and cardiac index all decreased. PEEP increased free water clearance, right atrial pressure, pulmonary arterial pressure, and pulmonary capillary wedge pressure. The level of plasma endothelin, mean blood pressure, and heart rate did not change significantly. These results suggest that not only hemodynamics and the vasopressin and renin-angiotensin-aldosterone system, but also the natriuretic peptide system (ANP and BNP), are involved in the renal effects of PEEP.

Adult↗
PubMed1993

Development of hypothyroidism with thyroid stimulation blocking antibody long after treatment with antithyroid drugs in a patient with hyperthyroid Graves' disease: a case report.

We observed a patient manifesting spontaneous hypothyroidism with thyroid stimulation blocking antibody (TSBAb) long after treatment with antithyroid drugs (ATDs) for hyperthyroid Graves' disease. A 19-year-old female with Graves' disease was treated with ATDs for approximately 2 years; after cessation of ATDs, hyperthyroidism did not recur. Nine years later, she was again seen in our hospital because of symptoms indicative of hypothyroidism. Thyroid hormone replacement was commenced after laboratory confirmation of hypothyroidism. TSH-binding inhibitor immunoglobulin and TSBAb were both positive, while thyroid stimulating antibody (TSAb) was negative, at the time of diagnosis of hypothyroidism. These results indicated that the alterations in thyroid function in this patient appeared to relate to the presumed decline in the activity of TSAb and the appearance of TSBAb years after ATDs administration had been discontinued.

Adult↗