[Treatment approaches to alcohol dependence and alcohol abuse in the world].
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Alcoholics Anonymous↗
Biomedical subjects
M Hayashida
Publications and source records attributed to M Hayashida.
[The effect of low-rose prostaglandin E1 on circulation, respiration and body temperature during surgical anesthesia].
We investigated the effects of low-dose prostaglandin E1 (PGE1) on circulation, respiration, and body temperature during surgical anesthesia. We studied 109 adult patients undergoing upper abdominal operations under thoracic epidural combined with inhalational anesthesia. Patients were divided into 2 groups; Control group (n = 42) and PGE1 group (n = 67). In PGE1 group, PGE1 infusion was started at the rate of 0.02 microgram.kg-1.min-1 before the induction of anesthesia and was terminated at the end of surgery. There were no differences between the groups in demographic, anesthetic and surgical characteristics. After treatment with PGE1, arterial pressure decreased slightly but significantly, resulting in lower arterial pressure in PGE1 group than in control group before the induction of anesthesia. After the induction of anesthesia, however, arterial pressure decreased significantly in both groups, and the differences in arterial pressure between the groups were not observed any more during surgery. Heart rate was not different between the groups throughout the study period. Intraoperative urine output was greater in PGE1 group than in control group. PaO2/FIO2 ratio was not different between the groups both before and during anesthesia. Rectal temperature remained slightly but significantly lower in PGE1 group throughout surgery. Rectal-to-palm temperature gradient tended to be smaller in PGE1 group 1 hour after the induction of anesthesia. Low-dose PGE1 reduced arterial pressure. However, the difference in arterial pressure between the groups was so small that the difference disappeared during surgery. Meanwhile, low-dose PGE1 increased urine output, suggesting that renal blood flow was better-maintained with PGE1. In spite of several investigations reporting an unfavorable effect of PGE1 on PaO2, low dose PGE1 did not affect PaO2 in this study. Finally low-dose PGE1 reduced core temperature, though slightly, probably through redistribution of the body heat.
Adult↗
[The effect of low-dose prostaglandin E1 on intra- and post-operative renal function].
We investigated the effects of low-dose prostaglandin E1 (PGE1) on intra- and post-operative renal function in 109 adult patients undergoing upper abdominal surgery. Anesthesia was maintained with a combination of thoracic epidural combined with inhalational anesthesia. Sixty-seven patients received PGE1 at a rate of 0.2 microgram.kg-1.min-1 throughout surgery. Forty-two patients, who did not receive PGE1, served as control. Pre- and post-operative renal function was evaluated with serum levels of BUN and creatinine (Cr), while intra-operative renal function was evaluated mainly with urine output and urine flow rate during anesthesia. Urinary Na excretion and creatinine clearance (Ccr) were determined during surgery in limited cases. Urine output and urine flow rate during anesthesia were greater in PGE1 group than in control group, whereas infusion volumes and infusion rates were not different between the groups. In PGE1 group, urine flow rate was greater during surgery than before surgery, while in control group, it was unchanged. Na excretion during anesthesia was also greater in PGE1 group than in control group. In control group, Na excretion and Ccr were smaller during surgery than before surgery, while in PGE1 group, they were unchanged. Postoperative serum BUN and creatinine levels were not different between the groups. Decreased Na excretion and decreased Ccr in control group indicated that renal function was depressed during surgery, whereas unchanged Ccr, unchanged Na excretion and increased urine flow rate in PGE1 group indicated that renal function was well-maintained during surgery with PGE1. Low-dose PGE1 thus prevented depression of renal function during surgical anesthesia.
Abdomen↗
[Low preoperative PaO2 in patients with ovarian and endometrial cancer].
We investigated preoperative PaO2 and changes of PaO2/FIO2 (P/F) during the operation in 40 patients with gynecologic malignancies (ovarian cancer (O group) = 14 cases, endometrial cancer (E group) = 14 cases, cervical cancer (C group) = 12 cases). Preoperative chest X-ray and respiratory function test of our patients were within normal ranges (% VC > or = 80, % FEV 1.0 > or = 70). There were no differences among 3 groups in age, height, weight, % VC, or % FEV 1.0. Preoperative PaO2 values in the O group and E group were significantly lower than the normal value (100--age/4). Preoperative PaO2 and P/F values in the O group were significantly lower in comparison with those in the C group. We suggest, therefore, that it is necessary to measure preoperative PaO2 in patients with ovarian and endometrial cancer.
Adult↗
[Successful treatment of intraoperative myocardial ischemia with nicorandil].
We report five patients who developed intraoperative myocardial ischemia but were treated successfully with nicorandil. Case 1; An 84 year-old male underwent emergent laparotomy and ileolysis under inhalational plus thoracic epidural anesthesia. During his emergence from anesthesia, arterial pressure and heart rate increased abruptly due to excitement, leading to ST-T depression on V5 lead. Bradycardia and hypotension developed subsequently. Immediately after i.v. injections of nicorandil 4 mg and atropine 0.3 mg, ST-T change and hemodynamics improved dramatically. Case 2; A 67 year-old male underwent esophagectomy under inhalational plus thoracic epidural anesthesia. Following the completion of surgery, elevation of ST-T developed suddenly on lead II, though hemodynamics were not compromised. ST-T elevation disappeared immediately after nicorandil 6 mg and continuous infusion of nitroglycerin (TNG) was initiated. Case 3; A 71 year-old female underwent aortic valve replacement under high-dose fentanyl anesthesia. Shortly after starting cardiopulmonary bypass (CPB), ST-T segment on leads II and V5 was elevated suddenly. This was accompanied by severe pulmonary hypertension suggestive of severe left ventricular failure. Shortly after nicorandil 4 mg via a pulmonary artery (PA) catheter, ST-T segment returned to the baseline and pulmonary arterial pressure was normalized. Case 4; A 61 year-old male underwent coronary revascularization under high-dose fentanyl anesthesia. During weaning from CPB, elevation of ST-T segment occurred on leads II and V5. ST change improved, responding to nicorandil 6 mg en bolus via a PA catheter. Case 5; A 67 year-old male underwent coronary revascularization under high-dose fentanyl anesthesia. He was unable to be weaned from CPB for several hours because of frequent and repeated attacks of ventricular tachycardia and ventricular fibrillation. The arrhythmia did not respond to various kinds of treatments including intra-aortic balloon pumping and continuous infusions of inotropes, anti-arrhythmic drugs and anti-anginal drugs. In spite of repeated intracoronary injections of TNG, graft flow to the left anterior descending branch remained low at 40 ml.min-1. After an intracoronary injection of nicorandil 1 mg, however, blood flow increased to 100 ml.min-1, resulting in a marked reduction in frequency of ventricular arrhythmia. The patient came off bypass successfully. In each case, intraoperative myocardial ischemia was treated successfully with nicorandil. Neither hypotension nor arrhythmia resulted from its bolus injection. Nicorandil might be a useful therapeutic tool for myocardial ischemia during anesthesia.
Aged↗
[The effect of low-dose prostaglandin E1 on intra- and post-operative liver function].
We investigated the effects of low-dose prostaglandin E1 (PGE1) on intra- and post-operative liver function in 109 adult patients undergoing upper abdominal surgery. Patients were divided into 2 groups; Control group (n = 42) and PGE1 group (n = 67). In PGE1 group, PGE1 was infused throughout surgery at a rate of 0.02 microgram kg-1 min-1. In both groups, anesthesia was maintained with a combination of inhalational and thoracic epidural anesthesia. Epidural anesthesia was maintained with 1.5% lidocaine infused epidurally at a constant rate (8 +/- 2 ml.hr-1). The continuous epidural infusion of lidocaine was initiated before surgery and discontinued at the end of surgery. Preoperative and postoperative liver function was evaluated with blood chemistry examination. Intraoperative liver function was evaluated in 84 patients (33 in control group and 51 in PGE1 group) by measuring plasma lidocaine concentration. Plasma lidocaine concentration was determined 1 and 3 hours after the initiation of lidocaine infusion and 0 and 2 hours after its termination. There were no differences between the groups in doses and infusion rates of lidocaine. In both groups, lidocaine concentration increased progressively as infusion was continued. Lidocaine concentration was significantly lower in PGE1 group than in control group at the end of the infusion. In 22 patients in control group and 35 in PGE1 group who received high-dose lidocaine (> 8 mg.kg-1), lidocaine concentration remained significantly lower in PGE1 group than in control group throughout the infusion period. The difference in lidocaine concentrations between the groups increased progressively as infusion was continued, though the doses and the infusion rates of lidocaine were not different between the groups. Postoperative liver function did not differ between the groups. Because removal of lidocaine from blood to liver parallels hepatic blood flow, the lower plasma lidocaine concentration in PGE1 group indicated that hepatic blood flow was higher and liver function was better-maintained with PGE1 during anesthesia and surgery. Low dose PGE1 thus improved intraoperative liver function during upper abdominal surgery.
Abdomen↗
[The effect of low-dose prostaglandin E1 on serum and urinary fluoride concentrations in patients anesthetized with sevoflurane].
We investigated the effects of low-dose prostaglandin E1 (PGE1) on serum and urinary concentrations of inorganic fluoride in 39 adult patients undergoing upper abdominal surgery. Anesthesia was maintained with a combination of N2O-O2-sevoflurane and thoracic epidural anesthesia. Twenty-two patients received infusion of PGE1 at a rate of 0.02 micrograms.kg-1.min-1 throughout surgery. Seventeen patients served as control by not receiving PGE1. Serum inorganic fluoride concentrations (FB) were determined before the induction of anesthesia and 0, 2 and 24 hours after the end of anesthesia. Urinary inorganic fluoride concentrations (FU) were determined before the induction of anesthesia, and 0, 24 and 48 hours after the end of anesthesia. These was no difference between PGE1 group and control group in anesthetic dose (MAC hours) of sevoflurane. In both groups, FB peaked at the end of anesthesia. In PGE1 group, UB peaked at the end of anesthesia, while in control group, it peaked 24 hours after anesthesia. There were differences between groups neither in FB nor in FU throughout the study period. The relationships between anesthetic dose and fluoride concentrations, however, differed significantly between the groups. In control group FB values of 0, 2 and 24 hours after anesthesia correlated positively with MAC hours, respectively, while in PGE1 group they did not. Similarly in control group, FU values of 24 and 48 hours after anesthesia correlated positively with MAC hours, respectively, while in PGE1 group, they did not. Thus in patients receiving high-dose sevoflurane, FB and FU tended to be lower in PGE1 group than in control group. In contrast, in PGE1 group, urinary excretion of fluoride during surgery correlated positively with MAC hours, while in control group, it did not. Urinary fluoride excretion during surgery was significantly greater in PGE1 group than in control group. These results suggested that PGE1 might prevent elevation of serum and urinary fluoride concentrations in patients receiving high-dose sevoflurane. This effect might result from enhanced urinary excretion of fluoride with PGE1.
Abdomen↗
[Effects of cardiac output on PETCO2 and PaCO2 during combined inhalational-epidural anesthesia].
We investigated the effects of cardiac output on PETCO2 in anesthetized patients. We studied 8 adult patients undergoing long-lasting lower abdominal surgery. Anesthesia was maintained with epidural combined with inhalational anesthesia. The minute ventilation volume was kept constant at 10 ml.kg-1 x 10 cycles.min-1. PETCO2, PaCO2, and cardiac index, (CI) by thermodilution method were measured simultaneously. PaCO2 was corrected for body temperature for comparison with PETCO2. Approximate value of alveolar dead space to tidal volume ratio was calculated as VD/ VTalv = (PaCO2-PETCO2)/PaCO2. The measurements were repeated every 10 to 20 minutes under the steady body temperature. One hundred and six sets of data were obtained from these patients. PETCO2 as well as PaCO2 correlated positively with CI, while VD/VTalv did not correlate with CI. PETCO2 correlated positively with PaCO2, while it did not correlate with VD/VTa1v. When examined in individual patients, PETCO2 correlated positively with CI in 7 patients. PaCO2 correlated positively with CI in 6 patients, while VD/VTa1v correlated negatively with CI only in 2 patients, in whom CI showed a large fluctuation. PaCO2 correlated positively with PETCO2 in 8 patient, while VD/VTa1v correlated negatively with PETCO2 only in 1 patient. By multiple regression analysis, VD/VTa1v change accounted for only 20.0 +/- 15.3% of PETCO2 change, while PACO2 or PaCO2 change accounted for 79.3 +/- 16.7%. Decreased CI was associated with a decrease in oxygen uptake (VO2), and PaCO2 correlated positively with VO2. Decreased CI was also associated with an increase in VA/Q, and PaCO2 correlated negatively with VA/Q. Thus, PETCO2 decreased with decreasing cardiac output. A decrease in PACO2 explained the decrease in PETCO2 better than an increase in VD/VT did. Decreased cardiac output caused hypocapnia through decreased CO2 production and/or increased ventilation to perfusion ratio i.e. relative hyperventilation.
Adult↗
Cancer screening of upper aerodigestive tract in Japanese alcoholics with reference to drinking and smoking habits and aldehyde dehydrogenase-2 genotype.
In this study, 1,000 Japanese male alcoholics were consecutively screened by upper gastrointestinal endoscopy with esophageal iodine staining. Associations among cancer-detection rates, drinking and smoking habits, and aldehyde dehydrogenase-2 (ALDH2) genotypes were evaluated. A total of 53 patients (5.3%) had histologically confirmed cancer. Esophageal cancer was diagnosed in 36, gastric cancer in 17, and oropharyngolaryngeal cancer in 9 patients: 8 of the esophageal-cancer patients were multiple-cancer patients, with additional cancer(s) in the stomach and/or oropharyngolaryngeal region. Multiple logistic regression revealed that use of stronger alcoholic beverages (whisky or shochu) in contrast with lighter beverages (sake or beer) and smoking of 50 pack-years or more increased the risks for esophageal (odds ratio 3.2 and 2.8 respectively), oropharyngolaryngeal (4.8 and 5.1 respectively) and multiple cancer (10.5 and 11.8 respectively). The inactive form of ALDH2, encoded by the gene ALDH2*1/2*2 prevalent in Orientals, exposes them to higher blood levels of acetaldehyde, a recognized animal carcinogen, after drinking. This inactive ALDH2 was detected in 19/36 (52.8%) patients with esophageal cancer, in 5/9 (55.6%) patients with oropharyngolaryngeal cancer, and in 7/8 (87.5%) patients with multiple cancer. All of these gene frequencies far exceeded that in a large alcoholic cohort (80/655, 12.2%). The triple combination of the risk factors of the inactive ALDH2, stronger alcoholic beverages and heavy smoking was more commonly associated with multiple-cancer patients than with patients with esophageal cancer alone (62.5% vs. 7.1%). These results show that the 3 risk factors are important for the development of upper-aerodigestive-tract cancer in Japanese alcoholics. For these high-risk drinkers, regimented screening appears to be indicated.
Adult↗
Polymorphisms of ethanol-oxidizing enzymes in alcoholics with inactive ALDH2.
Inactive aldehyde dehydrogenase-2 (ALDH2) is a well-known biological deterrent of heavy drinking among Asians, although some individuals who have inactive ALDH2 do become alcoholics. Unknown biological mechanisms facilitating the development of the disease may operate in such a way that these individuals overcome adverse reactions, or they may lower the intensity of the reactions. To examine our hypothesis that ethanol-oxidizing isoenzymes have lower catalytic properties in some persons, we investigated polymorphisms of ethanol-oxidizing enzymes that may alter their catalytic activities, viz., alcohol dehydrogenase-2 (ADH2) and -3 (ADH3), and cytochrome P450 2E1 (CYTP2E1), among 80 Japanese alcoholics with inactive ALDH2, 575 alcoholics with active ALDH2, and 461 controls. Although higher ADH2*1 and ADH3*2 allele frequencies were observed in alcoholics than in controls, there was no significant difference in ADH2 and ADH3 genotypes between alcoholics with inactive ALDH2 and alcoholics with active ALDH2. The genotype distributions of CYTP2E1 did not differ among the three groups, indicating no allelic association of the c1/c2 polymorphism of CYTP2E1 with alcoholism. These results suggest that genetic variations in ethanol-oxidizing activities are involved in the development of the disease, but that these variations are not specific in alcoholics with inactive ALDH2, a group at genetically low risk for alcoholism.
Adult↗
Pancuronium increases pulmonary arterial pressure in lung injury.
We studied 25 mongrel dogs who were anaesthetized and their lungs ventilated for investigation of the effects of pancuronium on pulmonary arterial pressure (PAP) in the normal lung, in oleic acid-induced lung injury and in lung injury with hypoxaemia. In the normal lung, PAP was not affected by pancuronium. During lung injury, however, PAP was increased from 21.5 (SD 2.8) to 24.6 (4.2) mm Hg (P < 0.01) and from 22.0 (4.2) to 27.0 (5.8) mm Hg (P < 0.01) after pancuronium 0.08 mg kg-1 and 0.16 mg kg-1, respectively, and from 26.0 (2.9) to 37.1 (3.1) mm Hg after pancuronium 0.16 mg kg-1 when hypoxaemia was present (P < 0.01). The increase in PAP induced by pancuronium was associated with increases in cardiac output and pulmonary vascular resistance. Pretreatment with phentolamine attenuated the pancuronium-induced increase in PAP. The increase in PAP induced by pancuronium was also reduced by vagotomy. If these results in dogs are relevant clinically, then pancuronium should be avoided as a neuromuscular blocker in lung injury.
Animals↗
Alcohol and aldehyde dehydrogenase genotypes and drinking behavior in Japanese.
The effects of the genotype of alcohol dehydrogenase-2 (ADH2) and mitochondrial aldehyde dehydrogenase (ALDH2) on drinking behavior were investigated in a population of 451 Japanese. Although the ALDH2*2 allele had a significant inhibitory effect on alcohol consumption, hence on drinking problems, the apparent association was not confirmed between ADH2 genotype and overall drinking patterns for either males or females. However, the frequency of the ADH2*2 allele was significantly lower in male Japanese classified as alcoholic on the basis of the Kurihama Alcoholism Screening Test than in nonalcoholic males. These results corroborate a previous study that revealed a significantly lower ADH2*2 allele frequency in hospitalized Japanese alcoholics than in the general population. Together, these studies suggest that the ALDH2*2 allele has an inhibitory effect on drinking behavior, irrespective of the level of alcohol consumption, whereas the effect of the ADH2 polymorphism only becomes apparent in individuals with higher alcohol consumption, such as alcoholics.
Adolescent↗
Alcohol and substance use among Japanese high school students.
In the first large-scale survey on the use of alcohol and tobacco and the inhalation of paint thinner by Japanese high school students, a higher percentage of respondents reported past or regular use of these substances than in a 1978 survey. The survey was conducted in 44 high schools. The 14,438 respondents (ages 15-18 years) represented 9 of Japan's 47 geographically distinct urban and rural prefectures. Most (76%) reported that they had consumed alcohol at some time, and 50% reported drinking on a regular basis. Alcohol consumption, drinking partners, and motivation for drinking were compared by student gender, geographic region, and years of education. Fewer students reported smoking cigarettes: 32% had smoked at some time, and 14% smoked regularly. Inhalation of paint thinner was rare: 3% had purposely inhaled it, and 1% had abused it. A significant percentage of the alcohol drinkers also used tobacco and/or thinner, a tendency that was the same despite differences in gender, grade in high school, and urban or rural geographic region. A tendency toward polysubstance use was evident among these high school students.
Adolescent↗
Association between alcoholism and the dopamine D4 receptor gene.
A point mutation in the aldehyde dehydrogenase 2 gene (ALDH2(2) allele) is considered to be a genetic deterrent for alcoholism; however, 80 of 655 Japanese alcoholics had the mutant allele. Genotype factors that might increase susceptibility by overriding the deterrent showed a higher frequency of a five repeat allele of the dopamine D4 receptor 48 bp repeat polymorphism in alcoholics with ALDH2(2) than in 100 other alcoholics and 144 controls. Alcoholics with the five repeat allele also abused other drugs more often. These data suggest the involvement of the dopamine system in the development of alcoholism and other addictive behaviour.
Adult↗
[Comparative study of the names of subjects in the official curriculum with those used by nursing schools in the southeast of Brazil].
The authors compared the names of the subjects that form the official curriculum to those offered by the schools of nursing in the South East of Brazil. Forty eight schools replied to the questionnaire, a variance in the names and numbers of the subjects offered was found, indicating a difference in the way each school performs the curriculum.
Brazil↗
[Expectations of hospital administrators about administrative functions of nurses].
The objective of the present study was to investigate hospital administrator's expectations about the administrative role played by nurses, utilizing functions proposed by the Neoclassical Theory of Administration: planning, organization, direction, and control as theoretical references. An instrument established in TREVIZAN (1989) was applied to 11 hospital administrators. The results showed they expect the four functions to be done by nurses. Therefore, the interaction between nurses and hospital administrators is critical to improve the patient's assistance.
Attitude of Health Personnel↗
[Analysis of the utilization of the operating room using a computer].
With this study, we intended to verify the possibility of settling a time control of the activities developed at the operating room of an University Hospital, which has more than 500 beds, through the introduction of a computer program. The results indicate that this kind of systematic time control, which is used by nurses, anaesthesia and surgery staff is able to offer a more rational utility to human and material resources.
Hospital Bed Capacity, 500 and over↗
Esophageal cancer and aldehyde dehydrogenase-2 genotypes in Japanese males.
Although drinking alcohol is an established esophageal cancer risk factor, the mechanisms by which alcohol induces this high-mortality rate cancer are not clear. To help elucidate this problem and develop an implementable preventive strategy, this genetic epidemiological study focused on aldehyde dehydrogenase 2 (ALDH2), the key enzyme for elimination of acetaldehyde generated by alcohol consumption. This enzyme is polymorphic; its mutant allele, ALDH2*2, which leads to the enzyme inactivity, is prevalent in Orientals. This Japanese case-control study of ALDH2-related risk for esophageal squamous cell carcinoma included alcoholics (40 cases and 55 controls) and nonalcoholic drinkers (29 cases and 28 controls). The analysis of the results of genotyping these subjects showed that the increased risk for esophageal cancer in those with one ALDH2*2 allele was substantially higher in both alcoholics (odds ratio = 7.6; 95% confidence interval = 2.8-20.7) and nonalcoholic drinkers (odds ratio = 12.1; 95% confidence interval = 3.4-42.8). The results strongly suggest that because persons who have this mutant ALDH2*2 allele have a high concentration of blood acetaldehyde after drinking alcohol, acetaldehyde (a recognized animal carcinogen) plays a pivotal role in the pathogenesis of alcohol-related esophageal cancer in humans. These results suggest that to help lower their risk for esophageal cancer, persons with the ALDH2*2 allele should be encouraged to reduce their consumption of alcoholic beverages.
Acetaldehyde↗