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Biomedical subjects

M Odashiro

Publications and source records attributed to M Odashiro.

At least 19 recordsLinked to original sources

[Two cases of epidural neulolysis using ethyl alcohol and histopathologic changes in the spinal cord].

We report two cases of cancer pain treated with transcatheter thoracic epidural neurolysis using ethyl alcohol, and epidural histopathologic changes in the spinal cord observed in one of the patients. Case 1: A 59-year-old woman complained of intractable right thoracic back pain due to mediastinal osteo-sarcoma. After obtaining pain relief by epidural block using local anesthetics, we did transcatheter thoracic epidural alcohol block using 2-4 ml of 75-100% ethyl alcohol for three times. Her VAS score decreased from 8/10 to 2/10 and the good pain control was obtained until her death 24 days after the third block. After obtaining permission from her family, necropsy was performed. Spinal nerve roots and the spinal cord showed no abnormality. But the laminar structure of the dura had been destroyed at the outer one third of the dura. Case 2: A 49-year old woman suffered from right upper abdominal pain due to giant metastatic liver tumor. We performed twice transcatheter thoracic epidural neurolysis using 2-3 ml of 75% ethyl alcohol. Her VAS score decreased from 7/10 to 3/10 and the pain relief was maintained until her death 2.5 months after the neurolysis. Motor palalysis was not observed in both cases.

Analgesia, Epidural↗

Kikuchi's disease: report of 2 cases and a brief review of the literature.

Kikuchi's lymphadenitis is a histiocytic necrotizing lymphadenitis without granulocytic infiltration, with fever and generally with a benign course, despite its pathologic resemblance to malignant lymphoma. The illness usually begins with localized cervical adenopathy in young adult females, predominantly before the fourth decade of life. Clinically, several agents could be the cause of such an illness--toxoplasmosis, herpes group viral infection, cat scratch disease, lymphoma, SLE and other infectious agents. The diagnosis is made by using a histological technique. The lymph node biopsy reveals fibrinoid necrosis, loss of lymph node structure with many histiocytes and an absence of granulomatous reaction. The immunohistochemical analysis shows that the main affected cellular components are the T cells. Laboratory exams show an erythrocyte sedimentation increase, neutropenia, leukopenia and lymphocytosis. We describe two cases that were followed since 1994 and 1996, respectively. Both were females under 25 years old, who developed a febrile disease with lymphadenopathy. Lymph node biopsies showed necrotizing lymphadenitis without granulocytic infiltrations. The patients had no evidence of other systemic diseases. Our objectives are to present a rare cause of febrile disease with enlargement of cervical lymph nodes, to review Kikuchi's disease, and to alert the medical community to this rare cause of fever and lymphadenopathy.

Adult↗

[Postoperative sore throat--a comparison of standard cuff, gas-barrier cuff and Brandt anesthesia tube cuff].

Excessive intracuff pressure due to nitrous oxide diffusion into the cuff can damage the tracheal mucosa. Several endotracheal tubes have been developed (Trachelon gas barrier type tube, Brandt Anaesthesia tube) to limit nitrous oxide-related intracuff pressure increase. We investigated whether the incidence of postoperative sore throat could be reduced by using these tubes. Endotracheal intubation was performed in 37 adult female patients with either a standard tube (group S, n = 14), a gas barrier type tube (group G, n = 11), or a Brandt tube (group B, n = 12). All patients were interviewed 16-30 h postoperatively by anesthesiologist who did not know which tube had been used. The increase of intracuff pressure was significantly lower in group G (7.6 +/- 5.1 mmHg, mean +/- SD) and in group B (3.4 +/- 1.7 mmHg) than that in group S (24.0 +/- 9.5 mmHg). The incidence of postoperative sore throat was not significantly different among the groups, 36% (5/14) in group S, 45% (5/11) in group G, and 33% (4/12) in Group B. This incidence did not correlate with intracuff pressure increase. In conclusion, specially manufactured endotracheal tubes to limit excessive intracuff pressure did not effectively attenuate the incidence of postoperative sore throat in this patient population.

Adult↗

[Coronary artery spasm as a cause of perioperative myocardial infarction and stunned myocardium].

We report a male patient who had recurrent coronary artery spasm on withdrawal from cardiopulmonary bypass, which led to myocardial infarction and stunned myocardium. The spasm responded to conventional medication. Transesophageal echocardiogram showed no remarkable asynergy during the operation. However, MB fraction of creatine kinase was 132 IU.l-1 and electrocardiogram showed new Q waves. After stopping intravenous catecholamines, hypokinesis of the anteroseptal segment appeared in the echocardiogram. Spotty myocardial necrosis and stunned myocardium might have resulted from recurrent coronary artery spasm.

Aged↗

[Herpes zoster and malignancy].

A retrospective survey was conducted regarding the relationship between hospitalized patients with herpes zoster and malignancy based on clinical records. A total of 220 patient were hospitalized for treatment of herpes zoster during the past 15 years, and 23 of them had involvement with malignant tumors. Malignancy was found during hospitalization in 4 cases (1.8%). This was significantly higher than 0.27, the predicted number of malignancy cases. Three of the 4 cases were gastric cancer. The discovery rate of gastric cancer through screening at admittance was 2.4%, which was higher than 0.14%, the discovery rate in gastric cancer checkups in Hokkaido. Examination for malignant tumors should be required for all patients with herpes zoster who need to be hospitalized.

Adolescent↗

[Development of an anesthesia ledger using relational database].

An anesthesia ledger was developed using relational database KIRI Ver3. This anesthesia database includes 33 items for input, for example patient's name, patient's I.D. number, data of operation, diagnosis, operative procedure, name of surgeon, name of anesthesiologists and so on. One can select data from displayed menu cards only by rolling down or rolling up the cursor at 19 items and can input numbers by keyboard at twelve items. Even a computer beginner can easily operate it after a minimal training. Only patient's name must be input by text style. We can construct this anesthesia database only by use of functions of KIRI Ver3 without programming. One can use this anesthesia ledger at any operative facilities by changing a part of database and a file of doctor's name.

Anesthesia↗

[Use of diltiazem in the anesthetic management of epinephrine predominant pheochromocytoma].

This report describes a case of epinephrine predominant pheochromocytoma successfully managed intraoperatively with an infusion of diltiazem. A 50-yr-old woman with a 10-yr history of diabetes mellitus was admitted to the hospital because of thirst and general fatigue. A cystic left adrenal tumor was found on computed tomographic scan. Although resting plasma catecholamine levels were normal, plasma norepinephrine and epinephrine levels obtained from the left adrenal vein were 1.6 ng.ml-1 (normal, 0.04-0.35) and 6.2 ng.ml-1 (normal, less than 0.12), respectively. Diltiazem was administered i. v. at a rate of 3 micrograms.kg-1.min-1 before induction of anesthesia. Anesthesia was induced with enflurane 2-3% and nitrous oxide in oxygen, followed by tracheal intubation facilitated with vecuronium. Anesthesia was maintained with enflurane 1-3% and nitrous oxide in oxygen. Paralysis was maintained with vecuronium. Hypertension during the manipulation of the tumor was controlled by increasing the inspired concentration of enflurane or by increasing the infusion rate of diltiazem to 5 micrograms.kg-1.min-1. There was no tachyarrhythmia. The infusion of diltiazem was continued until the draining vein from the tumor had been ligated. Hypotension, after removal of the tumor, was treated by the rapid infusion of fluid. Plasma norepinephrine and epinephrine levels during tumor manipulation were 1.18 ng.ml-1 and 6.57 ng.ml-1, respectively.

Adrenal Gland Neoplasms↗

[A case report of long-term post-thoracotomy pain management with intrapleural bupivacaine].

A 50-year old woman with right post-thoracotomy pain was referred to us for assistance with pain control. She required pentazocine 60-150 mg per day before our treatment. First, we treated her with intercostal nerve block or oral morphine sulfate. But the result was not satisfactory after five months. Then we tried intrapleural bupivacaine. An epidural catheter was inserted into the pleural space from eight intercostal space at the anterior axillary line and 10 ml of 0.5% bupivacaine was instilled. The treatment was effective for about 4-5 hours. We continued this method for 42 days with 10 ml of 0.25% or 0.5% bupivacaine once or twice a day. She felt so good from the intrapleural analgesia and could be discharged. There was no hypotension, respiratory depression, urinary retention except burning thoracic sensation. We think it is possible to use this intrapleural bupivacaine to treat a certain kind of unilateral chronic pain.

Bupivacaine↗

[A case of herpes zoster ophthalmicus with complete ophthalmoplegia].

A 58-year old man with herpes zoster ophthalmicus developed complete ophthalmoplegia, dissemination of herpetic lesions and meningitis. Eye movements improved two month after the onset of zoster. Five months later, eye movements recovered completely, but his sight was disturbed severely due to corneal ulcer.

Herpes Zoster Ophthalmicus↗