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Biomedical subjects

M Umino

Publications and source records attributed to M Umino.

At least 37 records · Page 2Linked to original sources
PubMed1994

Unexpected atrial fibrillation during tooth extraction in a sedated elderly patient.

A case is reported of unexpected atrial fibrillation in response to tooth extraction under intravenous sedation in a 70-yr-old patient with thoracic aneurysm of the aorta. Atrial fibrillation developed after the additional injection of a 2% solution of lidocaine containing 1:200,000 epinephrine. After 20 min, the arrhythmia disappeared spontaneously. The arrhythmia was associated with insufficient analgesia for tooth extraction, epinephrine in the local anesthetic, decreased blood pressure, and the presence of cardiovascular disease. Even when a low concentration of epinephrine is employed, caution should be paid to development of unexpected cardiovascular reactions in elderly patients with severe cardiovascular disease. We conclude that an electrocardiogram, blood pressure device, and pulse oximeter should be used in high-risk patients in order to prevent and detect potentially dangerous cardiovascular emergencies, even if dental treatment is scheduled under local anesthesia.

Aged↗
PubMed1993

Long-term observation of the relation between pain intensity and serum carbamazepine concentration in elderly patients with trigeminal neuralgia.

The relation between changes in pain intensity and serum carbamazepine (CBZ) concentration was studied in five elderly patients with trigeminal neuralgia. Measurement of pain intensity and serum CBZ concentration, and blood studies, were performed approximately every 2 or 3 months after initiation of CBZ therapy. Fluctuations in pain intensity were observed in four patients. In these patients, even when the serum CBZ concentration was maintained within a relatively high range, there were periods in which pain intensity increased. On the other hand, there were periods in which pain was relatively well controlled even though the CBZ concentration was relatively low. There were considerable interindividual differences in response to CBZ. The fluctuations in pain showed that the CBZ response curve varies from period to period even within an individual. It was concluded that it is essential to observe spontaneous variations in pain intensity and monitor serum CBZ during long-term administration.

Aged↗
PubMed1993

Effects of extensive oral surgery and hemorrhage on coagulation and fibrinolysis.

The changes in coagulation and fibrinolytic activity in 22 patients with oral cancer undergoing extensive surgical procedures were studied. The patients were divided into two groups: group I patients suffered blood loss of less than 2,000 mL and group II patients had blood loss of more than 2,000 mL. The platelet count decreased significantly during surgery, at the end of surgery and on the 1st postoperative day in both groups. Fibrinogen was decreased during and at the end of surgery in both groups, but increased significantly on the 3rd postoperative day and reached about two times the preoperative levels on the 7th postoperative day. Fibrin degradation products increased significantly after surgery and reached the maximum value on the 1st postoperative day in both groups. Plasmin inhibitor complex and plasminogen increased significantly on the 3rd and 7th postoperative days. There was no clear evidence regarding the influence of blood loss on coagulation and fibrinolytic factors except for platelets. It was concluded that coagulation and fibrinolysis are enhanced between the 3rd and 7th postoperative days.

Adult↗
PubMed1993

Morphologic airway changes after mandibular setback osteotomy for prognathism with and without cleft palate.

This study illustrates morphologic changes of the pharyngeal airway after mandibular setback osteotomy. Twenty-six patients with prognathism were evaluated preoperatively and postoperatively with standard lateral cephalograms to assess craniofacial morphology--in particular, airway size. Subjects were classified into two groups: those with mandibular prognathism and those with mandibular prognathism accompanied by maxillary hypoplasia caused by cleft palate. In the postoperative period, the width of the pharyngeal airway significantly diminished in both groups; the airway widths of those with maxillary hypoplasia were narrower than those without maxillary hypoplasia. These results indicate that mandibular setback osteotomy induces the narrowing of the pharyngeal airway, and the narrowing effect of this surgery was more pronounced in prognathic patients accompanied by maxillary hypoplasia caused by cleft palate.

Adolescent↗
PubMed1993

Systemic diseases in elderly dental patients.

Systemic diseases, blood pressure and pulse rate, were investigated in 1012 elderly patients who consulted the gerodontic clinic of Tokyo Medical and Dental University Hospital. One or more systemic diseases was found in 64.2 per cent of the subjects. Hypertension was the most frequent systemic disease, occurring in 30.9 per cent of the subjects, and was followed by angina pectoris, diabetes, arrhythmias, digestive diseases, cerebrovascular diseases and myocardial infarction, respectively. Nearly 17 per cent of the patients had two or more diseases. Among these diseases, hypertension was frequently combined with angina pectoris, myocardial infarction, arrhythmia, and cerebrovascular diseases. Patients with systemic diseases are at a greater risk during dental treatment. Psychosomatic stress and vasoconstrictors in local anaesthesia possibly induce the exacerbation of systemic diseases or unexpected cardiovascular reactions. Isolated systolic hypertension (systolic blood pressure of 160 mm Hg or more) was noted in 14.3 per cent of the patients. Among these patients, 6.3 per cent of patients were hypertensive patients who had both above 160 mm Hg systolic pressure and 95 mm Hg diastolic pressure. Elderly dental patients have various systemic diseases. Accordingly, it is very important for the dentist to identify systemic diseases of patients and to understand systemic conditions before treatment commences.

Age Distribution↗
PubMed1989

[Acute and chronic effects of a new oral inotropic agent, ibopamine hydrochloride, on hemodynamic and metabolic responses to ergometer exercise in patients with severe congestive heart failure].

The hemodynamic and metabolic effects of ibopamine, an orally active 3,4-diisobutylic ester of N-methyl-dopamine, at rest and during exercise, were evaluated in 8 patients with severe congestive heart failure, initially at 2 hrs after oral 100 mg and after 4 weeks of maintenance therapy (100 mg, 3 times a day). At rest, a single dose of ibopamine increased CI, SVI and SWI, and reduced PCWP, PAm, RA and PVR. These beneficial hemodynamic effects were maintained during supine bicycle exercise: CI and SVI increased markedly (p less than 0.05) and PCWP, PAm, RA and SVR increased at a lower extent (p less than 0.05) after ibopamine than on control conditions. After chronic therapy with the drug, LVDd and CTR decreased (p less than 0.05) and exercise tolerance time increased (p less than 0.01). HR, BPm, double product, norepinephrine, epinephrine, renin activity, aldosterone and lactate/pyruvate did not change significantly after administration of ibopamine. Clinical responses after 4 weeks of maintenance therapy were good in 4 cases and fair in 1 case. No adverse effects were observed. Therefore, ibopamine seems to have not only a positive inotropic action, but also a potent vasodilating action, leading to both afterload and preload reduction and so to be useful for the treatment of severe congestive heart failure at rest and during exercise after acute and chronic therapy with the drug.

Administration, Oral↗
PubMed1988

Automated determination of drugs in serum by column-switching high-performance liquid chromatography. II. Separation of theophylline and its metabolites.

The automated determination of theophylline and related compounds in human serum by column-switching high-performance liquid chromatography, including direct injection of serum samples, is described. TSK pre-column BSA-ODS and TSK gel ODS-80TM were used in the pre-column and analytical column, respectively. Serum samples of 20 microliters were directly injected on to the pre-column. After washing out serum proteins from the pre-column with 0.1 M NaH2PO4 at a flow-rate of 1.0 ml/min for 3.5 min, the effluent from the pre-column was introduced on to the analytical column by a column-switching device. The analysis was performed by stepwise gradient elution using 10 and 18% methanol in 0.1 M NaH2PO4. Theophylline and nine derivatives could be determined simultaneously within 40 min. The recovery of these compounds from serum was 95-103%. The linearity (1.0-50 micrograms/ml theophylline) and reproducibility (coefficient of variation less than 2.0%) were sufficient for drug monitoring at the lower and upper limits of therapeutic concentrations of theophylline.

Biotransformation↗
PubMed1988

Automated determination of drugs in serum by liquid chromatography with column-switching. I. Separation of antiepileptic drugs and metabolites.

This is a fully automated system for determining six common antiepileptic drugs and two principal metabolites of carbamazepine in serum. It is based on "high-performance" liquid chromatography (HPLC), with column switching. TSKprecolumn BSA-ODS and TSKgel ODS-120A (both from Toyo Soda) were used as the precolumn and analytical column, respectively. The former contains octadecylsilyl resins treated with bovine serum albumin (BSA), and does not adsorb macromolecules such as serum proteins but retains small lipophilic molecules such as antiepileptic drugs. Serum samples are directly injected onto the precolumn. After washing out the serum proteins from the precolumn with sodium phosphate buffer, we switch the column connections to introduce the retained substances onto the analytical column and elute with a step-gradient of acetonitrile/sodium phosphate buffer. The high analytical recovery (95-102%) and the reproducibilities (CV less than 5% within-run) indicate that this system is suitable for use in theraputic drug monitoring in clinical laboratories.

Acetonitriles↗
PubMed1988

Relationship between subjective pain estimation and somatosensory evoked potentials by electrical tooth stimulation.

The relationship between the amplitude of somatosensory evoked potentials (SEP) and the subjective pain estimation using a visual analogue scale (VAS) was examined in 8 volunteers undergoing randomized electrical tooth stimulation with 3 different intensities. Randomized stimulation was used instead of repetitive stimulation with a fixed intensity in order to minimize the phenomena of habituation and expectancy in recording the SEP and VAS. The VAS scores increased significantly with the stimulus intensity. The amplitude with a latency between 160 and 300 msec (N160-P300) showed a significant increase with the increased intensity. But the amplitudes between 60 and 110 msec (N60-P110) and between 110 and 160 msec (P110-N160) showed no significant change. There was a significant correlation between the amplitude of N160-P300 and the VAS scores. These findings indicate that the component between 160 and 300 msec reflects the perceived pain intensity and the psychological evaluation processes such as cognition, meaning, interpretation and appreciation of pain. The method of randomized stimulation can serve as a simple and useful way for the objective or subjective pain estimation.

Adult↗
PubMed1985

Effect of thiamylal and diazepam on release of myoglobin and creatine phosphokinase by succinylcholine chloride during halothane anesthesia.

The effects of thiamylal and diazepam on the release of myoglobin and creatine phosphokinase following the administration of succinylcholine chloride during halothane anesthesia were studied. Thirty patients receiving halothane anesthesia were divided into three groups. In Group I, 1.5-2 mg/kg of thiamylal were given intravenously as pretreatment before the injection of succinylcholine chloride. In Group II, 0.3 mg/kg of diazepam were given and, in Group III, only succinylcholine chloride was injected. A significant increase in the serum myoglobin and creatine phosphokinase levels was observed in all groups. However, the values in Group I were significantly lower than those in Groups II and III and a significant difference was not detected between Group II and III. Our results indicate that thiamylal has a considerable inhibitory effect on the release of myoglobin and creatine phosphokinase from the muscle following the administration of succinylcholine chloride.

Adolescent↗
PubMed1984

Effects of acupuncture anesthesia on the pituitary gland.

The skin pain threshold was elevated significantly by weak and nonstressful acupuncture stimulation. Although an analgesic effect was obtained by acupuncture stimulation, the beta-E, ACTH, GH and TSH levels were not changed. These findings indicate that these hormone levels were not necessarily related to the skin pain threshold elevation. It is concluded therefore that an analgesic effect was induced without involving the pituitary gland by the weak acupuncture stimulation employed in our study. However, the magnitude of the stimulation may determine whether or not an analgesic effect is mediated by the pituitary gland. The possibility remains that strong acupuncture stimulation produces stress-induced analgesia (SIA). Further detailed research should be attempted.

Acupuncture Therapy↗