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N Sakanishi

Publications and source records attributed to N Sakanishi.

10 recordsLinked to original sources
PubMed1992

An initial comparison of intensive care in Japan and the United States.

OBJECTIVE: The objective of this study was to compare the utilization of, and outcome from, critical care services in selected medical centers providing secondary and tertiary care in the United States and Japan. DESIGN: Prospective data collection on 1,292 patients from each of the participating Japanese study hospitals in 1987 to 1989 and compared with the 5,030 patients in the United States 1982 Acute Physiology and Chronic Health Evaluation (APACHE II) database used to develop the APACHE II equation. Detailed organizational characteristics of the participating ICUs and hospitals were also obtained. SETTING: Data collection took place in the ICUs of 13 U.S. hospitals and six Japanese hospitals. PATIENTS: Data were collected on consecutive, unselected patients from medical, surgical, and mixed medical/surgical critical care units, with a spectrum of medical and surgical diagnoses. MEASUREMENTS AND MAIN RESULTS: U.S. and Japanese ICUs have a similar array of diagnostic and therapeutic modalities. Only 2% (range 0.6 to 3.5) of beds in Japanese hospitals were designated to intensive care. The organization of the Japanese and U.S. ICUs varied by hospital. There were significantly fewer women admitted to Japanese ICUs and a substantially lower proportion of low-risk-of-death patients. Despite a rapidly aging population, there were relatively fewer elderly patients with chronic health ailments in the Japanese ICU population (8%) compared with the U.S. cohort (18%). CONCLUSIONS: In this sample of hospitals, similar high-technology critical care is available in the United States and Japan. Variations in utilization between the two countries represent differences in case mix and bed availability. The APACHE II equation stratified patients in the Japanese patient cohort across the full spectrum of increasing severity of illness.

Chi-Square Distribution↗
PubMed1992

Plasma alpha-human atrial natriuretic peptide concentration in patients with acute lung injury.

To elucidate the pathophysiologic role of alpha-human atrial natriuretic peptide (alpha-hANP) in acute lung injury, plasma alpha-hANP concentrations were measured in 15 patients with severe lung injury, and the relationships of plasma alpha-hANP levels to the severity of lung injury, diuresis/natriuresis, and fluid balance were examined. The mean concentrations of plasma alpha-hANP (188.0 +/- 94.6 pg/ml) in patients with severe lung injury at the entry into the study were significantly (p less than 0.001) higher than those in normal subjects (31.7 +/- 12.0 pg/ml). Plasma alpha-hANP levels decreased in parallel with the improvement of lung injury in nine of 15 patients, whereas they changed little, if any, in the patients who did not recover. Plasma alpha-hANP concentrations correlated positively with urine volume, urinary sodium excretion, and excreted fraction of filtered sodium, but they correlated negatively with fluid balance at the onset of the disease as well as during the clinical course. It is suggested that elevation of circulatory alpha-hANP may reflect an adaptative mechanism to remove excessive fluid retention and reduce pulmonary hypertension for acute lung injury.

Acute Disease↗
PubMed1991

[Investigation of limulus test during and after cardiopulmonary bypass. Part II. Effect of washing of the bypass circuit].

Previously we reported the presence of Limulus positive substance (LPS) in blood and urine for several days following cardiopulmonary bypass (CPB), and foreign particles in the primining fluids. The purpose of this study was to evaluate the effect of washing of the CPB circuit on appearance of LPS and to define the nature of it. Semi-quantitative Limulus test was performed in patients using washed CPB circuit (n = 54) and without washing (n = 41). LPS in the blood were negative in all patients before CPB. LPSs in the priming fluids did not disappear after washing, however the amounts of it in the blood were significantly lower than those without washing. Especially at second postoperative day. Limulus test were positive in 10% of patients with washed CPB circuit and 60% of those without it (p less than 0.01), and all the urine samples of patients with washed CPB circuit were negative to Limulus test at 1st postoperative day. The number of foreign particles decreased in parallel with the smaller pore size of the filter. Since reactions of Pregell to ethylene oxide gas, ethylene chlorohydrin and ethylene glycol were negative, ethylene oxides did not seem to be the LPS. These results indicate the superiority of employment of washed CPB circuit with micropore filter. However, further exploration is still mandatory to elucidate the LPSs.

Adolescent↗
PubMed1990

Plasma alpha-atrial natriuretic peptide concentrations in acute respiratory failure associated with sepsis: preliminary study.

Plasma alpha-atrial natriuretic peptide (alpha-ANP) concentrations were measured during mechanical ventilation in nine patients with acute respiratory failure (ARF) associated with sepsis. The relationships between alpha-ANP and pulmonary hemodynamic variables were examined. A total of 22 measurements of alpha-ANP and other variables were obtained. The mean plasma alpha-ANP concentration of 22 measurements was 120.1 +/- 79.8 pg/ml (normal 31.7 +/- 12.0, mean +/- SD). Plasma alpha-ANP concentrations correlated with mean pulmonary artery pressure (MPAP) (r = .703, p less than .01) and pulmonary vascular resistance (PVR) (r = .606, p less than .01), but not with other variables. These findings suggest that alpha-ANP elevation may be related to the increases in MPAP and PVR in ARF associated with sepsis.

Aged↗
PubMed1989

Two-dimensional echocardiographic evaluation of inferior vena cava, right ventricle, and left ventricle during positive-pressure ventilation with varying levels of positive end-expiratory pressure.

The effects of intermittent positive-pressure ventilation (IPPV) with 0, 10, and 15 cm H2O of PEEP on inferior vena cava (IVC), right and left ventricular length and septal-lateral dimensions, and cardiac output were examined in 19 patients with respiratory failure using two-dimensional echocardiography. In five patients, cardiac output was also obtained by the thermodilution technique. As PEEP was increased, IVC dimensions increased during both inspiration and expiration, and the IVC collapsibility index decreased. This indicated an increase in venous stasis and decrease in venous return to the right atrium. Increasing PEEP was associated with progressive decreases in cardiac output, and length and septal-lateral dimensions of both ventricles. The decreased cardiac output during IPPV with 10 and 15 cm H2O PEEP may be due to the decreased venous return and ventricular filling. Cardiac output determined by echocardiography was correlated closely to that by the thermodilution technique.

Adult↗
PubMed1989

[Investigation of Limulus test during and after cardiopulmonary bypass--analysis of Limulus positive substance and particles in the cardiopulmonary bypass circuit].

Patients undergoing heart surgery with cardiopulmonary bypass (CPB) frequently have positive Limulus test without any remarkable signs of endotoxemia. CPB circuit could be one of the possible causes of this phenomenon, but the exact mechanism has not been studied. Accordingly, a prospective study was made in 41 patients undergoing heart surgery with CPB. Limulus test were performed on the samples of priming fluids of CPB including the plasma and urine of those patients during and after surgery. Besides the Limulus test, the CPB fluids were analysed by the false positive test. Microscopic examinations were carried out on the priming fluids before and after using a 40 microns filter during recirculation without washing the CPB circuit and the fluid from a 4 microns filter been washed by 2000 ml of Martose-10 in order to find out the presence of any foreign particles in the CPB circuit. The size and the number of particles were measured by coulter counter. The studies revealed the following facts, 1) Limulus test; most of the samples from priming fluids (31/35), plasma circulating the CPB (36/36), urine during CPB (22/25) and plasma (34/35) and urine (21/30) just after the surgery revealed positive. However, only 4 samples from plasma at 3POD and 2 samples from urine at 2POD revealed positive, 2) false positive test of the samples from priming fluids was negative meaning the Limulus positive substances are not endotoxin, 3) under microscopic analysis and coulter counter, there were about 40 particles over 50 microns per ml of priming fluids before washing the CPB circuit.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Comparison of hemodynamic effects of morphine, butorphanol, buprenorphine and pentazocine on ICU patients.

Morphine and narcotic agonist-antagonists have been used to assist ICU patients in adapting to mechanical ventilation. In this study, 10 mg of morphine and the equipotent doses of synthetic analgesics, 2 mg of butorphanol, 0.6 mg of buprenorphine or 30 mg of pentazocine were administered intravenously to 29 patients requiring a ventilator. Hemodynamic effects on the heart rate, mean arterial pressure (MAP), cardiac index, stroke index, left ventricular stroke work index, mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP) and systemic and pulmonary vascular resistance (PVR) were measured. The hemodynamic effects of the four drugs were mild and not statistically significant except for the reduction in PCWP and the increase in PVR after morphine and the increase in MAP and MPAP after pentazocine administration. These doses of the four drugs could be given safely even in critically ill patients. The hemodynamic effects of these analgesics showed a similarity between the administration of butorphanol and morphine, and between buprenorphine and pentazocine. This study demonstrates that morphine and butorphanol are preferred to the cases with hypertension, increased pulmonary arterial pressure or wedge pressure and that pentazocine and buprenorphine are more suitable for the cases with hypotension or hypovolemia.

Adult↗