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Biomedical subjects

N Shime

Publications and source records attributed to N Shime.

14 recordsLinked to original sources
PubMed2001

Therapeutic administration of anti-PcrV F(ab')(2) in sepsis associated with Pseudomonas aeruginosa.

The effects of rabbit-derived polyclonal Ab against PcrV, a protein involved in the translocation of type III secreted toxins of Pseudomonas aeruginosa, was investigated in two animal models of P. aeruginosa sepsis. In a mouse survival study, the i.v. administration of anti-PcrV IgG after the airspace instillation of a lethal dose of P. aeruginosa resulted in the complete survival of the animals. In a rabbit model of septic shock associated with Pseudomonas-induced lung injury, animals treated with anti-PcrV IgG intratracheally or i.v. had significant decreases in lung injury, bacteremia, and plasma TNF-alpha and significant improvement in the hemodynamic parameters associated with shock compared with animals treated in a similar manner with nonspecific control IgG. The administration of anti-PcrV F(ab')(2) showed protective effects comparable to those of whole anti-PcrV IgG. These results document that the therapeutic administration of anti-PcrV IgG blocks the type III secretion system-mediated virulence of P. aeruginosa and prevents septic shock and death, and that these protective effects are largely Fc independent. We conclude that Ab therapy neutralizing the type III secretion system has significant potential against lethal P. aeruginosa infections.

Animals↗
PubMed2001

Bilateral transient radial nerve palsies in an infant after cardiac surgery.

PURPOSE: To describe the case of an infant who suffered bilateral transient radial nerve palsies after cardiac surgery. CLINICAL FEATURES: A one-month-old baby was found to have bilateral wrist and finger drop after the removal of splints that has been applied to the right hand for 14 days and to the right hand for six days during perioperative management of Blalock-Taussig shunt surgery. The hand splints had been applied to the forearms with adhesive silky tape to keep peripheral vascular lines in place. The patient also suffered from several episodes of cardiogenic shock, hypoxemia and generalized edema relating to cardiac dysfunction during this fine period. Given the findings of no impairment of median or ulnar nerves and brachioradial muscle, it was suspected that bandaging with adhesive tapes caused peripheral radial nerve damage at the level of posterior interosseus nerve on forearm. Diminished oxygen delivery and edema may additionally have contributed to peripheral nerve ischemia. The aforementioned neurologic symptoms resolved spontaneously after several days. CONCLUSION: Prolonged compression by bandaging of splints on forearm may have resulted in ischemic damage to the posterior interosseus nerve branch combined with extensor carpi radialis longus nerve branch of the radial nerve. We should attempt to reduce the frequency and duration of splinting of the extremities, especially in sedated, paralyzed babies, given the potential risk of compression neuropathy.

Arteriovenous Shunt, Surgical↗
PubMed2001

Application of modified sequential organ failure assessment score in children after cardiac surgery.

OBJECTIVE: To evaluate the usefulness of the modified sequential organ failure assessment (m/SOFA) score for assessing morbidity and mortality in pediatric patients after cardiac surgery. DESIGN: Analysis of a prospectively collected database. SETTING: Pediatric intensive care unit of a university-affiliated hospital. PARTICIPANTS: Consecutive pediatric patients (n = 142) undergoing cardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The m/SOFA score, consisting of 5 organ scores (maximum score of 20 points), was calculated on admission (initial) and at 12 and 36 hours postoperatively. An initial score of >5 points with an unchanged or upward postoperative trend predicted a higher postoperative mortality and a greater need for intensive care intervention. In neonates, sustained higher score >10 points predicted an outcome of death with a sensitivity of 100% and a specificity of 87%. Given the higher mortality related to immature organ function and a greater complexity of heart defects, the application of the m/SOFA score, a less invasive and simple way to assess organ damage, is especially suitable in neonates. The m/SOFA score would be more appropriately assessed according to the congenital heart defect or surgical procedure because the types of cardiac defect after the surgical repair affect each organ score measurement. CONCLUSION: Application of the m/SOFA score in the early postoperative period, which reflects cumulative perioperative organ damage, would provide some direction to eventual outcomes of morbidity and mortality in patients with congenital heart defects undergoing surgery.

Adolescent↗
PubMed2001

Arterial ketone body ratio for the assessment of the severity of illness in pediatric patients following cardiac surgery.

PURPOSE: The purpose of this study was to assess whether the arterial ketone body ratio (AKBR) can be effectively used to evaluate the severity of illness in children following cardiac surgery. MATERIALS AND METHODS: AKBR was measured in 157 consecutive pediatric patients following heart surgery on the odd numbers of postoperative days. The relationship between AKBR and patient outcome was analyzed using the data of 141 patients with cardiopulmonary bypass. RESULTS: Initial AKBR was frequently lower than 1.0, and this was associated with the increases in total ketone body counts. Insufficient glucose metabolism appeared to contribute to the low initial AKBR. As a result, the specificity of initial AKBR as a mortality predictor was lower than that of initial blood lactate. In the sequential analysis of AKBR for the 48 patients with PICU stay longer than 5 days, patients showing a sustained lower level <1.0 had significantly higher development of organ dysfunction (liver, heart) and greater mortality (56%). CONCLUSIONS: Sustained postoperative decrease in AKBR <1.0 represents lethal outcome. The analysis of AKBR trend in combination with a measurement of blood lactate level in early postoperative period appears to be useful for the assessment of the severity of illness in pediatric patients following heart surgery.

Adolescent↗
PubMed2001

[Perioperative assessment of blood lactate levels in pediatric heart surgery].

Measuring arterial lactate concentration is a prompt, easy and relatively non-invasive way to estimate tissue oxygen metabolism. We evaluated whether perioperative levels of the arterial lactate concentrations can reflect the general severity of a pediatric patient's condition. A consecutive series of 112 patients, aged 5 days to 17 years (median age: 12 months), admitted to our pediatric intensive care unit (PICU) following cardiac surgery under cardiopulmonary bypass were studied. Arterial blood lactate concentration was measured preoperatively, immediately upon termination of the cardiopulmonary bypass (postCPB), immediately following the operation, and 16th hours postoperatively (D1). Trends within arterial lactate concentrations were examined in relation to mortality rates, the duration of PICU stays and the patient's ages. The studied population had a mortality rate of 5.7% (6 patients). Lactate levels increased significantly and exceeded 4.0 mmol.l-1 during postCPB measurements in a majority of the patients. The increases in lactate levels are affected by the changes in interorgan blood flow, blood glucose levels and/or blood pH in addition to the effects of the CPB-priming lactated Ringer's solution. Thus, higher cut off values have to be determined, and lower probabilities assigned, when using postCPB lactate levels to predict the severity of an outcome. Significantly and sustained increases in D1 lactate levels were noted in neonates, patients with longer PICU stays (> 15 days) and those died later. Hyperlactemia greater than 2.2 mmol.l-1 at D1 predicted death with a sensitivity of 82% and a specificity of 72%. The measurement of early postoperative lactate levels, reflecting postoperative ability to eliminate intraoperative hyperlactemia, is a better way of assessing the severity of a pediatric patient's condition following cardiac surgery. The ideal time to measure early postoperative lactate levels should be determined by further research.

Adolescent↗
PubMed2000

[A case of rhabdomyolysis after open heart surgery in a child].

Rabdomyolysis usually occurs after trauma and release of myoglobin from the damaged muscle, i.e.; after ishchemic myopathy due to arterial occlusion or malignant hyperthermia. We encountered a pediatric case of rhabdomyolysis after Ross-Konnos' operation in an 8-yr-old girl with aortic regurgitation. After the first weaning from cardiopulmonary bypass (CPB), ventricular fibrillation occurred due to an insufficiency in coronary blood flow and CPB was resumed with rapid cooling of body temperature. The total CPB lasted for 5 hr 43 min. After the second weaning from CPB, myoglobinuria was found. Furthermore, blisters and abrasions appeared on her back and CPK levels were abnormally elevated (maximum 19,132 IU.l-1) without any elevation of body temperature in the postoperative course. Rhabdomyolysis due to intraoperative hypoperfusion was suspected and diuretics were administrated with a large amount of crystalloid to maintain urine output. The patient showed a good clinical course without acute renal failure. The course of this case suggests that rhabdomyolysis is one of rare complications of CPB and an early correct diagnosis of rhabdomyolysis and forced diuresis at an early stage are important to avoid acute renal failure.

Biomarkers↗
PubMed1999

[Assessment of oxygen transport in individual splanchnic organs using critical oxygen extraction].

Vulnerability in individual organs under ischemic stress can be assessed by critical oxygen extraction (critical O2ER). We measured critical O2ER in the whole-body, total splanchnic organs, liver and gut using a biphasic regression model of the oxygen delivery-consumption relationship in 7 dogs subjected to hemorrhagic stress under 1% isoflurane anesthesia. The difference in critical O2ER between the whole-body and total splanchnic organs was not significant, while hepatic critical O2ER was significantly larger than that of the gut (P < 0.05), 89.7 +/- 2.4% (mean +/- SD) and 66.1 +/- 5.1%, respectively. This finding indicated that the liver functions well under ischemic conditions due to its excellent ability to extract oxygen. The anatomical character of the sinusoid and the microcirculatory improving effect of isoflurane may affect the ability of oxygen extraction of the liver. The critical threshold of hepatic venous oxygen saturation as a marker of hepatic oxygen imbalance was considered to be below 10%.

Anesthesia, Inhalation↗
PubMed1995

Oxygen transport and hemodynamics during retrograde whole-body perfusion.

The changes in oxygen transport and hemodynamics during retrograde whole-body extracorporeal perfusion (retro-ECC) were studied in six mongrel dogs. Oxygen consumption during retro-ECC, in which the blood flow rate was set at 25% and 50% of the flow during antegrade extracorporeal perfusion (ante-ECC), respectively, was relatively high compared with that during ante-ECC. These changes were caused by an increase in the oxygen extraction ratio to 71.5% +/- 8.2% and 51.2% +/- 12.4% during retro-ECC/25% and retro-ECC/50%, respectively. Thus, tissue perfusion was apparently well maintained by retrograde perfusion on the basis of the oxygen transport data. However, central venous pressure increased markedly to 29.5 +/- 11.6 mmHg and 56.2 +/- 24.5 mmHg during retro-ECC/25% and retro-ECC/50%, respectively, because of massive venous congestion caused by insufficient arterial return of perfused blood. The great venous compliance and increased systemic vascular resistance were the main causes of circulatory failure during retro-ECC. The risk of serious complications owing to the venous congestion must be considered during retrograde perfusion, especially during the clinical application of retrograde cerebral perfusion.

Animals↗
PubMed1994

Cardiovascular changes during continuous hyperthermic peritoneal perfusion.

Changes in blood temperature, hemodynamics, and oxygen transport were evaluated in 11 patients during continuous hyperthermic peritoneal perfusion (CHPP), a technique in which the peritoneal cavity is perfused continuously with heated solution to treat intraperitoneal cancer. CHPP was undertaken 46.8 min after the resection of cancer. Blood temperature, measured with a thermistor of a pulmonary artery catheter, reached 39.2 degrees C. Heart rate increased to 100.7 +/- 21.4 bpm (mean +/- SD) and the cardiac index to 4.61 +/- 0.80 L.min-1.m-2. Mean arterial pressure decreased to 75.5 +/- 10.8 mm Hg and systemic vascular resistance index to 1239 +/- 394 dynes.s.cm-5.m2. Oxygen consumption greatly increased to 139.1 +/- 35.2 mL.min-1.m-2, concurrently with a smaller increase in oxygen delivery to 619.7 +/- 83.7 mL.min-1.m-2 and a slight increase in oxygen extraction. Pulmonary oxygenation capacity was also disturbed. Although these cardiovascular changes were mainly due to systemic hyperthermia, other changes may be caused by splanchnic heating, abdominal distention, and pharmacologic action of methoxamine, propranolol, diltiazem, and fentanyl.

Adult↗
PubMed1994

[The usefulness of transcutaneous gas monitoring during hemorrhagic shock; discrepancy between the two transcutaneous gas tensions of anterior thorax and femur].

We measured transcutaneous gas tensions of both anterior thorax and femur. The differences between the two transcutaneous gas tensions were compared, as well as the relationship between the two transcutaneous and mixed venous blood gas tensions, in 10 dogs during hemorrhagic shock. The changes in femoral transcutaneous gas tensions correlated better with the changes in mixed venous gas tensions. The correlation between the two transcutaneous gas tensions were fairly good (oxygen tensions; r = .827, carbon dioxide tensions; r = .867). However, the discrepancy between the two gas tensions became greater in severe shock. Hence, oxygen tensions became smaller and carbon dioxide tensions became greater on femur than on anterior thorax. This indicates the possibility of "maldistribution of blood flow", which has already been detected between vital organs and skin, also exists between peripheral and central skin. Therefore, transcutaneous gas tensions should be monitored at peripheral skin, where gas tensions show greater changes and reflect systemic perfusion precisely than at central skin, during shock.

Animals↗
PubMed1992

[Usefulness of transcutaneous gas monitoring during hemorrhagic shock].

This study was undertaken to confirm whether transcutaneous (tc) gas analysis during hemorrhagic shock could be used as an alternative to mixed venous gas analysis. Tc gases were measured and correlated with arterial and mixed venous gases in 10 anesthetized dogs during hemorrhagic shock and volume resuscitation. Throughout this experiment PtcO2 correlated well with PvO2 (r = 0.78, P less than 0.01), while PaO2 remained mostly constant, and PtcCO2 correlated well with PvCO2 (r = 0.82, P less than 0.01) rather than with PaCO2 (r = 0.63, P less than 0.01). A more detailed observation showed that during progressively decreased cardiac output, PtcO2 became lower than PvO2 and PtcCO2 became higher than PvCO2. We inferred from these observations that the changes of tc and mixed venous gases reflected those gases in tissues and that during severe shock maldistribution of peripheral blood flow prevented mixed venous gases from coming into equilibrium with tissue and tc gases. We conclude that the measurement of tc gases during shock is a more convenient and more reliable monitor of tissue gases than mixed venous analysis.

Animals↗
PubMed1990

[Anesthetic management of a patient with progressive spinal muscular atrophy].

Various problems especially weakness of respiratory muscle and abnormal reaction to muscle relaxant exist during the management of anesthesia for the patients with neuromuscular disease with the disturbance of motor neurons. We had a patient for trans-urethral resection of prostate with spinal progressive muscular atrophy. Using nitrous oxide-oxygen with halothane, and without muscle relaxant, we succeeded in avoiding respiratory failure, aspiration and other serious complications. By measuring serum sodium, rapid discovery and treatment of water intoxication could be achieved.

Aged↗
PubMed1990

[Anesthetic management for surgery of patients with metastatic brain tumors associated with lung tumors].

We had four patients who received anesthesia for metastatic brain tumors. All patients were complicated with primary lung tumors which had caused several respiratory problems. Respiratory failure and intratracheal hemorrhage from lung tumors were the severest complications during and after the operation. Two patients suffered from pneumonia at early postoperative stage and died of respiratory failure within eighty days after the operation. We consider that these preoperative findings of atelectasis and hemosputum are important signs that could predict those severe complications. To avoid postoperative respiratory complications in patients with atelectasis, the anesthetist should perform careful perioperative management such as active preoperative pulmonary physical therapy and should choose anesthetics which do not affect postoperative consciousness and respiration, and should perform intensive postoperative respiratory care. To prevent pulmonary hemorrhage, the fiberoptic bronchoscopy is useful for the diagnosis and the therapy. We also consider that the long operation aggravates postoperative complications. Planning of operation and performing operative procedure in a shortest time possible are also important.

Adult↗