PubMed Health⌕ Search

Biomedical subjects

R Ochiai

Publications and source records attributed to R Ochiai.

At least 19 recordsLinked to original sources
PubMed2002

Prognostic significance of dihydropyrimidine dehydrogenase expression in breast cancer.

We have investigated dihydropyrimidine dehydrogenase expression as a prognostic marker in breast cancer. A total of 119 women with breast cancer undergoing surgery between 1985 and 1996 were included in this study. Eighty-seven patients were treated with postoperative chemotherapy including 5-fluorouracil or 5-fluorouracil derivatives. Fifty-nine (50%) of 119 patients were determined to be immunostaining-positive for dihydropyrimidine dehydrogenase. There was no significant difference between dihydropyrimidine dehydrogenase staining and tumour size, lymph node status, clinical stage, oestrogen receptor status, histologic grade, or 5-fluorouracil administration. When evaluated in patients treated with 5-fluorouracil or 5-fluorouracil derivatives, patients with dihydropyrimidine dehydrogenase-positive tumours had a significantly (P<0.05) poorer disease-free survival compared to those with dihydropyrimidine dehydrogenase-negative tumour. No conclusion can be drawn about the prognostic impact of dihydropyrimidine dehydrogenase status in patients who were not treated with 5-fluorouracil regimes due to the small number of such cases in this series. Lymph node and dihydropyrimidine dehydrogenase status were independent prognostic factors for disease-free survival, and lymph node status for overall survival using multivariate analysis. In conclusion, dihydropyrimidine dehydrogenase is a possible prognostic factor in patients with breast cancer treated with 5-fluorouracil or 5-fluorouracil derivatives.

Adult↗
PubMed2000

Doxapram accentuates white matter injury in neonatal rats following bilateral carotid artery occlusion.

The effect of the respiratory stimulant, doxapram, on white matter damage was investigated in neonatal rats under cerebral ischemia. Five-day-old rats underwent bilateral carotid artery occlusion with or without 50 mg/kg i.p. of doxapram. Their brains were neuropathologically examined 48 h later. Doxapram induced about a 20% decrease of PCO(2) for 90 min, but did not cause any neuropathological abnormalities. Bilateral carotid artery occlusion resulted in mild cerebrocortical lesions in 67% of pups, and white matter lesions in the internal capsule in 44%. Doxapram, in addition to bilateral carotid artery occlusion, produced more severe white matter injury in the internal capsule (injury score; 0.67+/-0.87 vs. 1.70+/-0.48, P<0.05) and in the subcortical white matter (0.33+/-0. 67 vs. 1.10+/-0.54, P<0.05). These results demonstrated that the use of doxapram under an ischemic condition accentuates white matter damage in neonatal rats.

Animals↗
PubMed2000

Hypermagnesemia-induced cardiopulmonary arrest before induction of anesthesia for emergency cesarean section.

We describe a 42-yr-old woman scheduled for emergency cesarean section who had sudden cardiopulmonary arrest just before induction of general anesthesia. Hypermagnesemia, caused by accidental overdose of magnesium sulfate during transportation to the operating room, was the primary cause of this life-threatening event. Anesthetic management after such events and a brief summary of the literature regarding iatrogenic hypermagnesemia in obsteric patients are provided.

Adult↗
PubMed2000

Hemodynamic effects of milrinone during weaning from cardiopulmonary bypass: comparison of patients with a low and high prebypass cardiac index.

OBJECTIVE: To compare the hemodynamic effects of milrinone during weaning from cardiopulmonary bypass (CPB) in patients with a low pre-CPB cardiac index (CI) <2.5 L/min/m2) and in patients with a high pre-CPB CI (> or =2.5 L/min/m2). DESIGN: Prospective, randomized, double-blind study. SETTING: University hospital. PARTICIPANTS: Forty-eight patients scheduled for elective coronary artery bypass graft surgery. INTERVENTION: Patients were divided into 4 groups: (1) low pre-CPB CI/placebo, (2) low pre-CPB CI/milrinone, (3) high pre-CPB CI/placebo, and (4) high pre-CPB CI/milrinone. Patients received a loading dose of 20 microg/kg of milrinone followed by an infusion of 0.2 microg/kg/min or placebo 15 minutes before the anticipated weaning time. MEASUREMENTS AND MAIN RESULTS: In the low pre-CPB CI/ placebo group, low CIs and high systemic vascular resistances (SVRs) were observed after CPB. High doses of dopamine and dobutamine were needed, and infusion of epinephrine was used in 5 of the 12 patients for hemodynamic support. Milrinone improved CI and reduced SVR in the low pre-CPB CI/milrinone group. Norepinephrine was needed to maintain an adequate systemic blood pressure in 6 of the 12 patients, however. In the high pre-CPB CI/placebo group, satisfactory CIs and SVRs were observed during weaning from CPB with low doses of dopamine and dobutamine. Milrinone significantly increased CI and decreased SVR in the high pre-CPB CI/milrinone group: 10 of the 12 patients had CIs above the upper limit of normal, and 7 patients had SVRs below the lower limit of normal. CONCLUSION: Milrinone was effective during weaning from CPB in patients with a low pre-CPB CI. Milrinone in combination with norepinephrine was a good alternative to epinephrine for the treatment of myocardial dysfunction after CPB.

Aged↗
PubMed2000

[Anesthetic management of a patient with latex allergy diagnosed preoperatively].

Since the first report in 1979, the number of patients with latex allergy has progressively increased. We experienced an anesthetic management of a 3 year-old child who underwent the repair of anal atresia. The first operation was performed in newborn period. After the surgery, the patient developed skin rash and the loss of consciousness every time anal irrigation was made with latex-containing catheter. Latex-allergy was diagnosed at the age of 3 years, with the positive skin test by latex extract. It took enormous time and efforts to find out the possibility of latex-contamination in a wide variety of medical equipments and supplies to prevent allergic reaction during perioperative period. In this patient, perioperative cause was uneventful. It is suggested that preoperative preparation is essential and caution should be also paid to prevent allergic reaction in daily life.

Anesthesia, General↗
PubMed2000

[Anesthetic management for endoscopic surgery in two patients with goiter].

We report anesthetic experience of two patients for endoscopic removal of thyroid tumor by new surgical approach. A subplatysmal air pocket, which had been created by using a subcutaneous dissector, was maintained by insufflating carbon dioxide (CO2) at an insufflation pressure of 6 mmHg. In one patient, the arterial CO2 pressure increased from 29 mmHg to 44 mmHg, and in another patient from 31 mmHg to 36 mmHg. We did not experience any symptoms of sustained CO2 absorption such as severe hypercarbia, acidosis, and massive subcutaneous emphysema. The patients were discharged on the fifth and the fourth postoperative day with no complications. The advantages of this endoscopic surgery include little postoperative pain, quick recovery, and short hospital stay after operation. However, possible occurrence of intraoperative hypercarbia during endoscopic surgery must be considered, and continuous monitoring of ventilation by end-tidal CO2 or arterial CO2 pressure is mandatory.

Adult↗
PubMed2000

[Changes of vascular reactivity following esophagectomy measured by near-infrared spectroscopy].

We examined the alterations of peripheral vascular responses following ischemic insult during perioperative period of esophagectomy. Increase of palm blood flow after vascular occlusion, i.e., reactive hyperemia (RH), measured by near-infrared spectroscopy (NIRS) was employed to assess forearm vascular responses. The measurements of RH were performed in esophagectomized patients (n = 12) before induction of anesthesia and postoperatively until the next day of extubation in comparison with normal volunteers (n = 11). After esophagectomy, the RH, which was comparable with those in volunteers, was depressed by 50% on 1 POD, and did not recover until the third POD. In particular, patients receiving laparoscopy-assisted surgery showed less decrease of RH than those receiving the standard open laparotomy. These results suggest that vascular responses to increase blood flow against ischemic insult is depressed following esophagectomy.

Adult↗
PubMed1999

The relationship between modified pulse wave transit time and cardiovascular changes in isoflurane anesthetized dogs.

OBJECTIVE: To clarify the relationship between blood pressure and pulse wave transit time at the peripheral artery from the R wave of the electrocardiogram (m-PWTT), the effects of cardiovascular interventions on this relationship was evaluated. METHODS: Ten mongrel dogs were anesthetized by isoflurane inhalation, and catheter tip pressure transducers were inserted into the ascending aorta and at the bifurcation of abdominal aorta to measure central and peripheral pulse wave arrival. Pulse wave arrival at the ascending aorta from the R wave represents pre-ejection period (PEP) and pulse wave arrival between the ascending aorta and bifurcation of aorta represents pulse wave transit time (PWTT), thus m-PWTT = PEP + PWTT. Hypertension was induced by the continuous infusion of dobutamine and phenylephrine, and hypotension was induced by deepening isoflurane anesthesia, acute blood loss and nitroglycerine infusion. The relationship between timing components (PWTT, PEP, and m-PWTT) and blood pressure was recorded and analyzed by using the least squares method. RESULTS: The relationship between timing components (PWTT, PEP and, m-PWTT) and blood pressure was significant and highly correlated. When the change in blood pressure was due to the myocardial contractility, such as after dobutamine infusion, the relationship between all timing components and blood pressure was consistent and negative. However, when the change in blood pressure was due to the vasoactive agents, such as phenylephrine, the relationship between timing components and blood pressure was dependent on the reflex change in PEP. CONCLUSIONS: Change in m-PWTT is a good parameter to predict blood pressure changes, although the absolute blood pressure value cannot be obtained.

Anesthetics, Inhalation↗
PubMed1998

Leucocyte distribution during sevoflurane anaesthesia.

We have examined if sevoflurane anaesthesia per se modified the number of circulating leucocytes in humans. Fifty-nine patients undergoing elective surgery were anaesthetized with sevoflurane in oxygen. The inhaled concentration was increased gradually to 5% and maintained for 20 min. Arterial blood samples were obtained before induction of anaesthesia and at 20 min. While the total number of leucocytes remained constant, circulating neutrophils decreased (mean 3370 (SD 1030) mm-3 to 3170 (940) mm-3; P < 0.01) and lymphocytes increased (1870 (520) mm-3 to 2040 (580) mm-3; P < 0.01). We conclude that high concentrations of sevoflurane modified the distribution of leucocytes in anaesthetized patients.

Adult↗
PubMed1997

[The effect of cerebral perfusion pressure on cerebral blood flow in the rhesus monkey during sevoflurane anesthesia].

The effect of cerebral perfusion pressure on cerebral blood flow (CBF) was studied under the normocapnic condition in the rhesus monkey under sevoflurane anesthesia. CBF was measured by means of positron emission tomography technique. After the measurement of CBF at 0.5% sevoflurane as control, the measurement was repeated at 2.0% sevoflurane (1 MAC), when blood pressure was kept at a half of the control value. The measurement was also repeated at the same sevoflurane concentration, when the mean blood pressure was restored with the infusion of angiotensin II. Average CBF as well as regional CBFs were compared between two different mean blood pressures at 2.0% sevoflurane. Average CBF increased significantly (+35%), when the mean arterial pressure was increased by the angiotensin II infusion. All the regional CBFs except at frontal cortex increased significantly (+ about 30%) in response to the increase in the mean arterial pressure. The increase in occipital CBF was greatest (+52%). We conclude that CBF during sevoflurane anesthesia up to 2.0% might become dependent on the cerebral perfusion pressure, indicating the compromised autoregulation of CBF in the rhesus monkey.

Anesthesia, Inhalation↗
PubMed1997

[The effect of sevoflurane on regional cerebral metabolism and cerebral blood flow in rhesus monkeys].

The effects of sevoflurane on cerebral metabolism and hemodynamics were studied in rhesus monkeys. Cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMR O2) as well as their regional changes were measured by means of positron emission tomography technique. After the measurement of regional CBFs and CMR O2s at 1.5% sevoflurane as control, the measurement was repeated at 3.0% sevoflurane and at the same sevoflurane concentration with the infusion of angiotensin II to restore mean arterial pressure. Regional CBFs and CMR O2s were compared among three different conditions. At 3.0% sevoflurane, regional CBFs increased significantly in response to the increase in the mean arterial pressure, suggesting the inhibition of autoregulation of CBF. However, regional CBF/CMR O2 ratio was not significantly different among the cerebral regions with each condition. It could be concluded that CBF during sevoflurane anesthesia up to 3.0% might become dependent on the cerebral perfusion pressure and the changes in regional CBFs varied among the regions. On the other hand, the ratio of oxygen consumption and delivery was well maintained throughout the brain regions.

Anesthesia, Inhalation↗
PubMed1997

[Preventive use of diltiazem to suppress supraventricular tachyarrhythmia in the patients after esophagectomy].

We investigated the efficacy of preventive use of diltiazem to suppress supraventricular tachyarrhythmia such as paroxysmal atrial tachycardia (PAT) and atrial fibrillation (Af) in the patients who underwent transthoracic esophagectomy. We divided 52 patients into 2 groups; the diltiazem group (n = 26) and the control group (n = 26). In the diltiazem group continuous intravenous infusion of diltiazem (1-3mcg.kg-1.min-1) was started when the patient's heart rate remained over 110.min-1 without any predisposing factor. On the other hand, in the control group we did not use it preventively. In both groups, we did not restrict the use of antiarrhythmic agents if necessary. We recognized PAT or Af in the control group (54%) more often than in the diltiazem group (19%). PAT or Af seldom occurred after the 4th post-operative day in the both groups. Serum diltiazem concentrations of 9 patients after about 10 hours infusion showed great variation (between 30 and 250 ng.ml-1). In 7 of them the diltiazem concentration increased as the duration of infusion was prolonged. However, we did not observe bradyarrhythmia. We consider that the continuous diltiazem infusion is effective in suppressing supraventricular tachyarrhythmia after esophagectomy.

Aged↗
PubMed1997

[Minimally invasive technique for mitral valve repair--the importance of intraoperative transesophageal echocardiography].

A 65-year-old male with mitral regurgitation was scheduled for the mitral valve repair by means of minimally invasive technique. The technique, which requires a 10-cm right parasternal incision, offers minimal discomfort, less postoperative pain, quick functional recovery and excellent cosmetic healing. However, the intraoperative monitoring by the transesophageal echocardiography was required to evaluate the mitral valve function and to confirm the complete removal of air from the apex of the left ventricle and right upper pulmonary vein due to the small operative field. In addition, the monitoring of the short-axis view of the left ventricle makes it possible to evaluate and to confirm the preload and the left ventricular contractility. We considered that the transesophageal echocardiography is essential and useful for the minimally invasive mitral valve repair.

Aged↗
PubMed1997

[High-resolution CT of otosclerosis].

High-resolution CT (HRCT) scans of thirty-two patients (60 ears) with the clinical diagnosis of fenestral otosclerosis were evaluated retrospectively. HRCT was performed with 1-mm-thick targeted sections and 1-mm (36 ears) or 0.5-mm (10 ears) intervals in the semiaxial projection. Seven patients (14 ears) underwent helical scanning with a 1-mm slice thickness and 1-mm/sec table speed. Forty-five ears (75%) were found to have one or more otospongiotic or otosclerotic foci on HRCT. In most instances (30 ears), the otospongiotic foci were found in the region of the fissula ante fenestram. No significant correlations between CT findings and air conduction threshold were observed. We found a significant relationship between lesions of the labrinthine capsule and sensorineural hearing loss. We conclude that HRCT is a valuable modality for diagnosing otosclerosis, especially when otospongiotic focus is detected.

Adolescent↗