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R Okutani

Publications and source records attributed to R Okutani.

At least 19 recordsLinked to original sources
PubMed1998

[Unexpected anuria during Miles' operation in a renal-transplant patient].

We report a case of 33-yr-old-male after orthotopic renal transplantation 18 years ago, presenting with sudden anuria during Miles' operation. This anuria was caused by temporal compression of the transplanted kidney by retractor, neither by acute renal failure, the rejection nor the damage of the ureter by the surgical procedure. This case indicates that in the anesthetic management after renal transplantation, we have to be careful about renal dysfunction due to surgical procedure or positioning, in addition to side effects and pharmacokinetics of drugs used perioperatively.

Adult↗
PubMed1997

Immunohistochemical distribution of rabbit polyclonal antiurinary protein 1 antibody in the female (Skene's gland) and male prostate: new marker for neuroendocrine cells?

Using rabbit polyclonal antiurinary protein 1 antibody to study the female prostate (Skene's gland) and the male prostate, characteristic localizations patterns appeared in single cells and groups of cells. The majority correspond to cells positive for neuroendocrine markers. In the cytoplasm, cells positive for protein 1 were most frequently found in the epithelial lining of the female urethra, in the pars prostatica of the male urethra, and in the ducts of the female and male prostate where the lining consisted of pseudostratified columnar epithelium. Their occurrence rate was far lower among secretory and basal cells of the male and female prostate glands. The cells with protein 1 corresponded to those displaying positivity for chromogranin A, silver staining by the Grimelius and less by the Sevier-Munger method, and by neuron specific enolase. Using the Masson-Hamperl argentaffin method, positive cells were only exceptionally found. The cells positive for protein 1, and particularly chromogranin A, and characterized by Grimelius positivity, contained different amounts of neuroendocrine granules and varied in size and shape. The majority of these cells had contact with the lumen of male and female prostatic ducts (open type of neuroendocrine cells). In some cases of the male and female urethra and of the great paraurethral ducts, a remarkably high number of cells containing protein 1 corresponded to cells only containing neuron-specific enolase but not chromogranin A and other neuroendocrine markers. These cells can be considered stem cells responsible for the renewal of the uroepithelium of the urethra and prostatic ducts. Protein 1 may thus be a further, though presumably not specific marker for the identification of cells of the neuroendocrine system in the prostate of the male and female. This marker could well be used to study uroepithelium maturation. The corresponding immunohistochemical distribution of human protein 1 in neuroendocrine and other cells of the male and the female prostate provides another analogous functional and morphological parameter of prostatic tissue in both sexes and further evidence supporting the non-vestigial concept of the prostate in the female.

Adolescent↗
PubMed1997

Immunohistochemical localization of human protein 1 in the female prostate (Skene's gland) and the male prostate.

Mouse monoclonal anti-urine protein 1 antibody and the biotin-streptavidin-peroxidase technique were used for the immunohistochemical demonstration of human protein 1 in prostatic tissue of both sexes. In the female prostate (Skene's gland), like the male prostate, high expression of human protein 1 was observed on the luminal surface and in the apical cytoplasm of secretory cells of prostatic glands, as well as on the luminal surface of the epithelium of the large ducts of the female prostate and urethra. Expression was also found in the membranes of secretory and basal cells of the glands, in membranes of the urethral uroepithelium and of the female prostate ducts, in the content of glands and ducts, as well as in vascular endothelium and smooth muscle. Human protein 1 (urine protein 1) expression in the secretory cells of the male and female prostate and its incorporation into the surface of cells lining the lumina of the female urethroprostatic complex is indicative not only of the secretory role of protein 1 but also of its potential protective properties operative in shielding the uroepithelium from the aggressive urinary environment. All genito-urinary tissue, and especially the female prostate, were found to be a potential source of urine protein 1 (human protein 1), refuting the notion held so far that it is exclusively the genito-urinary prostatic tissue of the male that participates in its production. The corresponding immunohistochemical distribution of human protein 1 in the same structures of the male and female prostate provides yet another analogous functional-morphological parameter of prostatic tissue in both sexes and further evidence supporting the non-vestigial concept of the prostate in the female.

Adolescent↗
PubMed1997

Serum and BAL Clara cell 10 kDa protein (CC10) levels and CC10-positive bronchiolar cells are decreased in smokers.

Cigarette smoking has diverse effects on the structure and function of the lung. Smoking appears to reduce the levels of Clara cell 10 kDa protein (CC10) in the alveolar lining fluid, but the influence of smoking serum on CC10 levels is still debated, and it has not been clear whether smoking reduces the number of CC10-producing lung cells. The aims of this study were to clarify the influence of smoking on CC10 levels in the alveolar lining fluid and bloodstream, and on the number of CC10-producing lung cells. CC10 concentrations were measured in sera and bronchoalveolar lavage (BAL) fluids, by means of enzyme-linked immunosorbent assay using monoclonal and polyclonal antibody, and the immunohistochemical expression of CC10 was examined in the lungs of nonsmokers and smokers using the monoclonal antibody, TY-5, against CC10/human urinary protein-1. CC10 concentrations in sera and in BAL fluids from healthy smokers were significantly lower than in healthy nonsmokers. Immunohistochemical expression of CC10 was found exclusively in nonciliated bronchiolar epithelial cells. As compared to that of nonsmokers, the mean percentage of CC10-positive bronchiolar epithelial cells was significantly decreased in lung tissue specimens obtained from smokers who had normal results in pulmonary function tests. It was concluded that smoking reduces the proportion of Clara cell 10 kDa protein-producing bronchiolar epithelial cells, resulting in decreased levels of Clara cell 10 kDa protein in the lower respiratory tract and in the bloodstream. The protein is a new blood biochemical and immunohistochemical marker, reflecting structural changes in peripheral airways induced by cigarette smoking.

Adult↗
PubMed1997

[Unexpected hydrothorax occurring after a long gynecological laparoscopic surgery--a case report].

We experienced a case of the hydrothorax occurring after a long gynecologic laparoscopical surgery. The patient was a 36-year-old woman, weighing 51 kg and 151 cm in height. She had received a gynecological laparoscopy with no complication 5 years before. She showed no abnormalities in the preoperative examinations. The operative course was uneventful. Upon completion of the surgery, we examined the chest X-ray, and found the hydrothorax in the right thoracic cavity. A 16 gauge Angiocath was inserted into the 4th intercostal space, and found 770 ml of fluid containing saline solution, which had been used for irrigating around the uterus. We presumed the saline, which was withdrawn from the right thoratic space, had originated from vertebrocostal trigone in the diaphragm. Because blood gas data were improving, the tracheal tube was extubated. We emphasise that the routine chest X-ray examination is necessary after pneumoperitoneum of long duration.

Adult↗
PubMed1997

[Is laparoscopic cholecystectomy minor invasive surgery?].

We conducted a comparative study to investigate whether or not laparoscopic cholecystectomy is less invasive and safer than abdominal subcostal laparotomy, using findings in blood pressure, heart rate, blood gas and endocrinological functions. In laparoscopic cholecystectomy, the patients' hospitalization period and expense for surgery were markedly reduced. However, those patients who underwent laparoscopic cholecystectomy had increases in blood pressure, heart rate, plasma cortisol and norepinephrine concentrations; it was assumed that these increases might be the result of reduced venous return to the heart which accompanied increased intra-thoracic and abdominal pressures, with reduction of cardiac output. In conclusion, since laparoscopic surgery is very advantageous for patients, we consider that for the success of this surgical procedure, it will be necessary to conduct safe anesthetic managements as well as to select patients carefully.

Adult↗
PubMed1996

Preparation and characterization of human recombinant protein 1/Clara cell M(r) 10,000 protein.

Protein 1, which is identical to human Clara cell M(r) 10(4) protein, is a homodimeric, low molecular mass protein (M(r) 14,000) and an effective inhibitor of phospholipase A2 activity. We have expressed this protein in E. coli and characterized its physiochemical and biological properties. Using a pET expression system, about 1.7 mg of purified recombinant protein 1 was obtained from 250 ml of E. coli culture. The amino-terminal sequence of recombinant protein 1 up to the 20th residue was identical to that of native protein 1 except for an extra methionine at the amino-terminus. On reversed-phase HPLC, recombinant protein 1 eluted at the same retention time as native protein 1. The dose-response curves of recombinant protein 1 and native protein 1 in an enzyme-linked immunosorbent assay for protein 1 were identical. Recombinant protein 1 inhibited both porcine pancreas and cobra venom phospholipase A2 activities. These results indicated that recombinant protein 1 is structurally and biologically identical to native protein 1. We found that recombinant protein 1 also inhibits phosphatidylinositol-specific phospholipase C activity.

Chromatography, High Pressure Liquid↗
PubMed1996

[Anesthetic management for colon resection in a patient with polymyositis].

A patient was a 67-year-old female, 153 cm tall and weighing 47 kg. In 1988, she noticed sudden hypotonicity of her extremities, which led her to visit our hospital. Diagnosis of polymyositis (PM) was made. Treatment started with prednisolone 60 mg.day-1, followed by 2.5-5mg.day-1 as a maintenance dose. Her clinical symptoms were alleviated. However, in October, 1994, colon cancer was found and she underwent sigmoidectomy. For anesthesia, thoracic epidural block (Th 11/12) was performed. No problems occurred during and after the surgery. The following points must be considered for anesthesia of a patient with PM: (1) enhanced or delayed effect of muscle relaxant, (2) pulmonary complications--aspiration pneumonia and lung fibrosis, (3) cardiomyopathy--arrhythmia and cardiac failure, (4) steroid supplementation. In our case, because cardio-pulmonary functions were almost normal, epidural anesthesia without using muscle relaxant was a successful method.

Aged↗
PubMed1996

[Anesthetic management of a patient with esophageal hiatal hernia accompanied with chest pain].

We experienced the perioperative management of the esophageal hiatus hernia (sliding type). As the patient had had severe and frequent chest pain attacks and abnormal ECG, it was essential to evaluate the degree of cardiac and pulmonary functions. To prevent aspiration pneumonia, the patient had been placed on intravenous hyperalimentation and H2-blocker, and tracheal intubation was performed by rapid anesthetic induction technic without using awake or crash intubation methods. The intraoperative course was uneventful and the chest pain diminished immediately after the operation. In summary, the key points were as follows; (1) accurate evaluation of cardiac and pulmonary functions, and (2) prophylaxis for aspiration pneumonia at the time of anesthetic induction.

Anesthesia↗
PubMed1996

[The dual effect of ketamine on dopamine release from rat pheochromocytoma (PC-12) cells].

Ketamine is known to increase arterial pressure and heart rate with its sympathomimetic action. However, it also relaxes vascular smooth muscle and causes hypotension. We studied such a bipartite effect in terms of ketamine induced changes of dopamine (DA) release from rat pheochromocytoma (PC-12) cells as a model of sympathetic nervous system. Without KCl stimulation, ketamine increased the DA release from PC-12 cells in a dose-related fashion (10(-4)M: 2.6 +/- 0.4, 10(-3)M : 7.5 +/- 0.3, 10(-2)M: 27.1 +/- 3.2%). The similar increase of DA release was observed with absence of extracellular Ca2+. Exposure of KCl (50 mM) to PC-12 cells increased the DA efflux from 1.7 +/- 0.4 to 14.2 +/- 0.8% (P < 0.001). The release of DA stimulated by KCl (50 mM) was reduced to 9.0 +/- 1.0% and 11.4 +/- 0.3% in the presence of ketamine 5 x 10(-4)M and 10(-3)M respectively, and increased with the ketamine concentration of 10(-3)M. These findings indicate that ketamine depresses DA efflux related to membrane depolarization (K+) but it promotes a number of spontaneous DA efflux.

Adrenal Gland Neoplasms↗
PubMed1995

[Perioperative management of a patient with severe bronchial asthma attack].

We report an anesthetic management for Miles' operation in a 50-year-old female who had frequent severe bronchial asthmatic attacks prior to surgery. Because the surgical field was in the lower abdomen, we selected spinal anesthesia combined with epidural anesthesia. For spinal anesthesia, 15 mg of hyperbaric tetracaine with epinephrine was used. Moreover, 3 ml of 2% mepivacaine with epinephrine was injected via an epidural catheter, and then analgesia up to Th 6 was obtained. In order to prevent an asthmatic attack during surgery, the following cares were taken: (1) administration of moisturized oxygen by nebulizer via a nasal canula, (2) intravenous administration of steroid, (3) addition of epinephrine to the local anesthetics, and (4) sedation by music. The surgery was completed safely without asthmatic attacks. Postoperatively, pain control with buprenorphine was managed with a continuous extradural infusion. The patient was discharged 50 days after surgery, and was in a favorable condition without bronchial asthmatic attacks.

Anesthesia, Epidural↗
PubMed1994

Sex-associated differences in protein 1 values in urine: immunochemical detection of protein 1 in genital tissues.

Immunochemical methods were used to analyse sex-associated differences in urinary protein 1 concentration. Spot urine from seven normal men and seven women of reproductive age was collected in four sequentially divided fractions, and protein 1 concentration in each fraction was measured by an enzyme immunoassay using the sandwich method: protein 1 values in the first of the sequential urine samples from the male subjects were remarkably high (81.4 +/- 80.4 micrograms/l; mean +/- 1 SD), but were much lower in the remaining three fractions. In females, on the other hand, protein 1 values were low (0.7 +/- 0.4 microgram/l), were uniform in all four sequential fractions, and were close to those of the last three fractions of urine from male subjects. Based on this finding, protein 1 concentration was measured in 14 specimens of seminal plasma, where concentration of protein 1 was high (1259.1 +/- 1716.5 micrograms/l; range, 201.9 to 6580.0 micrograms/l). On Western blotting, protein 1 in seminal plasma had a molecular mass of M(r) 14,000, the same as that of protein 1 purified from the urine of patients with chronic renal failure of probable plasma origin, and of concentrated male urine collected at the initiation of voiding, which is thus thought to come mainly from genital tissue. Protein 1 was found to be in high concentration (434.8 +/- 504.6 micrograms/l) in five aspirated fluids collected at the ejaculatory duct after squeezing the prostate. Three prostate tissue extracts contained protein 1 concentrations ranging from 8.6 to 50.1 micrograms/l. Protein 1 is also present in seminal vesicle fluids (7.1 +/- 2.8 micrograms/l; range, 2.3 to 9.5 micrograms/l).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Anesthetic management in a patient with Beckwith-Wiedemann syndrome].

Beckwith-Wiedemann syndrome has three major symptoms, exomphalos, macroglossia and giantism. We report the anesthetic management of a 2-year-old male, weighing 16.1 kg and with a height of 94.6 cm, associated with bilateral retention testis. The anesthesia was maintained with oxygen, nitrous oxide, and sevoflurane. The surgery was completed safely without adverse events such as difficulty in tracheal intubation or refractory hypoglycemia. The anesthetic management of this syndrome requires: an assessment of difficulty in tracheal intubation and treatment, an understanding of the capacity of the patient's glucose metabolism, and assessment of complicated deformities. In particular, it is necessary to carry out a preoperative examination of the cardiovascular system.

Anesthesia, Inhalation↗
PubMed1994

[Anesthesiological management of a patient with primary aldosteronism complicated with hypertrophic cardiomyopathy].

A 49-year-old male with primary aldosteronism, accompanied by hypertrophic cardiomyopathy (HCM), underwent our anesthesiological management for resection of a left adrenal tumor. The preoperative examination revealed hypertension, mild nephropathy and hypokalemia. Spilnolactone treatment was discontinued 3 days before surgery. In the operating room, a Swan-Ganz catheter was inserted for monitoring hemodynamic parameters. Anesthesia was maintained with nitrous oxide-oxygen-isoflurane and vecuronium. During the surgery, prostaglandin E1 and nitroglycerin were used as vasodilators. During surgery, the patient was successfully managed, anesthesiologically. In anesthesiological management of patients with primary aldosteronism, care is needed regarding changes in blood pressure and electolyte levels during adrenalectomy. In cases where aldosteronism is accompanied by HCM, as in the present case, hemodynamic changes can cause a fatal outcome, and hence, carefulness is needed in using anesthetics and drugs which act on the circulatory system.

Adrenalectomy↗
PubMed1993

Protein 1: its purification and application in clinical medicine.

Protein 1 (P1) is a low-molecular-weight protein recently isolated from the urine of patients with chronic renal failure. Its molecular weight is 14 kDa on sodium dodecyl sulfate polyacrylamide gel electrophoresis and pI 4.7 on isoelectric focusing. We purified this protein, characterized its physicochemical properties, and analyzed its amino acid sequences to show that it is probably identical to human lung Clara cell 10 kDa protein. Its monoclonal antibody was prepared, and a reliable enzyme-linked immunosorbent assay employing the sandwich method was developed and used to investigate distribution and variation in concentration of P1 in various body fluids under an array of physiologic and pathologic conditions. Clinical studies indicated that, as is the case with other proteins of low molecular weight, the main catabolic site of P1 of plasma origin is the kidney: P1 is filtered by the renal glomeruli and reabsorbed by the renal tubules. Unabsorbed P1 is thus excreted into the urine. This protein is also synthesized in the genital tissues of males, however, from which it is also excreted into the urine. Clinical data obtained in our study of this protein is summarized here, and an attempt is made to determine the potential value of this protein in laboratory medicine.

Adolescent↗
PubMed1993

[Anesthetic management of a patient with polyarteritis nodosa who suddenly developed cardiac rupture after valve replacement].

We recently encountered a patient with mitral insufficiency, accompanied by PN (polyarteritis nodosa), who developed a cardiac rupture immediately after a mitral valve replacement. The patient was a 60-year-old woman. After she was diagnosed as having mitral stenosis and insufficiency in 1968, the patient developed congestive heart failure and underwent repeated hospital admissions and discharges. In 1989, she was diagnosed as having PN and began to receive a high-dose steroid therapy (prednisolone; total dose 5245 mg). Because of transient brain ischemia and exacerbation of the symptoms of heart failure, the patient underwent mitral valve replacement on December 19, 1991. For anesthesia, oxygen, fentanyl, midazolam and vecuronium were administered. During surgery, catecholamine, nitroglycerin and prostaglandin E1 were continuously infused intravenously. The patient was weaned smoothly from the cardiopulmonary bypass. The operation was completed in about 6 hours. Her postoperative course was satisfactory until she suddenly developed left ventricular rupture and died 6 hours after surgery. The rupture seemed to be attributable to a weakening of the myocardial wall following long-term, high-dose steroid therapy, and to myocardial degeneration caused by PN-associated necrotizing vasculitis of myocardial arterioles.

Female↗
PubMed1993

[Anesthetic management for cesarean section of a patient with transient diabetes insipidus and acute severe liver dysfunction].

A 26-year old woman presented with acute hepato-renal dysfunction, coagulation abnormalities and diabetes insipidus associated with hypernatremia in the latter term of pregnancy (39 weeks). Such transient diabetes insipidus during pregnancy as in this case has been reported to be resistant to AVP, but to respond to DDAVP. Because of fetal compromise, an urgent cesarean section was performed. Spinal anesthesia was chosen because of the possible deleterious effects of general anesthesia on liver function. After delivery of twin babies, her symptoms recovered gradually. In conclusion, diabetes insipidus during pregnancy as in this case is transient and disappear after delivery. However, multiple organ dysfunction may become worse and cause fetal death, unless surgical procedure with appropriate anesthetic management is performed.

Acute Disease↗