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Biomedical subjects

S Kawana

Publications and source records attributed to S Kawana.

At least 19 recordsLinked to original sources
PubMed1995

Comparison of haemodynamic changes induced by sevoflurane and halothane in paediatric patients.

The purpose of this study is to investigate the haemodynamic effects of 1 MAC and 2 MAC of sevoflurane in children in comparison with halothane. Thirty-eight children (aged from one to six years, average age; 3.6 +/- 0.2 yr) were randomly assigned to four groups, depending on the dose and agent (1 and 2 MAC of sevoflurane: S1 and S2; 1 and 2 MAC of halothane: H1 and H2, respectively). After collecting control data during 0.2 MAC of either anaesthetic, end-expired anaesthetics were kept at 1 MAC or 2 MAC for 15 min. Mean blood pressure (mBP) and stroke volume index (SVI), measured by impedance cardiometry, decreased in all groups without differences between groups. Heart rate (HR) increased in groups S1, S2 and H2 but not in group H1. The HR in S2 was higher than that in H2. The cardiac index (CI), a product of SVI and HR, tended to decrease but not significantly in all groups. These results suggested that the haemodynamic depressant effects of sevoflurane in children were similar to those of equipotent halothane concentration except for HR.

Analysis of Variance↗
PubMed1995

Effects of 2-deoxyglucose, a metabolic inhibitor, on spontaneous contraction and adrenoceptor responsiveness in cultured rat ventricular myocytes.

Although it is well known that myocardial ischemia induces the depletion of myocardial ATP and sustained myocardial dysfunction, the mechanisms causing impaired myocardial function have not been elucidated completely. To clarify the relationship between ATP depletion and myocardial contractility, we investigated the influence of myocardial ATP depletion on spontaneous beating in cultured rat ventricular myocytes. Furthermore, because catecholamines have been used to improve myocardial contraction in the ischemic heart, we attempted to determine whether the ATP depletion per se alters the contractile responses to alpha 1- and beta-adrenoceptor stimulation. After 24 hr of culture in the presence of a metabolic inhibitor, 2-deoxyglucose (2DG, 5mM), myocardial contractility decreased to 19% of the vehicle level, and returned to normal after the removal of 2DG. The beating rate did not show any alterations in the vehicle, in the presence of 2DG (2DG [+/+]) or after the removal of 2DG (2DG [+/-]). Norepinephrine (NE) caused significant decreases in beating rate and increases in contractility in all groups. Isoproterenol (ISP) caused significant increases in beating rate and contractility in all groups. In the 2DG (+/+) group, the contractility was significantly lower as compared to other groups during NE or ISP stimulation. However, the percent change of contractility was similar to those of other groups after NE or ISP stimulation in the 2DG (+/+) group. These results suggest that decreased myocardial ATP causes the decreased contractility and does not affect the alpha 1- or beta-adrenoceptor-mediated responses.

Adenosine Triphosphate↗
PubMed1995

[Anesthetic management for a patient with citrullinemia and liver cirrhosis].

We successfully anesthetized a 53-year-old female with hypercitrullinemia and severe liver cirrhosis. The hypercitrullinemia was accompanied with chronic hepatic encephalopathy due to hyperammonemia, which resulted from decreased activity of one of the urea cycle enzymes, argininosuccinate synthetase (ASS). She was scheduled for replacement arthroplasty of a fractured femoral neck. She suffered a consciousness disturbance due to hyperammonemia, which was successfully treated by oral administration of sodium benzoate before surgery. Spinal anesthesia was chosen because it would have the minimum metabolic load on the cirrhotic liver. During the operation, prostaglandin was continuously infused to maintain hepatic blood flow. Acetated Ringer solution was infused instead of lactated Ringer solution to reduce metabolic load on the liver. She was given a small dose each of fentanyl and midazolam for relief of pain and sedation. After the operation, naloxone and flumazenil were administered to antagonize the fentanyl and midazolam, respectively. Although the serum ammonia level temporarily increased during a postoperative interruption of oral administration of sodium benzoate, the patient did not develop loss of consciousness, which is a key sign of hyperammonemia. Surgery and anesthesia were uneventfully completed.

Ammonia↗
PubMed1992

Serum SC5b-9 (terminal complement complex) level, a sensitive indicator of disease activity in patients with Henoch-Schönlein purpura.

The concentration of the terminal complement complex (TCC), SC5b-9, was determined by enzyme immunoassay using 95 serum samples from 30 patients with Henoch-Schönlein purpura (HSP), 27 with other forms of inflammatory skin disease and 20 normal healthy donors. Twenty-five patients with HSP showed significantly increased TCC concentration in the active phase of the disease, during which newly formed urticarial or purpuric macules/papules could be seen. Skin biopsy specimens of skin lesions from patients with elevated TCC levels in nearly all cases contained the membrane attack complex of complement and consisted of C5b, C6, C7, C8, C9 without S protein on the vessel walls. Systemic and local activation of complement may thus possibly occur in HSP. Three patients with various manifestations of the disease were followed over a period of several years during which the active and inactive phases were scanned. TCC elevation in all cases was correlated with exacerbation of the disease. In contrast, C3, C4 and CH50 levels either remained normal or increased and thus were not reliable indicators of disease activity. Measurement of TCC should thus prove quite useful for monitoring the activity of HSP in patients in whom there is complement activation and also serve to facilitate clarification of the functions of complement in the pathogenesis of the disease.

Acute Disease↗
PubMed1991

[A case report of monitoring neuromuscular blockade during anesthesia in a patient with facioscapulohumeral muscle dystrophy].

Facioscapulohumeral muscle dystrophy (FSHMD) is characterized by slowly progressive wasting of facial, pectoral and shoulder-girdle muscles that begins in adolescence. A 31 year-old man with FSHMD had dystrophic changes in the deltoid, anterior serratus and pectoralis major muscles but not in the distal muscle of his arms and legs. He underwent an operation for thoraco-scapula fixation under enflurane-nitrous oxide anesthesia with vecuronium 6 mg. At the end of the surgical procedure, the train-of-four (TOF) responses of a thumb and a toe, as measured by using an acceleration transducer, were recorded simultaneously. TOF stimulation in an arm demonstrated an apparent fade phenomenon (TOF; 0.54), while a TOF test in the leg showed complete recovery of the TOF ratio (TOF; 1.0). The patient revealed no clinical signs of residual neuromuscular blockade. It was clear that there was a difference in the degree of neuromuscular block between the arm and the leg in a FSHMD patient. Use of the peripheral nerve stimulator only in the arm may be an unreliable guide to assess neuromuscular block in FSHMD patients. Therefore, two sites should be chosen for monitoring neuromuscular blockade in a FSHMD patient.

Adult↗
PubMed1991

[Urticarial erythema with neutrophilic infiltration--correlation of cutaneous vascular changes with clinical severity].

Twenty-seven cases of urticarial erythema with predominantly neutrophilic infiltration in the upper dermis were examined clinically, histologically and serologically. Their condition persisted longer than common urticaria, with transitory high fever and arthralgia being noted frequently. Based on histological examination results, the patients were divided into three groups. Ten patients with histological findings of leukocytoclastic vasculitis were diagnosed as urticarial vasculitis which was accompanied in 7 cases by systemic lupus erythematosus, Sjögren syndrome or viral hepatitis. This group frequently showed hypocomplementaemia and multiple organ involvement such as hepatitis and nephritis. An immunofluorescence study demonstrated immunoglobulin and/or complement components to be deposited in the vessel walls of upper dermis, thus implicating type III allergy in the pathogenesis. The second group consisted eight patients with moderate infiltration of neutrophils toward the vascular walls though vasculitic changes were not apparent. Systemic lupus erythematosus and Sjögren syndrome were noted in 5 of these patients but multiple organ involvement was relatively quite infrequent. Antihistamines and even systemic corticosteroids failed to have any effect in the majority of the patients on these two groups. The remaining nine patients constituting the third group showed neither neutrophilic infiltration toward vessel walls nor vascular damage and there was no multiple organ involvement. Bacterial infection of upper respiratory tract appeared to possibly be a trigger in most of these patients for whom antibiotics were effective as treatment. In conclusion, histological examination is particularly important for cases such as the present cases for accurate diagnosis and deciding appropriate treatment.

Erythema↗
PubMed1990

Membrane attack complex of complement in Henoch-Schönlein purpura skin and nephritis.

The present study using direct immunofluorescence with monoclonal antibodies to C5b-9 complex-related antigens was undertaken to determine whether complement activation in Henoch-Schönlein purpura (HSP) causes assembly of the membrane attack complex of complement (MAC) in skin and nephritis lesions. The deposition of C5, C6, C7, C8, C9, and C5b-9 neoantigens was noted in the vascular walls of papillary dermis and/or subpapillary dermal plexus of the vessels in 11 out of 15 patients with HSP. Their presence in vessel walls indicates complement activation which leads to terminal complement activation. There were small deposits of S protein at the same sites in three of the 11 skin specimens. Thus, the majority of C5b-9 demonstrated in HSP skin was the cytolytically active C5b-9 complex, MAC. Granular deposits of C5b-9 related antigens without S protein were also found in the capillary walls and mesangium of the glomeruli of two out of four specimens from patients with HSP nephritis; in the other two S protein was colocalized with the deposition of C5b-9. The results of the present study indicate that complement activation leading to generation of MAC may possibly be involved in the pathogenesis of vascular injury in a significantly large number of skin lesions and of HSP nephritis.

Antibodies, Monoclonal↗
PubMed1990

Increased levels of immunoreactive leukotriene B4 in blister fluids of bullous pemphigoid patients and effects of a selective 5-lipoxygenase inhibitor on experimental skin lesions.

The immunoreactive leukotriene B4 (i-LTB4) and i-LTC4 content in the blister fluids of patients with bullous pemphigoid (BP) was determined by radioimmunoassay. Their amounts significantly exceeded those noted in superficial dermal burn patients and those in the fluids of suction blisters produced on normal human skin. When either BP blister fluids or BP-IgG from the patient sera were injected into guinea pig skin, neutrophil and eosinophil infiltrates were produced in the dermis. In addition, the dermis was noted to undergo marked edematous change. A single oral administration of a selective inhibitor of 5-lipoxygenase 1 hr before the intracutaneous injection of BP-IgG was found to significantly inhibit cell infiltrates. Furthermore, the inhibitor partly suppressed dermal epidermal separation. On the basis of these results. LTB4 and LTC4 appear to be generated in the skin lesions of BP, the former attracting granulocytes to the dermis and the latter, causing exudation.

Animals↗
PubMed1990

[The evaluation of tracheal temperature to monitor core temperature in various operations].

Tracheal temperature was evaluated to monitor core temperature during cardiac, upper abdominal and lower abdominal operations. The tracheal temperature was measured by a thermistor attached to the intra-cuff of the tracheal tube. In cardiac surgery, there was a good correlation between tracheal temperature and forehead deep temperature (r = 0.93) before and after cardiopulmonary bypass, and also between tracheal temperature and the temperature of blood from the cardiopulmonary bypass (r = 1.00) during cardiopulmonary bypass. These results indicate that tracheal temperature accurately reflects carotid artery temperature. In upper abdominal operations, the tracheal temperature showed good correlations with forehead core, esophageal, bladder and rectal temperatures (r = 0.81-0.90). On the other hand, bladder and rectal temperatures were different from forehead deep (r = 0.43, 0.55) and tracheal temperatures in lower abdominal operations. These results suggest that the tracheal temperature is valuable to monitor core temperature.

Abdomen↗
PubMed1990

Involvement of membrane attack complex of complement in UV-B-induced acantholysis in pemphigus.

The initial acantholytic process induced by irradiation of UV-B on uninvolved skin of patients with pemphigus was immunohistologically studied using monoclonal antibodies that bind to antigenic determinants present in the C5b9 complex. Membrane attack complex of complement-related antigens in suprabasal intercellular sites could be detected after 5 hours of irradiation, at which time there was no acantholysis. At 24 hours, the staining intensity markedly increased and suprabasal clefts with acantholytic epidermal cells could be seen. In contrast, acantholysis did not develop in the absence of membrane attack complex formation at intercellular sites even 24 hours following UV-B irradiation. These findings suggest that UV-B can induce membrane attack complex assembly in the epidermis, which may itself be involved in the process of acantholysis and provide additional evidence for involvement of the complement system in pemphigus.

Acantholysis↗
PubMed1989

Neonatal lupus erythematosus with a high anticardiolipin antibody titer. Unusual variant of neonatal lupus erythematosus or early-onset systemic lupus erythematosus?

A malar rash associated with severe gastrointestinal manifestations developed in a 4-month-old baby 3 months after a normal delivery. Serum complement and IgA levels were low during the active phase of the illness. An increased anticardiolipin antibody titer was demonstrated at the onset of disease and persisted for more than 6 months, at which time the skin and gastrointestinal manifestations subsided. The baby's mother, who had no symptoms, had an elevated Ro (SS-A) antibody titer and a moderately elevated anticardiolipin antibody titer.

Antibodies, Antinuclear↗
PubMed1989

Deposition of the membrane attack complex of complement in pemphigus vulgaris and pemphigus foliaceus skin.

The present study was performed to determine whether complement activation in pemphigus vulgaris (PV) and pemphigus foliaceus (PF) results in the assembly of the terminal complement sequence or membrane attack complex (MAC) in skin lesions. Biopsy specimens of skin lesions from five patients with PV and three patients with PF contained C5, C7, C9, and the MAC related neoantigen (C5b-9 neoantigen) in intercellular substance areas (ICS), as well as IgG and the early complement components Clq, C4, and C3. The presence of these late complement components and the C5b-9 neoantigens in ICS sites of the skin lesions is indicative of complement activation by the pemphigus antibody, with subsequent assembly of the MAC. The binding of IgG and early complement components to ICS was observed in both non-lesional (normal appearing) skin and in skin lesions. However, no MAC could be detected in the normal appearing skin of our pemphigus patients. It was also noted that the MAC could be generated in vitro on cryostat sectioned normal human skin by pemphigus antibody in the presence of complement. Results of these studies suggest that complement activation may be related to membrane damage of epidermal cells in both PV and PF.

Complement Membrane Attack Complex↗
PubMed1989

[Leukotriene (LT) B4 and LTC4 in the blister fluid of bullous pemphigoid].

Leukotriene (LT) B4 and LTC4 content in the blister fluid of patients with bullous pemphigoid (BP) was determined by radioimmunoassay. In samples from BP patients, the former (3.80 +/- 1.99 ng/ml, n = 7) significantly exceeded the amount noted in second degree burn patients (0.93 +/- 0.82 ng/ml, n = 5) and that in the fluid of suction blisters produced on normal human skin (0.95 +/- 0.21 ng/ml, n = 2). The immunoreactive LTC4 (i-LTC4) content in the blister fluid of BP (3.63 +/- 1.13 ng/ml, n = 6) was not statistically significantly different from that observed in second degree burns (2.09 +/- 1.66, n = 5), but more than that in suction blisters on normal skin (0.86 +/- 0.20, n = 2). The chemotactic activity of BP blister fluid toward polymorphonuclear leukocyte (PMNL) of BP blister fluid was determined by injecting them into guinea pig skin and observing the time course of the increase in the number of infiltrated PMNL. Neutrophils and eosinophils had accumulated in the dermis at 3 hours and at 6 hours; the numbers of each had increased remarkably. Methanol-eluted samples of blister fluid used for the radio-immunoassay showed the same chemotactic activity. In addition, the dermis developed marked edematous changes. On the basis of the results presented above, LTB4 and i-LTC4 appear to be generated in skin lesions of BP, the former attracting PMNL to the dermis and the latter causing exudation of blister fluid. Both compounds directly enhance the exacerbation of BP skin lesions.

Animals↗
PubMed1989

[Assembly of the membrane attack complex of complement in pemphigus vulgaris skin].

The time course of the deposition of the membrane attack complex of complement (MAC) in the skin of a case of pemphigus vulgaris was studied by immunofluorescence technique using monoclonal antibodies to human C5, C6, C7, C8, C9 and C5b-9 neoantigens. Biopsy specimens of skin lesions always contained the MAC-related antigens in the ICS areas. No MAC could be detected in the non-lesional skin. It was also noted that MAC could be generated in vitro on cryostat-sectioned normal human skin by the patient serum in the presence of complement. The titer of this complement-fixing antibody rose during the clinically active phase. Results of these studies suggest that complement activation, with subsequent assembly of MAC, may be related to acantholysis in the pemphigus skin.

Complement Membrane Attack Complex↗
PubMed1988

Complement fixation by Brazilian Pemphigus foliaceus autoantibodies.

This study was undertaken to determine if Brazilian Pemphigus foliaceus (BPF) autoantibodies will fix complement as do P. vulgaris (PV) autoantibodies. When sections of human skin were examined following indirect immunofluorescence (IF) staining, BPF autoantibodies reacted with the upper layers of epidermis, while PV autoantibodies were reactive with the lower layers. When tissue culture epidermal cells were used for indirect IF, BPF autoantibodies were not detected after plating until 24 h, while PV autoantibodies reacted within 18 h of plating. Using complement IF staining methods, BPF autoantibodies were found to fix C1q, C4 and C3 to whole skin sections in an intercellular pattern and to the surface of cultured keratinocytes. Although reactive with different epidermal cell surface antigens, autoantibodies in BPF will fix complement in a fashion similar to autoantibodies in PV.

Animals↗
PubMed1986

Complement fixation by pemphigus antibody. III. Altered epidermal cell membrane integrity mediated by pemphigus antibody and complement.

The present study investigates the effects of pemphigus IgG and complement upon cell viability and/or membrane integrity using trypan blue exclusion, ethidium bromide (EB) staining, and fluorescein diacetate (FDA) conversion by living cells. Forty-eight-hour cultivated epidermal monolayers of neonatal BALB/c mice were incubated in media containing 1 mg/ml purified pemphigus IgG for 48 h in either the presence or absence of complement (absorbed AB sera). Adherent and detached cells were examined by both phase and fluorescence microscopy. Results from trypan blue exclusion showed that pemphigus IgG plus complement produced a modest decrease in exclusion of the dye compared to pemphigus IgG without complement. When FDA/EB comparisons were made, however, the differences were more substantial. When complement plus pemphigus IgG was added to cultures, the number of FDA-positive adherent cells decreased significantly and the number of EB-positive detached cells increased significantly. The effects of complement were inhibited by the use of heat-inactivated AB sera or by C1q depletion of AB sera. No significant effect on the cells was observed in the presence or absence of complement when pemphigus F(ab')2 fragments or when normal IgG was used. Plasminogen depletion of the complement source did not interfere with complement and pemphigus IgG effects as judged by the FDA/EB assay. These studies suggest that pemphigus antibody in the presence of complement alters cell membrane integrity and supports the contention that complement may play a significant role in the mechanism of acantholysis.

Animals↗