Biomedical subjects

S Nomiyama

Publications and source records attributed to S Nomiyama.

At least 19 recordsLinked to original sources

PubMed1997

[The effect of epidural anesthesia with combined use of vasodilator on hemodynamics and stress hormone levels during hepatectomy].

The combined effects of thoracic epidural anesthesia and vasodilators on hemodynamics, stress responses, sodium excretion and liver function were investigated in eight patients who received hepatectomy. As vasodilators, phentolamine and/or prostaglandin E1 were chosen. Under these conditions, systemic vascular resistance decreased and cardiac index increased by afterload reduction. This hemodynamic changes were induced by sympathetic nerve blocking, vasodilator and hemodilution. The increase of epinephrine and norepinephrine levels were suppressed during the surgery and there were no significant changes in plasma renin activity, angiotensin II and aldosterone levels. Sodium excretion was maintained during the surgery. Arterial ketone body ratio did not decrease and lactic acid/pyrvate acid ratio showed low values. None of the patients developed respiratory complications nor liver failure after the surgery. Combined use of epidural anesthesia and vasodilators kept stable hemodynamics and suppressed endocrine stress responses. These were considered beneficial for liver function and sodium excretion during and after the hepatectomy.

Adjuvants, Anesthesia↗

PubMed1995

Digestion and lymphatic transport of eicosapentaenoic and docosahexaenoic acids given in the form of triacylglycerol, free acid and ethyl ester in rats.

Lymphatic transport of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids given as trieicosapentaenoyl glycerol (TriEPA) and tridocosahexaenoyl glycerol (TriDHA) was compared with that of ethyl ester and free acid in rats cannulated with thoracic duct. Trioleoylglycerol (TO) served as a control. EPA and DHA, compared with oleic acid, were slowly transported in lymph irrespective of fat types administered. Total 24-h recovery of DHA in all fat types and ethyl EPA was significantly lower compared to that of oleic acid. Lymphatic recovery of EPA and DHA in rats given TriEPA and TriDHA was significantly higher at the first 3 h after the administration compared to those given as free acid or ethyl ester. The recovery in rats given free acid at a later stage (9-24 h) was higher than that of the other fat types. As a result, the 24-h recovery was comparable between triacylglycerol (TAG) and free acid, while it was significantly lower in ethyl ester. Although TriEPA and TriDHA were slowly hydrolyzed by pancreatic lipase in vitro compared with TO and TAGs rich in EPA or DHA at the second position, the hydrolysis rate at 60 min incubation was comparable among the TAGs examined. The hydrolysis rate of ethyl esters was extremely low even in 6 h incubation with lipase. These observations show that presence of EPA and DHA at the 1- and 3-positions of TAGs does not result in their lower recovery in lymph. Processes after lipolysis may be responsible for their low recovery in lymph. In a separate study, slower lymphatic recovery of DHA given as free acid than TriDHA was improved by the simultaneous administration of TO, but not by free oleic acid. The observations suggest that the slow recovery of free acid is caused by delayed TAG synthesis in mucosal cells and/or low micellar solubility of fatty acids in the intestinal lumen due to a limited supply of 2-monoacylglycerol (MAG). A large portion of EPA and DHA were recovered in lymph chylomicrons and very low density lipoproteins (VLDL, > 95%) and incorporated into TAG (84-92%) fraction in all fat types examined. Lymphatic recovery rate of simultaneously administered cholesterol was influenced by the fat types given.

Animals↗

PubMed1994

[Effect of neuroleptanaesthesia on endocrine-metabolic response during upper abdominal surgery].

The effects of neuroleptanaesthesia on endocrine-metabolic changes during elective gastrectomy was investigated, comparing with those of epidural anaesthesia. Nine patients were given neuroleptanaesthesia and fifteen patients given thoracic epidural analgesia combined with general anaesthesia. We evaluated the levels of stress hormones, insulin and blood glucose. Epidural anaesthesia suppressed the increase of catecholamine, but neuroleptanaesthesia did not inhibit the elevation of the catecholamines. In neuroleptanaesthesia group, glucagon and growth hormone increased during surgery, and the levels of these hormones were significantly higher than those of epidural analgesia group. Blood glucose increased during operation in both groups. In epidural anaesthesia, the levels of insulin and insulin/glucose ratio were kept higher than those of neuroleptanaesthesia group, but this was not statistically significant. Lactate/pyruvate ratio and free fatty acid did not show any significant change during the study in both groups. These results suggest that neuroleptanaesthesia is not a suitable method for upper abdominal surgery.

Adult↗

PubMed1993

[Anaesthetic management of pediatric renal transplantation for chronic renal failure].

We evaluated the preoperative and intraoperative general condition of 33 pediatric kidney recipients. Eighteen patients were anaesthetized with lumbar epidural anaesthesia. Ten patients were with nitrous oxide-oxygen-halothane, 5 cases were with NLA. Preoperatively many children had cardiovascular and metabolic complications. For example 39% of patients had history of hypertension. Sixty-seven percent of patients were found to have cardiomegaly (cardio-thoracic ratio > 50%) with chest X-ray film. Seven of 9 patients undergoing echocardiogram had abnormality of cardiac wall motion, valvular impairment, pericardial effusion. In forty-eight percent of patients, hyperlipidemia was found. During operation we could not maintain the cardiovascular stability following intratracheal intubation and manipulation of vena cava or abdominal aorta under NLA or nitrous oxide-oxygen-halothane anesthesia. Epidural analgesia inhibited the cardiovascular fluctuation following these surgical stresses. We concluded that epidural analgesia is the best anaesthesia for pediatric renal transplantation and phentolamine or PGE1 are useful to maintain cardiovascular stability and transplanted kidney function.

Adolescent↗

PubMed1991

[The anesthetic management of a patient with the malignant hyperthermia trait diagnosed preoperatively].

A patient for fixation of ankle arthrodesis diagnosed as having malignant hyperthermia trait preoperatively is reported. A 17 year old man was anesthetized with enflurane for orthopedic surgery of the knee joint. At that time malignant hyperthermia developed. He was critically ill, but resuscitated and recovered from acute renal failure on 7th day after operation. Ca2+ release test was performed. Ca2+ releasing speed was prominently accelerated in this patient. We could identify him as having malignant hyperthermia trait. Epidural anesthesia with procaine chloride was given cautiously. No drug which may induce malignant hyperthermia was used. Nevertheless, malignant hyperthermia occurred. This disease has various forms of presentation. The mechanism is equivocal, and in some cases, it is difficult to judge it immediately. This patient was managed without complication. We consider that tourniquet and stress provoked signs of malignant hyperthermia in this patient.

Adolescent↗

PubMed1990

[Clinical features of 36 cases of psittacosis].

Clinical features of 36 cases of psittacosis experienced from 1980 to 1988 were analyzed. The following results were obtained. 1) Sixteen patients were male; twenty were female. The thirty-six patients ranged in age from 29 to 76 years. 2) Fifteen patients had been exposed to Parakeets prior to the onset of illness. 3) High fever (94.1%) and cough (94.4%) were prominent clinical symptoms. 4) The number of pneumonic foci per lung field by chest X-ray, showed the right inferior lobe was most frequently involved (45.2%). According to the nature of roentgenological shadows, the ground-glass-like shadow was most frequent (70.6%). 5) Leucocytosis was present in only three patients. The erythrocyte sedimentation rate and C-reactive protein were high in many patients. Half of the patients had elevated serum glutamate oxaloacetate transaminase and glutamate pyruvate transaminase. 6) All cases were treated with antibiotics and cured. The incidence of psittacosis may be increasing. Therefore, it is useful for clinicians to know the clinical features of this disease. These results may be useful in early diagnosis.

Adult↗

PubMed1990

[Anesthetic management of patients with cardiomyopathies].

Anesthetic management of patients with cardiomyopathy was studied. In the past 8 years, we experienced 24 surgical procedures for 16 patients complicated with cardiomyopathy of whom 6 cases with hypertrophic type (HCM) and 10 cases with dilated type (DCM). In HCM there was no correlation between the incidence of intraoperative complication and preoperative evaluation by New York Heart Association. In HCM cases who revealed atrial fibrillation, conduction disturbance on ECG and hypokinesis on echocardiogram resulted in high incidence of cardiac complication during anesthesia. Induction of anesthesia is extremely risky if the anesthesiologist is not aware of the presence of cardiomyopathies. In DCM, preoperative episode of heart failure, arrhythmias and conduction disturbance on ECG were considered as anesthetic risk factors. Both in HCM and DCM, there were no statistical significance in complication between general anesthesia and epidural anesthesia. The authors recommend epidural technique as a method of choice for HCM patient.

Adult↗

PubMed1988