Movement of the Cauda Equina during the lateral decubitus position with fully flexed leg.
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Adult↗
Biomedical subjects
Shigeki Yamaguchi
Publications and source records attributed to Shigeki Yamaguchi.
[Inducible nitric oxide synthase gene expression induced by moderate hypoxia in the rat left ventricular myocardium].
BACKGROUND: Moderate hypoxia might influence the induction of nitric oxide synthase (iNOS) messenger RNA (mRNA) expression in the rat left ventricular myocardium. METHODS: Seventy-two Sprague-Dawley rats were divided into two groups as follows: 1) those with controlled ventilation with air (n = 36), and 2) those with controlled ventilation with 10% oxygen as a hypoxic group (n = 36). Heart rate (HR) and mean arterial pressure (MAP) were measured during the study. Before, and 2, 4, 6, 8, or 10 hr after, inhalation of air or 10% oxygen (6 rats for each time), thoracotomy was performed and the left ventricular myocardium was removed. Total RNA was assayed by the reverse transcription-polymerase chain reaction (RT-PCR) with gene-specific primers for iNOS and glyceraldehyde-3-phosphate dehydrogenase. RESULTS: In the air group, there were no significant differences in HR, MAP, and the level of iNOS mRNA throughout the study. In the hypoxic group, however, HR and MAP decreased significantly from 4 and 6 hr after inducing hypoxia, respectively. The level of iNOS mRNA increased significantly from 2 through 10 hr after inducing hypoxia. CONCLUSIONS: This study demonstrated that in the rat left ventricular myocardium, iNOS mRNA expression increased from 2 hr after inducing hypoxia, and seemed to increase concomitantly with longer duration of hypoxia.
Animals↗
[Vascular dementia--sign, symptoms and laboratory findings].
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Aged↗
[Preventive effects of anti-inflammatory drugs(non steroidal anti-inflammatory drugs) on Alzheimer disease].
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Alzheimer Disease↗
[Perioperative management of a patient with polycythemia who developed massive hemorrhage].
A 34-year-old man, 170 cm in height and 70 kg in weight, was scheduled for emergency operation because of gastric perforation due to gastric cancer under general anesthesia. His preoperative blood analysis showed 5.2 x 10(3) mm(-3) of red blood cell, 18 g x dl(-1) of hemoglobin and 48% of hematocrit. Based on this and other data, he was diagnosed as having polycythemia caused by stress. Anesthesia was induced with thiopental and maintained with O2-N2O-sevoflurane. The intraoperative blood loss reached approximately 7,000 ml. Although we administered only 4 units of fresh-frozen plasma (FFP) and 9,150 ml of fluid with no red cell concentrated, his hemodynamic state was stable during surgery. After the surgery, we administered the minimum amount of FFP according to his blood analysis. Although red cell concentrated was not administered in the perioperative period, his general condition remained stable.
Adult↗
[Anesthetic management for cesarean section in a patient with corrected transposition of great arteries].
A 20-year-old woman with corrected transposition of great arteries (height 163 cm, weight 69 kg) was scheduled for elective cesarean section at 36 weeks of gestation. Since her mitral insufficiency had deteriorated during pregnancy, she developed dyspnea and lower cardiac function. We decided to perform general anesthesia for her cesarean section. Under the continuous monitoring of arterial blood pressure, anesthesia induction was performed with thiamylal 150 mg, vecuronium 8 mg and fentanyl 0.2 mg, and maintained with oxygen-air-isoflurane (1-1.5%). A Swan-Ganz catheter was inserted for evaluation of her cardiac function. No cardiac events were observed during surgery. The postoperative course was uneventful, and the patient was discharged from the hospital on the 10th postoperative day. Swan-Ganz catheter was useful for the evaluation of cardiac function and for anesthetic management.
Adult↗
ACh differentially modulates voltage-gated K channels in glomus cells between DBA/2J and A/J strains of mice.
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4-Aminopyridine↗
Nicotinic acetylcholine receptor channels in cat chemoreceptor cells.
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Animals↗
A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients.
PURPOSE: To establish the appropriate inhalation induction technique using a high concentration of sevoflurane in the elderly. METHODS: Forty-five patients, aged 70-79-yr-old, were randomly divided into three groups: 1) Group I: anesthesia was induced with propofol 2 mg x kg(-1) and sevoflurane 2% (n = 15); 2) Group II: anesthesia was induced with a three- minute inhalation of sevoflurane 8%; 3) Group III: anesthesia was induced with inhalation of sevoflurane using a gradual reduction technique (8, 6, 4% for each minute). In Groups II and III, a modified vital capacity inhalation induction was performed. Mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO(2)) were measured continuously during induction. In addition, induction time and adverse events related to anesthetic induction were recorded. RESULTS: The induction time in Group I was significantly shorter than that in Groups II and III (P < 0.05). However, there was no difference in the induction time between Groups II and III. In Groups II and III, the majority of patients required additional breaths. In comparison with the other groups, stability of MAP was maintained in Group III. The variations of HR in all groups were small. During induction, no patient experienced a decrease in SpO(2) below 96%, except for two patients in Group I. Severe respiratory adverse events were not observed. Other adverse events were similar in all groups. CONCLUSIONS: Our results suggest that a high concentration sevoflurane induction using a gradual reduction technique may be an acceptable alternative to standard iv induction in elderly patients.
Aged↗
Outcome of total pelvic exenteration for primary rectal cancer.
PURPOSE: This retrospective study identifies the clinicopathologic factors (age, gender, size of tumor, location, tumor stage, lymph node metastasis, histologic differentiation, and adjuvant therapies) that are useful in predicting long-term survival in patients undergoing total pelvic exenteration for advanced primary rectal cancer. METHODS: We reviewed the medical records of 71 patients with stage T3 or T4 primary rectal cancer who underwent a curative total pelvic exenteration. The effects of various clinical variables on long-term survival were analyzed. RESULTS: The postoperative mortality, hospital death, and morbidity rates were 1.4, 4.2, and 66.2 percent, respectively. The overall five-year survival rate after total pelvic exenteration was 54.1 percent. The five-year survival rate was 65.7 percent for patients with T3 lesions and 39 percent for patients with T4 lesions. A univariate analysis showed that postoperative survival was affected by age, tumor stage, and lymph node metastasis, while a multivariate analysis showed that age and lymph node metastasis were independent prognostic factors. CONCLUSION: Total pelvic exenteration may enable long-term survival in younger patients with stage T3 or T4 primary rectal cancer and little or no lymph node metastasis.
Adenocarcinoma↗
Bispectral monitoring during vital capacity rapid inhalation induction with sevoflurane.
STUDY OBJECTIVE: To evaluate the variables of bispectral index (BIS) values during vital capacity rapid inhalation induction (VCRII) with sevoflurane. DESIGN: Randomized, prospective study. SETTING: University hospital. PATIENTS: 40 ASA physical status I and II patients scheduled for elective orthopedic surgery with general anesthesia. INTERVENTIONS: Patients was divided into two groups, both of which received intravenous (IV) injection of propofol 2 mg/kg followed by inhalation of sevoflurane 3% (Group P), or vital capacity inhalation induction with sevoflurane 8% (Group S). After loss of consciousness, tracheal intubation was performed with vecuronium 0.1 mg/kg. MEASUREMENTS AND MAIN RESULTS: The induction times in Group P were significantly shorter than those in Group S (p < 0.01). In Group S, BIS values were gradually decreased and maintained the adequate hypnotic levels were maintained during induction. In Group P, although BIS values were rapidly decreased, the values remained higher compared with Group S. The BIS value before intubation in Group S was significantly lower than that in Group P (25 +/- 9 and 38 +/- 7, respectively; p < 0.01). Five of 20 Group P patients had BIS values exceeding 60 before tracheal intubation, but no patient in Group S had a BIS value as high. Mean arterial pressure immediately after intubation in Group S was significantly lower than that in Group P (p < 0.05). CONCLUSION: VCRII with a high concentration of sevoflurane provided adequate BIS values during induction, suggesting that it may allow smoother transition from anesthesia induction to maintenance, and also maintain an adequate hypnotic level in readiness for certain stimuli such as laryngoscopy and tracheal intubation.
Adult↗
Magnitude of serosal changes predicts peritoneal recurrence of gastric cancer.
BACKGROUND: Peritoneal dissemination is the most frequent mode of recurrence in patients with gastric cancer. We tried to identify factors that predict peritoneal recurrence with high sensitivity. STUDY DESIGN: Clinical and pathologic data from 587 consecutive patients with gastric cancer were reviewed retrospectively. The stepwise Cox proportional hazards regression model was used to assess the prognostic significance of the magnitude of serosal changes. Multiple stepwise logistic regression analysis was used to determine factors associated with peritoneal recurrence in 375 patients who underwent curative resection. RESULTS: The 5-year survival rate of patients with S2 disease (greatest dimension of macroscopic serosal changes >/= 2.5 cm) was 18%, which was worse than S0 (no serosal changes) and S1 disease (macroscopic serosal changes < 2.5 cm)(p < 0.001). Patients with S0 tumors who underwent curative resection had the best 5-year survival rate. Multivariate analyses indicated that the magnitude of serosal changes was an independent prognostic factor for survival both overall and after curative resection. Logistic regression analysis showed that peritoneal recurrence was more than four times as likely with S2 than with S0 or S1 tumors. The sensitivity for predicting peritoneal recurrence was 79%; the sensitivity of cytologic examination was 38%. CONCLUSIONS: Magnitude of serosal changes is easy to measure intraoperatively and predicts peritoneal recurrence of gastric cancer with greater sensitivity than conventional peritoneal lavage cytology.
Gastrectomy↗
Structural and functional differences of the carotid body between DBA/2J and A/J strains of mice.
In a previous study, DBA/2J and A/J inbred mice showed extremely different hypoxic ventilatory responses, suggesting variations in their carotid bodies. We have assessed the morphological and functional differences of the carotid bodies in these mice. Histological examination revealed a clearly delineated carotid body only in the DBA/2J mice. Many typical glomus cells and glomeruli appeared in the DBA/2J but not in the A/J mice. The size of the carotid body in the DBA/2J and A/J mice was 6.3 +/- 0.5 x 10(6) and 1.5 +/- 0.3 x 10(6) micro m(3), respectively. The area immunostained for tyrosine hydroxylase, an estimation of the glomus cell quantity, was four times larger in the DBA/2J mice than in the A/J mice. The individual data points in the DBA/2J mice segregated from those in the A/J mice. ACh increased intracellular Ca(2+) in most clusters (81%) of cultured carotid body cells from the DBA/2J mice, but only in 18% of clusters in the A/J mice. These data suggest that genetic determinants account for the strain differences in the structure and function of the carotid body.
Acetylcholine↗
Identification of genes regulating colorectal carcinogenesis by using the algorithm for diagnosing malignant state method.
We studied the expression profiles of various stages of colorectal tumors (adenoma (AD), seven samples; carcinoma (CA), 16 samples) by using cDNA microarrays and developed ADMS (algorithm for diagnosing malignant state) method, selecting 335 clones characteristic of CA state. We, then, applied ADMS to 12 additional samples (five from primary lesions with metastasis and seven metastases); all 16 CAs and 12 metastatic tumors were diagnosed correctly as cancerous states. Although three of the seven ADs were diagnosed as "cancerous," the large size of two of these tumors suggested their potential malignancy. Our strategy for selecting clones characteristic of the malignant state is widely applicable to diagnosis and for predicting the stage of progression during multistep carcinogenesis. Of the 335 clones we selected, 135 were known genes. Included in the 135 genes were tumor suppressor and growth factor-related genes and were consistent with the literature. ADMS is a reliable means for identifying genes useful for the diagnosis of cancer.
Adenoma↗
Recovery of psychomotor function after propofol sedation is prolonged in the elderly.
PURPOSE: To assess the effects of age on recovery of psychomotor function for propofol sedation during spinal anesthesia. METHODS: Propofol was continuously infused during surgery and spinal anesthesia in 15 elderly patients (65-85 yr-old) and 15 younger patients (20-50 yr-old). Infusion rates were adjusted to maintain an appropriate level of sedation using the bispectral index (range 60-70). The sedative infusion was discontinued at the end of surgery. The early recovery times from the end of propofol infusion to opening of eyes on command, sustaining a hand grip, and recall of name were noted. Psychomotor function, as measured by the Trieger's dot test, was evaluated before anesthesia and 30, 60, 90, 120 min after the end of propofol infusion. RESULTS: The duration of anesthesia was 142 +/- 55 min and 134 +/- 61 min in the elderly and younger patients, respectively. No differences were observed in early recovery times between elderly and younger patients (opened their eyes on command, 6.3 +/- 4.0 min and 5.2 +/- 2.6 min; sustained a hand grip, 7.2 +/- 3.9 min and 6.1 +/- 3.5 min and recalled their name, 8.0 +/- 4.5 min and 6.5 +/- 3.8 min, P > 0.05 ). The recovery of psychomotor function in the elderly took longer compared with the younger patients, and psychomotor function in the elderly recovered at 120 min after the end of propofol infusion. CONCLUSION: Early recovery times following propofol sedation is similar between elderly and younger patients, but recovery of psychomotor function in the elderly is delayed compared with younger patients.
Adult↗
Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up.
PURPOSE: Although outcome of resection for colorectal carcinoma has improved, about 30 percent of patients develop metastatic lesions. Small pulmonary metastases 1 cm or less in diameter now can be detected by diagnostic tests including chest radiography and computed tomography. We evaluated results of our strategy for intensive follow-up after resection of colorectal cancer and aggressive resection of lung metastases disclosed by these periodic examinations. METHODS: Our follow-up program for lung metastasis includes a serum carcinoembryonic antigen assay every two months and chest radiography every six months. Surgical resection of lung metastases was performed if the primary and any nonpulmonary metastases had been controlled, lung metastases numbered four or fewer, and pulmonary functional reserve was adequate. Standard operation for lung metastasis was lobectomy, and lymph node dissection was added in cases of tumor size over 3 cm. Forty-two patients underwent 50 lung resections for metastatic colorectal cancer between 1992 and 1999. Long-term survival was assessed in terms of clinical variables. RESULTS: Overall five-year survival rate after resection of lung metastases from colorectal cancer was 63.7 percent. Variables significantly affecting postthoracotomy survival were primary tumor histology, number of nodules, and disease-free interval up to appearance of the lung metastases, and primary tumor histology was an independent prognostic factor. CONCLUSION: Intensive follow-up for lung metastases after resection of colorectal cancer and aggressive resection improved postoperative survival rate. Patients with well-differentiated adenocarcinoma of primary tumor, a solitary metastatic nodule, and disease-free interval of at least two years after initial surgery are likely to be long-term survivors.
Adult↗
Venous anatomy of the right colon: precise structure of the major veins and gastrocolic trunk in 58 cadavers.
PURPOSE: This study was designed to describe the precise venous anatomy of the right colon, which is especially important for laparoscopic right hemicolectomy. METHODS: Fifty-eight adult cadavers were dissected to define the three major venous tributaries of the right colon: the ileocolic vein, right colic vein, and middle colic vein. Two or three middle colic veins were often present, and the biggest one was designated as the main middle colic vein. The middle colic vein and the right colic vein occasionally formed a common trunk with the right gastroepiploic vein and/or the pancreaticoduodenal vein. This common trunk was defined as the gastrocolic trunk. RESULTS: All 58 cadavers had a single ileocolic vein. All of the ileocolic veins drained into the superior mesenteric vein. The right colic vein was absent in 56.9 percent (33/58), and the other 43.1 percent had a single right colic vein. The right colic vein joined the superior mesenteric vein directly in 56 percent (14/25) and the gastrocolic trunk in 44 percent (11/25). The middle colic vein was the most variable. A single middle colic vein was present in 37.9 percent (22/58), 2 middle colic veins were present in 50 percent (29/58), and 3 middle colic veins were present in 12.1 percent (7/58). The main middle colic vein drained into the superior mesenteric vein directly in 84.5 percent (49/58), whereas 12.1 percent (7/58) drained into the gastrocolic trunk. In two cadavers, there was anomalous drainage of the main middle colic vein to the splenic vein and the inferior mesenteric vein. Forty-three accessory middle colic veins were present in total. These drained into the superior mesenteric vein in 17 cadavers and into the gastrocolic trunk in 23. The gastrocolic trunk was present in 69 percent (40/58), being formed with the right colic vein in 27.5 percent (11/40; 1 was together with an accessory middle colic vein) and with the middle colic vein in 75 percent (30/40; 7 with the main middle colic vein, 23 with the accessory middle colic vein). CONCLUSION: Venous anatomy of the right colon is highly variable. It is especially important to recognize the lack of direct drainage of the right colic vein to the superior mesenteric vein and the high frequency of the presence of plural middle colic veins and the gastrocolic trunk.
Adult↗
[Sympathetic block in dogs by a local anesthetic with addition of clonidine].
BACKGROUND: The aim of this study is to examine the duration and magnitude of vasodilating effect induced by sympathetic block with the addition of different concentrations of clonidine to mepivacaine. METHODS: In dogs, mean arterial pressure (MAP), heart rate (HR), and right as well as left brachial artery blood flow (BABF) were measured before and after stellate ganglion block (SGB) used as sympathetic block. The experimental protocol was designed as follows: 1) Group 1: left SGB using 0.5% mepivacaine 1 ml (n = 6), 2) Group 2: left SGB using the addition of clonidine 0.5 microgram to 0.5% mepivacaine 1 ml (n = 6), 3) Group 3: left SGB using the addition of clonidine 5 micrograms to 0.5% mepivacaine 1 ml (n = 6). RESULTS: MAP showed no significant change throughout the study in the groups 1 and 2. In the group 3, MAP was lower than that of the group 1. HR showed no significant change throughout the study in the three groups. Left BABF increased significantly after left SGB in the three groups. The duration of increased BABF in the group 2 was the longest, and that in the group 3 was the shortest among them. Right BABF after left SGB decreased significantly throughout the study in the three groups, and the magnitude of the decrease in BABF in the group 3 was the highest among them. CONCLUSION: Sympathetic block with the addition of clonidine to local anesthetics increases both duration and magnitude of its vasodilating effect. However, sympathetic block with the addition of higher doses of clonidine to local anesthetics may induce shorter duration and lower magnitude of vasodilating effect compared with local anesthetics alone.
Analgesics↗