PubMed Health⌕ Search

Biomedical subjects

T Asoh

Publications and source records attributed to T Asoh.

At least 37 records · Page 2Linked to original sources
PubMed1994

Neuroleptic malignant syndrome occurring after an emergency operation for traumatic duodenal perforation: report of a case.

Neuroleptic malignant syndrome (NMS) is a potentially fatal complication which may develop in psychiatric patients taking neuroleptic drugs. We report herein the successful treatment of a 33-year-old schizophrenic man, prescribed neuroleptic drugs, who underwent an emergency operation for traumatic duodenal perforation with a retroperitoneal infection. Five days after the operation, he began to demonstrate clinical features consistent with NMS such as high fever, abnormalities in vital signs, leukocytosis, and an elevated serum level of creatine phosphokinase; however, these findings were first presumed to be secondary to either the preexisting tissue injuries or to postoperative complications. A definite diagnosis of NMS was thus delayed until muscle rigidity and autonomic instability became evident. After a tentative diagnosis of NMS had been made, sodium dantrolene, a drug used specifically for the treatment of NMS, was administered and the patient's condition remarkably improved. Since NMS can be induced by either interrupting the course of neuroleptic drugs or by the additional administration of sedative drugs, and since its mortality rate is high if prompt and appropriate treatment is not carried out, surgeons should bear in mind the possibility of NMS developing postoperatively in psychiatric patients.

Adult↗
PubMed1994

Enhanced induction of lymphokine-activated killer activity following a single dose of cisplatin in cancer patients.

The effects of intravenous cisplatin (CDDP) administration on the generation of lymphokine-activated killer (LAK) activity in peripheral blood mononuclear (PBM) cells were investigated in cancer patients. The ability of PBM to generate LAK activity was significantly augmented 3, 5 and 7 days after a single dose, 50 mg m-2, of CDDP injection when compared to that before injection. NK activity of PBM was not altered. The distribution of lymphocyte subsets exhibited no significant change following CDDP injection, except CD2+ cells. However, the ability of monocytes in PBM to produce TNF-alpha was significantly enhanced 5 days after the drug administration, although IL-1-alpha and IL-1-beta production was not augmented.

Cisplatin↗
PubMed1994

Laboratory correlates of chemoimmunotherapy with low-dose recombinant interleukin-2 and mitomycin C in patients with advanced carcinoma.

Based on our clinical findings that the ability of cancer patients to generate lymphokine-activated killer (LAK) cells was remarkably augmented after mitomycin C (MMC) administration, we designed a treatment regimen that consisted of MMC 12 mg/m2, i.v. on day 1 and recombinant interleukin-2 (IL-2) 700 U/m2, i.v. every 12 hr from day 4 through day 8. Of 29 patients with advanced carcinoma treated with this regimen, 10 had a partial response (PR) and 4 had a minor response. The correlation of hematological and immunological changes associated with this treatment with the antitumor response to this therapy was investigated. Pretreatment values of total white blood cell and lymphocyte counts, and the level of increase of eosinophil counts in responder patients who showed a PR, were significantly greater than those in nonresponder patients. However, there was no correlation between clinical response and cytotoxic activities of peripheral blood mononuclear (PBM) cells, including NK and LAK activity, and the ability to generate LAK cells after the treatment. The capacity of adherent cells in PBM to produce IL-1-beta was increased after the treatment in both responders and nonresponders, whereas IL-1-alpha production was not increased. In addition, a significant increase in the ability to produce TNF-alpha was observed only in responders, indicating the correlation of TNF-alpha production with clinical response to this therapy. Since these correlations had been reported in the previous studies using IL-2, the present results suggested that the therapeutic effectiveness of this therapy against advanced carcinoma, is due to IL-2 probably augmented by its combination with MMC. In addition, these parameters might be predictive of therapeutic efficacy of this treatment.

Adult↗
PubMed1994

[Reoperation for transposition of the great arteries: mid-term results and reoperation after arterial switch operation].

The arterial switch operation for transposition of the great arteries is now widely accepted as the therapeutic method of choice. As of December 1993, a total of 162 patients underwent the arterial switch. There were 100 patients with transposition and intact ventricular septum, 48 with a ventricular septal defect, 14 with ventricular septal defect and arch anomalies (coarctation: 11, interruption: 3). Early and late mortality were 3.7% (6 patients) and 4.5% (7 patients), respectively. Postoperative pulmonary stenosis (> 30 mmHg) was noted in 33 patients (22%), aortic regurgitation (> mild) in 20 (13%), supravalvular aortic stenosis (> 20 mmHg) in 5 (3%) and mitral regurgitation (> mild) in 5 (3%). Reoperation was performed in 27 patients with no mortality. Mean interval between the switch and the reoperation was 30 months. Twenty-three patients with pulmonary stenosis underwent patch plasty of pulmonary artery. Two children with severe aortic regurgitation underwent aortic valve replacement. Two patients who had undergone one-staged repair for interruption complex were reoperated due to supravalvular aortic stenosis and pulmonary stenosis. Actuarial survival and freedom from reoperation at 9 years were 90% and 69%, respectively.

Aortic Valve Stenosis↗
PubMed1993

Cytotoxic cell function and phenotypic analysis of peripheral blood mononuclear cells in cancer patients treated with low-dose interleukin-2 and mitomycin C.

We previously found that the ability of peripheral blood mononuclear cells (PBM) of cancer patients to generate lymphokine-activated killer (LAK) cells became remarkably augmented after mitomycin C administration. On the basis of the clinical findings, we designed a treatment regimen comprised of 12 mg/m2 mitomycin C i.v. on day 1 and 700 U/m2 recombinant interleukin-2 (IL-2) i.v. every 12 h from day 4 through day 8. Of 25 patients with advanced carcinoma, 9 had a partial response and 3 had a minor response. Cytotoxic cell function, including natural killer activity, lymphokine-activated killer (LAK) activity, and the ability to generate LAK cells, and lymphocyte subsets in PBM was measured 1 day before and after either the first or second course of this therapy. The relationship between these parameters and the clinical antitumor response to this treatment was examined. Although the cytotoxic activities were significantly augmented after either the first or second treatment course, no positive correlation was observed between the changes in these cytotoxic activities and the clinical response to this therapy, when patients who either showed a partial response or whose disease remission was partial or minor were defined as responders. Further, phenotypic analysis showed a significant increase in CD2+, CD3+, CD4+ and CD4+Leu8- cells after the first course, and CD25+ cells after either the first or second course of this treatment. The percentages of CD2+ and CD25+ cells were significantly elevated only in responders but not in nonresponders, suggesting the increase in these subsets was related to clinical response.

Aged↗
PubMed1989

Effect of voluntary exercise on urinary excretion of catecholamines after traumatic shock in rats.

Thirteen rats were kept in cages equipped with running wheels for 10 months (exercise group), and 12 rats were kept in cages without running wheels during the same period (control group). Rats in both groups were subjected to a Noble-Collip drum trauma (40 rpm, 350 revolutions in total) after the 10-month conditioning period. Urine output, urinary epinephrine (E), and norepinephrine (NE) were measured until the seventh day after the trauma. Urine output decreased after the trauma in both groups to the same extent, but the recovery of urine output after trauma was accomplished faster in the exercise group than in the control group, and diuresis after trauma was seen only in the exercise group. Urinary E increased in both groups within 24 hours after trauma, but the increase in the exercise group was significantly less than in the control group. The amount of NE excreted depended somewhat on the urine volume, but there was no significant difference in changes in urinary NE after trauma between the groups. These results suggest that rats bred in an active condition suffered less severe traumatic shock accompanied by a reduced sympathoadrenal activity as compared with rats bred in a relatively sedentary condition.

Adrenal Glands↗
PubMed1988

Effect of epidural analgesia on postoperative insulin resistance as evaluated by insulin clamp technique.

The influence of epidural neural blockade on postoperative insulin resistance was studied using the euglycaemic insulin clamp technique. Eighteen patients undergoing elective upper abdominal surgery of moderate severity were allocated to two groups: group G patients underwent operation under general anaesthesia, and postoperative pain was relieved by systemic administration of analgesia; and group E patients received epidural analgesia during surgery and epidural morphine postoperatively. In each patient the euglycaemic insulin clamp test was performed twice: several days before surgery and on postoperative day 1. Peroperative catecholamine and cortisol responses were also measured to investigate possible endocrine mechanisms of the insulin resistance. Glucose disposal (M) decreased in both groups on postoperative day 1 at plasma insulin concentrations ranging from 1.2 to 10.0 milliunits ml-1, resulting in the downward shift of dose-response curves. However, this downward shift was significantly smaller in group E than in group G patients. Urinary adrenaline excretion increased markedly on the day of operation in group G, but was significantly inhibited in group E. Urinary noradrenaline excretion increased mainly on postoperative day 1 in group G, but was significantly inhibited in group E. Plasma cortisol response was lower in group E than in group G during and shortly after operation, and was significantly inhibited in group E on postoperative day 1. These results indicate that insulin resistance after elective abdominal surgery is due to a postreceptor deficit in glucose utilization, as indicated by the downward shift of the dose-response curves. This disturbance in glucose metabolism was reduced by epidural analgesia, the results being associated with inhibited catecholamine and cortisol responses.

Analgesics↗
PubMed1987

Effects of epidural administration of local anaesthetics or morphine on postoperative nitrogen loss and catabolic hormones.

To examine the effects of postoperative epidural analgesia with local anaesthetics or morphine on the excess nitrogen loss after upper abdominal surgery and to assess the roles of catabolic hormones in the nitrogen loss, urinary excretion of nitrogen and catecholamines and plasma concentrations of cortisol and glucagon were measured in three groups of patients undergoing elective gastrectomy. Group G patients received the operation under general anaesthesia, and their postoperative pain was relieved by intermittent injections of analgesics. Group PE received prolonged epidural analgesia with local anaesthetics during and after surgery. Group EM received epidural analgesia intra-operatively and epidural morphine postoperatively. Urinary nitrogen excretion during the first three postoperative days was significantly less in the PE and EM groups than in the G group, and the PE group excreted slightly less nitrogen than the EM group. In the G group, urinary excretion of adrenaline increased mainly on the day of operation, and noradrenaline chiefly on postoperative days. These catecholamine responses were almost completely abolished in the PE group, and significantly inhibited in the EM group. Plasma cortisol response was most remarkable shortly after the operation and then decreased in all groups, but was significantly lower in the two epidural groups than in the G group throughout the study. Plasma glucagon increased postoperatively in all groups, and the increase was less pronounced in both epidural groups than in the G group. These results suggested that an elevated sympathetic activity, represented by increased noradrenaline excretion and elicited by painful nociceptive and sympathetic nervous afferents, is responsible for the postoperative nitrogen loss which is mediated by glucagon and cortisol.

Anesthetics, Local↗
PubMed1987

Effects of indomethacin on endocrine responses and nitrogen loss after surgery.

In 14 patients who had elective gastrectomy, 50 mg of indomethacin was administered intrarectally every 6-8 hours after operation until postoperative day 3. Body temperature, plasma cortisol and glucagon concentrations, blood glucose level, urinary catecholamine level, and urinary nitrogen excretion level were compared with those of 16 patients who did not receive indomethacin. Postoperative fever was significantly reduced by indomethacin. Plasma cortisol levels in the indomethacin-treated group were significantly lower on postoperative days 2 and 3. Postoperative increases in plasma glucagon and blood glucose levels were not influenced by indomethacin administration. Urinary epinephrine excretion tended to be inhibited, and urinary norepinephrine excretion was significantly inhibited in the indomethacin-treated group after operation. Urinary nitrogen excretion levels during the observation period were significantly less in the indomethacin-treated group. The cumulative urinary nitrogen level from postoperative days 1-3 in the indomethacin-treated group was 82% of that in the control group. These results indicated that fever reduction by indomethacin after surgery resulted in reduced protein loss, associated with attenuated cortisol and catecholamine responses.

Blood Glucose↗
PubMed1986

Role of the splanchnic nerves in endocrine and metabolic response to abdominal surgery.

The splanchnic nerves are inevitably stimulated during upper abdominal surgery and this may produce various responses. To assess the role of splanchnic nerve stimulation on the endocrine-metabolic responses to abdominal surgery, intra-operative splanchnic nerve blockade was carried out in 12 patients undergoing elective gastrectomy under general anaesthesia and the results compared with those of patients undergoing gastrectomy under general anaesthesia or epidural analgesia alone. In the splanchnic blockade group, intra-operative increase in plasma cortisol, glucose, FFA (free fatty acids) and urinary adrenaline excretion were significantly less than that of the general anaesthesia group. This inhibitory effect of splanchnic blockade on these endocrine-metabolic responses was almost the same as, but slightly less remarkable than, that of high spinal epidural blockade. Urinary noradrenaline excretion reached the highest level on the first postoperative day in the general anaesthesia group. This noradrenaline response was significantly inhibited in the splanchnic group as well as in the epidural group. These results appeared to indicate that mechanical stimulation to the splanchnic nerve due to operative manipulation is largely responsible for the endocrine-metabolic responses in abdominal surgery. The results also suggested that, in addition to the splanchnic nerve stimulation, conscious pain perception is responsible for catecholamine release.

Anesthesia, Epidural↗
PubMed1986

Effects of epidural analgesia on scalp-recorded somatosensory evoked potentials to posterior tibial nerve stimulation.

The effect of epidural analgesia with plain bupivacaine 0.5% on somatosensory evoked potentials (SEP) to electrical stimulation of the posterior tibial nerve was examined in six patients. Epidural analgesia significantly increased onset time and latencies of the early components in SEP, while the amplitudes decreased. These results suggest that SEP may be valuable in the objective evaluation of possible differential neural effects of local anaesthetic agents following epidural or intrathecal administration.

Adult↗
PubMed1986

Effect of voluntary exercise on resistance to trauma in rats.

To investigate the effect of voluntary exercise on the tolerance to trauma, female rats kept in cages with running wheels for 3-7 weeks (exercise group) were subjected to Noble-Collip drum trauma and compared to rats kept in cages without running wheels for the same period (sedentary group). Both food consumption and weight gain were greater in the exercise group than in the sedentary group. Mortality from the drumming of 600 revolutions was significantly decreased in rats kept in cages with running wheels for 5 weeks or 7 weeks but not in rats kept for only 3 weeks. Mortality from the drumming of 450 revolutions and of 500 revolutions was also significantly lower in the exercising rats. These results indicated that voluntarily exercising rats showed increased resistance to trauma as compared to rats kept under the sedentary condition.

Animals↗
PubMed1983

Attenuation of adrenocortical response to upper abdominal surgery with epidural blockade.

Plasma cortisol concentrations and urinary 17-OHCS excretion were measured in two groups of 15 patients receiving elective gastrectomy under either general anaesthesia or epidural blockade. In another 15 patients receiving epidural blockade, the vagus nerve was blocked by injection of local anaesthetics or by truncal vagotomy, and their cortisol response to gastrectomy was compared with the other two groups. Gastrectomy under general anaesthesia caused a marked increase in plasma cortisol concentrations and in urinary excretion of 17-OHCS. These adrenocortical responses to gastrectomy were significantly inhibited in patients operated upon under epidural blockade extending from T3-4 to L1-2 and continuing for 48 h postoperatively. In patients receiving both epidural and vagus nerve blockade, the plasma cortisol response was the same as in those receiving epidural blockade alone. The results indicated that the adrenocortical response to upper abdominal surgery was safely attenuated, though not abolished, with high spinal epidural blockade continuing for 48 h postoperatively. The vagus nerve was not likely to be playing an important role in the adrenocortical response to gastrectomy.

Anesthesia, Epidural↗
PubMed1983

Influences of splanchnic nerve blockade on endocrine-metabolic responses to upper abdominal surgery.

Twelve patients undergoing gastrectomy received combined epidural and splanchnic nerve blockade (Group E&S), and changes in plasma ACTH, cortisol, glucose and FFA were compared with those undergoing gastrectomy under general anaesthesia (Group G) or epidural analgesia alone (Group E). Plasma ACTH increased in all groups on the day of operation and was significantly higher in Group G than the other groups. Levels of ACTH in Group E&S were lower than Group E, but the differences were not significant. Cortisol response in Group G was most pronounced and prolonged. This cortisol response was significantly attenuated in Group E and was further inhibited in Group E&S. Blood glucose and FFA increased in Groups G and E during the operation but the increase was significantly less in Group E. In Group E&S, glucose and FFA concentrations showed practically no change throughout the study, being significantly lower than in Group E. The results indicated that the splanchnic nerve is responsible for producing endocrine-metabolic responses to gastric surgery even under epidural blockade.

Adrenocorticotropic Hormone↗
PubMed1983

Effect of epidural analgesia on metabolic response to major upper abdominal surgery.

Blood concentrations of glucose, lactate, non-esterified fatty acids (NEFA) and insulin (IRI) were measured in two groups of ten patients undergoing elective gastrectomy under general anesthesia with halothane (Group G) or epidural analgesia extending from Th3-4 to L1-2 without halothane (Group E). The rise in blood glucose and the rise in NEFA in group E during operation were significantly less than in Group G. Blood lactate levels during operation were lower in group E than in group G although the difference was not statistically significant. The increase in IRI/glucose ratio on postoperative day 1 was significantly less in Group E than in Group G, suggesting that insulin sensitivity after surgery was higher in Group E. The postoperative course was uneventful in all subjects. These results suggest that the endocrine-metabolic response to major upper abdominal surgery can be inhibited by epidural analgesia.

Anesthesia, Epidural↗