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T Kitajima

Publications and source records attributed to T Kitajima.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Differential lung ventilation using Fogarty catheter after accidental damage of bronchial blocker cuff].

We performed differential lung ventilation using a Fogarty catheter after accidental damage of a bronchial blocker. A 57-year-old-man underwent thoracoscopic surgery for right pneumothorax. Anesthesia was induced with fentanyl and midazolam, and maintained with propofol and continuous epidural block with 2% mepivacaine. We used a single lumen endotrachial tube with a bronchial blocker for differential lung ventilation. We inserted the tip of the bronchial blocker into the right bronchus under fiberoptic broncoscopy after the patient had been placed in the lateral position. Four milliliters of air were injected into the bronchial blocker cuff before inserting the thoracoscope and differential lung ventilation was started. The right lung expanded suddenly because of accidental damage of the cuff one hour after starting surgery. We inserted a Fogarty catheter (10 Fr.) into the right bronchus under fiberoptic broncoscopy. Its balloon was inflated for differential lung ventilation. The procedure was performed successfully and uneventfully. We conclude that Fogarty catheter is an effective replacement for a damaged bronchial blocker cuff during differential lung ventilation.

Catheterization↗
PubMed1999

[Anesthetic management for transtracheal placement of a catheter for intracavity infusion of an antifungal drug in patients with pulmonary fungus ball of aspergillosis].

A catheter was inserted through the cricothyroid membrane under general anesthesia using a laryngeal mask airway in two patients with pulmonary fungus ball of aspergillosis to administer an antimycotic into the fungus ball. Anesthesia was induced with fentanyl and propofol in both patients. The laryngeal mask airway was inserted using intravenous injection of vecuronium. Anesthesia was maintained with continuous infusion of propofol. The catheter was inserted through the cricothyroid membrane and placed in the pulmonary fungus ball using bronchoscope. Perioperative and postoperative courses were uneventful in both patients. It was concluded that the laryngeal mask airway is useful for airway management when a catheter is inserted into a pulmonary fungus ball through the cricothyroid membrane.

Aged↗
PubMed1999

[Anesthetic management of a patient with dilated cardiomyopathy under total intravenous anesthesia with propofol and ketamine combined with continuous epidural analgesia].

We report our experience with total intravenous anesthesia (TIVA) with propofol and ketamine combined with continuous epidural analgesia in a 72-year-old-male patient with dilated cardiomyopathy scheduled for a total prostatectomy. After premedication with atropine 0.5 mg and pethidine 35 mg, anesthesia was induced with ketamine 50 mg, fentanyl 0.1 mg and using a step down method of propofol (6-->4-->2 mg.kg-1.hr-1). After hemodynamic parameters had been stabilized, the trachea was intubated. Then, 1.5% lidocaine 6 ml was injected through an epidural catheter, placed at the L 1-2 intervertebral space. Anesthesia was maintained with continuous infusion of propofol 1 mg.kg-1.hr-1 and ketamine 1 mg.kg-1.hr-1, and continuous epidural analgesia with 1.5% lidocaine 2 ml.hr-1. Hemodynamics remained stable throughout the operative procedure. No postoperative complications occurred. TIVA with propofol and ketamine in combination with epidural analgesia is useful for patients with dilated cardiomyopathy in order to maintain stable hemodynamics during anesthesia.

Aged↗
PubMed1999

[Anesthetic management for urgent endoscopy in a child with heterotopic liver transplant].

A 6-year-old boy with heterotopic liver transplant underwent urgent endoscopy under general anesthesia because of bloody stool. He was taking cyclosporin as an immunosuppressant. His hepatic function was normal and no side effects of cyclosporin were observed. Preoperative blood transfusion was performed because of severe anemia. Anesthesia was induced with midazolam 2 mg, ketamine 20 mg and fentanyl 0.05 mg, and maintained with addition of midazolam and ketamine. We did not use any inhalation anesthetics to avoid postoperative hepatic dysfunction. The endoscopy was successfully performed and the postoperative course was uneventful. We conclude that preanesthetic evaluation of immunosuppressant state and the hepatic function of transplanted liver is important for anesthetic management of a patient with heterotopic liver transplant.

Anesthesia, General↗
PubMed1999

[A patient uninformed about his illness became aware of his lung cancer when an anesthesiologist visited him for pain control].

Much has been said about the importance of informed consent in Japan, but informing cancer to the patient has not been popular so far. We, as anesthesiologists, often treat pain in cancer patients, who occasionally, are not informed about the cancer. And we sometimes have patients with whom cautious consulting is necessary. This report presents our experience with a patient uninformed about the cancer but suspicious of his lung cancer. We met him as anesthesiologists, and this made the patient convinced that he had a cancer and was about to die soon.

Adult↗
PubMed1998

Involvement of the glutamate transporter and the sodium-calcium exchanger in the hypoxia-induced increase in intracellular Ca2+ in rat hippocampal slices.

Hippocampal slices prepared from adult rats were loaded with fura-2 and the intracellular free Ca2+ concentration ([Ca2+]i) in the CA1 pyramidal cell layer was measured. Hypoxia (oxygen-glucose deprivation) elicited a gradual increase in [Ca2+]i in normal Krebs solution. At high extracellular sodium concentrations ([Na+]o), the hypoxia-induced response was attenuated. In contrast, hypoxia in low [Na+]o elicited a significantly enhanced response. This exaggerated response to hypoxia at a low [Na+]o was reversed by pre-incubation of the slice at a low [Na+]o prior to the hypoxic insult. The attenuation of the response to hypoxia by high [Na+]o was no longer observed in the presence of antagonist to glutamate transporter. However, antagonist to Na+-Ca2+ exchanger only slightly influenced the effects of high [Na+]o. These observations suggest that disturbance of the transmembrane gradient of Na+ concentrations is an important factor in hypoxia-induced neuronal damage and corroborates the participation of the glutamate transporter in hypoxia-induced neuronal injury. In addition, the excess release of glutamate during hypoxia is due to a reversal of Na+-dependent glutamate transporter rather than an exocytotic process.

2-Amino-5-phosphonovalerate↗
PubMed1998

Arylsulfatase exists as non-enzymatic cell surface protein in sea urchin embryos.

The physiological role of arylsulfatase (Ars) and its function during development have yet to be satisfactorily defined in any species, though the proteins are widely distributed and the genes have been cloned from various organisms. Here we report the dual location of two types of Ars in sea urchin embryos. The majority of sea urchin Ars does not exhibit enzyme activity and is extracellularly distributed in aboral ectoderm cells (nonenzymatic Ars). Only a small portion has enzyme activity and is localized in lysosomal vesicles (enzymatic Ars). The elution pattern of Ars proteins processed by DEAE-cellulose or analytical gel-column chromatography reveals that although the molecular radius of enzymatic Ars differs from that of nonenzymatic Ars, they have the same charge. Furthermore, sedimentation analysis shows that purified Ars of sea urchin embryos is soluble in the absence of divalent cations but becomes insoluble in the presence of Ca2+ or Mg2+. Taken together, the present results suggest that non-enzymatic Ars is a new member of the cell surface component or extracellular matrix. It is possible that this cell surface Ars plays an important role in morphogenesis of sea urchin embryos.

Animals↗
PubMed1998

Superoxide radical generation and histopathological changes in hippocampal CA1 after ischaemia/reperfusion in gerbils.

PURPOSE: We investigated the relationship between the generation of superoxide radicals and histopathological changes on delayed neuronal death in the hippocampal CA1 subfield. METHODS: Seventy gerbils were randomly assigned to two groups, a sham group and an ischaemia/reperfusion (I/R) group. In the I/R group, transient forebrain ischaemia was induced by occluding the bilateral common carotid arteries for four minutes. The cerebrum was removed after reperfusion at intervals of one minute, six, twelve and twenty-four hr and at three, five and seven days. Each forebrain was cut into two portions including the hippocampus. The quantity of superoxide radicals was measured by using chemiluminescence, and histopathological changes in the hippocampal CA1 subfield were examined. RESULTS: In the I/R group, superoxide radicals increased on the 3rd and 5th days compared with the sham group (16.1 +/- 3.4 vs 3.2 +/- 1.0 on the third day (P < 0.0001); 10.9 +/- 1.9 vs 3.3 +/- 0.8 on the fifth day (P < 0.0001)). In the I/R group, the pyramidal cells were atrophic and pycnotic; vacuolation, and structural disruption of the radial striated zone were observed from the third through the seventh day. In the sham group, these changes were not observed. There were differences of degenerative ratios in the pyramidal cells between the two groups from the third to seventh days (5.6 +/- 2.0 vs 80.9 +/- 3.3 on the third day (P < 0.05); 6.9 +/- 0.4 vs 93.6 +/- 2.4 on the fifth day (P < 0.05); 6.2 +/- 1.5 vs 95.0 +/- 1.3 on the seventh day (P < 0.05)). CONCLUSION: There is a correlation between the generation of superoxide radicals and histopathological changes of the pyramidal cells in the hippocampal CA1 subfield.

Animals↗
PubMed1998

Small non-functioning endocrine tumor of pancreas: comparison with solid cystic tumor.

A small non-functioning islet-cell tumor of the pancreas in a 79-year-old man is reported. Ultrasonography showed a solid small mass in the body of the pancreas. All laboratory data, including serum hormones and tumor markers, were within normal limits. A distal pancreatectomy was performed. Cut sections of the specimen revealed a small, hard, solid mass measuring 2.8 x 2.2 x 2.0 cm. Histologically, the tumor consisted of large acidophilic cells with round nuclei, and these cells were similar to those normally found in solid and cystic tumors (SCT) of the pancreas. However, the tumor cells were slightly positive for somatostatin and neuron-specific enolase. Ultrastructural studies revealed clear nuclei with no zymogen but immature neurosecretory granules in the cytoplasm of the tumor cells. These findings were consistent with those of non-functioning islet-cell tumors. We describe the clinical and histological differences between non-functioning islet-cell tumors and SCT based on an analysis of the literature.

Adenoma, Islet Cell↗
PubMed1998

The protective effect of Clostridium novyi type B alpha-toxoid against challenge with spores in guinea pigs.

Clostridium novyi (C. novyi) Type B alpha-toxin was purified from culture supernatant by column chromatography, and was inactivated by formalin. A purified alpha-toxoid vaccine was prepared by mixing it with an aluminum phosphate gel adjuvant. Guinea pigs immunized twice with 4 micrograms or more of alpha-toxin survived against challenge with C. novyi Type B spores. Anti-alpha-toxin (antitoxin) titer was measured by toxin neutralization test using Vero cells. All of the guinea pigs having antitoxin titers of 10 units (U) or more at challenge were survived. In another experiment, guinea pigs were immunized with crude alpha-toxoid vaccines prepared by inactivated culture supernatant or by adding broken bacterial cells to the former. In this experiment, 10 U of antitoxin titer was the border of survival or death after challenge. Guinea pigs with antitoxin titers of less than 5 U, 5 U and 10 U died at 2, 3 to 4 and 4 days, respectively, after challenge. These results suggest that C. novyi alpha-toxin was the main protective antigen against challenge exposure to spores in guinea pigs.

Animals↗
PubMed1998

Protective effect of NaOH-extracted Erysipelothrix rhusiopathiae vaccine in pigs.

A vaccine was prepared from a NaOH-extracted antigen of the Kyoto strain (serovar 2) of Erysipelothrix rhusiopathiae (E. rhusiopathiae) with an oil adjuvant, and was injected twice at 3-week intervals into SPF pigs and conventional pigs with maternal antibodies. After the second vaccination, IgG-GA titers of immunized SPF pigs were more than 256-fold at 3 weeks, and immunized pigs with maternal antibodies were 64-fold at 7 weeks. The pig with maternal antibodies vaccinated once with live vaccine had less than 4-fold titers. The ELISA antibody titers which were measured by using the NaOH-extracted antigen showed similar transition to the IgG-GA antibody titers. All immunized pigs and nonvaccinated control pigs were challenged with the strains Fujisawa (serovar 1a) or Saitama-1 (serovar 2). After challenge exposure, all pigs immunized with the NaOH-extracted vaccine showed no clinical signs and survived, and the pig immunized with the live vaccine had a local rhomboidal lesion at the site of the injection. Nonvaccinated pigs developed typical symptoms of E. rhusiopathiae infection and one of them died. After the autopsy, the challenge strains were not recovered from the main organs except tonsils of the pigs immunized with the NaOH-extracted vaccine. These results indicated that the NaOH-extracted vaccine induces a protective effect in pigs with maternal antibodies as well as in SPF pigs negative for such antibodies, and that 67-64, 62-60 kDa proteins in the NaOH-extracted antigen play an important role in protecting against E. rhusiopathiae infection.

Animals↗
PubMed1998

[Urgent cesarean section under combined spinal and epidural anesthesia in a patient with aortitis syndrome].

We report the anesthetic management of a patient with aortitis syndrome using combined spinal and epidural anesthesia. A 28-year-old gravida with aortitis syndrome accompanied by faints was scheduled for an urgent cesarean section. Combined spinal and epidural anesthesia was thought to be better for this case in order to monitor the cerebral circulation by her consciousness level and to reduce the hemodynamic change during surgery as compared to spinal or epidural anesthesia alone. After inserting an epidural catheter at the Th 12/L 1 interspace, spinal anesthesia was performed with 1.5 ml of 0.3% dibucaine at the L 4/L 5 interspace. The level of analgesia was under L 1 with the pinprick method 10 min after the spinal anesthesia. Next, 5 ml of 1.5% mepivacaine was injected through the epidural catheter. The level of analgesia reached to Th 6 without major hemodynamic changes. A healthy 2740 g infant was delivered and she had an uneventful recovery. We conclude that combined spinal and epidural anesthesia is useful in a patient with aortitis syndrome undergoing an urgent cesarean section in order to monitor the cerebral circulation by the consciousness level and to reduce the hemodynamic change.

Adult↗
PubMed1998

[A patient with drug abuse who developed multiple psychotic symptoms during sedation with propofol].

We report a patient with drug abuse who developed multiple psychotic symptoms including euphoria, excitement, hallucination and delirium during sedation with propofol under spinal anesthesia. A 37-year-old man who had abused methamphetamines, thinner, phychomimetics and alcohol for 20 years was scheduled for skin transplant as day-case surgery. He was treated with cholorpromazine, haloperidol and flunitrazepam just before the surgery. Sedation with propofol under spinal anesthesia was thought to be suitable in order to prevent psychotic symptoms. After spinal anesthesia, propofol 5 mg.kg-1.h-1 was administered intravenously as sedation. However, euphoria and excitement appeared 10 min after the start of infusion. He also demonstrated excitement, hallucination and delirium under propofol 6-8 mg.kg-1.h-1. His symptoms were suppressed by intravenous injection of haloperidol 5 mg. We speculate that propofol may produce psychotic symptoms when it is used in patients with a history of drug abuse.

Adult↗
PubMed1998

[Anesthetic management using propofol and fentanyl of a patient with concealed Wolff-Parkinson-White syndrome].

We report the anesthetic management using propofol and fentanyl of a patient with concealed Wolff-Parkinson-White syndrome. A 62-year-old patient was diagnosed as having concealed Wolff-Parkinson-White syndrome by electrophysiologic study 7 years before. He felt palpitation in spite of administration of disopiramide. He was scheduled for a microsurgery of the larynx. After premedication with atropine 0.5 mg and hydroxyzine 50 mg i.m. 30 min prior to anesthesia, anesthesia was induced with a step down method of propofol (20-->12-->8 mg.kg-1.h-1) and fentanyl 0.15 mg Anesthesia was maintained with 6 to 8 mg.kg-1.h-1 of propofol and periodic administration of fentanyl. Immediately after the insertion of a laryngoscope, blood pressure increased but systolic blood pressure was maintained from 120 to 140 mmHg during the procedure. Thereafter anesthesia remained stable and paroxysmal tachycardia did not appear. The postoperative course was uneventful. We conclude that anesthesia using propofol and fentanyl is useful in a patient with Wolff-Parkinson-White syndrome in order to prevent paroxysmal tachycardia.

Anesthesia, Intravenous↗
PubMed1998

[Long-term administration of large doses of oral morphine for chronic pain].

We here report a patient with chronic pain who was treated with large doses of oral morphine. A 37-year-old female was diagnosed as Lyme disease and lumbar disc hernia. When she received lumbar puncture for myelography, she fainted due to severe pain in the legs. After this incident, her pain increased markedly, and she visited our outpatient clinic in 1996. After confirming the temporary pain relieving effect of caudal block, we prescribed oral morphine tablets 60 mg daily. The dose of morphine necessary to relieve her pain increased gradually to 220 mg. But she did not develop dependence or side effects. However, when the daily dose of 300 mg was administered, she felt dizzy. We therefore performed lumbar sympathetic block with phenol. After the block, her conditions improved markedly at a dosage of 300 mg. In conclusion, our experience in this case has shown the effectiveness of long-term morphine use with non-cancer patients and the efficacy of nerve block to avoid increasing the morphine dosage.

Administration, Oral↗
PubMed1998

Differential expression of sea urchin Otx isoform (hpOtxE and HpOtxL) mRNAs during early development.

Two distinct types of orthodenticle-related proteins (early type: HpOtxE, late type: HpOtxL) of the sea urchin, Hemicentrotus pulcherrimus, have been implicated as enhancer element binding factors of the aboral ectoderm-specific arylsulfatase (HpArs) gene. In order to understand the role of these isoforms during sea urchin development, we have isolated and characterized HpOtx gene. Here we describe the spatial expression patterns of HpOtxE and HpOtxL mRNAs and effects of overexpression of these mRNAs on embryogenesis. Whole-mount in situ hybridization using each isoform-specific probe reveals the complex and dynamic change of expression patterns among three germ layers. HpOtxE mRNA is maternally stored and exists apparently in a nonlocalized manner by the blastula stage. After hatching, HpOtxE transcripts are expressed predominantly in presumptive endoderm cells and gradually decrease during gastrulation. Signals for HpOtxL mRNA are intense at the vegetal half after hatching and subsequently, its expression is restricted to the micromere-derived cells. After primary mesenchyme cell (PMC) ingression, HpOtxL transcripts are localized at the vegetal plate and thereafter, concentrated primarily in ectoderm. Eggs injected with HpOtxE or HpOtxL mRNA develop into similar radialized structures without PMC ingression and gut invagination, whose oral-aboral axes are disrupted. Overexpression of HpOtxE induces accumulation of HpOtxL mRNA at the significantly earlier stages, though HpOtxL overexpression inhibits the accumulation of HpOtxE transcripts. Expression patterns of HpOtxE and HpOtxL in all three germ layers and dramatic morphological changes observed in the mRNA-injected embryos suggest that each HpOtx isoform has an important role in sea urchin embryogenesis.

Animals↗