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Biomedical subjects

T Nagaro

Publications and source records attributed to T Nagaro.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Massive swelling of the tongue in two patients following the repair of cleft palate].

Massive swelling of the tongue occurred following the repair of cleft palate in a one-year-old girl and a one-year-old boy. The duration of operation was 285 min and 225 min respectively. Massive swelling of the tongue became prominent within 30 min after the operation in both infants. The trachea was intubated immediately. Swelling of the tongue recovered slowly, and the trachea was extubated 6 and 7 days after the operation, respectively. The compression of the tongue by the retractor for a long time during the operation probably caused the reperfusion edema of the tongue. Early recognition of the swelling and prompt maintenance of the airway are essential to prevent the serious outcomes resulting from the swelling of the tongue.

Airway Obstruction↗
PubMed1995

[The histological changes in the spinal cord following percutaneous cervical cordotomy (PCC) and correlation of these changes with the efficacy of PCC].

We observed the histological changes in the spinal cord following percutaneous cervical cordotomy (PCC) and correlation of these changes with the efficacy of PCC in 7 cases. A fine monopolar electrode which we used, measured 0.25 mm or 0.27 mm in diameter with exposed length of 2 mm. An oval or elliptical-shaped lesion, 1 to 3 mm in width and 3 to 4 mm in length, was observed in 6 of these cases. The main lesion was found in the anterolateral column in 5 cases. In 3 of these 5 cases, the whole anterolateral column had been destroyed, and in the other 2 cases dorsal one half to two thirds of it had been destroyed. In these 5 cases, pain sensation on the opposite side of PCC was lost for a long time and pain was relieved until death (21-239 days after PCC). In the other 2 cases the lesion in the anterolateral column was tenuous or unrecognizable, and the loss of pain sensation was temporary with pain recurring by the next day. This study showed that an oval or elliptical-shaped lesion was made in PCC and that in cases in which main lesion was located in the anterolateral column, pain relief was long lasting.

Adult↗
PubMed1995

[The efficacy of intravenous lidocaine on various types of neuropathic pain].

We examined the efficacy of systemic local anesthetics on various types of neuropathic pain in 89 patients. Lidocaine 1.5 mg.kg-1 was infused intravenously for one minute. Pain score (PS) by visual analogue scale (VAS, 0-10) was measured 1, 5, 15 and 35 min after the infusion. The efficacy of intravenous lidocaine was evaluated by PS which was lowest after infusion. PS decreased to less than 50 percent of pre-infusion value in more than 75 percent of cases of cancer pain, postherpetic neuralgia, trigeminal neuralgia, low back pain with signs of root pain or spinal canal stenosis, peripheral nerve injury and thalamic pain, in 50-75 percent of cases of herpetic neuralgia, and in less than 50 percent of cases of cervical spondylosis, spinal cord injury, reflex sympathetic dystrophy, causalgia and psychogenic pain. This study suggests that systemic local anesthetics is effective in neuropathy due to cancer pain, postherpetic neuralgia, trigeminal neuralgia, low back pain with signs of root pain or spinal canal stenosis, peripheral nerve injury and thalamic pain.

Aged↗
PubMed1995

[Diltiazem potentiates the neuromuscular blockade by vecuronium in humans].

We investigated interaction of diltiazem with vecuronium using constant infusion technique in 24 ASA class I or II elective surgical patients with no preoperative administration of Ca antagonists. Neuromuscular blockade was evaluated with accelerometry, which measured single twitch height of adductor pollicis muscle. After tracheal intubation under isoflurane anesthesia, patients received either no diltiazem (control group, n = 8)m, 5 mg (bolus) + 2 mcg.kg-1.min-1 constant infusion (2 mcg group, n = 8) or 5 mg (bolus) + 4 mcg.kg-1.min-1 constant infusion (4 mcg group, n = 8). When single twitch height returned to 10% of control value, infusion of vecuronium was started and the infusion rate was adjusted to maintain twitch height at 10% of the control value. After 30 minutes of stable twitch height, the vecuronium infusion rate and plasma diltiazem concentrations were measured. Diltiazem infusion of 4 mcg.kg-1.min-1 decreased the vecuronium infusion rate by 45% compared with 2 other groups. Plasma diltiazem concentrations in patients receiving 4 mcg.kg-1.min-1 were significantly higher than those receiving 2 mcg.kg-1.min-1. In conclusion diltiazem 4 mcg.kg-1.min-1 potentiates the neuromuscular blockade of vecuronium and it relates with the plasma diltiazem concentration.

Adult↗
PubMed1995

[Estimation of respiratory functions by analysis of expired gas and blood gas during artificial ventilation and general anesthesia].

One-hundred and seven patients undergoing elective surgery were studied to analyze the correlations between preoperative spirometric values and respiratory parameters during general anesthesia. They were grouped according to 3 criterions; preoperative %VC of less than 80%, FEV1.0% of less than 70%, V50/V25 exceeding 4.0. Following the induction of general anesthesia and of mechanical ventilation, expiratory flow (VE), FECO2, PaCO2 and PaO2 were measured to calculate respiratory parameters including VCO2-SR, VD/VT-Bohr, VD/VT-physiological (phys), a-ETDCO2, Volume Pressure Index (VPI) and A-aDO2. Six respiratory parameters were compared between the groups, and correlations between preoperative spirometric values were studied. Those with lower %VC had higher values in VCO2-SR and in VPI, and those with lower FEV1.0% had higher values in VCO2-SR, in VD/VT-phys and in a-ETDCO2. Significant correlations were also observed between these parameters. Preoperative V50/V25 and A-aDO2 during general anesthesia did not correlate with any of the parameters studied. We conclude that VCO2-SR, VD/VT-phys, a-ETDCO2 and VPI during general anesthesia are useful to detect the patients with restrictive and/or obstructive lung dysfunction, although they are not sensitive enough to detect those with small airway disease.

Aged↗
PubMed1995

[Multiple regression analysis of pre- and intra-operative factors in relation to post-operative liver and renal functions].

We investigated the factors which may influence post-operative liver and renal function using a multiple regression analysis after isoflurane or sevoflurane anesthesia in 844 patients (ASA I or II, age 20-90 yr). Hepatic and renal surgeries were excluded from this study. The parameters examined were sex, age, degree of obesity, preoperative liver function, preoperative renal function, infection with hepatitis B or hepatitis C virus, inhalation anesthetics used, MAC.h of anesthesia, the duration of operation, blood loss, amount of blood transfusion, urine volume during operation, and surgical site. Serum GOT, GPT, total bilirubin, BUN and serum creatinine were examined on the 3rd and 7th day after surgery. An increase in serum GOT, GPT or bilirubin was observed for each of the following parameters; male, infection with hepatitis C virus, long operation, and upper abdominal surgery. Postoperative BUN and serum creatinine increased in patients with preoperative renal dysfunction, in elderly patients, and in hepatitis C carriers.

Adult↗
PubMed1994

[Classification of post-cordotomy dysesthesia].

Postcordotomy dysesthesia was classified from the clinical features of dysesthesia following percutaneous cervical cordotomy (PCC) in 66 patients. Dysesthesia occurred in 10 (15.2%) of 66 patients and was classified into three types. In the first type, dysesthesia occurred at the region where pain had been before PCC, and pain sensitivity had been lost due to PCC. This type of dysesthesia occurred in 6 patients. In this type, the peripheral nerve damage caused by tumor invasion was presumably the cause of dysesthesia. In the second type, dysesthesia occurred all over the region where pain sensitivity had been lost due to PCC. This type of dysesthesia occurred in 2 patients. The destruction of second order neurons of the nociceptive pathway by PCC was presumably the cause of this type of dysesthesia. In the third type, dysesthesia occurred at the region where pain had been before PCC and pain sensitivity had partially recovered. This type of dysesthesia occurred in 3 patients. The reduction of the effect of PCC was presumably the cause of this type of dysesthesia.

Adolescent↗
PubMed1994

[A case of hemifacial hyperhidrosis on the opposite side of the pancoast tumor].

An 82-year-old man was referred to our pain clinic for the relief of pain arising from Pancoast tumor on the right side. The pain was controlled well by cervical epidural morphine, but one month after admission, he complained of unilateral hyperhidrosis on the face, head and neck on the left side. Massive sweating occurred only during the sleep. At this stage Horner's sign on the right side was recognized. Cervical epidural block diminished sweating. Massive sweating was observed until his death two months after admission. We speculate that paralysis of the right cervical sympathetic system caused by invasion of Pancoast tumor elicited sympathicotonia of the opposite side, resulting in left hemifacial hyperhidrosis, which was exaggerated during the sleep when the activity of perspiration center increased. We recommend that the presence of hemifacial sweating should be closely evaluated, because it can be caused not only by irritation of the ipsilateral sympathetic nervous system, but also by the paralysis of the contralateral sympathetic nervous system due to malignant tumors or other diseases in the neck and upper mediastinum.

Aged↗
PubMed1994

[Response to a questionnaire on DNR-order from 307 trustee members of Japanese Medical Societies].

A questionnaire on the use of DNR-order was conducted on 427 trustee members of Japan Society of Reanimatology, Intensive Care Medicine and Anesthesiology with responses from 307 or 71.9%. The results of the questionnaire are as follows: DNR-order is unnecessary, 2.9%. Necessary depending on the situation, 96.7%. Here dying in dignity was the main reason for necessity of DNR-order and ethical, legal and technical problems were the reasons cited for objection. Patients' will is indispensable for DNR-order, 11.4%. Patients' will is not indispensable, 84.9%. Quality and quantity of treatment after the decision of DNR-order should not be limited or withdrawn, 21.2%. Should be withdrawn except for respirator, 60.6%. The percentage of those who had carried out a DNR-order was 69.1% (most of them more than once), but half of them did not describe the order on the chart. A guideline for a DNR-order by scientific societies and/or governmental policy for a DNR-order should be made and publicized not only for the benefit of the patients and their families but also for physicians themselves.

Adult↗
PubMed1993

An analysis of flow volume curves during artificial ventilation.

Expiratory flow-volume curves during artificial ventilation (FV-av) were analyzed in 48 patients undergoing general anesthesia. They were divided into 4 groups according to preoperative respiratory disorders; obstructive type (group 1), restrictive type (group 2), small airway disease (group 3) and normal control (group 4). Expiratory flow rates and volumes during artificial ventilation were plotted on an X-Y recorder to calculate V50/V25, mean time constant ratio (MTCR), obstructive index (OI) and slope ratio (SR). FV-av values were compared among groups. FV-av values in groups 2 were significantly higher than those in group 4. The values in group 1 and those in group 3 were not significantly different from those in group 4. FV-av values may reflect restrictive respiratory dysfunctions but they are not sensitive enough to detect obstructive lung disease.

Journal Article↗
PubMed1993

[Changes in human evoked spinal potentials (ESP) by epidural lidocaine].

Controversies exist on the sites of action of epidural anesthesia. Leading opinion says that it works on spinal nerve root. We examined ESP and tactile sensations in 4 patients during epidural anesthesia with lidocaine to determine the effects of the anesthesia on spinal cord. Prolongation of latency and decrease in amplitude of ESP appeared 10 min after injection of 1.5% lidocaine 4 ml, each parameter reaching maximum value of 115% and 60% of the control value 30 min afterwards, respectively. Then they started to recover slowly, reaching normal values 150 min later. Changes in ESP and tactile sensation were closely related. Decreases in amplitude to 90%, 80%, 60% of the control values were observed for hypesthesia, analgesia, and anesthesia, respectively. We conclude that the spinal cord also is an important site of action of epidural anesthesia.

Anesthesia, Epidural↗
PubMed1993

[Treatment of hyperhidrosis with caudal epidural alcohol block in a patient with cervical cord injury].

A 44-year-old man complained of intermittent and excessive sweating of head and neck throughout the day, followed by severe lower abdominal spasms. He had been suffering from complete paraplegia with neurogenic bladder for 16 years, due to C7 spinal cord injury. In the last 16 years he had four episodes of hyperhidrosis, and these were treated by subarachnoid phenol block. The patient was referred to our clinic this time because of the dry tap during attempted subarachnoid phenol block. We tried several test blocks, lumbar epidural block, inferior mesenteric plexus block, celiac plexus block and caudal epidural block in order to clarify the afferent route of this reflex, because as a cause of this reflex sweating, no physical abnormality was detected. With caudal epidural block abnormal sweating disappeared completely. This finding led us to conclude that the somatic sacral nerves from bladder were afferent routes. We injected 20 ml of 75% alcohol into the caudal epidural space to destroy sacral nerves 5 times in 4 weeks. In a follow up examination, 5 months after his discharge, except minimal complaints about mild lower abdominal spasms, there were no complications from alcohol injection.

Adult↗
PubMed1992

[A death caused by fulminant B-hepatitis which was latent preoperatively].

It is not always easy to evaluate the preoperative liver functions exactly. In this paper we report a patient who died of fulminant hepatitis postoperatively in spite of careful examination of preoperative liver functions. A 60-year-old male had severe bleeding following total cystectomy, resulting in cardiac arrest. He was resuscitated successfully but developed multiple organ failure. He came through it but thereafter he had repeated infectious episodes from uretero-cutaneous fistula and fluctuation of liver functions. Seven months later he had repair of postoperative ventral hernia. His liver functions were within normal limits except for positive HBs antigen. But eventually the patient died of acute fulminant transfusion hepatitis B 30 days after the operation. A cause of his death was, we presume, loading stress of surgical operation on the acute stage of hepatitis B. Other possible causes or deteriorating factors were drug liver injury, alcoholic chronic hepatitis, and coincidence of non A-non B hepatitis. When HBs antigen is positive in spite of normal liver function test, differential diagnosis between asymptomatic carrier and the first stage of acute hepatitis B should be made carefully.

Cystectomy↗
PubMed1992

[Anesthetic experience of two patients with holoprosencephaly].

We experienced anesthetic management of two 6-month-old female patients with holoprosencephaly (HP). HP is characterized by hypoplasia of prosencephalon, facial anomalies (hypotelorism, flat nose, and/or small prolabium), abnormality of autonomic nervous system functions (hypernatremia and/or poikilothermia), and clonic convulsion. First case was a lobar type and the second case was an alobar type according to DeMyer's classification. In both cases repair of bilateral cleft lip was performed. Anesthesia was slowly induced with N2O-O2-halothane and maintained with fentanyl in N2O-O2. Body temperature (BT) was adjusted with a warming blanket while monitoring rectal temperature. In the first case clonic convulsion and bradycardias occurred during the postoperative period, which were treated with IV diazepam and isoproterenol. In the second case BT rose to 39 degrees C during postoperative period; 2 episodes of convulsions were observed; and airway obstruction occurred. They were treated accordingly. The most important points which should be kept in mind in the management of HP patients are the prevention of convulsion, adjustment of BT, maintenance of normal pulse rate and keeping a patient airway.

Anesthesia, Inhalation↗
PubMed1991

A multi-arterial clamping method with arterial hypotension does not bring about complete brain ischemia in dogs.

The completeness of brain ischemia with a multi-arterial clamping method in dogs was examined using EEG, evoked potentials (EPs) and vessel staining with Evans blue. EEG was monitored by bipolar parietal lead. EPs stimulating electrodes were inserted into the first thoracic (T1) epidural space and recording electrodes into the C2 epidural space, brain stem and cerebral cortex. EPs were measured at 30 s intervals with 50 measurements each time using 3.0 mA current of 100 microseconds duration. In dogs in which brain ischemia was brought about by ventricular fibrillation (VF group, n = 5) EEG disappeared within 40 s in all dogs and the amplitudes of EPs at the C2 spinal cord, brain stem and cerebral cortex after 10 min ischemia were 57%, 0% and 0%, respectively. In the dogs in which a multi-arterial clamping method (clamping internal thoracic arteries, brachiocephalic trunk and left subclavian artery while lowering systolic arterial pressure (AP) below 50 Torr) was used (AC group, n = 5) EEG was still recognizable at 5 min in 2 dogs and the amplitudes of EPs at the C2, brain stem and cerebral cortex at 10 min ischemia were 103%, 53% and 0%, respectively. Stainings with Evans blue were observed in all soft tissue at and below thoracic level, entire intervertebral venous plexus, venous sinuses of cranial dura mater and spinal cord below the lower part of cervical region. Bright red fluorescence by Evans blue was observed microscopically in the vessels of the spinal cord, brain stem and cerebrum (1 dog only). In conclusion a multi-arterial clamping method with arterial hypotension brings about only incomplete brain ischemia.

Animals↗