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T Ohwada

Publications and source records attributed to T Ohwada.

At least 109 records · Page 6Linked to original sources
PubMed1990

[Left ventricular asynergy and myocardial necrosis accompanied by subarachnoid hemorrhage: contribution of neurogenic pulmonary edema].

One hundred-thirty patients with acute subarachnoid hemorrhages were investigated to examine the relationship of neurogenic pulmonary edema to cardiac lesions. Abnormal electrocardiograms were observed in 99 of these patients. Left ventricular asynergy was detected in nine of the 99 patients by two-dimensional (2D) echocardiography. In addition to 2D echocardiography, chest radiography, electrocardiography, serum CPK measurements and cardiac catheterization were performed for these nine patients in the acute stages of their subarachnoid hemorrhages. Abnormal electrocardiographic findings included prolongation of QT intervals and marked ST-T changes, which were observed in all nine patients. Pulmonary edema associated with increased pulmonary arterial wedge pressures were noted in seven, and increases in CPK and MB-CPK in all patients, suggesting the occurrence of myocardial necrosis. An increase in serum catecholamine was observed in all patients. Coronary angiography was performed in two patients and revealed normal coronary arteries in both. Biopsy findings were available in three and demonstrated severe fragmentation at the sites of left ventricular asynergy. Pulmonary edema, electrocardiographic abnormalities and left ventricular asynergy improved markedly during the courses of hospitalization. We concluded that left ventricular asynergy and myocardial necrosis may occur during the acute stage of subarachnoid hemorrhage and could produce neurogenic pulmonary edema rather than or in addition to permeability edema.

Adult↗
PubMed1989

[Blunt injury of the vertebral artery: report of three cases].

The authors reported three cases, whose vertebral arteries had been injured by blunt trauma to the neck which was followed by cerebello-brainstem infarctions. Case 1: a 32-year-old man, who developed severe vertigo and nausea 7 days after a traffic accident. He showed neck pain and horizontal nystagmus on admission. Three days later, he became drowsy. CT scan of the head demonstrated right-side cerebellar infarction, and the angiography revealed an occlusion of the right vertebral artery at C4-5 level. After the removal of the right cerebellar hemisphere, he recovered neurologically and was discharged from the hospital, able to walk. Case 2: a 47-year-old man, who suddenly became comatose 6 hours after an accident. Plain CT demonstrated a highly dense basilar artery. Angiography revealed the occlusion of the left vertebral artery, and severe stenosis of the right vertebral artery. The basilar artery was not visualized. Anticoagulant therapy was started immediately. He survived, but he developed locked-in syndrome. Case 3: a 53-year-old man, who developed transient apnea after an injury. On admission, neurological examination showed horizontal nystagmus, weakness of his right upper limb, and sensory disturbance in the left side of the body. Neck traction was done for spinal C1 and C2 fractures. Twenty-one hours after the injury, he became comatose suddenly. The four-vessels angiography revealed the occlusion of both vertebral arteries. The basilar artery was visualized through the posterior communicating arteries. He died on the 6th day after the trauma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Postoperative intracranial pressure in severe cases with hypertensive intracerebral hematoma].

The relationship between the postoperative ICP and the size of hematoma on CT scan and the time of operation was studied to evaluate their influence on the therapeutic results in the severe cases with hypertensive intracerebral hematoma. Twenty one patients of putaminal hemorrhage with severe neurological deficit (semicoma) were studied. ICP was monitored continuously by the Subdural balloon method after craniotomy to remove the hematoma. The relationship between the postoperative ICP level (High ICP: above 40 mmHg, Moderate ICP: 40-20 mmHg, Low ICP: below 20 mmHg), the size of hematoma estimated from CTscan (Large: more than 80 ml, Medium: less than 80 ml), the time from onset to removing hematoma and the therapeutic results were evaluated. The outcome six months after onset was determined according to the Glasgow Outcome Scale. Of 6 cases with Medium hematoma operated on within 8 hours, Low ICP was found in 5 cases (83%) and Moderate ICP was in one case (17%). Of 6 cases with Medium hematoma operated on after 8 hours, High and Moderate ICP were found in 3 cases (50%), respectively. In the cases with Large hematoma, Low ICP was not observed, but High ICP was found in 4 of 7 cases operated on within 8 hours (57.1%) and the other three indicated Moderate ICP (42.9%). High ICP was found in two cases with Large hematoma operated on after 8 hours (100%). The outcome of High ICP cases was severe disability in 4 cases, vegetative state in one and dead in 4, and that of Moderate ICP cases was moderate disability in 3 cases and severe disability in 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Comparison between fluctuating PEEP and conventional PEEP in dogs with lung injury induced by blood aspiration.

It has been documented that in some patients with acute hypoxic respiratory failure the application of positive end-expiratory pressure (PEEP) may produce no improvement or even a deterioration of pulmonary oxygenation due to an increase in ventilation-perfusion mismatching. Fluctuating PEEP (F-PEEP) is a newly developed PEEP in which end-expiratory pressure (EEP) is periodically changed within a certain range. In a dog model with localized lung injury induced by the aspiration of non-heparinized blood (2 ml.kg body weight-1), F-PEEP in which the EEP was periodically changed from 0.5 to 1.5 kPa at frequencies of 10 min, and conventional PEEP with 3 different fixed EEPs, 0.5, 1.0 and 1.5 kPa (C-PEEP0.5, C-PEEP1.0 and C-PEEP1.5) were each applied for 60 min. F-PEEP produced a periodical change in PaO2 and hemodynamic variables including cardiac output, and in comparison with C-PEEP0.5, C-PEEP1.0 and C-PEEP1.5, a significantly greater improvement of A-aDO2 and dynamic compliance with relatively large cardiac output in the low EEP phase. These results suggest that F-PEEP is a useful mode of artificial ventilation for treating some kinds of acute hypoxic respiratory failure due to increased ventilation-perfusion mismatching.

Animals↗
PubMed1988

Fluctuating PEEP (F-PEEP) versus conventional PEEP in dogs with asymmetrical lung injury.

Fluctuating PEEP (F-PEEP) is a newly developed PEEP in which end-expiratory pressure (EEP) is periodically changed within a certain range. In a dog model with unilateral lung injury induced by the introduction of hydrochloric acid, F-PEEP in which the EEP was periodically changed from 0.5 to 1.5 kPa at periods of 6 min, and conventional PEEP (C-PEEP) with an optimized EEP of 1.0 kPa, were each applied for 30 min. F-PEEP produced a significantly greater improvement of PaO2 and intrapulmonary shunt (QS/QT) than C-PEEP, and at the low EEP phase, the greatest improvement accompanied by an increased dynamic compliance and a large cardiac output was obtained. These results suggest that F-PEEP provides a useful mode of artificial ventilation for the treatment of unilateral lung injury.

Animals↗
PubMed1988

Serial changes in acute extradural hematoma size and associated changes in level of consciousness and intracranial pressure.

The authors report the cases of 37 patients encountered during the past 4 years who exhibited acute extradural hematoma but were initially treated conservatively because no or only small hematomas were observed on admission. The frequency of hematoma enlargement, hematoma size, and changes in the level of consciousness and intracranial pressure (ICP) were examined in these patients. The hematomas enlarged in 24 (64.9%) of the 37 patients, and attained a maximum thickness of 25 mm or greater in 19 patients (51.3%). The level of consciousness could be closely observed during enlargement of the hematomas in 13 patients: the level remained unchanged in eight, deteriorated in two, and improved in three, indicating relative stability in the state of consciousness despite the marked changes in hematoma size. The patients whose hematoma enlarged after the initial examination included three who underwent initial CT examination 5 hours after the injury. In five patients enlargement of extradural hematomas was observed unexpectedly during conservative treatment under ICP monitoring. The ICP also remained stable in three patients until the follow-up examination, but showed a rapid increase in two after a period of stability. However, there was no difference in the final size of the hematomas between the patients showing an increase in ICP and those who did not. These findings suggest that extradural hematomas enlarge progressively at rates varying with the condition of the source of hemorrhage. Moreover, a period of stability in the level of consciousness, such as the lucid interval seen in patients with extradural hematoma, is considered to be a period during which compensatory mechanisms can maintain the stability of the intracranial condition during progressive enlargement of the hematoma.

Adolescent↗
PubMed1988

[Long-term survival in malignant atrophic papulosis: a case report and review of the Japanese literature].

Malignant atrophic papulosis (MAP) is characterized by skin lesion and high mortality rate caused by perforation of the GI tract or involvement of the central nervous system. Approximately 100 cases have been reported in the world literatures, but etiology is unknown. A 44-year-old female patient was admitted for chest and abdominal pain with characteristic papuloses, which had been noted by the patient seven years ago. Because of positive peritoneal irritation and intraabdominal free air, exploratory laparotomy was done. Multiple red inflammatory or yellow atrophic maculae on the entire intestine with no obvious perforation but with air-leak were found. Those perforations were closed with seromuscular sutures. The patient is doing well sixteen months after surgery. Fourteen MAP cases have been reported in the Japanese literature. As is found in the world literature, the mortality rate is extremely high. All of reported cases were initially diagnosed because of the particular skin lesions. Abdominal symptoms developed in 10 cases and six of these died. Three cases died within three weeks after bowel resection. There are three surviving cases. One was treated conservatively even though intraabdominal free air was present. Two had three operations, including one simple closure and two intraabdominal explorations. According to this result, a bowel resection should not be performed on MAP patients because of this high mortality. Administration of anticoagulants, i.e., heparin, prostaglandin E1 and ticlopidine seems to be effective in alleviating symptoms and might prevent further deterioration.

Adult↗
PubMed1988

[A clinical study of severe cases of hemorrhagic cerebral arteriovenous malformations].

The clinical study was undertaken on 24 poor risk patients out of 69 cases with hemorrhagic cerebral arteriovenous malformations, AVMs, and the surgical problems of poor risk patients with the lesions were discussed. The 24 cases, 35%, out of 69 hemorrhagic AVMs cases showed disturbances of consciousness of 3 digits (100-300) according to the Japan Coma Scale at the time of admission. All cases of these poor risk patients were observed less than 24 hours after the onset of the symptoms. Fifteen of these 24 cases showed brainstem signs including anisocoria and/or decerebrate rigidity and/or respiratory arrest. Eighty-three per cent of 24 poor risk patients had serious neurological defects as a result of the first hemorrhage. Therefore, it was impossible to prevent serious state from occurring in poor risk patients. Of the 69 cases with hemorrhagic AVMs, 56 cases were operated upon. Although 90% out of 38 good risk patients whose level of consciousness was 0 to 30 according to the Japan Coma Scale showed good recovery, only 44% of 18 poor risk patients recovered well. It could not be said that the surgical treatment gave satisfactory results for the poor risk patients when compared with the surgical results of the good risk patients. In respect to the location of AVMs, all three poor risk patients with AVMs in the corpus callosum and the ventricles showed good recovery, whereas of the poor risk patients with AVMs in the cerebrum or the cerebellum, only 4 out of 9 cases (44%) and 1 out of 6 cases (17%) showed good recovery respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

An immediate and steep increase in ATP concentration in response to reduced turgor pressure in Escherichia coli B.

Osmotic treatment with sodium chloride of Escherichia coli B growing in the logarithmic phase induced an immediate increase in ATP concentration in response to increased concentrations of added solute in its growth medium in the first 10 min of the addition. After that, ATP concentration decreased gradually. Sodium arsenate and potassium fluoride almost abolished the ATP increase. The time course of the increase was quite different from that of cells treated with inhibitors of protein synthesis. The osmotic treatment did not decrease the viability of cells. In addition, there was no degradation of RNA by 5 min after sodium chloride addition, and, further, the lag time of ATP increase was extended by an inhibitor of nucleotide synthesis. These results indicated that a major fraction of the stress-increased ATP resulted from de novo synthesis, and that it was mainly dependent upon the reaction of substrate-level phosphorylation, which is regulated by turgor pressure.

Adenosine Triphosphate↗
PubMed1987

Effects of salbutamol and hyperventilation on the rise in serum potassium after succinylcholine administration.

It is known that circulating catecholamines stimulating beta 2-receptors and the acid-base balance play important roles in the regulation of serum potassium (K+). The present study was undertaken to investigate the effect of salbutamol (SB), a highly selective beta 2 agonist, and hyperventilation (HV)-induced alkalosis on the change in serum K+ after succinylcholine (SCh) administration in dogs. Pretreatment with SB (0.4 microgram.kg-1.min-1 for 30 min) produced sustained decreases in serum K+ and mean arterial pressure, and transient increases in cardiac output and serum insulin concentration. Maintaining respiratory alkalosis with HV (PaCO2 = 2.6-3.3 kPa) produced sustained decreases in serum K+ and cardiac output. Although both pretreatment with SB and HV-induced alkalosis significantly reduced the absolute increases in serum K+ after SCh, the effect of SB was more remarkable than that of HV. These results suggest that the degree of beta 2-receptor activity can strongly modulate the change in serum K+ after SCh administration.

Albuterol↗
PubMed1987

[Myelopathy caused by hypertrophy of the posterior longitudinal ligament (HPLL): case report].

A case of myelopathy caused by hypertrophy of the posterior longitudinal ligament at the cervical spine is reported. A 71-year-old man was hospitalized with myelopathy with progressed during the last two months. Plain X-ray of the cervical spine revealed only mild spondylotic change. Myelography demonstrated completely blocked contrast medium at C4 to C5 vertebral height due to epidural mass. This epidural mass was localized ventral to the spinal cord from C3 to C5. CT scan revealed slightly high density area behind the vertebral body. On surgery, no evidence of disc fragment but only hypertrophied posterior longitudinal ligament which was removed was found to be a cause of cord compression. Excellent recovery of neurological symptoms after operation was obtained. On histological study, remarkable hypertrophy, edema, hyalinoid degeneration and a little calcification of the ligament was found, which did not show any evidence of new bone formation. HPLL was characterized by thickened and broad epidural mass in the ventral side of cervical cord with Hounsfield number of 90-156 on CT scan, which is not very easy to differentiate from metastatic epidural tumor. The cause of HPLL is not well elucidated, though, this may be a new category of compression myelopathy.

Aged↗
PubMed1986

New equations to calculate temperature correction factors for PO2 in human blood.

Effects of hemoglobin concentration (Hb), pH, and body temperature (T) on the relationships between delta log PO2/delta T and PO2 were studied by means of a mathematical model using a Newton-Raphson iteration method. The functions between delta log PO2/delta T and PO2 were affected by the above three factors. New equations considering the effects of Hb, pH, and T were proposed by modifying the equation reported by Severinghaus: delta log PO2/delta T = (L +(U-L)/(A(vPO237)B + 1))(10(-2) where U = 3.15-0.45(7.4-pH37) L = 0.68-0.09(7.4-pH37) A = 5.86(exp10(0.074(T)-0.294(7.4-pH37)-11))((Hb)0.913) B = 6.33(exp10(-0.0051(T)))((Hb)-0.113) + 0.24(7.4-pH37) and vPO237 is virtual PO237 which may exist when PO237 is corrected to standard conditions (pH = 7.4, BE = 0) by the following equations: vPO237 = PO237(exp10(fB(7.4-pH37)-0.0013(BE))) fB = (PO237/26.6)0.08-1.52 where fB is the Bohr factor. The above equations provided values of delta log PO2/delta T which fit closely to those obtained by the complex iteration method with maximum differences of less than 1.3 X 10(-3) at T = 27, indicating that maximum % errors for PO2 at T (PO2T) are less than 3.0% at T = 27 and that our equations can be applied over a wide range of Hb, pH37 and T.

Bicarbonates↗
PubMed1985

[The usefulness of prolonged high dose delayed contrast computed tomography for the diagnosis of intracranial angiographically occult vascular malformations].

It is difficult to diagnose angiographically occult vascular malformations. When conventional CT (plain & contrast enhancement) can not demonstrate the lesions, it was impossible to diagnose in the past. We developed a new technique which enabled us to diagnose them. Materials and methods; Seven cases of spontaneous intracerebral hemorrhage, in which no abnormality was detected by repeated magnified serial angiography with subtraction technique and prolonged injection technique, were examined. In each case, conventional CT (plain & enhancement using 100 ml of 60% meglumine iothalamate) was performed first, which was immediately followed by the administration of 220 ml of 30% meglumine iothalamate for one hour. CT is taken at the end of the infusion. It, we call, is prolonged high dose delayed contrast CT: PHDD-CT. Total dose of iodine used in this technique was 59.22 gI (1.0 gI/kg body weight: BW). Results; Contrast enhancement effect of PHDD-CT was much better than that of conventional CT in all the cases. In three cases, the lesions were more clearly delineated in PHDD-CT. In four cases, only PHDD-CT could demonstrate the lesions. No side effect was observed. Comments; Several techniques for better enhancement have been reported, however they used large volume of contrast medium such as 1.5 or 2.0 gI/kg BW. Our technique can be performed with more security. Based on our good results, we recommend to use this PHDD-CT technique for the diagnosis of angiographically occult vascular malformations.

Adolescent↗
PubMed1984

[The mechanism of intracranial pressure-reducing effect of mannitol].

The effect of mannitol to decrease the raised ICP is well documented and mannitol is now widely used in clinical practice. However, its mechanism of lowering ICP still remains controversial, especially under the condition of vasogenic edema. The objective of this study is to reexamine and delineate the mechanism of ICP reducing effect of mannitol, using quantitative vasogenic edema model, specific gravimetric technique to measure the brain water content, and the method to estimate the CSF dynamics without disturbing the physiological condition of intracranial compartments in cats. Quantitative increase of water content of the white matter was produced by the infusion of 0.5 ml of normal saline though stereotaxically inserted 25-G needle into the left frontal white matter. In control group, cats were sacrificed and water content of the gray and white matter of each coronary sliced brain was measured by specific gravimetric technique. In the mannitol group, 20% of mannitol (2 g/kg) was administrated via femoral vein within 3 minutes. The maximum reduction of ICP was achieved at the average of 30 minutes. At this time, the cats were sacrificed and the water content of brain was measured in the same way as in the control group. PVI, Ro, If (Marmarou) were calculated before and after mannitol administration. In parameter group, BP, ICP, CVP, serum osmotic pressure and osmolarity were measured without terminating the experiment. The changes of water content of the gray and white matter before and after mannitol administration in the area of infusion edema were 80.7% to 80.8% and 76.8% to 77.1% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗