Masui. The Japanese journal of anesthesiology
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Hare lip and cleft palate surgery team activities in Cambodia were launched in 1989 by a non-governmental Japanese organization, Operations Unies. The objectives of the project are to provide appropriate surgical treatment and safe general anesthesia for local patients and also to conduct technology transfer of general anesthesia and surgery to the local medical staffs. From June 1991 to January 1993, a surgery/anesthesia team was dispatched 4 times and a total of 130 patients received surgical treatments under general anesthesia. ⋯ The reasons why we chose intravenous agents are difficulty in obtaining inhaled agents in Cambodia and lack of scavenging system in a operating room. Although halothane anesthesia with spontaneous breathing has been recommended in developing countries, total intravenous anesthesia could be one of the applicable techniques in these countries. In Cambodia, shortage of medical doctors and the absence of anesthesiologist constitute a major barrier to technology transfer in clinical anesthesia.
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We investigated the correlation between the endogenous hormonal changes of pituitary-adrenal and pituitary-thyroid hormones and the prognosis of patients in multiple organ failure, and elucidated the mechanism of blunted thyrotropin (TSH) secretion by histological and immunocytochemical studies of anterior pituitary glands. ⋯ Decreased cortisol, low T4 levels and blunted TSH response to TRH correlated with mortality in MOF patients. Histological and immunocytological studies suggest that blunted TSH secretion is not caused by pituitary damages or TSH exhaustion but by disturbances in TSH secretion. This blunted TSH secretion is reversible and its improvement is an indicator of survival.
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Recently we reported a case of inadvertent migration of an epidural catheter into the endothoracic fascia. Anesthetic injection into the fascia brought a broad unilateral analgesia. To clarify the mechanism of anesthesia. ⋯ The crimson dye, the substitute of the anesthetic agent, reached the transversial fascia in the abdominal cavity through medial and lateral arcuate ligament. Subcostal nerve, iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve and lateral femoral cutaneous nerve were found to be in the course of dye dispersion. The renal adiposal fascia plays a role of a reservoir for the anesthetic agent and prevents the further anesthetic dispersion.
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The effect of intraoperative stored blood transfusion on the changes in plasma neutrophil elastase (PMN-E) was studied in packed red cell, and in the patients transfused with stored blood (400-1000 ml) during surgery (n = 22), compared with the control in patients who had not received transfusion (n = 6). PMN-E was measured as elastase.alpha 1-antitrypsin complex (EAC) and the effect of ulinastatin (UTI) treatment on EAC was also evaluated. ⋯ There was no significant correlation between transfusion volume and EAC (r2 = 0.44, P > 0.05) in patients with UTI treatment during blood transfusion. These results and increased H2O2 concentration of expired breath in the patient whose plasma EAC exceeded 1,000 micrograms.l-1, suggested PMN-E is released from triggered neutrophil by increased EAC.