Masui. The Japanese journal of anesthesiology
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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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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.
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Case Reports
[Perioperative management of the patient with hypertrophic obstructive cardiomyopathy].
We experienced the perioperative management of a patient with hypertrophic obstructive cardiomyopathy, who underwent open heart surgery. We performed three kinds of overload examinations, which included overdrive test using the pacemaker, continuous dopamine infusion with overdrive test and continuous diltiazem infusion with overdrive test, before and after cardio-pulmonary bypass under observation of the cardiac performances with transesophageal echocardiogram. We gained some important and interesting informations about the cardiac reserve of the patient. We could perform adequate perioperative management for the patient, taking the results of overload examinations into consideration.
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Case Reports
[Anesthetic management for cesarean section in patients with maternal myotonic dystrophy].
Myotonic dystrophy involves not only voluntary muscles of extremities, pharyngeal muscle and respiratory muscle but also smooth muscle in the gastrointestinal tract. This muscle involvement can cause difficulty in excreting sputa, delayed emptying time of stomach and regurgitation of gastric content, all of which can lead to disastrous complications of anesthetic management. ⋯ In one case, the newborn baby had dyspnea due to congenital myotonic dystrophy, and in another case, patient experienced postoperative pneumonia. Our cases and other reports suggest that spinal or epidural anesthesia is safely applied for a cesarean section of a patient with myotonic dystrophy.