[Hokkaido igaku zasshi] The Hokkaido journal of medical science
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Hokkaido Igaku Zasshi · Jan 1998
Case ReportsEmergency appendectomy in a patient with Eisenmenger's syndrome.
For the successful management of an emergency appendectomy and abscess drainage in an Eisenmenger's patient with diffuse peritonitis, it may be preferable to use general anesthesia with awake intubation. Epidural anesthesia is commonly combined with this anesthetic management for emergency abdominal surgery. However, the combination of topical anesthesia with epidural anesthesia should be avoided for fear of toxicity of local anesthetics in a patient with complications due to Eisenmenger's syndrome.
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Hokkaido Igaku Zasshi · Nov 1997
Clinical Trial[Mechanism of ventilatory and heart-rate responses during sustained hypoxia in humans--role of endogenous adenosine].
To investigate whether lung stretch reflex modulates heart rate (HR) responses during hypoxia in humans, we measured ventilatory and HR responses to isocapnic progressive hypoxia and subsequent sustained hypoxia (arterial O2 saturation (SaO2); 80%, 20 min) in 22 healthy young adults. Moreover, to examine the role of endogenous adenosine in hypoxic ventilatory and HR responses in 9 of 22 subjects, a hypoxic challenge with or without dipyridamole pretreatment, an adenosine uptake blocker, was performed in a double-blind crossover fashion. Heart rate showed a biphasic change during the hypoxic challenge similar to that of ventilation. ⋯ As well as ventilatory decline during sustained hypoxia, which was completed earlier with dipyridamole than with control, HR decline was significantly affected with dipyridamole. There were no changes in blood pressure during hypoxic exposure except for a slight decrease in diastolic pressure at the end of sustained hypoxia in the control study. Accordingly we concluded that there was little effect of pulmonary stretch reflex on heart rate modulation during mild hypoxia in humans and that endogenous adenosine plays a modulating role more in ventilatory change during not only acute but also sustained hypoxia than in HR change.
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Hokkaido Igaku Zasshi · Nov 1997
Clinical TrialHaemodynamic correlation with lung biopsy findings in isolated ventricular septal defect with or without pulmonary hypertension.
Pulmonary hypertensive patients have been found to have greater morbidity and mortality from isolated ventricular septal defect closure than those pulmonary non-hypertensive patients. In this study, the author evaluated the relation between pulmonary artery muscularity and pulmonary artery pressure and resistance and compared the haemodynamic effects between normal and raised pulmonary artery pressure groups in isolated ventricular septal defect. The patients were divided into two groups, group-I (n = 14): pulmonary artery pressure of 50 mmHg or less than 50 mmHg, and group-II (n = 6): pulmonary artery pressure more than 50 mmHg. ⋯ Lung biopsy (n = 9) showed grade I Heath-Edward change in 6 cases (66.6%), grade II change in 1 case (11.1%), and grade III in 2 cases (22.2%). From these findings, when pulmonary vascular resistance is 8 units/m2 or more, operative indication should be determined on the basis of lung biopsy. Not only the gradings of pulmonary vascular changes, but the extent of vascular involvement and the duration of the lung exposure to the shunt anomally also need to be considered before surgery.
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Hokkaido Igaku Zasshi · Sep 1997
[Experimental studies concerning about the effects of the portal arterialization 4 weeks after ligation of hepatic artery under the optimal arterio-portal shunt blood flow].
The changes of hepatic hemodynamics and hepatic oxygen metabolism after portal arterialization (APS) were studied. Beagle dogs were used for the experiments. Dogs were grouped as follows: group I (n = 6) had 2 days of APS, group II (n = 6) had 1 week of APS, group III (n = 6) had 4 weeks of APS. ⋯ AKBR and mGOT were not significantly different compared with the preoperative level in all groups. Histologically, the liver structure, common bile duct and portal vein showed no ischemic change compared with the control biopsy in all groups. In conclusion, this study showed portal arterialization under the optimal arterio-portal shunt flow has beneficial effects on liver under hepatic arterial obstruction for 4 weeks.
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Hokkaido Igaku Zasshi · Jan 1997
[Experimental study of methamphetamine psychosis--role of glutamate and nitric oxide in methamphetamine-induced dopaminergic and serotonergic neurotoxicity in the rat brain].
The present study examined effects of a high dose of methamphetamine (MA) (5mg/kg, s.c., x 4) on extracellular concentrations of dopamine (DA), dihydroxyphenylacetic acid (DOPAC), 5-hydroxyindoleacetic acid (5-HIAA) and glutamate in rat striatum (ST) and nucleus accumbens (NA) using microdialysis. The toxic dose of MA markedly increased extracellular DA, and decreased DOPAC and 5-HIAA in both ST and NA. The increase in DA release was not different in magnitude between ST and NA. ⋯ Taking into account the relationship between NMDA receptor activation and NO formation, the present study examined effects of a NO synthesis inhibitor, N omega-nitro-L-arginine methyl ester (LNAME) on MA-induced decreases in contents of the monoamines and their metabolites, in order to clarify whether the MA-induced dopaminergic and serotonergic neurotoxicity would be mediated by NO synthesis. Coadministration with LNAME (30 mg/kg, i.p., x2), reduced the MA-induced decreases in contents of DA, DOPAC and HVA in ST, but not reduced the MA-induced decreases in contents of 5-HT in ST and NA. These findings suggest that the MA-induced dopaminergic, but not serotonergic neurotoxicity, may be related to the neural process such as NO formation caused by the activation of postsynaptic DA receptor.