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Volume 27, Issue 1
Displaying 1-12 of 12 articles from this issue
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Journal Symposium (1)
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Hiroyuki UCHINO, Yasuhiro KURODA, Go HIRABAYASHI, Nagao ISHII, Futoshi ...2007 Volume 27 Issue 1 Pages 1-26
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSWe sometimes face pathological conditions that lead to brain damage. Temporary brain ischemia often induces neuronal cell death and sequelae. At present, there is no effective way to prevent this, so analysis of the mechanisms of ischemic brain damage is needed. In doing so, our results showed that the calcineurin/immunophilin cascade plays an important role in inducing neuronal cell death.
In this article, we discuss the role of Ca2+, mitochondrial dysfunction, the effects of anesthetic neuroprotective agents, the clinical perspective of neuroprotection, present drug therapy, brain monitoring, and biomarkers that can reflect brain damage.
We also introduce our data that results from DNA chip analysis that searched for new molecular targets that participate in neuronal cell death.View full abstractDownload PDF (3024K)
Journal Symposium (2)
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Masahiro SHINOZAKI2007 Volume 27 Issue 1 Pages 27
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSDownload PDF (122K) -
Hiroshi KATAYAMA, Hiroshi MORIMATSU, Tetsufumi SATO, Yoshimasa TAKEDA, ...2007 Volume 27 Issue 1 Pages 28-33
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSHigh Flow means the increase of dialysate flow rate in continuous renal replacement therapy (CRRT) and at least 1L/h is required. These words are used together continuous hemodialysis (CHD) or continuous hemodiafiltration (CHDF) . High Volume means the increase in the filtration flow rate in CRRT and requires a filtration flow rate of at least 1L/h. These words are used together continuous hemofiltration (CHF) or CHDF. When both the dialysate flow rate and filtration flow rate are increased to more than 1L/h, this is called High Flow-High Volume (HF-HV) CHDF. HF-HV CHDF improved the recovery rate from hepatic coma in our institute. Ronco et al. provided data that showed that high volume CHF (more than 35ml/kg/hr filtrate) was associated with a better survivor rate than lower volume CHF (20ml/kg/hr filtrate) . For septic shock patients, high volume CHF or HFHV-CHDF might offer/provide a better prognosis than conventional dose CRRT.View full abstractDownload PDF (317K) -
Toshiaki IKEDA, Kazumi IKEDA, Yuichi KUROKI2007 Volume 27 Issue 1 Pages 34-41
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSIn 94 septic multiple-organ-failure patients who were treated with endotoxin adsorption therapy (PMX-DHP) , changes in circulatory parameters (SAP, MAP, SVR) , pulmonary oxygenation (PaO2/FiO2) , various cytokine levels (TNF-α, IL-6, IL-8, IL-1ra, and IL-10) and endothelial cell relating markers (ICAM-1, ELAM-1, PAI-1, thrombomodulin) were examined separately according to the patient outcome (45 survivors and 49 non-survivors) . Also, background factors and procalcitonin were examined in each group. Time of shock onset to PMX-DHP was not significantly different between the two groups. A circulatory system was improved in both groups, and PaO2/FiO2 was improved significantly in the survival group. TNF-α, IL-6, and IL-8 did not change in PMX-DHP. IL-10 and IL-1 receptor antagonist (IL-1ra) tended to be higher in the non-survival group than the survival group. In addition, IL-1ra decreased in both groups significantly after PMX -DHP completion, and ELAM-1 and PAI-1 decreased in the survival group after PMX-DHP completion. Procalcitonin in the survival group showed a significant decrease from 87±136ng/mL to 67±106ng/mL (P< 0.05) . On the other hand, PCT in the non-survival group increased from 44±106ng/mL to 49±72ng/mL. These results suggested that we should consider the timing of endotoxin adsorption therapy and the severity of the septic multiple organ failure in the patients.View full abstractDownload PDF (675K)
Educational Articles
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Kazuyoshi HIROTA2007 Volume 27 Issue 1 Pages 42-49
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSIn Hirosaki University Hospital, more than 80% of general anesthesia administration is performed with propofol-total intravenous anesthesia (TIVA) combined with ketamine and fentanyl. This causes a reduction in use of a greenhouse gas nitrous oxide and volatile anesthetics that destroy the ozone layer. In addition, previous reports suggest that intravenous anesthetics, ketamine and propofol may have anti-inflammatory effects while volatile anesthetics may promote inflammation. Volatile anesthesia may also reduce the phagocytic and microbicidal activities of alveolar macrophages, and natural killer cell activity compared to TIVA. Moreover, propofol has also been reported to inhibit cancer metastasis while volatile anesthetics may promote it. Therefore, propofol-TIVA should be popularized in the near future as this anesthetic method is environmentally friendly and protective against surgery-induced stress and inflammation.View full abstractDownload PDF (436K)
Original Articles
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Koichi MOGI, Soichiro INOUE, Masaaki SATO, Naoyuki TAGA, Yoshihiro HIR ...2007 Volume 27 Issue 1 Pages 50-54
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSJichi Medical University created a new residency program which restricts the amount of time residents can work to 80 hours a week. We evaluated the working conditions of the residents who rotated through the Department of Anesthesiology (rotating residents) and the residents who were specializing in anesthesiology (specialized residents) for 1 year to make sure that the new resident program in the Department of Anesthesiology can be completed within 80 hours a week. We also estimated the number of annual surgical cases in 2004 according to the tendency of the annual numbers of surgeries from 2000 to 2003. Rotating residents were engaged in anesthesia work for 109±25 hours (mean±SD) and worked 276±41 hours in one month, and specialized residents were engaged in anesthesia work for 98±24 hours and worked for 250±47 hours in one month. The number of the annual surgical cases in 2004 was expected to increase over 26% in one year due to the increase of 26. 5% between 2003 and 2000. These results indicated that it might be difficult to provide time for lectures for residents because the increasing number of surgery cases inevitably makes residents busier.View full abstractDownload PDF (257K)
Case Reports
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Makoto TAMURA, Masao NAKAMURA, Masayuki FUKASAWA, Shiho YAMATO, Wataru ...2007 Volume 27 Issue 1 Pages 55-60
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSA 74-year-old woman suffering from myelodysplastic syndrome had a splenic abscess and underwent laparotomy and splenectomy under general and epidural anesthesia.
On postoperative Day 9, a skin ulcer was noticed around the epidural catheter. Bacterial infection was suspected and antibiotics were administered. However, the skin ulcer gradually spread and also occurred at the skin close to the surgical wound in the abdomen. No bacteria were found in the skin lesions or on the epidural catheter tip. Histological examination showed the infiltration of neutrophils into the epidermis, dermis and interstitial tissue in the skin. From these findings, the skin lesion was diagnosed as pyoderma gangrenosum that was classified as a type of neutrophilic dermatosis. Systemic administration of predonisolone was remarkably effective and the skin ulcer healed completely after 70 days of administration of predonisolone.View full abstractDownload PDF (415K) -
Masayuki FURUICHI, Chiyo SATO, Hiroshi KAWAGUCHI, Hiroaki KISHIKAWA, C ...2007 Volume 27 Issue 1 Pages 61-65
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSWe experienced a case of difficult airway management caused by membranous tracheal protrusion in a middle-aged patient who underwent anterior vertebral spinal fusion surgery 18 years ago. Although the vocal cord could easily be seen during the intubation procedure, the reinforced endotracheal tube was not able to pass into the trachea below the vocal cord. The operation was eventually postponed and was rescheduled. Despite the choice of a smaller endotracheal tube on the following attempt at surgery, the tube was not passed as previously experienced. Intubation was succeeded by rotating the tube 180 degrees. Lateral vertebral X-ray picture after the operation revealed a membranous tracheal protrusion and spinal deformity. We have to pay attention to tardive complications in airway management of patients who underwent prior anterior vertebral spinal fusion surgery.View full abstractDownload PDF (304K) -
Yoshifumi OKADA, Takeshi SHIMA, Shigeyoshi SASAKI, Chihoko SATO, Masat ...2007 Volume 27 Issue 1 Pages 66-70
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSWe tried to perform an epidural in two patients and spinal anesthesia in another two patients who had very severe scoliosis (over 100 degrees) under fluoroscopic guidance. Although the epidural catheter was successfully inserted in both cases, we succeeded in spinal anesthesia in only one patient. The skin-to-subarachnoid-space distance was so great that we could not penetrate the dura matter in the other case.
When inserting needles under fluoroscopy, we recommend first identifying the positions of the spinous process and the bilateral pedicles of the vertebral arch, and then adjusting the fluoroscope to the point where you can see these anatomic landmarks as clearly as possible. Epidural and/or spinal anesthesia under fluoroscopy can be safely performed ; however, proficient skills may be required.View full abstractDownload PDF (330K) -
Shoko TAWA, Yoshiki FUJIWARA, Sirou KOJIMA, Yasuo SAKA2007 Volume 27 Issue 1 Pages 71-76
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSWe experienced a patient who suffered from severe pulmonary hypertension (systolic pulmonary arterial pressure was 76mmHg) , which was detected just before the start of total gastrectomy. Emergency total gastrectomy was performed because of the uncontrolled bleeding from gastric cancer. Although PaO2 was low, she did not complain of dyspnea or chest pain. Cardiac standstill occurred when the abdominal wall was being closed at the end of the operation. PCPS and IABP were needed for resuscitation. Postoperative examinations suggested pulmonary embolisation to be the most likely cause of cardiac standstill observed during abdominal closure. She was discharged after 69 days without any severe complications.View full abstractDownload PDF (344K) -
Saya YOSHIZAWA, Masato YUMOTO, Junji TANAHASHI, Tomoyo KAJINO, Masanao ...2007 Volume 27 Issue 1 Pages 77-79
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESSWe experienced a fire in the mouth during palatine tonsil extirpation under general anesthesia. In this case, a dry cotton ball and tracheal tube caught fire when the surgeon used an electrocauterizer to stop the bleeding. Later, we measured the oxygen concentration that would be necessary to cause combustion of a cotton ball in the mouth. When oxygen concentration is 40% or more, electrocoagulation caused a fire, but when it is below 35%, electrocoagulation did not cause a fire.
Our new protocole for tonsillectomy using an electrocauterizer is as follows :
1. Do not use dry cotton balls when an electrocauterizer is used.
2. Do not use an oxygen concentration of more than 30% when an electrocauterizer is used.
3. Use a suction device to decrease the oxygen concentration in the mouth cavity.View full abstractDownload PDF (250K)
Journal Symposium (3)
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Tatsuru ARAI2007 Volume 27 Issue 1 Pages 80-91
Published: 2007
Released on J-STAGE: January 29, 2007
JOURNAL FREE ACCESS
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