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  • 1
    ISSN: 1436-0691
    Keywords: Key words: hepatocellular carcinoma ; caudate lobectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: We aimed to assess isolated caudate lobectomy by the anterior approach for the treatment of large hepatocellular carcinomas originating in the paracaval portion of the caudate lobe. The surgical procedures consisted of ligation and dissection of the caudate branch of the portal vein and short hepatic veins from the right side of the hepatic hilum; liver resection cranially from the right side of the process portion; ligation and dissection of the short hepatic veins from the left side; hepatic resection between the lateral segment and Spiegel lobe; and, finally, dissection of the liver at the right of the Cantlie line, reaching the tumor in the paracaval portion of the caudate lobe. The important point in this procedure was the appropriate management of the short hepatic veins, the branches of the hepatic vein, and the glisson's vessels of the paracaval portion. The operative times for the three patients reported here were 430, 355, and 575 min, with blood loss of 1100, 1180, and 2000 ml, respectively. The duration of the operation was short and blood loss was minimal; severe complications were not observed. Complete recovery of liver function after this surgery tended to be slow. Early recurrence was observed during long-term follow-up. This procedure is considered to be a safe method, with optimal surgical vision for caudate lobe tumors of a relatively large size. However, adjuvant therapy to prevent recurrence is required.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1436-2813
    Keywords: parenteral nutrition ; urinary excretion of glucose ; maltose ; maltotriose and maltotetraose ; renal biosynthesis of maltotriose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine the extent of maltose excreted into the urine, sugar substances present in the urine following intravenous infusion of maltose were analyzed. Maltose, glucose, maltotriose and maltotetraose in the urine were detected by gas chromatography and identified by mass spectrometrical analysis. The total amounts of sugar substances excreted after 10 per cent maltose solution given at three different infusion rates were calculated. The excreted amounts of maltotriose and maltotetraose increased in a dose and time dependent manner. As these compounds were not detected in the plasma either during or after the administration of maltose, the kidney probably plays a role in the biosynthesis of maltotriose and maltotetraose. Studies on the organ homogenates of the rabbit showed that the enzyme activity for the biosynthesis of maltotriose from maltose was mainly in the kidney. The glucose excreted into the urine probably originates from maltose catalyzed to glucose, mainly by the action of kidney maltase. As the rate of excretion of sugar substances increased in a dose dependent manner, adequate infusion rates of maltose should be less than 0.5 g/kg/hour.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1438-8359
    Keywords: Key words: In vitro caffeine-halothane contracture test (in vitro CHCT), Ca-induced Ca release rate test (CICR), Malignant hyperthermia (MH), Malignant hyperthermia susceptibility (MHS)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose. We compared the results of the in vitro caffeine-halothane contracture test (CHCT) according to the protocols of the North American Malignant Hyperthermia Group (NAMHG) and the European Malignant Hyperthermia Group (EMHG) with the Ca-induced Ca release (CICR) rate test in the same patients with suspected malignant hyper thermia (MH). Methods. Five normal controls and 16 patients suspected of having MH susceptibility were studied. Muscle biopsies were usually obtained from the musculus vastus lateralis. Diagnostic cutoff points and procedures for CHCT protocols were as described in the original and renewal versions of NAMHG and EMHGs. The CICR rate test was performed according to the protocol reported by Endo et al. Results. All five normal controls and two patients with abortive MH, two with postoperative hyperthermia, and three with high serum creatine kinase levels were normal in the three tests. Three patients with MH reactions and one patient with a history of masseter spasm were classified as MH positive according to NAMHG criteria and MH susceptible and MH equivocal according to EMHG criteria. There were five cases with discordant results between the CHCT and CICR rate tests. Conclusion. We propose that muscle biopsy for diagnosis of MH susceptibility should combine the CHCT with the CICR rate test, which may identify the defective site of Ca release channels.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1438-8359
    Keywords: Halothane ; Enzyme inhibition ; Analgesics ; Hypnotics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Enzyme inhibition on anaerobic dehalogenation of halothane by various analgesic or hypnotic agents was investigated in vitro using rat liver microsomal fraction. The production rate of chloro-difluoro-ethylene (CDE) and chloro-trifluoro-ethane (CTE), anaerobic metabolites of halothane, was measured when various concentrations of analgesic or hypnotic agents (fentanyl, morphine, pentazocine, buprenorphine, ketamine, diazepam, chlorpromazine and hydroxyzine) were supplemented. Inhibitor constant (Ki) of each agent was calculated and compared with each other. The activity of NADPH-cytochrome c reductase (fp2) and NADH-ferricyanide reductase (fp1) was measured when each agent was added. The values of inhibitor constants (Ki) for CDE and CTE formation were in the following order from large to small values; morphine (656 µM and 2570 µM), chlorpromazine (49.7 µM and 68.1 µM), ketamine (24.9 µM and 64.4 µM), fentanyl (23.9 µM and 34.6 µM), hydroxyzine (19.2 µM and 50.8 µM), diazepam (17.0 µM and 13.9 µM), buprenorphine (11.2 µM and 22.4 µM), and pentazocine (1.96 µM and 6.67 µM) respectively. Pentazocine inhibited the formation of CDE 300 fold greater than morphine. The activity of fp2 and fp1 did not change by the addition of these analgesic or hypnotic agents. These results indicate that various analgesic or hypnotic agents, which are commonly used with halothane in clinical anesthesia, suppress the anaerobic dehalogenation of halothane in vitro. They also imply that the suppression of production of halothane metabolites is the result of direct enzyme inhibition on cytochrome P-450, since these agents did not affect the activity of fp2 and fp1 which are flavoproteins existing in the microsomal electron transport system. (Yamanoue T, Kikuchi H, Fujii K, et al.: Enzyme Inhibition by Analgesic and Hypnotic Agents on Anaerobic Dehalogenation of Halothane. J Anesth 5: 331–337, 1991)
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1438-8359
    Keywords: Liver transplantation from living donor ; Adult recipient ; Anhepatic phase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1438-8359
    Keywords: Pandysautonomia ; Heart rate variability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1438-8359
    Keywords: Key words Pharmacokinetics ; Propofol ; Compartment analysis ; Moment analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose. To determine the pharmacokinetic parameters of propofol after a single-dose injection in Japanese adults. Methods. This study was carried out in adult patients who underwent minor surgery under general anesthesia with sevoflurane. We injected 1.0, 1.5, or 2.0 mg·kg−1 of propofol at a constant rate using a syringe pump. Arterial blood samples were taken for 480 min after the administration of propofol. The whole-blood concentration of propofol was determined with gas chromatography, and a time–blood concentration curve was analyzed by a two-compartment open-model analysis and a model-independent analysis. Results. The half-lives of the central and peripheral compartment (t 1/2α and t 1/2β) were 2.26 ± 0.69 and 47.9 ± 22.1 min, respectively. The volume of the central compartment (Vc) was 0.582 ± 0.170 l·kg−1, and the apparent volume of distribution at a steady state (Vdss) was 2.62 ± 1.06 l·kg−1. The total body clearance (Cl) and mean residence time (MRT) were 53.7 ± 11.9 ml·min−1·kg−1 and 98.1 ± 16.4 min, respectively. Conclusions. Among the pharmacokinetic parameters determined in Japanese adults, t 1/2α, t 1/2β, and Vc were similar, Vdss was smaller, and Cl was larger, as compared with values in Caucasians. These findings suggest that propofol could be eliminated well during minor surgery in Japanese adults.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We studied the relation of perioperative blood transfusion and the outcomes in 175 patients with hepatocellular carcinoma (HCC) who underwent hepatic resection from 1986 to 1994 in our hospital. Hepatectomy was performed in 23 (13.1%) patients with and 152 (86.9%) without blood transfusions. The cumulative cancer-free survival rates for patients who had received blood transfusion was significantly lower than that for patients who had not received blood transfusions (p= 0.003). Further examinations revealed a significant difference in cancer-free survival rates for stage I–II patients (n= 75) of HCC (p= 0.02) but not for stage III–IV patients (n= 56) (p= 0.06). Cox regression analysis for recurrence revealed that blood transfusion was the most significant prognostic indicator (p= 0.001) for recurrence in stage I–II patients but not in stage III–IV patients (p= 0.99). These results suggest that a perioperative blood transfusion may be a significant prognostic indicator for patients with HCC who had underwent hepatectomy, especially in stage I–II patients of HCC.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1615-2573
    Keywords: Pulmonary artery catheter ; Transesophageal echocardiography ; Intraoperative monitor ; Complication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The usefulness of transesophageal echocardiography (TEE) for guiding the placement of a pulmonary artery (PA) catheter was evaluated in 31 patients (TEE group); 31 patients who were treated before TEE guidance was used (control group). In the control group, use of the PA catheter was abandoned in two patients; because of an unstable condition and marked arrhythmias, respectively. The key findings for TEE guidance were: (1) pulsatile to-and-fro movement of the balloon, i.e., “shuttle movement” and (2) loss of shuttle movement at wedging of the balloon, i.e., “anchoring sign.” When the PA catheter did not enter the right vertricle (RV), the balloon was found to be in the inferior vena cava or the right atrium (RA) without shuttle movement. Coiling of the catheter was suggested in the latter situation. Coiling also occurred in the RV, often associated with frequent arrhythmias. These findings indicate that the catheter should be withdrawn once. TEE allowed for readjustment of the catheter tip position by enabling the balloon to be wedged twice. An excessively deep placement of the catheter tip was seen in 5 of the controls, but in none of the TEE group. Biplane TEE was found to be advantageous for guiding PA catheter placement and for visualizing the RV inflow and outflow tract in a single view, with the shuttle movement of the balloon in its long axis. TEE acts as an “eye” in the operating room, as does fluoroscopy, enabling smooth placement of the PA catheter.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Journal of anesthesia 11 (1997), S. 1-2 
    ISSN: 1438-8359
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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