The Tohoku journal of experimental medicine
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Tohoku J. Exp. Med. · Nov 2005
Case ReportsSpinal anesthesia in a patient with severe thoracolumbar kyphoscoliosis.
Patients with spine abnormalities, present unique challenges to the health care provider responsible for administrating sedation and anesthesia during surgical and technical procedures. Spinal deformities may cause difficulties with both tracheal intubation and regional anesthesia. This report describes the anesthetic management for two urological operations that were performed in a patient with extremely severe thoracolumbar kyphoscoliosis. ⋯ Because of this unexpected effect of local anesthetic solution, in the second operation, the technique was changed to intrathecal injection of 12.5 mg hypobaric bupivacaine (4 ml), and the motor and sensory blockade at Th10 was achieved again. The patient reported satisfactory anesthesia each time, and developed no complications. In conclusion, spinal anesthesia can be successful even in cases of severe thoracolumbar kyphoscoliosis.
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Tohoku J. Exp. Med. · Nov 2005
Development of a food-frequency questionnaire to measure the dietary calcium intake of adult Japanese women.
Assessing calcium intake is necessary for epidemiological studies on osteoporosis. This study was aimed at developing a valid food frequency questionnaire (FFQ) to estimate the dietary calcium intake of Japanese people. The FFQ contains 26 items, representing common sources of calcium. ⋯ The calcium intake from dairy products showed a good correlation, r = 0.717. The coefficient of correlation between the values estimated based on two FFQ filled out three days apart was 0.900, showing good test-retest reliability. Therefore, this FFQ is valid and reliable in estimating dietary calcium intake for epidemiological studies.
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Tohoku J. Exp. Med. · Oct 2005
Comparative StudyHigh body mass index and long duration of intubation increase post-extubation stridor in patients with mechanical ventilation.
Approximately 20% of mechanically ventilated patients experience post-extubation stridor (PES) and reintubation, which subsequently may lead to an increased risk of morbidity and mortality. The risk of PES development is significantly higher in obese patients. Low air leakage between the endotracheal tube and the trachea, following cuff deflation, may indicate a higher risk for the development of PES. ⋯ The mean BMI was 36 +/- 13 kg/m2 in PES patients and 24 +/- 7 kg/m2 in non-PES patients (p = 0.046). BMI > 26.5 kg/m2 (OR: 1.2), low cuff-leak volume (< 283 ml) and mechanical ventilation required for more than 5 days (OR: 0.9) were independent variables for PES occurrence. We therefore suggest that non-obese patients, short-term intubated patients and those having a high air leakage around the endotracheal tube could be extubated without much difficulty.
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Tohoku J. Exp. Med. · Oct 2005
Comparative StudyUsefulness of warm fluid in acute burn resuscitation: an experimental study in dogs.
Hypothermia is a common complication in patients with extensive burns, receiving massive volumes of fluid for resuscitation at ambient temperature. It is therefore important to maintain the body temperature of patients with extensive burns. The present study was performed to evaluate the usefulness of warm fluid for burn injury resuscitation. ⋯ The urinary output was better in animals treated with warm fluid, indicating the improved hemodynamic state in these animals. These results suggested that the hemodynamic state in acute burn shock was ameliorated by the use of warm fluid. Therefore, warmed fluid resuscitation might be useful to perform immediate excision and grafting for the patients with extensive burns in acute burn shock.
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Tohoku J. Exp. Med. · Sep 2005
ReviewPreventive strategies for aspiration pneumonia in elderly disabled persons.
Pneumonia is the fourth leading cause of death despite the availability of potent new antimicrobials in Japan. Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia. Impairments in swallowing and cough reflexes among disabled older persons, e.g., related to cerebrovascular disease, increase the risk of pneumonia. ⋯ Similarly, since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, treatment with dopamine analogs or potentiating drugs such as amantadine can reduce the incidence of pneumonia. Furthermore, since mortality from infections correlates with cutaneous anergy, interventions that reverse these age-associated changes in the immune system are also effective. The main theme of this review is to discuss how pneumonia develops in disabled older people and to suggest preventive strategies that may reduce the incidence of pneumonia among these subjects.