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21.
22.
Hyperaemia prior to acute cerebral swelling in severe head injuries: The role of transcranial doppler monitoring 总被引:4,自引:0,他引:4
Z. Muttaqin M.D. T. Uozumi S. Kuwabara K. Arita K. Kurisu S. Ohba H. Kohno H. Ogasawara M. Ohtani T. Mikami 《Acta neurochirurgica》1993,123(1-2):76-81
Summary Acute cerebrovascular congestion after a closed head injury is significantly related to intracranial hypertension. As an indirect method of cerebral blood flow measurement, transcranial doppler sonography (TCD) provides a rapid and noninvasive assessment of cerebral haemodynamics, including hyperaemic conditions.TCD examinations was serially performed in 35 patients with severe head injury with intact cerebral circulation; i.e. the mean flow velocity (MFV) patterns of the middle cerebral artery (MCA) did not show signs of cerebral circulatory arrest such as systolic spike, to and fro, or no flow. The results showed that the MFV of the MCAs and ipsilateral extracranial internal carotid arteries (ICAs) in 9 of these patients increased sharply and pulsatility index (PI) decreased during 48–96 hours after the injury. This was soon followed by patterns of high intracranial resistance, consistent with elevated intracranial pressure (ICP) in monitored patients and acute brain swelling on repeated computed tomographic (CT) scans. The correlation between increased MFVs, decreased PIs, and cerebral haemodynamic changes leading to acute brain swelling is discussed.The number of patients who ended with severe disability, vegetative state, or death was 66% in this group of 9 patients, compared to only 34% for the 35 patients overall with severe head injury. Though the morbidity and mortality rates largely depend on the primary injury, the presence of acute cerebral swelling aggravate the grave course in these patients. And the ability of TCD to monitor the hyperaemic state prior to oedema should lead us to adjust the therapy in order to minimize the secondary insult related to intracranial hypertension. 相似文献
23.
Michihiko Fukui Maho Imoto Nobuaki Shime Tetsuo Hatanaka Hideaki Tojo 《Journal of anesthesia》1997,11(1):27-31
We developed a continuous oxygen consumption (Vo2) measurement system employed the reversed Fick method, in which Vo2 in computed from continuously measured sured arterial and mixed venous oxygen saturation assed by pulse oximetry and mixed
venous oximetry, respectively, and cardiac output by the heat deprivation technique. This system was compared with the conventional
intermittent reversed fick method in 7 patients during surgery and with indirect calorimetry in 4 intensive care unit (ICU)
patients. The Vo2 measured by the continuous reversed Fick method showed a high correlation with those simultaneously measured by the intermittent
Fick method (r=0.97,P<0.01) and by indirect calorimetry (r=0.74,P<0.01). The 95% confidence limits (bias±2 SD) of the continuous reversed Fick method were −0.6±45 ml·min−1 with the intermittent Fick method and −31±56 ml·min−1 with indirect calorimetry. The continuous Fick method is in satisfactory agreement with the conventional methods for the
measured of Vo2 and potentially allows for convenient assessment of Vo2 in critically ill patients.
This study was supported in part by Grants-in-Aid for the Encouragement of Young Scientists 01771185 and 04857171 from the
Ministry of Education, Science and Culture of Japan 相似文献
24.
在免眼中进行经瞳孔阈值下温热疗法的组织学效应和蛋白表达 总被引:1,自引:0,他引:1
Yoshihiro Morimura Annabelle A. Okada Atsushi Hayashi Sayuri Fujioka Sumie Kawahara Tetsuo Hida 李扬 《美国医学会眼科杂志(中文版)》2005,17(3):185-186
目的:研究阈值下经瞳孔温热疗法(TTT)对视网膜组织学的效应。方法:对正常视网膜色素的兔眼进行TTT,通过1个810nm激光二极管产生直径为1.2mm能量为50mW的光斑,持续时间为15、30和60秒。4周后进行荧光血管造影并摘除眼球,通过电子显微镜和免疫组化染色来检查。 相似文献
25.
26.
Hideyuki Iwai Ryuji Koike Jun Ogawa Takahiko Sugihara Hiroyuki Hagiyama Kenji Nagasaka Yoshinori Nonomura Junko Nishio Toshihiro Nanki Rieko Tsubata Hitoshi Kohsaka Tetsuo Kubota Nobuyuki Miyasaka 《Nihon Rinshō Men'eki Gakkai kaishi》2002,25(3):270-276
A 36-year-old man was admitted to a hospital with complaints of fever, polyarthralgia and dyspnea. Erythema was observed on his face, extensor surface of the fingers and extremities, and a chest X-ray revealed massive bilateral pleural effusion. He had no sign of myopathy at this point. Pleural fluid was proved to be exudative and contained extremely high levels of hyaluronic acid. He was also complicated with interstitial pneumonitis and was given a pulse therapy with methyl prednisolone followed by daily administration of 55 mg prednisolone (PSL). Twenty days after the commencement of the therapy, pleural effusion decreased but muscle weakness gradually appeared, accompanied by elevation of myogenic enzymes. Myogenic changes on electromyogram, and irregularity of the muscle fibers with slight inflammatory cell infiltrates in a biopsy specimen were demonstrated. He was transferred to our hospital, and a diagnosis of dermatomyositis was made. Later, pleural effusion waxed and waned depending on the dosage of PSL, but no other causative disorder was demonstrated by extensive examinations. This case indicates that the pleuritis could be one of the vasculitic manifestations of dermatomyositis. 相似文献
27.
Kelley Withy MD MS ; January May Andaya; Judith S. Mikami RN MPH ; Seiji Yamada MD MPH 《The Journal of rural health》2007,23(1):84-88
CONTEXT: Health disparities between rural and urban communities are well documented. There are many suggested causes and many proposed solutions but no one-size-fits-all answer. The most successful community interventions have been introduced by communities themselves. However, before communities invest in such interventions, each group must identify and prioritize their needs. PURPOSE: This article describes the Hoshin facilitation method as a practical option assisting communities in assessing their needs and gaining consensus for future steps. METHODS: Thirty-four meetings were held in 11 rural communities in Hawaii using the Hoshin process to identify factors that impact rural health. Themes were identified by constant comparative analysis and thematic frequency described. Commonality of responses between communities was examined. Informal feedback was collected from meeting participants. FINDINGS: There was a great deal of commonality between community responses, with economic factors, drug use, lack of community leadership, lack of health care services and access to services, lack of healthy activities for youth, and poor public education being the most common issues noted. Group involvement in the meetings was high, and the facilitation method received positive feedback from participants. CONCLUSIONS: The Hoshin facilitation method is a very useful tool to help communities rapidly identify and prioritize areas for programmatic attention. 相似文献
28.
Yuzo Kodaira Tetsuo Shibuya Koushi Matsumoto Kiichiro Uchiyama Toshihiro Tenjin Nobutaka Yamada Shigeo Tanaka 《Surgery today》1997,27(8):745-748
A 66-year-old man died of massive gastrointestinal hemorrhage caused by a fistula between the third portion of the duodenum
and the abdominal aorta. An autopsy revealed that duodenal tuberculosis had resulted in the development of a fistula into
the aorta with no pathological changes, and no active pulmonary tuberculosis was found. Duodenal tuberculosis and primary
aortoduodenal fistula (ADF) without an aneurysm are both extremely rare. Thus, we report herein a unique case of primary aortoduodenal
fistula without an abdominal aortic aneurysm, but associated with duodenal tuberculosis, and review the current literature. 相似文献
29.
30.
Akihisa Okumura Ikuya Tsuge Tetsuo Kubota Hirokazu Kurahashi Jun Natsume Tamiko Negoro Kazuyoshi Watanabe 《European journal of paediatric neurology》2007,11(6):385-388
We evaluated drug-specific T cell responses in a patient with refractory partial seizures and paroxysmal kinesigenic choreoathetosis successfully treated with clinical desensitization to phenytoin. Drug-induced lymphocyte transformation test before desensitization was negative with a stimulation index of 130%. The frequencies and cytokine-producing phenotypes of phenytoin-specific T cells were examined simultaneously by using a carboxyfluorescein succinimidyl ester (CFSE) dilution assay. Before desensitization, the proportion of CFSElow CD4+ cells in whole CD4+ was 3.09%; 13.6% of CFSElow CD4+ cells were stained with anti-interferon gamma antibody. After desensitization, phenytoin-specific CFSElow CD4+ cells decreased to background level. These results indicate that CFSE dilution assay will be useful for the diagnosis and monitoring of drug hypersensitivity. 相似文献