Factors Related to Osteosarcopenia in Kidney Transplant Recipients

Introduction

Sarcopenia and osteopenia are highly prevalent in older patients, and are associated with a high risk for falls, fractures, and further functional decline. However, related factors in kidney transplant recipients suffering from osteosarcopenia, the combination of sarcopenia and osteopenia, remain unknown.

Effect of radioisotope sentinel node mapping in patients with cT1 N0 M0 lung cancer

BACKGROUND: Application of the sentinel node concept to lung cancer is still controversial. Patients with peripheral small lung cancers would gain the most benefit from this concept, if it were valid. We sought to determine whether it is possible to choose between limited lymph node sampling and systematic lymphadenectomy from the distribution of sentinel lymph nodes in patients with node-negative disease on the basis of imaging. METHODS: Sixty-five consecutive patients with cT1 N0 M0 non-small cell lung cancer were enrolled. A radioisotope tracer (4 mCi of technetium-99m tin colloid, 2.0 mL) was injected in the vicinity of the tumor before surgical intervention with computed tomographic guidance. The radioactivity of each resected lymph node was measured separately with a hand-held gamma probe after complete tumor resection. Sentinel nodes were identified, and the accuracy of sentinel node mapping was examined. Whether the location of the sentinel node depended on the site of the primary tumor was also examined. RESULTS: Of the 65 patients, 3 were excluded because of the final pathologic results. Successful radionuclide migration occurred in 39 (62.9%) of the 62 patients. There was 1 (2.6%) false-negative result among 39 patients with a sentinel node, and therefore the sensitivity was 90%, and the specificity was 100%. The most common sentinel lymph nodes were at level 12 (46.7%), followed by level 11 (18.3%), the mediastinum (16.7%), and level 10 (11.7%). CONCLUSION: The sentinel node concept is valid in patients with cT1 N0 M0 lung cancer. The lobar lymph nodes were identified as sentinel nodes more frequently than other lymph nodes. We need to make further efforts to increase the sentinel node identification rate. However, we believe that if sentinel nodes are identified, sentinel node mapping can allow the accurate intraoperative diagnosis of pathologic N0 status in patients with cT1 N0 M0 lung cancer.     

Protein sparing during general anesthesia with a propofol solution containing medium-chain triglycerides for gastrectomy: comparison with sevoflurane anesthesia

Purpose

Despite the importance of the inhibition of catabolic response to surgery, the effects of different anesthetic techniques on the catabolic response in surgical patients are controversial. This study compared the endocrine-metabolic responses and protein catabolism during gastrectomy in patients who received either sevoflurane or propofol anesthesia with remifentanil.

Methods

Thirty-seven patients (American Society of Anesthesiologists status I–III) aged 20–79 years undergoing elective gastrectomy were randomly assigned to receive sevoflurane anesthesia with remifentanil (n = 19) or intravenous propofol anesthesia (Propofol-Lipuro^® 1 %; B. Braun, Melshungen AG, Germany) with remifentanil (n = 18). Urine samples were collected every 1 h after skin incision (0 h) and the urinary 3-methylhistidine:creatinine ratio (3-MH/Cr ratio) was used as a marker of protein catabolism. Respiratory quotient was measured during a 1 h period following skin incision.

Results

The 3-MH/Cr ratio significantly increased at 1–2 and 2–3 h compared to 0 and 0–1 h in both groups, but the propofol group exhibited a lower 3-MH/Cr ratio (nmol/μmol) than the sevoflurane group at 1–2 h (15.7 vs. 18.2, P = 0.012) and 2–3 h (15.9 vs. 18.1, P = 0.025). A difference was observed in the respiratory quotient between the sevoflurane and propofol groups (0.726 vs. 0.707, P = 0.003).

Conclusion

A lower 3-MH/Cr ratio and a lower respiratory quotient during propofol anesthesia, compared to those exhibited during sevoflurane anesthesia, suggest that protein sparing probably occurs through the utilization of medium-chain triglycerides contained in the fat emulsion of propofol solution as a fuel source.     

Report based on fiscal 2000 diagnostic x-ray equipment questionnaire survey(conditions of radiography)

X-ray equipment has seen advances in inverters and the digitalization of reception systems. The X-ray Systems Study Group, in order to examine changes in the conditions of radiography, including pediatric radiography, variations in shortest irradiation time, and standardization of the conditions of radiography, carried out investigative research using a questionnaire survey that was sent to 400 facilities. The recovery rate was 33%. In terms of the reception system, half of the general radiography systems were using computed radiography (CR). Seventy percent of respondents used an intensifying screen and film(S EF)in stomach double-contrast radiography. About 80% used digital radiography (DR) and digital subtraction angiography (DSA) in aorta abdominalis angiography. At least 70% of high-voltage generators were of the inverter type. The conditions of radiography were not greatly influenced by changes in reception systems and X-ray equipment. Many pediatric radiographies were carried out by radiological technologists. We consider it useful to conduct such survey investigations.     

Cerebrospinal fluid and arterial lactate, pyruvate and acid-base balance in patients with intracranial hemorrhages.

Lactate and pyruvate concentrations and acid-base balance in cerebrospinal fluid (CSF) and arterial blood were determined in patients with intracranial hemorrhages (28 subarachnoid hemorrhages and 15 intracerebral hemorrhages). A greater increase in CSF lactate and lactate-pyruvate ratio (L/P ratio) was observed in patients with impairment of consciousness, focal neurological deficits, poor prognosis, or CSF pressures higher than 300 mm H2O. A combination of CSF lactate greater than 2.5 mM per liter, L/P ration above 20, bicarbonate less than 20.4 mEq per liter, pH below 7.276, or arterial PCO2 below 31.5 mm Hg seems to indicate poor prognosis from intracranial hemorrhage. The mechanism of hyperventilation in acute cerebrovascular diseases and of CSF pH regulation in acid-base disturbances was also discussed.     

Factors related to the induction of ventricular fibrillation in the normal canine heart by programmed electrical stimulation

Programmed electrical stimulation was performed in eight normal dogs using a stimulator and endocardial electrode catheters identical to those used in human studies. The right and left ventricular apex were paced at a drive cycle length of 400 ms and, in some cases, 500 ms, with a pacing sequence of single (S1S2), double (S1S2S3) and triple (S1S2S3S4) premature impulses introduced after eight paced complexes. Pacing sequences were performed using combinations of pulse width (1, 2 and 4 ms) and current strengths of 2, 5 and 10 times diastolic threshold, and in three dogs, 15 times diastolic threshold. Twenty-two episodes of ventricular fibrillation were initiated in five dogs in 170 pacing sequences using current strengths up to 10 times diastolic threshold, and six episodes of ventricular fibrillation in the two of three remaining dogs tested at 15 times diastolic threshold. Ventricular fibrillation was reproducible on seven of nine occasions. Ventricular fibrillation was never induced by S1S2 at up to 15 times diastolic threshold; it was induced by S1S2S3 in 3 (1.8%) of 170 sequences, but only at 10 times diastolic threshold. It was induced by S1S2S3S4 in 19 (11.4%) of 167 sequences using 2 to 10 times diastolic threshold, although 20 of 28 episodes only occurred with S1S2S3S4 at 10 or more times diastolic threshold.(ABSTRACT TRUNCATED AT 250 WORDS)     

Tension changes during and after stretch in frog muscle fibres

1. Small fibre bundles from the semitendinosus muscles of the frog were stretched during tetanic stimulation, and the resulting tension changes were studied over a wide range of stretch velocities from 0.1 to 150 cm/sec (0.1-100 length/sec). The experiments were performed within the range of fibre lengths where the resting tension was negligible.2. With stretch velocities of more than 30 cm/sec (20 length/sec), the tension rose abruptly at first, and then started to fall while the stretch still continued, indicating the ;slip' of the contractile component. When the fibres were stretched at 80-150 cm/sec (70-100 length/sec), the tension fell quickly below the initial isometric level at the end of the stretch, and then began to rise again to the initial isometric value.3. Following stretches of 30-60 cm/sec (20-50 length/sec), the tension showed a delayed transient rise. The delayed rise of tension became more marked as the amount of stretch was increased.4. In some preparations, oscillatory tension changes were observed following stretches of 50-100 cm/sec (40-70 length/sec).5. The tension developed above the isometric level during moderate-velocity stretches of less than 15 cm/sec (10 length/sec) increased by lowering temperature, and showed a tendency to decay when the stretch velocity was suddenly reduced during a stretch.6. These results are discussed in relation to the sliding filament hypothesis, which provides an explanation for the findings of the present work.     

Sentinel node biopsy for staging of small peripheral lung cancer

Is it possible to choose between limited lymph node sampling and systematic lymphadenectomy from the distribution of sentinel lymph nodes in patients with small lung cancer less than 2 cm in diameter? METHODS: Twenty-four patients with cN0M0 lung cancer less than 2 cm in diameter were enrolled. A radioisotope tracer (Tc-99 m tin colloid or phyphate) was injected in the vicinity of the tumor before surgery under computed tomography (CT) guidance. The radioactivity of each resected lymph node was measured separately with a hand-held gamma probe after complete tumor resection. Sentinel nodes were identified and the accuracy of sentinel node mapping was examined. RESULTS: Successful radionuclide migration occurred in 20 of the 24 patients (83.3%). There were 21 N0 patients and 3 N-positive patients. There was no false-negative case, so the sensitivity and the specificity was 100%. The lobar lymph nodes were identified as sentinel nodes more frequently than other lymph nodes. CONCLUSION: The sentinel node concept is valid in patients with small lung cancer less than 2 cm in diameter. We believe that, if sentinel nodes are identified, sentinel node mapping can allow the accurate intraoperative diagnosis of pathological N0 status in patients with small peripheral lung cancer.     

A review and development of sentinel node navigation surgery for lung cancer

Sentinel node navigation surgery (SNNS) for lung caner has not yet been established. Sentinel node (SN) identification using dye or radioisotope has been developed; however, the SN identification rate was less than 50% in the dye method and use of radioisotopes is strongly restricted in Japan. The novel method using a CT or MRI contrast medium are expected. A study of local immune reaction for lung cancer in SN is also a very interesting issue.