Kunihiko Hoshi

Combined therapy with hypothermia and anticytokine agents in influenza A encephalopathy

Two children with influenza A-related encephalopathy were treated with a combination of mild hypothermia (deep body temperature of the forehead: 35 degrees C) and anticytokine agents (high-dose methylprednisolone and ulinastatin), while receiving amantadine. One of the cases exhibited acute necrotizing encephalopathy on computed tomography (CT). Although no severe complications occurred, correctable hypokalemia and hyperglycemia occurred in both cases. Both patients recovered without any neurological sequelae. Our therapeutic protocol appears to be effective for managing influenza A-related encephalopathy.

Comparison between in vivo and in vitro pharmacokinetics of succinylcholine in humans.

AbstractPurpose. To compare the in vivo and in vitro pharma-cokinetics of succinylcholine (SCh) in humans. Methods. A bolus of SCh 1 mg·kg−1 (n = 7) or 2 mg·kg−1 (n = 11) was given to 18 patients anesthetized with thiopental. Arterial blood samples for determination of in vivo SCh concentrations were collected every 30 s for 5 min. Another 20-ml blood sample was obtained before induction of anes-thesia for determination of in vitro SCh. Concentrations of SCh were measured by high-performance liquid chromato-graphy. In vivo and in vitro concentrations of SCh vs time data were analyzed by the one-compartment model. Results. The respective in vivo and in vitro pharmacokinetic parameters (SCh 1 mg·kg−1vs SCh 2 mg·kg−1) were as follows: Plasma clearance was 4.17 ± 2.37 and 1.85 ± 0.28 l·min−1, P < 0.05, vs 2.91 ± 2.01 and 1.27 ± 0.43 l·min−1, P < 0.05. Elimination half-life was 25.4 ± 10.6 and 47.4 ± 5.4 s, P < 0.002 vs 26.3 ± 10.0 and 75.2 ± 21.8 s, P < 0.00005. Conclusion. These results suggest that the rapid disap-pearance of SCh from the circulation is due to diffusion out of the blood vessels rather than to enzymatic hydrolysis.

Lens subluxation in homocystinuria. A case report.

A 6‐year‐old girl had bilaterally subluxated lenses and liver and platelet dysfunctions. A cyanide‐nitroprusside test of the urine was positive. Serum and urinary levels of methionine and homocystine were high. Cystathionine synthetase activity in the cultured skin fibroblasts was negligible. Pyridoxine, 1000 mg/day orally, normalized the serum and urinary methionine and homocystine levels and the liver and platelet functions. Episodes of pupillary block glaucoma prompted lens extraction. The subluxated lenses were extracted under general anaesthesia after administration of pyridoxine and dextran to avoid thrombosis. A good result without serious complications was obtained. We believe that homocystinuria should not be considered a contraindication to general anaesthesia. In the pyridoxine‐responsive patient general anaesthesia is not hazardous if platelet function can be controlled by the vitamin.

Effect of tube guide assembly of closed suction system on airway pressure gradient

We connected a Dual Adult TTL model 1600 test lung (Michigan Instruments, Grand Rapids, MI, USA), a pressure and flow sensor (OMR; Nihon Kohden, Tokyo, Japan), a TT (Mallinckrodt, St. Louis, MO, USA), another sensor, and an Evita 4 ventilator (Drägerwerk, Lubeck, Germany) in series (Fig. 2). Two kinds of TT (with IDs of 6.5 and 8.5mm) were used for this experiment. The distal side of each TT was set inside a plastic tube, which was connected to the test lung. The cuff was inflated with air to prevent leakage, and the proximal side of each TT was connected to the respiratory circuit of the Evita 4. We used the original Ballard Trach Care Directional Tip Closed Suction System for 12-Fr catheter (Ballard Medical Products, Midvale, UT, USA), and a modified closed suction system, in which the tube guide assembly in the L-connector was removed (Fig. 1). The settings of the Evita 4 ventilator were: tidal volume, 600ml; respiratory frequency, 12 breaths·min 1, inspiratory time, 1 s (with attenuation wave); FIO2, 0.21, inspiratory pause, 0%, and positive end-expiratory pressure (PEEP), 0cmH2O. The resistance and compliance of the test lung were set at 20cmH2O·l 1·s 1 and 0.05 l·cmH2O 1, respectively. The airway pressures were measured simultaneously at the proximal side of the closed suction system (P2) and the distal site of the TT (P1), and the flow was measured at the proximal site. Three signals (two pressures and one flow) were recorded simultaneously with a Power Book G3 (Apple Computer, Cupertino, CA, USA) via a MacLab AD converter (AD Instruments) at a sample rate of 100Hz. We calculated and analyzed the relationship between the airway pressure and the flow using Chart v3.6.4B5/s (AD Instruments) and Microsoft Excel (Microsoft, Redmond, WA, USA) for every breath. It has been reported that the pressure gradient across the TT (PTT) has a nonlinear dependence on the flow generated by the ventilator [2]. This relationship is