Yoshihiro Kido

Intravenous Administration of Nucleosides and a Nucleotide Mixture Diminishes Intestinal Mucosal Atrophy Induced by Total Parenteral Nutrition

Total parenteral nutrition (TPN) is associated with atrophic changes in the structure and function of the intestinal mucosa. Because rapidly renewing intestinal mucosal cells may require an external source of purines and pyrimidines for their optimal growth, it can be assumed that supplementation of nucleosides and a nucleotide mixture (OG-VI) during TPN may prevent the progression of mucosal atrophy by compensating for a relatively insufficient delivery from liver. To test that hypothesis, male Wistar rats receiving TPN for 7 days were divided into four groups according to different TPN solutions. Group C (n = 10) received a standard solution, group O (n = 10) received OG-VI in addition to the standard solution, and group G (n = 10) received a glutamine-rich TPN solution containing almost the same amount of calories and nitrogen as the standard solution. Group O+G (n = 10) received OG-VI in addition to the glutamine-rich solution. Various parameters were examined on the eighth day in the jejunal and ileal segments. The following significant changes in comparison with group C were observed: total wet weight of the jejunal segment in group O was significantly greater, as was mucosal wet weight of the jejunal and ileal segments in groups O and O+G; protein contents of the ileal segment in group O as well as the DNA content of the jejunal segment in group O increased significantly; and maltase activity of the jejunal segment in group O+G increased, as did the villus height of the jejunal segment in groups O and O+G and the villus height of the ileal segment in group G.(ABSTRACT TRUNCATED AT 250 WORDS)

The usefulness of bright light therapy for patients after oesophagectomy

OBJECTIVES The prevention of delirium is an important issue in the field of perioperative nursing. The objective of this study was to verify the usefulness of acute-stage bright light exposure on patients following oesophagectomy. METHODS The participants were oesophagectomy patients that were removed from their ventilators the day after surgery. After extubation, we assigned the participants to either the exposure group or control group. At Day 2 after surgery, the exposure group underwent two hours of bright light exposure for four days. In both groups, we monitored physical activity and autonomic activity. In addition, we scored the participants on the NEECHAM Scale and evaluated their postoperative delirium and postoperative arrhythmia. RESULTS On the nights of Days 4 and 5, the amount of activity of the exposure group was significantly lower and The sympathetic nervous index was significantly lower on the night of Day 5. The level of arrhythmia was lower in the exposure group and we observed a significant difference on the night of Day 4 and the daytime of Day 5 after surgery. The occurrence rate of postoperative delirium tended to be lower in the exposure group, but there was no significant difference. None of the participants in the exposure group had NEECHAM Scale scores below the cut-off value from the night of Day 4 onwards. CONCLUSION We conclude that postoperative bright light exposure adjusted the sleep-wakefulness cycle and improved the bed rest of patients. It was also indicated that bright light therapy is useful for reducing postoperative delirium.

Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma

PurposeWe evaluated the purpose reliability and validity of a preliminary scale, which we developed to assess postoperative dysfunction after surgery for gastric and esophageal carcinoma.MethodsAfter interviews with 12 patients, reviews of previous studies, and discussions with experts, we identified the physical symptoms that develop after resection of upper gastrointestinal (GIT) carcinoma, and devised a preliminary scale comprised of 34 items. A questionnaire survey based on this scale was then sent to 283 patients.ResultsThe questionnaire was returned by 223 patients (78.8%), and 219 responses (98.2%) were valid. Among the 219 respondents, 168 had gastric carcinoma and 51 had esophageal carcinoma. After the elimination of scale items regarded as irrelevant based on statistical considerations and the judgment of experts, factor analysis was done. Seven factors were valid, namely, limited activity due to decreased food consumption, reflux, gastric dumping, nausea and vomiting, deglutition difficulty, pain, and difficulty with passing stools, which were often poorly formed. Scale reliability was confirmed by a Cronbach α-coefficient of 0.924. The validity of the construction of this scale was confirmed using the known-group technique based on the operative procedures performed, and the results of factorial validity.ConclusionOur preliminary scale is sufficiently reliable and valid, and will prove to be clinically useful.

Schedule-dependent inhibition of thymidylate synthase by 5-fluorouracil in gastric cancer

Background. An optimal treatment schedule of 5‐fluorouracil (5‐FU) remains to be clarified.

The rate of lipid oxidation in septic rat models

In order to examine the rate of lipid oxidation in sepsis, lipid infusion studies were carried out using two experimental models of septic rats, namely; an endotoxin group, and a cecum ligation and puncture group. Following the administration of glucose at a caloric amount equivalent to the measured resting energy expenditure (REE), the respiratory quotient (RG) values dropped promptly in the control group, but decreased only slightly in the septic groups. Following the administration of a lower dose of glucose (0.5 kcal/100 g B.W./hr), however, a lipid infusion promptly decreased the value of RQ in the septic groups. These results suggest that lipid oxidation was depressed in the septic groups and that the degree of depression was greatly influenced by the relationship between REE and the amount of administered glucose.

Psychosocial factors that aggravate the symptoms of sick house syndrome in Japan.

Over the last 30 years in Japan, there has been a 10% increase in the number of people suffering from sick house syndrome due to toxic chemicals released from construction materials and wallpaper. This syndrome can develop into the more complex and disabling, chemical sensitivity syndrome, so preventing early exposure to toxins at home is critical in reducing the likelihood of health problems in the community. A qualitative study was undertaken using ethnographic methods to identify the psychosocial aggravating factors of sick house syndrome. As a result, the participants identified three aggravating factors that extended the period of exposure of the participant to toxic chemicals: a lack of knowledge about the disorder; the difficulty in establishing a diagnosis; and the difficulty of taking radical measures to improve the home environment. Public awareness of sick house syndrome and the dangers of toxicity from construction materials is vital to eliminate these aggravating factors and to prevent illness.

Postoperative Gastrointestinal Dysfunction after 2-field Versus 3-field Lymph Node Dissection in Patients with Esophageal Cancer

PurposeUsing an instrument we developed to assess postoperative dysfunction objectively (Surg Today 2005;35:535–42), we compared postoperative dysfunction after 2 - field versus 3 - field lymph node dissection retrospectively, in patents undergoing esophageal cancer surgery.MethodsSubjects were selected randomly from among patients who had undergone radical surgery for squamous cell carcinoma of the thoracic esophagus followed by reconstruction with a gastric tube and a cervical anastomosis. Patients rated 32 items related to postoperative dysfunction according to a 5-grade scale. Postoperative gastrointestinal dysfunction was evaluated on the basis of the total score and the scores for seven symptom categories: decreased physical activity, symptoms of reflux, dumping-like syndrome, nausea and vomiting, passage dysfunction, pain, and diarrhea or soft feces.ResultsWe studied 42 patients, 22 of whom underwent 2-field lymph node dissection and 20 of whom underwent 3-field dissection. The total gastrointestinal dysfunction score was significantly higher in the 3-field group than in the 2-field group (78.4 ± 14.1 points vs 67.9 ± 16.9 points, P = 0.038). When we analyzed the data according to the symptom categories, the 3-field group had higher scores for decreased physical activity, symptoms of reflux, dumping-like syndrome, nausea and vomiting, and passage dysfunction.ConclusionThree-field lymph node dissection was associated with greater postoperative gastrointestinal dysfunction than 2-field lymph node dissection. Thus, the preoperative identification of those patients with esophageal cancer who are most likely to benefit from concurrent cervical lymph node dissection is essential.

Increased Energy Expenditure After Intravenous Administration of Amino Acids

Nutrient-induced thermogenesis (NIT) after parenteral administration of amino acids (AAs) was investigated in rats and compared with result obtained with intragastric administration. Resting energy expenditure was measured with a new type of open-circuit indirect calorimeter. The NIT increased shortly after parenteral AAs administration and reached a steady state in 30 minutes. The change in resting energy expenditure (the increment of resting energy expenditure over preinfusion baseline values) showed a significant relationship not only with the amount of infused AAs but also with the AA concentration in the portal vein. Furthermore, the increase in plasma AA concentrations in the portal vein was proportional to the amount of the particular AA infused. This relationship held true over the entire range tested. NIT with parenteral infusion (11% to 12%) was lower than that with intragastric infusion (20% to 23%). Plasma insulin, corticosterone, and glucagon levels increased after both parenteral and intragastric AAs administration, but the two methods did not show any significant differences in hormonal changes. The plasma aminogram of the portal vein after intragastric infusion was compared with that after parenteral infusion. Total plasma AA concentration and the levels of glutamine, lysine, arginine, glutamate, aspartate, and histidine were lower but the level of isoleucine was higher after intragastric infusion. On the basis of these results, it is believed that parenteral administration of AAs can induce thermogenesis, which may be regulated by the intraportal AA concentration. Considering the remarkable decrease in glutamine in the portal vein after intragastric infusion, the cost of intestinal metabolism may predominantly contribute to the NIT resulting from intragastric infusion.

Secretion of Beta-2-microglobulin from human hepatoblastoma and hepatoma cells on stimulation with interleukin-6

beta 2-microglobulin (beta 2-M) was secreted in a dose- and time-dependent manner after interleukin-6 (IL-6) treatment of human hepatoblastoma (HuH-6) and hepatoma cells (HuH-7). Pancreatic secretory trypsin inhibitor, which is one of the acute phase proteins secreted in these cells, was also secreted dose- and time-dependently in HuH-6 cells and dose-dependently in HuH-7 cells. It is conceivable that IL-6 induces the production of beta 2-M as an acute phase protein in the liver.

An important role of silent aspiration of gastric contents as a cause of pulmonary complications following surgery for esophageal cancer

The progress of postoperative chest X-ray films was analyzed in patients who had undergone radical surgery for esophageal cancer at the second Department of Surgery, Osaka University Medical School from 1969 to 1981. We subsequently reached a conclusion that abnormal shadows were caused by the intratracheal aspiration of oropharyngeal secretions or gastric contents. In particular, the aspiration of gastric contents was considered to be a factor in the occurrence and aggravation of pneumonia. In order to prevent aspiration of gastric contents, a drainage tube was inserted into the stomach as a reconstructive organ and endotracheal intubation was maintained for more than 24 hours post-operatively in order to suction the tracheobronchial secretion. Consequently, the frequency of occurrence and the aggravation of pneumonia decreased and the operative mortality rate improved significantly.