Lumbar Anesthesia Research Articles

THREE CASES OF ACUTE POSTOPERATIVE PULMONARY EMBOLISM

Acute postoperative pulmonary embolism which occurs suddenly is a potentially fatal complication. Rapid diagnosis and proper therapy are necessary to rescue some patients. We report 3 cases of acute postoperative pulmonary embolism with a review of the literature. The first patient was a 47-year-old female who underwent radical mastectomy under general anesthesia because of left bresast cancer. The second was a 52-year-old female who underwent total thyroidectomy under general anesthesia because of multiple thyroid tumors. The third was a 76-year-old female who underwent herniorrhaphy under lumbar anesthesia. For each patient, the thrombolytic therapy with tissue-type plasminogen activator was performed after the diagnosis. The first and second patients survived but the died. It is important to consider surgical therapy in the even of thrombolytic therapy not being effective.

Effect of Extradural Anaesthesia on the Ventilatory Response to Hypoxaemia

Summary The eflect of lumbar or thoracic extradurul anaesthesia on the ventilatory response to progressive isocapnic hypoxaemia was studied in two groups of 10 unpremeditated patients. The ventilatory measurements were taken twice, before and 20 min after the administration of 10 ml of lignocaine 2%. Lumbar extradural anaesthesia did not change the slope of the hypoxic response curve, but it significantly increased minute ventilation by 27% at an arterial oxygen saturation of 90%. Thoracic extradural anaesthesia was not associated with any changes in either index. We conclude that neither lumbar nor thoracic extradural anaesthesia impairs the ventilatory response to progressive isocapnic hypoxaemia.

Effect of extradural anaesthesia on the ventilatory response to hypoxaemia.

The effect of lumbar or thoracic extradural anaesthesia on the ventilatory response to progressive isocapnic hypoxaemia was studied in two groups of 10 unpremedicated patients. The ventilatory measurements were taken twice, before and 20 min after the administration of 10 ml of lignocaine 2%. Lumbar extradural anaesthesia did not change the slope of the hypoxic response curve, but it significantly increased minute ventilation by 27% at an arterial oxygen saturation of 90%. Thoracic extradural anaesthesia was not associated with any changes in either index. We conclude that neither lumbar nor thoracic extradural anaesthesia impairs the ventilatory response to progressive isocapnic hypoxaemia.

A CASE OF MALIGNANT FIBROUS HISTIOCYTOMA ARISING IN THE SMALL PELVIS

A case of malignant fibrous histiocytoma (MFH) arising in the small pelvis is reported. A 37-year-old woman admitted to the hospital because of a left gluteal tumor. Prior to this admission, the patient visited another hospital for the left gluteal tumor, and it was diagnosed as tumor of the ischiorectal fossa. Per anal drainage was carried out under lumbar anesthesia. It was found that the content was blood. The patient was referred to the hospital. Pelvic CT revealed a huge tumor which mainly arised in the left ischeorectal fossa extending from the small pelvis to beneath the gluteal skin. Internal iliac angiography showed a hypervascular tumor, feeded by left internal pudenal artery. Resection of the tumor was performed. The resected mass measured 15×8×6cm and weighed 264g. Histologically, MFH was confirmed. The patient was discharged from the hospital on the 21st day after the surgery, and she is well four months later. MFH has poor prognosis and is liable to recur locally and to metastasize. Strict follow-up should not be lacked.

Arteriovenous Communications in Patients with Primary Varicose Veins: An Investigation Using Thermography, Blood Oxygen Tension, and Operative Microscopy

The presence of arteriovenous communications (AVCs) in the lower extremi ties of patients with primary varicose veins with or without ulcerations was inves tigated by use of thermography, analysis of the blood oxygen tension, and observation under operative microscopy. Fifty-six subjects, including 20 normal subjects and 26 patients with primary varicose veins, were studied. Subjects maintained a standing position in a quiet room while thermography was performed both before and after exercise. The exercise was performed tiptoeing at a rate of twenty times per minute. After exer cise, hot spots on the lower extremities of the patients with varicose veins were localized by thermography. In the normal subjects, blood samples were aspi rated percutaneously from the femoral artery and vein before and after lumbar anesthesia. In the patients with primary varicose veins, an incision was made in the inguinal region following lumbar anesthesia and samples of blood were aspirated from the femoral artery and vein, the saphenous vein, and the ther mographic hot spots. The venous and arterial blood oxygen tensions were deter mined immediately in the hospital laboratory by means of a blood gas analyzer. After lumbar anesthesia, there were significant differences between the oxy gen tensions of the hot spots and those of the femoral or saphenous veins in the patients with varicose veins (p < 0.01, p < 0.05). At operation, the hot spots were investigated by operative dissection and microscopy. Small, pulsating arteries were observed at the sites that corresponded to the hot spots. These results strongly suggest that AVCs open up in the dermal capillary bed as the result of a persis tently high venous pressure, and these shunts, by diverting oxygenated blood away from the overlying skin, produce skin ischemia and ulceration.

Spinal Coning after Lumbar Puncture in Prostate Cancer with Asymptomatic Vertebral Metastasis: A Case Report

A 60-year-old man was admitted to our hospital for complete urinary retention. Prostate cancer was diagnosed and anti-cancer chemotherapy was administered. Regression of prostatic enlargement was appreciated and difficult urination improved. At 6 months after the initial treatment vertebral metastasis of T10-11 was noted on a bone scintigram but there were no symptoms induced by bone metastasis. Orchiectomy was performed with the patient under lumbar anesthesia. Complete paralysis of both lower extremities occurred postoperatively. Computerized tomography and myelographic findings demonstrated complete subarachnoid block with an extramedullary spinal cord tumor. It was concluded that traction on the spinal cord producing neurological deterioration (spinal coning) occurred after removal of the cerebrospinal fluid by lumbar puncture.

Endothelin Family in Human Plasma and Cerebrospinal Fluid

To clarify whether endothelin may be present in human cerebrospinal fluid (CSF) and, if it exists, to compare its molecular forms with those of endothelin in human plasma, we analyzed pooled human CSF and plasma by high performance liquid chromatography with specific enzyme immunoassays for each endothelin peptide. Of the four human endothelin peptides hitherto identified, big endothelin-1 was the major molecular form of endothelin present in human CSF. In addition, there was a small but significant amount of endothelin-1 and endothelin-3 in CSF, while endothelin-2 was not detectable. Similarly, big endothelin-1, endothelin-1, and endothelin-3 were identified in human plasma. Although big endothelin-1 was the most abundant, a substantial amount of endothelin-1 and endothelin-3 was found in plasma with a resultant lower molar ratio of big endothelin-1 to endothelin-1 than in CSF. In all CSF samples from 17 patients requiring diagnostic lumbar puncture or lumbar anesthesia, endothelin was detectable, with a preponderance of big endothelin-1 relative to endothelin-1 and endothelin-3. The mean concentrations of endothelin-1 and endothelin-3 in simultaneously collected plasma were significantly (P less than 0.01) higher than those in CSF, while there was no significant difference between the mean big endothelin-1 concentration in plasma and that in CSF. There was no significant correlation among concentrations of big endothelin-1, endothelin-1, and endothelin-3 in each paired sample. These results indicate that endothelin is present in human CSF that is differently processed from endothelin in vascular endothelial cells and suggest a possible role for endothelin as a modulator of neuronal functions.

Transurethral uretero-lithotripsy of ureteral stones in Osaka City University

During the 39 months since the introduction of transurethral lithotripsy (TUL) for the treatment of ureteral stones at our hospital in August 1985, TUL was performed a total of 200 times in 178 patients with ureteral stones. Among them, 111 patients had left ureteral stones and 65 had right ureteral stones, while 2 patients had ureteral stones in both sides. The stones were divided into upper ureteral stone (84 patients) and lower ureteral stone (94 patients) at above and below the iliac brim. 89% of the stones were less than 2 cm in diameter. Most of the patients were given lumbar anesthesia, and a guide wire was inserted into the ureter. The ureter was dilated with a ureteral bougie, and a 13F or 14F Storz ureteroscope was inserted. The stones were disintegrated by an ultrasound lithotripto and removed using forceps and a basket catheter. After the TUL procedure, a double J catheter was indwelled and removed within 5 days. The results were evaluated by DIP which was done 2 to 3 months after TUL. The success rate included residual stones less than 4 mm in diameter, as they could be spontaneously discharged. As a result, the success rate for upper ureteral stones was 53%, and it was higher for smaller stones. On the other hand, the success rate for lower ureteral stones was 85% and significantly higher. The main reasons for failure were the upper migration of the stones (60%) and inability to insert the ureteroscope up to the stone due to ureterostenosis and ureteral perforation (39%).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Paraplegia due to Spinal Subarachnoid Hematoma after Lumbar Puncture

A 50-year-old male with advanced gastric cancer underwent artificial anal colostomy to improve ileus under lumbar anesthesia. After surgery the patient developed paraplegia. Myelography and computed tomography revealed an intradural hematoma at the thoracolumbar region. Emergency laminectomy showed that the subarachnoid hematoma was compressing the spinal cord at the levels from Th10 to L2. Lumbar puncture, myelography, and lumbar anesthesia are performed very often because of their clinical importance and benefits, and complications of these procedures are infrequent and usually insignificant. However, on rare occasions serious complications do occur, among which intraspinal canal hematoma causing paraplegia is the most severe. According to the literature, epidural hematomas occur most often, followed by subdural hematomas, whereas subarachnoid hematoma after lumbar puncture is extremely rare. Among the proposed factors that lead to this complication are bleeding tendency, thrombocytopenia, anticoagulant drug therapy, multiple punctures, and pre-existing narrow spinal canal.

The past, present and future of German surgery

It is imperative that all surgeons familiarize themselves with the history and development of his chosen field. Until the 18th century, surgery in Germany and other areas of Europe was not performed by physicians but by barber surgeons. Surgeons originated from these ranks. In the second half of the 18th century, Bernhard von Langenbeck was one on the founders of surgery in Germany. He was one of the most respected teachers of his time and his most famous student was Theodor Billroth who formed the school from which von Miculicz and Sauerbruch graduated. This was the time of remarkable innovations, namely the development of asepsis by Bergmann, the first laryngectomy and the first gastric resection by Billroth and the first cholecystectomy by Langenbuch. Bier introduced lumbar anesthesia, Schleich infiltration anesthesia, Kehr developed surgery of the bile ducts and von Esmarch performed amputations of the extremities, under conditions of exsanguination. In 1872, Langenbeck, Simon, and Volkmann founded the German Association of Surgery. The world-known Operationslehre von Bier-Braun-Kümmell and the surgical manual by M. Kirschner was then published. At the beginning of the 19th century, Sauerbruch paved the way for thoracic surgery with use of the low pressure method. Forssmann succeeded in the catheterization of the right heart. M. Kirschner performed the first successful embolectomy and the first bridging of an defect of the esophagus. During world War II, German surgery lost touch with international developments and reestablishment followed with the schools of K.H. Bauer in Heidelberg and of R. Zenker in Marburg and Munich and others. Zenker's contributions to cardiosurgery are particularly remarkable.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of X-prolyl dipeptidyl-aminopeptidase activity in human cerebrospinal fluid with that in serum

X-Prolyl dipeptidyl-aminopeptidase activities in cerebrospinal fluid and serum from the same patients without neurological diseases, undergoing surgery under lumbar anesthesia, were assayed fluorometrically with a newly synthesized fluorogenic substrate, 7-glycylproline-4-methylcoumarinamide; the values were 129.1 +/- 19.5 nmoles/min/l and 54.17 +/- 3.11 mumoles/min/l (mean +/- SEM, n = 23), respectively, and there was no correlation between both activities (r = 0.0894).

Blockade of the Ferguson reflex by lumbar epidural anaesthesia in the parturient sheep: effects on oxytocin secretion and uterine venous prostaglandin F levels.

The role of oxytocin in the increase in utero-ovarian venous prostaglandin F (PGF) level caused by vaginal distension was investigated by using lumbar epidural anaesthesia to block the oxytocin secretion reflex. Whereas vaginal distension raised jugular venous oxytocin and utero-ovarian venous PGF levels in untreated sheep, neither response occurred after lumbar anaesthesia. Lumbar anaesthesia had no effect on the rise in utero-ovarian venous PGF level caused by administered oxytocin. These findings support the suggestion that a reflex release of oxytocin is involved in the elevation of utero-ovarian venous PGF observed after vaginal distension in parturient sheep.

The effect of lumbar epidural anesthesia on fetal heart rate baseline variability.

Baseline fetal heart rate (FHR) variability has become an important parameter in the diagnosis of fetal distress when electronically monitoring the fetus. Loss of the baseline variability has been noted to be associated with fetal distress, and in association with late deceleration or severe variable deceleration patterns has been shown to be ominous. Baseline FHR variability, however, has been modified not only by fetal distress but also by prematurity and the administration of certain drugs to the mother. Because FHR is often monitored during labor in parturients given lumbar anesthesia, the question of the effect of this procedure on FHR variability arose. Fifteen such patients with no antepartum or intrapartum complications were studied in active labor. All were monitored by electrocardiography on a continuous basis, FHR being studied before and after epidural anesthesia with lidocaine, with and without epinephrine. Of the 15 patients, tracings in 8 (53 percent) revealed a minimal or moderate change in baseline variability within several minutes of drug injection. This change in variability was recorded from 4 to 18 minutes, after which time the pre-epidural FHR variability was reestablished. Although the mechanism for this result was not definitively determined, such variability in FHR does not in itself seem significant of fetal distress but suggests supportive measures for the patient.

Dorsal Dislocations of the Metatarsopharangeal Joints

The dorsal dislocations of the metatarsopharangeal joints are uncommon. Recently we have experienced a case of these dislocations at 2nd, 3rd, 4th metatarsopharangeal joints.These dislocations could not be reduced by manipulation under lumbar anesthesia next day after injury, they were, therefore, necessary to perform open reduction.Judging by the operation findings, we considered that most significant irreducible factor was fibrocartilagenous plate.

So-called silent bladder cancer

Cystoscopy is the most important method in the diagnosis of bladder cancers. However, some cases can not be diagnosed by cystoscopy. We had six cases of the socalled silent bladder cancer, in which the surface of the bladder was nearly normal or with appearance of chronic inflammation, and the sign of tumours could not be detected by the cystoscopical examination. Therefore, we report our experience and give some considerations on the diagnosis and treatment of such cases.Of all six cases, five cases had received the medical treatment in a certain hospital from 3 months to 3 years under diagnosis of chronic cystitis, cystitis tuberculosa or prostate hypertrophy. In those six cases, no marked abnormality was observed by IVP, cystogram, and arteriogram. And no tumour was found even by bimanual palpation nnder lumbar anesthesia. The cystoscopical diagnosis was not available for these cases. The highly malignant cancer cells were detected by the cytological examination of pumping method and then biopsy gave the correct diagnosis of the high grade transitional cell cancer. Any tumour was not found macroscroscopically on the surface of the bladder after radical cystectomy. But the histological study on the preparations of whole area of the cystectomized bladders revealed that considerable part of the mucosa was invaded by cancer and tumour embolisms occured in the blood and lymph vessels. Cancer cells infiltrated not so far, the stage being mostly stage 0 or stage A. On the other hand, the lymph node metastases were often observed around the bladder. We studied its chromosomal patterns in four cases and found abnormal chromosomes in all cases.Usually, the diagnosis of bladder cancer is relied on the cystoscope, and the therapeutic indication is dicided on the basis of the infiltration. However, as the matter of fact, this criteria does not apply to some cases of bllader cancer; for these cases, cytological examination and biopsy are indispensable.For these cases, even if they are low stage cancers, the palliative operations are improper, and the radical cystectomy combined with strong chemotherapy or radiotherapy are required.

Postoperative Intestinal Paralysis after Prosthetic Surgery of the Hip-Joint

A case of death due to intestinal paralysis after prosthetic replacement of the femoral head for the neck fracture was reported.A blind woman aged 76 years old had fractured herself at the femoral neck. On 20th day after accident, she came to our hospital for bloody treatment. As she was aged and riskful and her fracture was intracapsular showing typical displacement, prosthetic replacement was proposed her to recover early from bed. After premedication (atropine sulfate 0.4mg; meperidine hydrochloride 50mg) and during lumbar anesthesia (nupercaine hydrochoride 2.0ml) and surgical procedure, she showed slight or middling shock. Though the procedure often had to interrupt from shock conditions and exclusion of the head required excess times, the operation was acomplished in two hours with almost smooth except blood loss of about 500ml and somewhat unsatisfactory stability of prosthesis because of sever bone atrophy of the neck. The next day, she could take half sitting position, sometimes in a daytime. On the second day after surgery, she was injected meperidine hydrochloride (35mg) for abdominal-ache. On the third day, she showed meteorism or intestinal paralysis due to postoperative hypokalemia and treated with every possible conservative method, but symptoms were progressing incurably. At last, on the sixth day cardiac arrest happened her just bef or the gas-enterostomy. Immediately, open massage of the heart was begun and after 20 minutes once revival was successful for about half an hour but she had died eternally.

A study on the male sexual impotence. II. Treatment of organic impotence by implantation of a penile prosthesis

Except for the publications of Heller, Loefer et al., Pearman and Lash, we are unable to find any references in the literature relating to the treatment of organic impotence.We implant silicone implants to the patients who are incapable of erection because of true organic diseases. The purpose of this study is to design a prosthesis which conforms with the anatomical architecture of the penis.The shape of the silicone penile implant is a half circle rod, flat on the bottom and curved on top, 10-12mm. in diameter and 10cm. in length. Under general or lumbar anesthesia, a 3cm incision is made in the mid-dorsal shaft and subcutaneous tissue. Care is taken to minimize the disturbance to the veins and nerves by retracting them laterally. Colles' fascia is identified and incised. Below this, Buck's fascia is identified and incised. Further below this, the tunica albuginea is identified. With the aid of a vein retractor and with meniscus scissors a pocket is made between Buck's fascia and the tunica albuginea of corpora cavernosa proximally as far as the suspensory ligament of the penis and distally to just under the corona of the glans penis. The silastic rod is inserted into the pocket. Buck's fascia is closed with 5-0 chromic atraumatic catgut or 5-0 nylon. Colles' fascia is closed in a like manner. The skin is sutured with 5-0 nylon. Sexual intercourse is discouraged for at least 4 weeks.This operation is recommended as a treatment for organic impotence.

STUDIES ON HUMAN MINOR TREMORS

MT of normal adults and a patient with typical peripheral facial palsy (Bell's palsy) were recorded synchronous with the EKG, EMG, heart beat and EEG. Bio-information processing methods of correlation and frequency analysis were applied to the MT and EEG and the following findings were observed.1. The autocorrelogram of MT in the resting state showed, two groups of main vibrations, each of which was intimately correlated with the first and second heart beat (or R spike and T wave in EKG) respectively. They were more distinct in the crosscorrelograms of the heart beat or EKG and the MT. Both of these vibrations which followed the R spike (the first heart beat) and T wave (the second heart beat) were superimposed to cause a beat phenomenon in the autocorrelogram and crosscorrelogram. In the frequency spectra of the autocorrelograms of MT except those led from the forehead, dominant peaks were seen with a broader frequency range (7-15c/sec) than that of alpha wave (8-13c/sec) in EEG. The main vibration of MT in forehead, however, was verified to have a frequency lower than8c/sec.2. By deprivation of arterial pulsation, each of the dominant peaks in the frequency spectrum of the MT from the thenar did not shift in their frequency but only changed their height. In the MT ink record itself, two main vibrations synchronous to the heart beat were also observed. This finding suggests that the MT may be irrelevant to pulsation, but related to heart beat.3. In a patient with unilateral palsy of the peripheral facial nerve (typical Bell's palsy), the amplitude and frequency of MT in the paralysed side were lower than those in normal side only in the resting state but also during voluntarily active state.4. Under lumbar anesthesia, depression of MT vibration was observed, but vibrations correspondent to the R spike in EKG was sustained. Depression of MT due to lumbar anesthesia suggests the existence of neuromuscular MT components other than that of cardiac beat.

The importance of uncontaminated puncture needles and ampules in lumbar anesthesia

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

ジブカインとパントカインジエチル型の分離定性

Dibucaine and Pantocaine are often used for lumbar anesthesia in surgical operations but these sometimes cause death. From the point of forensic chemistry, separatory detection of these compounds from their mixture from spinal fluid was carried out by paper chromatography.