Inhalation of carbon monoxide following resuscitation ameliorates hemorrhagic shock-induced lung injury.

Even after successful resuscitation, hemorrhagic shock frequently causes pulmonary inflammation that induces acute lung injury (ALI). We previously demonstrated that when CO is inhaled at a low concentration both prior to and following hemorrhagic shock and resuscitation (HSR) it ameliorates HSR-induced ALI in rats due to its anti-inflammatory effects. In the present study, we administered CO to the same model of ALI only after resuscitation and examined whether it exerted a therapeutic effect without adverse events on HSR-induced ALI, since treatment of animals with CO prior to HSR did not prevent lung injury.

[Impact of beach chair position on the value of bispectral index during general anesthesia].

Background: Although the bispectral index (BIS) has been established as a common index of anesthetic depth, there is a possibility that head-up position may influence BIS values under general anesthesia. This study examined whether beach chair position with 57 degrees head-up would cause the variation of BIS values during shoulder surgery.

Methods: Two groups of patients were scheduled for surgery, one was supine position group, and the other was beach chair position group.

Heme breakdown and ischemia/reperfusion injury in grafted liver during living donor liver transplantation.

Living donor liver transplantation (LDLT) requires ischemia/reperfusion (I/R), which can cause early graft injury. However, the detailed mechanism of I/R injury remains unknown. Heme oxygenase-1 (HO-1) is a rate-limiting enzyme in heme catabolism and results in the production of iron, carbon monoxide (CO), and biliverdin IXα.

[Case of coronary vasospasm during lumbar discectomy in prone position].

A 62-year-old man with hypertension was scheduled for discectomy at L4-5 in prone position. Anesthesia was induced with propofol 70 mg, fentanyl 0.75 mg and rocuronium 40 mg and maintained with sevoflurane 0.

An increase in exhaled CO concentration in systemic inflammation/sepsis.

Despite recent progress in Critical Care Medicine, sepsis is still a major medical problem with a high rate of mortality and morbidity especially in intensive care units. Oxidative stress induced by inflammation associated with sepsis causes degradation of heme protein, increases microsomal free heme content, promotes further oxidative stress and results in cellular and organ damage. Heme-oxygenase-1 (HO-1) is a rate-limiting enzyme for heme breakdown.

Nonimmersive virtual reality mirror visual feedback therapy and its application for the treatment of complex regional pain syndrome: an open-label pilot study.

Objective: Chronic pain conditions such as phantom limb pain and complex regional pain syndrome are difficult to treat, and traditional pharmacological treatment and invasive neural block are not always effective. Plasticity in the central nervous system occurs in these conditions and may be associated with pain. Mirror visual feedback therapy aims to restore normal cortical organization and is applied in the treatment of chronic pain conditions.

[Anesthetic management of pediatric patients with insulinoma using continuous glucose monitoring].

Insulinomas are rare tumors, the incidence of which is 1-2 per million. Patients with insulinomas present with symptoms of hypoglycemia secondary to insulin hypersecretion. Surgical resection is a treatment of choice and offers the only chance of cure.

Heme Oxygenase-1 is an Essential Cytoprotective Component in Oxidative Tissue Injury Induced by Hemorrhagic Shock.

Hemorrhagic shock causes oxidative stress that leads to tissue injuries in various organs including the lung, liver, kidney and intestine. Excess amounts of free heme released from destabilized hemoproteins under oxidative conditions might constitute a major threat because it can catalyze the formation of reactive oxygen species. Cells counteract this by rapidly inducing the rate-limiting enzyme in heme breakdown, heme oxygenase-1 (HO-1), which is a low-molecular-weight stress protein.

[Central pontine myelinolysis after living donor liver transplantation].

Central pontine myelinolysis (CPM) is the most serious central nervous system complication that could be seen after liver transplantation and represents an important source of mortality early after liver transplantation. CPM following liver transplantation was reported more and more in literatures, but the true incidence of CPM after living related liver transplantation (LDLT) remains unknown. However, with the introduction of magnetic resonance imaging (MRI), early recognition has become possible.

Increased exhaled carbon monoxide concentration during living donor liver transplantation.

Exhaled carbon monoxide concentration (ExCO-C) has been reported to increase in oxidative tissue injuries such as systemic inflammation, and is thought to reflect increased heme breakdown in the affected organ. As a transplanted liver undergoes ischemia-reperfusion, we hypothesized that ExCO-C might also increase following liver transplantation and might serve as a measure of the severity of the graft tissue injury. We prospectively studied 67 living donor liver transplantation (LDLT) patients in a consecutive fashion.

The lower intestinal tract-specific induction of heme oxygenase-1 by glutamine protects against endotoxemic intestinal injury.

Objective: The aim of the present study was to investigate whether glutamine pretreatment improves intestinal injury in rats with endotoxemia by its heme oxygenase-1 induction in the lower intestinal tract.

Design: Randomized, blinded, controlled animal study.

Setting: University-based animal research facility.

Increased heme oxygenase-1 and decreased delta-aminolevulinate synthase expression in the liver of patients with acute liver failure.

Acute liver failure (ALF) remains a serious problem in critical care with a high rate of mortality. Although the pathophysiology of ALF has not been fully elucidated, oxidative stress has been in part implicated in its pathogenesis. Heme oxygenase-1 (HO-1) is known to be induced not only by its substrate, heme, but also by various oxidative stresses, and thought to play an important role in the protection of the host from oxidative tissue injuries.

[Severe acute pulmonary edema during living related liver transplantation surgery].

We report a case of severe intraoperative pulmonary edema during living related liver transplantation (LRLT) surgery. A 60-year-old woman with end-stage primary biliary cirrhosis underwent LRLT. After administration of several units of packed red blood cells and fresh frozen plasma, a gradual decline in oxygen saturation was observed.

Increased carbon monoxide concentration in exhaled air after surgery and anesthesia.

Heme oxygenase-1 (HO-1) is induced by oxidative stress and is thought to confer protection against oxidative tissue injuries. HO-1 catalyzes the conversion of the heme moiety of hemeproteins, such as hemoglobin, myoglobin, and cytochrome P450, to biliverdin, liberating carbon monoxide (CO) in the process. CO reacts with hemoglobin to form carboxyhemoglobin.

[Living-related liver transplantation in a patient with hepatopulmonary syndrome].

We experienced the perioperative management of the living related liver transplantation (LRLT) in a patient with hepatopulmonary syndrome (HPS). HPS is seen in 15% of patients of the endstage liver failure, and it accompanies the various types of hypoxia. The diagnostic standards of HPS are chronic liver disease usually complicated by portal hypertension with or without cirrhosis, arterial hypoxemia (PaO2 < 70 mmHg or A-aDO2 gradient > 20 mmHg), and intrapulmonary vascular dilation.

Correlation between the distribution of contrast medium and the extent of blockade during epidural anesthesia.

Background: If the epidural spread of contrast medium can be well correlated with the spread of local anesthetics, epidurography can predict the dermatomal distribution of the anesthetic block. The authors evaluated the relation between radiographic and analgesic spread.

Methods: An epidural catheter was inserted in 90 patients, and predicted catheter tip position was recorded.

[Massive bleeding due to hyperfibrinolysis during living-related liver transplantation for terminal liver cirrhosis; report of two cases].

We reported two cases of massive bleeding due to critical hyperfibrinolysis during living-related liver transplantation (LRLT) for end stage liver cirrhosis. The total volume of bleeding amounted to 57930 ml with the case 1, and amounted to 55980 ml with the case 2. TEG was useful for diagnosis of the hyperfibrinolysis.

[Changes of urinary tripsin inhibitor in blood and urine, as well as serum cytokines in living related liver transplantation].

Background: Living related liver transplantation induces the production of many inflammatory and anti-inflammatory cytokines. Urinary tripsin inhibitor (UTI) is produced in the liver and wellknown as one of the markers of surgical stress.

Methods: To clarify the significance of UTI in blood and urine and serum cytokines in living related liver transplantation, we examined the changes of UTI, polymorphonuclear elastase (PMNE), interleukin (IL)-6, IL-1 ra and IL-10 perioperatively.

Protective role of heme oxygenase-1 in the intestinal tissue injury in an experimental model of sepsis.

Objective: The aim of this study was to examine the role of heme oxygenase-1 induction in the intestinal tissue injury in a rat model of sepsis.

Design: Randomized, masked, controlled animal study.

Setting: University-based animal research facility.

CYP2E1 overexpression up-regulates both non-specific delta-aminolevulinate synthase and heme oxygenase-1 in the human hepatoma cell line HLE/2E1.

Cytochrome P450 (CYP) is known to turn over rapidly both in vivo in the liver, and in vitro in cultured hepatoma cells expressing CYP. We examined changes in heme metabolism by analyzing gene expression of the non-specific delta-aminolevulinate synthase (ALAS-N), and heme oxygenase-1 (HO-1), the rate limiting enzyme in heme synthesis and catabolism, respectively, in the human hepatoma cell line HLE/2E1, in which CYP2E1 was overexpressed by transfection of its expression vector. Both ALAS-N mRNA and HO-1 mRNA levels were found to be markedly up-regulated in HLE/2E1 cells as compared with those in non-transfected cells (HLE), or in mock-transfected cells (HLE/MOCK).

[A case of severe acute hyperkalemia during pre-anhepatic stage in living-related liver transplantation].

We reported a case of severe acute hyperkalemia during pre-anhepatic stage in living-related liver transplantation. The serum potassium concentration was elevated from 5.1 mmol.

High-flow-rate haemodiafiltration as a brain-support therapy proceeding to liver transplantation for hyperacute fulminant hepatic failure.

In fulminant hepatic failure (FHF), rapidly progressive cerebral oedema remains the main fatal complication and an obstacle in liver transplantation. A 29-year-old Japanese woman presented with sudden-onset hepatic encephalopathy and jaundice. Hepatic encephalopathy deteriorated within 2 days of the onset of jaundice.