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This study sought to determine the predicted Cp50 of propofol required for laryngeal mask airway insertion (Cp50LMA) and to investigate whether nitrous oxide reduces these required concentrations. Using target-controlled infusion and incorporating the standard Diprifusor pharmacokinetic model, 46 unpremedicated patients were randomly assigned to one of two groups. The patients received either 40% oxygen in air (control group: n = 23), or 60% nitrous oxide in oxygen (nitrous oxide group: n = 23). The target concentration for each patient was determined using the up and down method. Following equilibration between the predetermined blood and effect site concentrations, had been established for10 min, laryngeal mask airway insertion was attempted without neuromuscular relaxants. The data were analysed using a probit analysis to obtain Cp50LMA levels. The values for Cp50LMA were 3.24 micro g.ml-1 in the control group and 1.93 microg.ml-1 in the nitrous oxide group.

The present study was undertaken to evaluate the utility of the serodiagnosis of pulmonary tuberculosis and nontuberculous pulmonary mycobacteriosis by ELISA using a Pathozyme-Myco kit (Myco kit) and a Pathozyme-TB complex kit (TB kit) (OMEGA Diagnostics Ltd.).The subjects comprised 256 healthy volunteers (HV, healthy hospital employees), 66 patients with sputum-positive active pulmonary tuberculosis (apTB), 14 patients with healed pulmonary tuberculosis (hpTB), 24 patients with nontuberculous pulmonary mycobacteriosis (NTM) and 32 patients with pulmonary diseases other than mycobacteriosis.1) The serum IgG antibody titers determined with the Myco kit were significantly higher in the apTB group (p0.01), the hpTB group (p0.01), and the NTM group (p0.01) than those in the HV and the other pulmonary disease group. At a cut-off value of the mean + 2SD of the values obtained in the HV, the positive rate was 47.0% in patients with apTB, 50.0% in those with NTM, 21.4% in those with hpTB, 3.1% in those with other pulmonary diseases, and 1.6% in the HV. Analysis of ROC curves showed that the HV and the pulmonary mycobacteriosis group (apTB and NTM) were best distinguished by a cut-off value of -0.280 OD (log), with the sensitivity and the specificity being 83.3% and 78.5%, respectively. It was impossible to distinguish apTB from NTM. 2) The serum IgG antibody titers determined with the TB kit were significantly higher in the apTB group than those in the HV (p0.01), the NTM group (p0.05) and the other pulmonary disease group (p0.01). No significant difference was observed between the HV and the patients with NTM or those with other pulmonary diseases. Although the positive rate of the test was low in the apTB group (42.4%), there was a significant difference between apTB and NTM (12.5%) (p0.05), suggesting that apTB could be distinguished from NTM. 3) Since the serum antibody titers determined by the Myco kit showed no significant difference between apTB and NTM, and there was also no difference in the positivity between the two diseases, we performed serologic examination using the Myco kit to detect both diseases as pulmonary mycobacteriosis. After diagnosing pulmonary mycobacteriosis by the Myco kit, we then used the TB kit to separate apTB from NTM. In this case, the sensitivity and specificity of the test were 55.6% and 85.7%, respectively. Better methods should be developed to distinguish apTB from nontuberculous mycobacteriosis.

We report a preeclamptic patient who revealed severe pulmonary edema. A 37-year-old woman, at 32-week gestation, underwent emergency cesarean section under general anesthesia. She had no particular past medical history. SpO2 was 84% (room air) on the arrival at the operating room, and a chest X-ray showed pulmonary edema. She was managed in the intensive care unit postoperatively, she received an intensive treatment (positive pressure ventilation, furosemide, and inotropic support), and was extubated successfully on the third postoperative day. From clinical course and echocardiographic findings, we consider that this pulmonary edema was caused by peripartum cardiomyopathy.

Elevated levels of serum surfactant protein-D (SP-D) have been previously reported in patients with idiopathic pulmonary fibrosis (IPF) and pulmonary alveolar proteinosis. To determine whether the same change is seen in other pulmonary diseases, especially pulmonary tuberculosis (TB), we measured the serum SP-D levels in active pulmonary TB (smear and/or culture: positive), acute interstitial pneumonia (AIP), IPF, acute exacerbation of IPF, hypersensitivity pneumonitis (HP), pneumoconiosis, bronchiectasis, and bacterial pneumonia by an enzyme-linked immunosorbent assay using monoclonal antibodies to human lung SP-D, and compared them with those of healthy elderly subjects over 50 years of age. The SP-D level in the healthy elderly subjects was 57.6 +/- 38.4 ng/ml (mean +/- SD, n = 287). The levels in patients with active pulmonary TB (140.6 +/- 18.2 ng/ml, n = 49), AIP (1,021 ng/ml, n = 1), IPF (307.0 +/- 180.7 ng/ml, n = 42), acute exacerbation of IPF (817.7 +/- 283.6 ng/ml, n = 3), and HP (716.6 +/- 548.8 ng/ml, n = 4) were significantly higher than those in the healthy elderly controls (p0.05), whereas those of pneumoconiosis, bronchiectasis, and bacterial pneumonia, 121.9 +/- 92.8 ng/ml (n = 8), 93.9 +/- 72.9 ng/ml (n = 11), and 72.7 +/- 3.4 ng/ml (n = 4), respectively, showed no significant difference with the controls. In active pulmonary TB, the percentage of patients whose serum SP-D levels were over 134.6 ng/ml (mean + 2SD of healthy elderly controls) was 34.7%, and therefore we considered the serum SP-D level was not useful for the diagnosis of pulmonary TB. However, it was significantly higher in the patients with cavity formation than in those without (p0.05), and there was a significant positive correlation between the serum SP-D level and the number of tubercle bacilli in the sputum (r = 0.416, p = 0.00165), erythrocyte sedimentation rate at 1 hr (r = 0.489, p0.01), and CRP level (r = 0.383, p = 0.003). These findings suggest that the serum SP-D level is a useful indicator of the disease activity in pulmonary TB.

We chose five sedatives for premedication and investigated the effect of these drugs on the induction doses of propofol. One hundred patients were allocated into one of five groups of 20. These groups consisted of control group (C) given only atropine 0.5 mg i.m.; CL group (plus clonidine 0.15 mg orally); H group (plus hydroxyzine 25 mg i.m.); M group (plus midazolam 3 mg i.m.) and D group (plus diazepam 10 mg orally). The induction dose was measured using loss of count technique. Arterial pressure and heart rate were measured, before and after propofol induction as well as after intubation. We also calculated rate pressure products (RPP) at each point. The induction doses were significantly lower in M-group than those in C-group. On the other hand, in hemodynamic responses, RPP was unchanged in any groups after propofol induction and after the intubation. Both propofol and midazolam have been known to have a depressive effect on the central nervous system via GABA-A receptor-mediated inhibition, although the exact receptor for propofol is unknown. We thought, therefore, that when the interaction occurred, both midazolam and propofol had the same effect on the GABA-A receptor and increased chloride ion flux through the channels. Hydroxyzine and clonidine, however, do not share a common receptor or exert effect on the GABA-A receptor. We consider that this was one of the reasons why induction doses of both H and CL group could not decrease significantly. We concluded that midazolam 3 mg decreased propofol induction dose significantly. Both midazolam 3 mg and clonidine 0.15 mg decreased RPP before induction and hemodynamic responses to induction and intubation were stable.

A patient with mild hypothyroidism underwent a repair of abdominal aortic aneurysm. Although the serum TSH level of this patient was very high and T4, free T4 levels were low, T3 level remained within normal ranges. Inhalation anesthesia with continuous epidural block was selected and there was no complication such as hypotension or hypothermia during perioperative period. Recently, several reports demonstrate that the preoperative supplemental therapy of the thyroid hormone should not be necessary in the case of mild hypothyroidism. Moreover, the biological potency of T3 is higher than that of T4. Thus, in patients whose T3 level is kept within normal ranges even if serum T4 level is low and serum TSH level is high, we may say that they are in euthyroid state. We think these patients can be anesthetized safely.

During the 9 years between 1983 and 1992, 36 patients with renal pelvic and ureteral tumors were treated in our hospital. There were 24 males and 12 females. The most common chief complaint was macrohematuria. Intravenous pyelography (IVP) revealed the finding of non-visualized kidney, filling defects and hydronephrosis in 99%. Histologically, 26 were found to have transitional cell carcinoma, one squamous cell carcinoma and one adenocarcinoma. The 5-year survival rate of this study was 54.5% according to the Kaplan-Meier's method. In our study the most important prognostic factor was histopathological grading.

Interaction of midazolam and thiopental in amnestic effect was studied in 30 adult patients who underwent elective surgery of lower extremities under epidural or spinal anesthesia in combination with oxygen, nitrous oxide and low concentration of sevoflurane. Combination of midazolam 2.0-3.0 mg (0.041 +/- 0.006 mg.kg-1) and thiopental 3-5 mg.kg-1 produced amnestic effect in 87% of patients. No side effects, such as decrease in O2 saturation, upper airway obstruction, cardiovascular depression and delayed emergence were observed with this small dose of midazolam. Administration of midazolam 2.0-3.0 mg before epidural, or spinal anesthesia in the operating room under observation of anesthesiologists, followed by thiopental 3-5 mg.kg-1, was safe and comfortable to the patients.

The circulatory responses to tracheal intubation using timing principle were investigated in 40 adult patients who underwent elective surgery. They were randomly assigned to one of two groups; 1) timing principle group, and 2) SCC group. In timing principle group, vecuronium 0.15 mg.kg-1 was administered. At the onset of clinical muscle weakness, thiopental 5 mg.kg-1 was given promptly. Sixty seconds after thiopental, patients were intubated. In SCC group, thiopental 5 mg.kg-1 was administered, and when patients lost consciousness, SCC 1 mg.kg-1 was given. After fasciculation, patients were intubated. The increases in systemic blood pressure, heart rate and rate pressure product were significantly lower in patients in timing principle group than in those in SCC group. Intubating conditions were almost excellent in both groups, and there were no complications in this study. In timing principle group, intubation was done 60 seconds after thiopental administration, and its timing coincided with the peak cerebral concentration of thiopental. We considered this coincidence was one of the reasons of fewer responses in patients in timing group than in those in SCC group.

The intubating conditions using the timing principle combined with small priming doses of vecuronium were evaluated in forty patients who underwent elective surgery. They were randomly assigned to one of two groups: 1) timing, 2) timing with priming. In timing group, vecuronium 0.15 mg.kg-1 was administered, and at the onset of clinical muscle weakness, thiopental 4-5 mg.kg-1 was given promptly. Sixty seconds after thiopental, patients were intubated. In the timing with priming group, vecuronium 0.005 mg.kg-1 was administered as priming doses. Four minutes later vecuronium 0.15 mg.kg-1 was given. The administration of thiopental and the intubation were done in the same way as in timing group. The time to onset of clinical weakness after the administration of vecuronium 0.15 mg.kg-1 was significantly shorter in the timing with priming group than that in the timing group (46.1 +/- 4.8 vs. 57.6 +/- 7.8, P0.01). There were no significant differences in intubating score, T1, TR, onset time, and duration between the two groups. We conclude that the timing principle combined with small priming doses of vecuronium might be safe and useful for rapid tracheal intubation.