[Deep body temperature difference following open heart surgery, with special reference to hemodynamic parameters].
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Biomedical subjects
Publications and source records attributed to H Mohri.
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Intratumoral administration of a large dose of OK-432 has two antitumor functions; a direct cytotoxic effect and an indirect effect through the host reticuloendotherial functions. It has been pointed out that this method, however, occasionally results in shock. Several investigators have suggested the importance of the use of general anesthesia to avoid such shock. In order to explore the hemodynamic effect of intratumoral injection of OK-432, a simulated experiment (OK-432 or saline intramuscular injection) was carried out utilizing 10 anesthetized and 10 unanesthetized dogs. In addition, hemodynamic alterations during the OK-432 administration were studied in nine patients under neuroleptal anesthesia. In both anesthetized and unanesthetized dogs, OK-432 intramuscular injection resulted in a slight decrease of the mean arterial pressure, left ventricular systolic pressure and cardiac output as compared with those of the saline injected dogs. The hemodynamic alterations, however, were minimal and were thought not to cause severe hemodynamic derangements. Clinical experiences also showed no serious hemodynamic effects by the OK-432 intratumoral injections. It was concluded that the OK-432 intratumoral injection appeared not to induce hemodynamic derangement when applied to euvolemic and hemodynamically stable patients.
Out of sixty patients with thromboangitis obliterans from January 1966 to December 1981, 50 cases underwent such surgery as sympathetic ganglionectomy, thromboendarterectomy and arterial bypass. The remaining 10 cases received conservative therapies such as intravenous infusion of Prostaglandin E1 (60 micrograms in 5% glucose 500 ml) and epidural sympathetic ganglion block using 1% xylocaine. Good results were obtained in 29 operative cases and in 5 cases with non-surgical therapies. Among the operative cases, the subjective symptoms after discharge improved in forty-one patients (82%) unchanged in three (6%) and remained poor in six (12%). While, those of non-surgical group improved in eight and unchanged in two. In twelve of twenty-nine operative patients whose subjective symptoms improved immediately after discharge, their subjective distress turned worse again. However, the subjective symptoms of 5 patients in non-surgical group remained well in follow-up studies. Many patients who were diagnosed unchanged during follow-up period, had underwent the lumbar and/or thoracic sympathetic gangloinectomy. It is thus concluded that the effects of the sympathetic ganglionectomy are not permanent. The arterial reconstructive surgery is very effective for relief of peripheral ischemia in the follow-up studies if good function of the grafts was obtained in the early postoperative period.
Transcutaneous oxygen tension (tcPO2) of superficial layer of the foot at 44 degrees C was studied preoperatively in 33 patients (38 legs) with arteriosclerosis (ASO) or thromboangiitis obliterans (TAO). The cases were divided into two groups. The first group consisted of 3 legs, amputated. The second group consisted of 35 legs, not amputated but receiving such treatments as arterial bypass, lumbar sympathectomy or conservative therapy. The tcPO2 index was calculated by dividing the tcPO2 of the chest wall by the tcPO2 of the foot. The value of the tcPO2 of the chest decreased in proportion to the advance of age. There was no significant differences in the tcPO2 indices between ASO and TAO, nor among different sites of peripheral vascular occlusion. On the other hand, as the grade of Fontaine classification increased, the tcPO2 index reduced, with significant difference between grade II and IV. The tcPO2 index of the amputated group was 0.08 +/- 0.04. In contrast, the tcPO2 indices of the lumbar sympathectomy, arterial bypass and conservative therapy groups were 0.74 +/- 0.18, 0.84 +/- 0.12 and 0.74 +/- 0.13, respectively. There was significant difference between the amputated and non-amputated groups. From our results, it is suggested that oxygen tension measured transcutaneously is a useful indicator for the decision of operative indication and surgical procedure.
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A 36-year-old woman with a history of left nephrectomy for renovascular hypertension secondary to arterial occlusive lesion of Takayasu's arteritis was re-admitted to our hospital with complaints of postprandial abdominal pain in the sixth post-operative month. On the 14th hospital day, the developing abdominal distension and generalized tenderness suggested a mesenteric vascular occlusion. Following abdominal aortography, emergency surgery was performed. The entire small bowel was edematous and markedly cyanotic with spotted, dark colored areas and the mesentery was pulseless. The patient was successfully treated by thromboendarterectomy at the origin of the celiac and superior mesenteric arteries and the necrotic loop of intestine was then resected 7 days later. Takayasu's arteritis was diagnosed by histological examination of the resected specimens. Although the occurrence of mesenteric infarction secondary to Takayasu's arteritis is rare, the possibility of mesenteric vascular occlusion should be given consideration in the follow-up of patients with Takayasu's arteritis.
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A 63 year-old woman with a malignant duodenocolic fistula of colonic origin was so diagnosed following radiological examination. She had symptoms of feculant vomitus, persistent diarrhea and emaciation. Following preoperative treatment of the nutritional and electrolyte disorders with intravenous hyperalimentation, a one-staged right hemicolectomy and pancreatoduodenectomy was performed successfully. We emphasized that an en-bloc removal of all the possibly involved structures is the most successful procedure for malignant duodenocolic fistula of colonic origin.
A flow probe for direct measurement of blood flow of the mitral valve was devised. It was useful for acute experiment, particularly concerning pathophysiology of the mitral valve function. Insertion of the probe into the left atrium and fixation to the left atrial wall and thus to the mitral orifice were readily and satisfactorily performed without disturbance of blood flow and valvular function. It must also be emphasized that support with cardiopulmonary bypass was not necessary at the time of insertion of the probe. Effectiveness of the procedure has been confirmed through simultaneous observation of echocardiogram and mitral blood flow of the dog's heart with ruptured chordae tendineae.
Effects of the left heart bypass (LHB) by the left atrium (LA) to the aorta (AO) shunt on the heart were evaluated by measuring such parameters as tension time index (TTI), diastolic pressure time index (DPTI), DPTI/TTI ratio, coronary blood flow and myocardial oxygen consumption (MVO2) in open-chest dogs. A pneumatically driven bypass pump made of polyurethane was utilized in this study. No significant change of MVO2 was observed with surgical maneuver to connect the LA-AO LHB pump to experimental animals. During synchronous pumping of LHB, TTI decreased by 35%, MVO2 decreased by 56% of the control and DPTI/TTI ratio increased by 79%. However, coronary flow decreased by 35%, presumably due to autoregulation mechanism of the coronary circulatory system. Both synchronous and asynchronous LHB demonstrated the same level of effect in volume unloading. However, significant diastolic augmentation was noted only in the former. LA-AO LHB, which has a sufficient supporting effect and does not damage the ventricular wall, was considered to be very useful for temporary support for the failing heart, especially for postoperative low output state.
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