[Long term result of aorto-coronary bypass grafting (author's transl)].
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Biomedical subjects
Publications and source records attributed to H Tsuruta.
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New formulae for the estimation of change in water (delta W) and salt (delta NaCl) contents of the body from hematocrit, plasma Na, and protein concentrations were proposed based on a compartment model of body fluid regulation: delta W = 0.4(delta Vi/Vi0) + 0.2(delta Ve/Ve0) litres/Kg of body weight; delta NaCl = 1.64[delta Ve/Ve0 + 1)/(delta Vi/Vi0 + 1) - 1)-1] Gms/Kg of body weight; where delta Vi/Vi0, and delta Ve/Ve0 are relative increment of intra and extracellular fluid volume. delta Vi/Vi0 is considered equal to ([Na]0/[Na]-1) under the condition of normal cell membrane, whereas delta Ve/Ve0 may be a nonlinear function of relative increment of plasma volume and hematocrit or sodium concentration. Thus a nomograph was presented to obtain delta W and delta NaCl simultaneously. This nomograph could predict delta W and delta NaCl with satisfactory accuracy in the experiments with the dogs to which fluid of various osmolarity was given intravenously. It was also confirmed in a case of mixed water depletion in which the clinical estimation agreed with that of the present method. The conventional formulae of calculation based on either pure dehydration or purse salt loss proved not to be applicable in the usual cases of body fluid disturbances.
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Suitability for grafting and efficacy of aortocoronary bypass to the completely occluded coronary artery were studied in 25 patients in whom bypasses were attempted to the segments distal to the complete occlusion. We concluded that even when a coronary artery is occluded completely, if the distal coronary artery has a suitable lumen and viable muscle remains, bypass to the segment distal to the occlusion is worthwhile. Bypasses on the left anterior descending arteries were successfully constructed in 80% of grade 3 patients where distal segments of occlusion were severely compromised. Thallium-201 stress-myocardial scintigraphy is reliable in confirming myocardial viability beyond the area of complete coronary artery occlusion.