[Surgical management of the tricuspid valve--follow-up studies of valve replacement and annuloplasty].
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Biomedical subjects
Publications and source records attributed to K Kusajima.
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Rejection processes were studied in xenografts and allotransplants of cat or dog lungs to dogs. Cinemicroscopy of the microcirculation in untreated animals showed almost immediate sludging, cellular aggregation, reduced vascular caliber, diminished blood flow, and rapid development of perivascular edema. The principal mechanisms of the extremely rapid xenograft rejection include capillary and arteriolar obstruction due to cellular aggregation. Pretreatment with heparin was virtually valueless, while methylprednisolone offered temporary protection.
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Hyperacute pulmonary rejection was reproduced by perfusion of the isolated lung with heparinized heterologous blood. The cat lung was perfused with dog venous blood at a pressure of 30 mm. Hg. Pulmonary hemodynamic and functional studies showed that blood flow decreased to 14 per cent of the control and pulmonary vascular resistance increased sevenfold. Dynamic pulmonary compliance decreased only slightly to 83 per cent at 15 minutes, but normal pH, PO2, and PCO2 were maintained in the pulmonary venous blood even 15 minutes after the start of perfusion, because perfusion was decreased to a greater extent than ventilation.
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The role of positive end expiratory pressure (PEEP) was evaluated in preventing the deleterious mechanical respiratory effects of fatty acid pulmonary embolism. One group of animals had ventilation without PEEP, while the second group had PEEP of 10 cm H2O applied only to the right lung. In the right lung, PEEP slightly reduced the blood flow, increased the vascular resistance, but reduced intersititial edema and reduced the degree of shunting to almost normal. Hypoxemia was prevented in the right pulmonary venous system, but was prominent in the left. The hypoxemia and shunting in the left lung were comparable to the Group I animals without PEEP to either lung. These studies confirm the value of PEEP in the therapy of the pulmonary manifestations of fat embolism which are the lethal factors in the fatty embolism syndrome.
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