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大坪 修
1981 年 10 巻 1 号 p.
1
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
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賀来 克彦, 北村 惣一郎, 中埜 粛, 島崎 靖久, 奥田 彰洋, 中田 精三, 八木原 俊克, 前田 世礼, 佐藤 重夫, 榊原 哲夫, ...
1981 年 10 巻 1 号 p.
3-6
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
We performed veno-arterial bypass (V-A Bypass) in eight patients for severe postoperative heart failure intractable with medical control and intra-aortic balloonn pumping (IABP). The average bypass time was 62 hours ranging from 2 to 261 hours and perfusion index ranged from 0.8 to 2.8L/min/m
2.The problems we met during V-A Bypass were 1) uncontrollable bleeding, 2) renal failure, 3) rupture of a pump tube and a membrane lung, 4) unstable hemodynamics. Bleeding was relevant to the mode of heparinization and it was better controlled with continuous administration of heparin at the dose of 5-7 units/kg/hour by keeping the activated coagulation time (ACT) around 200 seconds. For the control of the renal failure, hemodialysis with a unit incorporated in the bypass circuit was preferred to peritoneal dialysis in its efficacy. Rupture of a membrane lung was experienced with a Landé-Edwards' lung, but not with a Kolobow lung. The lifetime of a pump tube of Latex rubber was about three days and the one of more durability was expected. Hypothermia in the level of 32-34°C seemed to be effective in decreasing the oxygen consumption during V-A Bypass with the proper use of vasodilator.
No survival was obtained in this series with V-A Bypass. Many troubles we experienced with the present type of V-A Bypass may be solved when an assist heart device becomes available.
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本郷 忠敬, 香川 謙, 仁田 新一, 渡辺 孝, 佐藤 尚, 堀内 藤吾
1981 年 10 巻 1 号 p.
7-9
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
In a purpose to evaluate the effect of V-A bypass as the most sinple mechanical assist for the heart in clinical use, changes in haemodynamics and blood gas analyses were investigated during high flow V-A bypass of 11/min for 10 healthy dogs. Acid-base balance wa rot mrrerted di rinca all the nroeedure.
Aortic flow did not decrease despite high flow bypass, resultl.rin high output state as a whole. No decrease in arterial pressure was noted, as a result of decrease in peripheral vascular resistance. Haemodynamics deteriolated after 60min of bypass, suggesting time limit of high flow V -A bypass for healthy dog in these condition.
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小田桐 重遠, 湘馬 康宏, 勝本 慶一郎, 仁熊 浩, 井上 正
1981 年 10 巻 1 号 p.
10-13
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Intra Aortic Balloon Pumping (IABP) have widely been employed as a mechanical support for card.iogenic shock.
However, insertion of intra aortic balloon through the femoral artery may be difficult for the patient who have obstructive aort-iliac atherosclerotic lesion.
we introduced new method for such patient, our circuit system consists of a Pulsatile Assist Device (PAD) with two ball-Valves at its inlet and outlet, Hemodynamic effect of V-A bypass pumping method using this device was already reported.
we applied this device for left heart bypass pumping method. Blood was drained from left atrium and infused only diastolie period from femoral artery. The flow was converted into pulsatile flow through PAD driven by Datascope System 80.
Data were as follows.
Aortic mean systolic pressure decreased 12.6±33%, Tension Time Index decreased 13.5±3.1% and Cardiac output decreased 35±6.3%. on the other hand, Mean aortic pressure increased 10.6±3.9% and Total Perfusion Flow increased 12.8±6.8%.
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田上 重喜, 望月 高明, 松村 誠, 岩宮 博, 大坪 厚美, 広中 智之, 中垣 満, 田口 一美
1981 年 10 巻 1 号 p.
14-17
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Two types of pulsatile assist devices were combined with transapical left ventricular bypass circuit, cylinder type combined with balloon for IABP and PBP-Model 20, in order to obtain the effect of counterpulsation. The hemodynamic effect of these devices were evaluated in calves with healthy or failing heart.
The experiment showed the following results:
1) PBP-Model 20 is superior in the effect of counterpulsation, damage of blood, and thrombus formation to the cylinder type device.
2) PBP-Model 20 showed the typical signs of diastolic augmentation and systolic unloading on the aortic pressure wave form.
3) PBP-Model 20 could be run for a week without any problem; it showed the sign of counter pulsation effect on the aortic pressure wave form throughout the experimental period.
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小林 繁夫, 高橋 英世, 菅原 修二, 西山 博司, 伊藤 宏之, 苅谷 庸子, 榊原 欣作, 青木 利三郎, 若井 秀治, 中山 芳則, ...
1981 年 10 巻 1 号 p.
18-21
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
The experimental studies on left ventricular assist circulation (LVAC) using a roller pump system able to deliver pulsatile flow has been carried out to relieve the strain on the failing left ventricle. This pulsatile pump was attached between left atrium and descending thoracic aorta in mongrel dogs weighing 15 to 20kg. Left atrial to aortic bypass was performed during 3 hours to reduce left ventricular pressure to zero and to maintain normal value for systemic blood pressure. In some instance, pulmonary artery pressure increased, Pao
2 decreased and Paco
2 increased gradually during LVAC. Though, in another instances, pulmonary artery pressure was miantained within normal limit, the same results were obtained on the data of blood gas analysis. More studies must be continued from both respects of pulmonary ventilation and bypass support.
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北村 惣一郎
1981 年 10 巻 1 号 p.
22
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
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田口 一美, 中垣 満, 望月 高明, 村下 純二, 松村 誠, 磯野 基明, 石川 政則, 川上 恭司, 岩宮 博, 田上 重喜, 大坪 ...
1981 年 10 巻 1 号 p.
23-26
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
The purpose of this study was to develop a total system of an implantable assisted heart for longer term circulatory assistance exceeding one month. This paper presents a pre-clinical evaluation of implantable assisted heart in a series of basic and animal experiments as followed:
(1) evaluation of assisted heart in quantitative models of ventricular failure,
(2) evaluation of thrombus formation in aorta-aorta bypass (Ao-Ao bypass) pump
(3) chronic implantation of left atrialthoracic aorta bypass (LA-Ao bypass) pump for left ventricular failure
(4) development of newly blood pump for left ventricular-abdominal aorta bypass (LV-Ao bypass).
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高橋 英嗣, 佐久間 まこと, 山本 克之, 三田村 好矩, 三上 智久
1981 年 10 巻 1 号 p.
27-30
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Although the clinical application of LVAD has started, we have only a little knowledge on the hemodynamic changes during LVAD pumping. The interaction between the natural heart and LVAD was investigated through the entrainment of the heart rate by LVAD asynchronous pumping.
Sinus rhythm was monitored in LVAD implanted dogs and sheep while changing the pumping rate. The entrainment of sinus rhythm by LVAD pumping was observed in anesthetized dogs and also awake sheep. Namely, sinus rhythm varied according to the change in pumping rate when the pumping rate was approximately equal to or half the sinus rhythm.
To explain the discovered entrainment, computer simulation was performed. The macroscopic model of 'External periodic force and Self-oscillatory system' was used, since it has been known to induce the entrainment. In the model SA node was assumed to be a self-oscillatory system and LVAD an external periodic force. The SA node was also assumed to have the characteristic that sinus rhythm changes depending on the phase when neural impulses happen to arrive at the SA node. The computer simulation showed the similar modification of sinus rhythm by LVAD pumping to that in experiment.
The above gives us some idea of the control system of the heart and, moreover, LVAD is a useful tool for the physiological investigation.
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喜多村 直, 明石 一, 赤松 映明, 城山 友広, 相馬 敬司, 西村 営三, 龍田 憲和, 松田 捷彦, 山里 有男, 村口 和彦, 福 ...
1981 年 10 巻 1 号 p.
31-34
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
This paper is concerned with a computer control design of blood pumps in multiobjective use—for extracorporeal circulation, cardio-circulatory assist and artificial hearts of total replacement type. The designed control system can implement constant control of blood pressure and/or pump output, and optimal control of cardiac work, wave form of blood pressure or driving pressure. Two experiments were made for test of system performance. The test resulted in precise adaptive control of hemodynamics under large variation of mechanical property of circulation.
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喜多村 直, 大曲 啓介, 明石 一, 赤松 映明
1981 年 10 巻 1 号 p.
35-38
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
This paper concerns with building a practical mathematical model of artificial valves used for assist devices. This model, together with the models of the cannulas, the pump sac, the pneumatic driver, and the cardiovascular model, is loaded in the control computer, being referred to for real-time control of the cardio-circulatory system. The model dynamics, with a pressure drop of the valves as the input and a volume flow through them as the output, is assumed to have four parameters to be identified. The identified value of them by a single input-output relation is true for a variety of pumping condition with 0 to 2 Hz. Simulatión results of an overall assist system model including the valve model meet well the experimental data by the mock circulation.
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三田村 好矩, 佐久間 まこと, 三上 智久, 大沼 武彦, 高橋 英嗣, 鈴木 幸司, 中村 孝夫
1981 年 10 巻 1 号 p.
39-42
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
An one piece diaphragm type transapical assist pump was developed. The pump consists of an inflow Dacron graft, inflow polyvinylchloride (PVC) tube, inflow bovine pericardial xenograft, pump body, outflow bovine pericardial xenograft, outflow PVC tube and Dacron graft. The pump body is lined with polyurethane. The design provides a seamless blood chamber, free of the seam at the junction of the pump housing and the diaphragm, a known location of thrombus formation. One piece fabrication is achieved by dipping the diaphragm mold in polyurethane, placing the epoxy housing on the diaphragm mold, then dipping the pump housing diaphragm mold assembly. This process coats both surfaces and forms an air dried film completely lining the blood chamber. Maximum stroke volume of the pump is around 40ml. The pump was paracorporeally implanted in seven sheep. Sheep survived up to 14 days. Causes of termination were infection, pump rupture, bleeding and lung edema. Examination of the pump revealed tiny spotted thrombus in one pump and ringlike thrombus at the junction of the PVC tube and the pump body in two pumps. It can be concluded that one piece fabrication is effective for prevention of thrombus generation in the pump.
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―コンピュータ制御による拍動流ポンプ―
福井 康裕, 土屋 喜一, 佐藤 勝彦, 今井 康晴, 菅原 基晃, 高梨 吉則, 本多 正知, 副島 健市
1981 年 10 巻 1 号 p.
43-46
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
A newly developed pulsatile roller pump for an advanced cardiopulmonary bypass system, which is specially designed for infants, is described. The pump is driven by a stepping motor under the precise control of a microcomputer, so that heart rate, cardiac output, tidal volume and S/D (Systolic to Diastolic) ratio for pulsatile flow perfusion can be set as desired. The pump can run either by an internal trigger or by an external trigger from the electrocardiogram or arterial pressure to allow synchronized counterpulsation. It is also possible to drive the pump as a conventional roller pump, delivering nonpulsatile blood flow. Results of testing the pulsatile roller pump with in-vivo (rabbit) experiments are presented.
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小松 作蔵
1981 年 10 巻 1 号 p.
47
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
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阿岸 鉄三, 江良 和雄, 金子 岩和, 星野 敏久, 佐中 孜, 鈴木 利昭, 太田 和夫, 佐々木 伸夫, 上田 満隆
1981 年 10 巻 1 号 p.
48-51
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
A carriable type artificial kidney system has been devised in an attempt to widen the social activities of dialysis patient. Mechanical components such as a blood pump, a dialysate delivery pump, a heparin infusion pump, controllers and monitors, and disposables for three times hemodialyses such as dialyzers, granulated dry chemicals for dialysate, are packed in a travel suitcase. A container works as an outer shell of a 70L dialysate tank.
Clinical hemodialyses have been successfully experienced both in terms of carriability and dialysis performance.
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梅香 家鎮, 三城 正紘, 窪田 宏明, 村上 瑛一, 内海 勇, 松崎 恒之, 中谷 史郎, 猪飼 康雄
1981 年 10 巻 1 号 p.
52-55
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
We have developed and produced a new portable artificial kidney system.
The dialysis machine has a blood pump, heparin pump, dialysate pump, pressure controller and UFR controller as well as all necessary safety and monitoring systems, with its various mechanisms and displays controlled by a microcomputer. It is very small and lightweight, measuring only 376×300×135mm and weighing a mere 8.5kg, and is designed with emphasis on high accuracy, reliability and easy handling.
This system is intended for multipurpose uses. For patients who take along it, the system permits a minimum consumption of dialysate (a batch type) and a shorter dialysis time by employing series of dialyser and adsorbent. And for patients in home and hospital, the system can use continuously diluted dialysate by utilizing a small dialysate supplier (340×410×160mm, 9.5kg) we have developed at the same time.
The dialyser is of small size and high performance, using cuprammonium rayon hollow fibers with thin wall thickness of 8 microns. The adsorbent column contains beads-type charcoal coated with polyalcohol that is excellent in blood compatibility.
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秋沢 忠男, 関口 孝, 中山 文義, 高橋 健, 佐藤 昌志, 北岡 建樹, 出浦 照国, 越川 昭三, 佐々木 寛治, 末広 哲郎, 津 ...
1981 年 10 巻 1 号 p.
56-59
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
We developed ion-exchangeable membrane composed of semi-permeable membrane, ion exchange resin and diffusion barrier membrane. In in vitro studies, ion-exchangeable membrane had ion exchange capacity for 4mEq of cation and 3.3mEq of anion per each gram of ion exchange resin. In in vivo experiments with acute renal failure dogs, electrolyte and acid-base disturbances in uremia were improved with blood perfusion to ion-exchangeable membrane device.
These results indicate that ionexchangeable membrane can be applied for the compact type of artificial kidney.
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白根 浩朗, 舟久保 煕康, 三浦 昇, 竹内 啓, 稲生 綱政
1981 年 10 巻 1 号 p.
60-63
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
For the realization of a wearable artificial kidney, the filtrationadsorption method with continuous low filtrate flow is suitable. For a filter for this use, a plasma separator is advantageous as regards the miniaturization of the filtration equipment. A parallel flow type plasma separator was designed based upon the relationship between filtrate flux and shear rate. To miniaturize the device, the blood cistern was laminated and in vivo experiments with dogs were performed. Filtrate flow rate was lower than the value of the design specification. From this result, some problems to be considered in more practical design were examined.
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―透析液循環ポンプ及び透析液保温システム等の改良―
瀬尾 真一, 大坪 修, 堀内 孝, 葛原 敬八郎, 杉本 久之, 高井 信治, 高橋 浩, 稲生 綱政
1981 年 10 巻 1 号 p.
64-67
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
A Wearable Artificial Kidney ( gross weight; 7kg) which has the possibility of clinical trial has been developed in our laboratory. Main improvement of the device are a dialysate pump, a reservoir and a dialysate warming system. This dialysate pump was 30% smaller in size and with 50% saving in weight as compared to conventional one. Because the reservoir is made of hard materials (polypropylene), the increase in level of liquid surface reveals volume of removed water. In regard to the dialysate warming system, bodywarmers and a patient's temperature were used as the sources of heat. We assembled the device consisting of these and tried in vivo experiments. An anephric dog was maintained under stable condition by this system for about three weeks. As the result of in vivo experiments, it seems that this system will be applied to a clinical trial.
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小高 通夫
1981 年 10 巻 1 号 p.
68
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
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清水 伸, 吉田 文武
1981 年 10 巻 1 号 p.
69-72
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
By using several cartridges in turn, which contain activated carbon immersed in dialysate or substitution fluid, considerable amount of urea and other toxins can be removed from recycled dialysate or ultrafiltrate. In
in vitro dialysis experiments, using 6 cartridges, each containing 1kg of activated carbon immersed in 1.5L of dialysate, 58% of urea, 74% of uric acid, and 77% of creatinine were removed from 30L of body fluid, containing 2g/L of urea et al., in 6 his of dialysis. In similar in vitro tests on filtration, using 6 cartridges, each containing 500g of activated carbon immersed in 750ml of substitution fluid, 51% of urea, 73% of uric acid, and 70% of creatinine were removed from body fluid in 6 his of operation. In
in vitro experiments on simultaneous filtration/dialysis, using 4 cartridges, each containing 1kg of activated carbon and 1.5L of dialysate, 52% of urea, 63% of uric acid, and 77% of creatinine were removed in 5 hrs of operation.
These systems require 3 to 6kg of activated carbon immersed in only several liters of dialysate or substitution fluid, conveniently packed in presterilized cartridges. Large amount of dialysate or substitution fluid and machines to prepare these fluids at the bed side are not required.
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屋ケ田 和彦, 大坪 修, 堀内 孝, 石川 州洋, 内間 高夫, 山内 潤, 山田 豊, 高井 信次, 高橋 浩, 稲生 綱政
1981 年 10 巻 1 号 p.
73-76
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
A new type siliceous adsorbent for ammonium ion was used for the dialysate regneration system.
This system is based upon the use of activated charcoal, alumina, urease, and the siliceous adsorbent for ammonium ion named ZEC-50. Waste products (Creatinine, Urea, Phosphate) was succesfully removed from 5-liters of dialysate in an anephric dog with this system. However, for a clinical demonstration it is thought to be necessary to improve the adsorbent for ammonium ion, because a large volume of adsorbent of ZEC-50 is needed according to its capacity of ammonium ion.
As a result of adsorption tests, it suggests that MORDENITE will be one of good adsorbents for ammonium ion in a new type dialysate regeneration system.
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広瀬 正美, 吉田 俊彦, 佐藤 好得, 鈴木 弘之, 三田地 広和, 小川 秋広, 高橋 源作, 都築 一夫, 山本 富夫, 杉山 敏, ...
1981 年 10 巻 1 号 p.
77-80
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
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山中 忠衛, 佐々木 寛治, 奥山 寛, 小林 力, 秋沢 忠男, 越川 昭三
1981 年 10 巻 1 号 p.
81-84
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
The impulse response method is applied to evaluate the performance of hemodialysers. This method gives various informations about the inner state of dialysers, which can not be obtained by ordinary steady state measurements. These informations make possible to evaluate the elements determining the dialysis efficacy, such as blood and dialysate flows, and dialysis membranes. Successive measurements in vivo are also possible by using an appropriate tracer.
In this paper, several kinds of hollow fiber and Kiil type dialysers are tested preliminarily in vitro, and hollow fiber type dialysers are tested in vivo. Degrees of stagnancy in blood and dialysate flows are evaluated by the impulse response data. It is shown by the response data in vivo that the time dependent lowering of the dialysis efficacy relates primarily to the blood compatibility in the blood inlet region of the dialysis membranes.
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峰島 三千男, 酒井 清孝, 西本 裕美子, 小林 快三
1981 年 10 巻 1 号 p.
85-88
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Pulse flow has been said to reduce overall transfer resistance. Therefore, pulse flow appliance to hemodialysis can improve total treatment efficiency.
In this report, pulsatile removal effects on K
+, urea, and creatinine were investigated
in vitro by using Asahi AM-06 dialyzer.
As a result, each mass transfer coefficient increased with 80-90 beats (min-1), higher amplitude, and lower Constant Flow Ratio, respectively.
In addition, same high efficiency will be expected for hemofiltration and hemoperfusion.
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―体内埋込用U字型ヘモフィルターの開発―
渡辺 俊文, 大坪 修, 堀内 孝, 内間 高夫, 草場 亮輔, 高橋 郁夫, 武藤 真, 高橋 貢, 土肥 健純, 福井 清, 渥美 和彦 ...
1981 年 10 巻 1 号 p.
89-92
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
As an approach to the implantable artificial kidney, we deviced a unique intrabowel-filtrate infusion artificial kidney which endowing gromerular filtration to hemofilter and tubular reabsorption function to the intestine.
Tests were carried out in dogs with renal failure, in which the blood was passed through a hemofilter via a cervical external shunt and the filtrate injected into a cecal fistula to permit reabsorption from thecolon. The hemofilter used are polyacrylonitryl, polymethylmethacrylate, and polysulfon.
Furthermore, U-shaped polysulfon hemofilter was designed in order to implant in the intraperitoneal space.
As the result of tests, animals were maintained contnuously by this system and survived for 180 hours. It seems to indicate a step forward in the development of implantable artificial kidney.
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大坪 修
1981 年 10 巻 1 号 p.
93
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
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阿岸 鉄三, 中島 俊秀, 谷原 正夫, 高倉 孝一
1981 年 10 巻 1 号 p.
94-97
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Specific adsorbents which selectively adsorb immunoglobulins from blood have been sought in an attempt to utilize them for removal of antibodies and immune complexes in immune diseases.
In vitro and in vivo experiments evidence that some inorganic porous materials adsorb γ-globulin with considerable selectivity. Selectivity of adsorption is improved by chemical treatment of material surface. Compatibility to blood cells is expected to be modified by surface coating with chemical materials.
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芝本 隆, 松井 則明, 小沢 潔, 中村 義弘, 秋葉 隆, 吉山 直樹, 中川 成之輔, 根本 毅志, 北岡 建樹
1981 年 10 巻 1 号 p.
98-101
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Evaluation method of dialyzer from the viewpoint of biocompatibility currently includes influence on blood corpuscles, activation of complement system, immunological reactions, and so on. As it is not totally systematized yet, there is still a need to find out new parameters. In present study, β-thrombogloburin (β-TG) was studied if it can be a tool of biocompatibility evaluation. Among various membranes tested, β-TG showed a significant elevation after single use of PAN and Cuprophane. As to the difference of binding of hollow fiber, spiral type showed marked elevation. β-TG was only detected in the filtrate of EVA. Thus, β-TG was confirmed as a useful and practical method for evaluation of biocompatibility of dialyzer.
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岡野 光夫, 片岡 一則, 桜井 靖久, 島田 昌, 鵜木 正夫, 篠原 功, 赤池 敏宏, 前田 瑞夫, 井上 祥平, 笠原 靖, 渡辺 ...
1981 年 10 巻 1 号 p.
102-105
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Adsorption behaviors of γ-lobulin on poly (2-hydroxyethyl methacrylate) (PHEMA), a hydrophilic surface, poly-styrene (PSt), a hydrophobic surface and HEMA-St block copolymer, microphase separated surface were studied by UV-CD method, wettability of protein solution and newly method of electron microscopy using ferritin labelled rabbit anti-human γ-globulin IgG as a staining agent. These results showed the different orientation of adsorbed γ-globulin on the hydrophilic and the hydrophobic surface. That is, γ-globulins were adsorbed onto the hydrophobic surface with therir Fc segment, but adsorbed onto the hydrophilic surface with their Fab segment. These data suggest that the deformation of the adhered platelets and lymphocytes was large on the γ-globulin precoated PHEMA surface because of specific reaction of platelet and lymphocyte Fc receptor with Fc segment which is exposed to liquid phase. On the contraly, γ-globulin selectively adsorbed on the hydrophobic domains of block copolymer surface. So it was elucidated that the adhered platelets and lymphocytes were observed to be round.
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―高分子材料を用いる血液細胞の粘着制御
片岡 一則, 岡野 光夫, 桜井 靖久, 西村 隆雄, 前田 瑞夫, 井上 祥平, 島田 昌, 篠原 功, 赤池 敏宏, 鶴田 禎二
1981 年 10 巻 1 号 p.
106-109
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Adhesion of rat platelets and lymphocytes on polystyrene/polyamine comb type copolymers (SA copolymers) was investigated. Shape changes of attached platelets can be controlled from “negligible” to “marked” by varying the mode of “microphase separation” of SA copolymer surfaces. Adhesivity of platelets and lymphocytes can be controlled, individually, by coating SA copolymer surfaces with plasma protein, suggesting that separation of lymphocytes from platelets could be achieved on an appropriate SA copolymer surface adsorbed with plasma protein. We assume that the “microphase separated” structure of SA copolymer may regulate the adhesion and shape change of cells through its effect on a redistribution of glycoproteins present at the plasma membrane of platelets.
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Y. ASANUMA, P. S. MALCHESKY, M. BLUMENSTEIN, I. ZAWICKI, J. W. SMITH, ...
1981 年 10 巻 1 号 p.
110-113
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Plasma exchange using either cell centrifuge or membrane filtration has been advocated for the treatment of autoimmune disorders. Major limitations to its chronic and widespread application are the requirement for plasma infusion products, loss of essential plasma substances, possible contamination of the infusion solutions and limited solute removal related to the volume of exchange. To overcome these problems a continuous cryofiltration technique has been developed for application in patients with immune complex mediated disease. Plasma containing the macromolecules to be removed is filtered from blood by an initial filter, then cooled and filtered by a second membrane to remove coldprecipitable proteins and large molecules. The treated plasma is then returned to the patient on-line. The removal of immune complex containing cryoglobulins by this technique has effected great improvement in a patient with severe unremitting rheumatoid arthritis.
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桜井 靖久
1981 年 10 巻 1 号 p.
114
発行日: 1981/02/15
公開日: 2011/10/07
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村瀬 允也, 阿部 稔雄, 清水 健, 鷲津 卓弥, 田中 稔, 野垣 英逸, 竹内 栄二, 椙山 直敏, 末永 義人, 鬼頭 修平, 渡辺 ...
1981 年 10 巻 1 号 p.
115-118
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Endcardial (J-type) and newly designed epicardial leads for atrial pacing were evaluated comparing with right ventricular endcardial lead.
Pacing threshold and P-wave voltage were measured at the time of initial implantation and after 1-2 weeks.
Pacing threshold was significantly higher in atrial pacing than in right ventricular pacing at the acute and chronic periods. After 1-2 weeks, it elevated to 2-3 times as much. Although there were no significant difference between these two atrial leads, the epicardial lead showed higher pacing threshold and failed to pace in some cases at short pulse duration.
The new epicardial lead needs farther investigation for permanent implantation.
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鈴木 隆, 横山 正義, 松下 功, 柳沢 正敏, 河村 剛史, 長柄 英男, 日野 恒和, 竹田 晴男, 板岡 俊成, 笠置 康, 毛井 ...
1981 年 10 巻 1 号 p.
119-122
発行日: 1981/02/15
公開日: 2011/10/07
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フリー
Theoretical benefits afforded by P-synchronous, atrial and A -V sequential pacing have been recognized before. However, historical difficulties associated with achieving and maintaining atrial lead position and low electronic pacing system reliability in comparison to ventricular systems have resulted in a low utilization of atrial systems. But recent reports in the medical literature suggest that reliable, practicable atrial pacing systems and surgical approaches to the atrim may now be available.
We performed the right parasternal approach to apply atrial sensing, pacing to three patients. We advocate this approach for permanent physiologic pacing since it permited easy mediastinal entry without entering pleura and a wider exposure of accessible atrial sensing, pacing sites.
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坂東 健, 木元 春生, 川浦 幸光, 坂東 徹, 三崎 拓郎, 岩 喬
1981 年 10 巻 1 号 p.
123-126
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Ventricular pacing have many problems. Cerebral embolus, chest pain or discomfort, night sweats or palpitation, and cardiac failure are them. Otherwise, atrial pacing is useful for tricuspid regurgitation, high ventricular threshold and rapid atrialstimulation. Atrial electrodes are necessary for atrial pacing, P-wave synchronized pacing, A-V sequential pacing or rapid atrialstimulation.
We have used various electrodes, and compared those properties. Those electrodes were Coronary sinus, J-shaped with tines, No tine, Fujiwara's method, Sutured endocardial, and new Urethane Jshaped with small tines. Comparison was done at the point of the threshold and P-wave sensing. Stimulation threshold of atriumwas minimum as 0.5V in J-shaped urethane catheter. But the atrial potential was unsatisfactory for sensing due to the small surface of the electrode. P-wave potential was maximum as 3.5mV in J- shaped electrode with no time. But having no tine caused low stability. Coronary sinus leads need high voltage to pace, and gain low potential to sense.
Accordingly, for sinus bradycardia, the J-shaped urethane catheter lead is the best. In demand pacing, a large surface electrode must be chosen. For P-wave synchronized pacing, new electrode was desirable to exclusive use for sensing.
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鄭 正勝, 中村 昭光, 嶋田 秀逸, 橋本 勇
1981 年 10 巻 1 号 p.
127-130
発行日: 1981/02/15
公開日: 2011/10/07
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フリー
The left ventricular myocardial blood flow of atrial pacing was compared to those of ventricular pacing in twenty rabbits with sinus arrest.
The regional myocardial blood flow was measured by hydrogen gas clearance method.
The distribution of myocardial blood flow during atrial pacing and ventricular pacing was demonstrated unequivocAlly and it was concluded that atrial pacing resulted in larger myocardial blood flow than ventricular pacing at the areas of apex, left circumflex coronary artery, left anterior descending coronary artery and interventricular septum. Furthermore, the following results was obtained. (MBF of ventricular pacing)=(MBF of atrial pacing) x 0.772-0.797
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阿部 稔雄
1981 年 10 巻 1 号 p.
131
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
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石原 智嘉, 宮田 義弥, 大宮 孝, 玉木 修治, 村瀬 允也, 清水 健, 阿部 稔雄, 弥政 洋太郎
1981 年 10 巻 1 号 p.
132-135
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Since 1965, 285 patients have been operated on artificial pacemaker implantation, and 134 patients with a endocardial pacemaker lead were subjected to this comparative study dividing into 3 groups; with the flange tipped, the non-flange tipped and the ring tipped tined.
At initial implantation, stimulating voltage threshold of the ring tipped tined lead, 8mm
2 in electrode surface area, averaged 0.61±0.17V. This value was significantly low in comparison with that of an old type of the falnge tipped lead. The sensing threshold of the former was superior, also. On venous insertion, little technical difficulty has been encountered with tines being folded, 3.0 to 3.3mm in lead diameter. The incidences of postoperative lead dislocation of the flange tipped, the non-flange tipped, and the ring tipped tined leads were 11.70, 9.1% and 4.5%, respectively.
From these results, the ring tipped tined lead is our choice of an endocardial pacemaker lead at present. However, removal of the lead may not be enabled, and some measures in such cases as pacemaker infection, would be devised.
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竹田 晴男, 横山 正義, 柳沢 正敏, 鈴木 隆, 山田 義帰, 伊藤 隆一, 松田 哲郎, 田原 士郎, 和田 寿郎
1981 年 10 巻 1 号 p.
136-138
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
We had the chance of using clinically new active, positive anchoring electrode, which was screw-in lead model 6957. This electrode had the following features that cork-screw electrode was exposed or withdrawn by rotation of terminal pin and had the X-ray control-indicator ring to verify exposed corkscrew.
We came to the conclusion that this electrode was satisfactory clinical results for getting the pacing thresholds and sensing signals, and tere were no complications for early follow-up period.
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一Polyurethane leadの臨床的検討
進藤 剛毅, 水野 明, 古瀬 彰, 小塚 裕, 傅尭 箕, 三枝 正裕, 松尾 博司, 高柳 寛, 井上 博
1981 年 10 巻 1 号 p.
139-141
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
New composite cardiac pacing leads, combining the new polyurethane insulator with high flex life multifilar conductor coil made by DBS wires was examined. Clinical evaluations including electrophysiologic ones such as voltage, current and energy thresholds and R wave sensitivity were underwent during acute period after the implantation. Several important andvantages to the pacing system were evidenced,
1. Safe, reliable, smaller diameter was established with stiffer and tougher material of insulator and increased flexual fatigue resistance was remarkable.
2. low dislodgement rate.
3, improved clinical energy efficiency as measured by energy deliverey to the heart tissues.
These advantages act as positive factors to improve lead longevity.
Catheter techniques to lodge it into the right ventricle, on the other hand, becomes more difficult than that previous silicon leads.
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楠原 健嗣, 三木 成仁, 臼井 典彦, 上田 裕一, 松本 雅彦, 大北 裕, 堀健 二郎
1981 年 10 巻 1 号 p.
142-145
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Since 1976 sutureless epicardial pacemakers have been implanted through the subxiphoid approach in 22 patients with complete atrioventricular block or sick sinus syndrome. In 9 (41%) of these patients, complications which necessitated medical and/or surgical therapy occurred and these were analyzed in this paper.
In three patients demand failure due to trouble of pacemaker was observed. Pericardial effusion as post-pericardiotomy syndrome appeared with signs of tamponade in 6 patients. In a 71 year old man with variant angina, the insertion of sutureless electrode resulted in perforation of right ventricular wall and hemorrhagic shock. The bleeding was surgically controlled through additional midsternotomy.
In conclusion, importance of cautious selection of the implantation site without fat and scars was emphasized, especially in such a patient whose myocardium is feeble as is aged or suffered from ischemic heart disease. Pericardial effusion tends to appear in the patient with severe illness in addition to heart disease.
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石橋 修, 越川 雅宏, 豊田 道明, 酒寄 享, 中込 恵美子, 塚越 茂, 池田 晃治, 光岡 洋, 仲勝 信
1981 年 10 巻 1 号 p.
146-149
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Utilizing the introducer set, developed by Littleford, attempts were made to implant the permanent endocardial electrode in 16 patients through the subclavian vein puncture. This techniq is easy and safe with a little technical practice. In only one patient, we were unable to puncture the subclavian vain. The complication were one pneumothorax, one electrode tip dislocation, one accidental subclavian artery puncture and in same case unable to remove J-guide wire. However, these complications were treated subsequently without serious sequelae.
Subclavian vein puncture method is alternative to cutdown of cephalic vein for insertion of the pacemaker electrode.
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兼古 悟, 杉木 健司, 大堀 克己, 安喰 弘, 田中 信行, 小松 作蔵
1981 年 10 巻 1 号 p.
150-153
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Because the resistance of myocardium is an impedance which contains a reactance compornent, a difference rate between the leading edge impedance and trailing edge impedance and in addition a difference in impedance arises in trailing edge, because of the changes in pulse width, and stimulating current (voltage). Another importan t point is the chages in electrode model and under various conditions, the impedance ratio between leading edge and trailing edge changes.As a general expression of impedance, we should think that the leading edge impedance which shows the least changes under various condition, should be used.
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水野 明
1981 年 10 巻 1 号 p.
154
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
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奥田 彰洋, 北村惣 一郎, 中埜 粛, 宮本 勝彦, 賀来 克彦, 井原 勝彦, 前田 世礼, 岸本 英文, 秦石 賢, 康 重夫, 川島 ...
1981 年 10 巻 1 号 p.
155-158
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
Gas transfer performances of H. F. O and N. K. O were evaluated using a testing and evaluation method which was pveviously reported from our laboratory. Gas transfer characteristics of both membrane oxygenators were summerized as follows
1. Both oxygen and carbarn dioxide transfer rates of H. F. O and N. K. O were decreased as blood flow rate increased.
2. The oxygen transfer rates of H. F. O and N.K.O were not changed as oxygen blood flow ratio(V/Q) increased, while carbon dioxide transfer rate of H. F. O was increased lineally until V/Q increased up to 4.0 and that of N. K. O was increased lineally less than 1.0 of V/Q and approached to the constant above 1.0 of V/Q.
3. Optimal membrane indexes and control indexes of H. F. O and N. K. O on the practical operation were discussed.
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矢田 公, 森本 保, 草川 實, 桑名 克之, 中西 光, 井上 政昭, 青木 利三郎
1981 年 10 巻 1 号 p.
159-162
発行日: 1981/02/15
公開日: 2011/12/02
ジャーナル
フリー
We recently developed a new membrane oxygenator using silicone hollow fibers in order to get steady gas exchange capacity and improve mechancal hemolysis.
Experimental evaluation of its performance showed better results in terms of gas exchange capacity and hemolysis compairing to other types of membrane oxygenators.
1) Structures of our oxygenator : It consists of silicone hollow fibers of 20 cm in length (16 cm in effective length), with 400μ of outer-and 200μ, of inner diameter. The fibers, the both ends of which were fixed with urethane, were packed into a housing forming 1.2m
2 of effective membrane area
2) Performance test in vitro: Heparinized bovine blood was passed through our apparatus and oxygen /blood flow (V/Q) ratio was maintained 3: 1.
A oxygenenation capacity test showed that our apparatus was capable of oxygenating 50%-60% saturated blood up to more than 95% saturated blood until its flow reached to 1.0 L/min/m
2. A carbondioxyde removal capacity test showed that it was capable of keeping a inflow-outflow CO
2 difference higher than 10mmHg while using blood with Pcoz of over 50mmHg until its flow reached to 1.0L/min/m
2.
3) Dog experiment: V-A bypass was performed with five mongrel dogs weighing 7 to 12kg in order to evaluate gas exchange capacity, morphological chage of blood cells and mechanical hemolysis.
Both oxygenation capacity and carbondioxyde removal capacity were stable and only minimal hemolysis was observed during 24 hours of experiments.
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大森 一光, 中岡 康, 伊良子 光正, 奈良田 光男, 瀬在 幸安, 中西 光, 桑名 克之, 井上 政昭, 青木 利三郎
1981 年 10 巻 1 号 p.
163-166
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
A new hollow-fiber membrane oxygenator is developed. This consits of a bundle of 10, 000 silicone hollow-fiber/M
2. Thickness of the fiber is 100g, inside diameter is 200μ, and length is 20 cm.
The surface area available for gas trasnfer is 1.2M
2. Ten fasted dogs are used for experimental evaluation. Total extra corporeal circulation is carried out for 6 hours. Gas transfer, plasma hemoglobin and platelet were examined. O
2transfer rate was 36.2ml/min. and CO
2 transfer rate was 73.5ml/min.
Plasma hemoglobin was 74 mg/dl after 6 hours perfusion.
This result shows that the silicone hollowfiber oxygenator is acceptable for clinical use.
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辻 隆之, 須磨 幸蔵, 竹内 靖夫, 井上 健治, 城間 賢二, 吉川 哲夫, 成味 純, 伊藤 信行, 小林 洋, 深澤 弘道, 長谷 ...
1981 年 10 巻 1 号 p.
167-169
発行日: 1981/02/15
公開日: 2011/10/07
ジャーナル
フリー
The polypropylene hollow fiber oxygenator (H. F. O.) was tested in animal experiments and applied to 100 cases in open heart surgery.
8 dogs were used as test animals for H. F. O. using veno-arterial bypass method. The 1.0 M
2 H. F. O. was perfused 5 hrs continuously with an average of 1.0 l/min of venous blood at 37°C and pure oxygen at a rate of 1.0 l/min. Average O
2 transfer rate was 43±3ml/min/M
2 and CO
2 transfer rate, 43±2ml/min/M
2 when Hb was 10.5g/dl. Free hemoglobin after 5 hr perfusion was 38.0±16.6 mg/dl. 100 cases including 77 congenital and 23 acquired heart diseases were operated using 1.8 or 3.3 M
2 H. F. O.. Perfusion time was 74±66 min and free hemoglobin was 41.6±34.4mg/dl at the end of CPB. Average blood perfusion rate was 2500± 1000ml/min and pure oxygen gas to blood flow ratio was 0.53±0.21. PaO
2 was 467±62 mmHg and PaCO
2 29±5mmHg when average Ht was 24±5%.
This H. F. O. was observed to have excellent capability of oxygen and carbon dioxide gas transfer with small amount of hemolysis in 100 patients undergoing open heart surgery
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板岡 俊成, 河村 剛史, 柳沢 正敏, 日野 恒和, 長柄 英男, 竹田 晴男, 笠置 康, 毛井 純一, 伊藤 隆一, 田原 士朗, 和 ...
1981 年 10 巻 1 号 p.
170-173
発行日: 1981/02/15
公開日: 2011/12/02
ジャーナル
フリー
We have incorporated a hemofilter in the ECC circuit. The hemofilter is made of polyacrylonitril membrane hollow-fiber tubes of 200μ in inner diameter. The membrane is 50μ in thickness.
The effective membrane surface is 1.1m
2. In-vitro studis, pressure drop was below 100mmHg at Ht 20-35% and Q/B 50-100mL/min and filtrate rate was 36-44mL/min. In clinical studies, this series was divided into 2 groups according to whether the hemofilter was used during EC C(group I 10 cases) or not (group II 10 cases). In group I it was easy to preserve the proper hematocrit value of the perfusate. Additionally the whole blood transfusion was diminished by 200mL during ECC comparing with the group II. The hemofilter yield 1291±176mL of filtrate, and potassium ion (6.12mEq) and sodium ion( 158mEq) were filtrated out during ECC. Therefore potassium content was more stable in using hemofilter than in the group II.
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