Jinko Zoki

An anion exchange resin (Ionex) capable of removing bilirubin and bile acids has been developed for use in artificial liver support systems and has been demonstrated to be effective in reducing serum bilirubin and bile acids experimentally and clinically in cases of hyperbilirubinemia. However, fibrin clots and platelet aggregates on the surface of the resin were problems in direct hemoperfusion. To overcome this problem we investigated the effect of on-line connection of a plasma separator (Plasmax, Toray Inc., Tokyo) with the anion exchange resin. The results of a hemoperfusion experiment showed that the Plasmax system yielded good plasma separation. Furthermore in an experiment in a group of 10 hyperbilirubinemic dogs this system obtained good removal of bilirubin and bile acids. Absorption rate by this combined system was no different from that of direct hemoperf usion, and during extracorporeal circuration there was no increase of perfusion pressure or any clot formation. In clinical cases of postoperative hyperbilirubinemia the adsorption of bilirubin and bile acid was poorer than in the experimental model, but there were no problems in terms of extracorporeal circuration.

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By interpositioning a heat exchanger between femoral artery and vein, body temperature can be easily controlled. Transcutaneous puncture is employed instead of using artificial vessel. Arterio-venous shunt flow through heat exchanger is 500-1, 000ml/min. Body temperature of an adult can be increased up to over 41°C in 50min. Cooling is much easier than warming of the patient.

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Urological complications caused by pathological state of the blood vessels in the pelvis are well known. Aneurysm of common iliac artery may result in hydoronephrosis due to ureteric compression or to fibrotic reaction round the aneurysm. Congenital anomalies like retro-iliac ureter can also cause ureteral obstruction. Nevertheless, only a few reports are available in the literature concerning the urological complications following iliac arterial reconstruction with synthetic graft. Because its etiology and treatment are still under discussion, we present two new cases. The first case was treated with patch grafting for stenosis of the left common iliac artery. Sixteen months after the operation, the patient developed an uretero-arterial fistula. This complication was caused by infected hydronephrosis due to a ureteric obstruction in the patch graft site. Then a similar obstruction cause of graft was detected on postoperative examinations of patients on whom we had performed iliac arterial reconstruction. Our experience in these cases and review of the literature indicate that during graft procedures, the ureter should be placed anterior to the graft possibly and fatty tissue, peritoneum or even omentum might be interposed between the ureter and the graft.

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