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M FUKUTOMI, S KITAMURA, K KAWACHI, R MORITA, T NISHII, S TANIGUCHI, K ...
1991 Volume 20 Issue 3 Pages
1161-1165
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We developed a new extracapillary blood flow type membrane oxygenator using new microporous polypropylene hollow fibers. The surface area available for gas transfer was 1.83 m
2 and the priming volume of the oxygenator was 250ml. The gas will pass inside the fibers and blood outside the fibers. In vitro and ex vivo evaluation showed high gas exchange performance. Heat exchange performance was sufficient and blood trauma was minimal.
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A. MURAKAMI, K. MORIYASU, N. MURATA, K. SAIDA, H. YOKOKAWA, M. KADOKUR ...
1991 Volume 20 Issue 3 Pages
1166-1171
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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This study concerns the relationships between the changes of pH and perfusion pressures. The experiments were performed with (Group I) and without (Group II) oxygenation. Group I, which had a total priming volume of 2000ml including 80ml of 7% NaHCO
3. Perfusion pressure rose rapidly when pH values exceeded 7.90 and severe deformity and blood mass formation (echinocyte and discocyte) were observed through the scanning microscope. Group II, which had a total priming volume of 2000ml was classified into 12 subgroups according to volumes of NaHCO
3 and priming blood. There were no correlations between the volumes of NaHCO
3 and perfusion pressures. The mild formation of echinocyte and discocyte were seen on the surface of the membrane oxygenatoos. It has been suggested that keeping the conditions described below is very important for safety in operations: 7% NaHCO
3; within 50ml, Priming blood; within 400ml, No oxygenation, Recirculation time; within 60 minutes, pH; below 7.9
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J. MEGURO, K. KUKITA, M. YONEKAWA, A. KAWAMURA, H. FURUI
1991 Volume 20 Issue 3 Pages
1172-1176
Published: June 15, 1991
Released on J-STAGE: December 02, 2011
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Rabbit kidneys were preserved utilizing normothermic (24°C) perfusion. Oxygenation is one of the most important factors for normothermic preservation. For this purpose, two methods of oxygenation were applied. One was oxygen bubbling of the perfusate, and the other was by using hollow-fiber-artificial-lung. These two methods were compared viz á viz the usefulness for maintaining the PO
2 levels of the perfusate and for preserving the kidney in good condition. The pH and osmotic pressure of our perfusate with 3% of perfluorochemical (FC-43) were 7.4 and 350mOsm respectively. In the artificial-lung group, the pH, PO
2 levels and flow rate of perfusate was well maintained for 24 hours. Histologically, the glomerulus and the renal tubulus of the artificial-lung group were better preserved compared with the findings of the bubbling group.
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K INUI, H ORITA, M FUKASAWA, T SHIMANUKI, S GOTOU, M WASHIO
1991 Volume 20 Issue 3 Pages
1177-1180
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Platelet Activating Factor (PAF) is an important factor in the activation of platelet and leucocyte. It is known that complement, platlet and leucocyte are activated in cardiopulmonary bypass (CPB). We measured the change of PAF level in 10 adult patients who underwent CPB. PAF level increased in the first 5 minutes from 527±69.0pg/ml to 776.1±111.2pg/ml, and then decreased slightly. After 5 minutes of aortic declamping, PAF level was 515.6±68.2pg/ml. Platelet counts, β-TG, PF4, and 11-dehydroTxB
2 suggested that platelet was rapidly activated in the first 5 minutes of CPB. These data suggest that platelet may be activated immediately after starting the CPB, and PAP may play an important role in platelet activation during CPB. Interestingly the potency of PAF for platelet activation was stronger at 25°C than 37°C. Therefore, it may also be important to prevent the PAF action during hypothermic CPB.
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S MURAKAWA, Y MORI, T YAMADA, K AZUMA, H SASAKI, S SAKAI, M KOKUBO, S ...
1991 Volume 20 Issue 3 Pages
1181-1185
Published: June 15, 1991
Released on J-STAGE: December 02, 2011
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The effect of Gabexate Mesilate (GM) on the coagulofibrinolytic system and platelet function was investigated in 25 patients undergoing CABG or valve replacement under extracorporeal circulation (ECC). In group G (11 patients), GM (40mg/kg/hr) was administrated during ECC, while group C (14 patients) had no administration of GM. In both groups heparin (4mg/kg) was administrated before the start of ECC. PT (%) was less in group G than in group C during ECC. But after ECC, PT (%) was higher in group G. AT III was higher in group G than in group C during and after ECC. EDP and D-dimmer were significantly greater in group C than in group G after ECC. Platelet aggregation function was more recovered after ECC in group G when compared to group C. There was no significant difference of fibrinolitic activity between these two groups. These results suggested that GM suppressed coagulation activity through ECC in cooperation with heparin and protected platelet function.
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S VKAWASHIMA, Y MORISHITA, H TOYOHIRA, S SHIMOKAWA, H SAIGENJI, Y MORI ...
1991 Volume 20 Issue 3 Pages
1186-1190
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The effect of haptoglobin for renal failure was evaluated in patients undergoing open-heart surgery. The patients with hemoglobinuria after extracorporeal circulation were divided into 2 groups; the control (Group C, N=10) not treated with haptoglobin, and the haptoglobin (Group H, N=12) treated. The urinary levels of α1-m were significantly higher in Group C than in Group H. The urinary levels of β2-m in Group H were less than 10, 000g/l for 7 POD, while those in Group C were still high at the 3rd POD. The urinary levels of α1-m and β2-m remained low from the 1st POD in the Group H. Haptoglobin is effective for renal failure after open-heart surgery.
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T ADACHI, K OYAMA, M KAWASHIMA, M ONUKI, M YOKOYAMA, S NITTA
1991 Volume 20 Issue 3 Pages
1191-1194
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Twenty-five patients receiving Mexiletine post cardiopulmonary bypass were involved in the study and determined for optimum dosage of the drug and its effective plasma concentrations. In an effort to determine the appropriate dosage of the drug, the patients were administered with the drug by continuous intravenous infusion at 0.01, 0.015, 0.02, 0.025 and 0.03mg/kg/min and then measured for plasma levels of the drug at 30, 60, 90, and 120min. after the initiation of infusion. Plasma levels of the drug bhus found were 0.49±0.16μg/ml (mean±SD) at 30min., 0.68±0.18 at 60min., 0.85±0.29 at 90min. and 0.92±0.26 at 120min. In order to obtain effective plasma levels more quickly a 125mg dose was administered as a bolus injection. This yielded a therapeutically effective plasma level of 0.78±0.11, 30min. after dosing. Significantly higher plasma levels of the drug were attained at 30min. after administration with bolus injection of 125mg than continuous intravenous infusion at a rate of 0.03mg/kg/min. (p<0.05).
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T SEO, T ITO, K IIO, J KATO, H TAKAGI
1991 Volume 20 Issue 3 Pages
1195-1200
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The Takagi's automatically air-driven blood pump was modified to prevent air embolism in a case of the rupture of blood chambers. The modified pump consisted of a blood, a saline, and an air chamber. The sack type blood chamber was placed in the acrylic cylinder filled with sterilized saline solution. The blood chamber was compressed and expanded indirectly by the diaphragm which separated the saline and the air chamber and moved with compressed air. An electro-air regulator was used instead of a stepping motor to simplify the regulating unit. On a mock circulation, the pump with 6ml blood chambers for neonates produced 600ml/min of flow and one with 20ml blood chambers for children did 900ml/min of flow. The modified pump was actuated under automatic control to change air pressure, pumping rates and pump flow in response to the preload and the afterload. It responded smoothly without any delay or decrease. It ran without mechanical problems for 21 days without an oxygenator and for 10 days with an oxygenator. Results obtained on animal experiments also confirmed the reliability and safety of our new ECMO system which could successfully bypass at the flow rate over 100ml/kg/min.
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J ANBE, Y OGURA, H NAKAJIMA, N IWAMA, S TAKAHASHI, M OZEKI, T MITUBISH ...
1991 Volume 20 Issue 3 Pages
1201-1205
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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A preliminary experimental model of the automatic microcomputer regulation system for extracorporeal circulation was developed. This experimental system consistes of three main parts, that is, 1) input device for data sampling, 2) central processing unit for data analysis and recording as well as real time monitoring, and 3) output device while controls each module. These modules are organized together with microcomputer by means of analyzing these data series and regulating each controlling device under the programmed conditions. The present study reports the basic principles of the automatic regulation and the outline of this system both from in vitro and in vivo experiments using canine. As a result, we could get 1) a good simulation curve in accordance with pump flow and blood pressure both in vitro and in vivo studies. 2) It was very easy to change software parameters for automatic regulation. 3) It showed a quite reasonable response to any accidents such as line occlusion or sudden decrease of blood volume in reservoir. In addition, this system could be handy because of its'easy add-on system with minimal modification to prevalant type of pump systems.
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Y OGURA, J ANBE, H NAKAJIMA, S TAKAHASHI, N IWAMA, M OZEKI, T MITSUISH ...
1991 Volume 20 Issue 3 Pages
1206-1209
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We evaluated hemody-namics of a centrifugal pump by means of short circuit in vitro and in vivo experiments using adult dogs. The Sarns model 7800 was used as the centrifugal pump. In the experiment of short circuit, the line pressure was curvilinearly correlated with the revolution with statistical significance. The flow was linearly correlated with the revolution with statistical significance. In the experiment of adult dogs the flow was linearly correlated with the revolution with coefficiency of 0.675. In range from 1500 up to 2250rpm, the flow pporoximately corresponded to the revolution, which means almost stable extracorporeal circulation could be obtained in its usual range.
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T IGARI, F IWAYA, T ABE, K HAGIWARA, M TANJI, H SATOKAWA, M WATANABE, ...
1991 Volume 20 Issue 3 Pages
1210-1213
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Plasma hemoglobin were measured consecutive 134 cardiopulmonary bypass (CPB). Hollow-fiber membrane oxygenator (MERA HPO-25) were employed for CPB and polypropylene hemoconcentrator (MERA HC-100M) were used during and after CPB. They were divided into three groups. Group A consisted with 68 cases in which pump was carried without donor blood, Group B consisted with 36 cases in which pump was started without donor blood and it was added during CPB, and Group C consisted with 30 cases in which CPB was primed with donor blood. During CPB, plasma hemoglobin of Group C showed higher level compared with Group A. At 60 minutes after initiation of CPB, plasma hemoglobin concentration of Group C was 105.6±67.8mg/dl and that of Group A was 65.3±77.3mg/dl. Hemoconcentrator ultrafiltrated plasma hemoglobin 0.2-0.3mg/dl/min during CPB. To summarize our results is as follows: CPB without donor blood has the advantage of decreasing hemolysis. Hemoconcentrator has merits as a plasma hemoglobin remover and demerits as a plasma hemoglobin generator. To avoid the hemolysis during ultrafiltration, negative pressure must be kept low.
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K SHIROMA, K SUMA, K INOUE, H KANEKO, F MIYAWAKI, S TORII, Y OE
1991 Volume 20 Issue 3 Pages
1214-1218
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Cardiopulmonary bypas using a hollowfiber oxygenator without blood priming was performed on 85 patients from 1986 to April 1990, Although cardiac surgery performed on 61 patients using a hollowfiber oxygenator combined with the ultrafiltration system with non-blood cardiopulmonary bypass in 1985, 20 of them consequently required blood transfusion during or after operation. When we determined influencing factors for indication of non-blood transfusion surgery by means of multivariate analysis, the duration of cardiopulmonary bypass, the amount of blood loss, and the least hematocrit value were found to be significant ones. We also compared respiratory function between patients underwent non-blood cardiac surgery and those required blood transfusion, and noted no significant difference in neither respiratory function nor the postoperative course until extubation when cardiopulmonary bypass was performed within 2 hours. In addition, it was also confirmed that indication for non-blood transfusion cardiac surgery can be widened through reduction of a priming volume from 2500 to 1300ml.
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N OHSHIMA, S TANABE, T YAMADA, H NAKAHARA, M YOKOYAMA, Y IRIE, M MUKOY ...
1991 Volume 20 Issue 3 Pages
1219-1223
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Thee effect of extracorporeal ultrafiltration method(ECUM) on blood preservation and for prevention of lactic acidosis in cardiac surgery was evaluated in 94 consecutive adult patients from Jan. 1988 to Dec. 1989. Patients were deviled into 3 groups; group HC(+) (n=45): ECUM during cardiopulmonary bypass(CPB) without blood priming group HC(-) (n=25): conventional CPB without blood priming, group BL(n=24): conventional CPB with blood priming. In 70 non-blood priming cases, 48 cases (69%) did not receive transfusion through their hospital stay. and the homologous blood requirement was only 2 units per patients. Use of ECUM prevented extreme hemodilution in non-blood CPB (dilution ratio; 23.3% in group HC(+) vs 27.4% in group HC(-)), so that postoperative release of max_CK and metabolic acidosis were decreased in group HC(+).
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Tadashi ISOMURA, Yoshio ISAMOTO, Ken-ichi OHNO, Kouichi HISATOMI, Hiro ...
1991 Volume 20 Issue 3 Pages
1224-1227
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Among 840 patients who underwent cardiac surgery in the past two years and ten months since 1987, extracorporeal ultrafiltration method (ECUM) or hemodialysis (HD) during cardiopulmonary bypass (CPB) was applied in five patients with preoperative severe renal failure. There were valvular disease in four and ischemic heart disease in one, and three of them had been requiring HD before operation. During CPB, the amount of 100 to 150ml of venous blood was drawn into the ECUM or HD circuit and then the blood was returned to the venous reservoir via the circuit. In patients receiving preoperative HD, HD was performed the day before operation and the ECUM was used during the operation. Postoperative HD was performed within three days after the operation and HD was maintained regularly after the seventh postoperative day. In patients without previous HD, HD was used during operation and they did not require postoperative HD. Although the deterioration of the renal function occurred after CPB, the cardiac operation in patients with severe renal failure seemed to be performed safely with the use of HD during CP B.
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Mituru AKASAKI, Kageharu KOJA, Yukio KUNIYOSHI, Kiyosi IHA, Kazuhumi M ...
1991 Volume 20 Issue 3 Pages
1228-1232
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We are presently using pulmonary artery drainage in partial cardiopulmonary bypass for operations of thoracic aneurysms. We have employed this method in 21 operative cases. The peripheral vascular resistance ratio (δR) can be represented by the equation δR=(0.0104t-0.022)
2+1.(t) is the aortic cross clamp time. The postoperative BUN, GOT and GPT showed a positive correlation to the aortic cross clamp time. A positive correlation was also seen between δR and BUN, GOT, GPT. In partial cardiopulmonary bypass, the peripheral vasclar resistance increases proportionaly to the aortic cross clamp time, and possibly is one of the factors contributing to organ damage.
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N UNNO, N SHINOZUKA, S KOZUMA, T OKAI, Y KUWABARA, M MIZUNO, K KUWANA
1991 Volume 20 Issue 3 Pages
1233-1238
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The changes of blood-gas values of goat fetuses during extrauterine incubation using umbilical arterio-venous extracorporeal membrane oxygenator (A-V ECMO) were investigated. Nineteen goat fetuses were incubated for more than 50 hours in an amniotic fluid container without lung respiration with a support of A-V ECMO via umbilical vessel catheters. The extracorporeal blood flow of 60-130ml/min/kg was maintained in all the fetuses that survived longer than 100 hours. The levels of PaCO2 were within the range of in-utero fetuses, and the levels of PaO2 were slightly higher than those of in-utero fetuses. The values of oxygen consumption were about 6 ml/min/kg, suggesting that the oxygen utilization of the extrauterine fetuses was mildly suppressed. These findings show that a goat fetus can survive with a support of umbilical A-V ECMO for several days, with almost normal blood-gas status.
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S TANABE, T YAMADA, H NAKAHARA, M YOKOYAMA, N OHSHIMA, Y IRIE, M MUKOU ...
1991 Volume 20 Issue 3 Pages
1239-1243
Published: June 15, 1991
Released on J-STAGE: December 02, 2011
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Although beneficial effects of membranous oxygenator for open heart surgery on the respiratory function have been reported, controversy still exists.
The influence of various perioperative factors on the postoperative respiratory index (RI, RI=AaDO2/PaO2) was examined in 28 cardiac surgical patients. The factors considered were as follows; (1) perfusion time, perfusion pressure, lowest body temperature, highest PaO2, minimal hematocrit (Hct), blood and water balance, blood trauma (platlet count and free Hb), serum complement levels (C3, C4, CH50, C3a, C4a) during extracorporial circulation (ECC), (2) blood loss and blood transfusion, urine output and fluid infusion during operation, and (3) postoperative hemodynamics. No single factor contributes to RI changes significantly using single regression analysis. These patients were diveded into 2 groups according to RI; Group A (14 pts), RI<1.9, Group B (14 pts), RI≥1.9. These two groups were significantly differentiated by the linear discriminant function (p<0.01) in respects to the function of perfusion time×maximal PaO2 during ECC, loss of C3 and C4, and preoperative RI. Possibility of maldiscrimination was estimated about 7%.
From these results it is concluded that changes in the RI is influenced by oxygen stress and activation of serum complements during ECC which probably contributes to the development of reperfusion injury of the lung.
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M MURASE, M MAEDA, Y TOMIDA, F MURAKAMI, K TERANISHI, T KOYAMA, T ITO, ...
1991 Volume 20 Issue 3 Pages
1244-1248
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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To protect the cerebral function during hypothermic circulatory arrest, continuous retrograde cerebral perfusion (CRCP) of oxygenated blood from the superior vena cava was performed in 5 cases with dissecting aneurysm. After the body temperature reached 20°C, CRCP was strated by the flow rate of 150-620 mL/min. The central venous pressure was maintained between 20 to 40 mmHg. The duration of circulatory arrest and retrograde cerebral perfusion was 50 to 73 mins. In 4 cases, the postoperative recovery was excellent without neurologic deficit. However, in the other case in which resuscitation was attempted in the emergency room, severe brain edema was the cause of death. CRCP by oxygenated blood during hypothermic circulatory arrest is a useful and effective means during the operation of the aortic arch.
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Masayasu YAMASHITA, Yoshio ISAMOTO, Ken-ichi OHNO, Shigeaki AOYAGI, Ke ...
1991 Volume 20 Issue 3 Pages
1249-1252
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The ability of polyacrylnytril hollowfiber hemoconcentrators (ASA800) to prevent loss of plasma protein was evaluated clinically in 30 patients during open-heart surgery. ASA800 were used in 16 patients for 92.6±40.7 minutes and were able to remove 1885.5±914.lmIl of water from diluted blood during CPB. Total serum pro-tein concentration during CPB decreased temporarily to 3.4mg/dl(Ht 16.5%) but stabilized at more than 4.5mg/dl(Ht20%). There was no significant difference in blood components after CPB between the group with ASA800 and that without ASA800. After the CPB, hemoconcentration of the residual priming blood was performed with ASA800. A slight elevation of linepressure and a prolongation of time required for hemoconcentration was found to occur as a result of plugging of the hollowfiber pores by plasma plotein. ASA800 was effective in hemoconcentratiog the priming blood of CPB both in terms of concentration of blood components and hemoconcentration rate. We concluded that ASA800 was useful for concentrating the hemodiluted priming blood both during and after CPB.
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H. ABE, T. KAWADA, S. HINATA, S. KAMADA, N. ANDO, M HOSON, S. FUNAKI, ...
1991 Volume 20 Issue 3 Pages
1253-1257
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We investigated on the effect of prostaglandin-E
1 (PGE
1) and Iloprost infusion during cardiopulmonary bypass (CPB). Ninety-three patients were randomly divided into 3 groups. Group I: control (30 cases), Group II PGE
1(0.05μg/kg/min) (30 cases), Group III: Iloprost (2 ng/kg/min) (33 cases). In Group II, perfusion pressure was significantly low during CPB, but there vas no postoperative complication. Platelet loss and increase of β-TG and PF 4 were significantly suppressed in Group II and III during CPB. and, postoperative platelet count was highest in Group II. There was no significant difference in postoperative blood loss in these three groups.
It is concluded that 0.05μg/kg/min of Prosta-glandin E
1 is more effective to preserve platelet than 2ng/kg/ min of Iloprost. It seems that a dose of Iloprost was too low to satisfactorily suppress the activation of platelet function during CPB.
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H OKABAYASHI, S NAKAYAMA, T ODA, T TAKEUCHI, K HIRATA, S NOMOTO, Y OKA ...
1991 Volume 20 Issue 3 Pages
1258-1262
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We studied a complement activation during cardiopulmonary bypass without blood transfusion. The degree of com-plement (CH50) consumption during cardiopulmonary bypass without blood transfusion was lower than that during cardiopulmonary bypass with blood transfusion. The level of C3a and C4a gradually increased after the initiation of cardiopulmonary bypass. The level of C3a decreased to the level before cardiopulmonary bypass on the first postoperative day. The level of C4a did not decrease to the level before cardiopulmonary bypass on the first postoperative day.
This indicates that the complement activation during cardiopulmonary bypass without blood trans-fusion occurs mainly via the alternative pathway and cardiopulonary bypass without blood trans-fusion has an advantage in performing cardiac operations.
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M MIURA, N UCHIDA, N SATO, H MOHRI
1991 Volume 20 Issue 3 Pages
1263-1267
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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During the last 5 years, a total of 67 cases of aneurysms requiring aortic clamping between the aortic arch and the lower descending thoracic aorta were operated on under extracorporeal circulation(ECC). Temporary shunt and cardiopulmonary bypass with roller pumps and “pumping through”oxygenators were used in group 1(36patients). 3 cases of paraplegia and 2 cases of ECC-related death occurred in this group. Centrifugal pumps and gravity drainage hollow fiber oxygenators were employed for left heart bypass and separate perfusion in group 2. No major ECC-related complications occurred and it is concluded that these are safe and simple adjunctive methods.
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A SAKAMOTO, J KONDOH, K IMOTO, H KAJIWARA, S SUZUKI, S ISODA, I YAMAZA ...
1991 Volume 20 Issue 3 Pages
1268-1271
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Cardiopulmonary bypass with selective cerebral perfusion (SCP) was applied for 24 consecutive patients who had aneurysm of the aortic arch. 15 patients had atherosclerotic aneurysms, and 9 patients had dissect-ing aneurysms. Management of SCP was variety. In general case, SCP was started immediately aorta was cross clamped. To keep cardiac beating until the nasopharyngeal temperature was under 29t was very important in this case. In case that needs AVR or CABG, SCP should be started after the procedure to reduce SCP time. And a patient with the atherosclerotic aneurysm or chronic dissec-ting aneurysm who had extremely narrowed true lumen had to receive the SCP that was started immediately cardiopulmonary bypass started.
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H BASHUDA, Y MORISHITA, H TOYOHIRA, S SHIMOKAWA, H SAIGENJI, H IWAMURA ...
1991 Volume 20 Issue 3 Pages
1272-1275
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Cerebral circulation under pulsatile cardiopulmonary bypass was clinically studied through aerobic and anaerobic metabolism of the brain. Pulsatile cardiopulmonary bypass was started at the lowest temperature of internal jugular vein (21°C) and was discontinued at the release of aortic cross-clamping. No differences were found in oxygen saturation, cerebral O
2 extraction, cerebral circulatory index, and cerebral excess lactate between pulsatile and non-pulsatile perfusion. The present study clarified that pulsatile perfusion under hypothermia at 24°C was not effective on the cerebral circulation.
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Kazuhiro HASHIMOTO, Kazuhiko SUZUKI, Katsuji KOYANAGI, Hiromitsu TAKAK ...
1991 Volume 20 Issue 3 Pages
1276-1280
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Summary; Mechanisms of organ failures following a cardiopulmonary bypass (CPB) were multi factorial although the hypoperfusion pressure was considered as a main cause. Plate-let aggregation initiated by the institution of CPB alternated eicosanoid metabolism, in which thromboxane A2 became dominant to prostaglandin I2. Reactive increase of endothelin excretion observed after the CPB also aggravated ischemic cellular damages due to induced vasoconstrictive status in the micro-vasculature. Further damages were accelerat-ed by elastase released from activated granulocytes. The damages were thought to be continued by both elastase and endothelin even after the CPB, however, thromboxane A2 related only during the CPB. The renal damage mainly concerned with endothelin and elastase, but not thromboxane A2.
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M HAYAKAWA, H MANABE, T TAKAHASHI, H TAKAGI, T HOTTA.
1991 Volume 20 Issue 3 Pages
1281-1286
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Since our left ventricular assist divice works automatically on the Starling's law of the heart, total heart lung bypass has been tested in 7 dogs using this device instead of usual roller pump. The circuit line to the pump and to the body was closed circuit, and open reservoirr to get blood through the suction line was connected to this closed circuit under the control of solenoid pinch valve which was closed when the blood level in the reservoir went down. This method made possible to maintain the extracorporeal circulation automatically up to 20 hours, in which the output was automatically controlled by the venous return and also circulating blood volume was automatically maintained normally at the blood level in the reservoir.
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K KODERA, M KITAMURA, M ENDOH, A HASHIMOTO, H KOYANAGI
1991 Volume 20 Issue 3 Pages
1287-1289
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Continuous blood cardioplegic method was employed after placing the aortic cross clamp. Pouring cold blood, Coronary perfusion pressure and coronary resistance are effected by sludging of red blood cells and viscosity of cold blood. Quantitative analysis of coronary perfusion pressure and resistance was assessed in 5 patients with mitral stenosis. The patients had no aortic valve disease and no signficant stenosis of coronary arteries, Coronary perfusion systemwas used to record the aortic root pressure. Temperature of cardioplegic solution was 3C Perfusion pressure was ranged 100 to 120mmHg at pump. Myocardial temper-ature was less than 5C. Perfusion pressure and flow were measured 17 times, (GIK: 6, cold blood: 11) Results were as follows. Aortic root pressure was less than 40mmHg in each cases. Perfusion flow was decreased in the case pouring cold blood, and coronary resistance was increased when pouring cold blood. Coronary resistance was defined as
MEAN AORTIC PRESSURE/MEAN FLOW.
Mean coronary resistance were 95.8 of GIK, 144.4 of cold blood, By these results, it was presumed that 660 of coronary vascular area is perfused with cold blood compared with GIK solution, because of sludging of red blood cells and visco-sity of blood.
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T MIKI, A YAMAGUTI, M OTAKI, H TAMARA, N KITAMURA
1991 Volume 20 Issue 3 Pages
1290-1293
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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53 patients 65 years of age and older who under-went valve replacement were divided into 3 groups. Croup I was done under CPB with blood riming. Group H was done under CPB with non-blood priming using ultra filtration. Group ffl was done under CPB with non-blood priming using Cell Saver. Intra-operative blood loss was respectively 1319+179ml, 1162+210ml, 1162+210ml, 137+21ml and was decreased in group III signifi-cantly p(p<0.01). Amount of drainaged blood after first post operative day showed no signifi cant between ups. Total amount of blood transfusion was respectively 3804+280ml, 2024+ 407ml, 320+113ml. Lompared with group I, blood transfusion volume was decreased 47% in group II and decreased 92% in group III. Large amount of blood transfusion more than 3000ml was needed 13 patients (76%) in group I, 3 (12%) in group II and none in group III. Open heart surgery without blood transfusion was possible in 3 patients (12%) of group. II and in 5 (45%) of group III. We conclude that open heart surgery with non-blood transfusion was possible even in elderly patients.
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K. HAGIWARA, K. YOKOYAMA, H. KITOH, T. KUROO, H. OSHIYAMA, O. NOMURA, ...
1991 Volume 20 Issue 3 Pages
1294-1299
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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We did experiments to increase the antithrombogenesity of the heparinized oxygenator and circuit by increasing the values of heparin bound to the surfaces. As the values of amino residues on the surface increased mainly, the values of heparin bound to the surfaces increased to 1.8-5.7 times higher than our primary methods, and anticoagulant activities were extreamely increased in vitro . And we also comf firmed that these heparinized surfaces scarcely activated platelets. Further more, we evaluated these improved heparinized oxygenator and circuit using A-V bypass for 24 hours without systemic heparinization. And we obtained the results that the values of platelets didn't diminish, and ACT was in the normal during perfusion, and at the end of the perfusion, occlusive fibers and thrombus around the header were scarcely. These results show that the antithrombogenesity has increased in the oxygenator and circuit.
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H TAKAGI, T TAKAGI, M HAYAKAWA, T TAKAHASHI, T HOTTA
1991 Volume 20 Issue 3 Pages
1300-1304
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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Since our pump works automatically on the Starling's law of the heart, partial and total heart lung bypass has been performed in 18 dogs with this pump. Results showed that partial bypass was continued automatically as long as the membrane oxygenater worked well. In total bypass, open reservoir from the suction line was con-was adjusted to minimize this delay time, because it should be no delay when the output is equal nected to this closed circuit by the particular connection line. Since blood in the reservoir moved freely into and out of the body, this method maintained normally both the out put and the circulating blood volume automatically up tp 20 hours.
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T AWAKA, K OGASAWARA, T KANAMORI, K SAKAI
1991 Volume 20 Issue 3 Pages
1305-1308
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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The quantitative research of hemolysis using the experimental circuit was performed in order to study the effect of screen filter for bovine blood. Experimental conditions were chosen referring to surgical operations, and the effect of a screen filter on bovine red cells was evaluated. The amount of hemolysis was determined by measuring concentration of plasma hemoglobin. Experiments were performed to confirm damages of red blood cells caused by the screen filter with variations in hematocrit, flow rate, materials of the filters and pressures. The degree of damage of red blood cells was evaluated by the osmotic fragility test. Subtle damages of red blood cells became apparent with the osmotic fragility test particularly with a 0.6 g/dl NaCl solution.
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N. KANAMORI, E. KINUGASA, F. NAKAYAMA, T. SEKIGUCHI, T. AKIZAWA, T. KI ...
1991 Volume 20 Issue 3 Pages
1309-1312
Published: June 15, 1991
Released on J-STAGE: October 07, 2011
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In order to clarify the effect of low molecular weight heparin (LH) as an anticoagulant for hemodialysis (HD) patients who required high dose of ordinary heparin (OH), minimum heparin requirement and changes in coagulation, fibrinolysis and platelet functions were compared between HD with OH (continuous infusion) and LH (single injection methods). Minimum requirement of heparin was less in LH than in OH. Although plasma anti-Xa concentration was higher in HD with LH than with OH, activated partial thromboplastin time (APTT) prolonged greater in the latter. No significant changes in intradialytic thrombin-antithrombin III complex, α
2-plasmin inhibitor-plasmin complex and D-dimer were observed in either OH or LH. β-thrombo-globulin was higher in OH than in LH at 15 minutes after the start of HD. Pletelet factor 4 decreased gradually in HD with LH. These results indicate that LH has several beneficial characteristics as an anticoagulant for HD patients who required high dose of OH.
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