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[in Japanese]
1977 Volume 6 Issue 6 Pages
265
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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Koich OSHIMA, Takashi TSUJI
1977 Volume 6 Issue 6 Pages
267-269
Published: December 15, 1977
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Preparation of a disposable disc oxygenator with lower blood volume was tried.
A disc made from polymethylmethacrylate with several raised arc-shaped fins on its surface was treated with an alkali solution to give hydrophilic property to the surface.
A greater part of the surface of the rotating disc was covered with blood, because the fins scooped up the blood onto the disc surface even if the blood was at low level and also because of the interaction between the hydrophilic surface and the disc rotation.
The role of the fins and the effect of the hydrophilic surface were confirmed by blood circulation tests.
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S. KISHI, S. OHTA, M. HONDA, A. HASHIMOTO
1977 Volume 6 Issue 6 Pages
270-273
Published: December 15, 1977
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From 1976 to 1977, Kolobow membrane oxygenator were clinically applied to 600 patients at the time open heart surgery.
Effect of compressed air and N20 gas on blood gas change during E. C. C. were studied, In relatively small Kolobow membrane oxygenator (0.8M
2 or 1.5M
2) addition of either compressed air or N
2O gas to oxygen has proven to be quite useful in maintaining arterial PO
2 and PCO
2 within adequate range.
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Keiichiro KATSUMOTO, Shigeyuki TAKEUCHI, Tadashi INOUE, Eiichi TSUCHIY ...
1977 Volume 6 Issue 6 Pages
274-277
Published: December 15, 1977
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The oxygenating efficiency of our own membrane lung was studied in vitro using oxygen transfer and rated blood flow. Arch or convex type design had a better oxygenating performance compared with plain boad type one. Our new WASHI lung showed a excellent value of rated blood flow, 1.92L/Min/M
2. The oxygenating efficiency was compared between four kinds of silicon membrane, i. e. polyester unfabricated sheet with 130 micron silicon coating layer, 40 to 50 micron silicon coating layer, plain silicon film, Sci. Med. silicon support film. The pressure drop between the inlet and outlet of our lung was not so prominent compared with Kolobow membrane lung.
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K. SHIRAMATSU, T. TAMIYA, T. NISHIZAWA, I. SUZUKI, K. MATSUZAWA, M. IN ...
1977 Volume 6 Issue 6 Pages
278-281
Published: December 15, 1977
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Comparative studies were done for improvement of the oxygen disperser in the bubble oxygenator. The materials used were 1) polycarbonate hard plate with manually made micropores of 250 micron diameter, and 2) sintered plates of various materials such as vinylidene fluoride with 25 micron micropores, polypropylene with 150 micron micropores and stainless steel with 100 micron micropores. Oxygenation was compared for the difference between the arterial and venous pO
2 in a mock-circuit, which consisted of deoxygenator (Kolobow of 0.8M
2) and two oxygenators with the testing disperses (our OCVC oxygenator) connected in parallel. Hemolysis was determined in a mock-circuit. The results turned out as follows:
Oxygenation was best with the sintered stainless steel plate, next with the sintered polypropylene plate or the porous polycarbonate plate, and worst with the sintered vinylidene fluoride plate. Hemolysis with the vinylidene fluoride plate was twice with the polycarbonate plate. It was observed that the sintered organic material distributed bubbles unevenly, while the sintered metallic material evenly. The sintered stainless steel plate seems promising on the above studies as well as easy manufacturing of microporous state of less than 100 microns, but further investigations should be demanded to confirm its clinical value.
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Hirotaka MURATA, Yasunaru KAWASHIMA, Tohru MORI, Soichi HASHIMOTO, His ...
1977 Volume 6 Issue 6 Pages
282-285
Published: December 15, 1977
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Gas transfer performance of recently commercialized artificial lungs were evaluated using a testing & evaluation method which was previously reported from our laboratory.
Using these indices, gas transfer characteristics & practical operation index of membrane oxygenators (Kolobow, Travenol, Landé-Edwards) & bubble oxygenators (Harvey, Optiflo, Rygg-Kyvsgaard, Temptrol Q-100 & Q-200A) were studied. Among the membrane oxygenators, Kolobow showed the best gas transfer performance. All bubble oxygenators tested except Temptrol Q-100 showed almost same gas transfer performance. Erom these data, optimum oxygen-blood flow ratio of artificial lung was introduced.
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[in Japanese]
1977 Volume 6 Issue 6 Pages
286-287
Published: December 15, 1977
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T. SAITOH, H. IKEDA, K. SAKAI, M. SUZUKI, N. AZUMA, R. AOKI, N. INOUE, ...
1977 Volume 6 Issue 6 Pages
288-291
Published: December 15, 1977
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The quantitative research of hemolysis by some mechanical effects was performed in extracorporeal circulation. The amount of plasma hemoglobin released by the effects was found to be determined by using an autohemolysis test of diluted blood. The bubbling type lung was used in order to determine the degree of hemolysis and the hemolysis curves obtained were shown in Fig. 5-10. These curves have saturated values and stand-up points, respectively. It was found that O
2 flow rate, O
2 bubbling time, ambient temperature and hematocrit were very important for the hemolysis.
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Hiroshi NAKAJIMA, Tetuo ANZAI, Hiroshi MATSUMOTO, Akibumi HIRAI, Goiti ...
1977 Volume 6 Issue 6 Pages
292-295
Published: December 15, 1977
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The mechanism of pulmonary, venal and brain damage during the use of extracorporeal circulation has been reported extensive investigation.
Obstruction of the microvasculature has been suspected, and intravascular microemboli have demonstrated histologically in both man and animals.
The blood filter is used in all our cases of cardiopulmonary bypass because it appears to have beneficial effects on the prophylaxis of the embolus in obove organs.
It has been thought that the major components of the emboli are composed of platelets. We studied the dynamics of the platelets during and after bypass with use of
51Cr labeled platelets. The influences of blood filter, dipyridamole and aspirin were compared for the change of the platelets during and after bypass with use of the bubble oxygenator. There was no-significant difference between the use of the filter or not.
Dipyridamole produced a significant increase in circulatory platelets after the discontinuation of cardiopulmonary bypass. Aspirin showed no effect in the preservation of the circulating platelets.
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Hideo HAGIWARA, A. KON, A. YAMAZAKI, T. HASEGAWA, Y. MAMIYA, Y. YAMAGU ...
1977 Volume 6 Issue 6 Pages
296-299
Published: December 15, 1977
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Twenty-two patients who underwent openheart surgery for heart disease received transfusion of 20 units of platelet concentrated (prepared from their own blood taken by the use of Haemonetics model 30) after peripheral circulation was adequately improved.
Determinations were mode of the platelet count and the adhensiveness and aggregation of platelets before operation, at termination of extracorporeal circulation, after the administration of protamin and also after transfusion of PC. The results indicated that the platelet count was lowest at termination of extracorporeal circulation and returned to the preoperative level after infusion of PC. Similarly, the adhensive and agglutination capacities of platelet were found lowest at termination of extracorporeal circulation and returned to almost preoperative levels after protamin dose and also after infusion of PC.
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Y. KITO, T. FUJITA, Y. NAITO, Y. KOU, H. MANABE, Y. KAWASHIMA, T. MORI ...
1977 Volume 6 Issue 6 Pages
300-303
Published: December 15, 1977
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The serial measurement of postoperative serum enzymes has been proposed as an important method for identifying myocardial damage following open heart surgery. Got, CPK, LDH and HBD were determined serially during and after operation in 5 patients undergoing myocardial pacemaker implantation, 29 undregoing mitral or/and aortic valve replacement or/and repair, and 6 under going coronary artery bypass surgery. The patients undergoing open heart surgery were divided into 4 groups: Group A consisted of 6 patients submitted to anoxic arrest for less than 15 minutes without topical cooling. Group B included 16 patients used anoxic arrest for 15 to 40 minutes without topical cooling. Group C presented 5 patients of anoxic arrest for 15 to 40 minutes with topical cooling. In Group D, 8 patients, anoxic arrest was carried out more than 40 minutes with topical cooling. LDH, HBD, and GOT elevated significantly in all patients after operation. However, no significant correlation was observed between the value of these enzymes and anoxic arrest time or combined procedure of topical cooling. On the otherhand the value of peak CPK and Σ CPK presented significant difference (P<0.05) in the Group of A, B, C and D. In other words peak CPK and Σ CPK presented excellent index for detection of myocardial injury during surgery.
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T. ARAKI, K. ITO, T. TANABE, T. SAGESHIMA, Y. IKOMA, K. HIRAI, T. AOYA ...
1977 Volume 6 Issue 6 Pages
304-307
Published: December 15, 1977
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It has been recognized that several of complications after the extracorporeal bypass are caused by the contamination of particulate matter in the circuit, particularly within the blood-gas interface oxygenator. The bubble oxygenators (Temptrol Q 110) were examined in 55 cases of patients by the filtration technique utilizing micromembrane filtration system (Sartorius, 3μ in pore size).
In this investigation, considerable amount of foreign bodies were demonstrated in the heart-lung machine. These foreign bodies were considered to be derived from the constituent materials of the heart-lung machine and were proved to be clearly different from the fat stain positive matters. These foreign bodies are thought to be distinctly extrinsic compared to the patient-born platelet aggregates or fat emboli, so that they may become more dangerous cause for postoperative pyrexia or disturbance of microcirculation, etc. This yields reason to wash away these foreign bodies from the extracorporeal circuit immediately before operation.
We conclude that the washing-out technique which is introduced in this paper is very useful, practical and simple, as well as adaptable even in cases of priming homologous blood.
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T. KISHIDA, H. ONOGI, H. KIDOKORO, H. KAZUI, M. ICHIKAWA, M. ASAI, Y. ...
1977 Volume 6 Issue 6 Pages
308-311
Published: December 15, 1977
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Human umbilical cord veins (HUCV) tanned with glutaraldehyde were used for vascular substitute.
The HUCV graft was experimentally replaced to a part of canine abdominal aorta. Twentynine of 33 showed patent. Four were occuluded as the result of thrombus.
The graft, which were patent, were removed in one week to six months after the implantation for morphologic studies.
Three were clinically bypass grafted in the femoro-popliteal region and are succesfully patent after 3, 5 and 5 months of the implantation at present.
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M. TOMIKAWA, H. SATO, Y. KOMORI, C. YOSHIDA, A. NAGAI, T. IWASE, T. IW ...
1977 Volume 6 Issue 6 Pages
312-315
Published: December 15, 1977
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Modified human umbilical cord veins were implanted into jugular vein of dogs. The histological change and organizing mechanism were studied by the microscope and electromicroscope after the implantation.
Histological reaction was strongly observed at the anastomotic site, and this reaction was noted contineously enchanced up to one month after the implantation, which probably is the chief factor caused the obstruction and stenosis of the anastomotic site. A further examination for the treated method was neccessary.
The immature endothelial cell was seen at one week and developed to mature cell after one month of the implantation, but the shape of the cell was different from that when used with expanded polytetrafluoroethylene.
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Yasuo SAWADA, Yoshikazu ONDA, Isamu KOSHINO, Yoshimi NAKANISHI, Fumio ...
1977 Volume 6 Issue 6 Pages
316-318
Published: December 15, 1977
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A cord is utilized as it is. The umbilical cord vessels have been tested in forms of raw (RM), alcohol (AL)- or glutaraldehyde (GA)-treated materials. AL and GA are equally superior to RM on pressure tolerance test. Tensile strength test showed that AL and GA both mechanically reenforced. The mechanical property is stable and irreversible in GA. Amino acids analysis indicates that crosslinking in GA takes place mostly among the lysine residue. Further assessment of material in view of surface characterization, antithrombogenicity and immunology are underway.
Based on these studies, 23 implants have been carried out clinically, No severe complication have thus far been encountered with the longest patency of 2 years.
The studies have indicated feasibility of the material for the purpose.
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T. ARSUTA, Y. KUBO, H. IKEDA, M. MATSUSHITA, Y. NISHIOKA, T. SASASHIMA ...
1977 Volume 6 Issue 6 Pages
319-321
Published: December 15, 1977
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Gluteraldehyde was applied to archieve sustained host tolerance maintenance of vascular function and suppression of antigenicity by chemical treatment of human umbilical cord vein.
Gluteraldehyde showed very strong bacteriocidal effect by our sterilization test.
The antibody product after transplantation of the modified human umbilical cord vein graft on to canine inferior vena cava was not detected by the method of complement dependent cytotoxi city test.
The content of mucopolysaccharides extracted from this graft was between canine thoracic aorta and inferior vena cave.
(Uroni c acid: 4.7 μ mole/g dry weight, Hexosamine: 4.8 μ mole/g dry weight and N-Sulfate: 1.2 μ mole/g dry weight)
We thoght this mucopolysaccharides to play the important role of antithrombogenicity of the inner surface of the graft.
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[in Japanese]
1977 Volume 6 Issue 6 Pages
322-323
Published: December 15, 1977
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M. ASAI, H. ONOGI, H. KIDOKORO, M. ICHIKAWA, H. KAZUI, T. KISHIDA, Y. ...
1977 Volume 6 Issue 6 Pages
324-326
Published: December 15, 1977
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The purpose of this paper is to describe a method to prepare autogenous fibrous tissue tube, structured in vivo in experimental animals. The prosthese consists of a silicone rubber rod covered with a porous mesh tube. The tubes were made by handicraft and used as an arterial graft homologously or autologously in experimental animals.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
1977 Volume 6 Issue 6 Pages
327-329
Published: December 15, 1977
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Arterial prostheses used in this study were internal velour grafts of 8 mm diameter and 30mm total length with thin silicone coating on the outer surface, i. e. non porous internal velour graft.
In 20 dogs, the grafts were implanted into the abdominal aorta, and were resected 2 weeks, 3 weeks, 7 weeks, 3 months and 6 months after implantation respectively to study healing mechanism of the prostheses.
Seven weeks after implantation, intimal formation had nearly completely developed anywhere in the graft. However, ulceration and dissection of the intima or thrombotic attachment to the graft had been seen at the middle portion, away from proximal and distal anastomoses in all the grafts implanted 3 months or 6 months before.
Thus intimal formation had well developed even in non porous graft in the earlier time, so that it was suggested that intimal components originated from circulating blood.
On the other hand, the porosity of the graft is necessary for the neo-intima to be viable.
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[in Japanese]
1977 Volume 6 Issue 6 Pages
330
Published: December 15, 1977
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Kaneyasu MIYATA, Kazuo YAMAGUCHI, Akinori KONDO, Makio FUJIMOTO, Yohic ...
1977 Volume 6 Issue 6 Pages
331-334
Published: December 15, 1977
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The sequential changes of the amounts of collagen, elastin, total protein, mucopolysaccharide and lipid in a swine carotid artery were studied during digestion with a chymotrypsin or a ficin solution. The chymotrypsin solution contains 50u/ml α-chymotrypsin, 12u/ml Urokinase, and 5mM CaCl
2 in 0.1M boric acid buffer of pH7.6. The Ficin solution contains 3u/ml ficin and 5mM HCl-cystein in phosphate citrate buffer of pH5.5. Following results were obtained.
1) A remarkable difference of elastolytic activity between chymotrypsin and ficin was shown in the fact that 8% and 97% of initial amount of elastin were hydrolyzed with the chymotrypsin solution and with the ficin solution for 5 hours respectively.
2) Amounts of decomposed collagen, protein and mucopolysaccharide increased, with a time course, in the both proteolytic enzyme solutions but lipid was decomposed little.
3) By procedures of immersion into 50% ethanol solution at 55°C for one hour for 3 times, about 95% of lipid was extracted from the proteinase-digested swine carotid artery.
4) The swine arteriograft, treated with the chymotrypsin solution for 10 hours and subsequently with 50% ethanol at 55°C, consisted of collagen (51%), elastin (32%), lipid (6.2%), muco-polysaccharide (1.1%) and ash (5.0%). On the other hand, the swine artetiograft, treated with the ficin solution for 2.5 hours and subsequently in 50% ethanol at 55°C, consisted of collagen (72%), elastin (4.0%), lipid (5.2%), muco-polysaccharide (4.3%) and ash (4.9%).
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N. AKABA, Y. YAMAMOTO, M. ISHIKAWA, T. YOHDA, R. KAN, T. HOSOYA, T. WA ...
1977 Volume 6 Issue 6 Pages
335-337
Published: December 15, 1977
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A non-woven vascular prosthesis has been developed for reconstruction of the small caliber arteries. The non-woven prosthesis consists of three layers. The outer and inner layers are made of non-woven polyester cloth, and the layer of rubber latex is inserted in between. (Fig. 2) The non-woven prostheses have been implanted into the forearm between an artery and a vein to construct A-V fistula for hemodialysis, yielding an excellent patency rate. Moreover, repeated direct punctures to this implanted prosthesis have been carried out without complications such as bleeding or hematoma after puncture. For the presence of rubber latex layer, the prosthesis is considered to bear repeated needle punctures for hemodialysis.
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I. Effect of fibrin clots prepared in vitro on thrombus formation
M. KAMATANI, K. HAYASHI, K. UMEYAMA, Y. KATAGAMI, Z. YANAGI, T. NAKAUE ...
1977 Volume 6 Issue 6 Pages
338-341
Published: December 15, 1977
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Fibrin clots prepared in vitro were examied for effect on thrombus formation as the first step toward experiments aiming at coating vascular prostheses with fibrin clots and imparting antithrombogenicity to the clots.
Pieces of filter paper were coated with fibrin clots prepared by addition of CaCl
2 to ACD plasma derived from a healthy man. They were placed on watch glasses and tested for antithrombogenicity by a kinetic method described by Komai and Nose. The fibrin clots prepared in this manner proved to be not antithrombogenic but significantly thrombogenic as compared with glass or silastic which served as the control.
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K. YASUDA, [in Japanese], [in Japanese], [in Japanese], [in Japanese], ...
1977 Volume 6 Issue 6 Pages
342-345
Published: December 15, 1977
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Nine composite grafts (6 Gore-tex-vein grafts and 3 Velour knitted dacron-rein grafts) were used to bypass femoro-distal popliteal or femoro tibial arterial obstructions in recent one year. Four grafts crossed the knee joint. Five patients had previous reconstructive arterial surgery.
Only one velour dacron graft was occuluded immediatly after operation. Four of 6 Gore-tex-vein composite grafts were occuluded by thrombosis at anastomotic site from 2 to 5 months after the bypassoprations. Two velour dacron grafts were patent in these period.
It is our opinion that bypass operation using composite grafts is a useful methed to restore the arterial circulation to the lower leg if the saphenous vein is too short or not usable for other reasons.
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[in Japanese]
1977 Volume 6 Issue 6 Pages
346
Published: December 15, 1977
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K. NAGAOKA, Y. MIYAUCHI, Y. NAKAGAWA, H. SAITO, K. ISOMURA, I. ADACHI, ...
1977 Volume 6 Issue 6 Pages
347-350
Published: December 15, 1977
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Dog or bovine aorta treated with both glutaraldehyde and ficin was transplanted to dog inferior vena cava. Heterologous bovine aorta preserved better patency than the homologous dog aorta as long as 6 months. Immunological examination of homologous dog aorta was revealed that there was no immunogenecity in terms of humoral and cell-mediated immunity.
Histopathological examination revealed that ficin treatment of dog aorta made the integrity of the vessel wall fragile. Therefore, we may conclude that treatment of aorta to reduce immunogenecity should be reconsider on the point of the vessel wall architechture to preserve it's function.
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H. KAZUI, H. ONOGI, H. KIDOKORO, M. ICHIKAWA, T. KISHIDA, M. ASAI, Y. ...
1977 Volume 6 Issue 6 Pages
351-354
Published: December 15, 1977
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Bovine carotid arteries were prepared for a vascular graft by means of digestion with ficin and tanning with glutar aldehyde.
The grafts were replaced the abdominal aortae of 35 mongrel dogs. The implanted grafts were observed angiographically and microscopically between one week and one year. None showed aneurysmal dilatation. Fibroblasts invaded into the media. Neointima was formed upto the midportion of the implanted graft after six months of implantation.
Author and coworkers repaired occlusive vascular diseses; two of arteriosclerosis obliterans, two of thromboangitis obliterans and one of external iliac artery, with the bovine carotid graft in the last six months. All of these five cases are patent in the implanted arteries.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
1977 Volume 6 Issue 6 Pages
355-357
Published: December 15, 1977
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Sixteen grafts of expanded polytetrafluoroethylene (EPTFE) with a diameter of 1.5mm, were placed in the femoral arteries of rabbits using micro-surgical technique.
There were two occlusions, an 88% patency rate. In histological study, light and scanning electron microscopic findings showed a thin neointima on the inner surface of the EPTFE grafts.
EPTFE may be usefull as the vascular prosthesis in micro-vascular surgery.
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-The healing mechanism-
T. KOBAYASHI, Y. FUJIEARA, T. OGATA, M. TOMONARI, S. ISHIMARU, T. FUJI ...
1977 Volume 6 Issue 6 Pages
358-361
Published: December 15, 1977
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Our studies include gross, microscopic and scanning electronmicroscopic inspections of the formation of inner capsule in the artificial blood vessels at 4 hours, 24 hours, 2 days, 3 days, 4 days, 1 week, 2 weeks, 6 weeks, 8 weeks and 10 weeks after implantation of EPTFE grafts into the superior vena cavae of dogs.
It was concluded that the reproduction, growth and organization of the neo-endothelial cells were controlled by the immature connective tissue located just beneath them.
At one week after implantation, the neoendothelial cells developed from the host veins with clearly notable continuity. 10 weeks following implantation, the neoendothelial cells grew densely, almost completely covering the surface of the inner capsule in membranous form.
The relatively rapid development of endothelial cells in venous grafts is probably due to typical characteristics of the vein such as lower blood pressure and blood flow velocity.
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-for optimal design of artificial organs-
S. NAKAJIMA, Y. MISHIOKA, T. SASAJIMA, K. TAKEUCHI, T. ATSUTA, M. TAMU ...
1977 Volume 6 Issue 6 Pages
362-365
Published: December 15, 1977
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We studied on the flow of fluid in the branching, stenotic, elliptic models of glass tube in order to find out the optimal design of artificial organs and optimal principle in vascular surgery.
Following results were obtained
1) The optimal branching angle exits in the relation between the side-main branch and the flow of fluid
2) Pulsatile flow increase the side branch flow in branching model but decreases the flow in stenotic vessel model
3) The lower the viscosity of fluid is, the more the side branch flow in branching model increases, but the more the flow of stenotic, elliptic vessel model decreases
4) We found out two factors which regulate the flow of fluid in elliptic vessel model
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[in Japanese]
1977 Volume 6 Issue 6 Pages
366-367
Published: December 15, 1977
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K. KUSUHARA, R. YASUDA, H. KOIE, K. YAMANISHI, R. KUSUKAWA
1977 Volume 6 Issue 6 Pages
368-371
Published: December 15, 1977
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A prolonged refractory period of about 0.55sec, was noted soon after exchange of Arco LI3D demand pacemaker due to electrical leakage which had been implanted 6 days before with sutureless epicardial lead by subxyphoidal approach. When a patient-QRS existed in this prolonged refractory period, demand failure occurred and the next pacing pulse was hazardously generated on T wave.
Our experiment revealed that the refractory period (0.26sec.) could be prolonged to 0.52sec., if a pulse was detected only in the period from 0.15 to 0.26 sec, after the pacemaker pulse, and that demand function did not work when a pulse existed in the refractory period and another in the prolonged refractory period, e. g. noises of very low frequency.
We assumed that the pacemaker detected the high voltage or high slew rate of T wave as a pulse in the period from 0.15 to 0.26sec. in this case. The manufacturer reported that the function of this pacemaker was within acceptable range. We thihk this pacemaker has such excellent function as the pacing pulses may not stop by low frequecy pulse-like noise (as low as 3.2Hz), but has such a weak point as mentioned above. We reimplanted another pacemaker (Medtronic 5973) successfully.
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Tomoyoshi ISHIHARA, Masaharu KOBAYASHI, Hiroshi HIKOSAKA, Katsuo OZAWA ...
1977 Volume 6 Issue 6 Pages
372-375
Published: December 15, 1977
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Three hundred and thirtyeight implantations of cardiac pacemaker with transvenous endocardial electrodes and myocardial electrodes have been performed in 181 patients at the First Department of Surgery, University Hospital of Nagoya, from March 1964, to October 1977.
Complications of implantable pacemaker have been so minimal. In our series, incomplete or complete disruption of pacemaker leads have occurred in 20 cases, most of which occurred in myocardial leads, used before December 1973.
Characteristic findings on ECG, manifested by irregular pacemaker pulse intervals and a good synchronization, were seen in most cases with pacemaker lead disruption.
Wire breakages of myocardial electrpde in old types occurred in 25% of cases. Recently, these breakages markedly decreased below 2% due to improvement of electrodes.
In this report, characteristic ECG patterns were analyzed in connection with lead trouble, and classified according to the location of lead disruption.
It is stressed that the classification would be very useful to diagnose pacemaker lead trouble both in location and in nature.
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T. HASEGWA, A. KON, A. YAMAZAKI, Y. MAMIYA, Y. YAMAGUCHI, F. INOUE, A. ...
1977 Volume 6 Issue 6 Pages
376-379
Published: December 15, 1977
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A cardiac pacemaker was implanted in a female patient (age 54) to manage the Sick Sinus Syndrome, but the pulse generatar was explanted because of the biorejection after 4.9 months service.
Matallurgical examination showed a surface effect over one-half of the case, exclusive of the area under the elastomeric boot. A thin film composed of carbon, calcium and phosphorous was found on the dark surface. The cause of the surface reaction has been tentatively identified as overaging of only one of the Haynes 25 cobot-chromium alloy case.
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Masayoshi YOKOYAMA, Akimasa HASHIMOTO, Hisae HAYASHI, Juro WADA
1977 Volume 6 Issue 6 Pages
380-383
Published: December 15, 1977
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[in Japanese]
1977 Volume 6 Issue 6 Pages
384
Published: December 15, 1977
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Keiichiro KATSUMOTO, Susumu TANAKA, Yusei SHIOIRI, Ikuo HAYASHI, Jyuen ...
1977 Volume 6 Issue 6 Pages
385-388
Published: December 15, 1977
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Recently permanent pacemaker electrodes with narrow surface area has been prevailed. When the surface area of the permanent electrode becomes small, stimulation threshold becomes low, and impedance becomes high but the amplitude of the endocardial myopotential obtained from it becomes also low, that will be a causative factor of a sensing abnormalities (undersensing) if the generator has a high sensing threshold. It is important to know the amplitude of the endocardial potential from the electrode at the time of implantation. The author compared the amplitude between various kinds of electrode in three stages, i. e. acute, subacute (7-14 days after implantation), and chronic stage (2-6 years) using temporary -permanent technique.
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Kageshige TODO, Satoru KANEKO, Takemi OHNO, Kenji SUGIKI, Yasufumi ASA ...
1977 Volume 6 Issue 6 Pages
389-392
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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Seven types of threshold analyzers were studied. The voltage and current wave form of each analyzers were observed with an oscilloscope when the electrode impedance was turned 200 up to 1100 OHM. The voltage and current pulse out-put of the analyzers were also measured. Then, a clinical study for thresholds of cardiac stimulation in patients with a implanted pacing lead was obtained. The v-constant and the c-constant threshold analyzers which were made in the same Inc. were used for the same five patients, and the difference of the data between the v-constant and c-constant type were compared. Measurements were made at initial implantation by obtaining stimulation threshold at each of four stimulus pulse durations ranging from 0.25 to 2.0msec.
Each analyzer has its own wave forms. The results of the measurements of the electrical threshold seem to be affected by the difference of the wave forms. The current pulse out-put of the v-constant analyzers increased and the voltage pulse out-put of the v-constant analyzers remained unchanged, when the electrode impedance was turned down. However, the voltage pulse out-put of the c-constant analyzers increased and the current pulse out-put of the c-constant analyzers remained stable, when the electrode impedance was turned up. When the different type analyzer is used, these differences between the v-constant and c-constant equipment may make an error on the patient with low electrode impedance. In fact, there are positive difference between the threshold data which were measured with the v-constant analyzer and the c-constant analyzer when they were used in the clinical study. When the threshold analysis is made, it is a satisfactory method if the same type of equipment (c-constant or v-constant) is available as an implanted generator.
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F. SAITOH, S. TANAKA, M. IKESHITA, T. SUZUKI, S. SAKAKIBARA, K. KOSEKI ...
1977 Volume 6 Issue 6 Pages
393-395
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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A total of 93 inter-electrode resistance were obtained. The resistance is devided into two parts of myocardial impedance and depolarization impedance. It is shown that the greater part of the energy supply to the electrode is consumed by the polarization impedance, which is proporsional to the electrode surface area. There is no significant deference in resistance due to electrode tip materials.
The increase of myocardial impedance is found 2 years after initial PM implantation. The resistance of myocardial lead don't differ from that of endcardial lead.
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S. KANEKO, [in Japanese], [in Japanese], [in Japanese], [in Japanese], ...
1977 Volume 6 Issue 6 Pages
396-399
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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The measurement of threshold and impedance are very important for the evaluation of successfull cardiac pacing.
Output amplitude of cardiac pacemaker is particularly depend upon impedance. In our clinical experiens, impedance usually ranged from 200 to 1000ohm.
It is concluded that threshold, impedance and amplitude of output pulse generator are important factors, related with satisfactory cardiac pacing.
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Ta. BANDO, T. MISAKI, J. SAKURAI, W. SAKAGUCHI, T. IWA, M. TERANAKA
1977 Volume 6 Issue 6 Pages
400-403
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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On the base of the control system forr limittation of output energy, pacmakers can be classified in two groups One is called constant voltage pacemaker of which spike is regulated by voltage, and the other is constant current pacemaker being limitted by current.
We observed the influence of pace maker pulse discharged from these two different types of pacemakers on the stimulation threshold of the heart for the purpose of saving energy and making good choice of pacemaker for a case of elevated threshold. In one case (using bipolar catheter electrode: USCI 6F) the threshold is 6.9μjoule on constant voltage stimulation, and 11.1μjoule on constant current. While in the other case (using myocardial electrod: Medtronic 6917) the threshold is 10.0μjoule on constant voltage, and 7.2μjoule on constant current. Therefore constant current stimulation is favorable for using a small surface electrode and constant voltage system is favorable for stimulation in use of a large surface electrode from the view point saving of its energy.
In the case of elevated threshold with heigh impeadance, the constant current pacemaker must be chosen.
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[in Japanese]
1977 Volume 6 Issue 6 Pages
404-405
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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-Mechanism and Its Clinical Trials-
Takayuki INOUE, Tsunemasa FUKUTOMI, Ikuho KOYAMA, Kosuke NAKAMURA
1977 Volume 6 Issue 6 Pages
406-409
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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In 1974, LeVeen and associates described a pressure activated valve which has proved to be useful when incorporated into a peritoneovenous shunt in patients with intractable ascites. This pressure activated valve permits flow in one direction only, and its characteristics are such that an intraperitoneal pressure which exceeds central venous pressure by 3 to 5 centimeters of water will allow flow of ascitic fluids into the central venous system. Thus, continuous, automatic intravenous infusion of ascitic fluid is now feasible. Since July 1976, four patients with intractable ascites were treated with LeVeen's peritoneo-venous shunting. Although 3 patients died of bleeding of esophageal varices 2, 3 and 7 months after shunting, all patients demonstrated a decreased abdominal girth, decreased body weight and increased urinary output. Indication and selection of the cases for the LeVeen's peritoneo-venous shunt will have to be clarified.
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T. NEMTO, H. SHIMAZU, K. YAMAKOSHI, T. TOGAWA, Z. YAMAZAKI, Y. FUJIMOR ...
1977 Volume 6 Issue 6 Pages
410-413
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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We developed the new system which was able to remove malignant cells and bacteria from ascitic fluid, then concentrate the ascitic fluid and finally reinfuse it to the patient. This system has been succesfully applied 50 times to, the patients with liver cirrhosis accompanied by diabetes mellitus, for these 2 years. The patient, who had been suffering from severe liver damage, and unable to walk, gradually recovered, was discharged 4 months ago. Since then he has had to stay over night in hospital for reinfusion of the concentrated ascites once a month. He is now so well to engage in office work.
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T. AGISHI, T. SUZKI, K. ERA, I. KANEKO, K. OTA
1977 Volume 6 Issue 6 Pages
414-417
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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A peritoneocaval shunt pump made of silicone rubber and actively transfering ascites from the peritoneal cavity to the superior vena cava was implanted in 8 intractable ascitic patients. Clinical improvements such as reduction in abdominal girth and body weight were obtained concurrently with increased urinary production in all but one who died of massive bleeding from esophageal varices in the night of the implantation.
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[in Japanese]
1977 Volume 6 Issue 6 Pages
418
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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K. TOMINAGA, S. SHINAGAWA, M. KOBAYASHI, N. AZUMA, Y. INOKI, S. TOKIMA ...
1977 Volume 6 Issue 6 Pages
419-421
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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Adsorbents manufactured by six companies, that are GAMBRO, B. D., MERA, KURARAY, ASAHI and S&N, have been compared with removal ratio of the serum before and after five hours direct hemoperfusion combined with hemodialysis to the same kidney insufficient patient by high performance gel chromatography. In high performance gel chromatography kidney insufficient patient shows specific five peaks named a-e, On peak-a ASAHI has a good removal ratio, on peak-b, d and e all adsorbents are simillar tendency to it, and on peak-c KURARAY has shown a excellent removal ratio. Also the removal ratio of Resin is as same as that of charcoal.
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T. SAKURAI, T. ABE, K. INAGAKI, N. KOMINAMI, Z. YAMAZAKI, K. SANJO, M. ...
1977 Volume 6 Issue 6 Pages
422-425
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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We have developed the new type spherical petroleum activated charcoal.
According to the comparative study with the conventional spherical petroleum activated charcoal made by Taiyo Kaken, It was clarified that this new type activated charcoal has the features as follows:
1) The adsorption capacity for basic substances was excellent.
2) The adsorption capacity for acidic substances was slightly less than that of conventional charcoal.
3) The adsorption capacity for other chemical compounds with various M. W. was same level.
4) The number of pulvelized charcoal particle released from charcoal bead was same level.
It seems likely that the difference of adsorption capacity depends on the oxidized surface property of activated charcoal.
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(PLASMA-PERFUSION DETOXIFICATION SYSTEM)
T. ABE, T. SAKURAI, K. INAGAKI, N. KOMINAMI, Z. YAMAZAKI, K. SANJO, M. ...
1977 Volume 6 Issue 6 Pages
426-428
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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A resin as a adsorbent for hepatic assist system has been newly developed.
The resin is a synthetic copolymer of styrene and divinylbenzene. The special technique has been developed to make more porous matrix in the resin than that of XAD-2 or -4.
An efficient adsorption of unconjugated bilirubin in the human ascitic fluid obtained from a patient with obstructive jaundice was demonstrated.
Therefore, the more efficient removal of tightly protein-bound toxic substances can be possible, applying this resin to our developed hepatic assist system ( plasma-perfusion detoxification system ) for patients with acute hepatic failure.
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Y. MORI, S. NAGAOKA, M. ITOGA, H. TANZAWA, Y. IDEZUKI, Y. YAMADA, S. K ...
1977 Volume 6 Issue 6 Pages
429-432
Published: December 15, 1977
Released on J-STAGE: October 07, 2011
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Heparinized hydrophilic polymer (H-RSD) consisted of hydrophobic unit, nonionic hydrophilic unit, cationic unit and heparin ionically bound was found to have both excellent antithrombogenicity and semi-permeability. Using H-RSD polymer, various kinds of procedures of coating pitch base activated charcoal bead have been developed. Treated activated charcoal was found to improve markedly antithrombogenicity keeping the adsorbance of untreated one. It seems that H-RSD coated adsorbent system leads to direct hemoperfusion therapy without systemic heparinization.
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