Hiroshi Shida

The role of the liver in the changes of acid-base balance and plasma lipids during surface-induced deep hypothermia.

The role of the liver in the changes of acid-base balance and plasma lipids in surface-induced deep hypothermia for open-heart surgery was investigated clinically and experimentally. The metabolic acidosis generally observed in open-heart surgery under surface-induced deep hypothermia is derived from lactacidemia. Although the accelerated anaerobic glycolysis is partly responsible, the depressed acidic metabolite-disposing ability of the liver also plays an important role. The evidence which is presented to show the decrease of plasma lipids other than NEFA under hypothermia is probably due to the hepatic accumulation of lipids and the decreased lipids release from the liver.

Metabolic Changes in Surface-Induced Deep Hypothermia Combined with Cardiopulmonary Bypass for Cardiac Surgery

Surface induced deep hypothermia combined with cardiopulmonary bypass (combined method) is excellent in open heart surgery of infants which combines each advantage of cardiopulmonary bypass and hypothermia. The present study was performed to investigate pathophysiological changes, especially metabolic changes, in combined method induced by two stressors such as cardiopulmonary bypass and hypothermia. In general, metabolic changes during hypothermia are temporarily enhanced immediately after the start of cardiopulmonary bypass. Lactacidemia and metabolic acidosis are rapidly improved after the start of perfusion rewarming, but abnormality of ceruloplasmin and cholesterol metabolism in the liver and hypopotassemia are not rapidly improved. Therefore, the treatment for these metabolic abnormalities seems to be necessary during and after the procedure.

Pathogenesis and treatment of metabolic acidosis in open heart surgery under surface induced deep hypothermia

Metabolic acidosis observed in open heart surgery under surface induced deep hypothermia is due to lactacidemia, but is reversible, returning to precooling level 24 hours after the operation, and it can be considered more or less as a pathognomonic finding. Although the correction of acidosis present did not influence the level of lactic acid in blood, it was found to be clinically advantageous during the heartresuscitation. Therefore, it is advisable to maintain acid-base balance within-10 mEq per 1 of base excess.

Somatic and Psychomotor Development of Children after Hypothermic Open-Heart Surgery

One hundred and seven patients with ventricular septal defect who survived one and a half to thirteen years after hypothermic open-heart surgery were reviewed with respect to somatic, intellectual, and psychomotor development. There were no negative effects associated with deep hypothermic arrest in any of these areas. Abnormal electroencephalograms were seen in one-half the number of patients examined, but there was no close relation between the circulatory arrest period and electroencephalographic findings. CT scanning of the brain indicated that the abnormality decreased with the lapse of the time after hypothermic open-heart surgery. It would appear that hypothermic open-heart surgery with limited circulatory arrest is a useful method, providing that the circulatory arrest is not allowed to exceed a limited period. However electroencephalographic assessment suggests that postoperative cerebral abnormalities may occur more frequently than previously suspected, despite the lack of preoperative abnormalities on the electroencephalograms.

Inhibitory mechanisms of insulin secretion associated with hyothermic open-heart surgery

In order to clarify the inhibitory mechanism of insulin secretion associated with open-heart surgery, the influence of insulin antagonistic hormones on insulin secretion was studied in 20 patients with congenital heart diseases undergoing open-heart surgery, under simple deep hypothermia. Despite a hyperglycemia, plasma immunoreactive insulin and C-peptide showed no change during the cooling period, while with the exception of plasma human growth hormone, dopamine-β-hydroxylase, immunoreactive glucagon, cortisol and cyclic AMP in plasma, either showed no change, or a decrease during the cooling period. It is assumed that catecholamine, glucocorticoid and glucagon do not play an important role in the inhibitory mechanism of insulin secretion during hypothermic open-heart surgery, and a transient hypofunction of the pancreas as well as the liver and the adrenal gland is probably involved.

Rare variants of Hodgkin's disease of the thymus: Report of two cases and proposal for effective clinical management

We treated two patients with rare variants of Hodgkins disease of the thymus. One was a 17-year-old girl with a thymoma-like shadow on the chest X-rays, an increased erythrocyte sedimentation rate and an elevated eosinophile count. Pathologically, a mixed cellularity variant of thymus Hodgkins disease was evident. The other patient was 22-year-old girl with evidence of mediastinal tumor on the chest X-rays. Pathological examination revealed Hodgkins disease of the lymphocyte predominance variety. She also had Von der Haeve syndrome. In both cases, Hodgkins disease was suspected by scintiscanning, using three kinds of radioisotope,201Thallium-chloride,67Garium-citrate and75Selenomethionine. Radical excision of the lesion plus preoperative and postoperative irradiations were carried out. Both are well 6 and 5 years after the treatment, respectively. We propose a new diagnostic procedure and a method of treatment for such patients.

Studies of lipid and carbohydrate metabolism during surface-induced deep hypothermia with circulatory arrest for open-heart surgery

Plasma lipids, blood glucose, plasma insulin (IRI) and serum dopamine-β-hydroxylase (DBH) were measured in 30 subjects undergoing surface-induced deep hypothermia with circulatory arrest for open-heart surgery. Non-esterified fatty acid (NEFA) in the plasma rapidly increased at the lowest temperature (23°C) reached and other lipids in the plasma decreased during the cooling period. An increase of NEFA and a decrease of triglyceride have been attributed to the action of lipoprotein lipase activity stimulated by heparin. It is also likely that the decrease of other lipids and β-lipoprotein in the plasma results from the transient hypofunction of the liver due to hypothermia. Blood glucose increased during the cooling period, while plasma insulin showed no significant change. Serum DBH reflecting catecholamine also showed no significant change during the cooling or rewarming periods. Therefore, hyperglycemia in hypothermic open-heart surgery may result from the decrease of peripheral utilization of glucose and from the inhibition of insulin secretion due to the transient pancreatic hypofunction.

Results of splenectomy for chronic schistosomiasis japonica with so-called Banti’s syndrome

In spite of many case reports of accidental or therapeutic hepatic artery ligation, very few were reported dealing with changes of postoperative liver functions. We performed hepatic artery ligation in 5 patients (3 proper, 1 right and left, 1 right) with metastases in both liver lobes with the purpose of reducing oxygen supply to hepatic tumors and examined the postoperative changes of liver functions and serum lipids. All the patients tolerated the procedure well except one who died on the 27th day due to obstruction of the choledochus. All patients showed elevated serum GOT and GPT activities with varying intensity and duration in the first postoperative week. The values of GOT and GPT moved paralled to each other. Serum LDH activities of all elevated more than 1000 units in the first week but returned to normal within 2 weeks. Postoperative hyperbilirubinemia with the maximal rise on the 3rd day was seen in all patients but the degree was slight. Serum alkaline phosphatase and leucine aminopeptidase were slightly elevated in three patients within 3 weeks postoperatively. All patients showed marked decrease of serum albumin level from the 3rd to 21st postoperative day. Serum levels of total cholesterol, total phospholipid and tryglyceride decreased in 3 patients more than after usual laparotomy, but returned to the preoperative level on the 21st postoperative day. All the changes mentioned above seem to be reversible and hepatic dearterialization might be done without any functional sequela.