Kazuhiro Arikawa

Cyanosis in atrial septal defect due to persistent eustachian valve.

Two cyanotic patients had venoarterial shunting from the inferior vena cava to the left atrium in an uncomplicated atrial septal defect with normal right ventricular pressures. Cyanosis was due to a large, anomalous inferior vena caval valve, the eustachian valve. The mechanism of cyanosis and technical problems for surgical repair are discussed.

Fatal hemolysis due to unidentified causes following mitral valve replacement with bileaflet tilting disc valve prosthesis

SummaryFatal hemolysis after mitral valve replacement with the St. Jude bileaflet tilting prosthesis is reported in two patients. Although one underwent re-replacement of the valve, both died from multiple organ failure and acute renal failure, respectively. Scanning electron microscopy revealed microthrombi adherent to a leaflet in one and irregular leaflet surfaces in the other. Such defects are rare but are possible causes of hemolysis in patients with the St. Jude mitral valve prosthesis.

Cardiac Lymph in Electrical Ventricular Fibrillation: An Experimental Study

The flow velocity of cardiac lymph during electrical ventricular fibrillation under normothermic cardiopulmonary bypass was studied experimentally in dogs. The time needed for the cardiac lymph node to become stained after injection of dye into the apex myocardium of the left ventricle was measured as an indicator in determining flow velocity of cardiac lymph. The flow velocity was markedly decelerated immediately after the commencement of electrical ventricular fibrillation. It was accelerated, however, after 2 hours of continuous electrical ventricular fibrillation. The difference between the two values was significant (p less than 0.01). Absent contractility of the heart influenced the deceleration of flow velocity of cardiac lymph immediately after the commencement of electrical ventricular fibrillation. Acceleration after 2 hours involved stasis of cardiac lymph as a result of absent contractility and increment of lymph production due to the nonphysiological condition of the myocardium.

Ruptured abdominal aortic aneurysm: Factors influencing operative mortality

Of fifty-eight consecutive patients surgically treated for aneurysm of the abdominal aorta, twenty were emergency cases following the rupture. Associated diseases were found in 85 per cent of patients; hypertension being the most common. Fifty per cent of patients were in shock on admission. The duration between rupture and operation was three hrs to two weeks with the average of 115.5 hrs. In six patients, the diagnosis of abdominal aortic aneurysm was known for over six months. The operative mortality rate in case of ruptured abdominal aortic aneurysm was 45 per cent. The most important determinants of survival were the incidence of shock on admission, the incidence of associated disease, the known duration of the aneurysm, and the time interval from rupture to admission. The intraoperative factors most influencing survival were the type of rupture, intraoperative hypotension, and total blood loss. Comparison of the mortality rate in elective surgery of abdominal aortic aneurysms (5.3 per cent) with that in ruptured aneurysms (45.0 per cent) suggests the necessity for early elective operations whenever abdominal aortic aneurysms are diagnosed.

Hyperbaric Oxygenation for Rectovaginal Fistula: A Report of Two Cases

A rectovaginal fistula after delivery is a rare complication, and its management can become difficult if infection occurs. In two such cases, we administered hyperbaric oxygenation (HBO) treatment against complicated infections, and we obtained a good outcome in each case.

Flow Velocity of Cardiac Lymph and Contractility of the Heart: An Experimental Study

The flow velocity of cardiac lymph in various abnormal conditions of the heart and in control situations was studied experimentally in dogs. The time needed for the cardiac lymph node to become stained after injection of contrast medium into the muscle layer of the left ventricular apex was measured as an indicator in determining flow velocity of cardiac lymph. Left ventricular contractility was studied simultaneously. The hypoxic dogs had a short staining time with a vigorous cardiac beat. (Short staining time means accelerated lymph flow through the heart). The hearts in which the coronary sinus was ligated revealed the shortest staining time with an insignificant contractile change. The exsanguinating dogs had a long staining time with reduced contractility. The dogs with ventricular fibrillation had the longest staining time. When the heart rate was fixed by pacing, the staining time reflected contractile change. The contractile force of the heart plays an important role in the flow velocity of cardiac lymph.

Effect of temperature on gastric intramucosal PCO2 measurement by saline and air tonometry

tures (34.0, 37.0, or 40.0°C) by a heater (TR-1; Icuchi Inst., Tokyo). A Tonocap monitor can be used with an infrared sensor to measure a patient’s end-tidal PCO2. In our set-up, an additional tube was inserted into the chamber and connected to the inlet of the Tonocap normally used for measuring end-tidal PCO2. The test chamber was flushed with a mixture of oxygen and carbon dioxide gas at a flow rate of between 8 l·m 1 to 11 l·m 1. The PCO2 in the chamber was set to 40mmHg by adjusting the flows of the two gases while viewing the screen of the Tonocap. The Tonocap monitor was calibrated using a standard gas (Quick CAL; Datex Engstrom, Helsinki, Finland). The two catheters for the saline method were prepared as recommended by the manufacturer. Saline was injected into the balloon and, after the dwell time (60min) had elapsed, the first 1.0ml was discarded. Then, the PCO2 of 1.5 ml of the saline from the balloon (PsCO2) was measured with an automated blood-gas analyzer (ABL 300; Radiometer, Copenhagen, Denmark). All PsCO2 values were corrected with respect to a temperature of 37°C when measured in the analyzer. PCO2 within the chamber (PbCO2) was recorded every 10 min during the dwell time. A correction factor for the saline method (CF-S) was then calculated for each temperature by dividing the average of the six PbCO2 values by the single PsCO2 value. The Tonocap measures the PCO2 of the tonometer gas (PgCO2) automatically every 10min (pre set by the manufacturer), so we obtained six values by the air-gas method while waiting for the dwell time for the saline method to be completed. Because the Tonocap displayed the PCO2 of the surrounding gas every 10 min, six PbCO2 values were obtained in 60min. Thus, values were obtained for both parameters (PbCO2 and PgCO2) at the same six time points (once every 10min, for an effective dwell time of 10min). A correction factor for the air-gas method (CF-G) was calculated for each temperature by dividing each PbCO2 value by the PgCO2 value obtained at Address correspondence to: H. Dohgomori, Division of Emergency Medicine, Ryukyu University Hospital, 207 Uehara, Nishihara-cho, Okinawa 903-0215, Japan Received: June 18, 2002 / Accepted: July 18, 2003

Accuracy of a peristaltic finger-type infusion pump during hyperbaric oxygen therapy.

AbstractPurpose. To evaluate the accuracy of a peristaltic finger-type pump during hyperbaric oxygen therapy (HBO). Methods. Using two examples of one type of infusion pump, we evaluated its accuracy at 2 ATA (atmospheres absolute) by measuring the actual volumes pumped at given time points (flow rate) and comparing these data with the corresponding data obtained at 1 ATA. Results. There was no significant difference in flow rates between 2 and 1 ATA. In terms of accuracy, the present pump was superior to the syringe pump tested in our previous study. Under our conditions, the ambient pressure might have acted equally on the inlet and outlet sides of the infusion line, which may explain the lack of effect of 2 ATA on flow rates. This is not the case with a syringe pump, and the difference in flow-generating mechanisms may help explain the different results obtained in our two studies. Conclusion. The present type of pump could be used during HBO (at 2 ATA) with the same accuracy as at 1 ATA. Whether the ambient pressure can affect pump input and output (peristaltic-pump infusion line) or only pump output (syringe type) may determine whether accuracy suffers under HBO conditions.

Long-Distance Transportation of Canine Hearts for Transplantation: The First Experience in Japan

Long-distance procurement of canine hearts following preservation by coro nary perfusion was twice attempted by simple cooling under septic conditions. Following cardiac arrest by cardioplegia, the donor heart was excised and switched to a Langendorffs model. Continuous hypothermic, low-pressure cor onary perfusion with a 4 ° C new modified Krebs solution was performed for seventeen hours. Thereafter, the graft was placed in a thermal (4°C) protected environment. In transportation of 2,124 km, automobiles and commercial air lines were used. The total transport and ischemic times were nine and twenty- seven hours, respectively. The myocardial temperature during both the preservation with coronary perfusion and the transportation by immersion was maintained at 5-7°C. After orthotopic transplantation, both grafts provided good support of the recipient circulation for six-hour and seven-hour observa tion periods. No contraction band injury was histologically observed in the myocardial cells, and the electron microscopic study also revealed almost nor mal features of the myocardial cells after transplantation. The present experi ence suggests that long-distance human heart procurement for transplantation may be safely performed using the conventionally available transportation sys tem in Japan and that the donor heart can be viably stored for a long time (twenty-six hours) by the combination method of coronary perfusion and simple cooling.

Hereditary Angioneurotic Edema: Report of a Case Undergoing Open-Heart Surgery— A Case Report

Hereditary angioneurotic edema is a familial disease due to the absence or to the functional deficiency of the inhibitor of the activated first component of complement. It is characterized by recurrent attacks of localized edema affect ing skin and mucosal membranes; edema of the laryngeal mucosa may be fatal. Because trauma and surgical intervention may become a trigger of attacks, a pitfall for surgeons or physicians is always present. We recently encountered a patient with hereditary angioneurotic edema who successfully underwent open- heart surgery following short-term prophylaxis with danazol and fresh frozen plasma transfusion.