Motokazu Hori

Treatment of postoperative chylothorax with intrapleural fibrin glue

Two patients with chylothorax after pulmonary resection for lung cancer were successfully treated without thoracotomy by injection of fibrin glue components into the pleural cavity. This new technique for closing the chylous leak is described.

Plasma endothelin-1 concentrations in the coronary sinus in dogs with artificially induced myocardial infarction

We have previously reported the marked increase in plasma levels of endothelin-1 in patients with acute myocardial infarction (AMI). To investigate the effects of severe myocardial ischemia on the production of endothelin-1, plasma concentrations of endothelin-1 were measured by a sandwich-type enzyme immunoassay that we developed recently in both the coronary sinus and the aorta of dogs with artificially induced AMI. Dogs were anesthetized and chests were opened. The proximal left anterior descending coronary artery was completely occluded by ligation for 1 h and then was reperfused for 1 h. Throughout the experiment (at the end of occlusion for 1 h, at the beginning of reperfusion, at the end of reperfusion for 1 h), plasma endothelin-1 levels were not significantly altered either in the coronary sinus or in the aorta. The present findings indicate that severe myocardial ischemia itself does not affect the production of endothelin-1 in the coronary circulation of dogs.

Increased plasma concentrations of endothelin-1 during and after pulmonary surgery.

We studied the involvement of endothelin-1 (ET-1) in the physiological response to surgical stress. Plasma concentrations of ET-1 were measured by a sandwich-type enzyme immunoassay. The blood samples were collected from the pulmonary artery (PA), the left atrium (LA), and the median cubital vein (MCV) in four patients who had undergone pulmonary lobectomy. The samples were collected before, during, and after surgery. Plasma ET-1 concentrations increased in the blood from all sampling sites. The highest concentration of plasma ET-1 was observed at 6 h after surgery in MCV (3.97 +/- 1.47 pg/ml, mean +/- SD) and at the end of surgery in PA (1.79 +/- 0.48 pg/ml) and in LA (1.93 +/- 0.43 pg/ml). These values returned to the baseline value within 72 h after surgery [1.21 +/- 0.19 (MCV), 1.00 +/- 0.18 (PA)]. Although the lung has a large capacity to remove ET-1 from the circulating blood, ET-1 concentrations measured in plasma samples obtained from the LA were not different from those obtained from the PA. This may suggest that the lungs have the ability to absorb and release ET-1 simultaneously during pulmonary surgery. The increase of ET-1 in MCV was greater than that in PA or in LA. This suggests the possibility of ET-1 release from the forearm.

Suppression of demand mechanism by inactive myocardial electrodes.

A 14 year old girl, at age 8, had had a bipolar pulse generator implanted with myo‐cardial leads. Because one of the myocardial leads fractured near the electrode, a second pair of myocardial leads were implanted. Thus, the patient had two pairs of myocardial leads and one demand pulse generator implanted.

Ultrasonic Aspiration in Coronary Artery Surgery

With the aid of an ultrasonically powered aspiration device, the coronary artery to undergo distal anastomosis during aortocoronary bypass grafting can be exposed in the beating heart prior to institution of cardiopulmonary bypass and systemic administration of heparin. The thick adipose tissue and bridging muscles of the superficial layer are removed with almost no bleeding, leaving the vascular elements intact. The optimal site for anastomosis of the coronary artery is readily exposed and confirmed, and aortic cross-clamp time is minimized.

Successful reconstruction for combined tracheal and bronchial disruption

After a head-on automobile collision, a 21-year-old man was admitted with respiratory distress and subcutaneous emphysema. Bronchoscopy revealed a disruption of the trachea and a complete transection of the intermediate bronchus. A right posterolateral thoracotomy was performed, and both lesions were reconstructed primarily using absorbable materials.

Comparative DNA Analysis by Image Cytometry and Flow Cytometry in Non-small Cell Lung Cancer

To determine whether image cytometry (ICM) is advantageous for clinical DNA analyses of tumor cells, nuclear DNA contents measured by ICM were compared with those by flow cytometry (FCM), using 46 samples of non‐small cell lung cancers. ICM was performed on smear specimens of fresh materials (f‐ICM) and cell suspensions obtained from paraffin‐embedded tumors (p‐ICM). The same cell suspensions were also analyzed by FCM (p‐FCM). Aneuploid rates/coefficient of variation (CV) of f‐ICM, p‐ICM, and p‐FCM were 76.1/4.90, 71.7/5.01 and 60.9/5.31%, respectively. There was a high correlation in the DNA indices between p‐ICM and p‐FCM (r=0.80). In the comparative DNA analysis, there were seven discordant samples. Six of them were estimated as aneuploid by p‐ICM, but they were miscounted as diploid or undefinablc (impossible) by p‐FCM. This was caused by measuring condensed nuclei or debris. All “impossible” samples in p‐FCM were squamous cell carcinoma with necrosis. In cell cycle analysis, the S and S+G2/M phase fractions in diploid samples were higher in p‐ICM than those in p‐FCM (P< 0.005), because the GO/G1 phase (2N) fraction presented by FCM was composed of cancer and non‐malignant cells in diploid cancers. In ICM, they can be separately measured by means of morphological selection. These findings indicated that ICM is superior to FCM, especially for the practical DNA measurement of a few cancer cells and in the evaluation of the proliferation rates.

Effects of Pentoxifylline and Prostaglandin E1 on Cold Blood Perfusion Studied by Red Blood Cell Deformability

The effects of pentoxifylline and prostaglandin E1 (PGE1) on red blood cell deformability during cold blood perfusion were studied by means of a filtration method. The deformability of normal red blood cells decreased with the temperature transition from 20° to 15°C (transit time: 3.5, 5.8, 25, and 99 seconds at 37°, 20°, 15°, and 10°C respectively). The effects of both pentoxifylline and PGE1 were not noticeable at 37°C but became significant with hypothermia (5.0, 12, and 48 seconds at 20°, 15°, and 10°C, respectively, in samples with pentoxifylline of 0.3 mg/ml; 5.3, 13, and 46 seconds at 20°, 15°, and 10°C, respectively, in those with PGE1 of 40 ng/ml). The results in this study suggest that pretreatment of blood by pentoxifylline or PGE1 could improve coronary microcirculation perfused with cold blood cardioplegic solutions owing to significant improvement of the deformability of red blood cells.

Effect of Stabilized Hemoglobin as a Component of Cardioplegia on Warm Ischemic Heart

Stabilized hemoglobin was utilized as a component of cardioplegia in isolated rat heart. While oxygen consumption and heart function was better preserved in long term after reperfusion, damage from reperfusion injury was suspected and reversed in part by diltiazem.

Results of Femoro-Femoral Vein Bypass Grafting with Temporary Arteriovenous Fistula for Femoro-Iliac Venous Thrombosis: Differences between Operations in the Acute and Chronic Phases

Femoro-femoral vein bypass operation using a synthetic vascular graft with simultaneous construction of a temporary arteriovenous fistula (A-V f.) was performed in eight patients with acute femoro-iliac venous thrombosis after successful femoral thrombectomy but unsuccessful iliac thrombectomy; this operation was also performed in one patient with subacute thrombosis of the iliac vein and three patients with femoro-iliac post-phlebitic syndrome. Of the first nine patients who underwent the operation in the acute or subacute phase of the disease, the synthetic vascular grafts remained patent after closure of the A-V f. in six (66.7%), and no recurrence of symptoms was observed in any of the nine, including those in whom the graft was occluded. However, the graft remained patent in only one (33.3%) of the three patients who underwent the operation in the chronic phase and no improvement in symptoms was observed in the patients with occluded grafts. These differences in the results of bypass grafting are considered to be due to differences in the development of pelvic venous collaterals. The indications for this operation should be evaluated after close examination of the state of collateral vasculature.