Shoichi Furukawa

Depression of host-defence mechanisms following cardiac surgery

The purpose of the present study was to determine the effects of open-heart surgery on host-defence mechanisms, by studying serial changes in serum immunoglobulins, circulating lymphocyte function in patients undergoing open-heart surgery. Serum proteins and immunoglobulins were significantly depressed immediately after operation and these depressions were correlated to the degree of the durations of cardiopulmonary bypass and associated hypothermia. White cell counts in peripheral blood increased significantly after operation. In contrast, total circulating lymphocytes were depressed postoperatively. The depression of circulating lymphocytes was mainly due to a marked decrease in the number of T-cells. Mitogen responses of lymphocytes stimulated by phytohemagglutinin were also depressed postoperatively. The quantitative and qualitative depression of cell-mediated immunity following open-heart surgery was observed. However, these depressions returned to preoperative levels in one week and had no clinical significance.

Pulmonary and Deep Vein Thrombosis in a Young Patient with Protein S Deficiency: Report of a Case

A 27-year-old man, who was diagnosed as having familial protein S deficiency, developed deep vein thrombosis complicated with pulmonary thromboembolism. Anticoagulant therapy and thrombolytic therapy were commenced after the insertion of a temporary inferior vena cava filter (t-IVC-f). However, on day 5 after t-IVC-f insertion, IVC venography showed filter thrombosis. On day 13, we made a venotomy and removed the captured thrombi and inserted a permanent IVC-f. After removal of the t-IVC-f via the right brachial vein, thrombi that had not been seen earlier appeared in the right atrium (RA). It was suspected that the thrombi around the catheter had likely been stripped off during the catheter removal procedure. After the abdomen was closed, an extra operation was immediately performed. Under complete extracorporeal circulation, the RA was opened and the all thrombi were removed. The patient recovered well and was discharged on the 21st postoperative day without any complications.

Aneurysms of the descending aorta: Surgical experience with three methods of adjunct procedures

Thirteen patients were surgically treated for the repair of aneurysms of the descending aorta, using three different types of adjunct procedures—an external temporary bypass with a vascular prosthesis, a tridodecylmethylammonium chloride (TDMAC) or a partial cardiopulmonary bypass. There was no operative death, though one patient died 73 days following surgery. Significant intraoperative morbidity occurred in 3 patients: one had ventricular fibrillation and the other two massive hemorrhages. There was no instance of paraplegia or renal failure. The only significant complication that developed was pulmonary insufficiency in two patients with a pump bypass. The mean operative time and the mean aortic occlusion time in patients with the TDMAC shunt were shorter than the times in patients with the vascular prosthetic shunt or the pump bypass. TDMAC shunt required no special equipment and cannulation was simpler and safer.

Renal Function after Cardiopulmonary Bypass and Effect of Urinastatin on Renal Function.

体外循環後の急性腎不全は重篤な合併症の一つである.今回糸球体と尿細管機能の諸指標を測定し,体外循環後の腎機能の変動およびウリナスタチンめ腎保護作用を検討した.対象は成人心臓手術で,ウリナスタチン投与群(U群)と非投与群(C群)に分けた.糸球体機能の指標である血中尿素窒素,血中クレアチニン,およびクレアチモンクリアランスは,両群で有意な変動を示さなかった.血中β2-microglobulinおよび尿細管機能の指標である尿中N-acetyl-β-D-glucosaminidase,尿中γ-glutamyl-transpeptidaseは,U群で有意に上昇し,C群ではU群に比し有意に低値であった.Fractional excretion of sodiumでは両群間に有意差はなかった.体外循環後臨床的に腎不全を呈さない症例においても潜在的に糸球体および尿細管機能障害を認めた.ウリナスタチンは糸球体および尿細管保護作用を有すると考えられた.