Susumu Omokawa

Exchange blood transfusion and on-line plasma exchange for sepsis in infants.

During the last 6 years, 19 infants with sepsis have been treated with exchange blood transfusions 47 times, and 13 patients survived. However, this procedure is compromised by antibody formation against WBCs and platelets. Accordingly, a miniature system for on-line plasma exchange (PE) between septic infant and healthy parent has been developed and evaluated using a canine model. Escherichia coli, at a dose of 5 X 10(9) CFU/ml/kg, was injected intravenously into 17 puppies that were divided into 3 groups; untreated; sham treated; and PE in which 80 ml/kg of plasma in each septic puppy was replaced during 2 hr with fresh plasma simultaneously obtained from healthy adult dogs. Four of 5 puppies survived in the PE group, while all other puppies died within 24 hr. In the PE group, viable cell counts of E. coli and endotoxin decreased significantly, and opsonic activity improved. This system is effective and applicable for treatment of sepsis in infants.

A simple experimental model of total hepatectomy, hepatic ischemia and extrahepatic portal obstruction in rats using splenic transposition

The objective of this study was to develop an easy and simple experimental rat model of total hepatectomy, hepatic ischemia and extrahepatic portal obstruction. The first operation involved transposing the spleen with its scarified capsule in a subcutaneous pouch to produce portasystemic anastomosis. Total hepatectomy was easily performed in a lobe-by-lobe fashion 2 weeks following the first stage operation. Anhepatic rats receiving a glucose infusion survived for about 10 hours and all died of acute hepatic failure. Hepatic support systems can be accurately evaluated in this anhepatic rat model because of its uniformity. Sixty minutes of hepatic ischemia was able to be performed in rats with a transposed spleen for a portasystemic shunt and no complicated or technically involved procedure was required for the ischemic model. No rats died due to technical difficulties, suggesting the reliability and reproducibility of this ischemic model. An animal model resembling extrahepatic portal vein obstruction was also obtained by ligation of the portal vein; a simple maneuver which was able to produce collateral veins to the liver and cavernous transformation, as similarly seen in clinical patients with extrahepatic portal obstruction. Because these 3 animal models were so easily achieved in the rat, and since the changes in hepatic function and formation of the collaterals to the liver after portal vein occlusion are still poorly understood, this model should prove valuable for future study.

Insemination of bile duct carcinoma to the liver after insertion of percutaneous biliary endoprosthesis

SummaryPercutaneous transhepatic biliary drainage is widely used to relieve bile duct obstruction which can be caused by bile duct or pancreas carcinomas. Although the incidence is low, insemination of carcinoma along the transhepatic catheter tract is considered to be a serious complication of percutaneous transhepatic biliary drainage. The authors present a case of intrahepatic insemination of bile duct carcinoma along the catheter that subsequently underwent a curative resection consisting of pancreaticoduodenectomy and right hepatic lobectomy. It is suggested that a percutaneous biliary endoprosthesis through the tumor should be avoided in patients in whom a possible curative resection can be considered. External biliary drainage should only be performed in order to minimize the manipuIation of the tumor in such patients.

Study of Safe Usage of High‐Flow Three‐Way Stopcocks in a Blood Circuit

Abstract:  To examine the safety of using a high‐flow three‐way stopcock in a blood circuit during extracorporeal blood purification therapy, we studied the risk of development of hemolysis and clot formation in both ex vivo and in vivo extracorporeal circulation. In the ex vivo study, no significant difference was observed in the decrease in hematocrit (HCT) or increase in the potassium level between the three‐way stopcock group and the control group. Nor was there a significant difference in the change in inlet pressure between the two groups. Thus, it was shown that the risk of hemolysis caused by the use of a high‐flow three‐way stopcock on both the outlet side and inlet side would be small. In the in vivo cases, there was no significant difference in the decrease in HCT or the increase in inlet pressure between the three‐way stopcock group and control group, suggesting that it is clinically possible to incorporate a high‐flow three‐way stopcock into a blood circuit.

AUTOLOGOUS BLOOD TRANSFUSION IN AKITA PREFECTURE-SURVEY IN 2001

The objective of this survey was to study the present status of autologous blood transfusion practice from January 2001 to June 2001 in Akita Prefecture and to evaluate changes in status by comparison with our previous survey in 1994. Questionnaires were sent to 151 surgical divisions of 34 hospitals with more than 50 beds in Akita Prefecture. A total of 112 answers (74.2%) were collected and evaluated.Autologous blood transfusion programs were conducted in 61 divisions (54.5%) in total. This value was increased compared with the previous result. The percentage of performance of autologous blood transfusion was highest in orthopedics (93.8%), and increased remarkably in gynecology. Status of collection and storage management of predeposit autologous blood further improved. Main practical problems identified in this survey were insufficient workforce in the predeposit method, a shortage of knowledge about hemodilutional methods, anxiety concerning contamination such as bacteria or fat, and insufficient workforce in salvaging methods. In future for allogeneic blood transfusion cases, 34 divisions are planning to institute autologous blood transfusion programs, mainly with predeposit method only or both predeposit and hemodilutional methods.Many divisions pointed out that in the promotion of autologous blood transfusion, it is necessary to arrange equipment and workforce, to enlighten doctors and to relieve limitations on medical insurance concerning autologous blood transfusion.

Status of predeposit autologous blood transfusion-Survey of hospitals approved by the Japan Society of Blood Transfusion: Collection, management and compatibility testing of autologous blood transfusion.

In 1999, the Japan Society of Blood Transfusion organized a small committee on autologous blood transfusion. The committee was assigned to evaluate the status of predeposit autologous blood transfusion in hospitals approved by the Japan Society of Blood Transfusion and to clarify problems concerning the promotion of autologous blood transfusion. Questionnaires were sent to 86 hospitals. Information on each hospital (number of beds, number of doctors and medical technologists approved by the Society, etc), establishment of blood transfusion service, preservation methods, and management and compatibility testing of autologous blood were evaluated. In addition, number of cases and units of autologous blood transfusion from. Jan 1999 to Dec 1999 and status of homologous blood transfusion during operation were analyzed. Predeposit autologous blood transfusion was performed in all 68 hospitals which answered the questionnaire. Blood transfusion service was established in 64 hospitals. However, the place of autologous blood collection and the personnel involved in blood collection were not centralized. Percentage of autologous blood without allogeneic blood cases in cases of blood transfusion during operation was 17% in total. Percentages among hospitals ranged from 3.6% to 76.9%. Percentage of autologous blood units in units of blood used during operation was 12% in total, and ranging from 0.5% to 77.6%. Differences in the status of predeposit autologous blood transfusion were significant among hospitals. Doctors approved by the Japan Society of Blood Transfusion should assume an important role in the promotion of autologous blood transfusion in hospitals.

Informed consent for transfusion medicine. Questionnair from Physicians.

Informed consent in autologous and homologous transfusion medicine was investigated by questionnaires sent to 77 blood transfusion departments of the university hospitals. On homologous transfusion, although 80% of physicians talked with patients about the risks of transfusion, 70% did not ask patients to sign a consent form before receiving blood. Further, most physicians spent no more than 10 minutes explaining to patients the risks and benefits of allogenic blood. With regard to autologous transfusion, more than 80% of physicians mentioned the risks and the benefits of this procedure, and also the procedures for preoperative donation. However, only 41% of physicians required written consent.In conclusion, the physician has the moral duty to inform the patient of the risks and benefits of blood transfusion. Institutions should consider written informed consent separate from surgical consent. This would result in increasing the patients knowledge and autonomy in transfusion medicine. Further, the ethical and educational elements of informed consent for blood transfusion should be a part the curriculum of residential training or undergraduate study.

Present status of autologous blood transfusion in a rural prefecture.

The objective of this survey was to study the present status of autologous blood transfusion practice from April 1992 to March 1993 in the hospitals including small clinics without blood transfusion service in Akita prefecture. A questionnaire was sent to 146 surgical divisions of 37 hospitals with more than 50 beds in Akita prefecture.A total of 129 answers (88.4%) were collected and evaluated. Autologous blood transfusion program was performed in 42 divisions (32.6%) in total. Predeposit autologous blood transfusion was widely applied. Enforcement percentage of autologous blood transfusion was higher in cardiovascular surgery and orthopedic surgery divisions compared with other surgical divisions. No homologous blood was transfused in 76% of total cases and 46% and 82% cases in cardiovascular surgery and orthopedic surgery, respectively. Ninety four divisions (73%) answered that they are performing or planning one of various autologous blood transfusion programs in future. However, 29% of general surgery divisions have no plans to perform autologous blood transfusion. Several practical problems such as a shortage of man power or time to participate, short preservation duration of predeposit blood and unavailability of erythropoietin for the program were pointed out to perform predeposit autologous transfusion program. Cooperation by the Japan Red Cross blood center was strongly requested in autologous transfusion practice. Since the MAP autologous blood needs to be separated by centrifugation, separation and freezing of autologous blood products were specially requested to be performed by the blood center.

Evaluation of the intrahepatic hemodynamics by a micropuncture method after portal vein ligation.

門脈本幹の遮断による肝内血行動態の変化を明らかにするために,脾皮下固着ラットを用いて,門脈遮断後,経時的に門脈終末枝圧と中心静脈圧との変化をmicropuncture法によって測定し,肝組織血流量および求肝性副血行路の形成状態との関連癒検討した.門脈結紮により,門脈終末枝圧,門脈終末枝-中心静脈圧較差,肝組織血流量は低下したが,門脈終末枝圧,圧較差は結紮後4週で,肝組織血流量は同じく3日で対照値に復した.門脈造影では,門脈結紮1週後より求肝性副血行路の形成を認め,4週後で著明となり肝内門脈枝も明瞭に造影された.門脈終末枝圧,門脈終末枝-中心静脈圧較差の回復は求肝性副血行路形成の経過とよく相関したことから,結紮後早期に代償性の肝動脈血流量増加があり,4週では求肝性副血行路形成によって門脈血流量が回復するものと推測された.