Terutake Sunada

Myocardial protection during open-heart surgery: intermittent aortic crossclamping versus coronary perfusion.

Twenty-seven patients undergoing open-heart surgery were divided into three groups, i.e., control, intermittent aortic crosslamping and coronary perfusion groups. Myocardial oxygen extraction, lactate extraction, arterial-coronary sinus hydrogen ion difference, potassium difference and glucose difference were determined during the operation, as well as, postoperative stroke and cardiac indices and comparisons were made. When the ascending aorta was not crossclamped, myocardial metabolism was well preserved during and after the perfusion at a flow rate of 2.0 L./min/m2. Intermittent aortic crossclamping for 15 minutes alternating with a period of perfusion for five minutes at 30°C was sufficient to protect the myocardium from ischemia. Perfusion of the left coronary artery alone at a flow rate of six per cent of total body perfusion (150 to 200 ml per minute) at 30°C was sufficient to protect the myocardium when the aorta was opened. Since intermittent perfusion of the left coronary artery may produce myocardial derangement, coronary perfusion should be continuous. Otherwise topical cardiac cooling or other means of myocardial protection should be used.

STUDIES ON THE SURGICAL CASES OF THE ESOPHAGEAL LEIOMYOMA

食道平滑筋腫の教室6手術例は, 32歳から52歳で男女比5: 1であり, Ce以外の食道の各部位にみられ, 全例核出術を施行しえた.文献上蒐集した本邦60手術症例の統計的観察を行った.年齢は2歳から62歳で, 性別差はなく, 発生部位はCeになくて60%が下部食道であり, 主症状は嚥下障害と異和感が多く, 無愁訴例が11.7%である.術前診断は, 癌腫とは区別されながらも, 本症と診断せるものは極めて少なく, 食道に16.7%に併発疾患があり, 多発例13.3%である.手術々式は腫瘤摘出術と食道切除術がおのおの57.4%, 40.8%である.本症の術前の確診, とくに悪性疾患との鑑別は困難であり, 本症は愁訴の有無にかかわらず手術的療法を考慮すべきである.

Prediction of prognosis in open-heart-surgery by regional difference in leg surface temperature.

Change of the surface temperature of the leg during open-heart-surgery was determined in five patients, in whom either side of the femoral artery was ligated for cannulation. While the surface temperature at the patella was least influenced, that at the ankle paralleled closely the changes in the core body temperature and blood supply to the leg. Their difference(P-A difference) was studied to see if they can be used to predict prognosis of patients undergoing open-heart surgery. The P-A difference was followed for several hours after the open-heart surgery. It was marked positive when the surface temperature at the patella was higher than that at the ankle. Total of 54 patients were studied. Only one out of 29 patients with negative P-A difference succumbed. This is in sharp contrast to the 25 remaining patients with positive P-A difference, from whom as many as 12 died. In addition, the postoperative course of the 13 survivors from the latter group was more eventful. Since P-A difference seemed to indicate accurately cardiac output by reflecting the state of the peripheral circulation, it can be used as a useful parameter in prediction of the prognosis in open-heart surgery.