[Saphenous vein to saphenous vein bypass grafting in four redo CABG patients]

In four redo CABG patients, new saphenous vein grafts were anastomosed to the angiographically normal part of the old, and partially narrowed or occluded saphenous vein grafts in an end-to-side fashion. Inner surface of the old saphenous vein was confirmed to be smooth and free of atherosclerotic change during anastomosis. Postoperative course was uneventful and angiography demonstrated the good patency of new saphenous vein grafts in all patients. Although this technique is not acceptable if the old saphenous vein graft shows extensive atherosclerotic change, this method may be a useful alternative in case of limited saphenous vein graft disease in terms of less difficulty and operation time.

Combined transjugular intrahepatic portosystemic shunt and segmental Lipiodol hepatic artery embolization for the treatment of esophagogastric varices and hepatocellular carcinoma in patients with cirrhosis: preliminary report

PURPOSE

To evaluate the feasibility of combining placement of a transjugular intrahepatic portosystemic shunt (TIPS) and transcatheter hepatic segmental artery chemoembolization with Lipiodol (Seg-Lp-TAE) in patients with cirrhosis, esophagogastric varices, and hepatocellular carcinoma (HCC).

METHODS

Five patients with bleeding or large, high-flow esophagogastric varices and HCC were treated by TIPS and Seg-Lp-TAE.

RESULTS

The mean portosystemic pressure gradient decreased from 20.8 cm H2O to 7.8 cm H2O after TIPS. The direct portogram and endoscopic examination revealed reduction of varices. At 6 months, one shunt had functionally occluded and could not be reopened; the other TIPS remained functional. Follow-up CT and the changes of alpha fetoprotein indicated effective therapy of Seg-Lp-TAE for HCC. Four patients are in stabile clinical condition at 9, 6, 1, and 1 months after the combined therapy; one died after 14 months due to decompensated liver cirrhosis.

CONCLUSION

The combined therapy of TIPS and Seg-Lp-TAE will become a new interventional approach for patients with HCC and esophagogastric varices.

Toxicological study on antineoplastons A-10 and AS2-1 in cancer patients

Antineoplastons, which were firstly described by Burzynski, are naturally occurring peptides and amino acid derivatives which control neoplastic growth. We conducted a toxicological study of the Antineoplastons A-10 and AS2-1 in combination with other anticancer agents or radiation in 42 patients, 46 tumors with terminal stage cancer. Antineoplaston A-10 oral formulation and A-10 injectable formulation was administered in 14 and 25 patients respectively. The maximum daily dose was 10 g and 40 g, respectively and the longest term of administration was 610 days and 67 days, respectively. Antineoplaston AS2-1 oral formulation and AS2-1 injectable formulation was administered in 33 and 10 patients, respectively, the maximum daily dose was 12 g and 30 g, respectively, and the longest term was 1070 days and 25 days, respectively. The major adverse effects that may have been related to these agents as used in combination with other conventional chemotherapeutic agents or radiation were general weakness, myelosuppression, and liver dysfunction, but these effects were not seen when either Antineoplaston was administered alone. The minor adverse effects observed in single use of either Antineoplaston A-10 or AS2-1 were excess gas, maculopapullar rash, fingers rigidity, reduced cholesterol, reduced albumin, increased amylase, eosinophilia, increased alkaline phosphatase, headache, hypertension, palpitation, peripheral edema but these adverse effects did not limit to continuation of either agent. The evaluation of the usefulness of the Antineoplastons in combination therapy based on the imaging findings during the course of treatment revealed disappearance or measurable shrinkage of the tumor lasting more than one months as visualized by magnetic resonance imaging or computed tomography was seen in 15 tumors (32.6%). No increase in size of tumor for more than 3 months was observed in 8 (17.4%). The mean survival time of these patients was significantly longer than that in patients with tumors showing progressive increasing (17.52 + 3.31 months vs 4.80 + 0.65 months, p < 0.005). Antineoplaston A-10 and AS2-1 are less toxic than conventional chemotherapeutics and they were useful in maintenance therapy for cancer patients.

Increase in respiratory resistance after exercise in conscious guinea pigs. As a model for exercise-induced asthma

We have developed an experimental model for exercise-induced asthma (EIA) using conscious guinea pigs. Respiratory resistance (Rrs) was measured before and after exercise (running). When a 0.05% lipopolysaccharide (LPS) was inhaled by guinea pigs which had been pretreated with a corticosteroid biosynthesis inhibitor metyrapone (50 mg/kg, i.v.), Rrs significantly increased 24 h after exercise. Metyrapone had no effect, however, on the LPS-induced increase in the numbers of macrophages, eosinophils, neutrophils and lymphocytes in bronchoalveolar lavage fluid (BALF). In order to examine the role of airway inflammation, the effects of murine recombinant interleukin-5 (mrIL-5) and platelet activating factor (PAF) were investigated in guinea pigs. The exercise-elicited increase in Rrs was observed 24 h later than the treatment with mrIL-5 in metyrapone-treated animals. The number of macrophages, eosinophils and neutrophils increased in the BALF of mrIL-5-treated animals. In contrast, a 0.05% PAF aerosol caused an increased number of eosinophils in BALF, but did not affect Rrs after exercise in either metyrapone-treated or non-treated animals. Moreover, to evaluate the value of this model as a pharmacological tool, the effect of ketotifen and prednisolone on the exercise-induced increase in Rrs was investigated. Prior administration of ketotifen and prednisolone showed a tendency to prevent, or clearly inhibited, the exercise-induced increase in Rrs in animals treated with the combination with LPS and metopyrone.

Terpendoles, novel ACAT inhibitors produced by Albophoma yamanashiensis. I. Production, isolation and biological properties

A series of new acyl-CoA: cholesterol acyltransferase (ACAT) inhibitors termed terpendoles were isolated from the culture broth of a fungal strain FO-2546 which was proposed to belong to a new genus designated as Albophoma yamanashiensis. Among four structurally related terpendoles, terpendole C showed the most potent ACAT inhibitory activity with an IC50 value of 2.1 microM in an in vitro enzyme assay, followed by terpendoles D (IC50: 3.2 microM), A (15.1 microM) and B (26.8 microM). Evaluation of their ACAT inhibition in the cell assay using J774 macrophages indicated that terpendole D exhibited the highest specificity (cytotoxicity vs. ACAT inhibition) among microbial ACAT inhibitors we discovered so far.

The usefulness of serial C-reactive protein measurement in managing neonatal infection

Recent advances in laboratory technology have enabled us to measure C-reactive protein with a higher sensitivity in a short period using a minimal amount of blood. Thus C-reactive protein can be measured easily several times a day. In this study, serial changes in C-reactive protein values were evaluated in 108 term and 240 preterm newborn infants with suspicion of infection, and the changing patterns of C-reactive protein values were compared with clinical outcome. For a diagnosis of infection, the negative predictive values in term and preterm infants were 99.0% and 97.8%, respectively, although the sensitivities were 61.5% and 75.0%, respectively. Antibiotic therapy was started at birth and discontinued when the changing pattern of C-reactive protein and clinical findings did not suggest infection. As a result, mean durations of administration of antibiotics in the term and preterm infants were 3 and 4 days, respectively. Recognition of the changing pattern of C-reactive protein was very useful in excluding infection and minimizing unnecessary antibiotic therapy in managing neonatal infection.

Terpendoles, novel ACAT inhibitors produced by Albophoma yamanashiensis. II. Structure elucidation of terpendoles A, B, C and D

Structures of terpendoles A, B, C and D, novel acyl-CoA: cholesterol acyltransferase (ACAT) inhibitors, were determined by spectroscopic studies. All terpendoles consist of diterpene and indole moieties in common. Terpendoles A, C and D possess an additional isoprenyl unit via oxygen atom(s) of their diterpene moieties. The relative stereochemistries of terpendoles C and D were confirmed by NOE experiments and X-ray crystallographic analysis.

[Phrenic nerve injury following coronary artery bypass surgery: its clinical implication and management]

The hospital records of 80 patients undergoing coronary artery bypass surgery, including 19 patients using the "isolation pad", were reviewed to examine the prevalence of the phrenic nerve injury (PNI). All patients received ice slush for topical cooling during operation. The degree of the elevated diaphragm was evaluated objectively by "Diaphragmatic Elevation Index, DEI" calculated from the plain chest roentgenogram taken before and after the operation. Sixty-one patients without using the isolation pad were subdivided into 3 groups, mild (35), moderate (15), and severe (11) according to the degree of the elevated diaphragm, and compared along with those using the isolation pad. All groups could not be distinguished by clinical course. The degree of left diaphragmatic elevation was significantly high compared with that of right, but recovered significantly at discharge except 2 patients. Pulmonary complication was highly associated with the "severe" groups. Because PNI is often transient and of little clinical significance, it is sometimes neglected. But considering the high frequency of the development of pulmonary complication, proper protective measure should be undertaken. Utilization of the isolation pad was effective means in terms of protection of phrenic nerve.

Inhibition of 15-hydroxy prostaglandin dehydrogenase activity in rabbit gastric antral mucosa by 13-hydroperoxyoctadecadienoic acid

The effect of 13-hydroperoxyoctadecadienoic acid (13-HPODE), a hydroperoxy adduct of linoleic acid (LA), on the activities of prostaglandin (PG) synthesizing and catabolizing enzymes in rabbit gastric antral mucosa was examined. 13-HPODE had no effect on the synthesis of PGE2, PGF2 alpha and PGD2 from exogenous arachidonic acid in the microsomal fraction of the gastric mucosa at concentrations ranging from 5-20 microM. On the other hand, at 1-10 microM, it inhibited the activity of 15-hydroxy PG dehydrogenase (PGDH), which catalyzes the initial step of catabolism of PGs, in a dose-dependent manner. The concentration required for 50% inhibition was approximately 1 microM. Experiments utilizing LA, 13-hydroperoxyoctadecadienoic acid and Fe2+ indicated the requirement of the hydroperoxy moiety for the inhibitory effect of 13-HPODE on the PGDH activity. These results suggest that 13-HPODE has the potential to increase the levels of biologically active PGs in gastric mucosa by preventing their inactivation and may have functional effects within the stomach.

[Effects of ingestion of "BON-NARINE" on immune functions in mice]

A study was carried out to examine the effects of ingestion of "BON-NARINE" (BN) on mice immune functions. Mice aged 12 weeks were divided into 4 groups. The first group was given BN at 30 mg/kg (BN-30 group), the second group was given BN at 90 mg/kg (BN-90 group), the third group was given zymosan at 50 mg/kg (Zy group) and the fourth group was a control receiving no treatment. The mice of groups BN-30 and BN-90 were given BN p.o. at doses of 30 mg/kg and 90 mg/kg per day for 20 consecutive days, respectively. The mice of group Zy were given zymosan i.p. at a dose of 50 mg/kg per day for 2 consecutive days. The results obtained were as follows: 1) Potentiation of phagocytic function of the reticuloendothelial system, examined by the carbon clearance method, was seen in the BN-30, BN-90 and Zy groups. 2) The glucose consumption of peritoneal macrophages (M phi) increased significantly in the BN-30 and Zy groups, but not in the BN-90 group. 3) Superoxide anion (O2-) production of peritoneal M phi significantly increased in the BN-30 and Zy groups compared with the control group, but an increasing tendency was observed in the BN-90 group. 4) The acid phosphatase (APH), beta-glucuronidase (GLU) and lactate dehydrogenase (LDH) activities of peritoneal M phi increased significantly in the BN-30, BN-90 and Zy groups. 5) The proliferation of splenocytes induced by Con A in the BN-30, BN-90 and Zy groups significantly increased compared with the control group. These results demonstrated that the ingestion of "BON-NARINE" promotes phagocytic activity in the reticuloendothelial system in mice and has a stimulatory effect on M phi because of increases in glucose consumption, O2- production, APH, GLU and LDH activities in the peritoneal M phi of mice. BN also intensified the T-cell function represented by Con A-induced splenocyte proliferation.

Localization of determinants for formation of the anterior-posterior axis in eggs of the ascidian Halocynthia roretzi

Unfertilized eggs of the ascidian Halocynthia roretzi are radially symmetrical along the animal- vegetal axis. After fertilization, ooplasmic segregation results in formation of an anterior-posterior axis horizontally, and eggs become bilaterally symmetrical. When 8–15% of the cytoplasm of the posterior- vegetal region of the egg was removed after the second phase of ooplasmic segregation, most of the embryos completed gastrulation but developed into radialized larvae along the animal-vegetal axis with no apparent anterior-posterior axis. Removal of cytoplasm from other regions did not affect formation of this latter axis. The cleavage pattern of the embryos that were deficient in posterior- vegetal cytoplasm (PVC) exhibited radial symmetry instead of the complicated bilateral symmetry of normal embryos. Detailed comparisons of cleavage patterns revealed the duplication of the anterior cleavage pattern in the originally posterior halves of the PVC-deficient embryos. The PVC-deficent larvae lacked muscle cells, which are normally derived from the posterior blastomeres. Examination of the developmental fates of the early blastomeres of the PVC-deficient embryos revealed that all of the vegetal blastomeres had assumed anterior fates. These results suggest that the PVC-deficient embryos are totally anteriorized. When posterior-vegetal cytoplasm was transplanted to the anterior-vegetal position of PVC-deficient eggs, the axial deficiency was overcome, and reversal of the anterior-posterior axis was observed. The results of transplantation of posterior-vegetal cytoplasm to the anterior-vegetal position in normal eggs demonstrated that formation of the anterior structure is suppressed by posterior-vegetal cytoplasm. These results suggest that posterior fate is specified by the presence of posterior-vegetal cytoplasm, while anterior fate is specified by the absence of posterior-vegetal cytoplasm. Thus, posterior-vegetal cytoplasm determines the anterior-posterior axis by generating the posterior cleavage pattern and conferring posterior fates on cells, as well as by inhibiting anterior fates that would otherwise occur by default.

Induction of notochord during ascidian embryogenesis

The tadpole larva of solitary ascidians has 40 notochord cells in its tail. Of these cells, 32 in the anterior and middle part of the tail are derived from the A-line blastomeres, while 8 in the posterior part of the tail originate from the B-line blastomeres. Previous experiments involving continuous dissociation of daughter blastomeres from the first cleavage to the 110-cell stage suggested that cellular interactions may be involved in the formation of notochord cells. In the present study, the presumptive-notochord blastomeres isolated from the 32-cell embryos did not develop features of notochord. These results suggest that cellular interactions may be required for the fate specification of notochord, that is to say, notochord formation occurs as a result of inductive interaction between blastomeres. In order to confirm the involvement of induction in the determination of notochord and to identify the inducer blastomeres, the presumptive-notochord blastomeres at the 32-cell stage were coisolated or recombined with one of the surrounding blastomeres in a series of experiments. The results suggested that, for the A-line precursors, notochord differentiation occurs as the result of an inductive influence from vegetal blastomeres that include the presumptive-endoderm blastomeres and the presumptive-notochord blastomeres themselves. It was also suggested that induction of notochord is complete by the 64-cell stage and that inductive interactions have to be initiated before the decompaction of blastomeres during the 32-cell stage. Ascidians are Urochordata and are closely related to vertebrates. In vertebrates, it is well known that inductive interactions play a crucial role in the determination of notochord. It appears, therefore, that induction of notochord is common throughout the phylum Chordata.

Staging hepatic tumors with CT and carbon dioxide

OBJECTIVE

Carbon dioxide (CO2) intraarterial dynamic CT (CO2-IADCT) was used to observe the micro- and macrocirculation of hepatic tumors and hepatic parenchyma.

MATERIALS AND METHODS

A total of nine patients with hepatic nodular mass [five patients with hepatocellular carcinoma (HCC), three with metastatic liver cancer originated from colon cancer, and one with cysts] were included in this study. Thirty to fifty milliliters of CO2 was injected into the proper or right hepatic artery, in approximately 15 s, using a manually operated syringe. Consecutive CT scans were performed with a slice thickness of 1 cm, using a TCT 900s (Toshiba Co., Tokyo, Japan), to evaluate visualization of hepatic arteries and portal veins around tumors, tumor vessels, and CO2 bubbles in tumors.

RESULTS

The hepatic arteries and portal vein were revealed in all patients. The tumor vessels were observed in all patients with HCC except one patient who received chemoembolization before this procedure and one of three patients with metastatic liver cancer. The spotty CO2 deposits in the tumor were revealed in all patients, except in two patients with hepatic cysts and embolized HCC. No spotty deposits were seen in the normal liver tissue.

CONCLUSION

Thus, CO2-IADCT provided visualization of tumor vessels, spotty deposits of CO2 in tumors, and retrograde visualization of the portal vein. This method seems to be useful for the precise evaluation of the staging of liver tumors.

Comparative study of five types of IABP balloons in terms of incidence of balloon rupture and other complications: a multi-institutional study

The Multi-Institutional IABP Balloon Study Group in Japan (14 institutions) conducted a retrospective nonrandomized study to elucidate the incidence and type of IABP balloon-related complications relative to design and durability of five different clinically available balloons: TMP (n = 960), Kontron (n = 943). Datascope (n = 485), Mansfield (n = 226), and Aries (n = 189) balloons. A total of 2,803 patients (1,973 males, 830 females, mean age 62.1 years) spent a total of 243,856 h on the pump. Forty-nine balloons (1.7%) ruptured as recognized by the appearance of blood in the catheter (39 cases) or console alarm (4 cases). Ten patients required surgical removal of the balloon due to entrapment. Other IABP balloon-related complications requiring surgical intervention or with a lethal outcome occurred in 89 patients (3.2%). They included lower limb ischemia (61 cases), hematoma (11 cases), extensive dissection (6 cases), perforation (5 cases), entrapment without balloon rupture (3 cases), and mesenteric infarction (3 cases). The incidence of rupture, other major complications, and total complications, respectively, for each balloon was 0, 2.7, and 2.7 for TMP, 1.6, 4.3, and 5.9% for Kontron, 4.1, 1.9, and 6.0% for Datascope, 1.3, 2.7, and 4.0% for Mansfield, and 5.8, 3.7, and 9.5% for Aries. In conclusion, the TMP balloon demonstrates a significantly lower rate of rupture while the incidence of other complications for the 5 balloons is not significantly different.

[Seventy-seven coronary reoperations: incidence, indication and results]

As the number of patients who have undergone primary myocardial revascularization continues to burgeon, the number of potential candidates for a secondary myocardial revascularization has increased gradually. The number of secondary CABG at the Cleveland Clinic were performed, which represents 18% of the total CABG. However, the number of secondary CABG at The Heart Institute of Japan were performed, which represents of 5-10% of the annual CABG. There was one operative death (1.3%). The graft patency rate was 92.8%. Including non-cardiac death, the actuarial survival rate at 10 years was 88.2%, and events free rate including all deaths, the third time CABG, PTCA and myocardial infarction was 78.4% at 10 years.

[Is extensive usage of arterial grafts in revascularization of the circumflex appropriate?: comparative study with the saphenous vein]

From September 1975 to March 1992, 584 patients underwent coronary artery bypass grafting (CABG) including revascularization of the circumflex artery (LCX) with either saphenous vein (Group S, n = 496) or arterial grafts (Group A, n = 88). Group S was divided into two subgroups. Group S I is the patients who underwent CABG before April 1988, when the first case of arterial revascularization of the LCX, and Group S II is the patients who underwent CABG after April 1988. No significant differences were noted in early mortality, late mortality, or event free curve among three groups. Although graft flow was significantly less in Group A (27.8 +/- 12.8 ml/min) than Group S (60.0 +/- 35.7 ml/min), the patency rate was better in Group A (94.3%) than Group S I (88.6%) or Group S II (87.7%). The proportion of usage of arterial grafts in revascularization of the left anterior descending artery (LAD) was smaller in Group A (65.5%) than Group S II (80.3%), but the patency rate was acceptably good in both groups (Group A: 98.8%, Group S II: 99.5%). These findings justify extensive usage of arterial grafts to the LCX area under proper assignment of grafts to obtain good patency rate and long-term results with keeping quality of revascularization of the LAD area.

High density lipoprotein inhibits platelet 12-lipoxygenase activity

The effects of high density lipoprotein (HDL) and low density lipoprotein (LDL) on the formation of 12-hydroxy-5,8,10,14-eicosatetraenoic acid (12-HETE), thromboxane (TX) B2 and 12-hydroxy-5,8,10-heptadecatrienoic acid (HHT) in washed rabbit platelets were examined. HDL had a powerful inhibitory effect on 12-HETE formation, while it produced only a small increase in TXB2 and HHT formation. LDL did not affect the formation of 12-HETE, TXB2 and HHT. These results suggest that HDL is a selective inhibitor of platelet 12-lipoxygenase and may play a protective role in atherogenesis by preventing the generation of 12-HETE.

Synthesis of doxorubicin-cyclodextrin conjugates

Doxorubicin-gamma-cyclodextrin conjugates have been synthesized by the coupling of 14-bromodaunomycin with mono half-ester compounds linked to a 6-hydroxyl group of gamma-cyclodextrin. Release of drug from the conjugates in saline phosphate buffer solution and in vitro antitumor activity against L1210 leukemia cells were also investigated.

Less platelet damage in the curved vane centrifugal pump: a comparative study with the roller pump in open heart surgery

The centrifugal pump with the curved vane (Lifestream Centrifugal Pump [LCP]) was applied to cardiopulmonary bypass (CPB) in 10 patients who underwent elective coronary artery bypass grafting. Serum hemoglobin levels, platelet counts, and serum beta-thromboglogulin (beta-TG) levels were measured during CPB. The results were compared with those for a comparative roller pump (RP) group (n = 10). There was no difference in CPB time between LCP (112 +/- 22 min) and RP (121 +/- 22 min) groups. Serum beta-TG levels (ng/ml) were lower in the LCP group than in the RP group (34 +/- 9 vs. 101 +/- 80, 5 min; 81 +/- 33 vs. 236 +/- 112, 30 min; 120 +/- 53 vs. 314 +/- 100, 60 min after initiation of CPB; p < 0.05). There were no significant differences in hemolysis and platelet depletion. The LCP showed excellent hemodynamic performance with less blood trauma in clinical application to open heart surgery.

Coronary artery bypass grafting with the right gastroepiploic artery and evaluation of flow with transcutaneous Doppler echocardiography

From December 1988 to December 1992, 174 patients (160 men, 14 women, mean age 59.7 years, range 38 to 79 years) underwent coronary artery bypass grafting with the right gastroepiploic artery. The graft was anastomosed to the right coronary artery (n = 137), the circumflex artery (n = 18), the left anterior descending artery (n = 23), and the diagonal artery (n = 1). Three early deaths (1.7%) and one late death (0.6%) occurred. Graft patency and flow were evaluated noninvasively in 44 of the patients, selected at random between 1990 and 1993. They underwent transcutaneous Doppler echocardiographically to detect postoperative gastroepiploic artery flow. The patients were divided into two groups on the basis of the angiographic study: group I, good patency (n = 38); group II, poor flow in the graft or more than 75% stenosis of the anastomosis (n = 6). Biphasic Doppler flow signals were identified in 39 patients (88.6%) (group I, 35/38; group II, 4/6). The ratio of diastolic to total flow measured by time-velocity integral was 0.68 +/- 0.07 in group I and 0.32 +/- 0.09 in group II (p < 0.001). We conclude that the right gastroepiploic artery is an effective graft and that Doppler echocardiography may be a useful tool to noninvasively evaluate the patency and flow of the gastroepiploic artery graft as a coronary artery graft.

[A new electrode (HN-5) for CM measurement in extra-tympanic electrocochleography]

A new electrode (HN-5) for CM measurement in extra-tympanic electrocochleography (ECochG) has been developed. The electrode consists of a silver wire 2.0 mm in diameter and 5 cm in length connected to a low noise cable. The electrode impedance values were low and the frequency characteristics were excellent. In order to explore various artifacts, the electrode was inserted into a glass cup containing 100 ml of tap water, which served as a dummy ear. A sound stimulus with an intensity of 90 dBnHL was delivered by a shielded loudspeaker located 50 cm from the dummy ear (glass cup). In this dummy test, contamination with measurable artifacts, such as electromagnetic inductions generated by a sound transducer and the CM-like mechanical vibrations which activated the dummy ear acoustically, was kept within the noise levels inherent in the recording system. The CMs were recorded from subjects with normal hearing by placing an electrode adjacent to the postero-inferior rim of the tympanic membrane (annulus tympanicus). Short tone bursts were employed as acousti stimuli and delivered by the shielded loudspeaker. CM detection thresholds were very low and CM-like responses with delayed onset time (delayed CM) were clearly observed at lower stimulus levels. The input-output curves of the CMs and delayed CMs were non-linear. These findings from the CMs did not differ from those obtained by the transtympanic needle electrode technique. Responses obtained had satisfactory S/N ratios and resulted in almost the same average calculations as those with transtympanic ECochG.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulsatile flow and simple flow control method during weaning period in centrifugal pump: toward more expanded usage in open heart surgery

To expand the usage of the centrifugal pump (CP) in open heart surgery, we performed two studies. In the first, we evaluated pulsatile flow in the CP. In vitro pump performance of the Terumo Capiox pump (TCP) and the Sarns Delphin pump (SDP) and increase of free hemoglobin (mg/dl) after driving 6 h were investigated using bovine blood. A roller pump (RP) was used as a comparison. Equally effective pulsatile flow was obtained in both CPs. Hemolysis was less severe in TCP (120 mg/dl) than SDP (210 mg/dl) and RP (320 mg/dl). In the second study, we evaluated a simple flow control method. Flow rate was easily controlled with step-wise clamping of 3-pronged tubing (Triple-flow) without changing rotational speed, regardless of afterload. Fluctuation of flow was much less with this method than with the rotational speed change method. The use of pulsatile flow of TCP, with its minimum increase of hemolysis and the easier flow control method during the weaning process, may expand the usage of CP in open heart surgery.

[Coronary intervention in patients less than 40 years of age]

Forty-eight patients less than 40 years of age who underwent coronary intervention (coronary artery bypass grafting, CABG or percutaneous transluminal coronary angioplasty, PTCA) were identified and compared with a control group (patients more than 40 years of age who underwent coronary intervention). In addition, the treatment of hyperlipidemia after coronary intervention was studied in patients who required re-intervention and in those who were event free. There were no early nor late deaths and good early results were obtained in young patients, but late follow-up demonstrated that a re-intervention rate in young CABG patients was significantly higher than that in patients aged over 40 years (23.3% vs 9.3%), while in PTCA patients it was also higher in younger patients than in older patients (5.6% vs 1.3%). However, early results in PTCA patients showed the restenosis rate in young patients was significantly lower than that in older patients (7.7% vs 40.7%). Event free curve showed that earlier re-intervention was necessary for PTCA patients than for CABG patients. Hyperlipidemia was not well controlled by treatment in either group. The use of arterial grafts will improve the late results of younger patients. The patency of grafts and the quality of life of young patients should be the focus of future investigation.