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Introduction Polysulfone (PSf) membrane has been widely used for hemodialysis. A few studies have been reported in which a method of sterilization may affect biocompatibility. In this study, the comparison was made between two PSf membranes in order to evaluate the effect of sterilization from the biocompatibility point of view. Methods We investigated the biocompatibility of the following two dialyzers, that is, APS-11SA (Asahi Kasei medical Co., Tokyo, Japan), sterilized by gamma-ray irradiation, and RENAK PS-1.0 (Kawasumi laboratories, Tokyo, Japan), sterilized by autoclave. Heparin of 40 units/mL was put in a syringe, and test blood was collected from healthy volunteers. Then, the dialyzer and blood circuit were filled with the test blood. Subsequently, the blood was circulated by a roller pump at the rate of 200 mL/min. We measured the platelet counts, CD41 and CD42b platelet surface markers, beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) at 30, 120, and 240 minutes, respectively. Findings The platelet counts at 30, 120, and 240 minutes decreased significantly from the initiation of blood circulation in both dialyzers. The average beta-TG and PF4 increased from 61.3 ± 22.1 and 17.0 ± 6.4 ng/mL to 680.7 ± 217.1 and 550.7 ± 116.7 ng/mL with APS-11SA and to 454.3 ± 85.6 and 402.0 ± 58.0 ng/mL with RENAK PS-1.0, respectively. The average expression of CD41 and CD42b in APS-11SA and RENAK PS-1.0 was similar. Discussion There are some reports that the gamma-ray irradiation changes the membrane structure of the PSf membrane, crosslinking the polyvinylpyrrolidone (PVP), a hydrophilic agent, on to the membrane. On the other hand, excess amount of PVP may have been eluted during the rinsing procedure in RENAK PS-1.0 because it was sterilized with autoclave. Because both these factors influenced on our results, APS-11SA and RENAK PS-1.0 dialyzers showed excellent blood compatibility.

Polysulfone (PSf) membrane has been widely used for hemodialysis. A few studies have been reported in which a method of sterilization may affect biocompatibility. In this study, the comparison was made between two PSf membranes in order to evaluate the effect of sterilization from the biocompatibility point of view.We investigated the biocompatibility of the following two dialyzers, that is, APS-11SA (Asahi Kasei medical Co., Tokyo, Japan), sterilized by gamma-ray irradiation, and RENAK PS-1.0 (Kawasumi laboratories, Tokyo, Japan), sterilized by autoclave. Heparin of 40 units/mL was put in a syringe, and test blood was collected from healthy volunteers. Then, the dialyzer and blood circuit were filled with the test blood. Subsequently, the blood was circulated by a roller pump at the rate of 200 mL/min. We measured the platelet counts, CD41 and CD42b platelet surface markers, beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) at 30, 120, and 240 minutes, respectively.The platelet counts at 30, 120, and 240 minutes decreased significantly from the initiation of blood circulation in both dialyzers. The average beta-TG and PF4 increased from 61.3 ± 22.1 and 17.0 ± 6.4 ng/mL to 680.7 ± 217.1 and 550.7 ± 116.7 ng/mL with APS-11SA and to 454.3 ± 85.6 and 402.0 ± 58.0 ng/mL with RENAK PS-1.0, respectively. The average expression of CD41 and CD42b in APS-11SA and RENAK PS-1.0 was similar.There are some reports that the gamma-ray irradiation changes the membrane structure of the PSf membrane, crosslinking the polyvinylpyrrolidone (PVP), a hydrophilic agent, on to the membrane. On the other hand, excess amount of PVP may have been eluted during the rinsing procedure in RENAK PS-1.0 because it was sterilized with autoclave. Because both these factors influenced on our results, APS-11SA and RENAK PS-1.0 dialyzers showed excellent blood compatibility.

Objective: The objective of this study was to clarify whether or not pulse volume recoding (PVR) parameters have screening capability equivalent to ankle-brachial pressure index after walking (Ex-ABI) for patients with 0.91 or higher ABI. Patients and Methods: The subjects were 87 patients (147 limbs) with symptoms of lower extremities with 0.91 or higher ABI. In all patients, upstroke time (UT), percentage of mean artery pressure (%MAP) of PVR and Ex-ABI were measured, and computed tomographic angiography (CTA) was concomitantly performed. Results: Area under the curve (AUC) of receiver operating characteristics (ROC) curves of Ex-ABI, %MAP, and UT were 0.90, 0.70, and 0.81, respectively. A significant difference was noted in AUC between Ex-ABI and %MAP (p

The combination of ruptured aneurysm of the sinus of Valsalva and a bicuspid aortic valve is very rare in an elderly person. A 71-year-old man with ruptured aneurysm of the sinus of Valsalva and a bicuspid aortic valve had undergone an operation. He was admitted to his other hospital because of heart failure. He was transferred to our hospital to undergo treatment for ruptured aneurysm of sinus of Valsalva. At our hospital, echocardiography findings showed ruptured aneurysm of the sinus of Valsalva, a ventricular septal defect (VSD), and severe aortic regurgitation with moderate stenosis of the bicuspid aortic valve. An aneurysm originating from the anterior sinus of Valsalva had ruptured into the right ventricular outflow tract. The ruptured aneurysm and VSD were repaired by patch closure through the right ventricular outflow tract. Additionally, the aneurysm of the sinus of Valsalva was repaired with direct closure through aortotomy. The insufficient bicuspid aortic valve was replaced with a bioprosthetic valve. After the operation, heart failure improved promptly, and he was making satisfactory progress in his recovery.

Background: The ankle-brachial pressure index (ABI) is widely used as a standard screening method for arterial occlusive lesion above the knee. However, the sensitivity of ABI is low in hemodialysis (HD) patients. Exercise stress (Ex-ABI) may reduce the false negative results. Patients and Methods: After measuring resting ABI and toe-brachial pressure index (TBI), ankle pressure and ABI immediately after walking (Post-AP, Post-ABI) were measured using one-minute treadmill walking in 52 lower limbs of 26 HD patients. The definition of peripheral arterial occlusive disease (PAD) required an ABI value of less than 0.90, TBI value of less than 0.60, and decrease of more than 15% of the Post-ABI value and 20 mmHg of Post-AP in Ex-ABI. Computed tomographic angiography (CTA) was performed in 32 lower limbs of 16 HD patients. PAD is defined as presence of stenosis of more than 75% in the case of lesions from an iliac artery to knee on CTA. Results: The accuracy of Ex-ABI (Sensitivity, 85.7%; Specificity, 77.7%) was higher than those of ABI (Sensitivity, 42.9%; Specificity, 83.3%) or TBI (Sensitivity, 78.6%; Specificity, 61.1%). Conclusion: Ex-ABI with one-minute treadmill walking is the most useful tool for the screening of arterial occlusive lesions above the knee in maintenance HD patients.

乳頭状弾性線維腫は, 稀な良性心臓腫瘍である. われわれは僧帽弁および腱索より発生した多発性乳頭状弾性線維腫の外科的切除を行った. 症例は59歳男性で3年前に急性心筋梗塞を発症した. 術前の経胸壁および経食道エコーでは左心室腔, 僧帽弁に付着する多発性で可動性のある球状の腫瘍を認めた. 人工心肺下に僧帽弁および腫瘍を切除し, 弁置換術を行った. 患者は退院し無症状である. 病理学的所見では計6個の腫瘍を認め, 乳頭状弾性線維腫と診断された. 乳頭状弾性線維腫は塞栓症状を引き起こすことがあり, 発見次第手術摘出が必要である.

In a group of 39 patients with ischemic heart and valvular disease (January 1997 to May 1998), three platelet collection methods were compared in terms of safety and effectiveness. The methods were: (i) collection of autologous platelets over several weeks and freezing them for storage until surgery (frozen group, 12 patients); (ii) collection of autologous platelets on the day before surgery and preserving them without freezing (fresh group, 8 patients); and (iii) collection of autologous platelets intraoperatively (intraoperative group, 9 patients). Ten patients served as controls (control group). Blood pressure was not significantly affected by platelet collection in the frozen and fresh groups, but both systolic (P < 0.01) and diastolic blood pressure (P < 0.05) decreased significantly after collecting platelets in the intraoperative group. Similarly, heart rate was unaffected by platelet collection in the frozen and fresh groups, while it increased significantly in the intraoperative group (P < 0.05). Blood loss after 24 h was significantly smaller in the fresh group than in the frozen group (P < 0.05). Total blood transfusion volume was significantly smaller in the frozen and fresh groups than in the intraoperative and control groups (P < 0.05). Bleeding time 2 h postoperatively, when administration of autologous platelets had been completed, was reduced compared with immediately postoperative values in all three groups receiving autologous platelets (P < 0.05). However, only the frozen and fresh groups showed a significantly shorter bleeding time than the control group (P < 0.05). In all three groups receiving autologous platelets, the platelet count was significantly increased after administration of autologous platelets, but only the fresh group had a platelet count that was significantly greater than the control group (P < 0.05). From these results we conclude that the frozen and fresh groups received safer treatment than the intraoperative group. Although hemostasis improved after all three regimes of autologous platelet transfusion, only the frozen and fresh groups had a reduced need for allogeneic blood transfusion compared with the control group. For this reason we conclude that the frozen and fresh groups were also superior to the intraoperative group in terms of effectiveness. However, the recovery of platelets after frozen storage was low, and to obtain a good effect with the freezing method it is necessary to collect and store large volumes of platelets. In terms of simplicity, safety, and efficacy, the fresh method seems to be the preferred technique.

It has been believed that fungal endocarditis is rare in this country, but the number of cases of the disease is increasing. Under a recent background where the operations for cachexic decreased resistance (immune) and these more infectious and severe valve diseases have been increasingly done. However, fungal endocarditis on the tricuspidal valve area in still rare. So far, we have inspected no more than 7 cases of fungal tricuspidal valve endocarditis including this case in Japan. A 66-year-old male with native tricuspidal valve endocarditis associated with acute suppurative cholangitis and pyogenic liver abscess due to Candida glabrata underwent tricuspidal valve replacement with Carpentier-Edwards pericardial bioprosthesis. On the 5th postoperative day bilateral lung pyosis caused by fungal infection developed. Candida glabrata was detected in pus culture from thoracic drains. He died of multiple organ failure 11 days after the operation. The vegetation of fungal endocarditis tends to grow and develop emboli. In this case, it was clear that the reason of postoperative lung pyosis was preoperative lung embolism due to lated surgical operation. We conclude that the principal solution for remedy of fungal endocarditis lies on early diagnosis, early surgical treatment and thorough postoperative chemotherapy.

11年間における111例の慢性血液透析 (HD) 患者の運動療法中の合併症を調査し, 冠状動脈疾患 (CHD) 患者と比較した.HD患者において運動誘発性の低血圧は高頻度に認められ, その頻度はCHD患者の5.4倍高かった. しかし, HD患者には心停止や重篤な心室性不整脈は認められなかった. CHD患者においては胸痛だけに高い頻度が認められたが, HD患者においては多彩な症状に高い頻度が認められた.この結果から, 著者たちはHD患者の運動療法に運動誘発性の低血圧のための対策を用意すべきであろうと結論した.

Oxygen uptake efficiency slope (OUES) and ventilatory efficiency (VE/VCO2 slope) are widely used as submaximal measurements of cardiopulmonary exercise testing as the evaluator or prognosticator of cardiac diseases. However, very few studies have compared the effects of submaximal exercise on these measurements. A total of 58 patients with coronary artery disease underwent maximal cardiopulmonary exercise testing on a treadmill. We compared the values obtained from the first 75% (VE/VCO2 slope75 and OUES75) and 90% (VE/VCO2 slope90 and OUES90) of the exercise period with the entire duration (VE/ VCO2 slope100 and OUES100). Although OUES100, OUES90 and OUES75 were virtually identical, submaximal calculations of VE/VCO2 slope underestimated the measurements. The Bland-Altman method revealed that submaximal measurements of OUES agreed very well with maximal OUES (limits of agreement -5.0% to +6.0% for OUES90, and -11.5% to +12.9% for OUES75). However, the submaximal calculations of VE/ VCO2 slope showed rather poor agreement with the maximal calculations (limit of agreement -11.8% to +3.1% for VE/VCO2 slope90, and -20.8% to +5.3%% for VE/VCO2 slope75). These results revealed that both the OUES and the VE/VCO2 slopes are not overly influenced by exercise.

This is a case report of left subclavian vein thrombosis in a chronic dialysis patient with functioning brachialmedian A-V fistula of the ipsilateral arm.A 50-year-old man undergoing continuous hemodialysis for 15 years was admitted to the hospital because of disabled left arm due to severe swelling which developed about one year before and gradually worsened. Phlebography showed total occlusion of the left axillary-subclavian vein and marked development of collateral superficial vein. Left axillary-internal juglar vein bypass was made with a 8 mm ringed E-PTFE graft. In postoperative course, functional disability in the left arm resolved rapidly although swelling of the upper arm remained for several months. Graft patency was confirmed by postoperative phlebography and was indebted to the presence of A-V fistula.Deep vein thrombosis complicated by A-V fistula in hemodialysis patients usually occurred secondary to central vein (CV) catheterization for temporary blood access. However, in this case there was no history of CV catheterization and the cause of deep vein thrombosis was unclear.

慢性血液透析 (HD) 患者に対するヒト遺伝子組み換えエリスロポエチン (rEPO) の臨床効果の指標として, 自覚症状と活動力について検討した. 腎性貧血を有する24例のHD患者に対して, 貧血の改善度に合わせて症状制約性トレッドミル運動負荷試験を実施した. また, 日常生活と血液透析中の自覚症状についてrEPO投与前と後で調査し, 以下の成績を得た.全例Hb濃度とHt値の有意 (p

There is epidemiologic evidence that the prognosis of patients with nonischemic heart failure is better than that for patients with ischemic heart failure. In addition, studies have revealed that patients with ischemic heart failure show a poorer response to medical therapy. However, the pathophysiologic difference between ischemic and nonischemic heart disease is unclear. To clarify this point, we measured atrial natriuretic peptide, brain natriuretic peptide, angiotensin II, endothelin (ET)-1. interleukin-1beta interleukin-6. tumor necrosis factor (TNF)-alpha soluble TNF receptor I, and soluble TNF receptor II concentrations in plasma and pericardial fluid in patients with ischemic or nonischemic heart disease undergoing cardiac surgery. The pericardial ET-1 concentration in patients with ischemic heart disease was statistically greater than that in patients with nonischemic heart disease (about 1.5-fold), although no difference was found in the plasma ET-1 concentration. These findings suggest that the production and secretion of ET-1 from the myocardium in patients with ischemic heart disease are augmented to a greater extent than in patients with nonischemic heart disease. This result may lead to a greater understanding of the pathophysiology of ischemic heart disease.

In this study we aimed to elucidate the validity and usefulness of the oxygen uptake efficiency slope (OUES) in the evaluation of adult cardiac patients. Cardiopulmonary exercise tests were performed on a treadmill by 50 adult patients with chronic heart failure. The OUES was calculated from data for the first 75%, 90%, and 100% of exercise duration. The OUES is derived from the following equation: VO(2)=ax logV(E)+b, where VO(2) is oxygen uptake (ml/kg/min), V(E) is minute ventilation (l/kg/min), and the constant "a" represents OUES. We also determined the ventilatory anaerobic threshold (VAT). The correlation coefficient of the logarithmic curve-fitting model was [mean (SD)] 0.986 (0.009). The OUES could be used to discriminate effectively between New York Heart Association functional classes (P < 0.001). OUES and maximum VO(2) were significantly correlated (r=0.78, P < 0.01). Agreement between the OUES values for the first 90%, 75%, and 100% of the exercise was excellent (intraclass correlation coefficient = 0.99). Our results suggest that OUES is applicable to adult cardiac patients as an objective, effort-independent estimation of cardiorespiratory functional reserve.

The purpose of this study was to investigate the circulatory response during muscular training in coronary heart disease patients. Thirty-five male patients with effort angina pectoris and a history of myocardial infarction were studied. All patients performed a cardiopulmonary exercise test (SL-GXT) and isokinetic training at elbow flexion. The pressure rate product (PRP) during training approached the PRP level at the endpoint on SL-GXT as myocardial aerobic impairment increased. Additionally, ST changes appeared when PRP during the training equalled or exceeded the PRP endpoint on SL-GXT. In conclusion, patients showing low exercise tolerance and poor cardiac function must be carefully monitored during isokinetic training.

野外監視型運動療法の導入について検討するため, 24例のHD患者に8075mの野外歩行を実施した. この歩行前には血液検査, 運動負荷試験および心臓超音波検査を施行した. また, 歩行中に酸素摂取量および歩行数を測定した, さらに歩行後には合併症を調査した. そして以下の成績を得た.全症例中, 10例は最後まで歩行可能 (完全歩行群) であったが, 14例は途中で棄権した (棄権群). 運動量は平均にして, 歩行距離6660.0m, 歩行数12704.7歩, 消費エネルギー675.4kcal, と多かった. しかし, 平均運動強度は3.25Metsと低かった. 歩行可能な距離および消費エネルギーは, 最大酸素摂取量と有意な相関関係を認めた. 完全歩行群は, 棄権群より平均年齢が有意に低値であった. 男性, 有職者および鍛練者の方に完全歩行の割合いが多く認められた. 完全歩行群の一回心拍出量は, 平均値の82.78±10.10mlに集中したが, 棄権群は100ml以上と80ml未満に分散し, 両群は明らかに異なった. 血液所見では両群間に明らかな違いが認められなかった. 症候限界性運動負荷試験を施行した20例の中で, 6例に心電図異常あるいは血圧異常が認められた. 野外歩行後, 非鍛練者に関節痛や筋肉痛の訴えが多く認められた.以上のことから, 歩行距離による運動能力の評価とその影響因子および運動処方上の留意点が確認され, 野外監視型運動療法の可能性が示唆された.

慢性血液透析 (HD) 患者の最大有酸素運動能力の制限因子を検討する目的で, 35例のHD患者と52例の健常者に対して, 心機能および末梢循環機能を評価し, またヘモグロビン濃度を測定した. HD患者は心疾患の合併がなく, β-遮断剤やdigitalis製剤の服用もしていない症例であった. また運動負荷試験の中止理由が心電図異常や血圧異常でない症例であることを厳守した. 全対象において最大運動負荷試験より得られた最大酸素摂取量, 最大pressure rate productからBruceの計算式に従いfunctional aerobic impairment (FAI), left ventricular impairment (LVI) およびperipheral circulatory impairment (PCI) を求めた. HD患者のヘモグロビン濃度は最大運動負荷試験の前に測定した.その結果, 次のような成績が得られた. HD患者のFAI, LVIおよびPCIは, 健常者と比較して有意に高い値を示した. またHD患者のPCIはLVIよりも高値を示した. 健常者のFAIはLVIとPCIの両方に有意な相関関係を認めた. しかしHD患者のFAIはLVIとは相関せず, PCIのみに有意な相関関係を認めた. HD患者のFAIはヘモグロビン濃度との間に有意な相関関係を認めなかった.以上の成績からHD患者の最大有酸素運動能力の制限を決定する因子としては, 心機能の低下よりもヘモグロビン濃度の低下以外の末梢循環系の機能の低下に関係するものと考えられた.

To assess accurately the indication and effects of aorto-coronary bypass graft surgery (ACBG) to the myocardium infarction area, 35 patients with myocardial infarction were analyzed by using exercise thallium-201 myocardial imagings. The patients were classified into group I (18 cases) and group II (17 cases) before ACBG. Group I consisted of patients with regional hypoperfusion in the initial image who showed redistribution in the delayed image to the infarction area of myocardium. Group II consisted of those with regional hypoperfusion in the initial image without redistribution in the delayed image. Group I showed a significant improvement in myocardial perfusion (p less than 0.01), pressure rate product (p less than 0.01), global left ventricular ejection fraction (p less than 0.01), segmental wall motion abnormality (p less than 0.01), and exercise tolerance when compared with those of group II before and after ACBG. The above study showed that the pre- operative redistribution of the infarction area in the delayed image suggests myocardial viability and ACBG will be effective.

This paper reports a surgical case of aneurysm in the right axillary area. The aneurysm was caused by a congenital arterio-venous fistula, which was recognized angiographically to develop with inflow from the thoracodorsalis and thoraco-lateralis arteries. Aneurysmectomy was undertaken easily and the wound healed without complication. This condition is difficult to treat completely satisfactorily because it has many multi-focal variations and develops in deep tissue. Additional treatment in combination with surgical therapy is thus necessary.

In this paper, we report four cases in which active assist circulation was performed using IABP and ECC with aortic cannulation at the ascending aorta to improve left ventricular function that had fallen into severe LOS at or after weaning from cardio pulmonary bypass (CPB) during cardiac surgery. Case 1: 51-year-old female, thrombectomy (LA)+MVR+single ACBG. Case 2:68-year-old female, AVR. Case 3: 51-year-old female, MVR + repair for postoperative rupture of posterior left ventricular wall. Case 4: 48-year-old male, emergency double ACBG. We performed active assist circulation on them at (Cases 1, 2 and 4) or after (Case 3) weaning from CPB. The condition of patients who require active assist circulation is very serious. Thus, it is difficult to treat them completely. When active assist circulation is continued for a long time, hemolysis, infection, ischemia of lower limb, multiple organ failure, etc., may develop, and the patient's prognosis will worsen. Consequently, for severe LOS patients at or after weaning from CPB, efforts must be made to solve these problems and active treatment which can be done at any institute must be given prior to the implementation of an artificial heart.