A safe and reliable method of weaning from a left ventricular assist system (LVAS) is necessary for successful circulatory support in patients with marginal heart failure. The purpose of this study is to assess the effect of additional intraaortic balloon (IAB) support during weaning from an LVAS by means of the LV pressure-volume relationship. A pneumatic LVAS with a sac-type blood pump was implanted in six adult mongrel dogs weighing 14 to 20 kg. All dogs had a drainage cannula placed in the left atrium and an outflow conduit in the ascending aorta. Hemodynamic parameters, pulmonary arterial flow, and pump output were monitored. An IAB was inserted through the groin. A conductance catheter and microtip manometer were inserted into the LV cavity. As a combination driving mode, LVAS ejection in the early diastolic phase and IAB inflation in the late diastolic phase were applied. After evaluation of baseline LV function, the pressure-volume relationship was repeatedly measured during change of driving modes as isolated LVAS, LVAS + IAB (1:1), LVAS + IAB (2:1), and isolated IAB supports. Finally, LV failure was introduced by stepwise ligation of left coronary arteries, and the LV pressure-volume relationship was measured in each driving mode. Under normal conditions, the pressure-volume loop showed no significant change among the four driving modes. In contrast, the LV pressure-volume relationship significantly improved according to the degree of additional IAB support on LVAS assistance under the condition of LV failure. These results suggest that additional IAB support might improve LV energy during weaning from an LVAS.

Animals↗

PubMedDate not supplied

Effectiveness of transaortic venting from a failing left ventricle during venoarterial bypass.

Insufficient unloading of the left ventricle (LV) is a limitation of percutaneous cardiopulumonary support (PCPS). We previously reported the unloading effect of transaortic catheter venting (TACV) during venoarterial bypass (VAB) in normal hearts. The aim of this study was to assess the effectiveness of TACV with VAB in a heart failure (HF) model. Seven adult mongrel dogs underwent TACV with VAB, and isolated LV failure was induced by multiple ligation of left coronary arteries. With standard hemodynamic monitoring, slope of the LV end-systolic pressure-volume relationship (Emax; mm Hg/ml), aortic elastance (Ea; mm Hg/ml), LV stroke work (SW; 10(-4)J), preload recruitable stroke work (PRSW; 10(-4)J/ ml), LV pressure-volume area (PVA; 10(-4)J), and potential energy (PE; 10(-4)J) were assessed using a micro-tip manometer and a conductance catheter. In addition to evaluation of LV function, myocardial adenosine 5'-triphosphate (ATP) was measured in each condition. The TACV combined support significantly reduced LV total energy (PVA) and LV work (SW). The LV energetic charge (PE/PVA, myocardial ATP) was significantly increased by TACV. These results suggest that TACV might be an effective technique for LV recovery during VAB or PCPS in patients with severe heart failure.

Animals↗

PubMedDate not supplied

Incidence of stroke in Shibata, Japan: 1976-1978.

A stroke registry was established in Shibata City, Niigata Prefecture, Japan (population 75,000) in 1976. WHO recommendations for criteria were followed. This paper reports stroke incidence for the initial 3 years of the registry: 1976 through 1978. All living patients were examined clinically by a staff physician. Only patients with a diagnosis of first stroke were included in the study. Sensitivity of the referral system was estimated at 85 + %, comparable to that in American studies. Average annual incidence per 1,000 in resident greater than or equal to 20 years was 2.61 for all strokes (3.42 for males; 1.88 for females), 0.20 for subarachnoid hemorrhage, 0.61 for cerebral hemorrhage, 1.51 for cerebral infarction - rates similar to those reported 10-20 years previously for the United States. The male-female ratio, 2:1, reflected a high rate among males, low among females. Rats among Shibata males were higher than 1972 U.S. rates reported by the Epidemiologic Study Group; rates among Shibata females were lower than corresponding U.S. rates. Incidence of all strokes combined increased with age, the age relationship being strongest for cerebral infarction. No subarachnoid hemorrhage was observed in Shibata residents greater than or equal to 70 years of age.

Adult↗

PubMedDate not supplied

Pilot trial of a combination comprising of consecutive oral administration of UFT, and two-divided administration of CDDP in non-small cell lung cancer.

A pilot study of a combination therapy comprising of consecutive oral administration of UFT, and two-part divided administration of CDDP was undertaken in patients with inoperative non-small cell lung cancer, based on the synergistic effects of CDDP and 5FU. UFT was administered orally at a dosage of 400 mg/m2 for two consecutive weeks (Day 1-Day 14) and CDDP was administered twice by intravenous infusion, once on Day 4 and again on Day 8. The unit dose of CDDP was increased sequentially, from 40 mg/m2 in step 1, to 50 mg/m2 in step 2, and then to 60 mg/m2 in step 3, with safety being confirmed during the process. The numbers of patients registered for each dose level were 3, 3, and 20, respectively. Evaluation of toxicities could be conducted for all the patients except one. No toxicities of grade 3 or higher were observed in step 1 or 2. There was no problem with continuous administration of UFT. The following toxicities of grade 3 or higher were observed in step 3: leukocytopenia in 2 patients; reduction of the hemoglobin count in 1; decrease in creatinine clearance in 2; anorexia in 3; and nausea and vomiting in 3. Bone marrow suppression was mild and transient. Renal failure and digestive symptoms, which were proved to be transient and treatable by symptomatic treatment, were also observed. The step 3 administration was effective in 8 (47.1%) of the 17 patients with measurable lesions (95% CI: 23-71%). In conclusion, since it was determined that the dose employed in step 3 should be recommended and that it could be expected to exhibit antitumour effects with mild bone-marrow suppression, a large scale phase II study should be conducted in no prior treatment non-small cell lung cancer.

Adenocarcinoma↗

PubMedDate not supplied

Effect of transaortic catheter venting on left ventricular function during venoarterial bypass.

Although venoarterial bypass (VAB) or percutaneous cardiopulmonary support (PCPS) can improve hemodynamics in patients with serious cardiac decompression, some cannot be weaned from circulatory support. Insufficient unloading of the left ventricle (LV) with blood stagnation is a main cause of unsuccessful LV recovery during PCPS. This investigation was undertaken to evaluate the effectiveness of transaortic catheter venting (TACV) for LV unloading. Eight mongrel dogs (mean weight 16.3 kg, range 14-20 kg) underwent VAB with TACV. In addition to monitoring standard hemodynamic parameters, the slope of the LV end systolic pressure-volume relationship (Emax) during transient occlusion of the inferior vena cava, the slope of LV end systolic pressure-stroke-volume (Ea), external stroke work (SW), LV pressure-volume area (PVA), and slope of the SW-end diastolic volume relationship (preload recruitable stroke work: PRSW) were assessed by means of a micro-tip manometer and a conductance catheter. We measured data under the following four conditions; before circulatory support (baseline), during isolated VAB, VAB with TACV, and VAB with TACV plus intra-aortic balloon pumping (IABP). The LV contractility (Emax) and LV elastance (Ea) were equivalent for the four conditions. By comparison with baseline and VAB with TACV, LV energy (PVA) and work (SW, PRSW) were significantly reduced by TACV (1283.9 +/- 197.1 vs. 793.3 +/- 124.8 x 10(-4) J, 897.1 +/- 147.2 vs. 474.2 +/- 83.0 x 10(-4) J and 35.6 +/- 2.7 vs. 25.7 +/- 1.7 x 10(-4) J/ml, respectively), and the PE/PVA increased with TACV (30.4 +/- 2.6 vs. 40.8 +/- 1.8%). In contrast, there was no significant difference in PVA, SW, PRSW, and PE/PVA between baseline and isolated VAB. These results suggest that TACV might be an adjunctive technique to VAB or PCPS for patients with LV failure.

Animals↗