Multiorgan procurement from non-heart-beating donors by use of Osaka University cocktail, Osaka rinse solution, and the portable cardiopulmonary bypass machine.
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Biomedical subjects
Publications and source records attributed to N Hatanaka.
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In anoxic perfused liver, conversion of fructose to lactate was greatly increased to about 3 mumol/min per g liver. This increase in lactate implied that the same amount of ATP was also produced. The rate of metabolism of glucose was less than 10% of that of fructose, as judged by rate of production of lactate. In anoxic liver perfused with fructose, the ATP levels of both the tissue and mitochondria remained high, despite lack of oxygen, thus preventing enzyme leakage and preserving processes requiring ATP, such as bile excretion and urea formation. The mitochondrial oxidative phosphorylation capacity of anoxic liver perfused with fructose was also unimpaired. Spectral analysis of light transmitted through the liver revealed that the mitochondrial electron transfer system was in the completely reduced state during anoxia, indicating that the mitochondria were incapable of synthesizing ATP. These results suggest that fructose metabolism during anoxia resulted in sufficient production of ATP for maintaining the physiological functions of the cells and the oxidative phosphorylation capacity of their mitochondria.
A case of pancreatic pseudocyst complicating with pregnancy and delivery was reported. This primipara patient with pancreatic pseudocyst was able to achieve a full-term, transvaginal delivery of a mature baby. The usefulness of ultrasonic monitoring of the pseudocyst during labor was clinically demonstrated. When intra-abdominal pressure increased, pancreatic pseudocyst was deformed.
A 17 year old male with mediastinal yolk sac tumor is herein reported. His chief complaint was anterior chest pain. Chest X-ray and chest CT indicated a 8 cm diameter mass in the anterior mediastinum. Laboratory analysis revealed 2,578 ng/ml for AFP and 54% for LDH I. HCG and CEA values were normal. Yolk sac tumor was cytologically suspected on needle aspiration specimen. Combined chemotherapy with CDDP, VP16, and PEP brought the AFP and LDH 1 values down to 10 ng/ml and 27%, respectively. The diameter of the mass decreased to 6 cm. The mass was removed together with the thymus and the right upper lobe of the lung. A post operative histological examination of the mass revealed total necrosis. Nine months after the initiation of the therapy, his AFP level was within normal limits. The patient is doing well.
Of 26 patients who underwent both coronary artery bypass grafting and abdominal surgery at our institution between 1977 and 1992, nine had severe coronary artery disease associated with UICC stage I gastric cancer. They were treated by coronary artery bypass grafting followed by a curative operation for gastric cancer; the initial four patients underwent two-staged surgery (group A), and the most recent five patients underwent simultaneous surgery (group B). The cardiac surgery was performed first in all patients, and in group A the interval between the two procedures was 2 to 7 weeks. There were no significant differences between the two groups in terms of preoperative characteristics: sex, age, preoperative complications, NYHA class, prior myocardial infarction, ejection fraction, cardiac index, number of vessels diseased, or number of grafts. There were no significant differences between the two groups in terms of blood loss during the gastric operation (A: 649 +/- 194 ml; B: 842 +/- 326 ml) or the operating time (A: 371 +/- 106 minutes; B: 343 +/- 46 minutes). Two group A patients had postoperative complications (one had arrhythmia, and one died of sepsis caused by sutural insufficiency). On the other hand, four group B patients had complications (three cases of transient hyperbilirubinemia and one case of postoperative bleeding; none died). The postoperative hospital stay after gastrectomy was not prolonged in group B compared with group A (A: 41.7 +/- 22.7 days; B: 46.0 +/- 25.0 days). In conclusion, simultaneous procedure of coronary artery bypass grafting and gastric surgery can be performed safely, although careful management is indispensable.
The maximal removal rate of indocyanine green (ICG Rmax) is considered to be an important parameter of hepatic function. However, the method of analysis has some flaws, and an abnormal value is obtained for about 15% of patients. We developed a new method of measuring the ICG Rmax with a clearance meter (RK-1000) that continuously measured the ICG concentration using a fingertip optical sensor. Twenty patients were examined. The histologic diagnosis was as follows: normal for 10, cirrhosis in 6, hepatitis in 4. The ICG concentration was measured in vivo continuously with the RK-1000. To obtain the Rmax by the Michaelis-Menten model, the ICG concentration in the VLDL compartment was subtracted from the values obtained by the RK-1000 because ICG binds to various serum proteins and its rate of removal in the VLDL compartment differs from that in other protein compartments. The removal velocity was calculated and a Michaelis plot obtained. Then Rmax was calculated from the reciprocal of the y-intercept of a Lineweaver-Burk plot. The Rmax in subjects with liver disease was significantly lower than in those with normal liver. It is concluded that our new method of measuring ICG Rmax with the RK-1000 reflects liver function appropriately.