We examined an 8-hour cardiopulmonary preservation technique and the role of free radical-induced injury during cardiopulmonary preservation and transplantation. Hence, donor dogs were placed on cardiopulmonary bypass, rapidly cooled to 15 degrees C, and heterotopic heart-unilateral left lung transplantations were performed. In group 1 (n = 5), hearts and lungs were transplanted immediately after core-cooling and cardioplegic arrest. In groups 2 to 5 (n = 5 in each group), heart-lung blocks were excised and stored at 4 degrees C for 8 hours before transplantation. During preservation hearts were perfused (20 mm Hg) with oxygenated extracellular solution (pH 7.4, 410 m0sm/L) and the lungs immersed in the same solution. In groups 3 through 5 recombinant human superoxide distumase (r,h-SOD, total 40 mg/kg) was administered during either donor cooling, donor preservation, or just before and during reperfusion, respectively. Load independent analysis of myocardial function was assessed by determining the ratio of the end-systolic pressure to end-systolic dimension. Pulmonary preservation was evaluated by determination of extravascular lung water of the implanted left lung, arterial oxygenation on 40% inspired oxygen, and pulmonary vascular resistance. Although arterial oxygenation was similar in each group, pulmonary vascular resistance was increased in groups 2 through 4 after implantation. Furthermore, in groups 2 and 4 impaired myocardial function and increased extravascular lung water were observed. Administration of r,h-SOD, however, just before and during reperfusion significantly enhanced cardiopulmonary preservation. These results indicate that free radical-induced injury is primarily the result of reperfusion. Thus the best time for administration of r,h-SOD is before and during reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

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Twenty-four-hour isolated heart preservation by perfusion method with oxygenated solution containing perfluorochemicals and albumin.

In Experiment 1 the donor hearts (group C) perfused for 24 hours with an intracellular-like solution containing perfluorochemicals, calcium antagonist, and albumin were compared with the hearts immersed for 24 hours in an intracellular-like solution to which calcium antagonist was added (group B) and the hearts in which the ischemic time was less than 1 hour (group A) followed by orthotopic heart transplantation. In Experiment 2 perfusates with (group I) and without (group II) perfluorochemicals and albumin were used for 24-hour isolated heart preservation. Periodic assessment of the hearts was performed during the perfusion. Experiment 1: All transplanted hearts started beating spontaneously. There was no statistically significant functional difference between the three groups. At the end of the preservation the creatinine phosphokinase and lactate releases of group C were at lower levels than those in group B. Electron microscopic examination revealed that the myocardium in group B was damaged more severely than in group C. Experiment 2: The level of the creatinine phosphokinase and lactate dehydrogenase released in group I was lower than that in group II. The lactate concentration was at a lower level in group I. At the end of the preservation the pyruvate concentration was higher in group I. The gain in heart weight in group II was more marked than that in group I. The passive compliance decreased only in group II. It is suggested that the perfusion method is superior to the immersion method for 24-hour isolated heart preservation and that the perfusate containing perfluorochemicals and albumin is useful.

Albumins↗

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'The motion of the spine and the related electromyogram of the patient suffering from lumbago'.

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Back Pain↗

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[Spinal electrostimulation in the treatment of advanced chronic obliterating arteriopathies].

From 1989 to 1992 83 patients suffering from peripheral vascular disease without medical or surgical possibilities, were treated by spinal cord stimulation (SCS). We studied claudicatio intermittens, rest pain and ischemic lesion behaviour in all the patients. We also studied microcirculation behaviour of 21 patients, by oxygen transcutaneous tension (vasodilatation index VI = TcPO2 42 degrees C: TcPO2 45 degrees C) and laser Doppler flowmetry (resting flow RF, standing flow SF, venoarteriolar reflex VAR = RF - SF, flow temperature increase FTI = F 40 degrees C 15'-RF). The clinical follow-up at 2 years showed an improvement of walking distance in 85.7% of 7 controls, a complete rest pain control in 82.35% of 17 controls, an improvement and healing of ischemic lesions respectively in 27.07% and 53.86% of 18 controls. In arteriosclerotic arteriopathy with or without diabetes but without neuropathy VI increased and FTI decreased, after SCS, showing a sympathetic tone decrease. In arteriosclerotic arteriopathy with diabetic neuropathy V.I. decreased and FTI increased, after SCS, showing a sympathetic tone reappearance. VAR improved or reappeared, in arteriosclerotic arteriopathy with or without diabetes, showing improvement of tissue perfusion as regards a better efficiency of "paramicrovessels" and "microvascular unit". We believe that SCS, as regards favourable clinical results represents a useful and effective treatment in peripheral vascular disease treatment.

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