ISSN:0014-312X    

DOI:10.1159/000129495

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The Pringle maneuver (PM) is recognized in conventional liver surgery as a method of controlling bleeding. To determine the hemodynamic effects of the PM during pneumoperitoneum (PP) for laparoscopic liver resection, we measured hemodynamic and blood gas changes in 7 healthy pigs. All variables were recorded 5 min before and 10 and 30 min after employing PP or PM and 10 min after discontinuation of PM. After the induction of PP, cardiac index and arterial carbon dioxide tension significantly increased, accompanied by a significant decrease in pH. After the beginning of PM, cardiac index and mean arterial and central venous presures decreased significantly, whereas the heart rate rose markedly. After discontinuation of the PM, the systemic vascular resistance index decreased, and the heart rate remained elevated. These results demonstrate severe hemodynamic deterioration with PP and a subsequent PM. The latter should, therefore, be considered only as a last resort for the control of bleeding during laparoscopic liver surgery.

ISSN:0014-312X    

DOI:10.1159/000129434

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0014-312X    

DOI:10.1159/000318647

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The protective effect of a novel prostacyclin (PGI2 analog, OP-2507, on mesenteric circulation was investigated in a canine warm ischemia model. In 20 mongrel dogs, the entire portion of the intestine supplied by the superior mesenteric artery (SMA) and drained by the superior mesenteric vein (SMV) was completely isolated, maintaining the blood and lymph vessels intact. Sixty or 120 min of complete warm ischemia (WI) of the intestine was induced by clamping SMA and SMV, followed by reperfusion for 120 min. Animals were divided into five groups (each n = 4): group 1, sham operation; group 2, 60 min WI; group 3, 120 min WI; group 4, 60 min WI with PGI2 analog administration; group 5, 120 min WI with PGI2 analog administration. The analog was administered at a rate of 6 µg·kg–1 • h–1 immediately after laparotomy until the end of the observation period. Mean arterial pressure, SMA blood flow (SMABF), SMV pressure were monitored and total mesenteric vascular resistance (TM VR) was calculated. To evaluate the endothelial activation, endothelin, which is secreted from the endothelium under hypoxic stress, was assayed from blood samples of SMV. None of the animals showed significant changes in mean arterial pressure. In groups 2 and 3, SMABF decreased significantly to les than 60% of preoperative value (15 ml •kg–1 • min–1) and TMVR significantly increased from 8.1 and 7.3 mm Hg·ml–1 • kg·min before WI to 14.0 and 16.4 mm Hg·ml–1 • kg·min after 120 min reperfusion, respectively, resulting in delayed hypoperfusion. In contrast, in groups 4 and 5, SMABF increased to over 110% of preoperative level, while TMVR declined from 7.8 and 8.4 mm Hg·mH·kg·min before WI to 6.2 and 6.3 mm Hg·mH·kg·min after 120 min reperfusion. After 60 min reperfusion, SMABF and TMVR showed a significant difference between the treated and nontreated groups. Only in group 3, high endothelin concentrations (over 20 pg/ml) were observed even after 120 min reperfusion. It was concluded that the PGI2 analog was able to suppress the endothelial activation and the disturbance of mesenteric circula

ISSN:0014-312X    

DOI:10.1159/000129435

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0014-312X    

DOI:10.1159/000318648

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Submucosal tissue oxygen tension (PtO2) was measured in 20 patients with cervical esophagogastrostomy after resection of esophageal carcinoma, using a Clark-type oxygen electrode. The mean gastric baseline PtO2 was 54.6 ± 10.7 mm Hg. Following ligature of the vasa brevia and the left gastroepiploic artery PtO2 decreased to 45.8 ± 9.9 mm Hg, ligature of the left gastric artery caused a decrease to 34.2 ± 9.7 mm Hg and resection of the lesser curvature and pulling up of gastric tube led to 25.5 ± 9.0 mm Hg. Clinical value and practicability of intraoperative PtO2 measurements could be pro

ISSN:0014-312X    

DOI:10.1159/000129436

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Since primary closure of the common bile duct is often not undertaken because of the risks of biliary leakage and peritonitis, we have evaluated feasibility and reliability of closure using biomaterials. In three groups of dogs, an unsutured choledochotomy was closed with circular glued patches: a sclero-protein patch in 4 dogs and an oxidized, compressed human collagen patch reinforced (n = 6) or not (n = 6) with three stitches. The scleroprotein patch (n = 4) was resorbed too soon, and in 2 dogs the unstitched collagen patches became unglued; biliary leakage was the result in both instances. The bile duct healed successfully within 1 month in the other 10 animals fitted with collagen patches, despite one common bile duct stricture. Safe primary closure of a choledochotomy may be envisioned in humans if the duct suture is protected by this new collagen biomaterial.

ISSN:0014-312X    

DOI:10.1159/000129437

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0014-312X    

DOI:10.1159/000318649

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A study was made of the effect of cyclosporin A on intimal hyperplasia in an experimental model of arterial autograft. Fifty female Sprague-Dawley rats weighing 250-300 g were employed. Using a microsurgical technique, an arterial autograft measuring approximately 5 mm in length was implanted in right common iliac artery. Two groups were established: group I (control), consisting of 25 animals subjected only to arterial autograft, and group II (preoperative cyclosporin A), also consisting of 25 animals, which received a daily subcutaneous dose of 5 mg/kg cyclosporin A (Sandimmun®, Sandoz) for 4 days before the surgical procedure. The animals were sacrificed on postoperative days 7, 14, 21, 30 or 50. Specimens were studied by optical microscopy, transmission and scanning electron microscopy, autoradiography, and morphometry. Endothelialization of the graft zone was slow in the cyclo-sporin-treated group. Hyperplasia was delayed notably, but at 30 days the hyperplastic process had improved and at 50 days it was similar to that of the control group. In the cyclosporin-treated group, thymidine was not taken up by the medial layer; the absence of medial thymidine uptake correlated with ultra-structural evidence of medial degeneration with lipid vacuolization of the smooth muscle cells and the presence of macrophages. These results suggest that cyclosporin A does not inhibit intimal hyperplasia but instead delays its occurrence, probably because of the drug’s toxicity for smooth muscle cel

ISSN:0014-312X    

DOI:10.1159/000129438

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0014-312X    

DOI:10.1159/000318650

出版商:S. Karger AG    

年代:1996

数据来源: Karger