Pig-Liver Perfusion

Three extracorporeal pig-liver perfusions on a patient, for the treatment of an acute hepatic failure, are described. The patient had massive postoperative necrosis of the liver, possibly due to halothane sensitization. There was an improvement in the patient's condition after the perfusions, but she died a few days later of a pulmonary embolism. Comparison between the pre-perfusion biopsy and autopsy specimens showed that liver cell regeneration had occurred. Histological study of the pig livers from the first two perfusions showed an accumulation of granulocytes in the liver sinusoids. The third perfusion had to be stopped after 20 minutes, owing to an acute increase in flow resistance. In this case, the histological study revealed compression of the sinusoids by oedematous liver cells and congestion of the portal areas.     

Perfusion balloon catheter

An autoperfusion balloon catheter was developed to allow passive myocardial perfusion during balloon inflation, through a central lumen and multiple side holes in the shaft proximal and distal to the balloon. This report reviews preliminary experimental animal data and initial human clinical experience with this device. In our first study with this device, the duration of inflation in dogs was compared with the maximal duration of inflation using a standard angioplasty catheter. Coronary arteriography was performed to demonstrate distal coronary blood flow through the perfusion balloon catheter. Electrocardiographic recordings and repeated left ventriculograms were performed to detect evidence of ischemia during standard and perfusion and balloon catheter inflations. The average inflation time was 3 +/- 1 minute for the standard catheter and 37 +/- 10 minutes for the perfusion catheter. Each dog had evidence of severe myocardial ischemia during standard inflation, yet none of the animals had ST-segment elevation, ventricular arrhythmia or wall motion abnormality during dilatation with the perfusion catheter. In a second experiment, the effect of prolonged balloon inflations (30 minutes) on intimal hyperplasia was evaluated in the rabbit model. Results of this study showed reduction of intimal and medial hyperplasia after 4 weeks in iliac arteries in rabbits treated with prolonged inflations compared with the contralateral vessel in rabbits treated with standard angioplasty. Initial clinical results from patients treated with this new catheter are presented. The availability of an effective autoperfusion catheter should allow for testing the hypothesis that prolonged inflations could alter the acute angioplasty success rate and long-term restenosis rate.     

The Acid Perfusion Test

Acid perfusion with 0.1 n HCl (5 ml/min for max. 30 min) and simultaneous intragastric instillation of equimolar amounts of sodium bicarbonate were performed in 55 patients with sliding hiatus hernia and symptoms attributable to gastro-oesophageal reflux. Acid perfusion reproduced the patient's spontaneous symptoms, and was thus positive, in 44 per cent of the cases. A positive acid perfusion test means that the patient's spontaneous symptoms may be of oesophageal origin, whereas a negative test does not allow any conclusions. The acid perfusion test was likewise performed before and three months after a modified Belsey MK IV repair in 37 patients with hiatal hernia and symptoms indicating surgical repair. The operation was followed by a reduction in oesophageal acid sensitivity (p>0.01).     

Perfusion of isolated human spleens

Summary Twelve normal human spleens were perfused in vitro for 17 h at normothermia. The histological structure was well preserved. Splenic imprints showed a normal cellular pattern, mitoses, and labelled lymphoid cells after³H-thymidine labelling. Metabolic parameters were comparable to in vivo data of human spleens. The perfusion system can preserve the structure and function of human spleens in vitro.     

正常灌注压突破综合征

正常灌注压突破综合征是脑血管疾病术中或术后的严重并发症。本文就近年来正常灌注压突破综合征的研究进展进行综述,重点探讨其发病机制、预测和预防。     

Cardiovascular Magnetic Resonance: Myocardial Perfusion

There is growing evidence that the noninvasive assessment of myocardial perfusion with cardiovascular magnetic resonance is a valid and accurate tool for the assessment of ischemic heart disease and its introduction into routine clinical evaluation of patients is rapidly expected. Magnetic resonance measurements allow the evaluation of reversible and irreversible myocardial ischemia, the assessment of acute myocardial infarction, as well as the recognition and detection of viable myocardium. Magnetic resonance perfusion measurements are mainly performed with T1-shortening contrast agents such as gadolinium-DTPA either by visual analysis or based on the analyses of signal intensity time curves. For the detection of myocardial ischemia the first pass kinetics of a gadolinium-DTPA bolus and for the detection of myocardial necrosis and the definition of viable myocardium steady state distribution kinetics are assessed. Quantitative analysis of myocardial perfusion can be performed but requires complex modeling due to the characteristics of gadolinium-DTPA. Thus, semi-quantitative parameters are preferred. There is accumulating evidence in the literature that magnetic resonance imaging can be used for the detection of coronary artery stenosis with high diagnostic accuracy both with semi-quantitative or visual analysis. Myocardial infarction can be reliably detected and the infarcted area determined. Non-reperfused infarcted myocardium can be differentiated from reperfused myocardium by different enhancement patterns that correlates with viability. Cardiac magnetic resonance is a promising technique that can combine different functional studies during one examination, such as the assessment of wall motion and perfusion at rest and stress. With further improvements in analysis software magnetic resonance perfusion measurement may rapidly become a routine tool for the assessment of patients with coronary artery disease.     

Extracorporeal Perfusion Treatment with Immobilized L-Asparaginase

2 female patients with malignant melanoma were treated with L-asparaginase immobilized in an extra-corporeal perfusion chamber constructed by Hydén et al. The patients were treated for 80 h during 26 d and for 99 h during 36 d, respectively. L-asparaginase was immobilized by covalent bonds on the surfaces of the chamber. Perfusion resulted in an effective decrease down to < 7 mmol/1 serum of the asparagine content. The patients withstood the treatments well without any signs of allergic reactions. Antibodies against L-asparaginase were not found. Analyses were continuously performed during the treatment with respect to electrolytes, enzymes and immunoglobulins. No abnormal variations could be found.