Nitroglycerin to relax the uterus during cesarean delivery for the low birthweight baby

BACKGROUND: The uterus at premature birth being thick and sensitive, we applied nitroglycerin (NTG) to relax the uterus during cesarean delivery for the low birthweight baby. METHODS: Twelve parturients of impending premature birth and nine of severe intoxication were included. General anesthesia was induced with thiamylal, and maintained with 5% inhaled sevoflurane. NTG was injected in an intermittent dose of 500 microg. The relative hardness of the uterus at delivery was evaluated by obstetricians in four ranks of categories. RESULTS: The mean gestation period was 27.4 weeks (24 weeks at the minimum-33 weeks at the maximum) and the mean birthweight was 986 g (561-1518 g). The mean time elapsed from induction of anesthesia to delivery was 8.3 min (2-14 min) while NTG was injected for the mean 1.8 times that reflected a total dose of 900 microg (500-1500 microg). The mean endtidal concentration of sevoflurane at delivery reached 3.8% (3.4-4.3%). The uterus was evaluated as "very soft" in 15 out of 21 cases, and all babies were extracted easily without injury through the lower J-shaped section of the uterus. The mean Apgar score was 2.9 points at 1 minute and 6.3 points at 5 minutes. No adverse effect of NTG on the mothers or babies was noticed. CONCLUSIONS: NTG relaxes the uterus effectively and facilitates cesarean delivery for the low birthweight baby.     

Comparison of cardiac output measured by pulseCO and that by vigilance during inferior vena cava clamping

BACKGROUND: PulseCO is a low invasive apparatus to measure cardiac output continuously from arterial pulse waveform (PulseCCO). It is thought that the accuracy of PulseCCO measurement is clinically acceptable with stable hemodynamics. We measured and evaluated PulseCCO during inferior vena cava clamp (IVC clamp). METHODS: Anesthesia was induced with propofol and vecuronium. After induction, an arterial catheter and a pulmonary artery catheter were inserted, and anesthesia was maintained with general anesthesia and continuous epidural anesthesia. At first IVC was clamped for five minutes and after an interval of five minutes IVC was clamped again. During IVC clamp maneuver, we measured PulseCCO and continuous cardiac output with Vigilance (VigilanceCCO). RESULTS: At the time of the first IVC clamp and declamp, VigilanceCCO was unchanged, but Pulse CCO showed a marked change. After the second IVC clamp, both PulseCCO and VigilanceCCO decreased, but the change was slower with VigilanceCCO. CONCLUSIONS: With IVC clamp maneuver which is thought to cause rapid change of cardiac output, PulseCCO showed more rapid change in comparison with VigilanceCCO. In the state where hemodynamics change rapidly, PulseCO can be a more useful monitor.     

Facial augmentation with groin osteoadiposal flap transfer

The authors report the advantages of the groin osteoadiposal flap for facial augmentation, which include the possibility of a conjoint type of flap harvesting with one main set of vessels (usually, the superficial circumflex iliac vessels); one-stage augmentation without secondary defatting; a donor scar in a concealed area; and rigid flap fixation with bone plating.     

The hemolytic characteristics of monopivot magnetic suspension blood pumps with washout holes

The hemolytic characteristics of monopivot magnetic suspension blood pumps as a function of impeller washout hole configuration and female pivot shape are observed. The pump impellers are designed with three washout hole configurations for blood circulation, and four female pivot shapes to reduce blood stagnation and to enhance antithrombogenicity. The hemolytic characteristics of the monopivot pumps were observed to be better than those of a currently available commercial centrifugal blood pump, BP-80, and changed to be nearly equal when the female pivot shape was changed. This indicates that hemolysis in monopivot pumps is mainly caused by shear stress between the male and female pivots.     

Resonant frequency control for artificial heart using online parameter identification

To develop effective medical care and therapeutic control using an artificial heart, a new control method has been developed. This new method can control the artificial heart effectively and can adapt to internal physiological behavior using measured physiological data; aortic pressure, aortic flow, and pump flow. This method consists of first, a second-order physiological model, which represents the internal physiological behavior by a mathematical equation; and second, an estimation method, which can identify the physiological parameters; aortic inertia, aortic resistance, aortic compliance, and peripheral resistance by a parameter identification method. It can then calculate the resonant frequency as the control signal for the artificial heart from the identified physiological model. To confirm the effectiveness, the proposed method was evaluated in a computer simulation study. This evaluation showed that the new method could estimate the physiological parameters and the resonant frequency within a 10% error. The impedance of the systemic circulation could also be reduced by this method.     

Renal Arteriovenous Fistula with Rapid Blood Flow Successfully Treated by Transcatheter Arterial Embolization: Application of Interlocking Detachable Coil as Coil Anchor

A 70-year-old woman presented to our outpatient clinic with a large idiopathic renal arteriovenous fistula (AVF). Transcatheter arterial embolization (TAE) using interlocking detachable coils (IDC) as an anchor was planned. However, because of markedly rapid blood flow and excessive coil flexibility, detaching an IDC carried a high risk of migration. Therefore, we first coiled multiple loops of a microcatheter and then loaded it with an IDC. In this way, the coil was well fitted to the arterial wall and could be detached by withdrawing the microcatheter during balloon occlusion (pre-framing technique). Complete occlusion of the afferent artery was achieved by additional coiling and absolute ethanol. This technique contributed to a safe embolization of a high-flow AVF, avoiding migration of the IDC.     

Promotion of beta-cell differentiation by conophylline in fetal and neonatal rat pancreas

Conophylline is a vinca alkaloid extracted from the tropical plant Ervatamia microphylla and has been shown to induce differentiation of pancreatic AR42J cells. In the present study, we investigated the effect of conophylline on the differentiation of pancreatic precursor cells. In the rat pancreatic rudiment in organ culture, conophylline inhibited the formation of cystic structure and increased the number of insulin-positive cells. Conophylline also markedly increased the expression of mRNA for insulin and the number of pancreatic duodenal homeobox-1-positive cells. These effects of conophylline were similar to those of activin A. We also examined the effect of conophylline on neonatal rats treated with streptozotocin, a model of type 2 diabetes. Treatment with conophylline significantly reduced the plasma glucose concentration and improved glucose tolerance in response to glucose loading. The insulin content and the beta-cell mass at 2 months were significantly increased by conophylline. The number of islet-like cell clusters and pancreatic duodenal homeobox-1-positive ductal cells was greater in conophylline-treated rats. These results suggest that conophylline induces differentiation of pancreatic precursor cells and increases the formation of beta-cells.