著者
吉田 忠正
出版者
The Japanese Circulation Society
雑誌
JAPANESE CIRCULATION JOURNAL (ISSN:00471828)
巻号頁・発行日
vol.28, no.9, pp.704-711, 1964
被引用文献数
1

Recently, the hepatic circulation in hemorrhagic shock has been investigated by HEINEMANN, BRADLEY, SELKURT, FRANK and others. However, the opinions among the authors have not yet been in agreement but rather controversial, par icularly, as to the relationship between hepatic blood flow and cardiac output. HEINEMANN reported that hepatic blood flow fell sharply following hemorrhage and then returned spontaneously the control level in absence of the restoration of blood pressure. While, the others reported that hepatic blood flow did not recovered and remained in decreased level, having the same trend in blood pressure change. It seems likely that such a controversy will be partly due to the difference of the methods employed in measuring hepatic blood flow and partly to the confusion in recognizing the stage of shock, because the sequence of respective hemodynamic phenomenon is considerably different at the period of observation in this condition. The purpose of the present paper is to classify the relationship of hepatic blood flow and cardiac output throughout the entire course of hemorrhagic shock and its bearing on the irreversibility of shock. Oxygen utilization in the splanchnic viscera was also studied. The Relationship between Hepatic Blood Flow and Cardiac Output 1) Methods : Hepatic blood flow was measured by modified Frank's method. Twenty-two dogs ranging in weight from 8 to 20 kg were used and anesthetized with intravenous pentobarbital sodium of 25 mg/kg. A polyethylene catheter was passed through a right external jugular vein into the hepatic vein and then wedged into one of hepatic lobar veins. The outer end of the catheter in the hepatic vein was fixed at the level of the vena cava and allowed to drain continuously. The rate of hepatic outflow was measured by a graduated cylinder and stop watch. The blood collected was returned by transfer to an elevated burette draining into a left external jugular vein. Heparin (3-5 mg/kg) was given intravenously during the experiments. Cardiac output was calculated from indicator dilution curves according to the STEWART-HAMILTON principle. Two different procedures were used. In one method <SUP>32</SUP>P labelled red cells were used as an indicator and injected intravenously. Blood samples were collected successively from the femoral artery. In another cases, radio-iodinated serum albumin (RISA) was injected as an indicator. Cardiac output was calculated from radio-cardiograms by using a scintillation detector at the heart region and a rate-meter. 2) Results : We could distinguish the following two stages in hemorrhagic shock in relation to hepatic blood flow and cardiac output. a) The first stage : In the early stage of shock, hepatic blood flow decreases in parallel with the changes in cardiac output. b) The second stage : After same delay from the initial bleeding, hepatic blood flow decreases progressively without marked reduction in cardiac output. Consequently, a difference or "gap" appears in percentile changes of hepatic blood flow and cardiac output. c) Effects of transfusion : Complete recovery of arterial pressure, cardiac output and hepatic blood flow can be obtained by a transfusion performed in the first stage. Whereas, the transfusion made in the second stage give rise only transient recovery of arterial pressure and cardiac output.
著者
Kiyoshi wakugami Kunitoshi Iseki Yorio Kimura Koichiro Okumura Yoshiharu lkemiya Hiromi Muratani Koshiro Fukiyama
出版者
日本循環器学会
雑誌
JAPANESE CIRCULATION JOURNAL (ISSN:00471828)
巻号頁・発行日
vol.62, no.1, pp.7-14, 1998 (Released:2001-11-25)
参考文献数
38
被引用文献数
33 40 52

Coronary heart disease (CHD) is rare in Japanese subjects and serum cholesterol levels are low. However, no data have been published relating the effect of serum cholesterol levels to the incidence of acute myocardial infarction (AMI) in Japan. Data from a large community-based mass screening registry are available for the geographically isolated island of Okinawa, Japan (1980 census, 1.11 million). A total of 38,053 participants (17,859 men and 20,194 women) whose serum cholesterol levels were determined in the 1983 mass screening were examined to determine whether they had experienced AMI. Every case of AMI that occurred during a 3-year period (1 April 1988 to March 1991) throughout Okinawa was recorded in a separate registry. The total number of cases of AMI was 1,021 (674 men and 347 women). Of these, 65 patients (41 men and 24 women) were identified by name, sex, birth date, and zip code in the mass screening registry. The cumulative incidence of AMI increased with the serum level of cholesterol: 42.1 (serum cholesterol ≤ 167 mg/dl), 133.5 (serum cholesterol 168-191 mg/dl), 188.9 (serum cholesterol 192-217 mg/dl), and 323.0 (serum cholesterol ≥ 218 mg/dl) per 100,000 screened subjects. Multiple logistic analysis was conducted to examine the effect of serum cholesterol on the risk of AMI with adjustment for other variables such as sex, age, systolic and diastolic blood pressure, and proteinuria. The adjusted odds ratio (95% confidence interval) of the observed serum levels of cholesterol was 1.66 (1.29-2.15) with a reference serum cholesterol level of ≤ 167 mg/dl. The risk of AMI increased in proportion to the serum level of cholesterol. Serum cholesterol is an independent predictor of AMI in Okinawa, Japan. (Jpn Circ J 1998; 62: 7 - 14)
著者
YOSHIKAZU SUZUKI TADASHI KAMIKAWA NOBORU YAMAZAKI
出版者
日本循環器学会
雑誌
JAPANESE CIRCULATION JOURNAL (ISSN:00471828)
巻号頁・発行日
vol.45, no.5, pp.552-559, 1981-05-20 (Released:2008-04-14)
参考文献数
38
被引用文献数
12 17

The effects of L-carnitine on ventricular arrhythmias were evaluated in dogs with acute myocardial ischemia and a supplement of excess free fatty acids (FFA). Acute myocardial ischemia was induced by ligation of left anterior descending coronary artery. After 80 minutes of coronary occlusion, high plasma FFA was induced by intravenous injection of heparin 200 u/kg and Intralipid(R) 5 ml/kg as a bolus. After additional 60 minutes, beating hearts were removed from animals and tissue levels of free carnitine, short and long chain acyl carnitine, FFA and adenosine triphosphate (ATP) were determined. L-carnitine 100 mg/kg was administered intravenously 5 minutes before coronary artery ligation. Electrocardiograms were recorded continuously by a Holter electrocardiographic recorder during the experiment and ventricular arrhythmias were quantified by an arbitrary scoring system. In ischemic and excess FFA supplemented myocardium, free carnitine and ATP decreased, whereas long chain acyl carnitine and FFA increased. And these metabolic changes tended to be reduced by L-carnitine. Pretreatment of L-carnitine also reduced the grade of ventricular arrhythmias induced both by acute myocardial ischemia and by supplement of excess FFA. These results suggest that the administration of L-carnitine may be beneficial to prevent serious arrhythmias in ischemic heart disease, presumably by restoring the impaired FFA oxidation.