Background: The axillary artery is frequently used for cardiopulmonary bypass, especially in acute aortic dissection. We have cannulated the axillary artery using a side graft or by directly using Seldinger's technique. The purpose of this study was to assess the technical problems and complications of both cannulation techniques. Materials and Methods: From January 2003 to December 2009, 53 patients underwent operations using the axillary artery for arterial cannulation. The axillary artery was cannulated with a side graft in 35 patients (side graft group) and directly using Seldinger's technique in 18 patients (direct group). Results: The results were compared between two groups, focusing on cannulation-related morbidities including neurologic morbidity. Arterial damage or dissection of the axillary artery occurred in 1 (2.9%) patient in the side graft group and in 1 (5.6%) patient in the direct group. Malperfusion and insufficient flow did not occur in either group. There were no postoperative complications related to axillary cannulation, such as brachial plexus injury, compartment syndrome, or local wound infection, in either group. Conclusion: Technical problems and complications of the axillary arterial cannulation in both techniques were rare. Direct arterial cannulation using Seldinger's technique was done safely and more simply than the previous technique. It was concluded that both axillary arterial cannulation techniques are acceptable and it remains the surgeon's preference which technique should be used.
An arterial street control is performed for the purpose of the progression of a traffic flow using the arterial. However during the progression in the arterial, the change according to the time is one of the most representative problems occurring at a signal plan. This paper intends to efficiently operate the arterial progression by applying fuzzy logic, which is thought to be the most possible one in the inference as that of the human logic, to the traffic responsive control system. Fuzzy Logic controller is appliable to the daily human language (linguistic). can be dealt with the uncertain traffic data and is useful on planning the signal control to sensitively confront the randomly changing traffic condition. This study, based on the signal control part of the isolated intersection in "A Development of a Real-time, Traffic Adaptive Control Scheme Through VIDs"(Seong Ho. Kim. 1996). suggested the strategy for the progression control in the arterial and analyzed its effect by comparing the effect of the existing control method. In addition, the study compared each effect by using TRAF-NETSIM which is the traffic simulation software to analyze each control method.
Extra-corporeal membrane oxygenation (ECMO) has the potential to rescue patients in cardiac arrest or respiratory failure. ECMO has two systems such as veno-arterial and veno-venous circulation. In cardiac arrest resulting from acute myocardial infarction, veno-arterial ECMO is mandatory for systemic circulation and oxygenation. A 75-year old female patient underwent primary coronary intervention for acute myocardial infarction. Despite successful revascularization, recurrent ventricular tachycardia and heart failure were progressing. We performed a veno-arterial ECMO through the femoral artery and vein, then the patient seemed to be stable clinically. However, laboratory studies, echocardiography, and vital signs indicated multi-organ failure and decreasing cardiac function. We found out an error that we performed veno-venous ECMO instead of veno-arterial ECMO. We added a femoral artery cannula and exchange the circuit system to veno-arterial ECMO. While the systemic circulation seemed to be recovered, the left ventricular function was decreased persistently. A hypovolemia resulting from pulmonary hemorrhage was occurred, which lead to ECMO failure. The patient died of cardiac arrest and multi-organ failure 23 hours after ECMO. Because the color of arterial and venous circuits represent the position and efficacy of ECMO, if unexpected or abnormal circuit colors are detected, prompt and aggressive evaluation for ECMO function is mandatory.
Yoon, Wonki;Kim, Jang Hun;Roh, Haewon;Kwon, Taek-Hyun
Journal of Korean Neurosurgical Society
/
v.65
no.2
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pp.245-254
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2022
Objective : The etiology of angiographically occult spontaneous subarachnoid hemorrhage (AOsSAH) is unclear. Three-dimensional (3D) high-resolution vessel wall magnetic resonance imaging (HVM) might be useful in detecting the hidden arterial wall angiopathy in patients with AOsSAH. We aimed to demonstrate the feasibility of HVM for detecting the arterial cause of AOsSAH. Methods : Patients, who were diagnosed with AOsSAH in the first evaluations and underwent HVM, were enrolled. Their clinical and radiologic data were retrospectively reviewed. Especially, focal enhancement of arterial wall on HVM and repetitive catheterized angiograms were precisely compared. Results : Among 251 patients with spontaneous SAH, 22 patients were diagnosed with AOsSAH in the first evaluations (8.76%). After excluding three patients who did not undergo 3D-HVM, 19 patients were enrolled and classified as convexal (n=2) or perimesencephalic (n=4), and diffuse (n=13) groups. In convexal and perimesencephalic groups, no focal enhancement on HVM and no positive findings on repetitive angiography were noted. In diffuse group, 10 patients showed focal enhancement of arterial wall on HVM (10/13, 76.9%). Repeated angiography with 3D reconstruction revealed four patients of angiographically positive causative arteriopathy and possible lesion in one case in the concordant location of intramural enhancement on 3D-HVM (5/10, 50%). Three of them were treated with endovascular stent insertion. All patients, except one, recovered with good clinical outcome (3-month modified Rankin score, 0 and 1). Conclusion : 3D-HVM was useful in detecting hidden true arteriopathy in AOsSAH. It may provide new insights into the etiologic investigation of AOsSAH by proving information about the arterial wall status.
[Purpose] Aerobic exercise training (AT) reverses aging-induced deterioration of arterial stiffness via increased arterial nitric oxide (NO) production. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase, was decreased by AT. However, whether AT-induced changes in ADMA levels are related to changes in nitrite/nitrate (NOx) levels remains unclear. Accordingly, we aimed to clarify whether the relationship between plasma ADMA and NOx levels afected the AT-induced reduction of arterial stifness in middle-aged and older adults. [Methods] Thirty-one healthy middle-aged and older male and female subjects (66.4 ± 1.3 years) were randomly divided into two groups: exercise intervention and sedentary controls. Subjects in the training group completed an 8-week AT (60%-70% peak oxygen uptake [${\dot{V}}O_{2peak}$] for 45 min, 3 days/week). [Results] AT signifcantly increased ${\dot{V}}O_{2peak}$ (P < 0.05) and decreased carotid β-stifness (P < 0.01). Moreover, plasma ADMA levels were significantly decreased while plasma NOx levels and NOx/ADMA ratio were significantly increased by AT (P < 0.01). Additionally, no sex diferences in AT-induced changes of circulating ADMA and NOx levels, NOx/ADMA ratio, and carotid β-stifness were observed. Furthermore, the AT-induced increase in circulating ADMA levels was negatively correlated with an increase in circulating NOx levels (r = -0.414, P < 0.05), and the AT-induced increase in NOx/ADMA ratio was negatively correlated with a decrease in carotid β-stifness (r = -0.514, P < 0.01). [Conclusion] These results suggest that the increase in circulating NOx with reduction of ADMA elicited by AT is associated with a decrease in arterial stiffness regardless of sex in middle-aged and older adults.
Objective : This study was undertaken to evaluate the effect of Sunghyangchungisan (SHCS) on the regulation of vascular tone and $Ca^{2+}$ metabolism in arterial tissues. Vascular rings isolated from rabbit carotid artery were myographed isometrically in isolated organ baths and the effect of SHCS on contractile activities, endothelial function and $Ca^{2+}$ metabolism were determined. Methods : In phentobarbital sodium-anesthetized rabbits, SHCS administered through ear vein (100 mg/Kg body wt.) or intragastric dwelling tube (300 mg/Kg body wt.) attenuated phenylephrine (PE, 10 ${\mu}g$/Kg, i.v.)-induced increases in both systolic and diastolic cartoid arterial blood pressure. Results : In experiments with isolated arterial strips, SHCS relaxed arterial rings which were pre-contracted by phenylephrine (PE, 1 ${\mu}M$). The responses to SHCS were partially dose-dependent at concentrations lower than 0.5 mg/ml. When SHCS was applied prior to the exposure to PE, it inhibited the PE-induced contraction by a similar magnitude which was comparable to the relaxation of pre-contracted arterial rings. Washout of SHCS after observing its relaxant effect resulted in a full recovery of PE-induced contractions, indicating that the action mechanism is reversible. The observation that SHCS did not change the $ED_{50)$ of PE oh its dose-response curve ruled out the possible interaction of SHCS with ${\alpha}$-receptors. The relaxant effect of SHCS was not affected by removal of endothelium or a nitric oxide synthase inhibitor, L-NAME. Methylene blue, an inhibitor of the soluble guanylate cyclase, did not affect the relaxant effect of SHCS. These results suggest that the action of SHCS is not mediated by the endothelium nor soluble guanylate cyclase. Constant cGMP production determined in arterial strips in the presence or absence of SHCS is consistent with this conclusion. When contraction was induced by additive application of $Ca^{2+}$ in arterial rings which were pre-depolarized by high $K^+$ in a $Ca^{2+}$-free solution, the relaxant effect of SHCS was attenuated by increasing the $Ca^{2+}$ concentration. SHCS, when applied to the arterial rings pre-contracted by PE and then relaxed by nifedipine, a $Ca^{2+}$ channel blocker, did not show additive relaxation. SHCS partially blocked $Ca^{2+}$ influx stimulated by PE and high $K^+$ which was determined by 5-min ^{45}Ca$ uptake, while it did not affect $Ca^{2+}$ efflux. Conclusions : From above results, it is suggested that SHCS relax PE-induced contraction of rabbit carotid artery in an endothelium independent manner, andinhibition of $Ca^{2+}$ influx may contribute to the underling mechanism.
The arterial blood pressure response elicited by stimulating the peripheral afferent fibers of different groups and origins was studied in cats. Experimental animals were anesthetized with a-chloralose [60mg/kg] and artificially ventilated with a respirator. The lumbosacral spinal cord was exposed through a laminectomy and L7 ventral root was isolated. The sural, medial gastrocnemius and common peroneal nerves were also exposed in the hindlimb. The arterial blood pressure was monitored continuously while the exposed peripheral nerves and L7 ventral root were being stimulated. Then, spinal lesions were made on the dorsolateral sulcus area, dorsolateral funiculus and other areas at the thoracolumbar junction. The arterial blood pressure responses were compared before and after making spinal lesions. The following results were obtained. 1. The mean arterial blood pressure was elevated from 103*7.3 to 129*8, 1 [mean*S.E.] mmHg [p<0.001] during stimulation of the sural nerve with C-strength [1000T], 20Hz. Stimulation with Ad-strength, 1Hz resulted in the depression of the arterial pressure by 8 mmHg [p<0.01]. 2. Stimulation of the medial gastrocnemius nerve with Ad-strength did not elicit any significant change in arterial blood pressure. Stimulation with C-strength, 20 Hz induced a pressor response from 102*6.2 to 117*6.4 mmHg [p<0.01] while that with C-strength, 1Hz induced a depressor response from 104*6.1 to 93*4.9 mmHg [p<0.001]. 3. A pressor response by 56 [from 107*7 5 to 163*9.4] mmHg [p<0.001] was induced during stimulation of the common peroneal nerve with C-strength, 20Hz stimuli. Stimulation with A4-strength, 1Hz depressed the arterial blood pressure from 111~9.3 to 94*7.8 mmHg [P<0.005]. The activation of the ventral root afferent fibers with C-strength, 20 Hz stimuli induced a pressor response by 22 mmHg [from 115*9.4 to 137*8.6 mmHg] [p<0.001]. 4. The pressor response elicited during stimulation of the sural nerve was abolished by making lesions on the dorsolateral sulcus area bilaterally. With the medial gastrocnemius nerve, the pressor response had not been abolished completely by the dorsolateral sulcus lesions. The pressor response disappeared completely with addition of the bilateral dorsolateral funiculus lesions. 5. The depressor response induced by stimulation of the sciatic nerve with Ad-strength, 1Hz was decreased by making lesions on the dorsolateral funiculus. 6. From the above results it is concluded that the difference in the blood pressure responses to the activation of the muscular afferent and the cutaneous afferent fibers is responsible for the groups of afferent fibers and the spinal ascending pathways.
Kim, Seung Hyun;Yoon, Gil Sung;Cho, Yong Jin;Shin, Kyoo-Ho;Suh, Jin-Suck;Yang, Woo-Ick
The Journal of the Korean bone and joint tumor society
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v.19
no.2
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pp.50-55
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2013
Purpose: The purpose of this study is to determine the usefulness of arterial embolization on sacral and pelvic giant cell tumor (GCT). Materials and Methods: We retrospectively reviewed the medical records of 9 patients who had undergone serial arterial embolization between December 1996 and May 2008. We analyzed the clinical outcomes and therapeutic responsiveness of arterial embolization on sacral and pelvic GCT. Results: Six of 9 cases showed progression of disease (PD) status, even if 5 cases showed PD status despite of additional treatments including surgery and radiation, implying that serial arterial embolization on sacral and pelvic GCT is not effective. Three of 9 cases showed stable disease (SD) or continuous disease free (CDF) status and we analyzed associated factors with these good responses for embolization by ${\chi}^2$ test. The number of feeding vessels under six (p=0.048) and the number of collateral arterial supply under three (p=0.048) in the first angiogram showed significant relationships with good response for embolization, while remaining tumor staining by contrast after the first embolization and repeated embolization times were not significant. Conclusion: Although serial arterial embolization is not an effective modality on sacral and pelvic giant cell tumors, it may be a pilot modality under narrow indication of tumors with poor vascularity at first angiogram.
Pulmonary function is the determinant of blood gas tension. However, Acid-Base disturbances can also alter partial pressures of oxygen and carbon dioxide in arterial blood. During respiratory acidosis $PO_2$ will be lowered and reverse changes will be produced during respiratory alkalosis. On the other hand, in metabolic acidosis $PO_2$ will be elevated and $PCO_2$ will be lowered by the respiratory compensation, and reverse response will be induced in metabolic alkalosis. Urinary gas tension has many influencing factors than arterial blood and difficult to estimate the tendency of its alterations. Urinary $PO_2$ and $PCO_2$ are not always identical level as venous blood. It is to be altered by blood gas tension, flow rate of urine, metabolic rate of kidney, and Acid-Base status of blood. Particularly countercurrent exchange of oxygen and carbon dioxide in the renal medulla will make larger alteration of gas tension than venous blood. After induction of Acid-Base disturbances [disturbances] arterial and urinary $PCO_2$, $PO_2$, urinary volume, and osmolarity were determined in dogs, and the relationships between arterial and urinary $PCO_2$ , $PO_2$ Acid-Base disturbances, urinary volume, and osmolarity were investigated. 1. During the acute Metabolic and Respiratory disturbances urinary pH did not respond on respiratory origin. However, there were immediate urinary response in pH on metabolic origin. 2. Urinary $PO_2$, $PCO_2$, did not always follow arterial or venous gas tension and Acid-Base disturbance. Urinary $PCO_2$, correlate well with the urinary volume. The larger the urinary volume, $PCO_2$ lowered to the venous level. The smaller the urinary volume, urinary $PCO_2$ tends to be higher. However urinary $PO_2$ did not have any particular correlation with urinary volume. 3. Correlation between urinary $PCO_2$ and $PO_2$ were inversely proportional to arterial blood. Differences of $PCO_2$ between arterial blood and urine also did not have any particular correlation with urinary volume. This may suggest that changes on blood gas tensions can influence on urinary $PCO_2$. 4. There were eminent clear inverse correlation between urinary $PCO_2$ and osmolar concentrations of urine. Above results strongly suggest that partial pressure of gas in urine primarily depend upon counter-current exchanges in renal medullary tissues.
Endogenous analgesic systems are known to be activated by peripheral noxious stimulation as well as arterial carbon dioxide elevation. In the present study, neuronal Activities in the rostral ventrolateral med- ulla were identified and classified in according to their rhythmic activities, and their responses to noxious peripheral nerve stimulations before and after elevating the arterial carbon dioxide partial pressure were investigated Using extracellular recording technic, a total of 53 spontaneously active neurons were recorded from the rostral ventrolateral medulla in u-chloralose anesthetized cats. These were classified as cardiovascular (28), respiratory (16), both cardiovascular and respiratory (2) and noncardiovascular - nonrespiratory (7). - Among the 28 cardiovascular neurons eleven showed increased activities during arterial hypercapnia, thirteen showed decreased responses, and four showed no change. Nine respiratory neurons showed increased responses to arterial hypercapnia, six showed decreased responses and one showed no change. neither of the cardiovascular and respiratory neurons showed significant change in its activity during ar- terial hypercapnia, however, four of the noncardiovascular - nonrespiratory neurons exhibited decreased their activities in response to arterial hypercapnia while two exhibited increased activities. Arterial hypercapnia increased the responses of cardiovascular neurons to peripheral nerve stimulation with C-inteniity, while not changing the responses to Ak_stimulation significantly . From the above results it was conclllded that during arterial hypercapnia, some cardiovascular neurons and respiratory neurons have increased activities as well as increased reponses to C-Hber stimulation.
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