Studies of cardiopulmonary function and acid-base balance were performed on 29 dogs during control period, during oligemic hypotension and following return of blood to the animals. Intravenous morphine and local anesthesia were used. Fifteen of the 29 animals survived the complete experiment. The 14 animals that failed to survive the experimental period died between 15 to 90 minutes after the onset of bleeding. The results were as follows. 1. The heart rate increased after the onset of bleeding and failed to return to control level following reinfusion. Stroke volume decreased markedly after bleeding and failed to recover after return of blood from the reservoir. Cardiac output also decreased during oligemic hypotension and was maintained at this level after re-infusion. Total peripheral resistance decreased significantly immediately after bleeding, however it increased soon over the pre-bleeding level. Central venous pressure decreased after the onset of bleeding and remained at lower level for the rest of the experimental period. Arterial blood pressure, clown to 40-45 mmHg by acute hemorrhage, was elevated near to control level. Left ventricular work decreased tremendously during oligemic hypotension and failed to return to control level with the re-infusion of blood. Hematocrit value showed no significant decrease after bleeding and increased after re-infusion. Hemoglobin decreased after the onset of bleeding and recovered to control value after re-infusion. 2. The respiratory rate fell rapidly after bleeding from 124 to 29 and remained at this lower level for the remainder of the experiment. The tidal volume increased after bleeding and was maintained at this level for the remainder of the experiment. The respiratory minute volume showed no significant changes throughout the experimental period. Oxygen consumption fell lightly in all animals during oligemic hypotension and returned to normal levels following re-infusion. Arterial oxygen content and arterial oxygen saturation decreased following bleeding and the values returned to normal levels after the return of blood from the reservoir The arterio-venous oxygen difference increased after the onset of bleeding. It failed to return to normal values following re-infusion. Arterial $Pco_2$ decreased in all animals after the beginning of the bleeding. Partial pressure of $Co_2$ continued to fall until re-infusion, after which the values returned toward normal. Animals became acidotic. The pH fell to lower level following bleeding. Lactic acid and lactate: pyruvate ratio also increased during same period. Arterial pH and lactic acid failed to return to control value and lactate: pyruvate ratio increased more after re-infusion. Sodium bicarbonate decreased after bleeding and returned to control value following re-infusion.
[Purpose] The present study investigated the effect of endurance exercise with blood flow restriction (BFR) performed at either 25% maximal oxygen uptake (${\dot{V}}O_2$ max) or 40% ${\dot{V}}O_2$ max) on muscle oxygenation, energy metabolism, and endocrine responses. [Methods] Ten males were recruited in the present study. The subjects performed three trials: (1) endurance exercise at 40% ${\dot{V}}O_2$ max without BFR (NBFR40), (2) endurance exercise at 25% ${\dot{V}}O_2$ max with BFR (BFR25), and (3) endurance exercise at 40% ${\dot{V}}O_2$ max with BFR (BFR40). The exercises were performed for 15 min during which the pedaling frequency was set at 70 rpm. In BFR25 and BFR40, 2 min of pressure phase (equivalent to 160 mmHg) followed by 1 min of release phase were repeated five times (5 × 3 min) throughout 15 minutes of exercise. During exercise, muscle oxygenation and concentration of respiratory gases were measured. The blood samples were collected before exercise, immediately after 15 min of exercise, and at 15, 30, and 60 minutes after completion of exercise. [Results] Deoxygenated hemoglobin (deoxy-Hb) level during exercise was significantly higher with BFR25 and BFR40 than that with NBFR40. BFR40 showed significantly higher total-hemoglobin (total-Hb) than NBFR40 during 2 min of pressure phase. Moreover, exercise-induced lactate elevation and pH reduction were significantly augmented in BFR40, with concomitant increase in serum cortisol concentration after exercise. Carbohydrate (CHO) oxidation was significantly higher with BFR40 than that with NBFR40 and BFR25, whereas fat oxidation was lower with BFR40. [Conclusion] Deoxy-Hb and total Hb levels were significantly increased during 15 min of pedaling exercise in BFR25 and BFR40, indicating augmented local hypoxia and blood volume (blood perfusion) in the muscle. Moreover, low-and moderate-intensity exercise with BFR facilitated CHO oxidation.
Total body perfusion using Sarns Heart-Lung-Machine, five head pump motor system with Travenol disposable bubble oxygenator was attempted in the dogs by the hemodilution method with total prime of buffered Hartman`s solution under moderate hypothermia. The first of all, the functions of Sarns Heart-Lung-Machine and effects of the hemodilution perfusion by buffered Hartman`s solution was studied. At the same time the changes of pressure of artery and vein, gas contents of the blood, and influence on the blood pictures were observed before, during, and after perfusion in 1-2 days. Hemodilution rates were the ranges of 85.0ml/kg to 97.3ml/kg and perfusion flow rates were maintained with the average 80. 5ml/kg/min [the ranges of 73.3ml/kg/min to 92.8ml/kg/min]. Hypothermia was employed between $35^{\circ}C$ and $31^{\circ} of the esophageal temperature. The total body perfusion was continued for 50-60 minutes. In the total cardiopulmonary bypass, atriotomy, ventriculotomy, and atrioventriculotomy were performed respectively. Arterial pressure was ranged approximately between 50 mmHg and 140 mmHg, but generally, it was maintained over 75 mmHg. Venous pressure was measured between 3.8 cm$H_2O$ and 16.0 cm$H_2O$. Optimum oxygenation could be achieved when oxygen flow into the oxygenator was maintained approximately at 5. 5L/min. In this way, the $pO_2$, $pCO_2$, and oxygen saturation were measured before, during, and afterperfusion in 1-2 days. The $pCO_2$ ranged approximately between 26.0 mmHg and 38.5 mmHg, but generally, it was maintained in the average 30.9-32.5mmHg. The $pO_2$ was ranged between 73.0mmHg and 332.2 mmHg, but it was maintained in the average 103.0-219.0 mmHg. Oxygen saturation was measured over 95. 0% during and after extracorporeal circulation respectively. Erythrocyte count, hemoglobin, hematocrit, and leucocyte count were decreased to 49.2%, 49.0%, 49.4%, and 21. 1% of the preoperative value during extracorporeal circulation respectively and these reductions were not recovered until 1-2 days after perfusion. These. resulted from relatively high degree of hemodilution rate and operative bleeding during these experimental studies. The platelets count was also decreased about to 71% during perfusion, on the contrary, it was increased progressively after perfusion and in 1-21 days after perfusion, the value was returned to preoperative contro1 level. Three dogs were all recovered after extracorporeal circulation.
Experiments were performed to investigate changes in metabolic rate (MO2), critical oxygen saturation (Scrit) and hematological parameters of black rockfish, Sebastes schlegeli exposed to hypoxia at 15, 20 and 25℃. The MO2 was measured at an interval of 10 min using intermittent-flow respirometry. The normoxic standard metabolic rate (SMR) was 116.5±5.5, 188.6±4.2 and 237.4±6.8 mg O2/kg/hr, and Scrit was 22.1±1.2, 30.6±1.5 and 41.9±1.4% air saturation at 15, 20 and 25℃, respectively. Q10 values were 2.62 between 15 and 20℃, 1.58 between 20 and 25℃, and 2.04 over the full temperature range. In the investigation of blood (hematocrit and hemoglobin) and biochemical parameters (plasma cortisol, glucose, electrolyte and osmolality), the rockfish were subjected to Scrit for each temperature during 4 hr. All of hematological parameters of the rockfish exposed to hypoxic water were significantly higher than those of normoxic control. Moreover, blood and biochemical parameters of the rockfish maintained to normoxic water showed the tendency of increase with temperature, and were significantly higher at 25C. As a result of this experiment, it was found that physiological stress due to hypoxia increased at high temperature.
Sixty-nine patients with various types of cyanotic congenital heart disease underwent systemic-pulmonary artery shunts with a microporous polytetrafluoroethylene [PTFE] prosthesis between 1979 and 1985. Their ages ranged from 2 months to 39 years [mean$\pm$SD: 5.2$\pm$7.4, median: 3.3 years]. Diagnosis included the following: Tetralogy of Fallot, 45: Double outlet right or left ventricle, 11: Single ventricle, .5: Transposition of great vessels, 4: Tricuspid atresia, 3 and Pulmonary atresia with intact ventricular septum, 1. Forty-eight patients had subclavian-pulmonary artery anastomosis, 12 patients aorta-right pulmonary artery anastomosis, 6 patients aorta-main pulmonary artery anastomosis, and 3 patients descending aorta-pulmonary artery anastomosis. The PTEE graft of 3 mm in diameter was used in 1, 4 mm in 29, 5 mm in 35 and 6 mm in 4 patients. Ten patients were died within 30 days after operation [mortality rate: 14.5%]. Among them, 6 patients were operated in urgency due to cardiac arrest or severe anoxic spell after cardiac catheterization, and so surgical mortality of elective operation is 9.5%. The 59 survivors showed improvement of the arterial oxygen saturation [65.4% - 9.8%] and hemoglobin [18.8 gm/dl - 16.0 gm/dl] values [V<0.01]. The follow up period ranged from 1 month to 67 months, [752 patient-months] and during this periods there were 4 late shunt failures after 3 months postoperatively with 4 mm graft, and 2 with 5 mm graft. The over-all patency rate of 4 mm PTFE was 85.9$\pm$9.2% [SEM] in 12 months and 40.9$\pm$22.5% in 24 months. The over-all patency rate of 5 mm PTFE was 87.5$\pm$9.6% in 12 months and 58.3$\pm$24.6% in 36 months. The lowest systolic pressure in death group was 64.9$\pm$15.0 mmHg and in survival group, 86.4$\pm$12.1 mmHg [P<0.001]. We think that the PTFE graft is useful in palliative shunt operation, but the effectiveness of the 4 mm PTFE graft may be limited. The blood pressure also may play an important role in patency of Prosthesis.
Kim, Sun-Pyo;Kim, Dong-Hwan;Sun, Kyung-Hoon;Yoon, Dae-Heung;Kim, Seong-Jung;Cho, Soo-Hyeong;Cho, Nam-Soo
Journal of The Korean Society of Clinical Toxicology
/
v.6
no.2
/
pp.134-137
/
2008
Methylene blue is the first choice for treating methemoglobinemia, any increase in normal methemoglobin levels. Methemoglobin is an abnormal hemoglobin in which the iron has been oxidized to the ferric(+3) state, making it incapable of oxygen transport. Methemoglobinemia most commonly results from exposure to oxidizing chemicals, but may also arise form genetic, dietary, or even idiopathic etiologies. Patients with low methemoglobin levels are asymptomatic, but high methemoglobin levels can lead to headaches or even death. Methylene blue, the first-line treatment for methemoglobinemia, can also produce hemolytic anemia. Jaundice or dark urine during methylene blue treatment may indicate hemolytic anemia. A 47-year-old female patient with a history of depressive mood disorder developed significant methemoglobinemia after ingesting a Propanil overdose. Twenty-two hours after ingestion, methemoglobin levels in the blood were 73.2%. She was treated with intravenous methylene blue in the therapeutic range (1 mg/kg every 4 h for 3days). The 2nd day after methylene blue use, methemoglobin levels in the blood were 33%, and the 5th day decreased to 10% with better general condition. The patient had hyperbilirubinemia after hemolytic anemia, but she recovered completely.
A free-range wild raccoon dog (Nyctereutes procyonoides) was rescued with cachexia. Physical examination revealed generalized hyperkeratosis and alopecia typical of scabies as well as hypothermia (35.6℃). The patient was obtunded and severely dehydrated (10%). Hematological parameters included a low packed cell volume (PCV; 15%) and hemoglobin concentration, leukocytosis, and hypoglycemia. A blood smear revealed different subtypes of hypochromic leptocytes, indicating a regenerative response against severe anemia. This case was initially tentatively diagnosed as a severe anemia due to chronic external bleeding presumed to be caused by scabies-induced skin injuries. Darbepoetin alpha (DPO), iron dextran, and fluralaner were administered at the initial presentation, and supportive care including oxygen supplementation, warming, and nutritional support was provided. However, on day 5, the PCV dropped to 5.9% presumably caused by rapid rehydration due to drinking water ad libitum. DPO was boosted on days 5 and 6 along with daily iron dextran. On day 21, the PCV had recovered to 19.8%, and a blood smear evaluation showed a strong regenerative response. This case shows that even if severe anemia occurs in a raccoon dog, it can be managed with an appropriate response. In particular, since the rehydration rate due to food intake is faster than the hematopoietic response rate of raccoon dogs, the PCV may decrease rapidly in the early stage of treatment; therefore, diagnostic examination and additional medical management for hematopoiesis are necessary.
Objective: Physical activity can promote physical and mental well-being. University students are more sedentary recently due to the increased use of computers and other technology. The aim of this study was to investigate differences between immersive 360-degree virtual cycling (IVC) and virtual cycling with head-mounted display (VCHMD) on aerobic capacity and usability in young adults. Design: A crossover study. Methods: Twenty-five university students (13 male, 12 female) participated in this study and completed 2 separate 30 min cycling sessions, such as IVC and VCHMD. In the IVC, participants rode on a stationary cycle while watching curved TV where recorded video was played. To enhance the sense of realism, auditory stimulation was given to the headset, and the gyroscope sensor was used to track the screen as the head moved. In the VCHMD, participants rode on the stationary cycle with head-mounted display, and other conditions were the same as IVC. Participants were assessed the aerobic capacity which included gas analyzer and portable near-infrared spectroscopy, and usability which included simulator sickness questionnaire and system usability scale. Results: Aerobic capacity was significantly difference in the IVC compared with the VCHMD except for the total hemoglobin of right and left rectus femoris and muslce oxygen saturation of left rectus femoris (p<0.05). Cybersickness was less in the IVC than VCHMD and usability was high in the IVC than VCHMD (p<0.05). Conclusions: The findings suggested that IVC might be beneficial exericse to improve aerobic capacity and has lower cybersickness and higher usability than VCHMD.
One hundred and one patients with tetralogy of Fallot who were older than 16 years of age underwent a total correction of the anomaly between May, 1964 and July, 1987. This group comprised 14.9% of the 679 consecutive patients who had repair of the tetralogy at our institution during the same period. Of the 101 patients, 8 had a previous shunt procedure for palliation. The preoperative mean hemoglobin value was 16.9*1.0% and the mean systemic oxygen saturation, 84.4*0.9%. In 76 patients[75.2%], a type II ventricular septal defect was seen whereas in 14 patients[13.9%], the defect was type I. In 72 patients[71.3%], other cardiac anomalies were present which included patent foramen ovale in 37.6%, atrial septal defect in 8.99b, vegetations in 6.9%, right sided aortic arch in 5.9% and coronary artery anomaly in 5.0%. The right ventricular outflow obstruction was caused most commonly by combination of infundibular and valvular stenosis[74.3%], followed by isolated infundibular stenosis[19.8%] and valvular stenosis [5.9%] alone in order. The preoperative mean diameter of the pulmonary valve ring size was 10.2*0.5 mm in diameter. A transannular patch enlargement of the right ventricular outflow tract was performed in 28 patients and, in 12 a pericardial monocusp was utilized. Major anomalous aorto-pulmonary vessels were encountered in 5 patients which were detected before or during the operation. In 3 patients, they were ligated beforehand to control the flooding of the operative field. Postoperatively, the mean systolic pressure gradient between the right ventricle and the main pulmonary artery was 16.2*2.3 mmHg and the mean systolic pressure- ratio between the right and the left ventricle was 45.3*2.0%. Perioperative complications including bleeding in 8.9%, pleural effusion in 7.9%, dysrrhythmia in 4.9%, and residual VSD in 4.0%. Operative mortality was 8.9%. There has been no operative death in the recent 65 cases since 1981. There were 2 late deaths, 68 and 113 months after surgery. There were 2 late detachment of the VSD patch during the follow-up period. Of the 6 patients with patch detachment found during the postoperative period, 3 had subacute bacterial endocarditis before or after the operation indicating The serious nature of this complication. Two of these patients subsequently underwent a successful reoperation.
Iwai, I.;Yamashita, T.;Ochiai, N.;Masuda, Y.;Hosokawa, K.;Kohno, Y.
Proceedings of the SCSK Conference
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2003.09a
/
pp.162-177
/
2003
It has been known that the color of skin reflects the blood flow within. In lips, the capillaries close to the skin surface are numerous; hence lips are redder than the rest of face. However, dermatological research on lips is not as advanced as research on facial or body skin, and little was known about the relationship between relatively dull-colored lips and skin blood flow. The physiological differences between colorful and dull-colored lips were studied by a two-dimensional laser Doppler blood flow analyzer, a spectrometer for the measurement of the degree of oxygen saturation, and a confocal microscope for observing inside lips non-invasively. Dull-colored lips and the corner of lips (dull-colored compared to the center) showed relatively poor blood flow and lower oxygenated hemoglobin. It was found that colorful lips (generally the young) had a blood flow that tended to run straight in parallel with the skin surface. This unique blood-capillary structure can express clear red blood. Those with dull-colored lips had lost this unique structure. Their blood ran perpendicularly from the deep of the skin and down back again into the deep part as like the blood circulation patterns of facial skin. Therefore, the lips of the latter group had fewer blood capillaries near skin surface in the lips than that of the colorful-lips group. A lipstick containing a-glucosyl-hesperidin, which is derived from certain citrus fruits and can enhance blood circulation, was applied for evaluating its effects. Blood flow was increased 30 min after the application. After two weeks of daily application, the lips' condition became noticeably less dull. These findings suggest that the decrease of blood flow in dull-colored lips is caused by the loss of the unique capillary structure and the use of the lipstick to increase blood flow can give a vivid color to lips.
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