• Journal of Chest Surgery
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• v.26 no.7
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• pp.513-520
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• 1993

Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch still poses one of the most complicated technical and tactical challenges in surgery. The use of total circulatory arrest[TCA] with profound hypothermia in the surgical treatment of aneurysmal dissection involving the ascending aorta and aortic arch has been reported as popular surgical methods. However, the safe period of prolonged circulatory arrest with hypothermia remains controversial and ischemic damage to the central nervous system and uncontrollable perioperative bleeding have been the major problem. We have found profound hypothermic circulatory arrest with retrograde cerebral perfusion via the superior vena cava to achieve cerebral protection. We experiment the aortic anastomosis in 7 adult mongrel dogs, using profound hypothermic circulatory arrest with continuous retrograde cerebral perfusion[RGCP] via superior vena cava. We also studied the extent of cerebral protection using above surgical methods, by gas analysis of retrograde cerebral perfusion blood and returned blood of aortic arch, preoperative, intraoperative and postoperative electroencephalography and microscopic findings of brain tissue. The results were as follows: 1. The cooling time ranged from 15 minutes to 24 minutes[19.71$\pm$ 3.20 minutes] ; Aorta cross clamp time ranged from 70 minutes to 89 minutes[79.86 $\pm$ 7.54 minutes] ; Rewarming time ranged from 35 minutes to 47 minutes[42.86$\pm$ 4.30 minutes] ; The extracorporeal circulation time ranged from 118 minutes to 140 minutes[128.43$\pm$ 8.98 minutes] [Table 2]. 2. The oxygen content in the oxygenated blood after RGCP was 12.66$\pm$ 1.25 ml/dl. At 5 minutes after the initiation of RGCP, the oxygen content of returnedlood was 7.58$\pm$ 0.21 ml/dl, and at 15 minutes 7.35$\pm$ 0.17 ml/dl, at 30 minutes 7.20$\pm$ 0.19 ml/dl, at 60 minutes 6.63$\pm$ 0.14 ml/dl [Table 3]. 3. Intraoperative electroencephalographic finding revealed low amplitude potential during hypothermia, and no electrical impulse throughout the period of circulatory arrest and RGCP. Electrical activity appeared after reperfusion, and the electroencephalographic reading also recovered rapidly as body temperature returned to normal [Fig. 2]. 4. The microscopic finding of brain tissue showed widening of the interfibrillar spaces. But there was no evidence of tissue necrosis or hemorrhage [Fig. 3]. We concluded the retrograde cerebral perfusion during hypothermic circulatory arrest is a simplified technique that may have a excellent brain protection.

• Journal of Photoscience
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• v.7 no.4
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• pp.161-167
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• 2000

Temperature-dependent electroretinogram responses were investigated in the dark adapted bullfrog eyes within the physiological temperature range 0-40$\^{C}$. In hypothermic process(25→0→25$\^{C}$), the amplitude of b-and c-wave decreased with lowering the temperature again. Both b-wave amplitude and threshold responses were maximal around 15$\^{C}$ during the temperature increment. Upon warming to room temperature again (25$\^{C}$), the b-wave amplitude was approximately doubled as compared to that of control without temperature changes. During the hyperthermic process (25→40→25$\^{C}$), however, the responses decreased with warming, and the wave amplitude failed to recover by cooling to 25$\^{C}$ again. As describe above, the recoveries of ERG in both processes show the striking difference. The hypothermia induces the amplification of the b-wave, that is, enhances the retinal function with the temperature recovery toward room temperature. While the hypertherima produces the decrease of the b-wave even though recovered to room temperature, which indicates an irreversible retina. The morphological alteration is shown both hypothermic and hyperthermic process, such as an appearance of large vacuoles and degenerating outer segments, more intense in hyperthermia, similar to light induced damage.

• Biomedical Science Letters
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• v.23 no.1
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• pp.39-43
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• 2017

In this study, we evaluated the effects of various hypothermic conditions ($32^{\circ}C$), including lithium chloride treatment, on insulin-like growth factor 1 (IGF-1) gene expression in PC12 cells. The results show that short-term hypothermic treatment (<1 day) resulted in relatively higher IGF-1 gene expression than did longer-term treatment (>1 day). Repeated switching between normal temperature and hypothermia every 2 h increased IGF-1 gene expression approximately 3-4-fold. These findings indicate that hypothermia dynamically regulates IGF-1 gene expression. This study could be helpful for the development of treatment and diagnostic strategies for ischemia.

• Molecules and Cells
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• v.23 no.1
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• pp.88-93
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• 2007

Neuropeptide Y (NPY) is an orexigenic and hypothermic peptide. To understand its role in hypothermic conditions, male rats were placed in a $24^{\circ}C$ or $4^{\circ}C$ air chamber for 1.5 h. The expression of c-Fos protein, and NPY mRNA and protein, was analyzed in the hypothalamus 1 h-2 h later. The cold treatment increased the number of c-Fos-immunoreactive cells in the paraventricular hypothalamic nucleus (PVN) and arcuate nucleus (ARC). At the same time it decreased the density of NPY-immunoreactive components in the PVN, dorsomedial hypothalamic nucleus and ARC, as well as of NPY transcripts in the PVN and ARC. No colocalization of c-Fos with NPY was detected. These results suggest that short-term cold exposure should reduce indirectly NPY production in some hypothalamic nuclei to facilitate thermogenesis without inducing feeding behavior.

• Clinical and Experimental Pediatrics
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• v.56 no.10
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• pp.446-450
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• 2013

Purpose: This study evaluated the extent of damage due to hypothermia in the mature and immature brain. Methods: Hippocampal tissue cultures at 7 and 14 days in vitro (DIV) were used to represent the immature and mature brain, respectively. The cultures were exposed at $25^{\circ}C$ for 0, 10, 30, and 60 minutes (n=30 in each subgroup). Propidium iodide fluorescent images were captured 24 and 48 hours after hypothermic injury. Damaged areas of the cornu ammonis 1 (CA1), CA3, and dentate gyrus (DG) were measured using image analysis. Results: At 7 DIV, the tissues exposed to cold injury for 60 minutes showed increased damage in CA1 (P<0.001) and CA3 (P=0.005) compared to the control group at 48 hours. Increased damage to DG was observed at 24 (P=0.008) and 48 hours (P=0.011). The 14 DIV tissues did not demonstrate any significant differences compared with the control group, except for the tissues exposed for 30 minutes in which DG showed less damage at 48 hours than the control group (P=0.048). In tissues at 7 DIV, CA1 (P=0.040) and DG (P=0.013) showed differences in the duration of cold exposure. Conclusion: The immature brain is more vulnerable to hypothermic injury than the mature brain.

• Journal of Chest Surgery
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• v.27 no.7
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• pp.581-586
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• 1994

From February 1985 to February 1993, 18 operations were performed in 17 patients for treatment of aneurysmal disease [n=12] and/or dissection of the ascending aorta [n=6]. The ages ranged from 26 to 69 years [mean 44.3 $\pm$ 11.0 years].The proposed operations include composite graft replacement of aortic valve and ascending aorta with coronary reimplantation in 11, graft replacement of ascending aorta alone in 5, aortic valve replacement and supracoronary graft replacement in 1 and ascending aorta to abdominal aorta bypass with thromboexclusion of descending aorta in one patient. Both Bentall [n=6] and Cabrol [n=5] technique were utilized for reimplantation of coronary arteries.Concomitant replacement of aortic arch and arch vessel reconstruction was necessary in two patients. Hypothermic circulatory arrest was utilized in 6 patients. Recently, four patients were managed on warm blood continuous cardioplegia via retrograde route. There were no operative deaths. No significant postoperative complications were noted. Postoperative follow up was complete in 15 patients from 1 month to 72 months. Redo operation was necessary in one patient who had suffered from distal recurrence of dissection 5 years after successful Bentall operation. The other patients are all in excellent clinical condition. From our early experience with those 17 cases, we assume that satisfactory operative result could be achieved with a variety of surgical technique including hypothermic circulatory arrest. In addition, continuous perfusion of warm blood cardioplegia via retrograde route is supposed to be beneficial in selected cases.

• Journal of Chest Surgery
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• v.28 no.6
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• pp.549-556
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• 1995

We investigated the effects of aprotinin, a protease inhibitor, on isolated rat heart subjected to cardioplegia and global ischemia for 4 hours and then reperfused for 40 minutes. Before ischemia, hearts were perfused with either aprotinin 1x105KIU/L[Aprotinin group,n=8 or no aprotinin[control group,n=8 added to Krebs-Henseleite solution for 30 minutes. Hemodynamic and biochemical parameters such as heart rate, LVP, dP/dt, coronary flow and creatine kinase were measured before cardioplegia and after reperfusion 10,20,30,40 minutes. After completion of experiment, wet and dry heart weight were measured for tissue water and water content evaluation. On reperfusion, recovery of LVP of aprotinin group at each time point was significantly better than that of control group[p<0.05 , and of dP/dt at reperfusion 40 minutes[p=0.034 . No statistically significant differences in heart rate, coronary flow and CK were observed between the two groups, but aprotinin group seemed to have better recovery. No significant differences in tissue water and water content were observed between the two group.These results suggest that pretreatment of aprotinin is effective in myocardial preservation in prolonged hypothermic ischemia and reperfusion.

• Biomolecules & Therapeutics
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• v.9 no.3
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• pp.224-230
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• 2001

DKY is an oriental drug preparation composed of 17 natural products and is known to have antihyperglycemic action at 100 mg/kg po in animal tests. The general pharmacological properties of DKY preparation were investigate in mice, rats, guinea pigs and rabbits. This preparation did neither show any effects on central nervous system, nor effects on algesia, nor epilepsia at the large doses of 3000 mg/kg po in mice or rats. However, the preparation showed hypothermic action at the doses of 330 and 1000 mg/kg po. In the guinea pig ileum, rat fundus strip and estrogenized rat uterus, DKY did not influence their tension at a concentration of 3$\times$10$^{-3}$ g/ml, and the spasmogenic actions produced by histamine, ACh and 5-HT were not blocked in the presence of DKY at 3$\times$10$^{-3}$ g/ml. The blood pressure and respiration were not considerably influenced at 10 mg/kg iv of DKY in rabbits. It did not influence the intestinal propulsion of mice and the normal gastric secretion of rats. These results may suggest that DKY preparation have little effects on central nervous, autonomic and gastrointestimal systems, except hypothermic action.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1657-1663
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• 2000

The authors report a case of a 72-year-old woman who presented with intraventricular and subarachnoid hemorrhage of Hunt and Hess grade IV after the rupture of a giant aneurysm arising from the right internal carotid artery. The aneurysm was clipped successfully with the aid of cardiopulmonary bypass(closed chest method), deep hypothermic circulatory arrest, and cerebral protection with barbiturate resulting in moderate disability. We discuss the usefulness and problems related to technique of circulatory arrest and cardiopulmonary bypass using closed chest method, and suggest the possible benefits of open chest method in elderly people and the importance of preoperative plan to coordinate anesthesia and operation.

• Journal of Chest Surgery
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• v.25 no.5
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• pp.458-468
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• 1992

With the aid of extracorporeal circulation, nine dogs underwent orthotopic cardiopulmonary transplantation after preservation of the donor heart in a hypothermic amino acid[glutamate, aspartate] enriched high potassium extracellular solution, and preservation of the donor lung with hypothermic low potassium dextran solution from June 1990 to May 1991. The mean body weights of dogs were 20kg and the recipients` preoperative hematologic and hemodynamic pictures were within normal range except slightly decreased level of albumin and total protein, which was supposed to be due to malnutrition. The following modifications of the original Stanford technique were emphasized: [1] the posterior mediastinum is dissected as little as possible with meticulous hemostasis; [2] the surgical procedure is kept away from the phrenic and vagus nerves; [3] the tracheal anastomosis may be wrapped with recipient`s pulmonary artery flap or surrouding soft tissues. A combination of Cyclosporine, Azathioprine, corticosteroid was used as perioperative immunosuppressive therapy. Postoperatively all recipients could be weaned from extracorporeal circulation, showing favorable vital signs, but within 24 hours, irreversible congetive heart failure, ascites, arrhythmias developed with a mean survival time 13.6$\pm$6.6[n=9, range=6~26] hours. Hemoglobin and platelet counts were significantly[p<0.05] decreased postoperatively, which is thought to be attributed to blood damage by cardiopulmonary bypass and hemodilution. Postmortem finding included multiple subendocardial patch hemorrhage in both atrial and ventricular cavities, pulmonary and liver congestion, and all tracheal anastomoses were intact. Further consideration about quality control of the animal, infection, rejection, the effect of cardiopulmonary bypass on the experimental animal is required to improve the results.