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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Remplacer la fonction cardiaque par une pompe à débit continu est un défi à la nature, la circulation normale étant de type pulsatif. Il y a quelques années déjà nous avons émis l'hypothèse que les mammifères étaient capables de s'adapter à une circulation à débit continu sans alterations physiologiques. Dans notre institution, nous avons expérimentalement mis au point chez le veau un appareillage assurant sous débit continu le remplacement de la circulation sanguine. A ce jour cinq veaux soumis à cette expérimentation ont vécu plus de trois mois. Nos études nous ont montré que l'implantation de cet appareillage était suivie d'une phase d'adaptation d'une durée de 7–10 jours. Cette phase est caractérisée par une élévation de la résistance vasculaire systémique qui paraît être en corrélation avec une augmentation des catécholamines circulantes. Après cette phase la résistance vasculaire systémique est normale comme sont normales les fonctions rénales biochimiques et endocriniennes. Notre expérience montre qu'un appareil assurant la circulation sanguine sous un débit continu représente pas un facteur qui limite le maintien de la vie chez les mammifères.
    Abstract: Resumen El reemplazo de la función cardiaca por medio de una bomba sanguínea no pulsátil representa un verdadero desafío para la naturaleza, la cual ha desarrollado, a través de la evolución biológica, el sistema de circulación sanguíneo pulsátil. Hace algunos años elaboramos la hipótesis de que la fisiología mamífera era capaz de adaptarse a un flujo sanguíneo crónico no pulsátil y mantener una función orgánica normal. La metodología del reemplazo circulatorio por medio del flujo no pulsátil ha sido establecida en experimentos con terneros no anestesiados en nuestra institución. Hasta la fecha, cinco animales han vivido con perfusión sanguínea no pulsátil y fisiología casi normal hasta por tres meses. Nuestros estudios en animales biventriculares no pulsátiles han demostrado que inmediatamente después de la cirugía se produce una fase de adaptación que dura aproximadamente 7 a 10 días. Esta fase se caracteriza por un aumento en la resistencia vascular sistémica total (RVS), la cual parece estar correlacionada con un aumento en las catecolaminas circulantes. A continuation de esta fase los animales exhiben valores normales de RVS y función renal, bioquímica y endocrina normales. Nuestros hallazgos muestran que el flujo sanguíneo no pulsátil no es un factor limitante para el mantenimiento de la vida mamífera.
    Notes: Abstract Replacing the heart function by means of a nonpulsatile blood pump is a great challenge to nature, which evolved pulsatile blood circulation. Some years ago, we hypothesized that mammalian physiology was capable of adapting to chronic nonpulsatile blood flow and maintaining normal organ function. The methodology of complete circulatory replacement with nonpulsatile flow has been established in awake calf experiments in our institution. To date, 5 animals have lived with nonpulsatile blood perfusion with near normal physiology for up to 3 months. Our studies on nonpulsatile biventricular animals have shown that immediately following surgery there is an adaptation phase which lasts approximately 7 to 10 days. This phase is characterized by increased total systemic vascular resistance (SVR), which appears to correlate with an increase in the circulating catecholamines. After this phase, these animals showed normal values of SVR, renal, biochemical, and endocrine function. Our data show that nonpulsatile blood flow is not a limiting factor to maintain mammalian life.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 4 (1980), S. 343-344 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-2614
    Keywords: Monitoring: pulse oximetry ; Measurement techniques: pulse oximetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract The objective of this study was to evaluate a new reflectance pulse oximeter sensor. The prototype sensor consists of 8 light-emitting diode (LED) chips (4 at 665 nm and 4 at 820 nm) and a photodiode chip mounted on a single substrate. The 4 LED chips for each wavelength are spaced at 90-degree intervals around the substrate and at an equal radial distance from the photodiode chip. An optical barrier between the photodiode and LED chips prevents a direct coupling effect between them. Near-infrared LEDs (940 nm) in the sensor warm the tissue. The microthermocouple mounted on the sensor surface measures the temperature of the skin-sensor interface and maintains it at a preset level by servoregulating the current in the 940-nm LEDs. An animal study and a clinical study were performed. In the animal study, 5 mongrel dogs (weight, 10–20 kg) were anesthetized, mechanically ventilated, and cannulated. In each animal, arterial oxygen saturation (SaO2) was measured continuously by a standard transmission oximeter probe placed on the dog's earlobe and a reflectance oximeter sensor placed on the dog's tongue. In the first phase of the experiment, signals from the reflectance sensor were recorded while the dog was immersed in ice water until its body temperature decreased to 30°C. In the second phase, the animal's body temperature was normal, and the oxygen content of the ventilator was varied to alter the SaO2. In the clinical study, 18 critically ill patients were monitored perioperatively with the prototype reflectance sensor. The first phase of the study investigated the relationship between local skin temperature and the accuracy of oximeter readings with the reflectance sensor. Each measurement was taken at a high saturation level as a function of local skin temperature. The second phase of the study compared measurements of oxygen saturation by a reflectance oximeter (SpO2[r]) with those made by a co-oximeter (SaO2[IL]) and a standard transmission oximeter (SpO2[t]). Linear regression analysis was used to determine the degree of correlation between (1) the pulse amplitude and skin temperature; (2) SpO2(r) and SaO2(IL); and (3) SpO2(t) and SaO2(IL). Student'st test was used to determine the significance of each correlation. The mean and standard deviation of the differences were also computed. In the animal study, pulse amplitude levels increased concomitantly with skin temperature (at 665 nm,r=0.9424; at 820 nm,r=0.9834;p〈0.001) and SpO2(r) correlated well with SaO2(IL) (r=0.982; SEE=2.54%;p〈0.001). The results of the clinical study are consistent with these findings. The proto-type reflectance pulse oximeter sensor can yield accurate measurements of oxygen saturation when applied to the forehead or cheek. It is, therefore, an effective alternative to transmission oximeters for perioperative monitoring of critically ill patients.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Digestive diseases and sciences 36 (1991), S. 1327-1340 
    ISSN: 1573-2568
    Keywords: artificial liver ; hepatic assist systems ; fulminant hepatic failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract If an effective hepatic assist system existed, it could serve as a bridge to transplantation. Most of the patients waiting for liver transplantation have chronic liver insufficiency but are not in hepatic coma. Various hepatic assist systems have been used to salvage patients with acute liver insufficiency. Most attempts have been disappointing. The methods used have included plasma exchange, plasma adsorption, double filtration, cryofiltration, thermofiltration, the combination of plasma exchange and amino acid hemodialysis, and others. For patients with chronic liver disease with moderate liver function impairment and limited to one or only a few areas of metabolic abnormality, a hepatic assist might allow the life of the patient to be maintained temporarily. The application of hepatic assist methods for chronic liver disease patients treated at the Cleveland Clinic has been encouraging. One of the patients who suffered from sclerosing cholangitis has maintained a near-normal life for almost five years by 170 plasma treatments. This is in spite of the fact that, at the onset of treatment, the patient was nearly comatose. Unfortunately, this patient did not wish to receive a liver transplantation. Based upon this experience, the concept of a bridge to transplantation approach to hepatic assist devices appears feasible. In addition, it is speculated that hepatic assistance during the early recovery stage of liver transplantation and during mild episodes of rejection may be useful.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of artificial organs 1 (1998), S. 3-3 
    ISSN: 1619-0904
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1619-7089
    Keywords: Fourier analysis ; Cardiac phantom model ; Artificial heart
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Using pusher-plate-type artificial hearts, changes in the degree of synchrony and stroke volume were compared to phase and amplitude calculations from the first Fourier component of individual-pixel time-activity curves generated from gated radionuclide images (RNA) of these hearts. In addition, the ability of Fourier analysis to quantify paradoxical volume shifts was tested using a ventricular aneurysm model by which the Fourier amplitude was correlated to known increments of paradoxical volume. Predetermined phase-angle differences (incremental increases in asynchrony) and the mean phase-angle difference calculated from RNAs showed an agreement of -7°±4.4° (mean ±SD). A strong correlation was noted between stroke volume and Fourier amplitude (r=0.98; P〈0.0001) as well as between the paradoxical volume accepted by the ‘aneurysm’ and the Fourier amplitude (r=0.97; P〈0.0001). The degree of asynchrony and changes in stroke volume were accurately reflected by the Fourier phase and amplitude values, respectively. In the specific case of ventricular aneurysms, the data demonstrate that using this method, the paradoxically moving areas may be localized, and the expansile volume within these regions can be quantified.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0021-9304
    Keywords: Chemistry ; Polymer and Materials Science
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine , Technology
    Notes: The clotting problem inside the artificial heart device is one of the major obstacles standing in the way of a successful long-term implantation of the artificial heart. To date, there have been two artificial heart devices used clinically. One is the auxiliary ventricle and the other is the left heart bypass pump. The former is for permanent implantation and the other is implanted only temporarily. Several experimental results which had contributed to the successful implantation of the auxiliary ventricle are described, especially from the standpoint of avoiding the clotting inside the device. Basic experiments with the left heart bypass pump are also described. The valves are the foremost problem and the next is the junction of the two materials. It is ideal to have a smooth, seamless surface made entirely of one material. It is also necessary to have a flow pattern analysis inside the artificial heart device as well as a clotting pattern analysis. Since the pump oxygenator and heparinization are involved in the procedure, the clotting problems in the total heart experiment are usually less than in the left heart bypass experiments. Our most urgent requirement is the development of new antithrombogenic material. However, even with our present material a large part of the clotting could be avoided if the heart is carefully constructed.
    Additional Material: 12 Ill.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Hoboken, NJ : Wiley-Blackwell
    Journal of Biomedical Materials Research 4 (1970), S. 313-339 
    ISSN: 0021-9304
    Keywords: Chemistry ; Polymer and Materials Science
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine , Technology
    Notes: The objective of this study was to determine the feasibility of using a fluorocarbon liquid in a liquid-liquid contacting device for extracorporeal blood oxygenation. Extraction experiments were carried out wherein blood was gently contacted with FC-43 (a fluorinated tributyl amine) for up to 48 hr. The fluorocarbon caused no significant change in red cell volume, white cell count, plasma hemoglobin, platelet count, plasma fibrinogen, or the relative amounts of thirteen different plasma proteins. To determine toxicity, FC-43 slugs and emulsions were injected intravenously and intraaortically into dogs. No chemical toxicity has been found, but the fluorocarbon is intolerable above about 1.7 mg/kg because it retards the flow of blood through pulmonary capillaries. FC-43 was used for several in vivo tests of a vertical cylindrical blood oxygenator. The hemolysis caused by the falling film of fluorocarbon on the inner Teflon wall of the cylinder was considerably less than that caused by direct contact between blood and Teflon, suggesting that the blood-fluorocarbon interface is quite atraumatic. All these results indicate that this fluorocarbon liquid holds considerable promise for use in a liquid-liquid blood oxygenator.
    Additional Material: 14 Ill.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Hoboken, NJ : Wiley-Blackwell
    Journal of Biomedical Materials Research 4 (1970), S. 469-485 
    ISSN: 0021-9304
    Keywords: Chemistry ; Polymer and Materials Science
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine , Technology
    Notes: For patients performing hemodialysis at home the assembly of the artificial kidney must be simple. To achieve this, a disposable envelope, consisting of two membranes bonded to a supporting substructure, was developed for the Kiil artificial kidney. This envelope was tested in vitro for metabolite clearance, pressure-flow relationship, ultrafiltration, and priming volume. The clearance of this envelope for different metabolites proved to be higher than that achieved with conventional assembly of the Kiil with wet Cuprophan membranes. Analysis of the resistance to mass transfer indicated that the disposable envelope has decreased the blood- and dialyzate-side resistances and provides an increase in effective membrane area, thereby enhancing overall mass transfer. The envelope also showed higher resistance to blood flow and a lower priming volume. In vitro testing of this envelope has shown the feasibility of practical clinical application.
    Additional Material: 12 Ill.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Hoboken, NJ : Wiley-Blackwell
    Journal of Biomedical Materials Research 11 (1977), S. 85-100 
    ISSN: 0021-9304
    Keywords: Chemistry ; Polymer and Materials Science
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine , Technology
    Notes: The pseudoneointima (PNI) deposited onto a cardiac prosthesis surface reflects many factors of biocompatibility, surface morphology, flow distribution, design, animal's physiological condition, and duration. In the evaluation of any prosthesis, the PNI is one of the prime considerations from both material and functional standpoints.Historically, Dacron fabric has been used as an internal lining for cardiac prostheses. However, we have observed cracks on the Dacron fibers, fiber fracture, fiber protrusion, and poor attachment to the diaphragm, which can cause potentially disastrous complications. In addition, there are basic differences in the PNI formation on aldehyde-treated pericardium and natural aortic valves as compared to the Dacron fabric.1Minimal degeneration takes place on the chemically treated natural tissue compared with the fabric surface. Intact cells on the tissue suggest a greater compatibility. In later specimens (13 and 24 days), there is active cell infiltration into the pericardium structure with capillary formation.2The deposits on natural tissue are mostly fibrin, with minimum cellular involvement and a trend toward reduction in thickness.3Fibroblast cells are found on the natural tissue as early as 7 days but were not observed on the Dacron fabrics.Based on these findings, the Dacron fabric-covered diaphragm studied was not favorable for use in long-term implantation of cardiac prostheses.
    Additional Material: 15 Ill.
    Type of Medium: Electronic Resource
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