J.Jpn. Surg. Soc.. 60(2): 230-252, 1959
EFFECT OF SURGICAL STRESS UPON DIURESIS
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2nd Surgical Department, Tokyo University School of Medicine (Director: Prof. S. Kimoto) Susumu ICHIKAWA |
In the second part the changes of blood chemistry and hemodynamic have been studied on the cases applied with artificial kidney which the author has devised in collaboration with his colleagues for surgical treatment of anuria or oliguria. Marked diuresis following the application of artificial kidney has been discussed and several new findings on this subject are presented.
1) A new method of measurement of ADH has been devised modifying Inou and Osono's method.
2) Except for the conception of ADH secretion through Ach., the author proposes a new thesis that ADH is secreted throngh the ionic heavy metal.
3) Antidiuretic effect has been affirmed following the administration of histamine. This effect could be inhibited by the administration of antihistaminic agents and antagonized by ADH in the tubulus of the kidney.
4) Inhibitory effect for secretion of ADH by chlorpromazine, methobromine, and antihistaminic agents are noticed and administration of these agent has been attempted in clinical cases for duresis following the surgery.
5) Under hypothermia ADH secretion decreases and can be completely inhibited in a condition under 20°C of brain temperature. In the cases of intracardiac surgery under direct vision with aid of selective brain cooling, ADH secretion seems to be inhibited in early convalescence period but it maintains rather high level of ADH secretion in later convalescence period following the surgery.
6) The hypersecretion of ADH has been noticed following the surgery with usual spinal anesthesia. The author has succeeded for the first time in reducing the postoperative secretion of ADH with sufficient basal anesthesia and adequate general anesthesia.
7) The experiment of extracorporeal eirculation with arteriovenous shunt produces low blood pressure, tachycardia, and increase of cardiac out-put. When the flow of extracorporeal circulation increases, vascular resistance of peripheral and renal cappilaries rises and cardiac out-put decreases. The author classified these characteristic changes of hemodynamics into three periods: completely compensatory period, incompletely compensatory period, and irreversible period.
8) When adequate amount of extracorporeal circulatory flow is maintained, both cardiac output and renal blood flow increas reasonably without rise of vascular resistance of renal cappilaries. This status last in several hours following the application of extracorporeal circulation, and seems to contribute in restoring the normal renal function.
9) Biochemical changes of blood in the application of extracorporeal circulation, involving serum ADA, Ach., Adr., Ch-E, 17-0HCS, histamine, and free essential aminoacids, have the tendency to parallel to those in general surgical stress.
10) These dialysable substances could be removed through the hemodialysis, and increase more slightly or rather d crease in comparing to thos in simple extracorporeal circulation. Decrease of adr naline pr vents the rise of vascular resistance of peripheral and renal cappilaries, maintaining th sufficient amount of r nal blood flow. D er ase of serum ADH and free aminoacids by dialysis s emed to result in th r duction of ADH production in the hypothalamic nucleus and promote diuresis.
(author's abstract)
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