ABSTRACT
A 25-year-old woman, at 38 weeks of gestation, suddenly developed a left lumbar pain. Emergency cesarean section was performed to rescue the fetus since there was fetal bradycardia. At operation, a slight amount of retroperitoneal hematoma was observed, but was left without further examination. After the surgery, the patient complained of severe lumbar pain and fell into shock. A ruptured aneurysm of the left renal artery was suspected by computed abdominal tomography. At the second operation, a massive hematoma was observed in the retroperitoneal space, and a ruptured aneurysm of the left renal artery was confirmed after mobilization of the left kidney with the aid of manual hemostasis. Aneurysmectomy with arterial reconstruction was not considered feasible, and complete left nephrectomy was done because the patient was severely ill, in addition to the fact that the aneurysm was located at the trifurcation of the left main renal artery. The postoperative course was uneventful. On the surgical specimen the aneurysm measured 27mm in circular length, the lower half of which was ruptured. Histologically, the internal elastic lamina was torn, and the medial smooth muscle fibers were sporadically replaced with fibroblastic cells. The prognosis of ruptured aneurysm of a renal artery is often lethal. Therefore it is very important to suspect this lesion when we have to manage physical problems with patients in pregnancy so that we can make an early diagnosis with better results.
ABSTRACT
To investigate the efficacy of human superoxide dismutase (h-SOD) in myocardial ischemia and reperfusion with difference of administration of h-SOD, twenty four dogs were subjected to 120min ischemia by the cross clamping of the ascending aorta, and followed by 60min reperfusion, The dogs were randomly assigned to three groups: group G, h-SOD (8mg/kg) was injected into the cardiopulmonary bypass (CPB) circuit 5min prior to reperfusion; group L, h-SOD (3mg/kg) was administered by bolus injection through the aortic root into the coronary artery 1min prior to reperfusion; group C, nothing was administered. The values of creatinine phosphate MB isozyme (CPK-MB) and a-hydroxydehydrogenase (HBD) in coronary effluent, and lipid peroxides (LPO) in coronary artery and sinus blood, were measured during CPB. Cardiac function was evaluated by cardiac index (C. I.) and LV max <i>d<sub>p</sub>/d<sub>t</sub></i>, and it was expressed as a percent recovery of pre-CPB state. Myocardial water contents as myocardial edema were measured after CPB. Effluents of CPK-MB and HBD at 60min after reperfusion were less in group L than group G, C. Generations of LPO (A-Cs difference) were less at 5min after reperfusion in group G, L than group C and there were significant differences between group G, L and group C. The percent recovery of C. I. and LV max <i>d<sub>p</sub>/d<sub>t</sub></i> at 60min after reperfusion was superior in group G, L than group C and there were significant difference between group G, L and group C. Myocardial water contents at 60min after reperfusion were less in group G, L than group C and there were significant difference between group G, L and group C. In the lipid peroxides generation, cardiac function and myocardial edema except effluents of cardiac enzymes, group G was as well as group L. These data suggest that the injection of h-SOD into the CPB circuit just before reperfusion is effective to prevent the reperfusion injury as well as the administration through the aortic root.