[Improved sternotomy closure with polyester tapes and conventional wires].

In the purpose of reducing the occurrence of postoperative sternal dehiscence, improved technique of closure with supplemental use of polyester tapes was performed. To add to the conventional closure with wires, two polyester tapes were used around the body of sternum through the intercostal spaces just before approximation of sternum. The sternum was firmly fixed at the body and the tapes will prevent cut sternum by the wires and disruption of the wires themselves. In our series of recent 155 cases with this technique of closure, no sternal dehiscence occurred.

Postprandial hypotension: hemodynamic differences between multiple system atrophy and peripheral autonomic neuropathy.

To clarify the mechanism of postprandial hypotension (PPH), we performed hemodynamic investigation after oral glucose ingestion in ten patients with multiple system atrophy (MSA), three patients with peripheral autonomic neuropathy (PN) and 16 normal controls. Blood pressure (BP) and heart rate (HR) were measured with an automatic sphygmomanometer; cardiac out (CO) and lower leg blood flow (LBF) with impedance plethysmography; and portal blood flow (PBF) using a B-mode pulse Doppler. In normal subjects, BP, LBF and vascular resistance of the lower leg (LVR) were not changed, but HR slightly increased, and PBF and CO significantly increased after oral ingestion of 75 g glucose. In the patients with MSA, BP fell significantly 15 min after glucose ingestion, and HR and CO did not increase. PBF and LBF increased and LVR fell significantly. In PN patients, BP decreased at 15 min after glucose ingestion, but soon recovered. Increase of PBF and decrease of LVR in them were almost similar to those in the MSA group, and increase of CO was greater than that in the controls. These results suggest that both systemic vasodilatation (presumably due to gastrointestinal vasodilatatory peptides) and lack of compensatory increase of CO and LVR play important roles in PPH.