To determine postoperative significance of hyperdynamic state in esophageal varices due to liver cirrhosis, sixteen patients undergone transthoracic esophageal transection and eight undergone devascularization of the proximal stomach and splenectomy were divided into two groups, either of which was given dobutamine, 3μg/kg/min, d.i.v., immediately after surgery and the remaining was not given. The two groups were compared in systemic hemodynamics and oxygen metabolism. Dobutamine had no effect on systemic hemodynamics and oxygen metabolism after transthoracic esophageal transection. In patients undergone devascularization of the proximal stomach and splencetomy, however, dobutamine increased the cardiac index and oxygen consumption and maintained oxygen delivery. Furthermore, in these patients given dobutamine the ICG-K value which reflects hepatic blood flow, was maintained whereas it was decreased in controls. These results suggest that, to support systemic hemodynamics, oxygen metabolism and hepatic blood flow in patients who have undergone devascularization of the proximal stomach and splenectomy for esophageal varices due to liver cirrhosis, maintenance of postoperative hyperdynamic state with dobutamine is important.
Bony contact after the maxilla had been mobilized by Le Fort I osteotomy was evaluated by computed tomographic examination of 52 Japanese dry skulls. The lateral piriform wall and the base of the zygomatic process of the maxilla which consist of thick bone are important areas to achieve good stability. Some cases of maxillary advancement and/or impaction lacked an osseous interface at the posterior wall. Preoperative CT along the osteotomy-line is recommended to achieve better postoperative stability.
