Chest
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Mean lung density (dm) and radiologic (VLx) lung volume can be calculated using CT scan data. As many emphysematous patients are overdistended, the analysis of dm alone could be meaningless. However, lung mass (m) can be calculated as the product of dm and VLx. ⋯ Unexpectedly, these results show that most patients (22/24) with emphysema have a normal or increased lung mass. Normal or above normal m values might be due to oversecretion in some patients. Nevertheless, the synthesis of new tissue due to chronic inflammation is the most likely explanation that could account for this finding.
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Progressive advances in perfusion technology and perioperative supportive management have made it possible for members of the Jehovah's Witnesses religious group to undergo open cardiac operations with remarkable safety. However, hospital mortality remains high in (1) patients requiring reoperation (in whom both technical and bleeding problems tend to be more frequent) and (2) patients with significantly compromised cardiac performance requiring urgent or emergency operation. ⋯ None of the patients required surgical exploration for bleeding. We suggest that currently available methodology permits Jehovah's Witnesses to undergo reoperation, emergency surgery, or urgent open cardiac operation at a level of risk not dissimilar to that seen in patients who permit use of homologous blood and products in their treatment.
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Comparative Study
Glucose homeostasis. Comparison between hypothermic and normothermic cardiopulmonary bypass.
Disturbance in blood glucose homeostasis during cardiac surgery may cause visceral and metabolic alterations. Hypothermic CPB induces glucose and hormonal changes. As normothermic CPB is used at some institutions, a comparison of blood glucose and plasma hormones between hypothermic and normothermic CPB was performed. ⋯ Hyperglycemia occurred perioperatively in cardiac surgery with dextrose-free priming both during hypothermic and normothermic CPB but normothermic CPB resulted in a slow and steady increase in both glucose and insulin concentrations without the major perturbations that occurred with hypothermic CPB. Postoperatively, higher blood glucose was observed in the hypothermic CPB group.
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The measurement of arterial blood gases, P(A-a)O2 and VD/VT, during cycle ergometry is the "gold standard" for the assessment of pulmonary gas exchange. However, some patients are unable to perform cycle ergometry because of other medical problems. ⋯ Proposed criteria for arm crank exercise testing accurately identified all patients with normal and abnormal pulmonary gas exchange during cycle exercise. The data from the present study suggest that arm crank can be an acceptable alternative exercise testing modality for the assessment of pulmonary gas exchange.