The Annals of thoracic surgery
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Prenatal correction of certain cardiac lesions with a poor prognosis may have advantages over postnatal repair. For this to be done, safe and effective support of the fetal circulation must be devised. Studies involving fetal cardiac bypass have demonstrated progressive fetal hypoxemia, hypercapnia, and acidosis, indicating placental dysfunction. ⋯ At the lower flow rate, mean aortic pressure, arterial pH, and oxygen tension decreased whereas carbon dioxide tension and lactate levels increased when compared with prebypass levels. At the higher flow rate mean aortic pressure, pH, oxygen tension, carbon dioxide tension, and lactate levels remained similar to prebypass levels during the 30-minute study period. When the animals were weaned from the bypass circuit after studies at high flow rates, arterial oxygen tension and pH decreased whereas carbon dioxide tension increased to levels similar to those in the low-flow group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Malignant pleural effusion and its treatment both cause substantial morbidity in patients with advanced neoplastic disease. We hypothesized that this morbidity might be ameliorated by placement of an indwelling Tenckhoff catheter into the involved pleural space. Catheters were placed in 9 patients under local anesthesia. ⋯ No catheters malfunctioned and no patients required further treatment or hospitalization for symptoms of malignant pleural effusion. We conclude that this technique may reduce the morbidity stemming from malignant pleural effusion and its treatment by allowing patients to conveniently and painlessly drain the effusion at home when it becomes symptomatic. This technique may provide superior palliation in patients with malignant pleural effusion.
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The aorta is a commonly unrecognized source of systemic embolization. Transesophageal echocardiography is a reliable method for visualization of the intima of the thoracic aorta and identification of aortic thrombi. Balloon embolectomy of the aorta can be used to remove thrombi and prevent further embolic events.
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Case Reports
Systolic anterior motion of the mitral valve after valve repair without an annular ring.
A 78-year-old woman underwent mitral reconstruction, consisting of a quadrangular posterior leaflet resection without a concomitant annular ring, for symptomatic mitral regurgitation. Postoperatively she became hypotensive while being treated with dopamine. ⋯ With discontinuation of the dopamine regimen, institution of phenylephrine administration, and volume loading of the ventricle the systolic anterior motion disappeared as did the mitral regurgitation. The patient recovered uneventfully.
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Biography Historical Article
Chevalier Jackson: the father of American bronchoesophagoscopy.
Chevalier Jackson was involved with bronchoesophagoscopy from the late 1800s until shortly before his death in 1958. A pioneer in the field, he developed numerous instruments used in peroral endoscopy and taught their safe and effective use. Most of the next generation of leaders in the field of bronchoesophagoscopy were trained in his clinics in Pittsburgh and in Philadelphia, where he held academic appointments at the six leading medical institutions of these cities. He was a keen observer, inventor, prolific writer, and humanitarian.