The Annals of thoracic surgery
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Venovenous access via a double-lumen cannula in the right internal jugular vein is the extracorporeal life support mode of choice for neonates with respiratory failure. We report a simplified method of cannulation. The advantages of this "semi-Seldinger" method include the ability to cannulate without ligating the internal jugular vein, and to adjust the position of the cannula and decannulate without re-exploring the wound.
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Comparative Study
Critical importance of the first 10 minutes of lung graft reperfusion after hypothermic storage.
We have shown previously that lung graft function can be improved by achieving reperfusion with stepwise increments of perfusion pressure over 60 minutes. This study aimed to establish whether similar benefit could be achieved with a shorter, simpler protocol and different storage conditions. ⋯ An initial 10-minute period of 50%-pressure reperfusion improves the function of stored rat lung grafts, whereas 5 minutes is insufficient.
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Despite the incidence of heart disease during pregnancy falling to 1.5% over the last 25 years, when a cardiac operation is required the risk is obviously greater as two lives are at risk. The risk to the mother is now similar to that for nonpregnant female patients (3% overall) but the fetal mortality remains high (19%). Cardiac operation is ill advised except in extreme emergencies during the first two trimesters as the incidence of teratogenesis is high. ⋯ Finally, uterine contractions occur in response to bypass, possibly due to a dilutional effect from the stabilizing influence of progesterone. Various techniques to modify this include the administration of progesterone, beta2-agonists, and intravenous alcohol, all with some effect. Uterine monitoring is essential to allow early control of these contractions as they are associated with significant fetal loss.
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Since 1990 we have evaluated 12 children and teenagers in whom severe cardiorespiratory symptoms have developed due to failure of chest wall growth after very extensive pectus excavatum operations (removal of five or more ribs) at very early ages (< 4 years). ⋯ This report is an alert to recognize such patients and also to recommend delay in operative repair in small children until at least 6 to 8 years of age. The younger the patient the more limited the chest wall resection for pectus excavatum should be. Five of these patients have had a chest cavity expansion operation with encouraging early results.