The Annals of thoracic surgery
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Postintubation tracheobronchial rupture is usually responsible for unstable intraoperative or postoperative conditions, and its management is discussed. We insist on conservative treatment as a viable alternative after late diagnosis of postintubation tracheobronchial rupture. ⋯ Aggressive surgical repair is not always mandatory after delayed diagnosis of iatrogenic tracheobronchial rupture. Conservative treatment must often be considered, except after lung resection.
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Patients with Werlhof's disease and undergoing a cardiac surgical procedure with cardiopulmonary bypass are at increased risk for bleeding complications. We report the usefulness of preoperative immunoglobulin treatment in selected patients. ⋯ Our data demonstrate that immunoglobulin treatment of patients with Werlhof's disease and mean platelet counts of less than 80x10(9)/L significantly augments platelet counts preoperatively. It may be useful in selected patients.
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Comparative Study
Right atrioventricular extracardiac conduit as a fontan modification: late results.
The right ventricle, when incorporated in the Fontan circulation, might enlarge and function as a pump to the pulmonary circulation. Experience has shown that over the long-term, this operation can be associated with major difficulties. ⋯ Right atrioventricular connection as a Fontan modification can provide good early palliation, but is a poor long-term solution, as it is associated with a high incidence and difficulties in relieving the obstruction.
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Comparative Study
Effects of mast cell membrane stabilizing agents in a rat lung ischemia-reperfusion model.
The aim of this study was to test the hypothesis that agents which stabilize the mast cell membrane may modulate the phenotype of the vascular wall in a lung ischemia-reperfusion model, including altering expression of endothelial and leukocyte adhesion receptors and the inducible nitric oxide synthase (NOS-2). ⋯ These data establish that mast cell stabilizing agents modulate the vascular phenotype in the setting of pulmonary ischemia and reperfusion by decreasing ICAM-1 expression, augmenting expression of NOS-2, and increasing tissue cGMP levels. As decreasing ICAM-1 expression and increasing cGMP levels have proven useful to limit proinflammatory mechanisms of tissue injury, mast cell stabilizing agents may provide a new therapeutic option to improve organ function in the setting of reperfusion.
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Lung rest is the primary goal of venovenous extracorporeal membrane oxygenation for severe acute respiratory failure. To achieve this there has to be adequate extracorporeal flow. ⋯ We report 8 patients in whom we achieved adequate blood and oxygen delivery using a three-cannula technique. Five patients survived (62.5%).