The Annals of thoracic surgery
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Clinical Trial
The use of routine chest X-ray films after chest tube removal in postoperative cardiac patients.
The use of routine postoperative chest x-ray films (CXRs) for postoperative cardiac patients has been challenged, suggesting that only clinically indicated CXRs be obtained. The removal of chest tubes has been used as an indication for CXRs. Our hypothesis is that routine postoperative chest tube removal CXRs are not indicated in the asymptomatic postoperative cardiac patient. ⋯ Omission of routine postoperative chest tube removal CXRs in postoperative cardiac patients is safe. The removal of chest tubes in these patients is not an indication for CXRs.
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Heparin is the standard agent used for systemic anticoagulation during cardiopulmonary bypass in cardiac operations. Alternatives are needed when patients with heparin-induced thrombocytopenia type II are encountered. We present a patient with a clinical picture of heparin-induced thrombocytopenia type II who was effectively anticoagulated with bivalirudin, a direct thrombin inhibitor, during cardiopulmonary bypass for a cardiac operation.
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Randomized Controlled Trial Clinical Trial
Pleural tent after upper lobectomy: a randomized study of efficacy and duration of effect.
The object of this study was to assess the efficay and maximum duration of effect of the pleural tent in reducing the incidence of air leak after upper lobectomy. ⋯ Pleural tenting after upper lobectomy was a safe procedure that reduced the duration of air leaks and the hospital stay costs. The benefit from that procedure was achieved before postoperative day 4.
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A 22-year-old man presented with traumatic aortic transtion associated with rupture of the right atrium and underwent urgent median sternotomy to repair the right atrium. A T-shaped extended left anterior thoracotomy was performed, and ruptured descending thoracic aorta was repaired under total bypass. ⋯ A 4-cm long Hemoshield graft was used to repair the aortic transection. The patient made a full recovery and was discharged 13 days after the accident.
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Ischemic preconditioning (IP) is gaining more acceptance as a protective method in beating heart surgery. Yet it remains controversial whether preconditioning can attenuate myocardial dysfunction during reperfusion after severe coronary hypoperfusion. We examined this issue and also the issue of whether this protection is mediated by adenosine A1 receptors. ⋯ The results, derived from load-insensitive measures, confirm that IP provides protection after episodes of severe hypoperfusion by attenuating systolic dysfunction without improving diastolic dysfunction and reduces the severity of anaerobic metabolism as well as ischemic injury. Contractile efficiency and external efficiency both indicate improved energetics after IP (oxygen utilization by the contractile apparatus). The protective effect, at least in part, is mediated by adenosine A1 receptors.