The Annals of thoracic surgery
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Brain protection during cardiopulmonary bypass and hypothermic circulatory arrest is incomplete. Activation of blood protease cascades may contribute to cellular injury under these conditions. To test this hypothesis, effects of the protease inhibitor aprotinin on recovery of brain energy metabolism after hypothermic circulatory arrest were studied in the piglet. ⋯ The response to endothelium-independent vasodilation (nitroglycerin) was the same in both groups. Carotid blood flow tended to be greater at 20 minutes of reperfusion and less during 45 to 80 minutes after reperfusion in the aprotinin-treated animals. Brain water content postoperatively was 0.8077 in the aprotinin group and 0.8122 in control animals (p = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)
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Removal of cerebrospinal fluid (CSF) has been proposed as a means of protecting the spinal cord against ischemic injury during thoracoabdominal aneurysm operations. We investigated the effect of altering CSF pressure (CSFP) on lumbar spinal cord blood flow (SCBF) in an experiment using dogs. The SCBF was measured before and after withdrawal of CSF in settings with and without thoracic aortic clamping. ⋯ Elevation of CSFP significantly reduced SCBF. Elevation of CSFP reduces SCBF, but lowering CSFP per se does not increase SCBF whether the thoracic aorta is occluded or not. This supports the notion that removal of CSF offers spinal cord protection only when CSFP is abnormally elevated.
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Obliterative bronchiolitis is a major cause of long-term morbidity after lung transplantation. It is characterized by small-airway inflammation and occlusion by fibrous tissue. The pathogenesis is uncertain. ⋯ None of these changes were seen in group 1. Our findings suggest obliterative bronchiolitis is an immunologically mediated phenomenon related to chronic graft rejection after lung transplantation. This model will allow systematic study of the pathogenesis of obliterative bronchiolitis and possible therapeutic intervention.
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The laterolateral anastomosis between the superior vena cava and the pulmonary artery trunk is presented as a modified technique for total cavopulmonary connection. This procedure was successfully performed on a 9-year-old girl, associated with the exclusion of the right atrium, for the treatment of tricuspid atresia and transposition of the great arteries.
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Chylothorax, a potentially lethal disorder that may cause profound respiratory, nutritional, and immunologic complications, has become increasingly common in recent years. Medical therapy has been found to have a significant failure rate. Therefore, surgical treatment of complicated chylothorax has become a mainstay of care. ⋯ In 2 cases, a video-assisted thoracic operation was used in conjunction with pleuroperitoneal shunting: a previously placed pleuroperitoneal shunt that was malfunctioning was repositioned thoracoscopically after a pleural adhesiolysis, and a pleural adhesiolysis was performed thoracoscopically before placement of a pleuroperitoneal shunt. In all cases the effusion resolved after the video-assisted thoracic operation without further intervention. Video-assisted thoracic surgery offers an effective means of treating chylothorax, regardless of cause, allowing the advantage of access to thoracic structures without the morbidity of more extensive procedures.