The Annals of thoracic surgery
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Described is an unusual injury, arising from a motorized vehicle accident, in which a detached fractured rib from a flail chest caused lung perforation and hemopericardium. The full diagnosis was only appreciated on computed tomography. Therefore, thoracotomy averted potential disaster.
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Carinoplasty was performed in 42 patients: 7 with wedge pneumonectomy, 15 with sleeve pneumonectomy, 14 with one-stoma-type carinal reconstruction, 5 with montage-type carinal reconstruction, and 1 other. Diagnoses in the 42 patients consisted of lung cancer in 31 (73.8%), tuberculous stenosis in 10 (23.8%), and tracheobronchial injury in 1 (2.4%). ⋯ Left wedge or sleeve pneumonectomy, without right thoracotomy, could be done by midline sternotomy and left thoracotomy but with limited tracheal resection. Left one-stoma-type carinoplasty was undertaken, sacrificing one lobe, as an alternative to pneumonectomy, where an approach drawing the carina down to an aortopulmonary window was considered to be preferable to the drawing-up approach.
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Comparative Study
Pulsatile versus nonpulsatile reperfusion improves cerebral blood flow after cardiac arrest.
Cardiopulmonary bypass using nonpulsatile flow (NF) is currently advocated for treating refractory cardiac arrest. Although the heart can be revived using cardiopulmonary bypass support, the brain must recover if such therapy is to be considered successful. Previous studies have demonstrated that pulsatile flow (PF) reperfusion can improve neurologic outcome compared with NF reperfusion after cardiac arrest. ⋯ There were no statistically significant differences in brain perfusion variables by 15 minutes of reperfusion. However, a relative hyperemia was exhibited at 15 minutes of NF versus PF reperfusion, which suggests nutrient flow was insufficient during early NF versus PF reperfusion. In conclusion, PF reperfusion can better restore cerebral blood flow and oxygen consumption than can NF reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Two-dimensional echocardiography in the evaluation of penetrating intrapericardial injuries.
Patients with penetrating pericardial trauma whose vital signs stabilize after fluid administration may present a therapeutic dilemma. Two-dimensional echocardiography has emerged as a diagnostic technique to help determine whether surgical intervention may be required. We present 5 patients with penetrating pericardial trauma whose vital signs stabilized after fluid administration and who had minimal clinical findings. ⋯ All 5 underwent surgical exploration and had major intrapericardial injuries. We conclude that a normal echocardiographic study does not rule out major intrapericardial injury in patients with penetrating chest trauma. Furthermore, small areas of effusion seen on echocardiography in these patients represent indications for surgical exploration.
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Multicenter Study Clinical Trial
Postcardiotomy shock: clinical evaluation of the BVS 5000 Biventricular Support System.
This prospective trial evaluated the safety and efficacy of a new pulsatile, temporary ventricular assist device, the BVS 5000. Patients were eligible for treatment if they were hemodynamically unstable despite maximal pharmacologic and intraaortic balloon pump therapy, were free of concomitant complications, and were less than 6 hours from the first attempt to separate from cardiopulmonary bypass. Fifty-five postcardiotomy patients were enrolled; 31 met all selection criteria and the remainder failed to meet criteria (n = 15) or were not successfully supported (n = 9). ⋯ Survival among patients not experiencing arrest was 47%. Eight patients are long-term survivors and were asymptomatic in New York Heart Association class I or II at 1-year follow-up. The BVS 5000 restored hemodynamics, permitted myocardial recovery, and improved survival in a group of patients who would have otherwise died.