The Annals of thoracic surgery
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Although fortunately rare, the serious and potentially fatal complication of air embolism continues to occur following open-heart surgery. Its reliable prevention is dependent on the avoidance of specific procedural hazards and the exercise of various maneuvers to evacuate residual air from the heart before it is allowed to eject. Specifically, the beating heart should not be opened without ventricular fibrillation, cardioplegia, or aortic cross-clamping unless special precautions are exercised.
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The cases of 17 patients with tuberculous pericarditis were reviewed. Thirteen patients had effusive pericarditis, and 10 had surgical drainage of the effusion. ⋯ A pericardial window is recommended for the short-term management of patients suspected of having tuberculous pericarditis with a major pericardial effusion by echocardiography. If a thickened pericardium is found during the window procedure, early pericardiectomy is strongly encouraged.
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Comparative Study
Transfusion of predonated autologous blood in elective cardiac surgery.
Despite blood conservation techniques, the average transfusion requirement in patients undergoing elective cardiac surgical procedures remains 1 to 3 units. We studied the efficacy of predonated autologous blood in decreasing homologous transfusion in two matched groups of 58 patients each. Group 1 received homologous blood perioperatively, and Group 2 was transfused with predonated autologous blood. ⋯ There were no complications related to autologous blood transfusion. Total transfusion requirement was related to the length of cardiopulmonary bypass. We conclude that autologous predonation is a simple, safe, and cost-effective method of reducing homologous transfusion and thereby decreasing the risk of transfusion-related reactions and infections.
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Comparative Study
Prophylactic antibiotic treatment prevents infection after cardiopulmonary bypass: a study in dogs.
The effect of two prophylactic antibiotic regimens during cardiopulmonary bypass (CPB) was investigated in dogs. Airborne contamination was determined by spraying two different bacterial strains (Staphylococcus aureus and Serratia marcescens) into the air of the operating room. Dogs were operated on and underwent CPB with a bubble oxygenator. ⋯ Cefuroxime enhanced the PMN respiratory burst. As a result, two weeks postoperatively the rate of infection was small in both groups. We conclude that prior to CPB, antibiotics should be administered prophylactically to overcome a period of impaired humoral host defense during CPB.
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A 4-year-old boy presented with a single seizure following a viral syndrome. He had a pericardial effusion on admission, and this increased suddenly on the third day of hospitalization, producing cardiac tamponade. ⋯ A laceration of the right atrium was repaired at operation, and the boy made a good recovery. Cardiopulmonary resuscitation by lay persons is not without hazard, and patients with such a history should be watched carefully for the possibility of damage to intrathoracic structures.