Artificial organs
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The aim of this study is to evaluate the benefit of the simultaneous use of a BioMedicus left ventricular assistance device (Medtronic, Minneapolis, MN, U. S. A.) and an intra-aortic balloon pump on regional blood flows, pressure, and pulsatility. ⋯ Coronary and carotid flows even increase to values higher than in the basal conditions. The simultaneous use of an intra-aortic balloon combined with the BioMedicus pump provides a pulsatile flow and increases coronary and carotid blood flows in pigs. An intra-aortic balloon can easily be combined with a BioMedicus pump whenever possible and may improve myocardial recovery in patients with postcardiotomy ventricular failure.
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Catheters for large vessels have become essential tools for the management of hospitalized or chronically ill patients requiring intensive medical treatments such as extracorporeal detoxification procedures. The increased use of such devices has been accompanied by a corresponding increase in complications, such as infection, sepsis, and thrombosis. In two retrospective studies, the first (1979-1990) with 1672 patients and 2626 large-bore catheters and the second (1996-2001) with 182 patients and 332 acute catheters, the frequency of infections, thrombosis, bleeding, and other side-effects were investigated. ⋯ In total, the complication rate was in the first study 27.7% (internal jugular vein 23.8% in 2105 catheters, subclavian vein 43.5% in 521 catheters) and in the second study 32.2% (internal jugular vein 20% in 231 catheters, subclavian vein 60.6% in 94 catheters, femoral vein 57.1% in 7 catheters). The majority of complications were puncture not possible, puncture of the artery abscess, septicemia, bleeding, thrombosis, and faults in catheter material. To minimize these complication rates the handling of the inserted catheters before, during, and after the hemodialysis or apheresis treatment is minimized.
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Case Reports Clinical Trial
Treatment of full-thickness skin defect with concomitant grafting of 6-fold extended mesh auto-skin and allogeneic cultured dermal substitute.
The aim of this clinical study was to evaluate an allogeneic cultured dermal substitute (CDS) as a biological dressing for highly extended mesh auto-skin grafting. The subjects were five patients with extensive deep burn wounds. Allogeneic CDS was prepared by seeding fibroblasts on a spongy matrix of hyaluronic acid and atelo-collagen. ⋯ In all cases, the wounds were closed by successful take of mesh auto-skin graft and prompt epithelization from the grafted skin. The skin on the grafted area had a cicatrix appearance, but was soft and thin, maintaining good quality. The application of 6-fold extended auto-skin graft in conjunction with allogeneic CDS is an effective method for treatment of extensive severe burn wounds.
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Randomized Controlled Trial Clinical Trial
Comparison of pH-stat versus Alpha-stat during hypothermic cardiopulmonary bypass in the prevention and control of acidosis in cardiac surgery.
To compare the effects of blood-gas management using either alpha-stat (temperature-uncorrected blood-gas management) or pH-stat (temperature-corrected blood-gas management) strategies, 30 patients undergoing coronary artery bypass surgery allocated randomly to either one of the approaches were studied. Acid-base balance, tissue oxygenation, and biochemical parameters were measured at distinct times: before bypass, after 15 min of hypothermia at 32 degrees C, after 45 min of hypothermia at 32 degrees C, after 15 min of rewarming at 37 degrees C, and 45 min after the end of bypass in normothermic conditions. ⋯ It was found that during the rewarming period and following bypass, the resulting acidosis caused by the procedure was less in the alpha-stat group. It was found that there were no difference between the two groups, with regard to tissue perfusion, as is seen by the tissue oxygenation parameters and lactic acid concentration.
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Comparative Study
Cardiac output determination during experimental hemorrhage and resuscitation using a transesophageal Doppler monitor.
Transesophageal Doppler (TED) monitoring has been considered a noninvasive and accurate alternative to pulmonary artery catheterization for volume replacement and cardiac output measurement in patients undergoing major surgery. This study tested the hypothesis that TED can accurately predict cardiac output during hemorrhage, shock, and resuscitation, by comparing it to total pulmonary artery blood flow (PABF) and to standard intermittent bolus cardiac output (ICO). In eight anesthetized dogs (18 +/- 1.0 kg), PABF was measured with an ultrasonic flowprobe while ICO and mixed venous O2 saturation (SvO2) were measured through a Swan-Ganz catheter. ⋯ In general, TED overestimated PABF (r2 = 0.3472), but changes in TED paralleled PABF throughout the experimental protocol, particularly during massive hemorrhage (r2 = 0.9001). We concluded that TED accurately reflected the direction and magnitude of the changes of cardiac output over time during abrupt hemodynamic changes. Probes designed for lower weights and smaller aortas may improve its accuracy in medium size animal models under less dramatic alterations induced by hemorrhage, shock, and resuscitation.