European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 1992
Induced hypothermia in the management of refractory low cardiac output states following cardiac surgery in infants and children.
Post-operative low cardiac output states remain a major cause of mortality following cardiac surgery in infants and children. Since 1979 we have used moderate induced whole-body hypothermia in the management of low-output states refractory to conventional modes of therapy. This is based not only upon the relationship between body temperature and oxygen consumption, but also on experimental work showing a beneficial effect of cooling upon myocardial contractility, particularly when there is pre-existing impairment of ventricular function. ⋯ A fall in the platelet count (P < 0.001) was not accompanied by any change in the white cell count (P = 0.15). Although it is impossible to say whether cooling influenced the outcome in any of these children, it was usually effective in stabilising their clinical condition. The technique is simple and has a sound theoretical basis.(ABSTRACT TRUNCATED AT 250 WORDS)
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We review 1696 patients with blunt chest trauma. Road traffic accidents were the main cause of injury followed by domestic falls and labour accidents. Outdoor falls and sport accidents accounted for a small number of injuries. ⋯ The results were generally good: 9 patients did not need any mechanical ventilation and 11 were ventilated for a short period. No deaths were due to the surgical procedure. The authors maintain that a selective attitude restricting, but not ignoring, surgical stabilization is the best policy.
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Eur J Cardiothorac Surg · Jan 1992
Complications from intra-aortic balloon counterpulsation: a review of 303 cardiac surgical patients.
From January 1980 to January 1990 all patients undergoing cardiac surgery at the Royal North Shore Hospital, Sydney, and requiring intra-aortic balloon counterpulsation (IABCP) were retrospectively reviewed. A total of 99 patients (32.6%) developed complications. Vascular/haemorrhagic complications occurred in 46 patients (15.2%); 79 patients (26%) required platelet transfusions. ⋯ Intra-aortic balloon pump-related deaths occurred in 6 patients (2%). Use of the intra-aortic balloon pump can be a life-saving procedure, but it carries a significant morbidity and mortality rate. This makes it imperative to temper our indications to those patients who demonstrate a need for it.
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To determine the role of expandable metal stent (Wallstent) in treating tracheobronchial strictures, 12 patients with recurrent symptoms of airway obstruction due to either benign or malignant strictures were studied. The seven benign strictures were anastomotic stricture following sleeve resection (2) and single lung transplant (1), tracheal amyloidosis (1), idiopathic chondritis (2), and post-tracheostomy stricture (1). The five malignant strictures were due to recurrent adenoid cystic carcinoma of trachea (1), large-cell carcinoma of lung (1), recurrent laryngeal squamous carcinoma (1), squamous carcinoma of the trachea (1), and malignant melanoma (1). ⋯ One patient with relief of stridor died at 4 months due to carcinomatosis. Tumour ingrowth through the metal stent remains problematic in two patients. However, the incidence of palliative interventions required has markedly reduced after stenting.
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Eur J Cardiothorac Surg · Jan 1992
Randomized Controlled Trial Clinical TrialReoperation and the centrifugal pump?
Postperfusion syndrome is still a problem in long cardiac operations using extracorporeal circulation (ECC). To evaluate whether or not centrifugal blood pumping during open heart surgery is beneficial, a randomized, prospective study was undertaken of 50 consecutive patients undergoing elective coronary artery bypass grafting. The patients were divided into two groups of 25 each. ⋯ Significant differences in favor of group 1 were found in plasma hemoglobin (P less than 0.05), beta-thromboglobulin (P less than 0.01), D-dimer (P less than 0.05), and platelet counts (P less than 0.5). These differences were clearly ECC-time-dependent and became statistically significant after 90 min bypass. We conclude that roller pumps still can be safely used for standard cardiac procedures.(ABSTRACT TRUNCATED AT 250 WORDS)