Surgery today
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Comparative Study Clinical Trial
Arterio-jugular differences in serum S-100beta proteins in patients receiving selective cerebral perfusion.
The early increase in serum S100beta after cardiopulmonary bypass (CPB) seems to be derived from an extracerebral source. To exclude contamination, we investigated the arterio-jugular differences in S100beta levels in patients receiving selective cerebral perfusion (SCP). We also evaluated the brain-protective effect of SCP by comparing the arterial S100beta levels with those in patients undergoing coronary artery bypass grafting (CABG). ⋯ The arterio-jugular differences in S100beta did not clarify the origin of their increase. Thus, measuring the jugular venous levels of S100beta in patients without postoperative clinical neurological deterioration would be of little benefit. However, SCP seems to protect the brain against S100beta release as effectively as conventional CPB.
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Cardiac surgery performed under cardiopulmonary bypass (CPB) causes abnormalities of the renin-angiotensin-aldosterone system, resulting in decreased urine output and an accumulation of water in the third space. We studied the efficacy of continuous low-dose human atrial natriuretic peptide (hANP) in patients undergoing thoracic aortic surgery. ⋯ These findings support the consensus that hANP exerts its diuretic effects to their full potential when administered continuously at low doses during thoracic aortic surgery. We found it to be effective for postoperative hemostasis and for preventing ischemic reperfusion injury.
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Case Reports
Venovenous extracorporeal membrane oxygenation as an adjunct to surgery for empyema: report of a case.
Empyema is a serious and often life-threatening condition. We report the case of a 45-year-old man with severe hypoxia caused by empyema after streptococcal pneumonia, which we successfully treated by surgical drainage assisted by a venovenous extracorporeal membrane oxygenation (ECMO) device. This device provided sufficient oxygenation during the perioperative period and was not associated with excessive bleeding under systemic heparinization. This case report shows the effectiveness of ECMO in allowing surgery and enhancing its benefits in patients with serious hypoxia.
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Case Reports
Simultaneous bilateral spontaneous pneumothorax secondary to metastatic angiosarcoma of the scalp: report of a case.
Angiosarcoma is a highly malignant neoplasm, which most often develops on the scalp or face of elderly people. Common distant metastatic sites include the lung, liver, lymph nodes, and skin. ⋯ Chest computed tomography showed multiple thin-walled cavitary metastatic pulmonary lesions, which increased in size as new lesions appeared over the clinical course of several months. This case suggests that a finding of simultaneous bilateral spontaneous pneumothorax may indicate a serious parenchymal lung disorder.
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Comparative Study
Receiver-operating characteristic analysis of leukocyte counts and serum C-reactive protein levels in children with advanced appendicitis.
To assess the diagnostic value of the white blood cell count (WBC) and serum C-reactive protein (CRP) level in children with advanced appendicitis. ⋯ These findings suggest that increased values of CRP and WBC more than 48 h after the onset of acute abdominal symptoms are indicators of advanced appendicitis.