Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Jun 2004
Review Case ReportsDelayed cardiac tamponade after penetrating thoracic trauma.
Acute cardiac tamponade is very common after penetrating injuries to the chest. However, delayed cardiac tamponade is a rare phenomenon that may appear several days after injury. This paper presents three cases of delayed cardiac tamponade diagnosed weeks after ice pick wounds to the back. These experiences and a review of the literature on the subject are discussed.
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Asian Cardiovasc Thorac Ann · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialDose comparison of tranexamic acid in pediatric cardiac surgery.
To compare different doses of tranexamic acid, 150 consecutive children with congenital cyanotic heart disease were randomly assigned to one of 5 groups of 30 each. Group A served as a control. Group B received 50 mg.kg(-1) of tranexamic acid at induction of anesthesia. ⋯ The control group had the longest sternal closure time, the greatest blood loss in the first 24 hours, and the highest requirements for blood and blood products. Among the 4 groups given tranexamic acid, group D (triple dose) had the best results, followed by group E (double dose). Group B (single dose) had the worst results among the groups receiving tranexamic acid.
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Asian Cardiovasc Thorac Ann · Jun 2004
Comparative StudyHuman leukocyte antigens in hypertrophic cardiomyopathy patients in South India.
Hypertrophic cardiomyopathy is characterized by massive ventricular hypertrophy, reduced diastolic function, and excessive ventricular contraction. The human leukocyte antigens HLA-A, HLA-B, and HLA-DR were studied in 14 hypertrophic cardiomyopathy patients with left ventricular obstruction from South India. They were compared with 81 normal age- and sex-matched individuals from the same ethnic background. ⋯ The HLA-B51 and HLA-DR2 levels were significantly increased in hypertrophic cardiomyopathy patients compared to controls, whereas HLA-A19, HLA-B7, and HLA-DR4 were decreased when compared to the controls. It was noticed that haplotype B51-DR2-DQ3 was significantly associated with hypertrophic cardiomyopathy patients from South India. Hypertrophic cardiomyopathy may be associated with genes in the human leukocyte antigen region, and immunogenetic factors linked to human leukocyte antigens appear to play a major role in the pathogenesis.
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Asian Cardiovasc Thorac Ann · Mar 2004
Comparative StudyOpen fixation in flail chest: review of 64 patients.
The strategy for treatment of flail chest remains controversial. Various alternatives were assessed by reviewing the records of 64 patients treated from 1991 through 2000. Patients were classified according to therapeutic approach: group 1 was 27 patients who underwent open fixation of the fractured ribs, group 2 was 19 patients managed by intermittent positive-pressure ventilation, and group 3 was 18 patients managed mainly by synchronized intermittent mandatory ventilation. ⋯ Mortality was 27.0% (10/37) in patients treated nonsurgically; 21.0% (4/19) in group 2, and 33.3% (6/18) in group 3. In groups 2 and 3, pain control required epidural analgesia in 13 (35.1%) cases, intercostal nerve blockade in 16 (43.2%), and narcotic or nonnarcotic parenteral analgesia in 8 (21.6%). Open fixation is a successful treatment modality for traumatic flail chest.
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Asian Cardiovasc Thorac Ann · Mar 2004
Comparative StudyActivated clotting time during cardiopulmonary bypass: is repetition necessary during open heart surgery?
We evaluated the need of activated clotting time monitoring and efficacy of heparinization protocol in 100 patients undergoing open heart surgery. Patients were anticoagulated with 300 or 400 units.kg(-1) heparin, based on their heparin sensitivity assessed at 5 min by activated clotting time. One-third of the initial dose was repeated at 90 min and thereafter hourly until completion of cardiopulmonary bypass. ⋯ No clot was observed in the surgical field or extracorporeal circuit. This anticoagulation protocol ensures adequate anticoagulation during hypothermic cardiopulmonary bypass. With this protocol, only one activated clotting time at 5 min after heparin administration is required and essential; subsequent monitoring is not necessary.