J Cardiovasc Surg
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Randomized Controlled Trial Comparative Study Clinical Trial
Cardiac interleukin-6 release and myocardial recovery after aortic crossclamping. Crystalloid versus blood cardioplegia.
Pro-inflammatory cytokines may play an important role in patient response to cardiopulmonary bypass (CPB). Since the myocardium is proposed to be a major source of cytokines, we studied the influence of the cardiolpegia type on interleukin-6 release and early myocardial recovery. ⋯ Inflammatory response to CPB is associated with delayed myocardial recovery. The use of blood cardioplegia may attenuate inflammatory reactions.
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Randomized Controlled Trial Comparative Study Clinical Trial
Real time measurement of heparin concentration during cardiopulmonary bypass.
A heparin/protamine titration system for measurement of heparin levels (Hepcon) is promising for efficient anticoagulation during cardiopulmonary bypass (CPB). ⋯ In conclusion, whole blood heparin measurements correlated well with plasma heparin concentration. Protamine titration of heparin reduced the dose of protamine and decreased the chance of adverse reactions.
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The author presents three decades of experience in the management of anterior chest wall deformities. During this period more than 800 operations were performed on patients with pectus excavatum and carinatum. In this series, there was no death and serious complications were rare. ⋯ The present method applied for correction of pectus excavatum utilizes the above principles and a substernal Marlex mesh support with bilateral muscle coverage. For carinatum repair, the author routinely uses positional correction of the sternum and sternal shortening. Patients who have significant pectus deformities should undergo surgical repair, preferably between one and eight years of age.
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The heparin-protamine interaction is a topic of intense scrutiny due to its mandatory use during cardiopulmonary bypass. It can be estimated that over 2,000,000 patients are exposed to the heparin-protamine interaction each year. ⋯ These multiple cardiovascular effects are mediated via complement activation, histamine release, thromboxane and nitric oxide production, and antibody formation. This article reviews the current understanding of the heparin-protamine interaction from the world's literature.
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Comparative Study
The significance of creatine kinase in cardiac patients with acute limb ischaemia.
The value of creatine kinase (CK) and aspartate transaminase (AST) has not been previously evaluated following cardiac surgery in the diagnosis of acute limb ischaemia. Our objective was to assess the value of CK and AST with reference to the diagnosis of limb ischaemia, effect on renal function and prognosis following cardiac surgery. ⋯ PATIENTs who develop limb ischaemia following cardiac surgery have a high morbidity and mortality. A CK of 17,000 U/L (5667-46539) is indicative of serious limb ischaemia. Renal failure is likely to develop in patients with CK>15,000 U/L. AST may become a useful additional marker of limb ischaemia.