J Cardiovasc Surg
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Cardiopulmonary bypass (CPB) is frequently associated with hemodynamic disorders caused by a whole blood inflammatory response. In particular vasoplegic syndrome occurs in the immediate postoperative time of patients who underwent normothermic CPB. Nitric oxide (NO) was described as an endothelium derived relaxing factor (EDRF). We report changes in NO concentration occurred in patients who experienced vasoplegic syndrome following CPB. ⋯ NO plays a role in the CPB-related hemodynamic disorders. Use of NO synthase inhibitors could provide a better management of vasoplegic phenomenon following CPB.
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Marker bands that cast dense shadow on X-ray are placed at crucial points on a catheter (for example on a peripheral angioplasty catheter on either side of the balloon) so that those parts of the catheter can be guided inside the body by X-ray. For catheter guidance by ultrasound, an ultrasound sensor in the mid-balloon region of an angioplasty catheter is integrated to the scanhead of an ultrasound scanner, via a catheter system interface (CSI). ⋯ This allows accurate catheter guidance using ultrasound. This paper describes the principles of ultrasound guidance of catheters and the initial clinical experience using this new catheter system (Echomark) in carrying out peripheral transluminal angioplasty.
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Review Case Reports
Traumatic rupture of the pericardium. Case report and literature review.
Rupture of the pericardium due to blunt thoracic trauma is a rare pathology with a range of mortality between 30 and 64% according to different authors. We review 40 cases which have been reported in the literature in the last decade and report a case of our own. We have found that 82% of the patients with traumatic rupture of the pericardium were men with a mean age of 45 years. ⋯ Nevertheless, this is a disease which can threaten the life of the patient and we should keep it in mind to diagnose and treat it as soon as possible. It is known that an early and aggressive management of these patients implies a much better prognosis with a significant reduction of the mortality. In this article we want to give useful clues to allow a preoperative diagnosis and an early and adequate management.
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A 34-year-old male presented with an infected intralobar pulmonary sequestration of the left lower lobe. Aortography revealed bilateral anomalous systemic arteries, originating in the lower level of the descending thoracic aorta, to the lower lobe on each side. The portion of the right lower lobe, which was perfused by the anomalous systemic artery was seen otherwise normal in anatomy without any recognizable sequestered lung tissue. ⋯ A left lower lobectomy with division of the left aberrant artery as well as ligation of the right anomalous artery were done. A postoperative pulmonary perfusion scan depicted normal uptake of radioactivity in the right lower lobe, suggesting normal pulmonary arterial perfusion to the area receiving previously the anomalous systemic arterial flow. An anomalous systemic artery perfusing an otherwise normal lung can be classified as one of the forms of intralobar pulmonary sequestration and could be ligated without resection of the involved area of the lung.
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We investigated the effect of intraoperative autologous blood sequestration (IABS), an old blood conservation method, on transfusion requirements for homologous packed red blood cells (PRBC), platelets, and fresh frozen plasma (FFP) for patients undergoing coronary bypass surgery. This non-randomized retrospective study involved 204 patients who underwent isolated primary coronary artery bypass grafting (CABG). In 140 patients (IABS Group), autologous heparinized whole blood was removed intraoperatively via aortic cannula before bypass and retransfused at the conclusion of extracorporeal circulation. ⋯ In the No IABS Group, 1.31 units of FFP was transfused and in the IABS Group, 0.49 units was transfused (p = 0.0004). To identify possible confounding factors, we performed a multivariate Poisson regression analysis for the 22 patient variables by a forward stepwise procedure. Regression analysis indicated that IABS did not alter the need for PRBC transfusion (p = 0.6194) but adjusted differences did confirm that IABS was associated with decreased need for transfusion of platelets and FFP (p = 0.0001 and p = 0.0002, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)