J Cardiovasc Surg
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To document severity of illness and to evaluate the predictive value of clinical scoring systems in infants and children with cardiopulmonary insufficiency after cardiac surgery. ⋯ APSC, PRISM and TISS describe accurately severity of illness in infants and children with cardiopulmonary insufficiency after cardiac surgery and all scores identify those patients at increased risk for mortality.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prophylaxis of heart transplant rejection with either antithymocyte globulin-, Minnesota antilymphocyte globulin-, or an OKT3-based protocol.
We compared an equine antithymocyte globulin (ATGAM)-based protocol with a Minnesota antilymphocyte globulin (MALG)-based protocol and a murine monoclonal CD-3 (OKT-)-based protocol in 3 groups of heart transplant (HT) recipients. Thirty-four recipients received a four-day course of ATGAM. Thirty HT recipients received a 14-day course of OKT3. ⋯ The ATGAM group received a higher dose of CyA during "induction" therapy than the OKT3 and MALG groups, and experienced a greater rise in post-transplant serum creatinine levels. We found no difference between the 3 groups in: preoperative creatinine levels, one-year post-transplant creatinine levels, number of patients who could be successfully "weaned" from steroids, or one-year survival. Other data are tabulated as episodes/patient: [table: see text] We conclude that ATG plus preoperative CyA is superior for rejection prophylaxis following heart transplantation when compared with either MALG plus postoperative CyA or OKT3 plus postoperative CyA.
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Cardiopulmonary bypass surgery may be complicated by a systemic inflammatory reaction, which has been ascribed to activation of complement. For such activation, the choice of priming solution for the heart-lung machine may be of importance. ⋯ The concentration of the C3 activation product C3a in the plasma was significantly increased after simulated extracorporeal circulation. However there were no differences within the increase of C3a concentrations between the various priming solutions.
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Complete avulsion of the azygos venous arch associated with a subtotal longitudinal laceration of the posterior mediastinal pleura resulting from blunt motor vehicular trauma is reported. A sudden forceful anteromedial rotation of the decelerating cardiac mass may be the etiologic mechanism of the rare injury.
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Case Reports
Profunda femoral artery pseudoaneurysm after percutaneous transluminal procedures manifested by neuropathy.
The incidence of arterial complications following femoral artery cannulation is low; however, with the increasing number of cardiac diagnostic and interventional procedures, vascular surgeons are being confronted with an increasing number of pseudoaneurysms and arteriovenous fistulas. Swelling and a painful pulsating groin masse are the most frequent presenting symptoms of a common femoral artery false aneurysm. ⋯ Surgical repair of the pseudoaneurysm was successful in all patients. We discuss the reasons for this unusual finding and rare location for a pseudoaneurysm.