J Cardiovasc Surg
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Nine cases of traumatic thoracic aortic rupture (TAR), operated on at St. Marianna University Hospital between July 1980 and December 1988, were reviewed in order to evaluate the role of contrast-enhanced CT in the early diagnosis of TAR. The absence of mediastinal hematoma on CT eliminated the need for aortography in 30 (38.5%) of the 78 patients suspected of having TAR on the basis of chest roentgenograms. ⋯ As a rule, emergency operations were performed in these patients. Simple aortic crossclamping was employed in 4 patients, and heparinless left heart bypass with the BioPump was performed for spinal cord protection in 2 recent patients without complication of embolization. Use of the BioPump as an adjunct in the repair of TAR appears to be promising.
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Biography Historical Article
The Lériche memorial lecture 1989. A history of open heart surgery in Japan. Experience at the University of Tokyo.
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One hundred and fifty-four carotid endarterectomy plaques were studied to determine the correlation of multiple intraplaque hemorrhages to (1) carotid symptoms, (2) the percentage of carotid stenosis, and (3) the preoperative antiplatelet therapy. The plaques were evaluated histopathologically for the presence of multiple hemorrhages. The data were analyzed using the chi 2 test. Multiple hemorrhages were noted in 60.4% and single or not hemorrhage in 39.6% of patients with hemispheric symptoms. In patients with nonhemispheric symptoms, 9.4% had multiple hemorrhages and 90.6% has single or no hemorrhages; 89.4% plaques with multiple hemorrhages had stenosis greater than 75% in contrast to 37.5% in plaques with single or no hemorrhage; and 62.5% with single or no hemorrhage had stenosis of less than 75% (p less than 0.001). In patients receiving antiplatelet therapy, 80.1% of plaques with multiple hemorrhages were removed, in contrast to 19.7% from patients not receiving antiplatelets (p less than 0.001). ⋯ Multiple intraplaque hemorrhages were seen more often in patients with hemispheric symptoms and are associated with more critical carotid stenosis. Preoperative antiplatelet therapy increases the incidence of repeated plaque hemorrhages; therefore, we question the validity of this therapy in certain patients with carotid disease.
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A subxiphoid pericardial window made in 123 patients allowed drainage and diagnosis of pericardial effusions. In 40 patients with malignancy and effusions, median drainage was 450 ml; cytology was positive in 17 or 36 (47%), and pericardial biopsy showed cancer in 13 (43%) of 30 patients. In 11 patients with malignancy, both cytology of effusions and biopsy of the pericardium were negative. ⋯ No deaths resulted from recurrent effusions. The establishment of a subxiphoid pericardial window allows rapid and safe drainage of pericardial effusions with sampling for cytology and pericardial biopsy. It has minimal morbidity and few recurrent effusions.
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Venous return for cardiopulmonary bypass is successfully achieved using of two stage cavoatrial cannula. Right heart decompression is facilitated and drainage optimized by the use of a caval occluding clamp which stabilizes the cannula. This technique is described.