J Cardiovasc Surg
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The occlusive arterial lesions of the upper extremity in Takayasu's arteritis is estimated in 72.3% in the left and in 45.6% in the right subclavian arteries, respectively. Buerger's disease also involves the arteries distal to the elbow and the digital arteries in about 22% of total cases. In Takayasu's arteritis, the surgical treatment for the upper extremity ischemia is rarely indicated, except for the cases with aneurysm, because the occlusive lesion involves exclusively the aorta and its branches, and severe ischemia of the upper digital arteries in Buerger's disease frequently causes severe ischemic symptoms of hand and fingers, such as rest pain, trophic changes and tissue loss. Therefore, the surgical treatment, including upper thoracic sympathectomy and amputation, is mandatory in some cases.
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Case Reports
Bullet embolism following gunshot wound of the chest. Case report and review of the literature.
A 24 year old male was shot in the low left posterior chest. Initial x-rays localized the bullet in the region of the left atrium or pulmonary veins. ⋯ Sixty-one cases with gunshot wound to the chest and 63 arterial emboli were reviewed. There was a mortality rate of 38%.
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A precipitate observed in Hartman's solution used to prime a cardiopulmonary bypass circuit was identified as calcium carbonate. Analysis of the chemical equilibrium showed that the precipitation was caused by sodium bicarbonate added to prevent acidosis. Although this practice is acceptable for haemic primes, in which buffers and albumins will prevent precipitation, it should not be done with non-haemic primes prior to bypass.
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Since 1962 a total of 1,361 femoro-popliteal/tibial reconstructions have been performed and followed up. In addition to the saphenous vein, Dacron, PTFE, and umbilical vein grafts were used. ⋯ Cumulative patency rate for the PTFE grafts were 76.4% after 39 months with above knee and 62.2% after 2 years with below knee reconstructions. After 12 months 85.7% of the umbilical vein grafts were functioning.
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A simplified technique relating individual heparin dose to desired anticoagulant effect was used in 152 patients during cardiac surgery. Activated clotting time (act) was measured by semi-automated technique (Hemochron) before and after heparin, 200 U/kg I. V. ⋯ Protamine dose (1.3 mg/100 U. heparin) was individualized to precisely reverse anticoagulant effect to control ACT in 127 of 152 patients (84%) with a single dose. Elimination of patient and product variability by simplified semi-automated dose-response technique for heparin therapy provides uniform anticoagulant effect and its accurate neutralization. This technique is recommended for precise anticoagulant therapy during open heart surgery.