The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Oct 1975
Platelets, hemostasis, and thromboembolism during treatment of acute respiratory insufficiency with extracorporeal membrane oxygenation.
Twenty-eight patients were supported with long-term extracorporeal membrane oxygenation as a treatment for acute respiratory insufficiency. Clinical, laboratory, and autopsy data concerning platelets, hemostasis, and thromboembolic disease are presented for the periods during and after bypass. ⋯ The abnormal bleeding is attributed to heparin, thrombocytopenia, and a qualitative platelet defect. Possible causes of the thromboembolic events including disseminated intravascular coagulation are also discussed, and speculations are offered concerning clinical management and directions for future investigation.
-
Because of increasing interest in the application of the Blalock-Taussig shunt in smaller infants, we reviewed the course of 18 infants aged 6 months or less who underwent this procedure. The mortality rate in 4 infants under 2 weeks of age was 50 per cent and that in those 2 weeks to 6 months of age, 28 per cent. The patency rate was 70 per cent. Because of late problems with the Waterston shunt and a comparable mortality rate, the Blalock-Taussig procedure is recommended for all infants, except perhaps those under 2 weeks of age.
-
Since 1958, a series of 112 patients with severe or moderately severe chest injuries have been treated. An aggressive policy has been adopted toward correcting or preventing major paradoxical chest wall movement by intramedullary pinning of ribs, costal cartilages, and the sternum. Whenever possible, positive-pressure mechanical ventilation and tracheostomy have been avoided. ⋯ Three of the patients who died were over 70 years of age. Operative stabilization permits avoidance or reduction in the duration of tracheostomy and mechanical ventilation. Permanent chest wall deformity is lessened or avoided.
-
One hundred heart surgery patients were followed throughout their postoperative periods to assess the incidence and etiology of postcardiotomy delirium. Factors evaluated were: age, sex, history of previous psychiatric illness, history of cerebrovascular disease, cardiac diagnosis and operation, time of anesthesia, time of bypass, time spent in the intensive-care unit, and amount of sleep during the postoperative period. Six patients developed delirium, five of whom had a lucid postoperative interval; four patients had perceptual disturbances only, without loss of contact with reality; three had neurological symptoms with mild confusion; 87 kept a clear mental state. ⋯ Operative factors did not seem to be of major importance. While postoperative delirium probably has multidetermined causes, the author believes that sleep deprivation superimposed on the other contributory condition is a common precipitating factor. Suggestions about the prevention and treatment of delirium are made.
-
Data on 50 patients with multiple separate primary carcinomas of the lung are presented. Eighteen had synchronous tumors and 32 had metachronous tumors, the intervals between diagnoses varying from 4 months to 16 years. Histologic patterns in the two different carcinomas were the same in 31 patients, most commonly epidermoid, and they were different in 19 patients. The problems involved in establishing the diagnosis of multiple primary lung cancers, the choice of treatment, and the expectation for survival are discussed.