The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 1986
Clinical features of hyperosmolar hyperglycemic nonketotic diabetic coma associated with cardiac operations.
Hyperosmolar hyperglycemic nonketotic diabetic coma after cardiac operations was reviewed in a total of 12 patients from the literature and from my experience in an attempt to determine the clinical features of this condition. Among the unique features of this disease were the following: The mortality is high (42%). The morbidity and mortality are higher in patients with no previous history of diabetes mellitus (67% and 50%) than in those with such a history (33% and 25%). ⋯ A high or rising serum sodium concentration and/or blood urea nitrogen level with polyuria may be a warning sign of this complication. Too hasty correction of the hyperosmolar state can be dangerous. Pulmonary dysfunction may be involved in the symptoms of hyperosmolar hyperglycemic nonketotic diabetic coma.
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We report on two young patients with unusual airway foreign bodies: blowgun darts. These homemade darts are constructed with yarn, thread, and a common pin. Because only the pin is radiopaque, and because the child may be reluctant to disclose the nature of the foreign body, the bronchoscopist may encounter unexpected difficulty in extracting the dart. A radiograph showing a pin head down in the trachea or bronchus, coughing (especially with hemoptysis) in excess of that expected from just an aspirated pin, and a child hesitant to divulge the full history suggest blowgun dart aspiration.
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J. Thorac. Cardiovasc. Surg. · Jun 1986
Case ReportsThe hypoplastic mitral valve. When should a left atrial-left ventricular extracardiac valved conduit be used?
Limited experimental and clinical experience with extracardiac bypass of the mitral valve has been reported. We describe the case history of a 3-year-old child in whom a left atrial-left ventricular valved conduit was successfully used to bypass a severely hypoplastic parachute mitral valve. The potential applications of this unconventional surgical option are reviewed.
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J. Thorac. Cardiovasc. Surg. · Jun 1986
Comparative StudyAn eight-year experience with porcine bioprosthetic cardiac valves.
A total of 589 porcine bioprostheses were implanted in 509 patients from January, 1976, through December, 1983. Of the valves implanted, 390 were Hancock and 199 were Carpentier-Edwards. A total of 1,633 patient-years was accrued, with a mean follow-up of 38 months per patient. ⋯ As yet there has been no primary tissue failure of the Carpentier-Edwards prosthesis. There also appears to be a lower incidence of thromboembolism (Edwards, 0.3% per patient-year; Hancock, 0.8% per patient-year) and endocarditis (Edwards, 0.6% per patient-year; Hancock, 1.0% per patient-year). The low incidence of complications with the porcine bioprosthetic valve, especially the Carpentier-Edwards, encourages us to recommend its continued use, especially in situations in which anticoagulation is contraindicated.