The Journal of thoracic and cardiovascular surgery
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Thymectomy has been shown to be effective in the treatment of myasthenia gravis. The logical goal of operation has been complete removal of the thymus, but there has been controversy about the surgical technique and its relation to results. Surgical-anatomic studies have shown gross and microscopic thymus widely distributed in the neck and mediastinum. ⋯ The response in group C was also less good than in group A and proportionately fewer benefited. These results support the recommendation for thymectomy in the treatment of patients with generalized myasthenia gravis and indicate the desirability of a maximal procedure. For persistent or recurrent severe symptoms after previous transcervical or submaximal transsternal resections, reoperation by this technique is also recommended.
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J. Thorac. Cardiovasc. Surg. · May 1988
Ventricular septal defects and arteriovenous fistulas, with and without valvular lesions, resulting from penetrating injury of the heart and aorta.
Thirty-one patients with post-traumatic intracardiac shunts or arteriovenous fistulas were treated surgically in the past 8 years. All patients had had penetrating injuries of the heart, ascending aorta, or aortic arch 1 week to 4 years earlier, but only three had an early emergency operation. Eleven patients (35%) had ventricular septal defects and seven (23%) had other types of intracardiac fistulas. ⋯ The remaining 29 patients were alive and well when last seen, with no signs of residual shunt and with good valve function. The high prevalence of late complications necessitates routine investigation of patients with penetrating injuries of the heart and the aorta. Surgical correction carries a low mortality and morbidity and is advised in all patients with symptoms.
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J. Thorac. Cardiovasc. Surg. · May 1988
Comparative StudyCoronary bypass grafting after failed elective and failed emergent percutaneous angioplasty. Relative risks of emergent surgical intervention.
Emergency coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty can be performed with acceptable complication rates. Recently, however, a new class of patients with unsuccessful angioplasty has evolved with the use of thrombolytic therapy and emergent angioplasty as treatment for developing acute myocardial infarction. The efficacy of surgical intervention after failure of angioplasty in this setting has not been demonstrated. ⋯ Six patients in group II (15.6%) required reexploration for bleeding, versus none in group I (p = 0.04). Nonhemorrhagic complication rates, mean in-patient and acute care days, total hospital charges, and blood product utilization rates were not statistically different. These data indicate that emergency coronary artery bypass grafting can be performed when necessary in the setting of failed emergent percutaneous transluminal coronary angioplasty with results comparable to coronary bypass after failed elective angioplasty.
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J. Thorac. Cardiovasc. Surg. · May 1988
Comparative StudyA physiologic comparison of external cardiac massage techniques.
On the basis of recent investigation, controversy has arisen regarding which of several cardiopulmonary resuscitation methods optimizes hemodynamics. The present study was designed to compare five recently described chest compression techniques: high-impulse manual chest compression at 150/min, mechanical compression at 60/min with simultaneous ventilation, mechanical compression at 60/min with simultaneous ventilation and either systolic or diastolic abdominal compression, and pneumatic vest compression at 60/min. Eight dogs were chronically instrumented with electromagnetic flow probes in the ascending and descending aorta while matched micromanometers measured aortic, left ventricular, and pleural pressures. ⋯ Brachiocephalic blood flow generally followed cardiac output and was statistically the greatest with high-impulse manual compression at 273 +/- 47 ml/min (p less than 0.05). Finally, high-impulse manual compression provided the highest coronary perfusion pressure of 31 +/- 4 mm Hg (p less than 0.05) compared to 23 +/- 2 mm Hg for mechanical compression and simultaneous ventilation, 23 +/- 2 mm Hg for mechanical compression and simultaneous ventilation with systolic abdominal compression, 23 +/- 3 mm Hg for mechanical compression and simultaneous ventilation with diastolic abdominal compression, and 11 +/- 2 mm Hg for vest resuscitation. These data demonstrate that high-impulse manual compression generated physiologically and statistically superior hemodynamics when compared with other methods in this model of cardiopulmonary resuscitation.
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J. Thorac. Cardiovasc. Surg. · May 1988
Relationship between cerebrospinal fluid dynamics and reversible spinal cord ischemia during experimental thoracic aortic occlusion.
This study was designed to assess the effects of hemodynamic changes and cerebrospinal fluid dynamics on spinal cord function during experimental thoracic aortic occlusion. We investigated the effects of dopamine, sodium nitroprusside, and sodium thiopental in this model. ⋯ By multiple regression analysis, the degree of spinal cord ischemia was positively related to the cerebrospinal fluid pressure (p = 0.0092) and negatively related to the percent change in cerebrospinal fluid pressure (p = 0.028); there were no significant drug effects on cerebrospinal fluid pressure or on the degree of spinal cord ischemia. This study indicates that cerebrospinal fluid pressure is an important factor in determining the degree of spinal cord ischemia during aortic occlusion and suggests that measures to reduce cerebrospinal fluid pressure will mitigate the degree of spinal cord ischemia.