The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 1986
Cryoanalgesia after thoracotomy. Improvement of technique and review of 600 cases.
The efficacy of cryoanalgesia for the control of post-thoracotomy pain has led to the acceptance of the technique as a routine procedure in this unit. A study of 600 consecutive patients in whom an improved technique was used is not reported. The freezing time for each intercostal nerve in this group was reduced to one 30 second exposure instead of the two 30 second exposures previously used. ⋯ Freezing above the fifth intercostal nerve is no longer practiced in women. Modification to the probe has simplified the procedure. Pulmonary function studies and blood-gas analysis are also described.
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J. Thorac. Cardiovasc. Surg. · Aug 1986
Late results after left-sided cardiac valve replacement in children.
Selection of types of cardiac valve substitutes for children remains controversial. Between 1976 and 1984, 166 children, 15 years of age or younger, underwent aortic (N = 53) or mitral valve replacement (N = 90) or both (N = 23). Biological prostheses were used in 84 patients and mechanical prostheses in 71; both a mitral bioprosthesis and an aortic mechanical valve were used in 11 patients. ⋯ The 7 year probability rates of freedom from all valve-related complications were 43% +/- 6% in the bioprosthesis group and 86% +/- 4% in the mechanical valve group (p less than 0.001). In the aortic position, a mechanical adult-sized prosthesis can always be implanted, and satisfactory long-term results can be anticipated. In the systemic atrioventricular position, the results are less than satisfactory with either type of prosthesis; every effort should be made to preserve the natural valve of the child.
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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.