The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 1980
A technique for continuous intercostal nerve block analgesia following thoracotomy.
Early after thoractomy, incisional chest pain may lead to a sequence of undersirable effects on respiratory function, in addition to causing patient discomfort. Pharmacologic blockade of the intercostal nerves innervating the incisional area can improve respiratory function as well as patient comfort. The postoperative production of continuous intercostal nerve blockade can be accomplished by the insertion of indwelling analgesic catheters at the time of thoracotomy closure.
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A major change has occurred in the incidence and management of pulmonary tuberculosis in patients of all ages. This review emphasizes the effectiveness of drug therapy and the declining role of surgical management of pulmonary tuberculosis in children. ⋯ The remaining 138 children were treated successfully with anti-tuberculous drugs. Pulmonary tuberculosis in children is primarily a medical disease and only rarely is surgical intervention indicated.
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J. Thorac. Cardiovasc. Surg. · Jul 1980
Randomized Controlled Trial Comparative Study Clinical TrialMembrane versus bubble oxygenator for cardiac operations. A prospective randomized study.
The advantages of membrane oxygenators over bubble oxygenators for cardiopulmonary bypass during clinical cardiac operations are controversial. A prospective randomized double-blind experimental design was utilized in 64 adult patients undergoing elective cardiac operations with either the Travenol microporous polyprolyene membrane oxygenator or the Bentley Q-100 bubble oxygenator. Sixteen patients in each group underwent coronary artery bypass grafting (CABG) and 16 underwent valvular or other types of operation. ⋯ Higher relative platelet counts (percent of control) were observed immediately after bypass in CABG patients in whom the membrane oxygenator was used. Otherwise, no significant differences were noted in objectively assessed results between the two oxygenators in regards to bleeding, pulmonary, renal, cardiac, and neurologic function, duration of ICU stay, and postoperative hospital stay. Thus no significant advantages in terms of clinical results could be detected with this type of membrane oxygenator versus another type of bubble oxygenator for elective cardiac operations in adults.
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J. Thorac. Cardiovasc. Surg. · Jul 1980
Operative experience with infective endocarditis and intracerebral mycotic aneurysm.
The surgical management of eight patients with infective endocarditis and intracerebral mycotic aneurysm is presented. Three patients had craniotomy before valve replacement and four patients had valve replacement before craniotomy. ⋯ Two of the eight patients died in the hospital of continuing sepsis resulting from undrained foci of infection. It is concluded that the drug-addicted patient with a mycotic aneurysm and hemodynamic decompensation from endocarditis can be successfully treated by staging the operations according to the more severe problem.
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J. Thorac. Cardiovasc. Surg. · Jun 1980
Comparative StudyAggressive management of potential penetrating cardiac injuries.
Since 1970 all patients admitted with penetrating injuries near the cardiac silhouette are transferred immediately to the operating room for resuscitation and evaluation for immediate thoracotomy. The clinical courses of 10 patients with penetrating cardiac injuries treated between 1962 and 1969 were analyzed and compared with those of 33 patients who presented between 1970 and 1977 and were managed more aggressively. ⋯ Of 53 patients with injuries in the area of the cardiac silhouette, 33 (62%) actually sustained cardiac injury. The high probability of cardiac injury in patients with external wounds in the silhouette and the improved survival rate seen with aggressive surgical therapy justifies the change to this policy.