The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 1978
Use of microporous expanded polytetrafluoroethylene grafts for aorta-pulmonary shunts in infants with complex cyanotic heart disease. A report of seven cases.
Seven cyanotic infants in our institution have undergone central aorta--pulmonary artery shunt operations with a microporous expanded polytetrafluoroethlene (PTFE) graft. All of these patients have had pulmonary atresia, in four cases associated with endocardial cushion type defects. ⋯ Congestive heart failure and kinking of the pulmonary artery, frequently seen with other types of central aorta-pulmonary shunts, have not been a problem. Until further experience is gained with this procedure, however, we reserve its use to the occasional cyanotic infant in whom neither open-heart repair or the Blalock-Taussig shunt is feasible.
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J. Thorac. Cardiovasc. Surg. · Oct 1978
Sequential evaluation of DNCB reactivity in patients with primary lung cancer. Correlation with prognosis.
Delayed hypersensitivity reactions before therapy in 137 patients with lung cancer and in 50 patients with benign thoracic lesions were evaluated by 2,4-dinitrochlorobenzene (DNCB) contact sensitization using the patch test. Ninety-eight percent (49/50) of control patients and 46 percent (62/137) of patients with lung cancer were sensitized by 250 mug of DNCB. There was an excellent correlation between the initial reactivity to DNCB and resectability. ⋯ In 15 of 74 patients with resectable disease, the conversion was noted postoperatively, and among 12 patients followed for 2 years, only two patients had died. Conversion from a reactive to nonreactive status to DNCB occurred only in the terminal stage of the disease. From these observations, we found that, in order to evaluate the afferent limb of cellular immunity in patients with lung cancer who have once expressed reactivity to DNCB, one must use some new sensitizing agents which show no cross-sensitivity with each other thereafter.
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J. Thorac. Cardiovasc. Surg. · Jul 1978
Case ReportsExtracorporeal membrane oxygenator support for human lung transplantation.
Extracorporeal membrane oxygenator (ECMO) support was provided for a 19-year-old boy undergoing right lung transplantation. Perfusion was begun several hours prior to transplant, to correct profound hypercapnia. After the operation, ECMO was required because of inadequate gas exchange by the transplanted lung. ⋯ During this time, the temporary malfunction of the transplanted lung owing to the reimplantation response reversed, and the patient was successfully removed from the oxygenator and subsequently weaned from the ventilator. He died on the eighteenth postoperative day of bronchial dehiscence. ECMO support appears to be a feasible means of supporting patients during lung transplantation and during the period of reversible lung malfunction that may occur in the early postoperative period.
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The incidence of postoperative delirium following coronary artery bypass surgery was 28%. This rate is comparable to that after open-heart surgery. ⋯ The relationship between personality type and delirium, previously found to be signficant, was suggestively associated in these patients. A history of myocardial infarction prior to surgery was significantly associated with delirium.
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J. Thorac. Cardiovasc. Surg. · Jun 1978
Case ReportsMassive impalement wound of the chest. A case report.
A 29-year-old man sustained an impalement wound of the right side of the chest with a 6 foot long, 4 by 4 inch wooden post during a high-speed automobile accident. The post entered the right side of the chest anteriorly and exited posteriorly. ⋯ Removal of the post, treatment of pulmonary parenchymal damage, and reconstruction of the two large chest wall defects presented problems in management. Rapid transport of the patient to the hospital, effective emergency treatment, surgical repair of the chest injury, and appropriate supportive measures contributed to his survival.