The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 1978
Surgery for coccidioidomycosis in 52 diabetic patients with special reference to related immunologic factors.
Fifty-two diabetic patients who underwent pulmonary surgery for coccidioiodmycosis were evaluated by a retrospective study which included classification by stage of disease, status of insulin dependency, and reaction to coccidioidin skin test. The insulin-dependent diabetic patient had a fourfold increase in the incidence of more severe (progressive) disease. ⋯ Such surgery in the progressive stages should be totally extirpative. The presence of inadequately resected disease may adversely affect subsequent immunologic resistance of the host.
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J. Thorac. Cardiovasc. Surg. · Apr 1978
Comparative StudyComparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. III. Response of anterior pituitary gland to thyrotropin-releasing hormone.
Previous studies have indicated that, during nonpulsatile cardiopulmonary bypass, the anterior pituitary gland fails to respond to the tropic stimulus of thyrotropin-releasing hormone (TRH). This is in contrast to the normal response seen during closed cardiac and general surgical procedures. The Stöckert pulsatile pump system described in Part I has been employed in a comparative study of TRH responses in 20 patients subjected to pulsatile or nonpulsatile perfusion during open-heart surgery. ⋯ In the pulsatile group, however, the pituitary response to TRH was normal in nine patients out of 10. The quantitative difference between the groups was statistically highly significant (p less than 0.005). These results indicate that the subnormal pituitary function seen with nonpulsatile bypass may be prevented by the use of pulsatile perfusion.
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J. Thorac. Cardiovasc. Surg. · Apr 1978
Comparative StudyComparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. II. The effects on adrenal secretion of cortisol.
Previous studies have indicated that a significant reduction in plasma cortisol levels occurs during nonpulsatile cardiopulmonary bypass as a result of adrenocorticol hypofunction. The Stöckert pulsatile pump system described in Part I has been employed in a comparative study of plasma cortisol levels in 20 patients subjected to pulsatile or nonpulsatile perfusion during open-heart surgery. ⋯ Correction of the plasma cortisol values for the effect of hemodilution was performed and, again, corrected cortisol values indicated a highly significant increase in end-bypass levels in the pulsatile groups (p less than 0.001). These results clearly indicate that the reduction in cortisol secretion during nonpulsatile bypass may be prevented by the use of pulsatile perfusion.
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J. Thorac. Cardiovasc. Surg. · Apr 1978
Comparative StudyComparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. I. Pulsatile system employed and its hematologic effects.
A new, commercially available roller pump system able to deliver pulsatile and nonpulsatile flow has been studied in patients undergoing elective open-heart surgical procedures. The pulsatile pump (Stöckert Instrumente) may be used with standard extracorporeal circuit equipment and consistently produces a peripheral arterial pulse pressure of 25 to 30 mm. Hg at mean flow rates of 3.5 to 4.0 L. per minute. ⋯ Comparative studies of the hematologic effects of pulsatile and nonpulsatile perfusion were carried out. There was no evidence of increased hemolysis with pulsatile flow, nor was there increased depletion of red blood cells (RBC's) or platelets in the pulsatile group. This pulsatile pump system may therefore be used to produce pulsatile perfusion during cardiopulmonary bypass without the fear of producing excessive blood cell trauma.