The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 1981
Effects of transfusion of emboli and aged plasma on pulmonary capillary permeability.
The effects of transfusion of whole blood clot emboli and aged citrated platelet-poor plasma on pulmonary capillary permeability were investigated in anesthetized sheep by continuous collection of pulmonary lymph. Changes in lymph flow and lymph-to-plasma ratios (CL/CP) for albumin and globulin were utilized to detect changes in permeability. Infusion of 0.5 cc/kg of finely (less than or equal to 1 mm) diced autologous whole blood clot resulted in a 170% increase in lymph flow over control with no change in CL/CP for albumin or globulin. ⋯ The results in these latter two experiments suggest that increased perfusion per unit lung capillary bed or increased PVR were not primarily responsible for the changes observed in the emboli-treated and plasma-infused animals. Since both emboli and aged platelet-poor plasma increased pulmonary capillary permeability, the permeability increasing factor appears to be humoral in origin. Similar humoral factors may be important in the pathogenesis of the adult respiratory distress syndrome in man.
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J. Thorac. Cardiovasc. Surg. · Aug 1981
Case ReportsRight ventricular bullet embolectomy without cardiopulmonary bypass.
Victims of gunshot wounds may be noted to have bullets overlying the cardiac silhouette on roentgenogram. Direct cardiac penetration, bullet embolus to the heart, and missile proximity to the heart are all possibilities which must be differentiated. ⋯ At the time of exploration, an intracardiac bullet embolus was fortuitously palpated and trapped within the apex of the right ventricle. Right ventriculotomy and embolectomy without cardiopulmonary bypass were performed to prevent retrograde or distal migration.
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J. Thorac. Cardiovasc. Surg. · Aug 1981
Comparative StudyEffects of dopamine, ethanol, and mannitol on cardiopulmonary function in patients with adult respiratory distress syndrome.
Dopamine, ethanol, and mannitol were investigated to determine if they could increase pulmonary blood flow and oxygen delivery without significantly increasing intrapulmonary shunt. These drugs were studied in adult patients with respiratory distress following trauma, operation, or sepsis. Intravascular pressure, cardiac output, oxygen consumption and delivery, and limb blood flow and peripheral oxygen delivery were measured in all patients. ⋯ Mannitol increased oxygen delivery and consumption in both the total body and limb. Thus in patients with adult respiratory distress syndrome (ARDS), increases in pulmonary blood flow can be achieved with several distinct pharmacologic agents without significant increases in intrapulmonary shunt. These increases in flow are generally accompanied by increases in oxygen delivery without increased pulmonary vascular resistance.
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J. Thorac. Cardiovasc. Surg. · Jun 1981
Case ReportsPathological study of infective endocarditis on Hancock porcine bioprostheses.
A pathological study has been performed on 10 infected Hancock bioprostheses removed from nine patients who died of prosthetic endocarditis. The devices had been in place from 2 to 87 months (average 37.5), the interval between operation and onset of infection averaging 30 months. The offending organisms were Gram negative bacteria in three patients (Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens), Gram positive bacteria in two (Staphylococcus aureus and Streptococcus viridans), and fungi in four (Candida species in three and Aspergillus species in one). ⋯ Therefore surgical intervention appears appropriate in the presence of severe hemodynamic complications after adequate antibiotic treatment. However, infection of these particular prostheses still carries an extremely high mortality. In the present series, this poor outcome might be explained by the frequently associated septic and thromboembolic events.
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J. Thorac. Cardiovasc. Surg. · Jun 1981
Case ReportsPrimary malignant lymphoma of the trachea. Report of a case successfully treated by primary end-to-end anastomosis after circumferential resection of the trachea.
A 67-year-old Japanese man with exertional dyspnea was found by laminagraphy to have tracheal obstruction. The stricture was localized at the cervical and mediastinal trachea and was 5.0 cm long on an x-ray film. Eight tracheal rings were successfully resected and the ends of the trachea were anastomosed. ⋯ The patient had serum hepatitis postoperatively, but now he is living normally without any difficulty in respiration. No signs of recurrence have been seen in the 5 years, 4 months since the operation. From this experience, the rarity and the possibility of curative operation of this tumor are discussed.