The Journal of thoracic and cardiovascular surgery
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One hundred heart surgery patients were followed throughout their postoperative periods to assess the incidence and etiology of postcardiotomy delirium. Factors evaluated were: age, sex, history of previous psychiatric illness, history of cerebrovascular disease, cardiac diagnosis and operation, time of anesthesia, time of bypass, time spent in the intensive-care unit, and amount of sleep during the postoperative period. Six patients developed delirium, five of whom had a lucid postoperative interval; four patients had perceptual disturbances only, without loss of contact with reality; three had neurological symptoms with mild confusion; 87 kept a clear mental state. ⋯ Operative factors did not seem to be of major importance. While postoperative delirium probably has multidetermined causes, the author believes that sleep deprivation superimposed on the other contributory condition is a common precipitating factor. Suggestions about the prevention and treatment of delirium are made.
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Data on 50 patients with multiple separate primary carcinomas of the lung are presented. Eighteen had synchronous tumors and 32 had metachronous tumors, the intervals between diagnoses varying from 4 months to 16 years. Histologic patterns in the two different carcinomas were the same in 31 patients, most commonly epidermoid, and they were different in 19 patients. The problems involved in establishing the diagnosis of multiple primary lung cancers, the choice of treatment, and the expectation for survival are discussed.
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In this report, we shall review the clinical and pathological features of 64 patients who survived 10 years or longer after resection for bronchogenic carcinoma. Most of these patients had either adenocarcinoma or bronchioloalveolar carcinoma. ⋯ In many of the long-term survivors, there were pathological findings generally considered to indicate a poor chance for survival. Thus we believe that curative resection for bronchogenic carcinoma should be attempted whenever feasible to offer the patient every hope of long-term survival.
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J. Thorac. Cardiovasc. Surg. · Aug 1975
A study of the electroencephalogram during surgery with deep hypothermia and circulatory arrest in infants.
Seveteen infants (2 1/2 to 28 months old) were continuously monitored by six-channel electroencephalography (EEG) during the entire surgical procedure of open-heart repair. They were subjected to surface hypothermia supplemented by cold extracorporeal circulation (ECC) down to an average esophageal temperature of 21 degrees C., to cardiac arrest of 40 minutes average (range 19 to 62 minutes), and to ECC rewarming. Survival time of the EEG was correlated to esophageal temperature at the time of arrest. ⋯ Reappearance latency was well correlated with the duration of arrest. Potential normalization was oberved in 13 infants, but true normalization was observed in only 2 infants during the 90 to 120 minute period after ECC. By judging the EEG and by comparing this series with two previous series of moderate and deeper hypothermia in older patients, we concluded that the immediate tolerance of the brain to deep hypothermia and circulatory arrest seems no different in infants and in older patients.