Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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The authors describe a serious anaphylactic reaction after protamine administration and its successful control. In cardiovascular surgery protamine a basic peptide, is used as a matter of routine to eliminate the anticoagulation effect of heparin. The use of this drug is associated with a number of negative haemodynamic reactions, most of them not serious, the incidence of which varies from 0 to 100%. ⋯ Prevention in patients with known risk factors is problematic. Treatment of the allergic reaction to protamine is still symptomatic. In the authors' patient the condition was coped with by administration of colloid solutions, adrenaline and solumedrol.
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The authors describe the case-history of a rare covered injury of the musculus pectoralis major, abruption of the attachment of its tendon on the humerus. In the world literature only three major groups were described, the majority of publications pertain only to individual observations. In the development of the injury always a very similar mechanism is involved, a considerable proportion are sports injuries. ⋯ As the loss of function is marked, surgical repair is considered the method of choice. The importance of early operation is emphasized. The described technique of reinsertion produced results satisfactory from the patient's point of view.
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The authors present a group of 22 patients with iatrogenic pneumothorax. They analyze the basic causes of development of iatrogenic pneumothorax, such as cannulation of the subclavicular vein thoracic puncture. They give an account of their experience with the therapeutic procedure which involves the insertion of a classical thoracic drain and several days of active exhausting. In the conclusion they discuss the possibility to use a new method-videothoracoscopy-in some indicated cases.
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Historical Article
[The Royal College of Surgeons of England--a society of English surgeons].
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In the child cardiocentre in Prague 5-Motol in 1977-1993 a total of 420 neonates with critical inborn heart disease were operated. Obstructive defects of the left heart were found in 178 children, obstructive defects of the right heart in 87, defects with a left-right shunt with pulmonary hypertension in 75, conotruncal malformations in 73 and various operations were made in 7 children. Complete repair of the defect was achieved in 281 neonates, incl. 104 where extracorporeal circulation was used. ⋯ Early mortality during the entire period was 26%, whereby a decrease from 40% to 16% was recorded during the last three years. At present it is possible to repair permanently critical inborn heart disease in the majority of neonates. This is made possible in particular by early non-invasive diagnosis, treatment with prostaglandins E in duct-dependent critical heart disease, optimal time for and selection of most suitable surgery, microsurgical technique, miniaturization of extracorporeal circulation and the method of deep hypothermia.