Thorax
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Case Reports
Tracheal laceration with massive subcutaneous emphysema: a rare complication of endotracheal intubation.
Our patient sustained a laceration of the membranous portion of the trachea associated with massive subcutaneous emphysema after an apparently uneventful intubation. The patient was successfully operated on within seven hours. The importance of prompt diagnosis and treatment in the event of this rare complicatoin and the different causative factors are discussed.
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Comparative Study
Peripheral vascular resistance and angiotensin II levels during pulsatile and non-pulsatile cardiopulmonary bypass.
The effects of pulsatile and non-pulsatile cardiopulmonary bypass (CPB) on levels of peripheral vascular resistance and plasma angiotensin II (AII) have been studied in 24 patients submitted to elective cardiac surgical procedures. Twelve patients had conventional non-pulsatile perfusion throughout the period of CPB (non-pulsatile group), while 12 had pulsatile perfusion during the central period of total CPB, using the Stockert pulsatile pump system (pulsatile group). There were no significant differences between the groups in respect of age, weight, bypass time, cross-clamp time, or in mean pump flow or mean perfusion pressure at the onset of CPB. ⋯ Plasma AII levels (normal less than 35 pg/ml) rose during perfusion from 49 pg/ml to 226 pg/ml in the non-pulsatile group. The rise in the pulsatile group from 44 pg/ml to 98 pg/ml was significantly smaller than that in the non-pulsatile group (P less than 0.01). These results indicate that pulsatile cardiopulmonary bypass prevents the rise in PVRI associated with non-pulsatile perfusion, and that this effect may be achieved by preventing excessive activation of the renin-angiotensin system, thus producing significantly lower plasma concentrations of the vasoconstrictor angiotensin II.