Thorax
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Comparative Study Clinical Trial
Cryoanalgesia in the management of pain after thoracotomy.
The demand for postoperative analgesia was compared between 29 patients treated with cryoanalgesia to the relevant intercostal nerves during thoracotomy and a control group who did not have cryoanalgesia. The cryoanalgesia group required significantly less (p < 0.005) postoperative analgesia than did the control group.
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Lung volumes, maximum expiratory flow rates, and static volume-ressure curves were measured in 16 patients with clinically stable asthma. It was found that flow rates were reduced in such patients because of the combined effects of reduced elastic recoil (transpulmonary pressure) and intrinsic diseases of the airways. In nine patients treated with an aerosol of isoprenaline, flow rates improved as a result of reduction in airways resistance as the static recoil pressure of the lungs fell further in those patients. The possibility is suggested that muscle tone in peripheral airways or alveolar ducts contributed to the elastic recoil measurements.
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In 10 patients undergoing ventilation, venous admixture was measured at different values of positive end-expiratory pressure (PEEP). The measurements were performed at the level of fractional inspired oxygen (FIO2) at which each patient was ventilated, and at FIO2=1. ⋯ With FIO2=1, increased PEEP produced a reduction in venous admixture in all cases (p less than 0.05). These observations suggest that in patients similar to ours, PEEP does not reduce venous admixture at low levels of FIO2 (0.21--0.3), and the observed reduction with PEEP at FIO2=1 may be misinterpreted.
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Comparative Study
Intravascular haemolysis after valve replacement: comparative study between Starr-Edwards (ball valve) and Björk-Shiley (disc valve) prosthesis.
Seventy-four patients with single prosthetic valves (Björk-Shiley or Starr-Edwards) in the mitral or aortic position and 18 controls with rheumatic valvar heart disease were investigated for evidence of intravascular haemolysis. Serum lactate dehydrogenase (LDH) was used as the most sensitive indicator of haemolysis. ⋯ Eight out of 12 patients with haemosiderinuria had Starr-Edwards valves. Intravascular haemolysis was of little clinical significance in patients with Björk-Shiley prostheses, but some patients with Starr-Edwards prostheses became iron deficient as a result.
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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.