Thorax
-
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.
-
Case Reports
Elective correction of intracardiac lesions resulting from penetrating wounds of the heart.
Controversy exists regarding the timing and technique of total correction of traumatic intracardiac lesions. Five patients with penetrating wounds of the heart received emergency treatment aimed at securing normal haemodynamics. No attempt was made to identify intracardiac lesions at this stage. ⋯ Traumatic intracardiac lesions in patients with stable haemodynamics after initial treatment should be operated on electively. The aortic approach is preferable for aorto-right ventricular fistulae. Conservative plastic repair of valvar injuries achieves long-term competence thus avoiding prosthetic replacement.
-
Hydropneumopericardium is a very rare and usually fatal complication of peptic oesophageal ulceration. The patient reported here survived and the report resembles one previously made about a child. In both patients failure to show the fistula radiologically or on endoscopy suggests that rapid spontaneous healing had occurred, and that this was responsible for survival.
-
Case Reports
The pulmonary angiographic appearance of pleurisy associated with subdiaphragmatic inflammation.
In two patients who had recently undergone major abdominal operations and were later suspected of having pulmonary emboli, pulmonary angiography showed no evidence of embolism, but in both cases one of the hemidiaphragms was clearly outlined by contrast material. It is suggested that subdiaphragmatic inflammation was responsible for this unusual appearance.
-
A technique for the management of anterior flail chest consisting of osteosynthesis and the positioning of two long Kirschner wires behind the sternum in the form of a St Andrew's cross is described. The procedure is easy to perform, the patient is ambulant early, and the results are good.