The Journal of the Kentucky Medical Association
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Prevention of perioperative cerebrovascular injury in patients undergoing open heart surgery is a serious task for the surgeon, especially as age and severity of atherosclerotic disease increases. The most significant predisposing factors have been identified as existing carotid arterial disease or prior stroke, heavy calcification of the aorta, renal dysfunction, advanced age, and diabetes mellitus. We have studied a series of 600 open heart patients from 1992 to 1995 from the incidence of peri-operative stroke and mortality, evaluating 16 risk factors: heavy calcification of the ascending aorta, asymptomatic carotid disease, insulin-dependent diabetes mellitus, prior CVA, left ventricular function (ejection fraction of 20% or less), age greater than 70, renal dysfunction, transmural myocardial infarction, fluid balance index greater than 2500 ccs, smoking, type of procedure, emergency procedure, non-insulin-dependent diabetes mellitus, cardiopulmonary bypass time, gender, and hypertension Stroke occurred in 8 patients (1.3%), one of whom die postoperatively. ⋯ Two of 9 patients with heavy calcification of the aortic arch suffered cerebrovascular injury. Six or more of the risk factors studied were present in 81 patients; all 8 stroke patients (9.9%) came from this subgroup. The study suggests the importance of pre-operative evaluation of cerebrovascular atherosclerotic disease and the minimal manipulation ("minimal touch" technique) of a calcific aortic arch.
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Comparative Study
The lateral chest radiograph in the detection of pericardial effusion: a reevaluation.
The purpose of this study was to evaluate the usefulness of 10 previously published plain film signs for diagnosing pericardial effusion and to determine whether the posteroanterior (PA) or lateral chest radiograph was the better view for detecting pericardial effusion. A retrospective study of 100 consecutive adult patients with pericardial effusions confirmed by echocardiography and/or computed tomography was undertaken. Five signs were found to be useful in detecting pericardial effusion on plain films, and the lateral chest radiograph was found to be better than the PA view in detecting pericardial effusion. ⋯ However, these signs were only seen in moderate-to-large effusions. The displaced epicardial fat pad sign and the posteroinferior bulge sign on the lateral view improved the detection of moderate-to-large pericardial effusions, and were also present in many of the cases with small pericardial effusions. Recognition of specific signs of pericardial effusion on the lateral chest radiograph may significantly improve the plain film detection of pericardial effusion.