Cardiovascular surgery (London, England)
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Randomized Controlled Trial Clinical Trial
Antifibrinolytic therapy with tranexamic acid in cardiac operations.
To demonstrate its antifibrinolytic effects and establish an effective regimen of tranexamic acid for hemostasis, the authors measured alpha2-plasmin inhibitor-plasmin complexes, thrombin-antithrombin III complexes and postoperative blood loss in three groups undergoing different regimens during cardiac operations. Forty-six patients undergoing coronary artery bypass grafting or valve replacement were enrolled in this study. They were divided into three groups of drug administration. ⋯ The difference in postoperative blood loss only reached significant levels between the control group and group B (P < 0.05). Although a significant increase in thrombin-antithrombin III complexes during cardiopulmonary bypass was similarly observed in all groups, no thromboembolic events occurred in any group, nor was any difference seen in graft patency. From the tranexamic acid therapy regimens tested in this study, a continuous infusion of 10 mg/kg per h starting at the time of skin incision to 6 h after cardiopulmonary bypass, with a bolus infusion of 50 mg/kg at the beginning of cardiopulmonary bypass, proved to be the most effective.
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Case Reports
Replacement of the common carotid artery by a plastic prosthesis. Report of a case with forty years of follow-up.
An 18-year-old man suffered a 38 caliber gunshot wound to the right side of the neck on 25 September 1957. On 16 October 1957, a traumatic arteriovenous aneurysm between the common carotid artery and the internal jugular vein was resected. ⋯ The patient has been followed-up during more than 40 years and his condition is normal. To the best of our knowledge, this operation was the first of its kind performed in the world and has the longest follow-up.
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Comparative Study
Lumbar sympathectomy in critical limb ischaemia: surgical, chemical or not at all?
The value of surgical and chemical lumbar sympathectomy was studied in patients with critical lower-limb ischaemia without the option of vascular reconstruction. Clinical success rates, defined as improvement of ischaemia stage, and limb salvage rates were recorded for 76 limbs of 70 consecutive patients. Chemical lumbar sympathectomy patients were older and had more concomitant diseases than surgical lumbar sympathectomy patients. ⋯ Complications were minor in both groups. Lumbar sympathectomy still has a limited role in the treatment of critical limb ischaemia in patients without the option of vascular reconstruction. Both surgical and chemical lumbar sympathectomy can be performed with very little morbidity and may provide a benefit over the natural course of the arterial insufficiency.