Cardiovascular surgery (London, England)
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Comparative Study
A comparative study of the effect of autologous platelet-rich plasma and fresh autologous whole blood on haemostasis after cardiac surgery.
The effects of fresh autologous platelet-rich plasma and autologous whole blood on haemostasis after cardiopulmonary bypass were examined in adult cardiac surgery patients. Platelet count, adenosine diphosphate 10 microM maximum aggregation rate and clotting Factor VIII were greater in the platelet-rich plasma group (n = 11) than in the whole blood group (n = 8) after platelet-rich plasma or whole blood reinfusion. ⋯ The number of patients who required homologous blood transfusion was less in the platelet-rich plasma group. In conclusion, the reinfusion of autologous platelet-rich plasma improves haemostasis after cardiopulmonary bypass, and may enable surgery to be performed without homologous blood transfusion.
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Controversy exists over the value of intraoperative monitoring and shunting in patients undergoing carotid endarterectomy. Although it is widely believed that contralateral carotid occlusion and previous stroke mandate intraoperative shunting, the susceptibility of these two groups of patients to cerebral ischemia during carotid artery endarterectomy is not well defined. Somatosensory evoked potentials (SSEPs) were monitored in 113 carotid artery endarterectomy patients. ⋯ Thirty-two patients with prior strokes were selectively shunted (nine shunted, 23 not shunted); of these, one shunted patient undergoing combined carotid artery endarterectomy and coronary artery bypass grafting had a perioperative stroke. Intraoperative monitoring with SSEPs accurately identifies cerebral ischemia secondary to carotid clamping as well as patients requiring shunts. With use of intraoperative SSEP monitoring, selective shunting may be safely performed in patients with a contralateral carotid occlusion or a previous stroke.
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Adult respiratory distress syndrome, characterized by high permeability pulmonary oedema caused by endothelial cell damage, resulting in refractory hypoxemia, has a very high mortality. Cardiopulmonary bypass is said to be responsible for the development of adult respiratory distress syndrome after cardiac surgery. The present study was performed in order to identify predicting and aetiological factors of adult respiratory distress syndrome and multiple organ failure after cardiac surgery. ⋯ Preoperative predictors were identified. Cardiopulmonary bypass alone was not found to be an important factor. Postoperative low cardiac output leading to splanchnic hypoperfusion may be the most important single factor in developing adult respiratory distress syndrome after cardiac surgery.
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The initial treatment of uncontrolled hemorrhage shock from an abdominal source is controversial. The hemodynamic effects of transfemoral diaphragmatic aortic occlusion with a balloon followed by a single bolus of hypertonic saline solutions have been evaluated in 28 dogs. The animals were submitted to pressure-driven hemorrhage for 90 min, according to mean arterial pressure in the abdominal aorta and randomized into four groups, according to the treatment employed at 34 min after hemorrhage. ⋯ The recovery of mean arterial pressure in aortic-occluded dogs given isotonic NaCl was associated with a marked increase in systemic vascular resistance index, without improvements in cardiac index, systolic index and cardiac filling pressures. In occluded dogs given hypertonic NaCl and NaAc the mean arterial pressure recovery lasted longer, with lower increases in systemic vascular resistance index, while the cardiac index, systolic index and cardiac filling pressures showed a marked albeit transient increase. Injection of hypertonic saline following aortic occlusion produced significantly better hemodynamic profiles and should be seriously considered for the first treatment in severe uncontrolled hemorrhagic shock from an abdominal vascular source.
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Mycotic aortic aneurysm continues to present challenging and difficult management issues with a significant morbidity and mortality. The offending organism in the etiology of this aneurysm can be variable and unusual. The first report of two mycotic aortic aneurysms caused by Clostridium septicum in the same patient is described here. Presentation and management as well as conditions commonly associated with Clostridium septicum infection and a review of all clostridial mycotic aortic aneurysms in the English literature are discussed.