Chest
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The present study was undertaken to ascertain the feasibility of using a 25-gauge needle for arterial punctures. A total of 11,500 arterial punctures were performed over the past four years by this technique without any major complication. Repeated arterial punctures were well tolerated by all patients, and the necessity for indwelling arterial catheters was almost totally eliminated during this period of study.
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Pneumothorax as a complication of continuous positive pressure ventilation may result in the formation of bronchopleural fistula. If positive end-expiratory pressure cannot be sustained, the functional residual capacity and the ratio of alveolar ventilation to perfusion may decrease, and pulmonary gas exchange may be severely impaired. ⋯ We applied positive intrapleural pressure equal to the end-expiratory airway pressure of three patients who developed bronchopleural fistula during therapy for acute respiratory failure. Positive intrapleural pressure facilitated resolution of the bronchopleural fistula in each case.
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The clinical, hemodynamic, and pathologic findings in two newborn infants with persistent truncus arteriosus and stenosis of the truncal valve are described. In one case the anatomic features of the basic condition were classic, with a dysplastic semilunar valve which was mainly stenotic and also incompetent, while in the other the truncus arteriosus arose exclusively from the right ventricle and was almost exclusively stenotic. A ventricular septal defect was the only outlet for the left ventricle. In this case, mitral stenosis was also present and associated with a left-to-right shunt at the atrial level.
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A case of recurrent tumor emboli secondary to choriocarcinoma is described. The patient presented with obvious pulmonary hypertension and was diagnosed and treated as a case of multiple pulmonary embolism. Information which suggested the possibility of tumor emboli was indeed present but recognized only retrospectively.