The Annals of thoracic surgery
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Resection of superior sulcus neoplasms is associated with a number of complications resulting from the extensive nature of the resection and the necessity to sacrifice certain adjacent structures. One of the complications of resection is the development of subarachnoid-pleural fistula, with the subsequent appearance of air in the cerebrospinal fluid circulation. We report a case in which a subarachnoid-pleural fistula led to persistent pneumocephaly in a patient who exhibited postoperative hyponatremia, confusion, and gait disturbance.
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Between 1983 and 1994, 115 infants and children underwent repair of a complete atrioventricular canal defect with the two-patch technique and routine mitral valve "cleft" closure. ⋯ For infants with complete atrioventricular canal defect, repair using the two-patch technique with routine mitral valve cleft closure at 4 to 6 months of age results in a low operative mortality, a low incidence of permanent heart block, and a low reoperation rate for mitral insufficiency.
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This report describes the conditions and results of coronary-coronary bypass using the radial artery on the right coronary artery. The angiographic and clinical results are excellent.
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Comparative Study
Exercise oximetry versus spirometry in the assessment of risk prior to lung resection.
Spirometry remains a standard method of assessing patient risk prior to lung resection despite its poor sensitivity and specificity. This study compares the relative ability of standardized exercise oximetry and spirometry--forced expiratory volume in the first second--to predict morbidity and mortality after lung resection. ⋯ We conclude that standardized exercise oximetry is a superior screen of the high-risk patient than spirometry (forced expiratory volume in the first second) prior to pulmonary resection when there are no other risk factors noted on initial history and physical examination. A prospective, randomized trial is required to substantiate this conclusion.
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Advances in myocardial protection have been instrumental in making cardiac surgery safer. Debate exists over the optimal medium and the optimal temperature for cardioplegia. Currently blood cardioplegia is preferred over crystalloid; the optimal temperature, however, remains controversial. ⋯ Warm blood cardioplegia represents the latest development in myocardial protection. Preliminary studies support its efficacy. Additional studies are needed to determine the ideal route of delivery and to identify any risks associated with the inherent warm cardiopulmonary bypass required.