The Annals of thoracic surgery
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Case Reports
Long tracheobronchial and esophageal rupture after blunt chest trauma: injury by airway bursting.
Tracheobronchial rupture can be associated with blunt thoracic trauma. An important factor in the physiopathology of these lesions is reflex closure of the glottis, which can be related to closed chest trauma. ⋯ Both lesions were diagnosed by flexible bronchoscopy. The postoperative period was without serious complications.
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Comparative Study
Non-heart-beating donors: a model of thoracic allograft injury.
4ACKGROUND. Non-heart-beating donors (NHBDs) have been proposed for the critical shortage of donors for cardiac and pulmonary transplantation. We determined the effects of prearrest hypoxia and postarrest warm ischemia on cardiac and pulmonary allografts procured from NHBDs undergoing hypoxic arrest. ⋯ CONCLUSIONS. We conclude that prearrest hypoxic perfusion significantly contributes to the dysfunction of NHBD cardiac allografts. Pulmonary allografts may be more amenable to procurement of NHBDs.
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Randomized Controlled Trial Comparative Study Clinical Trial
Normothermic versus hypothermic cardiopulmonary bypass: do changes in coagulation differ?
The differences between hypothermic and normothermic cardiopulmonary bypass (CPB) on platelet function and endothelial-related coagulation (eg, the thrombomodulin/protein C/protein S system) should be investigated. ⋯ Hypothermic CPB resulted in more pronounced alterations of platelet aggregation and endothelial-related coagulation than normothermic CPB. Plasma levels of soluble thrombomodulin were more increased in hypothermic than in normothermic CPB indicating more extensive endothelial damage or activation associated with hypothermic CPB.
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The case of a 21-year-old woman without previous cervical pathology in whom irreversible tetraplegia developed after operation for tracheal stenosis is reported. After tracheal resection the neck was kept in extreme flexion and after extubation she was moved to a sitting position. The different causal agents that could produce the neurologic damage remain unclear, although we think that the combination of relative arterial hypotension secondary to the sitting position and disturbed autorregulation, caused by extreme neck flexion, could result in ischemic spinal cord injury.
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The treatment of infants with hypoplastic left heart syndrome has been challenging and controversial. ⋯ Both the Norwood procedure and heart transplantation have encouraging early to intermediate results in infants with hypoplastic left heart syndrome. Hypoplastic left heart syndrome should be managed selectively on the basis of cardiac morphology, donor availability, and family wishes. Development of a flexible program involving the use of both procedures may aid in the successful management of infants with hypoplastic left heart syndrome.