The Annals of thoracic surgery
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Comparative Study
Neutrophil adhesion molecule expression during cardiopulmonary bypass with bubble and membrane oxygenators.
The neutrophil-mediated tissue injury associated with cardiopulmonary bypass (CPB) is thought to require the interaction of specific neutrophil and endothelial adhesion molecules. In this study, the effects of CPB on the expression of neutrophil CD11b and CD18 (the components of the Mac-1 adhesion molecule) were examined; the effects of membrane versus bubble oxygenators on the expression of neutrophil CD11b and CD18 were compared; and the plasma levels of the intercellular adhesion molecule-1 (cICAM-1), an inducible endothelial adhesion molecule, were measured. In addition, the time courses of complement activation and neutrophil granule release were measured to determine their temporal relationship to the expression of the neutrophil adhesion molecule. ⋯ Blood samples were drawn before, during, and after CPB for determination of the expression of neutrophil CD11b and CD18 (immunofluorescent flow cytometry), and the plasma cICAM-1, elastase, lactoferrin (enzyme-linked immunoabsorbent assay), and plasma C3a (radioimmunoassay) levels. CPB caused an immediate and sustained increase in the neutrophil CD11b and CD18 expression in both groups; after 60 minutes of CPB, CD11b expression had increased by 116.9% +/- 19.1% in group B and by 79.3% +/- 8.5% in group M (p = 0.78). Over the same period, CD18 expression increased by 97.2% +/- 17.9% in group B and by 72.4% +/- 16.8% in group M (p = 0.67).(ABSTRACT TRUNCATED AT 250 WORDS)
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A 32-year-old woman swallowed a fish bone and presented to the hospital 3 days later with chest pain and fever. While in the hospital, she became hypotensive. ⋯ At the time of the operation, the fish bone was noted to be abrading the surface of the left atrium. We report this case of cardiac tamponade secondary to a perforated esophagus after foreign body ingestion.
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Comparative Study
Pulsatile versus nonpulsatile reperfusion improves cerebral blood flow after cardiac arrest.
Cardiopulmonary bypass using nonpulsatile flow (NF) is currently advocated for treating refractory cardiac arrest. Although the heart can be revived using cardiopulmonary bypass support, the brain must recover if such therapy is to be considered successful. Previous studies have demonstrated that pulsatile flow (PF) reperfusion can improve neurologic outcome compared with NF reperfusion after cardiac arrest. ⋯ There were no statistically significant differences in brain perfusion variables by 15 minutes of reperfusion. However, a relative hyperemia was exhibited at 15 minutes of NF versus PF reperfusion, which suggests nutrient flow was insufficient during early NF versus PF reperfusion. In conclusion, PF reperfusion can better restore cerebral blood flow and oxygen consumption than can NF reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Thoracic surgeons have recently pursued innovative techniques that can help minimize postoperative pain. These have taken two basic directions. The first consists of a modification of the operative procedure itself, such that the surgical insult and hence the resulting pain are minimized. ⋯ Many authors have advocated the induction of spinal analgesia after thoracotomy, using either epidural opioids or local anesthesia, or both. Patient-controlled analgesia and multiple intercostal nerve blocks are other methods for managing postthoracotomy pain. The potential benefits conferred by aggressive pain control after thoracotomy are enormous for the patients, the surgeons, and the entire health-care system.