The Annals of thoracic surgery
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Clinical Trial Controlled Clinical Trial
Effect of routine fibrin glue use on the duration of air leaks after lobectomy.
The effectiveness of fibrin glue as a sealant to reduce postoperative air leaks after pulmonary lobectomy was evaluated in 28 consecutive patients between November 1988 and May 1989. A fibrin glue spray was used in 14 patients, and 14 patients served as controls. Assignment of either group was made before thoracotomy. ⋯ The fibrin glue-treated group had a mean air leak duration of 2.3 +/- 3.7 days, chest tube drains for 6 +/- 4.1 days, and a postoperative hospitalization of 9.8 +/- 3.1 days. The control group had a mean air leak duration of 3.3 +/- 3.3 days (p = 0.94), chest tube drains for 5.9 +/- 3.9 days (p = 0.95), and a postoperative hospitalization of 11.5 +/- 3.9 days (p = 0.21). We conclude that the routine use of a fixed quantity of fibrin glue is not effective in reducing the duration of air leaks, chest tube drainage, or hospitalization after uncomplicated pulmonary lobectomy.
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With the pH-stat acid-base regulation strategy during hypothermic cardiopulmonary bypass (CPB), carbon dioxide (CO2) is generally administered to maintain the partial pressure of arterial CO2 at a higher level than with the alpha-stat method. With preserved CO2 vasoreactivity during CPB, this induction of "respiratory acidosis" can lead to a much higher cerebral blood flow level than is motivated metabolically. To evaluate CO2 vasoreactivity, cerebral blood flow was measured using a xenon 133 washout technique before, during, and after CPB at different CO2 levels in patients who were undergoing coronary artery bypass grafting with perfusion at either hypothermia or normothermia. ⋯ After CPB, a transient increase in cerebral blood flow was noted in the hypothermia group, the reason for which remains unclear. The study shows that manipulation of the CO2 level at different temperatures results in similar changes in cerebral blood flow irrespective of the estimated metabolic demand. This finding further elucidates the question of whether alpha-stat or pH-stat is the most physiological way to regulate the acid-base balance during hypothermic CPB.
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Case Reports
Ventricular pseudoaneurysm associated with cardiopulmonary resuscitation 6 weeks after mitral valve replacement.
Trauma to the heart and mediastinum is associated with external cardiac massage. A patient had undergone a redo mitral valve replacement and experienced an uneventful postoperative course. ⋯ Postresuscitation evaluation revealed a posterior pseudoaneurysm of the ventricle. This was repaired via a transthoracic approach with the use of profound hypothermia.
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We retrospectively reviewed the records of 99 patients who suffered sternal fractures between 1968 and 1987. Patients ranged in age from 5 to 86 years. The most common cause of injury was a motor vehicle accident. ⋯ Traumatic aortic rupture occurred in 2 of 99 patients with sternal fractures (2%) and in 75 of 2,106 patients without sternal fracture (3.6%). This difference was not statistically significant by the Fisher exact test (p = 0.326). We conclude that traumatic aortic rupture does not occur more commonly in patients with sternal fracture when compared with other patients with blunt chest injuries.
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A patient sustained an episode of hypoxemia during cardiopulmonary bypass. Investigation of the extracorporeal circuit after successful resolution of the problem showed that a white, crystalline substance later identified as mannitol occluded the oxygen supply line to a bubble oxygenator. The management and subsequent investigation of the problem are presented.