The Thoracic and cardiovascular surgeon
-
Thorac Cardiovasc Surg · Oct 2001
Lipopolysaccharide-binding protein (LBP) and markers of acute-phase response in patients with multiple organ dysfunction syndrome (MODS) following open heart surgery.
Cardiopulmonary bypass (CPB) is associated with an immunological injury that may cause pathophysiological alterations in the form of a systemic inflammatory response syndrome (SIRS) or a multiple organ dysfunction syndrome (MODS). Previous studies on this issue have reported different changes of immunological parameters during and after CPB, but there are no reports about the lipopolysaccharide-binding protein (LBP) in relationship to other markers of inflammation in patients with MODS following cardiovascular surgery. In the present study, we investigated the acute-phase response of patients with MODS of infectious and non-infectious origin following open-heart-surgery. ⋯ CRP and LBP showed no differences between the MODS and the SIRS group. Comparing the MODS patients with and without positive microbial findings, we found significantly elevated levels of PCT and LBP in those patients with documented infections. Our results indicate that LBP may be a new marker for the differentiation between a severe non-infectious SIRS and an ongoing bacterial sepsis in the early postoperative course following CPB, while a microbiological result is still missing.
-
Thorac Cardiovasc Surg · Aug 2001
Case ReportsBronchial repair with pulmonary preservation for severe blunt trauma.
After a motorcycle accident, a 22-year-old male was diagnosed with multiple rib fractures, left-sided tension pneumothorax, hemothorax and left upper lobe bronchus rupture at its origin. An emergency left thoracotomy revealed an almost complete avulsion of the upper lobe bronchus from the main stem bronchus, a severely damaged pulmonary artery, and a concurrent deep intraparenchymal lower lobe laceration. ⋯ In the event of complex pulmonary trauma, pulmonary preservation is desirable since emergency pneumonectomy is usually associated with high mortality. Early bronchoscopic assessment, careful anesthetic management, and meticulous surgical technique with liberal use of fibrin glue were crucial to successful outcome.
-
Thorac Cardiovasc Surg · Aug 2001
Historical ArticleThe history of coronary artery surgery -- a brief review.
-
Thorac Cardiovasc Surg · Jun 2001
Randomized Controlled Trial Comparative Study Clinical TrialSerum S-100beta protein release in coronary artery bypass grafting: laminar versus pulsatile flow.
Cerebral injury after Cardiopulmonary bypass (CPB) is still a serious and unpredictable complication. The S-100beta serum marker has been suggested as potentially useful in the detection of cerebral injury during and after CPB. Direct comparisons of whether laminar or pulsatile pump flow in CABG leads to higher S-100beta values and which type might be more neuroprotective have not been made so far. ⋯ The results indicate that pulsatile flow might have a more neuroprotective effect than laminar flow as S-100beta values were lower.
-
Thorac Cardiovasc Surg · Jun 2001
Case ReportsParaplegia as an unusual manifestation of aortic coarctation.
In this report, we present an unusual case of a 20-year-old man whose first symptom of aortic coarctation was sudden paraplegia due to spinal epidural hemorrhage caused by rupture of an aneurysmal collateral vessel. Now, one year after surgical correction of coarctation, the patient has had no cardiac or neurological problems. To our knowledge, this is the only clearly documented case of such an aortic coarctation complication.