J Cardiovasc Surg
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Randomized Controlled Trial Comparative Study Clinical Trial
Application of cryoprecipitate as a hematostatic glue.
The effectiveness of cryoprecipitate, harvested from a patient's own fresh frozen plasma, for use in cardiac surgery as a hematostatic glue was studied in 32 randomized elective adult cardiac surgery patients from January 1993 to July 1994. ⋯ We conclude that autologous samples of human cryoprecipitate prepared from a patient's own FFP had a strong hematostatic effect compared to conventional fibrin glue and was a very valuable hematostatic agent during cardiac surgery.
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Comparative Study
Intraoperative management for removal of tumor thrombus in the inferior vena cava or the right atrium with multiplane transesophageal echocardiography.
To investigate the role and impact of multiplane transesophageal echocardiography during thrombectomy in the inferior vena cava or the right atrium. ⋯ We presented four surgical cases, in which the removal of the tumor extended into the inferior vena cava or the right atrium using MTEE. MTEE could provide valuable information such as excellent images of the tumor, cardiac function, the position of a cannula or the caval occlusion balloon catheter. These findings could improve the anesthetic management of the patients, as well as the surgical approach and technical maneuvers, and facilitate removal of neoplasm into the IVC.
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A new form of postperfusion manifestation is detailed, a vasoplegic syndrome presenting in the postoperative period after cardiopulmonary bypass (CPB) heart surgery. ⋯ The appearance of vasoplegic syndrome augmented operative morbidity with a consequent increased risk to the patient in the early postoperative period.
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A case of lobar torsion after lung surgery is reported here. She developed a right middle lobar torsion diagnosed by postoperative bronchial fiberscopy, suggesting incomplete obstruction of the intermedial bronchus. Re-operation was performed successfully either by fixing the right lower lobe to both the middle lobe and the thoracic wall. Careful postoperative observation with chest radiography, bronchial fiberscopy, are important for precise diagnosis of and therapy for lobar torsion following pulmonary lobectomy.
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Comparative Study
r-Hirudin inhibits platelet-dependent thrombosis during cardiopulmonary bypass in baboons.
Systemic anticoagulation is required during cardiopulmonary bypass (CPB) to inhibit the activation of platelets, the coagulation system and ultimately thrombus formation. Unfractionated heparin is most commonly used, but it is neither entirely safe nor completely effective. The use of protamine sulphate to reverse the anticoagulant effect further complicates the use of heparin. The clinical need for a heparin substitute is therefore obvious. We evaluated the efficacy of r-Hirudin, a potent and specific inhibitor of thrombin, as anticoagulant in a baboon model of cardiopulmonary bypass. ⋯ Our results strongly suggest that r-Hirudin is superior to heparin especially with respect to its inhibitory effect on platelet dependent thrombogenesis caused by the biomembranes of the oxygenator.