The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2002
Aggressive management of lung donors classified as unacceptable: excellent recipient survival one year after transplantation.
A dire shortage of lungs for transplantation exists. We hypothesized that aggressive organ procurement organization management of lungs usually rated as unacceptable (ratio of Pao(2) to inspired oxygen fraction <150) might make them acceptable for transplantation. We also hypothesized that lungs from donors who died of trauma could be used for transplantation with recipient survival comparable with that seen with lungs from donors who died of nontraumatic causes. ⋯ Aggressive organ procurement organization management of donors initially considered unacceptable may increase the number of lungs available for transplantation.
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J. Thorac. Cardiovasc. Surg. · Aug 2002
Proportion of ground-glass opacity on high-resolution computed tomography in clinical T1 N0 M0 adenocarcinoma of the lung: A predictor of lymph node metastasis.
In patients with clinical T1 N0 M0 lung adenocarcinoma, we investigated whether the proportion of ground-glass opacity area measured on high-resolution computed tomography was valuable for predicting the existence of lymph node metastasis, lymphatic invasion, or vascular invasion. ⋯ In patients with clinical T1 N0 M0 adenocarcinoma, the proportion of ground-glass opacity area on thin-section computed tomography scans was a strong predictor for tumor aggressiveness and thus could be a useful index for planning limited surgical resection for these patients.
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J. Thorac. Cardiovasc. Surg. · Aug 2002
Cardiopulmonary bypass for bilateral sequential lung transplantation in patients with chronic obstructive pulmonary disease without adverse effect on lung function or clinical outcome.
The use of cardiopulmonary bypass in lung transplantation remains controversial. Previous studies have concluded that cardiopulmonary bypass is deleterious, but these studies were confounded by the inclusion of patients with different diagnoses undergoing single- and double-lung transplantation with elective or emergency use of bypass. The goal of this study was to determine whether cardiopulmonary bypass has deleterious effects on lung function or clinical outcome by analyzing the cases of patients with a single disease entity and elective use of bypass for bilateral sequential lung transplantation. ⋯ Cardiopulmonary bypass appears to have no deleterious effect on early lung function or clinical outcome. We hope that this pilot study removes some of the unwarranted fear of the use of bypass in lung transplantation for chronic obstructive pulmonary disease.
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J. Thorac. Cardiovasc. Surg. · Aug 2002
Myocardial protection with oxygenated esmolol cardioplegia during prolonged normothermic ischemia in the rat.
We previously showed that arrest with multidose infusions of high-dose (1 mmol/L) esmolol (an ultra-short-acting beta-blocker) in oxygenated Krebs-Henseleit buffer (esmolol cardioplegia) provided complete myocardial protection after 40 minutes of normothermic (37 degrees C) global ischemia in isolated rat hearts. In this study we investigated the importance of oxygenation for protection with esmolol cardioplegia, compared it with that of St Thomas' Hospital cardioplegia, and determined the protective efficacy of multidose esmolol cardioplegia for extended ischemic durations. ⋯ Oxygenation of esmolol cardioplegia (Krebs-Henseleit buffer plus 1.0 mmol/L esmolol) was essential for optimal myocardial protection. Multidose infusion of oxygenated esmolol cardioplegia provided good myocardial protection during extended periods of normothermic ischemia. Esmolol cardioplegia may provide an efficacious alternative to hyperkalemia.