The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 1996
Comparative StudyMediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography.
We compared the abilities of positron emission tomography and computed tomography to detect N2 or N3 lymph node metastases (N2 or N3) in patients with lung cancer. Positron emission tomography detects increased rates of glucose uptake, characteristic of malignant cells. Patients with peripheral tumors smaller than 2 cm and a normal mediastinum were ineligible. ⋯ Positron emission tomography mislabeled one node station as positive (100% sensitive, 98% specific, positive predictive value 91%). The differences were significant when the data were analyzed both for individual lymph node stations (p = 0.039) and for patients (p = 0.031) (McNemar test). Positron emission tomography and computed tomography are more accurate than computed tomography alone in detecting mediastinal lymph node metastases from non-small-cell lung cancer.
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J. Thorac. Cardiovasc. Surg. · Mar 1996
Comparative StudyInterleukin-10 release related to cardiopulmonary bypass in infants undergoing cardiac operations.
To evaluate cytokine balance related to cardiopulmonary bypass, we prospectively investigated 11 infants undergoing cardiac operations for congenital heart disease. Proinflammatory cytokines (tumor necrosis factor-alpha and interleukin-8) and the antiinflammatory cytokine interleukin-10 were measured at multiple time points before, during, and after bypass. Tumor necrosis factor-alpha and interleukin-8 values were within normal range before the operation. ⋯ This result suggests that besides immunologically mediated production of interleukin-10, hypothermia itself could modulate interleukin-10 production. In conclusion, this study demonstrates interleukin-10 production, in addition to interleukin-8 and tumor necrosis factor-alpha synthesis, in response to cardiopulmonary bypass in infants. Interleukin-10 could play a protective role by down-regulating proinflammatory cytokine release during and after cardiopulmonary bypass.
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J. Thorac. Cardiovasc. Surg. · Mar 1996
Comparative StudyCoronary arterial perfusion during venoarterial extracorporeal membrane oxygenation.
The effects of venoarterial extracorporeal membrane oxygenation on left ventricular performance have not been studied in detail. Coronary arterial flow obtained by direct measurement with an electromagnetic flowmeter and blood gas analysis from the aortic root were tabulated during venoarterial extracorporeal membrane oxygenation 14 puppies, and these parameters were evaluated with respect to changes in the venoarterial extracorporeal membrane oxygenation flow. Unique automatic blood pumps generating pulsatile flow were used for the venoarterial extracorporeal membrane oxygenation bypass. ⋯ The decrease in coronary arterial flow is therefore predominantly caused by increased coronary arterial resistance. Tension-time index, an indicator of myocardial oxygen consumption, did not decrease with venoarterial extracorporeal membrane oxygenation. In conclusion, high-flow venoarterial extracorporeal membrane oxygenation causes undesirable hemodynamic effects on the left ventricle.
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J. Thorac. Cardiovasc. Surg. · Feb 1996
Clinical TrialHomograft replacement of the mitral valve. Graft selection, technique of implantation, and results in forty-three patients.
Because of experience gained in reconstructive mitral valve surgery, we have reevaluated the implantation of cryopreserved homografts in the mitral position. Forty-three patients, aged 11 to 69 years (mean 34 years), underwent mitral valve replacement with cryopreserved mitral homografts. The indications for the procedure were acute endocarditis (n = 14), rheumatic stenosis (n = 26), systemic lupus endocarditis (n = 2), and marasmic endocarditis (n = 1). All homografts were obtained from hearts explanted in the course of transplantation and were cryopreserved at -160 degrees C in 10% dimethyl sulfoxide solution without antibiotics. Appropriate sizing was based on morphologic study of the homografts and preoperative echocardiographic assessment of the recipient valve. In 82 homografts analyzed, the height of the anterior leaflet was 25 +/- 3 mm and the distance from the anulus to the apex of the anterior papillary muscle was 21 +/- 3 mm. The morphologic features of the papillary muscles were classified according to four types of increasing complexity. Nine valves with complex (type IV) papillary muscle abnormalities were discarded. Echocardiographic measurements of the valve were matched with those of the homograft identification cards and a slightly larger homograft was selected (measurements + 3 mm). Partial homograft replacement was done in case of a localized lesion (abscess or calcification) (n = 21). Total homograft replacement was undertaken in the presence of diffuse lesions (n = 22). Two hospital deaths occurred as a result of poor cardiac output. One patient required reoperation on the tenth postoperative day after a dehiscence on the valvular suture line. After a mean follow-up of 14 months, there has been one late death caused by a bronchial neoplasm and one reoperation for residual stenosis (partial replacement). The remaining patients were in either New York Heart Association class I (n = 25) or II (n = 13). Thirty-three patients were in sinus rhythm. Follow-up echocardiography has revealed no mitral regurgitation (n = 20), minimal mitral regurgitation (n = 13), and mild mitral regurgitation (n = 5). Surface valve area has been calculated at 2.5 +/- 0.4 cm2 in partial homograft reconstruction and 2.7 +/- 0.3 cm2 in total homograft replacement, with a transvalvular gradient of 3 +/- 4 mm Hg. ⋯ In a selected group of patients, the use of mitral homografts significantly extended the present limitations of reparative surgery of the mitral valve.