The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 1976
Case ReportsHemolysis following correction of double-outlet right ventricle.
A 41/2-year-old child developed a severe degree of intravascular hemolysis within 24 hours after intraventricular correction of double-outlet right ventricle with a Dacron patch. The child developed jaundice, with a serum bilirubin of 4.3 mg. per cent. ⋯ We presume that the hemolysis was due to turbulence caused by a long, curved patch and that its disappearance coincided with the endothelialization of the patch. The child is well 3 years after the operation.
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J. Thorac. Cardiovasc. Surg. · Feb 1976
Comparative Study Clinical TrialImmunologic defects in lung cancer patients.
Ninety-three patients with lung cancer were evaluated by delayed cutaneous hypersensitivity testing. Twenty-eight of these patients were evaluated by in vitro lymphocyte function. ⋯ In vitro and in vivo studies indicate an antigen recognition defect in the cellular immune mechanisms of these patients. Preliminary studies suggest that the immunopotentiating agent Levamisole may be able to augment this defective cellular immunity in patients with lung cancer.
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J. Thorac. Cardiovasc. Surg. · Feb 1976
Comparative StudyChronic hemolysis following mitral valve replacement. A comparative study of the Björk-Shiley, composite-seat Starr-Edwards, and frame-mounted aortic homograft valves.
Hemolysis was assessed in 86 patients after mitral valve replacement. Twenty-four patients had mitral valve replacement with a Björk-Shiley valve, 32 patients with a Starr-Edwards composite-seat valve, and 30 patients with an irradiated frame-mounted aortic homograft valve. Hemolysis was determined by red cell survival and autologous 51Cr-tagged red cells, LDH, serum haptoglobin, hemosiderinuria, reticulocyte count, red cell fragment count, and hemoglobin estimation. ⋯ The homograft series did not show any comparable evidence of hemolysis. Statistical analysis of the parameters of the study comparing homograft with Björk-Shiley valves showed no significant difference except in red cell survival, which showed a highly significant difference (p less than 0.001). Comparing homograft with Starr-Edwards valves, all parameters showed highly significant differences (p less than 0.001).
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J. Thorac. Cardiovasc. Surg. · Jan 1976
Cricothyroidotomy: elective use in respiratory problems requiring tracheotomy.
Surgical teachings insist that cricothyroidotomy should be performed only under emergency conditions as a temporary means of securing an airway. Subsequent subglottic stenosis is thought to occur in alarming numbers of patients intubated for any length of time. The incidence of complications associated with cricothyroidotomy has not been critically examined since Jackson's classic paper in 1921, condemning the operation. ⋯ Chronic subglottic stenosis did not occur, although 5 patients required resection of tracheal strictures. No additional complications occurred if the procedure was carried out at the bedside instead of in the operating room. The simplicity, absence of cross-contamination of median sternotomy incisions, and safety documented by this study recommend routine use of cricothyroidotomy in patients whose management requires tracheotomy.
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J. Thorac. Cardiovasc. Surg. · Dec 1975
Comparative StudyLong-term morphologic and hemodynamic evaluation of the left ventricle after cardiopulmonary bypass. A comparison of normothermic anoxic arrest, coronary artery perfusion, and profound topical cardiac hypothermia.
In order to assess the long-term effects of cardiopulmonary bypass (CPB) in combination with pupular methods of myocardial protection, 37 dogs were placed on CPB for 100 minutes with the use of a bubble oxygenator without hemodilution. A separate group (I) of eight normal dogs served as a control for assessment of hemodynamic changes. The operative groups were as follows: II, continuous coronary perfusion with an empty, beating heart for 60 minutes at 35 degrees C.; III, hypothermic anoxic arrest (aortic occlusion) for 60 minutes with topical cold saline lavage (4 degrees C.); IV, anoxic arrest for 60 minutes at 35 degrees C. ⋯ Evidence of subendocardial fibrosis was found in each of the operative groups, with the most marked changes found in the normothermic arrest group. Moderate fibrosis was present, however, in some survivors in both the continuous coronary perfusion and topical hypothermic arrest groups. These data indicate that although survival is greatly enhanced when coronary artery perfusion or topical hypothermia is used, neither method prevents chronic deterioration in ventricular function nor the development of subendocardial fibrosis.