The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 1985
The surgical treatment of atrial myxomas. Clinical experience and late results in 33 patients.
Thirty-three patients (28 female and five male) from 17 to 70 years of age (mean age 48 years) underwent excision of left atrial myxomas between 1957 and 1981 at The Cleveland Clinic Foundation. Twenty-four patients presented with congestive heart failure, three with tachyarrhythmias, two with syncope, and one each with angina, peripheral embolization, hemoptysis, and recurrent pleural effusions. Symptoms were present from 1 to 72 months before operation (mean 11.2 months). ⋯ Altogether, 24 patients have been studied by two-dimensional echocardiography up to 20 years after operation (mean 4.0 years). In this series, excellent results were obtained by simple excision of the tumor, with or without a margin of normal atrial septum. Long-term clinical and echocardiographic follow-up is recommended since late recurrence, although rare, has been reported.
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J. Thorac. Cardiovasc. Surg. · Feb 1985
Venoarterial bypass: a technique for spinal cord protection.
In the present study, we examined the effects of various levels of oxygen tension on spinal cord blood flow while using somatosensory evoked potentials to monitor spinal cord sensory function during hypoxia. In this experiment, six adult, mongrel dogs were heparinized and placed on right atrial-femoral artery bypass with an oxygenator in the bypass circuit. The aorta was cross-clamped proximal to the left subclavian artery, and bypass flow and fluid balance were adjusted so as to maintain a distal aortic perfusion pressure of greater than 80 mm Hg. ⋯ The somatosensory evolved potential signal was invariably present as long as the distal aortic pressure was greater than 80 mm Hg; there were several transient hypotensive episodes (less than 5 minutes), which were accompanied by reversible loss of somatosensory evolved potentials. The spinal cord blood flow increased from 13.6 to 119.7 ml/100 gm/min as the distal oxygen tension fell to a mean value of 30 mm Hg, while latency of somatosensory evolved potentials increased 19.3% and amplitude decreased 43.3%. These results suggest the following conclusions: (1) In response to hypoxia, spinal cord blood flow dramatically increases and somatosensory evolved potentials deteriorate (increase in latency and decrease in amplitude). (2) However, during prolonged hypoxia, spinal cord sensory function can be maintained by sufficiently high flow rates and perfusion pressures. (3) Somatosensory evolved potentials can be used to monitor continuously spinal cord sensory function under these conditions.
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J. Thorac. Cardiovasc. Surg. · Feb 1985
Modified Blalock-Taussig shunt in infants and young children. Clinical and catheterization assessment.
The effectiveness of 19 modified Blalock-Taussig shunts performed with expanded polytetrafluoroethylene was evaluated clinically and by cardiac catheterization with angiography 4 to 24 months after operation. Fifteen patients underwent operation in infancy. Conduit diameters included 4 mm (nine cases), 5 mm (eight cases), and 6 mm (two cases) sizes. ⋯ There were no deaths. Thirteen children underwent more complete elective cardiac repair 5 to 24 months later. Although the modified Blalock-Taussig procedure is an effective short-term alternative to the classic Blalock-Taussig shunt, the effectiveness of the 4 mm diameter conduit may be limited without postoperative anticoagulant therapy.
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J. Thorac. Cardiovasc. Surg. · Jan 1985
Alterations of insulin and glucose metabolism during cardiopulmonary bypass under normothermia.
Anesthesia, surgical trauma, heparinization, priming volume composition, and temperature control of the heart-lung machine individually affect carbohydrate, protein, or lipid metabolism during cardiac operations. The impact of some of these factors on glucose and insulin regulation was assessed before, during, and after normothermic cardiopulmonary bypass in nondiabetic patients with use of a servo-controlled insulin delivery system. With a glucose-free prime, cardiopulmonary bypass induced a slight hyperglycemia but no endogenous insulin response, suggesting a partial inhibition of insulin secretion. ⋯ A glucose load in the priming fluid led to marked and persistent hyperglycemia without commensurate insulin release. Elevated stress hormone levels, a concomitant reduction of insulin release and insulin action, and a depression of peripheral glucose utilization, as demonstrated by glucose clamp experiments, contributed to these perturbations of glucose and insulin metabolism. Although the metabolic alterations observed are not critical in routine cardiac operations, they may become clinically significant in postoperative states with unusual persistence of stress conditions.
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A review of 56 cases of primary malignant germ cell tumors of the mediastinum revealed that, as with benign teratomas, the tumors occurred in young adults (mean age 29 years) but that the sex distribution differed (86% male and 14% female). A single germ cell element was found in 37 (66%) of the tumors, and various combinations were present in the remaining 19 (34%). The tumors were classified among five recognized types of germ cell tissues. ⋯ Although aggressive combination chemotherapy may represent a significant treatment modality for nonseminomatous mediastinal tumors, the present study spanned many years in which no chemotherapy was available. Patients in the later years of the study received combination chemotherapy with various treatment regimens. No conclusions concerning specific chemotherapy, therefore, can be derived from this study.