The Journal of thoracic and cardiovascular surgery
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The role of angiography in cervicothoracic trauma is controversial. Since 1967 the policy at San Francisco General Hospital has been to use liberal indications for angiography in hemodynamically stable patients with either penetrating or blunt cervicothoracic trauma. The 304 patients in Group 1 had emergency angiographic evaluation: 102 had penetrating cervical wounds: 202 had thoracic injuries-71 penetrating and 131 blunt trauma. ⋯ Angiographic results were useful whether abnormal or normal. In cases with adnormal findings operative treatment was specific and improper incisions were avoided. In cases with normal angiographic results, clarification of the vascular status avoided unnecessary operations and permitted concentration of therapeutic effort upon the main clinical problems of the patients.
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J. Thorac. Cardiovasc. Surg. · Nov 1978
Postperfusion lung syndrome. Comparison of Travenol bubble and membrane oxygenators.
To examine the role of the oxygenator in the postperfusion lung syndrome, we studied 16 patients undergoing aorta-coronary bypass with a bubble oxygenator and 14 similar patients with a membrane oxygenator both before and for 2 days after the operation. To maintain the same pulmonary artery occluded pressure and hemoglobin level at the end of the surgical procedure, significantly more blood was required in the bubble than in the membrane group. Postoperative pulmonary dysfunction in the bubble group was characterized by increased pulmonary vascular resistance (PVR) and lung water. ⋯ The bubble group had a significantly greater increase in PVR at the immediate postoperative study time than did the membrane group. PVR returned to control value for the duration of study. These differences in lung water and PVR measurements may be related to greater blood component trauma with a Travenol bubble oxygenator than with a membrane lung.
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J. Thorac. Cardiovasc. Surg. · Oct 1978
Use of microporous expanded polytetrafluoroethylene grafts for aorta-pulmonary shunts in infants with complex cyanotic heart disease. A report of seven cases.
Seven cyanotic infants in our institution have undergone central aorta--pulmonary artery shunt operations with a microporous expanded polytetrafluoroethlene (PTFE) graft. All of these patients have had pulmonary atresia, in four cases associated with endocardial cushion type defects. ⋯ Congestive heart failure and kinking of the pulmonary artery, frequently seen with other types of central aorta-pulmonary shunts, have not been a problem. Until further experience is gained with this procedure, however, we reserve its use to the occasional cyanotic infant in whom neither open-heart repair or the Blalock-Taussig shunt is feasible.
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J. Thorac. Cardiovasc. Surg. · Oct 1978
Sequential evaluation of DNCB reactivity in patients with primary lung cancer. Correlation with prognosis.
Delayed hypersensitivity reactions before therapy in 137 patients with lung cancer and in 50 patients with benign thoracic lesions were evaluated by 2,4-dinitrochlorobenzene (DNCB) contact sensitization using the patch test. Ninety-eight percent (49/50) of control patients and 46 percent (62/137) of patients with lung cancer were sensitized by 250 mug of DNCB. There was an excellent correlation between the initial reactivity to DNCB and resectability. ⋯ In 15 of 74 patients with resectable disease, the conversion was noted postoperatively, and among 12 patients followed for 2 years, only two patients had died. Conversion from a reactive to nonreactive status to DNCB occurred only in the terminal stage of the disease. From these observations, we found that, in order to evaluate the afferent limb of cellular immunity in patients with lung cancer who have once expressed reactivity to DNCB, one must use some new sensitizing agents which show no cross-sensitivity with each other thereafter.
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The incidence of postoperative delirium following coronary artery bypass surgery was 28%. This rate is comparable to that after open-heart surgery. ⋯ The relationship between personality type and delirium, previously found to be signficant, was suggestively associated in these patients. A history of myocardial infarction prior to surgery was significantly associated with delirium.