The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 1978
Case ReportsExtracorporeal membrane oxygenator support for human lung transplantation.
Extracorporeal membrane oxygenator (ECMO) support was provided for a 19-year-old boy undergoing right lung transplantation. Perfusion was begun several hours prior to transplant, to correct profound hypercapnia. After the operation, ECMO was required because of inadequate gas exchange by the transplanted lung. ⋯ During this time, the temporary malfunction of the transplanted lung owing to the reimplantation response reversed, and the patient was successfully removed from the oxygenator and subsequently weaned from the ventilator. He died on the eighteenth postoperative day of bronchial dehiscence. ECMO support appears to be a feasible means of supporting patients during lung transplantation and during the period of reversible lung malfunction that may occur in the early postoperative period.
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J. Thorac. Cardiovasc. Surg. · Jun 1978
Case ReportsMassive impalement wound of the chest. A case report.
A 29-year-old man sustained an impalement wound of the right side of the chest with a 6 foot long, 4 by 4 inch wooden post during a high-speed automobile accident. The post entered the right side of the chest anteriorly and exited posteriorly. ⋯ Removal of the post, treatment of pulmonary parenchymal damage, and reconstruction of the two large chest wall defects presented problems in management. Rapid transport of the patient to the hospital, effective emergency treatment, surgical repair of the chest injury, and appropriate supportive measures contributed to his survival.
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J. Thorac. Cardiovasc. Surg. · May 1978
Surgery for coccidioidomycosis in 52 diabetic patients with special reference to related immunologic factors.
Fifty-two diabetic patients who underwent pulmonary surgery for coccidioiodmycosis were evaluated by a retrospective study which included classification by stage of disease, status of insulin dependency, and reaction to coccidioidin skin test. The insulin-dependent diabetic patient had a fourfold increase in the incidence of more severe (progressive) disease. ⋯ Such surgery in the progressive stages should be totally extirpative. The presence of inadequately resected disease may adversely affect subsequent immunologic resistance of the host.
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J. Thorac. Cardiovasc. Surg. · Apr 1978
Comparative StudyComparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. II. The effects on adrenal secretion of cortisol.
Previous studies have indicated that a significant reduction in plasma cortisol levels occurs during nonpulsatile cardiopulmonary bypass as a result of adrenocorticol hypofunction. The Stöckert pulsatile pump system described in Part I has been employed in a comparative study of plasma cortisol levels in 20 patients subjected to pulsatile or nonpulsatile perfusion during open-heart surgery. ⋯ Correction of the plasma cortisol values for the effect of hemodilution was performed and, again, corrected cortisol values indicated a highly significant increase in end-bypass levels in the pulsatile groups (p less than 0.001). These results clearly indicate that the reduction in cortisol secretion during nonpulsatile bypass may be prevented by the use of pulsatile perfusion.