Scandinavian journal of thoracic and cardiovascular surgery
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Scand J Thorac Cardiovasc Surg · Jan 1995
Randomized Controlled Trial Clinical TrialThrombin generation during cardiopulmonary bypass using heparin-coated or standard circuits.
For quantitative comparison of thrombin generation during cardiopulmonary bypass (CPB) with heparin-coated vs conventional CPB circuits, thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F1 + 2) were analyzed in 20 patients undergoing combined heart valve surgery and coronary artery bypass grafting (CABG), in ten cases with heparin-coated circuits (COMB-HC) and in ten with standard circuits (COMB-C). Extensive thrombin generation was found in both groups, with maximal TAT and F1 + 2 levels at the end of CPB. Of 15 operations with only CABG, seven were performed with heparin-coated circuits and heparin dose 40% of normal (CABG-HC), and eight with standard circuits and normal heparin doses (CABG-C). ⋯ The abundant thrombin generation during CPB thus was much more pronounced during complex operations. Use of heparin-coated circuits did not reduce thrombin generation, which was increased by 60% reduction of the systemic heparin dose. The clinical implications are still unknown, as no complications were observed.
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Twenty-three cases of inferior vena caval injury (1.4% of all operatively managed abdominal injuries) are reviewed. The caval injury presented as free haemorrhage in 15 cases and as a retroperitoneal haematoma in eight. The site of vena caval injury was at or above the level of the renal veins in 14 cases (61%). ⋯ Factors positively associated with survival were stab wound, presentation as retroperitoneal haematoma, infrarenal injury, low Abdominal Trauma Index score and small peroperative blood loss. Concomitant injury to the abdominal aorta, liver or kidney worsened the prognosis. The crucial factor in management of inferior vena caval injuries is rapid and effective control of bleeding, whether from the caval or associated injuries.
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Scand J Thorac Cardiovasc Surg · Jan 1994
Comparative StudyHigh frequency jet ventilation in tracheobronchoplasty. An experimental study.
An experimental study on dogs was performed to determine the optimal driving gas pressure and frequency in high-frequency jet ventilation (HFJV) during tracheobronchoplasty. Right thoracotomy, sleeve upper lobectomy and sleeve pneumonectomy were done with various HFJV settings and insufflation via a 3.0 mm catheter with 2.4 mm internal diameter. ⋯ Driving gas pressure 0.5-1.0 kg/cm2 and frequency 6-10 Hz were the optimal settings for sleeve lobectomy. In sleeve pneumonectomy adequate ventilation and oxygenation were achieved with HFJV to the contralateral lung, and the optimal HFJV settings were 1.0-2.0 kg/cm2 driving gas pressure and 6-10 Hz frequency.
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Scand J Thorac Cardiovasc Surg · Jan 1993
Osteosynthesis of the injured chest wall. Use of the AO (Arbeitsgemeinschaft für Osteosynthese) technique.
Open reduction and osteosynthesis with AO (Arbeitsgemeinschaft für Osteosynthese) technique, using 3.5 mm reconstruction plates and 3.5 mm cancellous screws, were performed in all cases of chest wall injury considered for surgical stabilization since 1990, viz. 11 with posttraumatic flail chest and one with painful nonunion of two ribs. In the ten survivors with flail chest, stability was achieved without secondary dislocation, giving good pain relief, improved respiratory mechanics and reduced duration of ventilatory support and intensive care requirements. ⋯ No complications related to the osteosynthesis arose during follow-up for a mean of 11 months. Chest wall injuries in flail chest and painful nonunion of ribs can be easily and efficiently stabilized with the AO technique.
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Scand J Thorac Cardiovasc Surg · Jan 1992
Randomized Controlled Trial Clinical TrialDecreased blood loss after cardiopulmonary bypass using heparin-coated circuit and 50% reduction of heparin dose.
In a randomized, double-blind study of patients undergoing elective coronary artery grafting, the effect of heparin-coated circuit combined with 50% reduction of systemic heparin bolus was investigated. Ten patients comprised group HC (heparin-coated) and ten group C (controls). The mean total doses of heparin were 172 IU/kg in group HC and 416 IU/kg in group C and the respective protamine doses were 0.96 and 3.96 mg/kg (both p < 0.001). ⋯ Hemolysis at the end of bypass was significantly greater in group C. Apart from one perioperative myocardial infarction in group HC the postoperative course was uneventful. Use of a heparin-coated circuit is concluded to permit complication-free reduction of heparin and protamine doses and to decrease both intra- and postoperative bleeding, which may favorably influence the outcome of coronary artery grafting.