Scandinavian journal of thoracic and cardiovascular surgery
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Scand J Thorac Cardiovasc Surg · Jan 1984
Case ReportsBronchial rupture caused by blunt chest trauma.
Tracheobronchial rupture is a rare and serious complication of blunt chest trauma. The cause is often a traffic accident and the rupture may be associated with other, fatal injuries. Three cases were treated at our clinic in the period 1970-1982. ⋯ The early clinical picture may vary, depending on the site and extent of the injury, from only minimal mediastinal emphysema to severe dyspnea with extensive subcutaneous and mediastinal emphysema or persistent pneumothorax. The correct diagnosis was confirmed in all three of the described cases by bronchoscopy, which was performed in the late course because of respiratory difficulties and roentgenographic evidence of pulmonary complications. Since early surgical repair is essential for a good functional result, the possibility of tracheobronchial rupture must be kept in mind in any case of severe thoracic trauma.
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Scand J Thorac Cardiovasc Surg · Jan 1984
The value of activated coagulation time in monitoring heparin therapy during extracorporeal circulation.
The anticoagulant effect of heparin was studied in 20 patients undergoing aortocoronary bypass surgery. The protamine dose necessary to reverse heparin after extracorporeal circulation (ECC) was assessed in ten patients from individual heparin dose-response curves (HDR group). The other ten patients received protamine according to a routine protocol (control group). ⋯ The postoperative bleeding was not related to the levels of heparin or coagulation parameters after heparin reversal. The concentrations of fibrinogen and AT-III showed variations dependent on the changes in haematocrit. A number of factors other than heparin that influence ACT are discussed.
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Scand J Thorac Cardiovasc Surg · Jan 1983
Comparative StudyTemporary incomplete ischemia of the legs induced by aortic clamping in man. Metabolic and hemodynamic effects of temporary extracorporeal by-pass.
The effects on central hemodynamics and skeletal muscle metabolism during surgery for abdominal aortic aneurysm were compared in 6 patients given a preoperative adrenergic block (group B) and in 6 patients who additionally had a temporary brachio-femoro-femoral by-pass during the aortic clamping (group B + S). The cardiac output, heart rate, arterial and pulmonary artery pressures and the cardiac filling pressure were studied. Biopsy specimens from the lateral vastus muscle and blood samples from the radial artery and the iliac vein were taken before aortic clamping and also before and 30 minutes, 4 and 16 hours after the aortic declamping. ⋯ After the declamping, only a minor MAP drop was observed. In both groups, a brief rise in pulmonary vascular resistance after the aortic declamping suggested transient pulmonary microembolism. If a high-risk patient is to undergo reconstructive surgery of the abdominal aorta and/or technical difficulties can be expected to necessitate prolonged cross-clamping during the operation, a temporary extracorporeal by-pass may be a favorable adjuvant, improving cardiac performance and preventing derangement of muscle metabolism.
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Scand J Thorac Cardiovasc Surg · Jan 1982
Comparative StudyThe postoperative prognosis of primary pulmonary sarcomas. A review with a comparison between the histological forms and the other primary endothoracal sarcomas based on 474 cases.
On the basis of 41 personally observed cases from 1957 to 1974 and 435 case reports in the literature from 1957 to 1972, a scale of malignancy of the histological forms of primary pulmonary sarcomas is presented. A fairly continuous rise in the rate of malignancy according to the differentiation of the tissues can be convincingly recognized. The more mature a pulmonary sarcoma is, the better is the postoperative prognosis. ⋯ At the same time it is shown that the postoperative prognosis of endothoracal sarcomas is determined not only by their histological structure, but also by their localization in the lungs, mediastinum, or chest wall. Forty-one primary pulmonary sarcomas were compared with 22 sarcomas of the mediastinum and 17 sarcomas of the chest wall. Due to their long period of development, with rare symptoms and late diagnosis, sarcomas of the lungs and the mediastinum have a similar postoperative prognosis, in contrast to the endothoracal sarcomas of the chest wall which have a clearly more favourable prognosis.
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Scand J Thorac Cardiovasc Surg · Jan 1982
Surgical treatment of acute superior vena caval syndrome. A report of two cases.
The syndrome caused by the acute obstruction of the superior vena cava with central nervous system symptoms as well as with symptoms related to the oedema of the upper respiratory tract is often very severe and fatal to the patient. Conservative treatment is usually of no help, and consequently the palliative reconstruction of the superior vena cava may be indicated. Two cases of acute superior vena caval syndrome with reconstruction of the superior vena cava are presented. ⋯ In the second case the obstruction of the superior vena cava was caused by anaplastic carcinoma of the upper lobe of the right lung. The acutely obstructed superior vena cava was reconstructed with a Dacron prosthesis. 9 months postoperatively the superior vena caval syndrome recurred and two months later the patient died of lung cancer. In both cases good palliation of the obstruction of the superior vena cava was obtained.