Scandinavian journal of thoracic and cardiovascular surgery
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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 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 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 StudyClosed pleural biopsy and fluid cytology in the diagnosis of suspected pulmonary cancer with pleural involvement.
In a retrospective study of 44 cases of suspected primary pulmonary cancer with pleural involvement, the diagnostic value of pleural biopsy a.m. Abrams was evaluated. ⋯ Among the patients under study, closed pleural biopsy combined with pleural fluid cytology proved malignancy in 96% of the cases in which neoplastic disease of the lungs and pleura was otherwise diagnosed. These findings indicate the value of using both fluid cytology and closed pleural biopsy at an early stage of the diagnostic procedure in cases of suspected pulmonary cancer with pleural involvement.
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Scand J Thorac Cardiovasc Surg · Jan 1982
Case ReportsPancoast's syndrome following an intrapleural rupture of a hepatic echinococcus cyst.
A case of Pancoast's syndrome due to a hydatid cyst is described. The cyst developed secondarily, after intrapleural rupture of an echinococcus cyst situated in the liver. The patient was operated and the cyst excised. ⋯ The Horner's syndrome needed longer to subside. Three years after the operation there is still some constriction of the pupil of the right eye. The development of Pancoast's syndrome due to hydatid disease is very rare and this case--caused by a secondary cyst after intrapleural rupture of a similar hepatic echinococcus cyst--is the first described in the literature.