Articles: postoperative-complications.
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The American surgeon · Jul 1975
Adult respiratory distress syndrome in postoperative patients: study of pulmonary pathology in "shock lung" with prophylactic and therapeutic implications.
Lungs of 44 patients who died after postoperative respiratory distress and shock had a significantly higher incidence of atelectasis and thromboembolism than did 31 control patients. However, both lesions were as inconstant in occurrence as all other 15 investigated pulmonary changes. ⋯ While possibly a contributing factor, shock is not the most important cause of the pulmonary lesions in postoperative patients. The term "shock lung" should be eliminated and renewed emphasis should be placed on detection, prevention and treatment of the pathogenic mechanisms involved in each individual case.
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A series of 29 femoropopliteal bypass operations is described. The patients were selected carefully to exclude those with clinical and aortographic evidence of aorto-iliac disease. ⋯ There was a highly significant difference in the result of the operation between patients with a pulsatility index of 4 or more in the common femoral artery and patients with a pulsatility index of less than 4. We concluded that calculation of this pulsatility index provides useful additional evidence when selecting patients suitable for a femoropopliteal bypass.
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Dopamine and isoproterenol were each administered in two different doses to 12 patients with coronary artery disease in the period immediately after open heart surgery. The two doses of dopamine resulted in respective increases in cardiac output of 23 and 43 percent and reductions in systemic vascular resistance of 23 and 32 percent; neither dose significantly altered heart rate. The two doses of isoproterenol caused respective increases of 23 and 37 percent in cardiac output and 18 and 28 percent in heart rate and reductions in systemic vascular resistance of 22 and 29 percent. We conclude that lack of chronotropic effect of dopamine as compared with isoproterenol may make the former the agent of choice in patients requiring inotropic agents for their care in the early period after cardiac surgery.
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Previous studies of psychiatric complications following open heart surgery have included few if any patients who had coronary bypass surgery. This experiment reports the relative incidence of psychiatric complications in a sample of 97 open heart surgery patients of whom 51 patients (53 per cent) had coronary bypass surgery. The results suggest that the incidence of psychiatric symptoms following coronary bypass surgery is significantly lower (16 per cent) than that following cardiac valvular surgery (41 per cent). Several possible reasons for this large discrepancy in incidence of psychiatric complications are considered.