RESUMEN
This study compared the incidence of postoperative atrial fibrillation in a group of 34 patients undergoing coronary artery bypass graft surgery without the use of cardiopulmonary bypass and cardioplegia with a control group of 747 patients undergoing coronary artery bypass graft surgery using cardiopulmonary bypass and standard cardioplegia. A trend toward a lower incidence of postoperative atrial fibrillation was found in the group that underwent coronary artery bypass graft surgery without the use of cardiopulmonary bypass (n = 0.06).
Asunto(s)
Fibrilación Atrial/etiología , Puente Cardiopulmonar/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Análisis de Varianza , Distribución de Chi-Cuadrado , Estudios de Cohortes , Puente de Arteria Coronaria/métodos , Electrocardiografía Ambulatoria , Femenino , Paro Cardíaco Inducido/efectos adversos , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Incidencia , Cuidados Intraoperatorios , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Propanolaminas/administración & dosificación , Propanolaminas/uso terapéutico , Estudios Retrospectivos , Volumen Sistólico/fisiologíaRESUMEN
Air embolism remains a potential hazard of cardiopulmonary bypass. We describe a simple technique for deairing the heart that is inexpensive and requires no manipulation or extra cannulation of the heart.
Asunto(s)
Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/métodos , Embolia Aérea/prevención & control , Puente Cardiopulmonar/instrumentación , Embolia Aérea/etiología , Humanos , Cuidados Intraoperatorios , Transductores de PresiónRESUMEN
We tested in pigs the hypothesis that regional deep hypothermia of the spinal cord achieved by cerebrospinal fluid cooling will protect against ischemic injury during thoracic aortic cross-clamping. Eight control animals underwent aortic cross-clamping at the distal aortic arch and just above the diaphragm for 30 minutes. Eight experimental animals had placement of two subarachnoid perfusion catheters through laminectomies at T4 and the lower lumbar region. The subarachnoid space was perfused with normal saline solution at 6 degrees C delivered by gravity infusion, with infusion rates adjusted to maintain cord temperatures at less than 20 degrees C. After 30 minutes of aortic cross-clamping, the infusion was stopped and the cord allowed to warm to body temperature. Hind limb neurologic function was graded by Tarlov's scale. All of the animals in the control group had complete hind limb paraplegia (Tarlov grade 0) postoperatively. Seven of the 8 animals in the experimental group had preservation of hind limb motor function (Tarlov grade 2), and 1 animal had complete hind limb paraplegia (Tarlov grade 0) (p = 0.002, Fisher's exact test). We conclude that regional deep hypothermia of the spinal cord in pigs does provide some protection from ischemic injury during thoracic aortic cross-clamping. Clinically this may be a useful adjunct for prevention of paraplegia during thoracic aortic operations.
Asunto(s)
Aorta Torácica , Hipotermia Inducida/métodos , Isquemia/prevención & control , Paraplejía/prevención & control , Médula Espinal/irrigación sanguínea , Animales , Temperatura Corporal , Constricción , Médula Espinal/fisiología , PorcinosRESUMEN
We describe a case of recurrent dedifferentiated retroperitoneal liposarcoma with light microscopy features of rhabdomyosarcoma, the first such reported case. The tumor contains a pleomorphic pattern consisting of plump fusiform cells, tadpole cells, malignant appearing lipoblasts, and other nondescript bizarre cells. Of particular interest is a number of tumor cells with plump, bizarre nuclei which contain cross-striations of skeletal muscle pattern. The literature on dedifferentiated liposarcoma is reviewed, and the significance of this case in terms of a current model of mesenchymal differentiation is discussed, with particular attention to the postulate of a common precursor for a variety of soft-tissue tumor histologies.