Biomedical subjects
Publications and source records attributed to G Baslaim.
A 6-year-old girl was found to have a combination of accessory mitral valve tissue and subaortic membrane. The association caused left ventricular outflow tract obstruction leading to severe left ventricular dysfunction. Surgical relief of the obstruction resulted in immediate improvement of ventricular function.
An infant developed severe desaturation within a few hours of construction of a modified Blalock-Taussig shunt. Echocardiography revealed that the shunt had become occluded, and this was confirmed angiographically. At catheterisation, therefore, we passed a 0.014" percutaneous transluminal coronary angioplasty wire through the occluded shunt into the right pulmonary artery and then dilated the shunt successfully using a 5 mm coronary angioplasty balloon. Six weeks later, the shunt remained patent.
OBJECTIVE: To evaluate the efficacy of a simple method of central nervous system (CNS) protection in patients undergoing deep hypothermic circulatory arrest (DHCA) lasting less than 30 minutes, for a variety of complex cardiovascular procedures. DESIGN: A retrospective case review. SETTING: A university teaching hospital. PARTICIPANTS: Fifty consecutive patients (25 women, 25 men) undergoing elective or emergency cardiovascular operations requiring DHCA between August 1991 and December 1996. INTERVENTIONS: Patients underwent DHCA for a variety of surgical procedures. Neurologic protection was with thiopental, ice packs to the head, and systemic core hypothermia to a nasopharyngeal temperature (NPT) of 18 degrees to 20 degrees C. MEASUREMENTS AND MAIN RESULTS: The mean duration of circulatory arrest was 18 +/- 10 minutes (range, 5 to 42 minutes). The mean NPT at time of arrest was 18.7 degrees +/- 1.7 degrees C. Three patients (6%) had gross CNS morbidity, one of whom died. The circulatory arrest times for these three patients were 8, 39, and 40 minutes. Perioperative mortality was 8% (n = 4). The circulatory arrest times for the patients who died were 12, 13, 23, and 39 minutes. CONCLUSION: The anesthetic management of DHCA described is simple, effective, and safe, and can be performed in any institution that performs cardiac surgery.
An unusual case of superior vena cava syndrome, caused by localized fibrosing mediastinitis is presented. A 41-year-old woman had swelling of the face and upper extremities, associated with headache and fatigue. Radiologic investigations, which included venography, computed tomography and magnetic resonance imaging of the chest, documented the presence of superior vena caval (SVC) obstruction secondary to what appeared to be an intraluminal tumour. The patient underwent SVC resection and reconstruction with a spiral saphenous vein graft under cardiopulmonary bypass and deep hypothermic circulatory arrest. On histopathological examination localized idiopathic fibrosing mediastinitis causing SVC obstruction was diagnosed.
With the prevalence of bronchopulmonary disease in the intensive care unit, bronchoscopy has become an essential tool for the management of patients. This article describes the variety of situations in which bronchoscopy can be of assistance in establishing diagnosis, managing the difficult airway, and supporting the patient's suffering of trauma, hemoptysis, atelectasis, and pneumonia.
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