Thoracoscopic pleurodesis.

Thoracoscopic pleurodesis for pneumothorax was performed on 23 patients (16 men, 7 women), including seven with chronic obstructive pulmonary disease, over a 12-month period. Single-lumen intubation with spontaneous ventilation were used making intrapleural insufflation unnecessary. Postoperatively the patients required chest drainage for 1-28 (mean 3) days and remained in hospital for 3-33 (mean 6) days.

Time for new concepts about measurement of complement activation by cardiopulmonary bypass?

Fifty-one patients admitted for routine coronary bypass operations were randomized to cardiopulmonary bypass with a membrane oxygenator (Capiox) or a bubbler (Polystan or William Harvey). Complement activation was measured using enzyme immunoassays for concentrations of C3 activation products and the terminal complement complex. From 5.

[Traumatic pneumopericardium with cardiac tamponade].

A 20 year old male motorist with multiple injuries, including bilateral lung laceration, developed cardiac tamponade 12 hours after injury. X-ray showed characteristic findings of pneumopericardium with air all around the cardiac silhouette, which was diminished in size. A chest tube was inserted intrapericardially through a subxiphoid incision.

Reduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations.

Complement activation after cardiopulmonary bypass is correlated with postoperative organ dysfunction. Heparin coating of the entire blood-contact surface of the cardiopulmonary bypass circuit has proved to reduce complement activation in vitro. A membrane oxygenator and tubing setup coated with functionally active heparin was compared with an uncoated, otherwise identical setup in 20 patients undergoing routine coronary bypass operations.

Surgery in Afghanistan: a light model for field surgery during war.

Owing to a poor capability for evacuation, mobile medical teams were sent to the area of Gazni in Afghanistan to work with local paramedics as part of a medical programme for the area. The teams were equipped to perform major surgery. During 1 month a surgical team inside Afghanistan performed 53 operations.

Complement activation and bioincompatibility. The terminal complement complex for evaluation and surface modification with heparin for improvement of biomaterials.

The degree of biocompatibility of biomaterials can be evaluated using various assay systems detecting activation of the blood cascade systems, leukocytes or platelets. Activation of complement is one mechanism associated with adverse effects observed when bioincompatible materials are used. We present data showing that the terminal complement complex, an indicator of terminal pathway activation, is suitable for evaluation of biocompatibility of biomaterials such as cardiopulmonary bypass devices.

[Decortication of the lung].

During a six year period 18 patients were operated by decortication of the lung. Eight patients had empyema, five were decorticated for postoperative/posttraumatic formation of haematoma. Four patients had restrictive pleuritis and one patient was operated due to insufficient expansion of the lung after operation for emphysematous bullae.

[Emergency thoracotomy. Aortic clamping in major bleeding].

Emergency room thoracotomy was performed in 22 cases. 19 of the patients were admitted following injury. Four of the injured patients survived.

[Surgical pleurodesis in spontaneous pneumothorax].

Over a five year period 41 operations for spontaneous pneumothorax were performed on 38 patients. In all cases a transaxillary thoracotomy was performed in the third, or in some cases the fourth, intercostal space. Bullae were resected and operative pleurodesis carried out by rubbing the parietal pleura with a dry sponge.

Complement activation with bubble and membrane oxygenators in aortocoronary bypass grafting.

Thirty-three patients admitted for coronary bypass grafting were randomized to cardiopulmonary bypass with a bubble oxygenator (Cobe or Polystan) or a membrane oxygenator (SciMed). Plasma concentrations of C3 activation products and the terminal complement complex were measured using enzyme immunoassays. Both variables increased almost linearly after onset of cardiopulmonary bypass, with maximal concentrations at closure of the sternum.

[Fluid therapy changes in surgical treatment of abdominal aortic aneurysm].

The use of blood components and blood substitutes was studied in 25 patients undergoing surgical treatment for abdominal aortic aneurysm in 1983, and was compared with the use of such components in 44 patients operated in 1988. The use of blood components had decreased by 49% from 1983 to 1988. In 1988, erythrocytes were administered only when the hemoglobin concentration fell under 9 g/100 ml.

[Blood transfusion in heart surgery].

We have studied the effect of blood-saving measures in open heart surgery. Such measures were introduced in 1987. All fluids administered on the day of operation and on the first postoperative day were registered in all cardiac patients operated during one month in 1986, 1987, 1988.

Mediastinal fibrosis. A case report.

Mediastinal fibrosis may be part of a multifocal fibrotic disease, including retroperitoneal fibrosis, lung fibrosis and Riedel's struma. A case of mediastinal fibrosis, with a previous history of retroperitoneal fibrosis and lung fibrosis, is discussed. There are many known causes of retroperitoneal and mediastinal fibrosis, but as in the present case the etiology often remains unknown.

Different oxygenators for cardiopulmonary bypass lead to varying degrees of human complement activation in vitro.

Complement activation was studied in vitro with six different membrane and bubble oxygenators for cardiopulmonary bypass. There was a similar increase in terminal (C5 to C9) activation with all oxygenators (p less than 0.001), ranging from 281% (117% to 444%) to 453% (225% to 680%) after 60 minutes (median and 95% confidence intervals).

Human immunodeficiency virus and hepatitis B virus in injured patients and victims of violence.

Of a total number of 643 injured patients admitted during 1986 and 1987, 113 were tested for antibodies against the human immunodeficiency virus (HIV) and hepatitis B surface antigen HBsAg and the concentration of hepatitis B surface antibodies (HBsAb) was determined. Nine patients were HIV positive while HBsAg was detected in two patients and increased levels of HBsAb were found in 19 patients. HIV antibodies were found in 6 (4.

The siege of Tripoli 1983: war surgery in Lebanon.

When Syrian-backed troops attacked the city of Tripoli and the surrounding Palestinian refugee camps in November and December 1983, the authors worked in the Palestine Red Crescent Society (PRCS) Hospital in the area. The hospital was situated close to the front line of the battle at all times and the transportation of casualties was therefore short. During the first month of the battle this hospital received approximately 1,500 casualties, and 390 primary and 24 secondary operations were performed.

Complement activation by extracorporeal circulation: effects of precoating a membrane oxygenator circuit with human whole blood.

In an in vitro study of extracorporeal circulation (ECC), uncoated oxygenators (UC), oxygenators precoated with whole human blood (CN) and oxygenators precoated with blood and then rinsed with Ringer's acetate (CR) all significantly (p less than 0.001) activated the initial and terminal parts of the complement cascade. After 60 min C3 activation had increased by 692% (UC), 750% (CN) and 393% (CR), and terminal complement complex (TCC) concentrations by 194% (UC), 215% (CN) and 273% (CR).

Complement activation during major operations with or without cardiopulmonary bypass.

Plasma concentrations of the complement products C3dg and the terminal complement complex, as well as the number of granulocytes (polymorphonuclear neutrophils), were assessed in patients undergoing aorta-coronary bypass with extracorporeal circulation, abdominal aneurysmectomy with implantation of an aortic graft, or thoracotomy without the introduction of synthetic material into the circulation. The concentration of terminal complement complex increased significantly only in the group undergoing extracorporeal circulation, with a corresponding drop in the number of granulocytes. In contrast, the C3dg concentration increased during both extracorporeal circulation and abdominal aneurysmectomy, which indicates that other factors than extracorporeal circulation may affect C3 activation during major operations.

Alterations in T-helper and T-suppressor lymphocyte populations after multiple injuries.

Fifteen patients with multiple injuries and an Injury Severity Score (ISS) ranging from 2 to 57 (median 25) were studied for variations in lymphocyte populations on the day of injury and the three following days. Nine of the patients had an ISS above 16. In all patients the total number of lymphocytes fell during the first 24 hours after the injury (P less than 0.

Granulocytes in bronchial lavage fluid after major vascular surgery.

Increased numbers of polymorphonuclear granulocytes (PMN) in the airways, as measured by PMN content in bronchial lavage fluid (P less than 0.01), were found 3 h postoperatively in ten patients undergoing surgery for lumbar aortic aneurysms. An increase in plasma levels of the complement split product C3dg from 6 (0-19) AU/ml preoperatively to 20 (13-50) AU/ml 3 h after surgery (P less than 0.

Complement activation following multiple injuries.

Complement activation was evaluated by assay of plasma C3dg and the terminal complement complex (TCC) in 19 patients with multiple injuries. In the nine patients with thoracic involvement, statistically significant increase of plasma TCC was found at first sampling (average 90 min post-trauma), and of C3dg after 24 hours. Such increase was not found in the ten patients without thoracic involvement.

Effects of methylprednisolone on complement activation and leukocyte counts during cardiopulmonary bypass.

Generation of the complement activation products C3dg and terminal complement complex (TCC) and numerical changes in peripheral granulocytes (PMN) and lymphocytes were assessed in patients undergoing aortocoronary bypass surgery with extracorporeal circulation (ECC). Fluid from bronchial lavage performed preoperatively and 4 hours postoperatively was analyzed for granulocyte elastase activity and PMN content. Ten of the 20 patients received methylprednisolone (30 mg/kg b.

An outbreak of group B meningococcal disease: tracing the causative strain of Neisseria meningitidis by DNA fingerprinting.

Following an outbreak of meningococcal disease in three schoolchildren in a small community in northern Norway, DNA fingerprinting, serotyping with monoclonal antibodies, serogrouping, and sulfonamide sensitivity testing were applied for characterization and tracing of the causative agent. The three case isolates were genomically indistinguishable, sulfonamide-resistant, serogroup B, serotype 15 meningococci. Throat specimens were collected from 552 healthy contacts, including all children below age 17 and their parents.