bluuebunny/crossref_metadata_2025_split huggingface dataset:
β2 microglobulin excretion as an index of renal function on pulsatile and nonpulsatile cardiopulmonary perfusion
Authors: Manche AR , Walesby RK , Goode AW , Kirk Cjc 
Published: November 2007

The renal clearance of β2 microglobulin was measured in two groups of patients undergoing surgery involving cardiopulmonary bypass. The first group of patients received pulsatile perfusion whilst group two were subjected to non pulsatile flow. There was no difference between the two groups in the rate of β2 clearance throughout the study period. For both groups the clearance rate was signifi cantly elevated from four hours following surgery to the third postoperative day. These results suggest that during standard periods of cardiopulmonary bypass, pulsatile perfusion does not confer any significant advantage over conventional nonpulsatile flow with regard to renal blood flow and tubular function.
Haemocompatibility of membrane and bubble oxygenators
Authors: Pearson D.T. , McArdle B. 
Published: November 2007

During clinical hypothermic cardiopulmonary bypass (CPB), the haemocompatibility of six groups of membrane oxygenators (Cobe CML2, Shiley M2000, Maxima, Bard HF4000, Bard HF5000, Capiox E has been studied in 60 patients having open-heart surgery. A standardized anaesthetic and perfusion protocol was used, during which the abilityof the perfusionist to achieve target blood gas values (PaO2 20kPa and PaCO2 5.3kPa: alpha-stat) using inline electrodes was assessed. Haemocompatibility was evaluated by measurement of platelet numbers and function, betathromboglobulin (BTG), plasma haemoglobin, complement (C3a des Arg) and white blood cell (WBC) count pre- and post-CPB. Platelet and WBC numbers were also measured every five minutes throughout CPB. All oxygenators allowed the perfusionist to control blood gases adequately to prescribed levels. There were only minor differences in the degree and pattern of platelet depletion, reduction in platelet aggregation, elevation of BTG and C3a des Arg observed between oxygenator groups, which did not appear to be influenced by membrane type (flat plate versus hollow fibre). The membrane oxygenator haematological data was amalgamated with that obtained in previous clinical studies using membrane and bubble oxygenators (Cobe CML, Polystan Venotherm, Harvey H 1700, Bentley BIO-10, Bentley 1 0B, Bentley 1 OPlus, Gambro 10 and Shiley S100A HED) in which a similar evaluation protocol was employed. Comparison of the percentage change in platelet count when the pre- and post-CPB values were compared, demonstrated statistically significantly less platelet depletion (p <0.001 ) in the membrane oxygenator groups (-0.2 ± 8.3%) when compared to the bubble oxygenator groups (-21.7 ± 8.7%). A significantly lower percentage rise in BTG was also observed in the membrane oxygenator group when compared to the bubble oxygenator groups (p <0.001 ). All oxygenator groups showed elevation of both WBC count and plasma haemoglobin with a nonspecific fall in platelet aggregation over the period of bypass but no significant differences could be found between the two types of oxygenator. Membrane oxygenators, when compared to bubble oxygenators, exhibit lower GME production and improved haemocompatibility and allow superior blood gas control. Membrane oxygenators manifestly must be the oxygenator type of choice for clinical CPB.
Comparison of dextran 40 with albumin and Ringer's lactate as components of perfusion prime for cardiopulmonary bypass in patients undergoing myocardial revascularization
Authors: McGrath Lynn B. , Gonzalez-Lavin Lorenzo , Neary Michael J. 
Published: November 2007

A major expense for the conduct of cardiopulmonary bypass in many institutions is the cost of 5% albumin. Potential advantages in using dextran 40 as the colloid component of the priming solution for cardiopulmonary bypass include decreased cost and less viscosity in the microcirculation. Possible disadvantages include bleeding and anaphylactic reactions. From August 1985 to February 1986, 60 consecutive patients undergoing elective myocardial revascularization were prospectively randomized to receive either 5% albumin ( N = 29) or dextran 40 (N = 31) as the colloid component of the priming solution for cardiopulmonary bypass. Twenty matched patients also underwent revascularization with the prime consisting only of Ringer's lactate solution. There were no differences among the three groups for age, sex, size, crossclamp time, cardiopulmonary bypass time or number of coronary artery bypass grafts performed. In all three groups important postoperative changes were noted in platelet count, bleeding time, thrombin time, prothrombin time, fibrinogen and fibrin split products. Complement levels (C5a) were elevated in the dextran group (p = 0.03). Postoperative crystalloid (p = 0.04) and colloid (p = 0.0001 ) requirements were increased in the Ringer's lactate group and there was a significant weight gain (p = 0.0001). Colloid osmotic pressure was highest in the dextran group during (p = 0.0001) and after bypass (p = 0.001). There was no difference in clinical events and no hospital deaths. In conclusion, we found dextran to be a safe colloid for use as prime in uncomplicated coronary artery bypass grafting patients. The cost of dextran prime was substantially less than for albumin prime. A purely crystalloid prime is discouraged because of a tendency for fluid retention.
Thoracic organ preservation
Authors: Wheeldon Dereck 
Published: November 2007

Clinical heart transplantation began in December 1967 when Cristiaan Barnard performed the first human to human heart transplant on a 57 year old man with ischaemic heart disease, in Cape Town. This ushered in a bout of enthusiastic heart transplantations world-wide over the subsequent few years which soon waned as the problems of acute rejection and infection became apparent to those who had embarked on this venture without fully understanding the complications.The importance of a well functioning donor heart cannot be overemphasized. Early donor heart failure accounts for approximately 26% of the deaths of heart transplant recipients today and there is also a steep rise in acute mortality associated with storage times in excess of two hours (9.8% < 2 hours rising to 17.6% > 4 hours), although satisfactory function has been reported in a few hearts stored for up to 6 hours.1Careful selection and meticulous management of the donor, followed by optimal storage, are therefore essential to a satisfactory outcome.2There is evidence that some of the problems of organ preservation are related to metabolic changes in the donor consequent upon brain death3-6and recent ongoing studies by our own group show some benefit from hormone replacement therapy in the donor.7There are essentially two major approaches to the problem of organ storage; metabolic inhibition resulting in reduced substrate requirements, and the supply of metabolic requirements, or a combination of both. Although nonperfusion methods currently predominate, the simplicity of these methods are overshadowed by the short safe time interval which they allow and the variable functional quality which results. The author believes that perfusion preservation methods will predominate in the future and may also allow expansion of the donor pool bywhole donor and/or ex vivo thoracic organ resuscitation.
In vitro evaluation of the Mera Silox-S 0.5 and 0.8 m2 silicone hollow-fibre membrane oxygenator for use in neonatal ECMO
Authors: Rais-Bahrami K. , Mikesell G. , Seale WR , Rivera O. , Hearty JP , Short BL 
Published: November 2007

The Mera Silox-S is a silicone hollow-fibre membrane oxygenator made up of thousands of fibres in a clear polycarbonate housing. Being a silicone membrane it does not have the plasma leakage problem associated with conventional microporous hollow fibres when used in a long-term application. This device (Mera Senko Medical Instrument Co., Japan) is made in three sizes: 0.3, 0.5 and 0.8 m2. The performance of the 0.5 m2 and 0.8 m2 Silox-S membrane oxygenators was tested in vitro using filtered ovine blood and a customized test circuit designed to provide a continuous source of de-oxygenated, CO2-laden blood, according to the AAMI standard for oxygenator performance. The 0.8 m2 membrane provided excellent oxygenation, with a transfer rate of 13.0-43.5 ml/min for blood flows of 200-800 ml/min. CO2 transfer over the same range of flows measured 32.3-40.8 ml/min. Flow rates of 100-500 ml/min for the 0.5 m2 membrane provided an oxygen transfer of 6.8-28.3 ml/min and would probably not be suited for the existing neonatal ECMO population. A matter of concern with both oxygenators was an increased pressure drop for blood flow through the devices. The Δ Pfor the 0.5 m2 for flows of 100-500 ml/min ranged from 155 ± 7 mmHg to 516 ± 6 mmHg. For the 0.8 m2, Δ P was 194 ± 39 mmHg to 492 ± 53 mmHg for flows of 200-800 ml/min. Overall, favourable results support further long-term evaluation for potential use in neonatal ECMO.
Haematocrit measurements during cardiopulmonary bypass surgery: comparison of three stat methods with a blood cell counter
Authors: Al-Odeh Ahmed , Varga Zsolt A. , Angelini Gianni D. 
Published: November 2007

Monitoring packed cell volume (PCV) is essential to safeguard oxygen delivery to the tissues during cardiopulmonary bypass (CPB). We compared the results obtained using a PCV monitor, a blood gas analyser and a microcentrifuge with those from a laboratory-based automated blood cell counter. PCV was measured in 221 samples of 40 patients undergoing open-heart surgery. The limits of agreement (mean difference ± 2 SD) was unacceptably wide when the results obtained with the PCV monitor and the blood gas analyser were compared with those of the automated blood cell counter. This was most pronounced when PCV was measured in low concentration samples. The microcentrifuge showed good limits of agreement regardless of sample concentration. The data suggests that measurement of PCV by either continuous monitoring or by a blood gas analyser is not an accurate alternative to an established laboratory method. The microcentrifuge is the most accurate method of the ones investigated to measure haematocrit during CPB.
Re-inventing the wheel: the use of autologous and fresh donor blood in cardiac surgery
Authors: Reece Ian J , Linley Gerrard H , Tolia Jitesh , Sheth Jayesh , Al Tareif Habib 
Published: November 2007

From the opening of a new cardiac surgical programme in November 1992, autologous and fresh donor blood (FDB) were used rather than cold stored blood (CSB) wherever possible in patients undergoing operations involving the use of cardiopulmonary bypass (CPB). In the first 250 consecutive patients, autologous blood was used in 168 (67.2%), fresh blood was used in 188 (75.2%). A total of 740 units of fresh blood were obtained on the day of operation (mean 3.9 ± 1.6 units per patient able to supply donors; 4.9 ± 1.7 units in the 147 who received fresh blood) and 728 units of stored blood were used (mean 3.08 ± 1.84 units per patient where fresh blood was used; 6.2 ± 2.5 units in the 114 where no fresh blood was used). The use of autologous blood significantly reduced FDB and CSB requirements (p < 0.001), was associated with a shorter intensive care and total postoperative stay (p = 0.006 and p = 0.033 respectively), even though there were more urgent and emergency cases in this group (p = 0.009) and no significant difference in chest drainage. Coagulopathy developed in 41 patients (16.4%) and was significantly associated with bypass time (p = 0.0001) and preoperative renal dysfunction (p = 0.005), although not with advanced age, sex, redo operation, diabetes or glucose-6-phosphate dehydrogenase deficiency. Patients with coagulopathy had significantly more transfused blood and blood products (p = 0.0001) and longer intensive care and total postoperative stays (p = 0.0001). In terms of blood conservation, the use of autologous blood was of primary importance. Correction of renal dysfunction and keeping overall bypass time to a minimum reduced the incidence of coagulopathy and, therefore, blood use. The use of FDB in this series was not clearly associated with improved overall results, but did generate more blood than was actually used, a factor of extreme importance in situations where stored blood is always in short supply.
Profound accidental hypothermia in the deep South: clinical experience
Authors: Tyndal Charles M , Rose Michael W , McFalls Richard E , Jacks Allen , Pinson Terry , Athanasuleas Constantine L 
Published: November 2007

Accidental hypothermia resulting from exposure is generally associated with frigid regions and not with the more temperate areas of the South. However, we present clinical experience from two cases in which the victims of motor vehicle accidents were exposed to the elements for prolonged periods and became profoundly hypothermic. The first patient was a 21-year-old male who was ejected from, and pinned under, his vehicle for approximately four hours in -15°C ambient temperature. Upon admission to the Emergency Room, the patient was unresponsive with fixed and dilated pupils and his core temperature was 25°C. After a prolonged period of cardiopulmonary resuscitation, percutaneous femoral to femoral cardiopulmonary bypass (CPB) was instituted for core rewarming. After reaching 37°C, the patient was removed from bypass. The patient was discharged from the hospital on the fourth postoperative day. The second patient was a 40-year-old male who was ejected from his vehicle into a stream, where he was partially submerged for several hours. Although the ambient temperature was approximately 22°C, his core temperature at admission was 27°C. After a positive peritoneal lavage, the patient was taken to the Operating Room and placed on percutaneous femoral to femoral CPB for core rewarming. During rewarming, an exploratory laparotomy and a splenectomy were performed. The patient was discharged from the hospital on the seventh postoperative day. These cases are unique in that both were trauma patients with suspected internal injuries which required the avoidance of anticoagulation. Therefore, both cases utilized a Carmeda-bonded circuit without systemic anticoagulation.
Cardiopulmonary bypass support for treatment of left ventricular failure following coronary artery bypass grafting: the effects on epicardial microflow and graft flow
Authors: Yijiang Chen  , Bo Liu  , Belboul Ali 
Published: November 2007

The relationship between graft blood flow, epicardial microflow and mean arterial pressure were studied to evaluate the use of repeated cardiopulmonary bypass (CPB) support for intraoperative heart failure following aorto-coronary bypass surgery. Ten patients with unstable angina and suffering from intraoperative heart failure (group A) were compared to 22 patients with stable angina (group B). In group A, during heart failure, the mean arterial pressure fell by 41 % (29.9 ± 6.8 mmHg, p < 0.01), graft flow (GF) by 67% (9.2 ± 2.6 ml/min, p < 0.01) and epicardial microflow by 64% (19 ± 4 AU, p < 0.01). After 15-56 min of assisted CPB support, the epicardial microflow and GF were partially restored. There were significant correlations between GF, epicardial microflow and CPB time. In group B, after protamine infusion, the epicardial microflow and GF were significantly greater than group A values (66 ± 14 AU, p < 0.001 and 29 ± 9 ml/min, p < 0.001, respectively). It is concluded that the use of temporary assisted CPB support to treat intraoperative heart failure allows the recovery of the myocardium and thereby restores the mean arterial pressure. The recovery of GF and epicardial flow occurred to a lesser extent. CPB support appeared to be suitable for about 60 min, probably because of increasing disturbance to the GF and the epicardial microcirculation.
Low extracorporeal priming volumes for infants: a benefit?
Authors: De Somer F. , Foubert L. , Poelaert J. , Dujardin D. , Van Nooten G. , François K. 
Published: November 2007

An extracorporeal circuit consisting of an oxygenator especially designed for neonatal use and appropriately sized tubing, with an average total priming volume of 205 ml, was used on 80 infants undergoing cardiac surgery for congenital heart-disease. The priming volume and foreign surface area of the circuit were determined. The influence of low priming volumes on the use of blood products and the management of cardiopulmonary bypass was studied. No whole blood or platelets were used in this study. The mean volume of packed red blood cells used over the hospital stay was 202 ± 67 ml. The mean volume of fresh frozen plasma (FFP) used until the second postoperative day was 62 ± 72 ml. The mean total blood loss until the second postoperative day was 15.8 ± 9.2 ml/kg. The priming volume of the extracorporeal circuit was 62% lower than values commonly reported in the literature. The low priming volume had a strong influence on the use of platelets and FFP and to a lesser extent on the use of packed red blood cells.
Including children in family-focused acquired brain injury rehabilitation: a national survey of rehabilitation staff practice
Authors: Webster Guinevere , Daisley Audrey 
Published: November 2007

Objective: To establish whether rehabilitation staff work regularly with child relatives of adults with acquired brain injury to involve them in their family member's rehabilitation. To explore factors influencing rehabilitation staff's decisions about involving child relatives. Design: A cross-sectional postal survey design was used for the main study. Questionnaire packs were sent to rehabilitation staff, followed by a reminder letter one week later. Non-responders received a follow-up pack after three weeks. A prospective design was used with a subsample of participants who re-completed the questionnaire one month later. Subjects: Participants were 393 multidisciplinary staff working in rehabilitation services for adults with acquired brain injury throughout the UK. Main measures: A questionnaire based on the theory of planned behaviour was designed specially for the purposes of the study. Results: A response rate of 67% (n = 263) was obtained. Few respondents (19%, n = 50) reported carrying out work with child relatives. Perceived behavioural control (e.g. access to training, resources and support) significantly predicted staff's intention to work with child relatives, and whether they carried this out. Staff's attitudes towards work with child relatives also significantly predicted intentions. Other influential factors were anxiety, training, work setting and perceptions of colleagues' attitudes. Conclusions: Little work is carried out with child relatives by acquired brain injury rehabilitation staff, influenced by several factors. A priority in addressing this is to provide staff training.
Patterns of postural deformity in non-ambulant people with cerebral palsy: what is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation?
Authors: Porter David , Michael Shona , Kirkwood Craig 
Published: November 2007

Objective: To investigate: (a) associations between the direction of scoliosis, direction of pelvic obliquity, direction of windswept deformity and side of hip subluxation/ dislocation in non-ambulant people with cerebral palsy; and (b) the lateral distribution of these postural asymmetries. Design: Cross-sectional observational study. Setting: Posture management services in three centres in the UK. Subjects: Non-ambulant people at level five on the gross motor function classification system for cerebral palsy. Main measures: Direction of pelvic obliquity and lateral spinal curvature determined from physical examination, direction of windswept hip deformity derived from range of hip abduction/adduction, and presence/side of unilateral hip subluxation defined by hip migration percentage. Results: A total of 747 participants were included in the study, aged 6—80 years (median 18 years 10 months). Associations between the direction of scoliosis and direction of pelvic obliquity, and between the direction of windswept hip deformity and side hip subluxation/dislocation were confirmed. A significant association was also seen between the direction of scoliosis and the direction of the windswept hip deformity (P<0.001) such that the convexity of the lateral spinal curve was more likely to be opposite to the direction of windsweeping. Furthermore, significantly more windswept deformities to the right (P = 0.007), hips subluxed on the left (P = 0.002) and lateral lumbar/lower thoracic spinal curves convex to the left (P = 0.03) were observed. Conclusions: The individual asymmetrical postural deformities are not unrelated in terms of direction and not equally distributed to the left/right. A pattern of postural deformity was observed.
Tilted seat position for non-ambulant individuals with neurological and neuromuscular impairment: a systematic review
Authors: Michael S.M. , Porter D. , Pountney T.E. 
Published: November 2007

Objective: To determine the effects of tilt-in-space seating on outcomes for people with neurological or neuromuscular impairment who cannot walk. Data sources: Search through electronic databases (MEDLINE, Embase, CINAHL, AMED). Discussions with researchers who are active in field. Review methods: Selection criteria included interventional studies that investigated the effects of seat tilt on outcome or observational studies that identified outcomes for those who had used tilt-in-space seating in populations with neurological or neuromuscular impairments. Two reviewers independently selected trials for inclusion, assessed quality and extracted data. Results: Nineteen studies were identified which fulfilled the selection criteria. Seventeen of these were essentially before—after studies investigating the immediate effects of tilting the seating. All studies looked at populations with neurological impairment, and most were on children with cerebral palsy (n = 8) or adults with spinal cord injury (n = 8). Reviewer's conclusion: Posterior tilt can reduce pressures at the interface under the pelvis.