In coronary bypass surgery myocardial protection by injection of a cardioplegic fluid is made uneven by the presence of stenotic segments. In order to make it even, the authors suggest that the fluid should be injected first into the aortic origin, then into the coronary sinus. This method should provide greater safety when multiples bypasses are performed and in cases of impaired left ventricular function.
In a retrospective study involving 24 transplantation centres and 858 cadaveric kidney recipients, a number of transfusion factors affecting transplant survival were identified. The best results were observed with the most intensive transfusion schedules including at least one transfusion per month. The optimal number of transfusions varied from 6 to 20. However, it was impossible to determine whether a minimal interval was required between the last perfusion and transplantation, or whether the effect of each transfusion was limited in time. Qualitatively, it appeared that whole blood and packed red cells gave better results than leucocyte-deprived blood. Moreover, fresh blood taken less than 3 days before the transfusion clearly proved more effective than blood stored for more than 5 days. All this suggests that live leucocytes and platelets may be important factors. The mechanism by which blood transfusions improve the outcome of kidney transplants remains unknown.
Median sternotomy associated with anterior lateral thoracotomy with section of the sternum opposite the gaping intercostal space is a classical, though rarely used, incisional approach. The authors are convinced that it is safe, easy to perform and well tolerated. Their experience in 14 cases without morbidity shows that its alleged problems are more theoretical than real. They recommend this approach for aneurysms of the thoracic aorta and in some cases for access to the atrial area and superior vena cava.
The insulin requirements of 10 insulin-dependent diabetic patients were evaluated during and after surgery (including 4 caesarian sections) by connecting the patients with an artificial pancreas. Considerable variations were observed in the intra-operative period. In contrast, the amounts of insulin released during the immediate post-operative period were more regular and reproducible (mean: 2.36 U/h for a glucose intake of 200-250 g/24 h). A satisfactory control of glycaemia was obtained with this dosage in 7 insulin-dependent post-operative patients without using an artificial pancreas. It would therefore seem that in most cases continuous insulin infusion combined with direct measurement of capillary glycaemia could replace an artificial pancreas and make the intra- and post-operative care of diabetic patients simpler and more effective.
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