SUMMARY Between June 1978 and January 1982, 115 patients underwent 122 subclavian arterypulmonary artery shunts using polytetrafluoroethylene (PTFE Impra) grafts. Forty-six of the patients had a ductus dependent pulmonary circulation, the patency of which was maintained by an infusion of prostaglandin E2 in 29 cases. There were nine hospital deaths, four of which were related to shunt failure. Five patients underwent a second shunt procedure witiin one week of the first. There were two cases of late graft occlusion. Twelve shunts were considered to have failed. The actuarial estimate of shunt patency was 90% (± 3%) at two years for all patients and 74% (± 10%) for neonates. There was no statistically significant difference in two year shunt patency between 4 mm grafts (88 5%) and 6 mm grafts (96 3%).The modified Blalock shunt using a PTFE graft is an effective pulmonary-systemic shunt with a good short term patency.
A small solid state transducer was used to measure pericardial pressure (PP) in 13 pediatric patients (mean age 18 months) at hourly intervals for 24 h following cardiac surgery. The mean PP following closed cardiac surgery via a left thoracotomy (group 1: 5 patients) was 2.7 +/- 1.4 mmHg and did not change with time. Maximum PP occurred during isovolumic relaxation of the ventricle rising to a peak at the onset of the 'a' wave of the central venous pressure (CVP). PP was strongly correlated with CVP (r = 0.58, P less than 0.001) but not with airways pressure (r = 0.27, P less than 0.2). Mean PP in the 3 patients undergoing transatrial surgery (group 2) was 4.5 +/- 2.7 mmHg (group 1 vs group 2, P less than 0.001). PP was significantly raised in the 2 patients undergoing transventricular correction of Fallot's tetralogy (group 3, PP = 10.2 +/- 3.2 mmHg; group 3 vs group 2, P less than 0.001) and in the 3 patients undergoing homograft conduit reconstruction of the right ventricular outflow tract for truncus arteriosus (group 4, PP = 9.3 +/- 2.6 mmHg; group 4 vs group 2, P less than 0.001). The results confirm that PP is a mathematical function of the expansile forces of the heart and the restricting forces of the pericardium and mediastinum. Patients with pulmonary regurgitation or pulmonary hypertensive crisis leading to increased right ventricular end diastolic dimension or a space occupying conduit have a high PP and are therefore at risk of atypical tamponade. In this situation splinting open the chest may reduce PP and break the cycle of falling cardiac output.
SUMMARY Bacterial contamination of gastrointestinal fibre-endoscopes is a potential source of clinically significant infection. Aqueous 2% alkaline glutaraldehyde adequately disinfects fibre-endoscopes but may cause serious sensitivity reactions among endoscopy staff. A new 'closed-system' disinfecting apparatus is described that disinfects with glutaraldehyde for 30 minutes before an endoscopy session, for two minutes between patient procedures, and for 10 minutes before storage. Bacteriological cultures of the endoscope after disinfection were virtually sterile. Extremely low glutaraldehyde vapour levels were detected by gas chromatography in endoscopy room air during disinfection procedures. This relatively simple apparatus offers rapid, effective, and safe disinfection of fibre-endoscopes.In recent years there has been an increasing awareness of the potential for infection with gastrointestinal endoscopic procedures and of the need for thorough disinfection of endoscopic equipment.1-10The intricate design and delicate materials of endoscopes make them difficult to disinfect and easily damaged. Aqueous 2% alkaline glutaraldehyde, the most widely used disinfectant for endoscopic equipment in Great Britain, causes sensitivity problems, especially contact dermatitis, among endoscopy staff.1' The ideal disinfecting apparatus must rapidly and thoroughly disinfect fibre-endoscopes with a technique which protects endoscopy staff from contact with potentially toxic disinfectants and is safe for the endoscopes themselves. We have designed a new 'closed-system' disinfecting apparatus to meet these requirements. Methods APPARATUSThe disinfecting apparatus (Fig. 1) consists of two rectangular Perspex chambers with a connecting tap. The lower chamber is connected to mains water and has a draining outlet. The upper chamber is connected to a conventional suction apparatus and has a vacuum release valve.
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