John Heysham Gibbon, Jr., M.D., was the first researcher to develop a heart-lung machine that could fully support an adult's cardiac and respiratory functions during surgical procedures to repair defects in the heart and lungs. The difficulty of such a task can be seen in the number of people who attempted it for over a century: the list is long. Gibbon succeeded on May 6, 1953, when he repaired an atrial-septal defect with the patient supported entirely by the machine for 27 minutes. Ada Romaine-Davis contends that few realize how long Gibbon worked to achieve this success. To rectify the situation, Romaine-Davis here provides a thorough study of Gibbon and his accomplishment. She shows how Gibbon overcame discouragement from his peers and mentors and obtained crucial support from IBM Board Chairman Thomas Watson. She examines each of the models produced by Gibbon and puts his achievement into historical perspective. Gibbon himself chose not to pursue cardiac surgery; he remained a thoracic surgeon. Others went on to develop the knowledge and skills that today make open-heart surgery as safe as other major surgical procedures. As Romaine-Davis amply demonstrates, these pioneers stand on the shoulders of a stubborn, persevering, single-minded genius whose determination to leave a legacy to his profession resulted in the one thing essential for sustained progress in heart surgery: John Gibbon's heart-lung machine. This meticulously researched study will make fascinating reading for physicians-especially surgeons-as well as for students and scholars of medical history and science and technology.

Written by internationally acclaimed specialists, Cardio-Thoracic, Vascular, Renal and Transplant Surgery provides pertinent and concise procedure descriptions spanning benign and malignant problems and minimally invasive procedures. Complications are reviewed when appropriate for the organ system and problem, creating a book that is both comprehensive and accessible. Stages of operative approaches with relevant technical considerations are outlined in an easily understandable manner. Forming part of the series, Surgery: Complications, Risks and Consequences, this volume Cardio-Thoracic, Vascular, Renal and Transplant Surgery provides a valuable resource for all general surgeons and residents in training. Other healthcare providers will also find this a useful resource.

Attempts to reconstruct various parts of the heart started even before the beginning of open cardiac surgery. By the late 1950s and early 1960 s several closed and open procedures had already been described. In that era, several surgeons in Europe and the Americas were particularly prompted to develop various techniques of valve re construction because of the lack of acceptable valve prostheses and conduits which have become available subsequently. At that time, several congenital lesions still defied definitive correction, and clinical attempts at left ventricular wall replacement had not yet got under way. A renaissance in different cardiac reconstructive procedures started at the beginning of the 1980s. As the problems relating to valve prostheses became more generally appreciated and the importance of chamber volumes and geometry (atrial or ventricular) was accorded due importance in the long-term follow-up, there was a resurgence of surgical attempts at reconstruction in congenital and acquired cardiac lesions so as to approximate the natural state. At the same time several characteristics of this reconstructive "discipline" became apparent. First, cardiac reconstructive surgery has remained a surgical "art" with a gradually increasing number of interested cardiac surgeons."

Safe surgery is founded upon careful dissection and clear identification of vital structures. Knowledge of the appropriate anatomy and anatomical relations is therefore essential, not only during surgical training, but as the cornerstone of surgical practice. The aim of this book is to describe the essential anatomical basis of a range of common procedures in general and vascular surgery. The large-format multi-volume texts on operative surgery, despite their undoubted excellence, are now too expensive for individual purchase. Single-volume books on operative surgery have been unable to devote sufficient attention to anatomical detail and the surgeon is left ploughing through anatomy texts, often failing to find illustrations which demonstrate clearly the features that are important in an operative dissection. The present text highlights features of the operations which are important anatomically while not attempting to give a complete description of the operative procedure. A combination of line diagrams and cross sections has been used to provide the topographical detail. The volume is aimed mainly at surgeons in training, to help them on a day-to day basis and to provide a text which will be useful in revising for post graduate examinations in surgery. It is also hoped that the book will be of use to practising surgeons, providing an easy means of highlighting important anatomical aspects of the procedures they perform relatively infrequently. 1989 S.J.S."

Fibrin plays a central role in wound healing. It has a hemostatic effect by forming a temporary wound closure and assists in neovascularization and fibroblast prolifera- tion. It therefore makes the repair of injured or severed parts of the human body by simple glueing possible, a notion that men have dreamed of since ancient times. The first modern attempts in this direction, using clotting substances derived from human blood to achieve hemostasis, were reported by Bergel (in 1909), Grey (in 1915), and Harvey (in 1916), who used fibrin powder or fibrin patches to control bleeding from parenchymatous organs. Two decades later Young and Medawar (1940) and Cronkite (1944) used blood plasma or fibrin solutions, adding thrombin to seal nerve anastomoses and to fix skin grafts in humans. Due to the poor adhesive strength of the fibrinogen the results were unsatisfactory. In 1972 a new era in fibrin sealing was initiated by Matras. By using highly concentrated fibrinogen in combination with factor XIII (fibrin-stabilizing factor) and by delaying fibrinolysis with a fibrinolysis inhibitor (aprotinin), a method was developed which after satisfactory results in animals, soon began to be applied in humans.

Die Endoskopie vermochte bisher Gewebsformationen zu dehnen, zu durchtrennen, abzutragen und zu zerstoren. Gewebedefekte auszufullen, miteinander zu vereinigen und zu heilen, war bislang endoskopisch nicht moglich. Die Einfuhrung von Fibrinklebern eroffnete neue Anwendungsbereiche. Der Kleber kann, in seine Komponenten getrennt, uber doppellumige Sonden uber beliebig weite Strecken an den vorgesehenen Einsatzort unter Sicht des Endoskopes transportiert werden. Die Klebung von Fisteln, Rupturen oder Leckagen an Bronchusstumpfen, im Lungenparenchym oder an gastrointestinalen Anastomosen kann heute komplizierte Heilungsverlaufe und riskante operative Re-Interventionen ersetzen. Die spezielle Technik der endoskopischen Fistelklebung wird in diesem Buch erstmals zusammenfassend und interdisziplinar erortert. Daneben werden neue Moglichkeiten zur Stillung gastrointestinaler Blutungen mit Fibrin durch intramurale Injektion oder oberflachlichem Spray besprochen. Grundlegende Untersuchungen zeigen, dass im Vergleich zu anderen Substanzen, die Fibrinapplikation in das Gewebe zu deutlich geringerer Traumatisation und zu geringeren entzundlichen Reaktionen bei gleichem Hamostaseeffekt fuhrt. Ziel des vorliegenden Buches ist, verstreute Einzelbeobachtung zu sammeln, zu ordnen und zu vergleichen, um dem interessierten Leser die neue Technologie der Verklebung von Defekten und der Hamostase mit biologischen Substanzen zu vermitteln.

Effective treatment of acute myocardial infarction remains one of the major issues in cardiology and internal medicine. The present monograph summarizes the relevant experimental data and the results of major clinical trials in the treatment of myocardial infarction. There are contributions of fundamental anatomical and physiological concepts of vascular occlusion and myocardial damage due to ischemia as well as discussions of therapeutic strategies involving thrombolytic agents, adjuvant drug therapy for limitation of myocardial damage, improvement in myocardial tolerance to ischemia and prevention of coronary reocclusion. In this regard, there is an extensive discussion of the role of coronary angioplasty and bypass surgery in the setting of acute myocardial infarction.

In this issue of Surgical Clinics, guest editor Dr. Daniel G. Cuadrado brings his considerable expertise to the topic of Cardiothoracic Surgery. In this issue, top experts in the field provide updates on the most common procedures in cardiothoracic surgery, including articles on the lung, heart and chest, as well as two articles on epidemiology that give an accurate scope of heart disease. Contains 15 relevant, practice-oriented topics including lung cancer: epidemiology and screening; open surgical and extended resections for lung cancer; surgical management of pneumothorax and pleural space disease; management of coronary artery disease; minimally invasive and sub-lobar resections for lung cancer; and more. Provides in-depth clinical reviews on cardiothoracic surgery, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

In recent years, major social forces such as: ageing populations, social trends, migration patterns, and the globalization of economies, have reshaped social welfare policies and practices across the globe. Multinational corporations, NGOs, and other international organizations have begun to influence social policy at a national and local level. Among the many ramifications of these changes is that globalizing influences may hinder the ability of individual nation-states to effect policies that are beneficial to them on a local level. With contributions from thirteen countries worldwide, this collected work represents the first major comparative analysis on the effect of globalization on the international welfare state.

The Welfare State in Post-Industrial Society is divided into two major sections: the first draws from a number of leading social welfare researchers from diverse countries who point to the nation-state as case studies; highlighting how it goes about establishing and revising social welfare provisions. The second portion of the volume then moves to a more global perspective in its analysis and questioning of the impact of globalisation on citizenship, ageing and marketization.

With its integrative analyses of policy and practice in countries struggling to provide social welfare support for their needy populations, The Welfare State in Post-Industrial Society will become an important voice in the debate on social welfare.

The joint workshop between the European Society of Cardiology and the European Society ofCardiovascular Surgery, held October 14-15, 1983 in Innsbruck, Austria, was a unique event. The idea originated in Atlanta, 1982, with C. Hahn and was supported by V. Bjork and N. Browse. H. Denolin and F. Loogen brought added impact from the European Society of Cardiology. The joint workshop specifically emphasized new trends and controversies in coronary artery surgery. The contri- butions appearing in this edition were selected by a scientific committee: H. Deno- lin, H. Kraft-Kinz, F. Unger, F. Loop, L. Cohn, F. Loogen, P. Lichtlen, T. Killip, and F.Kaindl. The specific aim was to evaluate controversial review points in coronary artery surgery. These were covered in six discussions and in nine forums with slide presen- tations. The topics were: 1. Indications for coronary artery surgery 2. Graft patency and long-term results 3. New operative techniques 4. Myocardial preservation and anesthetic management 5. Combined procedures 6. Long-term follow-up Coronary artery surgery is a model for comprehensive cardiology, whereby sur- gery serves as a link between diagnosis and rehabilitation. Because coronary artery surgery has become a routine procedure with standardized techniques, the demand is increasing dramatically as reflected by enormous waiting lists. Hospital mortality can be kept under 1 %, so that the value of this operation can also be discussed with regard to its social and economic aspects. In the majority of cases, patients improve and finally retum to work, finding life most enjoyable again.

Leaving a life marked by crippling setbacks and his father's doubt, in 1967 a twenty-something doctor from India arrived in America with only five dollars and the desire to claim his American dream. The journey still awaiting Dr. Arun K. Singh would be unparalleled. Faced with an entirely new culture, racism, and the lasting effects of disabling childhood injuries, through hard work and perseverance he overcame all odds. Now having performed over 15,000 open heart surgeries, more than nearly every surgeon in history, Dr. Singh reflects on his most memorable patients and his incredible personal life. Shared for the first time, these intimate and uplifting accounts, along with photos, will have you cheering for the underdog and appreciating the enduring determination of the human spirit.

Since the last meeting "Myocardial Biopsy - Diagnostic Signifi cance" was held under the auspices of the International Society and Federation of Cardiology (ISFC) in Munich, many new data and new aspects have been developed in the field of myocardial dis eases. Most importantly, the classification of cardiomyopathies and specific heart muscle diseases, as described in the report of the WHO-ISFC task force (see reference 1 in the Introduction), is now widely accepted as a basis for clinical practice and scientific work. Investigators from all over the world have again assembled un der the auspices of the ISFC at an international workshop on viral heart disease and its implications with regard to congestive cardio myopathy, which was held in Munich January 1983. This book con tains the significant results of the workshop. For practical use, the authors have incorporated important points made in the discussions into their contributions and a subject index has been provided. First of all I should like to thank Professor Riecker, Director of the Medizinische Klinik, Klinikum Grol3hadern, University of Mu nich, West Germany. Without his friendly support in many aspects, this meeting would not have been possible. I should like to thank Professor Goodwin and Dr. Olsen from the ISFC for their active participation and advice in organizing the meeting. Last but not least, I am particularely grateful to all the contributors, whose co operation has made this book possible."

Mankind in the second half of the twentieth century has encountered a number of social and economic problems, which, as never before, determine its future. Among the main problems facing medicine, meriting distinction is organization of the struggle against the increase of cardiovascular and oncological diseases which, with the birthrate, are the main demographic indices of our planet. According to the World Health-Organization, the deathrate from diseases of the cardiovascular system has risen by 60% in recent years, and there has been a sharp increase of myocardial infarctions and cases of sudden death in young people aged 25-30. The "geography" of heart and blood vessel diseases has changed: a dramatic increase of morbidity has been recorded in rural regions, and in districts where 10-20 years ago the native population was practically unaffected by atherosclerosis. Diseases of the cardiovascular system have become widespread among women as well as men. Cardiovascular diseases tax the national economy: they are responsible for over half the mortality among people at the prime of their productive life. More than 50% of temporary disability is also accounted for by ischemic heart disease, hypertension, stroke, etc.

Microcirculation is a rather new field which has been of predominant interest to basic scientists, linking togeth~r technical, hemodynamic, and biochemical aspects. The fmdings elaborated, however, are not only of theoretical interest, but bear in addition great clinical implications. In clinical cardiology this became quite evident by the use of tracers in order to study myocardial perfuSion and by the deSCription of certain clinical entities - such as angina with normal coro nary arteries - which are best explained by "disturbed microcirculation". With respect to this new developing theoretical and clinical field of cardiac microcirculation it was the aim of the Microcirculation Working Group of the European Society of Cardiology to have a symposium on which all different but clinically relevant aspects of cardiac microcirculation will be covered. This symposium, held in Heidelberg in January 1980, was planned not only for the exchange of concepts and ideas, but was expected to be in addition partially a teaching session; the basic scientists should be directed toward a better under standing of the clinical problems, and the clinicians should learn more about the basic mechanisms regulating substrate and ion exchange in such an impor tant organ as the heart, and furthermore the theoretical limitations of some of the diagnostic and therapeutical procedures should be taught. Without a lot of help we would never have succeeded in organizing the sym posium and editing its results.

The International Congresses of Angiology have had a 25-year tradition. Let us remember the 10 previous International Congresses, the first of which took place in Paris in 1952. On this occasion a stimulus for the foundation of the International Union, "Union Internationale d Angeiologie" came into existence. The period of 25 years is lon.qenough to evaluate the scientific progress which has been made in diagnosis, therapy and prevention of vascular diseases. Proceedings of the previous International Congresses of Angiology became attractive resources for scientific information in libraries all over the world. They represent really historic documents of remarkable development of angiology and wittness successful international cooperation in the settlement of serious medical problems of the twentieth century. The Proceedings of the XI. International Congress of Angiology held in Prague 1978 under the stimulating title "Adaptability of Vascular Wall" contains 284 original papers dealing with scientific and clinical research in arterial, venous and lymphatic circulation. The papers are incorporated into 12 chapters according to the main topics. In the first sections the questions of atherogenesis and thrombogenesis are discussed with regard to the adaptability of vascular wall in various metabolic, immunobiologic, and hemodynamic disorders. In the further sections attention is paid to new procedures in investigation, treatment, and prevention of arterial, venous, and lymphatic diseases. Peri pheral microangiopathies, renovascular hypertension, and coronary circulation represent another part."

The first cardiovascular operation in Duesseldorf, a ligation of an open ductus arteriosus (Botallo), was performed in 1938 by E. K. Frey. During the Second World War and the subsequent years many difficulties hindered cardiovascular surgery in Duesseldorf. However, it was resumed on 3 May 1949 by Prof. Ernst Derra, again by ligating an open ductus arteriosus. This was the starting pOint of the successful cooperation between the cardiological and surgical working groups - the "birthday" of the Duesseldorf Heart Centre. Further highlights in cardiac surgery were the introduction of open heart surgery by means of surface-cool- ing hypothermia (9 February 1955) and extracorporeal circulation (21 February 1959) . In addition to cardiac catheterization and surgery in patients with acquired and congenital heart disease, the diagnosis and treatment of arrhythmias was one of the focal points of the centre. On 3 October 1961 the first pacemaker was implanted in a patient with a third-degree AV-block after he had been treated using an external device for about 1 year. In recent years interest has increasingly turned to the tachy- arrhythmias. Close cooperation between the medical and surgical teams made possible the application of new pacing techniques for the treat- ment of tachycardia. In patients with intractable arrhythmias, surgical interventions were made to eliminate the "focus" of the arrhythmia. In the past 2 years intraoperative electrophysiologic studies (endo-cardi- al and epicardial mapping) were applied to enhance the success of the surgical procedures.

Diagnostik und Therapie sind die Pfeiler, auf denen die Medizin ruht. Beide wurden in der letzten Zeit wesentlich erweitert und vertieft - teils zum Nutzen der Patienten, teils aber auch zu deren Nachteil. Betroffen sind alle Fachgebiete der nicht-operativen Medizin inklusive der Pneumologie. Im Bereich der Pharmakotherapie von Lungenerkrankungen fehlte bisher ein Nachschlagewerk im deutschen Sprachraum. Meistens wird das Thema lediglich kursorisch in Lehrbuchern der Inneren Medizin und Pneumologie abgehandelt: Wenig vertieft bzw. kritisch abgehandelt mit Therapieempfehlungen ohne wissenschaftliche Evidenz. Erstmalig im deutschen Sprachraum liegt nun dieses fachbezogene Lehrbuch mit neuesten Erkenntnissen der Pharmakotherapie vor. Es wendet sich vor allem an Internisten und Pneumologen, ist aber auch fur Padiater, Thoraxchirurgen und Allgemeinarzte von grossem Interesse.

Summary A comprehensive review is given of the literature, and the advantages and disadvantages of the bypass operation are discussed in detail. Of all surgical interventions aiming at revascularisation of the myocardium the aorto coronary bypass operation is the one which indoubtedly has earned its place in cardiac surgery. The most suitable candidates for this operation are those with a normal left ventricular angiogram and a good peripheral vascular pattern. Even in these people the question still remains whether the vein can stay patent for many years; moreover what happens to the proximal coronary arteries is as yet uncertain. In the case of poorly contracting ventricles little good is to be expected from the by pass operation. Possible, anastomosis of the internal mammary artery with a stenotic coronary artery merits preference over a venous bypass. To demonstrate the ultimate influence of this type of surgical intervention on life expectance and on a secondary pre vention of angina pectoris and myocardial infarction, Chalmers (1972) and Spodick (1971) favour follow-up studies of patients who are divided at random into a surgical and a non-surgical group. 1.1. OBJECT The object of this investigation is to establish on basis of the results and complications of saphenous vein bypass grafting (briefly termed bypass surgery): - reliable indications for this operation; - to provide the surgeon with a guide to the choice of surgical technique.

The second edition of this critical text features heavily revised chapters detailing how to approach the anesthetic and perioperative management of adult and pediatric patients with congenital heart disease. Initially, a broad overview of relevant concepts in pediatric cardiovascular embryology, physiology, and pharmacology is provided. Subsequently, relevant diagnostic approaches including the use of three-dimensional modeling in surgical planning and preoperative considerations are described. The intraoperative management of a wide range of specific lesions is discussed, with full descriptions of anesthesia plans and the appropriate diagnostic methods and surgical interventions. New topics detailed include the use of hybrid techniques and applications of electrophysiology in patients with congenital heart disease. Postoperative care and potential future approaches are also addressed. Congenital Heart Disease in Pediatric and Adult Patients: Anesthetic and Perioperative Management provide a comprehensive, up-to-date overview of the care of the pediatric patient undergoing cardiac surgery and anesthesia. It is therefore of interest to all practicing and trainee medical professionals who encounter these patients in their day-to-day practice.

Selected as a Doody's Core Title for 2022! Unique in the field of cardiac surgery, Khonsari's Cardiac Surgery: Safeguards and Pitfalls in Operative Technique details the most important techniques in a concise, readable, and richly illustrated format, with a focus on avoiding and managing surgical pitfalls and complications. From general considerations through the surgical correction of acquired and congenital heart conditions, it provides a wealth of practical, hands-on guidance to help both seasoned and less-experienced cardiac surgeons achieve optimal outcomes. Key Features: Apply the very latest know-how with new sections on endovascular procedures, transcatheter aortic valve replacement (TAVR), new approaches to Norwood reconstruction and repair of Ebstein anomaly, and alternative anatomic repairs of congenitally corrected transposition, as well as thorough updates to all chapters. Master nuances of surgical technique thanks to a wealth of step-by-step illustrations, many of them new, others colorized for greater clarity. Optimize outcomes with special coverage of avoiding and managing technical pitfalls and complications. Spot important details with the aid of distinctive "Nota Bene" notations. Now with the print edition, enjoy the bundled interactive eBook edition , offering tablet, smartphone, or online access to: Complete content with enhanced navigation A powerful search that pulls results from content in the book, your notes, and even the web Cross-linked pages , references, and more for easy navigation Highlighting tool for easier reference of key content throughout the text Ability to take and share notes with friends and colleagues Quick reference tabbing to save your favorite content for future use

In this issue of Thoracic Surgery Clinics, Guest Editor Farid Shamji brings considerable expertise to the topic of Lung Cancer in this second issue covering this topic. Top experts in the field cover key topics such as biological treatments, improving anesthesia safety in pulmonary resection for lung cancer, history of surgical instruments in thoracic surgery, The Hemithorax - the empty chest syndrome, and more. Provides in-depth, clinical reviews on lung cancer, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field; Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews. Contains 16 relevant, practice-oriented topics including Assessment of Operability and Resectability in Lung Cancer; Complications of chest wall resection in conjunction with pulmonary resection; Sepsis in the postpneumonectomy space: pathogenesis, recognition and management; Neuroendocrine cancers of the lung: natural history, pathological classification, biological behaviour and treatment; and more.

Central venous access devices (CVADs) are used within a variety of areas in both hospital and community health care settings to administer blood or fluids, to provide long term access for repeat transfusion of blood or blood products, chemotherapy, parenteral nutrition and antibiotic therapy, and to provide immediate access in emergency situations.
Central venous access devices is a practical guide to the care and management of CVADs aimed at student nurses, newly qualified nurses and more experienced nurses who are unfamiliar in dealing with these devices.
Central venous access devices addresses patient assessment and education, relevant anatomy and physiology, appropriate device selection, and guidelines on insertion, follow-up care and management of CVADs. Each category of CVAD - including peripherally inserted central catheters, non tunnelled central venous catheters, skin tunnelled catheters and implanted ports - is explored in turn. Concluding chapters explore hazards of insertion, prevention and management of complications, and patient perspectives on living with a CVAD

Get expert, step-by-step guidance on a wide variety of both open and interventional cardiac surgical techniques. Atlas of Cardiac Surgical Techniques, 2nd Edition, helps you expand your surgical repertoire and hone your skills with a vividly illustrated, easy-to-navigate text, procedural videos online, and pearls and pitfalls throughout. This revised atlas covers the surgical procedures you need to master, including minimally invasive techniques, robotic surgery, aortic dissection, and much more. Seven brand-new chapters cover Hybrid Coronary Revascularization, Aortic Valve Repair Techniques, Transcatheter Aortic Valve Replacement, Robotic Mitral Valve Surgery, Surgery for Hypertrophic Cardiomyopathy, Approaches and Techniques to Extra-Corporeal Membrane Oxygenation, and Pulmonary Endarterectomy. Multiple new contributing authors offer a fresh perspective in their areas of expertise. A consistent chapter format guides you quickly from surgical anatomy and preoperative considerations through operative steps and postoperative care. Online videos highlight key stages of surgical procedures. More than 400 full-color images, line drawings, and intraoperative photographs clearly depict the step-by-step progression of procedures. Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.