Stapled Porcine Pericardium Displays Lower Infectivity In Vitro Than Native and Sutured Porcine Pericardium
Benjamin Del TattoDidier Le RoyMartine LambeletJean-Marc CorpatauxNabil ChakféStefano GiulieriFlorent AllagnatThierry RogerFrançois Saucy
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Infectivity
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Abstract Frog erythrocytes injected into the pleural cavity of mice reached the pericardial cavity. Pericardial pores that connect the two cavities were the routes of the migration. As soon as 5 minutes after injection, frog erythrocytes were surrounded and phagocytosed by attached macrophages in milky spots facing the pericardial cavity. The pericardial pores may function in an allied self‐defense mechanism between the pleural and pericardial cavities in this species.
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Previous studies of cardiac function in elasmobranch fishes have not included the influence of the pericardioperitoneal canal on pericardial pressure and volume and thus on cardiac function. Accordingly, we studied the function of the pericardium and pericardioperitoneal canal in sharks and rays. We found negative pericardial pressure that rose to a plateau of approximately 0 mmHg when fluid was infused into the pericardium with the canal undisturbed. However, this pericardial pressure elevation caused severe cardiac tamponade. After the canal was occluded, the pressure plateau was substituted with an exponential rise. We injected radioisotopes into the pericardial cavity and obtained scintigrams several hours later. The scans and counts of body fluids and tissues indicated absorption, disputing the suggestion that the primary function of the canal may be inadequate absorption of pericardial fluid. We conclude that the pericardioperitoneal canal maintains negative pericardial pressure, which is a prerequisite in elasmobranch fishes and may serve to regulate pericardial pressure level to optimize cardiac function in relation to changes in cardiac size.
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The form and structure of the rat pericardium has been stated to be closely connected both with its function and with the function of the whole cardio-pulmonary complex, as well as with its topography in the thoracic cavity. As for certain specific peculiarities, it should be mentioned: presence of fascial-ligamentous duplication constructions and connections with the surrounding organs, which ensure the fixed position of the heart. The interconnections revealed between the pericardium and the pleura demonstrate that the lateral portions of the pericardium could be regarded as a single integrated wall of two serous tunics. A possibility for a direct injection of substances into the pericardial cavity is considered. An isolated position of the pericardium in the thoracic cavity is described.
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Pericardial cavity
Parietal Pleura
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Objective To search the value of central venous catheter in the treatment for lung cancers fluid in pleural cavity and pericardium.Methods The fluid drown from thoracic cavity,pericardiumby subcutaneous puncture and placing catheter were made through the routine examination and cytologic examination.After excluding the fluid completely, the medications were injected into the cavity.Results The punctures were successfully performed in thoracic cavity and pericardium.The catheters were placed for 14 days on average.The effective rate with synthetically treatment in tumor was 76.67%.Conclusions Central venous catheter is placed safely and conveniently in the puncture of fluid in pleural cavity and pericardium.The technique is worthy to be recommended for a wise use.
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11 cases of malignant mesothelioma (0.153%) were among 7184 autopsies in Tambov Bureau of Pathology from 1978 to 1987. There were 4 cases of pleural mesothelioma (0.055%), 5 cases of pericardial mesothelioma (0.069%), one case of peritoneal mesothelioma and one case of a simultaneous involvement of the peritoneum, pleura and pericardium. Two cases of malignant epithelioid mesothelioma of the pericardium are described, which characterized by a diffuse growth along both surfaces of the pericardium with the accumulation in its cavity of two litres of hemorrhagic liquid. In the case of a 50-year-old man who had a contact with asbestos the tumour grew into the coronary artery resulting in clinical symptoms and morphology of the myocardial infarction. Metastases were found in the anterior mediastinal lymph nodes only. In the second case-that of a 48-year-old women--there were metastases in the regional lymph nodes, pleura, the lung and liver.
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Heterologous
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The operative procedures employed today to relieve symptoms produced by pericardial adhesions consist of (1) removing the extra pericardial adhesions extending between the pericardium and the thoracic wall (cardiolysis) and (2) extirpation of the pericardium (decortication) in those cases in which there is considerable fibrous contraction of the pericardium. It is self evident that both of these procedures are largely palliative and have been performed in patients with marked cardiac damage. Delorme advocated the division of the intrapericardial adhesions, but, because of the invariable recurrence of the adhesions, this operation was soon abandoned. Believing that the re-formation of pericardial adhesions might be prevented following their division as peritoneal adhesions by the use of digestants, the following experiments were performed: Sixty-five dogs were used. Roentgenograms and electrocardiograms in 3 positions (back, left and right) were taken before and after each operation and immediately before sacrificing the animal. Careful clinical and radiographic observations were made pre and post operatively. As a preliminary operation a pericarditis was produced by introducing irritating inorganic and organic substances into the pericardial cavity, as performed by Herrmann and Musser. Pericardial adhesions, usually causing a complete synechia of the pericardial cavity, resulted in all animals. After varying periods of time, a 2nd pericardotomy was performed, and the pericardial adhesions were divided. In one series a vegetable digestant of the papain group was introduced into the pericardial cavity, following the division of the adhesions, in order to prevent their re-formation. In one control series physiological saline solution, and in another 2nd control series nothing, was introduced into the pericardial cavity. Of the 65 animals many were lost early in the series, because of faulty technic. Many died as a result of barbital anesthesia. In the control animals in which, following the division of the pericardial adhesions, either nothing or physiological saline solution was added to the pericardial cavity, adhesions invariably re-formed.
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Eight animals died from 1 to 6 years after the operation, from undetermined diseases, or from pneumonia. Two animals are still alive 7 years after the operation. 1. Condition of the Pleural and Pericardial Cavities.—In the first experiments, extensive pleural and pericardial adhesions were observed 1 year and more after the patching of the pulmonary artery. There was also a great deal of fibrous tissue between the pulmonary artery, the aorta, and the left auricle. In the other experiments, the adhesions of the lungs, pleura, and pericardium were less marked. This was due to some improvements in the technique of handling the viscera. At the time of the operations, it was hoped that no pleural or pericardial adhesions would occur. Great care was taken not to injure the endothelial surfaces by rough handling or by sponging. No blood was allowed to flow into the pleural cavity. The surface of the pericardium was protected by fine silk membranes. The pleural cavity was occluded by thick pads made of cotton and Japanese silk. It seemed that the serous surfaces were almost completely protected against infection and mechanical irritation. The occurrence of primary pleurisy and pericarditis was prevented by this technique. But the development of adhesions in several of the experiments shows that the procedures for the handling of the viscera should be perfected. 2. Condition of the Arterial Wall.—In the experiments in which the orifice was patched, a slight dilatation of the artery was observed. It was not possible to ascertain from the specimen preserved in formaldehyde whether or not there was an insufficiency of the valves. It is probable that there was no leakage, as in none of these cases could any diastolic murmur be heard 6 months after the operation. The only animal which presented clinical evidence of pulmonary insufficiency died during the War. The normal condition of the pulmonary orifice was due to the incision which did not extend far enough on the ventricle, and to the power of redintegration possessed by an organ which is not diseased. The cicatrization of the grafted flap was excellent. Its outline could not be seen on the external side of the wall. Even after opening the artery, the transplant could not be located easily. However, in Experiment 1 the anterior wall of the artery showed a depression about 7 or 8 mm. wide, 18 mm. long, and 2 or 3 mm. deep, behind and above the anterior valve. But the flap was made of human artery, and it is known that a heteroplastic graft always undergoes some dilatation. When transplants of dog tissue were used, no dilatation occurred and the location of the patch could hardly be detected. In Experiment 7, 6 years after the operation, the endothelial surface was smooth, glistening, and no scar could be seen. However, the upper and lower parts of the incision were marked by a slight depression of the wall. The presence of the patch was detected by a distinct thickening of the wall. Although the edges of the incision had not been sutured to the edges of the flap, the endothelial surface was quite smooth. A transverse section of the artery was made through the middle part of the flap in Experiment 4. It showed the width of the arterial opening and the way in which the transplant became adherent to the arterial wall. The examination of these four specimens demonstrated that, in spite of the unfavorable location of the graft, an excellent union had taken place. It showed that homoplastic or heteroplastic tissue can be transplanted onto the pulmonary artery as well as onto the smaller arteries. Where the arterial wall had simply been incised without interposition of a patch, a linear scar was always found. 6 years after the operation, the incision used in the course of an operation for cauterization of the sigmoid and sutured with heavy thread was transformed into a linear scar and the surface of the intima was quite smooth. 3. Condition of the Sigmoid Valves.—In three experiments, the sigmoid valves had been cauterized along their margin and their point of insertion in the artery. One of the animals was still living 7 years after the operation. There was no diastolic murmur. The other animals died 3 and 6 years after the operation. The valves were thin and transparent, and quite normal. However, one of the valves showed two holes, one near the base and the other near the margin. The animal on which the section of the right posterior valve without suture was performed, died 2 or 3 years after the operation. The edges of the incision had not united. They were thickened and the whole valve was rigid. The surface was rough and irregular. No permanent result was obtained by the union of two sigmoid valves by a stitch. There was no stenosis of the orifice, and no union of the valves 4 years after the operation. The stitch had disappeared. There was some scar tissue at the common point of insertion of the posterior valves, which were more rigid and showed thickened edges. 7 years after the section and suture of a sigmoid had been performed, the animal was still living and in good health. No diastolic murmur could be detected.
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