The accumulation of activated leukocytes in the pulmonary circulation plays an important role in the pathogenesis of lung dysfunction associated with cardiopulmonary bypass. Animal studies have demonstrated that the elimination of leukocytes from the circulation reduces postoperative lung injury and improves postoperative pulmonary function. We conducted a prospective randomized clinical study to evaluate whether postoperative lung function could be improved by use of a leukocyte filter during cardiopulmonary bypass. Elective coronary artery bypass grafting was done with a leukocyte-depleting arterial blood filter incorporated in the extracorporeal circuit (14 patients, leukocyte filter group) or without the filter (18 patients, control group). Blood samples collected at intervals before, during, and after operation were used for analysis of blood cell counts, elastase concentrations, and arterial blood gases. The use of the leukocyte filter caused no significant reduction in leukocyte count (p = 0.86). There were no differences in postoperative lung function between the groups, as assessed through (1) oxygenation index (290 for leukocyte filter group compared with 329 for control group, 95% confidence interval, 286 to 372, p = 0.21), (2) pulmonary vascular resistance (p = 0.10), and (3) intubation time (16.6 hours for leukocyte filter group versus 15.7 hours for control group, 95% confidence interval, 12.1 to 19.1 hours, p = 0.72). The levels of neutrophil elastase were significantly higher at the end of cardiopulmonary bypass in the leukocyte filter group (460 microgram/L in leukocyte filter group versus 230 microgram/L in control group, 95% confidence interval, 101 to 359 microgram/L, p = 0.003). We conclude that the clinical use of the present form of leukocyte-depleting filter did not improve any of the postoperative lung function parameters analyzed in this study.

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Methods: In order to assess intermediate-term speech outcome after pharyngeal flap surgery for velopharyngeal dysfunction in children with cleft palate between 1980 and 1998, their pre- and postoperative speech performance was analyzed in a blinded fashion by speech pathologists and adult lay people. Speech was evaluated on the basis of tape recordings with regard to resonance, intelligibility, articulation, voice and secondary speech disorders. Results: Twenty-three patients could be evaluated. Both lay assessors and speech pathologists noted a significant improvement in speech performance after pharyngeal flap surgery. The percentage of children who improved was 83% (19/23, 95% confidence interval: 0.68–0.98, p = 0.002) when rated by lay people, and 87% (20/23, CI 0.73–1.01, p < 0.0001) when rated by professionals. Rated on a 5-point scale, the mean improvement per speech characteristic was 0.52 ± 0.32 scale points when judged by lay people, and 0.75 ± 0.8 points when judged by experts. Experts considered none of the children to have normal speech after surgery. Agreement with regard to outcome between lay people and speech pathologists occurred in 87% of the patients. Conclusion: The cranially based pharyngeal flap can improve speech performance in cleft palate children with chronic velopharyngeal insufficiency. However, it cannot be expected that this type of surgery will result in normal speech.