Talk:Postperfusion syndrome

Mayo Study
need a cite for the Mayo study. When I try to find it, i get to about.com which is a closed site and a dead end. Take Care Will314159 01:33, 19 October 2006 (UTC)

Reliable Sources
There is a serious problem using National Enquirer as a source to imply this syndrome is affecting Dick Cheney; especially when it never mentions Dick Cheney even once. The article is even titled CLINTON'S SECRET HEALTH CRISIS . I've removed the source and tagged it as needing citation. Let's remember WP:Reliable Sources as well as the policy of no original research AuburnPilot Talk 00:14, 22 October 2006 (UTC)

Super Article. Needs to be footnoted I"ll come back and do it as soon as I remember how. Pumphead. Stutz, Bruce. Sci Am. July 2003. Vol.289. No.1. p.68-73. I have a subscription. I"ve downloaded it and reading it now. Espabila, Favila, que viene el Oso! Will 01:33, 7 November 2006 (UTC)

Footnote didn't work. Here was the effort. Espabila, Favila, que viene el Oso! Will 02:22, 7 November 2006 (UTC)


 * I created a reference section and converted the citations to references. If the links/sources in the External links section are actually references, they should be cited properly and removed from the External links section. -- AuburnPilot talk 17:33, 8 November 2006 (UTC)

Thanks APilot for getting the refs to fly right. Espabila, Favila, que viene el Oso! Will 17:39, 8 November 2006 (UTC)

Plagerism (from the National Enquirer)
The line:

Side effects include memory loss, stilted speech, confusion, depression, and reduced hand-eye coordination. Some patients also suffer diminished sex drive.

Is a direct copy paste from the national enquirer article cited later in the article without being properly referenced or quoted.

Dlodge 18:26, 9 December 2006 (UTC)

PlagIrism. More charitably. Thanks for starting an interesting article. You failed to make an attribution, but I took care of it for you. Godspeed John Glenn! Will 11:49, 21 April 2007 (UTC) "PlagIrism" - the sp was corrected, I see.Godspeed John Glenn! Will 15:14, 14 October 2007 (UTC)

Too Academic?
I have done a literature search on this subject and written sections with a lot of academic references - does anyone get the feeling this page has become too academic? Dlodge 18:43, 17 December 2006 (UTC)
 * IMHO, references are good-- and I think others agree. If you look at the (medical) FAs and GAs they usually have loads of references. That said, I'm not sure if the language is accessible--e.g. I'm not sure if the average lay person knows what a neurocognitive impairment is. If you haven't already read it-- WP:MEDMOS has a few things to guide medical article writing. I think a good guide to "is it too jargon filled?" is --how would you explain it to a patient? Nephron  T|C 22:45, 7 April 2007 (UTC)

See my comment in Name below. QuintBy (talk) 23:44, 4 February 2012 (UTC)

Cytomegalovirus?
Why does googling "postperfusion syndrome" return so many entries referring to cytomegalovirus, none of which seem to be related to pumphead?


 * "In the early 1960s, a postperfusion syndrome was recognized in open heart surgery patients who received large quantities of blood which were contaminated with CMV." ... "The postperfusion syndrome is essentially CMV mononucleosis acquired by blood transfusion."


 * Two separate syndromes, the CMV postperfusion syndrome is a syndrome of mononucleosis like symptoms (now known to be CMV infection) after receiving CMV contaminated blood products. This may be something worth discussion on the CMV page. Dlodge 14:42, 14 October 2007 (UTC)

Medical misinformation
Medical misinformation has no place here. Political speculation by the National Enquirer has no place here. It's trivia, and it's misleading. - Nunh-huh 09:21, 23 October 2007 (UTC)
 * I'm glad to see someone else taking interest in this article. A couple of points.
 * I think the now deleted in the press section discussing speculation by the Enquirer is appropriate - it is clearly labeled as speculation, and identifies origination of public awareness of the issue.
 * The text "Symptoms of postperfusion syndrome are thought to include memory impairment, stilted speech, depression, confusion, and diminished hand-eye coordination. Patients are also thought to experience altered sex drive, lessened inhibitions and other personality changes." is sourced directly from the National Enquirer, and should be changed to reflect the definition of the issue by the medical community.
 * I agree the NPOV line "although some people claim the effects are permanent" is unreferenced. It may be more appropriate to say many people continue to believe the effects are permanent; but this would be difficult to reference.  I would prefer to see this phrase removed altogether; if someone wanted to restore it, a section outlining the evidence would be required. Dlodge 22:00, 23 October 2007 (UTC)


 * [1] No, speculation by a supermarket tabloid newspaper is not encyclopedic, and is therefore not appropriate, no matter how it is labeled. It's also misinformative, trivial, and tangential to the subject.
 * [2] ok, let's remove it. It's silly, as well as unreferenced.
 * [3] as you know, I've asked for further medical input on the article; in any case, the National Enquirer should never be used as a "reliable source" for medical information. The section you cite seems, however, to be sourced to "Scientific American"...which may also be problematic as a source, but far less so than National Enquirer. - Nunh-huh 00:28, 24 October 2007 (UTC)


 * [1] I abhor the use of the Enquirer as well; it was the primary source the article was originally based upon until I found the article and cleaned it up. The link is now dead, so we may as well delete the reference anyway.
 * [2] Agree, it is now replaced with text providing a lay description of the neurological changes in question.
 * [3] It will be difficult to find other medical experts on such a specialized subject aside from myself (you can see qualifications on my user page). The sentences attributed to "Scientific American" but are not contained within the article.  This text was taken from the Enquirer but incorrectly referenced; unfortunately the cached version of the dead link is no longer available on Google.  All references to Scientific American and National Enquirer are now out of the article. Dlodge 01:20, 24 October 2007 (UTC)
 * There are a wide variety of people who contribute here; including at least one board certified cardiologist, and a neurologist or two. (Not that such qualifications are needed to find valid references). So I don't think you need worry that you are alone. - Nunh-huh 01:53, 24 October 2007 (UTC)

ICD-9 classification
The ICD-9 code 999.8 was added to the page by User:Arcadian and subsequently removed by User:Nunh-huh with the edit summary "remove bogus ICD9 code." Reviewing the ICD database this code does appear to be incorrect - 999.8 refers to complications of blood transfusions not otherwise defined. Dlodge 03:36, 25 October 2007 (UTC)


 * Indeed. I've just removed it again. The confusion is based on the fact that more than one syndrome has been called "postperfusion syndrome". ICD-9 code 999.8 does not relate to the subject of this article, but rather to a syndrome roughly equivalent to SIRS. - Nunh-huh 06:13, 25 October 2007 (UTC)
 * SIRS is . Postperfusion syndrome is . If you feel that 999.8 doesn't describe this article, then this article will need to be renamed or disambiguated. On my talk page, you stated "Unfortunately, ICD-9 coding seems fraught with confusion based on this sort of superficial similarity of naming, since it's not based on clinical criteria and is carried out by people without direct clinical experience." I do not believe your perspective on ICD coding is shared by the community at WikiProject Clinical medicine. --Arcadian 09:28, 25 October 2007 (UTC)
 * You're just plain wrong on the code. ICD9 code 999.8 is, to quote the ICD itself, "also known as" "Septic shock due to transfusion". Ignoring the ICD-9's disambiguation results in erroneous coding. Matching names in a codebook is never going to be a substitute for actually understanding diseases.- Nunh-huh 10:20, 25 October 2007 (UTC)

Searching "postperfusion syndrome" on the ICD-9 database reveals 996.85 (Complications of transplanted bone marrow) and 999.8 (Other transfusion reaction not elsewhere classified); both referring to blood transfusions. Postoperative stroke is classified 997.02 (Iatrogenic cerebrovascular infarction or hemorrhage) and includes ischemia, embolism and hemmorage; however this is not appropriate because it refers to Type I neurological injury - overt stroke. The symptoms of neurocognative decline attributed to CPB bypass runs are found in 780 (Symptoms, Signs, And Ill-Defined Conditions). The correct code would be 429.4 (Functional disturbances following cardiac surgery) - which consists of a broad category of long-term effects post cardiac surgery. Dlodge 14:51, 25 October 2007 (UTC)


 * There's no "correct" ICD-9 code here, so it's silly to add one. Why would it be 429.4 rather than, say 999 (complication of surgical and medical care, not elsewhere classified, which includes complications of extracorporeal circulation)? It certainly doesn't seem to be "a febrile illness associated with pericardial and sometimes pleuropulmonary reaction that often follows extensive pericardiotomy (429.4)." A classification scheme that fails to distinguish between Dressler's syndrome and "pump head" is medically and pedigogically useless. This is a case in which the ICD-9 code (even if there were a "correct" one, rather than several which could be cobbled together) adds no useful information to the article. - Nunh-huh 16:34, 25 October 2007 (UTC)
 * Dressler's syndrome is . --Arcadian 17:40, 25 October 2007 (UTC)
 * No, that's only for Dressler's syndrome following an infarction. It's not used for postcardiotomy Dressler's. This once again demonstrates that there is no one-to-one correspondence between the ICD-9 and actual medical terminiology, and that similarity of names is no guarantee of similarity of ICD-9 code. - Nunh-huh 18:20, 25 October 2007 (UTC)
 * 429.4 is named "Functional disturbances following cardiac surgery" - and contains 38 index entries, with a common theme of being post cardiac surgery. Many of these illnesses have their own code, but when attributed to a long term complication of cardiac surgery, they are coded as 429.4.  The ICD database does not have a specific index entry for post-perfusion syndrome, but if there were one, it would be 429.4.  The lack of a code is likely because there is no evidence of long-term cognitive decline caused by cardiac surgery (but good evidence of association with vascular disease). The solution is probably to remove the ICD box since no specific index entry actually exists. Dlodge 18:12, 26 October 2007 (UTC)
 * In the absence of any comments here to the contrary, then, I'm going to go ahead and remove the classification again. - Nunh-huh 04:12, 13 November 2007 (UTC)

McKhann reference
I have reverted the statements "conducted with no effort to properly randomize participants in each of the various study groups" and "the authors themselves noted the need for future studies to be conducted using proper population selection methods" by QuintBy to a prior revision. These statements are a misinterpretation of the paper. This is a prospective, longitudinal study comparing three comparable groups with coronary artery disease with different medical and surgical interventions to heart healthy controls. The authors acknowledge the non-randomization of the treatment strategy is "not ideal" - however the important result is all groups with CAD experienced cognitive decline versus the heart healthy controls. You cannot randomize someone to have CAD or lack thereof; this non-randomization of treatment groups would only have relevance if the study claimed one treatment methodology was superior to another treatment. The authors state in the abstract "this study emphasizes the need for appropriate control groups for interpreting longitudinal changes in cognitive performance after CABG" - this isn't noting this study needs to be redone with proper control groups, this is saying this study demonstrates the need for other studies to use proper control groups when investigating neurocognitive decline post CABG. Dlodge (talk) 00:03, 4 April 2008 (UTC)

New references
Dlodge (talk) 00:17, 5 October 2009 (UTC)
 * Pumphead: Does the Heart-lung Machine have a dark side? Scientific American January 9, 2009 http://www.scientificamerican.com/article/pumphead-heart-lung-machine/
 * Discussion on theHeart.org: http://www.theheart.org/article/1009465.do
 * http://www.ncbi.nlm.nih.gov/pubmed/19762724?dopt=Abstract
 * Editorial: http://www.ncbi.nlm.nih.gov/pubmed/19762723?dopt=Abstract

Name
I couldnt find on the article; does anyone know how this thing got the "pumphead' nickname? I get the "pump" part but the "head" seems rather arbitrary (and somewhat mean sounding.) I will be trying to find a definitive answer to put in the article, but if anyone else already has such information that will save some time. 74.132.249.206 (talk) 13:51, 14 August 2011 (UTC)

If the term pumphead sounds "mean" it is almost surely because it is a pejorative slang term used in the earlier days of CABG surgery by anesthesiologists and surgeons in the OR locker room to express doubt as to its legitimacy. It was never intended to be in common circulation and is very rarely if ever used by surgeons in their discussions with their patients or the patient's family about post-surgery neurocognitive difficulties. In fact, even postperfusion syndrome is very seldom mentioned by surgeons unless the patient or family mention such difficulties first. QuintBy (talk) 23:41, 4 February 2012 (UTC)

Systematic review
10.7326/M14-2793 JFW &#124; T@lk  12:40, 23 July 2015 (UTC)