General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Mar 2011
Case ReportsBronchial and cardiac ruptures due to blunt trauma.
Tracheobronchial and cardiac injuries following blunt thoracic trauma are uncommon but can be life-threatening. We report a case in which the patient with bronchial and right atrial ruptures due to blunt trauma survived after emergent repairs. An 18-year-old female driver was transported to our hospital after a traffic accident and was hemodynamically stable on arrival. ⋯ A median sternotomy was undertaken, and a laceration of the right atrium was oversewn without the use of cardiopulmonary bypass. After that, right-sided thoracotomy was performed. The tear in the membranous portion of the right main bronchus was repaired with interrupted sutures, and the suture lines were wrapped with a pedicled flap of intercostal muscle.
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Gen Thorac Cardiovasc Surg · Mar 2011
Esophageal ruptures: triage using the systemic inflammatory response syndrome score.
Esophageal rupture is a rare entity. Delay in the diagnosis and treatment may threaten the patient's life. ⋯ Using this criterion for 12 patients resulted in the survival of all of them. Therefore, we advocate use of the SIRS score for triage of an esophageal rupture.
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Gen Thorac Cardiovasc Surg · Feb 2011
Case ReportsSurgical treatment for chronic type A aortic dissection and aortic regurgitation in a patient with a tracheostoma.
We successfully performed aortic root replacement and partial aortic arch replacement by a T-shaped sternotomy at the second intercostal space in a patient who had undergone tracheotomy for respiratory insufficiency and cardiac failure caused by methicillin-resistant Staphylococcus aureus pneumonia during preservation treatment of chronic type A aortic dissection and aortic regurgitation.
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Gen Thorac Cardiovasc Surg · Feb 2011
Case ReportsEndobronchial hamartoma with obstructive pneumonia due to Nocardia asiatica.
A 60-year-old man who had diabetes had a history of hospitalization for pneumonia in the right lower lobe at the age of 57 years. He visited our facility complaining of fever and cough. He was admitted owing to pneumonia in the right lung. ⋯ Complete resection of the bronchial tumor could not be achieved with a high-frequency snare, although the patient was preoperatively diagnosed as having hamartoma. The patient subsequently underwent resection of the right lower lobe due to his deteriorated clinical condition. The postoperative course was favorable, and there has been no recurrence of nocardiosis or bronchial hamartoma for 3 years.
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Gen Thorac Cardiovasc Surg · Feb 2011
Intraoperative direct hemoperfusion with a polymyxin-B immobilized fiber column for treatment of infective endocarditis.
Endotoxin adsorption treatment (direct hemoperfusion using a polymyxin-B immobilized fiber column, or PMX-DHP) is now considered a useful option for treating severe sepsis. However, the efficacy of PMX-DHP for infective endocarditis (IE), in which the causative microorganisms are usually gram-positive cocci, remains unclear. In the present study, we investigated the impact of intraoperative PMX-DHP on clinical parameters during the treatment of IE. ⋯ Intraoperative PMX-DHP demonstrated several positive effects, such as a drastic decrease in the doses of inotropic agents and shortening of the duration of mechanical ventilation, in patients who underwent emergent surgery for active IE. Intraoperative PMX-DHP can be a useful option for the treatment of critically ill patients with IE.