The Annals of thoracic surgery
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A 55-year-old woman underwent coronary artery bypass grafting and mitral valve repair using intraoperative transesophageal echocardiography (TEE). Postoperatively she had hemodynamic instability associated with an increase in abdominal size and a drop in hemoglobin. ⋯ She underwent emergent splenectomy. This case demonstrates that although rare, serious complications can occur with TEE.
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Several techniques for esophageal resection have been reported. This study examines the morbidity, mortality, and early survival of patients after transthoracic esophagectomy for esophageal carcinoma using current staging techniques and neoadjuvant therapy. The technique includes right thoracotomy, laparotomy, and cervical esophagogastrostomy (total thoracic esophagectomy) with radical mediastinal and abdominal lymph node dissection. ⋯ Total thoracic esophagectomy with node dissection for esophageal cancer appears to have acceptable morbidity and mortality with encouraging survival results in the setting of neoadjuvant therapy. Patients who show complete response after induction chemoradiotherapy appear to have improved long-term survival.
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Randomized Controlled Trial Clinical Trial
High-dose cimetidine reduces proinflammatory reaction after cardiac surgery with cardiopulmonary bypass.
Cimetidine, which is usually used for gastric ulcer, enhances cellular immunity. The effect of cimetidine on perioperative proinflammatory response after cardiac surgery with cardiopulmonary bypass was investigated. ⋯ Cimetidine may reduce surgical stress and augment the immune system after cardiac surgery with cardiopulmonary bypass.
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Comparative Study
Off-pump coronary artery bypass grafting for elderly patients.
The use of off-pump coronary artery bypass grafting (CABG) has recently become widespread, and it has been proven to be less invasive and to facilitate early recovery. In this study, we investigated the efficacy of off-pump CABG for patients aged 75 years or more. ⋯ Off-pump CABG is safe for the elderly patient. Off-pump CABG successfully facilitates early recovery and reduces the incidence of postoperative complications among elderly patients.
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Surgical management of patients with coexisting ischemic heart disease and pheochromocytoma remains challenging. We present one such case in which hybrid myocardial revascularization (angioplasty with stenting and off-pump coronary artery bypass grafting) and resection of pheochromocytoma were undertaken. Unusual features included simultaneous coronary artery surgery and tumor resection and, in particular, coronary artery surgery being performed without cardiopulmonary bypass.