The Annals of thoracic surgery
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Case Reports
Extraction of large tracheal foreign bodies through a tracheostoma under bronchoscopic control.
Despite various technical manipulations through contemporary endoscopic equipment, large tracheal foreign bodies may be lost during bronchoscopic extraction, with a 1 to 2% in-hospital mortality. Recently, emergency tracheostomy was performed during bronchoscopy after a tracheal foreign body had become dislodged in the subglottic region causing blockage of the airway, and the results of this procedure provoked its deliberate application in a second patient. In 3 additional infants, aspirated tracheal T tubes (Montgomery tubes), which were producing acute respiratory distress, were brought from the carina to the performed tracheostoma under bronchoscopic manipulation and were withdrawn. Elective application of this simultaneous approach--tracheostomy with bronchoscopy--may decrease morbidity and mortality from large tracheal foreign bodies.
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Five-hundred members of The Society of Thoracic Surgeons were canvassed to discover which cannulas are currently used for open-heart surgical procedures in adults; 120 surgeons responded. The mean arterial line pressure produced by 29 disposable arterial perfusion cannulas (size range, 16F to 30F) at flow rates of 1 to 5 liters per minute was compared. A roller pump with perfusion tubing 95 mm (0.75 inch) in diameter was used with water as the test solution. ⋯ A number of cannulas kinked easily, and these showed marked increases in line pressure. The following results were obtained from this study: (1) a wide range of line pressures was observed in disposable arterial perfusion cannulas currently in clinical use; (2) some cannulas currently used for cardiopulmonary bypass in adults generated excessive line pressure; and (3) both material and design affect function, with some designs being safer than others. Cardiac surgeons should base the choice of an arterial perfusion cannula on the best performance and safest design available to avoid cannula-related problems at operation.
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False aneurysm of the aorta developed in a 14-month-old child following endoscopic removal of an open safety pin from the esophagus. The diagnostic techniques and operative repair of this rare complication of foreign body ingestion are described.
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Traumatic diaphragmatic hernia is an uncommon but important problem in the patient with multiple injuries. Since diaphragmatic injuries are difficult to diagnose, those that are missed may present with latent symptoms of bowel obstruction and strangulation. From 1957 to 1982, we treated 41 patients with traumatic diaphragmatic hernias. ⋯ Traumatic diaphragmatic hernia should be suspected on the basis of an abnormal chest radiograph in the trauma victim with multiple injuries. Right-sided injuries occur more commonly than previously thought and often require dual incisions (laparotomy and thoracotomy) for diagnosis and treatment. The organization of emergency care for such patients is critical in avoiding the potential of long-term sequelae.
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Case Reports
Late postoperative tamponade following coronary artery bypass grafting in patients on antiplatelet therapy.
Myocardial revascularization was performed in 1,361 patients over a 66-month period (February, 1978 to August, 1983) without a single occurrence of late cardiac tamponade. During a subsequent 4-month-period, aspirin and dipyridamole were administered routinely to all coronary bypass patients. The incidence of late cardiac tamponade rose significantly (p less than 0.001) to 3 of 85 patients (3.5%). Routine perioperative administration of aspirin and dipyridamole to patients undergoing myocardial revascularization may be associated with an increased incidence of delayed cardiac tamponade.