General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Nov 2013
Case ReportsMature teratoma of the posterior mediastinum: report of a case.
Mediastinal teratoma generally arises in the anterior mediastinum. Posterior mediastinal teratomas have been rarely reported to date, especially in adults. We report a case of posterior mediastinal teratoma in a 57-year-old woman. ⋯ The imaging features of posterior mediastinal teratomas are identical to those in the anterior mediastinum, except for their location. To be different from anterior mediastinal teratomas, benign teratomas in the posterior mediastinum are often involved with a major surrounding structure, including aorta, chest wall, and esophagus. When a posterior mediastinal tumor has the typical features of a mature teratoma in the pre-operative findings, the adhesion to the surrounding structure should be considered.
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Gen Thorac Cardiovasc Surg · Nov 2013
Adding coronary artery bypass grafting to aortic valve replacement increases operative mortality for elderly (70 years and older) patients with aortic stenosis.
This retrospective study aimed to determine the effect of simultaneous aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) on operative outcomes and long-term survival in elderly patients with a high prevalence of comorbidity. ⋯ The satisfactory operative and long-term results in our study support a more aggressive simultaneous coronary revascularization combined with AVR for aortic valve stenosis in elderly patients.
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Gen Thorac Cardiovasc Surg · Oct 2013
Case ReportsIntractable pneumothorax with empyema in a patient with interstitial pneumonia.
Secondary pneumothorax occurring in interstitial lung disease cases is a refractory and life-threatening condition, because of compromised lung function. A 70-year-old woman with interstitial pneumonia was referred to our hospital after treatment failure for pneumothorax associated with empyema. ⋯ After the covering muscles were completely adhered to the lung surface and stopped air leaking, the chest was successfully closed. The wide covering technique of the lung with chest wall muscles is effective for intractable pneumothorax with multiple fistulae.
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Gen Thorac Cardiovasc Surg · Oct 2013
Thoracoscopic resection of solitary lung metastases evaluated by using thin-section chest computed tomography: is thoracoscopic surgery still a valid option?
This study evaluated long-term outcomes of pulmonary metastasectomy for solitary lung metastases to clarify the role of video-assisted thoracoscopic surgery in the selected population. ⋯ In a highly selected group with solitary lung metastases, pulmonary metastasectomy by thoracotomy or thoracoscopy did not affect survival. There were comparable oncologic results from both surgeries when applied in solitary lung metastases from an extra-thoracic malignancy. Thoracoscopic metastasectomy is a promising option in small, solitary pulmonary metastases.
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Gen Thorac Cardiovasc Surg · Oct 2013
Current treatment of active infective endocarditis with brain complications.
We describe the optimal timing of surgery in active infective endocarditis patients with brain complications. (1) Non-hemorrhagic infarction: elective surgery has been recommended in patients with non-hemorrhagic infarction. However, the timing is changing to an earlier phase. Recent studies have shown that silent brain embolism and small-size infarction (15-20 mm) without coma can be operated safely without delay. ⋯ Among these, primary intracerebral hemorrhage is the most frequently observed. In patients with the primary intracerebral hemorrhage, surgery must be postponed for at least 4 weeks to prevent exacerbation of bleeding. In patients with ruptured infectious aneurysm, neurosurgery or endovascular surgery is performed initially and cardiac surgery should be postponed at least 2-3 weeks.