General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Jul 2011
Hypothermic circulatory arrest for acute traumatic aortic rupture associated with shock.
Hypothermic circulatory arrest is considered to be a contraindication in acute traumatic aortic rupture (TAR) because full heparinization and hypothermia may lead to fatal bleeding if concomitant hemorrhagic injuries are present. However, in extremely emergent situations, rapid volume infusion via cardiotomy vacuums and the institution of hypothermic circulatory arrest appears to be the only method for saving patients with uncontrollable bleeding. In this study, we evaluate the feasibility of hypothermic circulatory arrest for treating patients with TAR with hemorrhagic shock. ⋯ Hypothermic circulatory arrest is feasible for saving TAR patients with unstable hemodynamics resulting from rupture, provided associated injuries are properly treated in advance.
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Gen Thorac Cardiovasc Surg · Jul 2011
Review Case ReportsLarge posterior mediastinal retrosternal goiter managed by a transcervical and lateral thoracotomy approach.
Most retrosternal goiters are situated in the anterior mediastinal compartment. Posterior mediastinal goiters are uncommon, comprising 10%-15% of all mediastinal goiters. Although most of the anterior mediastinal goiters can be removed by a transcervical approach, posterior mediastinal goiters may require additional extracervical incisions. ⋯ The literature is reviewed to clarify the management of retrosternal goiters with regard to the various approaches, indications for extracervical incisions, and their complications. In conclusion, whereas most retrosternal goiters can be resected through a transcervical approach, those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy. The overall number of complications associated with this approach, however, is higher than that seen with the transcervical approach.
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Gen Thorac Cardiovasc Surg · Jun 2011
Case ReportsPostoperative pleural effusion in living lobar lung transplant donors.
In living-donor lobar lung transplantation, the importance of donor safety should be emphasized because of the necessity of placing two donors at risk for each recipient. Approximately 3% of donors were reportedly readmitted to hospitals owing to complications after the donor surgery. Herein, we report two cases of living lobar lung transplant donors who exhibited accumulation of pleural effusion after discharge and were readmitted for treatment. The mechanism of this complication was not clearly elucidated, but surgeons should not ignore the possibility of pleural effusion necessitating readmission in living-donor lobar lung transplant donors.
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Gen Thorac Cardiovasc Surg · Jun 2011
Case ReportsCastleman's disease along the left tracheobronchial tree with a difficult preoperative diagnosis.
A 39-year-old man was referred to our hospital because of an asymptomatic middle mediastinal tumor. A preliminary histological diagnosis of the tumor by bronchoscopy was difficult to obtain because the tumor was located along the left tracheobronchial tree, which is difficult to approach. ⋯ Radiological findings of the lesion were typical; however, the rarity of the tumor made the imaging diagnosis difficult. If a lesion is located along the tracheobronchial tree, Castleman's disease should be considered in the differential diagnosis.
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Gen Thorac Cardiovasc Surg · Jun 2011
Multicenter Study Comparative StudyAtrial fibrillation after esophagectomy: an indicator of postoperative morbidity.
The relevance of new-onset atrial fibrillation (AF) after esophagectomy remains poorly defined. This study's primary goal is to better define the incidence, clinical patterns, and outcomes associated with the development of AF after esophagectomy. ⋯ New-onset AF after esophagectomy is associated with anastomotic leaks, pulmonary complications, and decreased 60-day survival. Although pulmonary complications typically occurred coincident with the onset of AF, anastomotic leaks were usually diagnosed 4 days after AF onset. New postesophagectomy AF should prompt vigilance for the presence of other concurrent complications.