General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Jan 2010
Case ReportsRetained foreign body following pleural drainage with a small-bore catheter.
Small-bore radiopaque drains can be used to drain pleural effusions. They offer reliable drainage of simple pleural effusions and provide a safe, less-invasive, more comfortable alternative to the standard tube thoracostomy. ⋯ Emphasized is the need for all staff to be familiar with the normal appearance of equipment being utilized in the ward and to report when incomplete removal of drain equipment is suspected. In addition, amendments to insertion techniques for such small-bore drains are proposed to avoid similar undue complications.
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Gen Thorac Cardiovasc Surg · Jan 2010
Case ReportsBilateral lung transplantation with closure of ventricular septal defect in a patient with Eisenmenger syndrome.
We report the first case with Eisenmenger syndrome secondary to an isolated perimembranous ventricular septal defect (VSD) in a patient who underwent bilateral lung transplantation and closure of the VSD in Japan. This male patient was diagnosed as having a VSD associated with severe pulmonary hypertension at the age of 7, and right unilateral pulmonary artery banding was performed at age 9. ⋯ The ventricular contractility had gradually improved, and ventricular arrhythmia requiring amiodarone prior to lung transplantation had disappeared. When cardiac function is preserved, bilateral lung transplantation is an option for patients with Eisenmenger syndrome secondary to VSD and should be considered as an alternative to heart-lung transplantation, especially in Japan, where donor organ shortage is critical.
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Gen Thorac Cardiovasc Surg · Dec 2009
Case ReportsTranssternal transpericardial closure of a postpneumonectomy bronchial fistula in a patient who underwent pneumonectomy because of a war injury.
Most common causes of intrathoracic empyema include pulmonary infections and postoperative bronchopleural fistulas complicating a lung surgical resection, mainly pneumonectomy, as a result of the failure of the bronchial stump to heal. A 22-year-old Serbian patient presented with chronic posttraumatic empyema. Two years before during a war, he experienced chest injury due to a firearm wound, with massive intrathoracic bleeding and need for emergency left pneumonectomy. ⋯ The patient underwent left open window thoracostomy with a daily bandage change. Here we report the treatment of the bronchopleural fistula using sequential surgical approach including transsternal transpericardial closure of the fistula followed by reconstruction of the chest wall with a regional muscle flap. Our case report highlights the feasibility and efficacy of the transsternal surgical approach to treat postpneumonectomy bronchopleural fistula, thereby avoiding the direct approach to the bronchial stump through the infected pneumonectomy cavity.
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Despite the increasing success of lung transplantation as the mainstay therapeutic modality for end-stage lung disease, the 1-year survival rate after lung transplantation remains 80% and primary graft dysfunction (PGD) accounts for 30% of mortality. Ischemia-reperfusion injury has been identified as one of the main causes of PGD, and thus significant efforts have been made to optimize the methods for lung preservation in an attempt to minimize lung injury during the period of ischemia. The composition of the lung preservation solution used in the pulmonary artery flush has been considered to be the key to successful lung preservation, and many lung transplant programs have been shifting the use of the preservation solution from the intracellular fluid type to the extracellular fluid type because of preferable posttransplant lung function with the latter. This review summarizes the experimental and clinical studies on lung preservation, particularly focusing attention on the preservation solution being employed for clinical lung transplantation.
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Gen Thorac Cardiovasc Surg · Dec 2009
Case ReportsBilateral multiple sclerosing hemangiomas of the lung.
This report presents a case of bilateral multiple sclerosing hemangiomas of the lung in a 73-year-old woman. A computed tomography (CT) scan of the chest showed a total of three well-defined small nodules in the right and left lower lobes of the lung. Because malignant metastatic lung tumors were highly suspected, a wedge resection of the left lower lobe was performed to obtain a definitive diagnosis. ⋯ The final diagnosis was that both tumors were sclerosing hemangiomas. After surgery the residual lesion of the right lower lobe was carefully followed by chest CT. The size of the right lung nodule did not change over the course of 9 years, and no new lesion has emerged.