General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Oct 2007
Review Case ReportsDelayed hepatothorax due to right-sided traumatic diaphragmatic rupture.
We present a 48-year-old man with delayed hepatothorax due to right-sided traumatic diaphragmatic rupture. An initial chest radiograph showed no specific signs except elevation of the right diaphragmatic border. The diagnosis was confirmed by coronal reformatted helical computed tomography (CT) imaging, which revealed intrathoracic displacement of the liver. ⋯ Impaction of the liver through the diaphragmatic ruptured region was observed. Chest radiographic examination after the operation revealed a more normal position of the right diaphragmatic border and resolution of the right lung atelectasis. The problems associated with the diagnosis and operative treatment of hepatothorax with right-sided traumatic diaphragmatic ruptures are discussed in the light of this case report.
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Gen Thorac Cardiovasc Surg · Oct 2007
Long-term survival and functional recovery after isolated coronary artery bypass grafting in patients with severe left ventricular dysfunction.
Coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction has been considered to be a challenging operation. We assessed the early angiographic and long-term clinical and functional outcomes of patients with poor left ventricular function who underwent isolated CABG. ⋯ CABG in patients with left ventricular dysfunction was effective, with favorable early graft patency rates. The long-term outcome was also acceptable, with echocardiographic functional recovery.
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Gen Thorac Cardiovasc Surg · Oct 2007
Case ReportsSuccessful treatment of sclerosing mediastinitis with a high serum IgG4 level.
Sclerosing mediastinitis is not a common condition in the thoracic cavity and is difficult to cure. Several medications have been used; however, most of the cases do not achieve satisfactory results, and the most successful treatment is operative resection. ⋯ The patient clearly showed remission of the symptoms after steroid therapy. Our findings suggest that the serum IgG4 level is a good selection indicator for steroid therapy in sclerosing mediastinitis.
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Gen Thorac Cardiovasc Surg · Jun 2007
Case ReportsSharp rib fragment threatening to lacerate the aorta in a patient with flail chest.
A 50-year-old man who was the victim of an accident during work was taken to the hospital. His chest radiograph and computed tomography (CT) scan showed pulmonary contusion, multiple rib fractures (left 5th to 1lth ribs), hemopneumothorax, and splenic rupture. On the fourth posttrauma day, CT showed bone particles of the ninth rib migrating to the thoracic aorta. ⋯ He was mobile and was discharged on the 17th postoperative day. A literature review revealed cases of sudden death when such rib fragments lacerated the aorta. We therefore propose an early operation for patients who have multiple bone fractures in the left chest.