The Annals of thoracic surgery
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Over a 24-month period, tracheostomy was performed in 55 patients using a percutaneous, wire-guided, dilatational technique. All such procedures were undertaken at the patient's bedside in the intensive care unit, with the patient under local anesthesia and mechanically ventilated through an oral endotracheal tube. ⋯ The percutaneous method was found to be rapid and simple, to leave almost no cosmetic deformity, and to be almost totally free from infectious complications. This technique should be considered for routine use in critically ill, ventilator-dependent patients.
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Case Reports
The importance of two-dimensional echocardiography in the location of a bullet embolus to the right ventricle.
Bullets which enter a sufficiently large vein may embolize to the right ventricle. This finding is usually determined after the bullet has been removed from the heart. A chest x-ray study cannot, however, differentiate with certainty between localization in the right ventricular cavity, the right ventricular wall, or the pericardium. We recommend echocardiography to document bullet localization in the right ventricular cavity prior to surgical removal.