The Annals of thoracic surgery
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Case Reports
Reversal of protamine-induced catastrophic pulmonary vasoconstriction by prostaglandin E1.
A case of catastrophic pulmonary vasoconstriction occurring after cardiopulmonary bypass after protamine reversal of heparin treated successfully with intravenous prostaglandin E1 is reported. Systemic hypotension was counteracted by epinephrine given through the left atrium. Protamine-heparin reactions are reviewed and a pathophysiological mechanism for the beneficial effect seen with prostaglandin E1 is proposed.
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A 36-year-old housewife complained of a tight feeling in the pharynx with increasing dysphagia, dyspnea, and mild fever. Chest roentgenogram was interpreted as a cystic mass in the middle mediastinum. Computed tomography showed a cystic mass compressing the carina and the esophagus. ⋯ Esophagofiberscopy showed two fistulas communicating with a cyst that had two chambers. Thoracotomy performed 40 days after onset showed a true duplication of the esophagus with rupture into the esophagus. This is a rare case in which it was possible to observe the sequence of events of a ruptured intramural duplication cyst by means of chest roentgenography, computed tomography, esophagofiberscopy, and cystogram.
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Systemic arterial air embolism is frequently unrecognized as a cause of death among patients with isolated penetrating lung injury. Between 1975 and 1983 at Parkland Memorial Hospital, the complication of systemic arterial air embolism developed in 9 patients with penetrating lung injury (six gunshots and three stabbings). Eight patients were either in profound shock or experienced cardiac arrest and all were intubated and on positive-pressure ventilation, frequently on a manual resuscitator bag before or at the time of diagnosis. ⋯ Thus, it clearly behooves us to be more alert to the possible occurrence of this complication among all victims of penetrating chest trauma. We must accept that systemic arterial air embolism is an established complication of penetrating lung injury and must recognize that it occurs much more frequently than has been previously reported. Prompt diagnosis coupled with aggressive efforts at cardiopulmonary resuscitation is crucial for successful management of patients with air embolism.