The Annals of thoracic surgery
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A case of multiple sharply circumscribed pulmonary hematomas ("coin" lesions) following blunt, non-penetrating thoracic trauma, is reported. The finding mimicked cancerous "cannon ball" metastatic deposits. A computed tomographic scan combined with puncture biopsy provided the correct diagnosis. Spontaneous complete resolution of the hematomas took 3 years.
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Bleeding after cardiac surgery remains a major potential problem. Numerous pharmacologic approaches to attenuating hemostatic system activation in cardiac surgery patients have been studied to further improve patient management. Therapeutic approaches studied include inhibiting thrombin generation or activation, preserving platelet function, and decreasing the need for transfusion of allogeneic blood products. ⋯ The increasing use of platelet inhibitors (clopidogrel and IIb/IIIa receptor antagonists) and new anticoagulants (low-molecular weight heparins, pentasaccharide, recombinant hirudin, bivalirudin, and argatroban) also pose interesting problems in managing cardiac surgery patients. Aprotinin and lysine analogues (epsilon-aminocaproic acid and tranexamic acid) have become mainstay therapeutic agents to prevent bleeding and the potential need for allogeneic transfusion. Newer therapies that are important to consider include the potential of recombinant activated factor VIIa as a therapy for refractory bleeding after cardiac surgery.
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Editorial Comment Review
What's in a name? Would that which we call death by any other name be less tragic?
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Clinical Trial
Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery.
Acute nonocclusive mesenteric ischemia (NOMI) is a rare but often fatal event after cardiac surgery. ⋯ Selective mesenteric angiography with continuous papaverine administration is a simple, fast, and effective diagnostic and therapeutic tool to reduce the need for laparotomy for symptoms of ileus after open-heart surgery.
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Acquired coronary artery to left atrial fistulas are rare and previously only described in mitral stenosis associated with left atrial thrombus or coronary arteriosclerosis. We present the case of a patient who developed a left circumflex coronary artery to left atrial fistula associated with mitral regurgitation 12 years after excision of a left atrial myxoma. This was successfully ligated at the time of mitral valve replacement.