The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Jun 1998
Case ReportsChronic herniation of the lung in a patient with chronic obstructive pulmonary disease. Case report and review of the literature.
Lung herniation is a rare condition and can be classified by both anatomical site and etiology. A 70-year-old man was referred with dyspnea, productive cough, and right-sided chest pain. ⋯ Two years after surgical repair the patient is free of complaints. Treatment can be conservative or surgical, but as experience is limited no long-term results have been reported.
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In contrast to its use in other surgical disciplines, intraoperative sonography has so far been of minor importance in thoracic surgery. The technique of intrathoracic, intraoperative, ultrasonic examination was applied in 85 patients with different indications: in 61 patients during thoracoscopy, in 24 patients during open thoracic surgery. 6 patients eventually underwent a combination of both procedures. In order to improve the intrathoracic maneuverability of the sonographic probe we developed an electrically controllable handle for the probe. ⋯ The sound frequency available so far for intraoperative application allows a safe distinction of non-infiltrating tumors from vascular structures; the reliable identification of an infiltration mostly requires a higher resolution. If our experiences are confirmed by further application of the method, explorative thoracotomies will surely be partly replaced by explorative thoracoscopic interventions. Ultrasonography has also proved to be useful in visualisation of mediastinal lymph-nodes and tumors, with the possibility of assessing their size.
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Thorac Cardiovasc Surg · Jun 1998
Case ReportsCoarctation of the aorta presenting in a 79-year-old male.
We present a case of coarctation of the aorta with a post-stenotic aneurysm in a 79-year-old male patient. Diagnostic studies included computed tomographic angiogram, magnetic resonance angiogram and digital subtraction angiogram. Our patient underwent operative therapy that resulted in improvement of his hypertension and cardiac function.
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Thorac Cardiovasc Surg · Apr 1998
Percutaneous dilatational tracheostomy done early after cardiac surgery--outcome and incidence of mediastinitis.
During November 95 to April 97, 45 percutaneous dilatational tracheostomies were performed in a nonselected patient series of 2788 open cardiac surgery cases. Tracheostomy was performed as early as the 2nd postoperative day (median: 6th day), when extubation was not foreseen within the next few days. Duration of intubation was 13 days (mean). ⋯ Clinically evident tracheal stenosis and inadequate granulation of the stoma were not observed after extubation. In our opinion, percutaneous dilatational tracheostomy is justifiable, shows good results, and entails minimal risk if done early after cardiac surgery, and it is also superior to standard surgical tracheostomy. Increased incidence of mediastinitis was not seen.
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Thorac Cardiovasc Surg · Feb 1998
Case ReportsVideo-assisted thoracoscopy in single-stage resection of a para-aortic posterior mediastinal dumbbell tumor.
We report the successful single-stage thoracoscopic resection of a neurogenic mediastinal dumbbell tumor close to the aortic arch, using a combined posterior approach. A 63-year-old asymptomatic male was referred to our hospital for evaluation of an abnormal round shadow in the left thoracic cavity on a chest radiograph. ⋯ Surgery combined both a laminectomy and thoracoscopic tumor resection. The tumor was lysed as deeply as possible via a posterior approach, then with the patient in the right lateral position the pleura around the tumor on the aortic side was clipped and cauterized thorocoscopically, freeing the tumor completely and allowing it to be extracted in toto.