Surgery today
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We report an unusual case of superior vena cava syndrome (SVCS) caused by thoracic actinomycosis in a 35-year-old man. The patient presented with a mediastinal mass and the diagnosis was confirmed by a right exploratory thoracotomy. Treatment with penicillin for a 15-month period resulted in a reduction in the size of the mediastinal mass and improvement of his clinical symptoms.
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Aortic dissection is characterized by fragility of the tunica media, and matrix metalloproteinases (MMPs) are enzymes that degrade the extracellular matrix of the aorta. This study examines MMPs in patients with acute aortic dissection (AAD) in an attempt to elucidate the mechanisms of their actions. ⋯ Low TIMP-2/MMP-2 and TIMP-2/MMP-9 ratios might play an important role in the onset of aortic dissection, when the tunica media becomes fragile with chronic breakage and degradation of the extracellular matrix.
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Case Reports
Emergency celiac revascularization for supramesocolic ischemia during pancreaticoduodenectomy: report of a case.
Occlusive atherosclerotic disease of the celiac artery may be diagnosed late during pancreatic resection, inducing a sudden ischemic threat to the liver, stomach, pancreas, and new anastomoses. Failure to identify and correct the insufficient supramesocolic flow can result in serious morbidity. ⋯ We describe this technique as an alternative treatment for acute supramesocolic ischemia caused by celiac axis occlusion. It is important that surgeons performing pancreatic surgery are aware of the possibility of this complication because the test occlusion of the gastroduodenal artery, which must always precede its ligation, can be negative.
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The purpose of this study was to compare the clinical results of extracorporeal membrane oxygenation (ECMO) using a centrifugal pump (CP group) and that using a roller pump (RP group) for the treatment of acute respiratory failure (ARF). ⋯ Although the centrifugal pump ECMO improved the clinical results of ARF, the overall prognosis nevertheless depended on the original disease.
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Diaphragmatic rupture following trauma is often an associated and missed injury. This report documents our experience of treating traumatic diaphragmatic rupture (TDR). ⋯ A high index of suspicion and early surgical treatment determine the successful management of TDR, with or without the herniation of abdominal organs. The surgical approach to TDR is individualized. Acute left-sided injuries are best approached through the abdomen, although we prefer the chest approach, adding laparotomy when necessary. Acute right-sided injuries and chronic injuries should be approached through the chest.