Surgery today
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Lung herniation is a rare event defined by protrusion of the lung through an abnormal weakness in the thoracic wall. We report a case of spontaneous intercostal pulmonary herniation, which occurred as a result of vigorous coughing. We repaired the herniation by approximating the ribs with heavy stitches. The mechanism of intercostal muscle disruption, and the etiology and treatment of lung herniations, are discussed.
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Controlled Clinical Trial
Release of brain natriuretic-related peptides (BNP, NT-proBNP) and cardiac troponins (cTnT, cTnI) in on-pump and off-pump coronary artery bypass surgery.
We studied the kinetic release of cardiac troponins (cTnI and cTnT) and B-type natriuretic peptides (BNP and NT-proBNP) in patients undergoing off-pump or on-pump coronary artery bypass surgery. ⋯ The data were analyzed first for off-pump versus the CPB procedures and second for warm versus cold cardioplegia. The plasma troponin releases appeared to be significantly higher in the CPB groups in comparison to the beating heart group (P < 0.001 and P < 0.002 for cTnI and cTnT peak values, respectively). The peak of the B-type natriuretic peptide release appeared to be more delayed in the groups undergoing CPB than in the beating heart group (day 6 versus days 2 and 4 for NT-proBNP and BNP, respectively). Taken together, our results indicated that the new generation of cTnT assays seemed to be more sensitive than the cTnI assays for the diagnosis of myocardium injury. A lower increase in the cTnT values in the warm cardioplegic group indicated less damage of the myocardium than with cold cardioplegia. Our data also confirm better preservation of the myocardium with off-pump cardiac surgery than with CPB.
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Since 1993, we have performed laser surgery for cutaneous lesions, such as simple hemangioma and nevus of Ota, in children under ambulatory anesthesia. Although we anticipate that the numbers of patients treated under ambulatory anesthesia will increase, few reports detail the procedures involved and their perioperative management. We describe this method of anesthesia and discuss its limitations, and future issues. ⋯ Ambulatory anesthesia can be performed safely using oxygen, nitrous oxide, and sevoflurane for the laser treatment of cutaneous lesions in pediatric patients.
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Tracheobronchial injuries following blunt chest trauma are uncommon in children. The involvement of both the trachea and right main bronchus separately is highly unusual. ⋯ While the tracheal laceration required a tracheotomy, a delayed repair of right main bronchial disruption was performed with a complete preservation of the right lung. The features of this uncommon entity are discussed, with special emphasis on early diagnosis and surgical management.
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Randomized Controlled Trial Clinical Trial
Effect of a polymorphonuclear elastase inhibitor (sivelestat sodium) on acute lung injury after cardiopulmonary bypass: findings of a double-blind randomized study.
We evaluated the effect of sivelestat sodium (SiV), a novel synthesized polymorphonuclear (PMN) elastase inhibitor, on acute lung injury (ALI) caused by cardiopulmonary bypass (CPB). ⋯ Sivelestat sodium suppressed the production of PMN elastase and IL-8, resulting in improved respiratory function in patients with ALI caused by CPB.