Canadian journal of surgery. Journal canadien de chirurgie
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Ascending aortic dissection complicated by aorta-right atrial fistula is a very rare occurrence. The patient may present with atypical clinical findings such as a continuous murmur or atrioventricular block, making the diagnosis difficult. Surgical repair is straightforward unless the correct diagnosis is missed, in which case there may be difficulties during the initial period of cardiopulmonary bypass. This report deals with the successful management of a 67-year-old man with this condition.
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Patients with empyema not responding to simple chest-tube drainage and antibiotic therapy have been managed by a "Clagett"-type procedure that consists of open-window thoracostomy, antibiotic irrigation and closure of the window. The results of such treatment were reviewed. Of the 103 patients with empyema treated between 1967 and 1983, 41 underwent open-window thoracostomy. ⋯ Unsuccessful closure resulted in chronic fistulas in four patients in each of the two groups. Six deaths in group 1 and two in group 2 were related to the original disease, but one was an operative death. These results demonstrate both the effectiveness and limitations of open-window thoracostomy in the management of these difficult cases.
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From January 1975 to December 1984, 93 patients with penetrating chest wounds were admitted to three hospitals in Regina. Sixty-three percent of the wounds were caused by knives and 34% by firearms. ⋯ Whereas the majority of penetrating wounds to the chest may be treated by observation or thoracostomy alone, a surgical approach is recommended when penetrating injuries are thought to have traversed the mediastinum, because of the high incidence of associated cardiac injuries. In doubtful cases the decision should favour early thoracotomy.