J Cardiovasc Surg
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The efficacy of tube thoracostomies inserted at the sixth intercostal space at midaxillary line was evaluated retrospectively in children. ⋯ On the basis of these data we suggest that all thoracostomy tubes should be inserted on the sixth intercostal space where both air and the accumulating fluid can be reached. The insertion of the thoracostomy tube at the second intercostal space must be avoided since it carries a high risk of subclavian vein injury in small children, and also a secondary tube is frequently required to drain the accompanying intrapleural fluid.
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An unusual case of traumatic pericardiophrenic rupture is presented. The defect was limited to the central tendon of the diaphragm, with herniation of the stomach into the pericardial sac. ⋯ Successful operative repair of the tear was performed, with interrupted reabsorbable sutures. The case is discussed and the management of patients with these rare lesions is reviewed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of perioperative myocardial tissue damage in ischemically preconditioned human heart during aorto coronary bypass surgery.
Preconditioning myocardium with short periods of ischaemic stress interspersed with reperfusion increases its resistance to infarction. Ischaemic preconditioning protection occurred in human beings during unstable angina preceding myocardial infarction, during percutaneous transluminal coronary angioplasty and during aorto coronary bypass surgery. The purpose of this study was to test (utilised cardiac troponin T measurement) whether ischaemic preconditioning was able to protect myocardial tissue during the perioperative period and how long that protection lasted. ⋯ These data illustrate that ischaemic preconditioning limits myocardial damage during operative procedure and it may probably afford protection during a postoperative period.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cardiac Troponin T to evaluate myocardial protection via intermittent cold blood or continuous warm blood cardioplegia in coronary artery bypass grafting.
The aim of our study was to evaluate the efficacy of myocardial protection during coronary artery bypass grafting (CABG) in cold blood intermittent (CBIC) and warm continuous blood cardioplegia (WCBC). To assess myocardial necrosis, Troponin T, a structural protein belonging to the troponin complex, was measured. Troponin T is released in the blood stream 4 hours after myocardial damage, and it does not cross-react with the isomeric form of the skeletal muscle. ⋯ The results of this preliminary study suggest that fewer necrosis markers are released during CABG in the WCBC group; in the CBIC group the release of cTn-T whether measured by peak serum level or by area under the curve, shows a statistically significant correlation with cross-clamping time. Warm blood cardioplegia is safe and supplies adequate myocardial protection during CABG; the more prolonged cross-clamping is, the more myocardial protection is afforded by WCBC.
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Boerhaave's syndrome (spontaneous esophageal perforation) is an uncommon clinical entity that frequently presents with an antecedent history of marked vomiting followed by chest or abdominal pain. We report a case of spontaneous rupture of the esophagus in 53-year-old male who was referred to our hospital with a chest discomfort. A chest radiogram revealed pleural effusion and pneumomediastinum. ⋯ She underwent operative repair and, after a prolonged stay, was discharged in relatively good condition 55 days after admission. The absence of vomiting prior to presentation is the distinguishing feature of this particular case. This is the seventh case in the English literature to our knowledge.