J Cardiovasc Surg
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To assess the long term efficacy of intercostal tube drainage for spontaneous pneumothorax and determine the clinical parameters associated with surgery. ⋯ We recommend early surgery to hasten recovery and shorten the hospital stay in patients with history of recurrent spontaneous pneumothorax, respiratory distress and those requiring tube thoracostomy for more than 4 days and negative suction to expand the lung.
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Case Reports
Superior-septal approach for transmitral mapping and cryoablation of ventricular tachycardia.
A superior-septal approach was used for mapping and cryoablation of the left ventricular endocardium over the mitral annulus in a patient with ventricular tachycardia associated with an inferior myocardial infarction without a ventricular aneurysm. This approach provides an excellent view of the mitral valve, and allows safe, adequate mapping and cryoablation of the left ventricular endocardium without the necessity of a ventriculotomy.
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Secondary aortoenteric fistula (SAF) is a rare but fatal complication of reconstructive aortoiliac surgery. The prevention, diagnosis and treatment of this complication remains a challenging problem in everyday practice. Nine cases of secondary aortoduodenal fistulae during the period of 1980 to 1992 are presented. ⋯ Three patients died postoperatively. Follow-up of the remaining patients ranged from one month to 8 years. Bleeding of the upper gastrointestinal tract in patients with a history of intrabdominal reconstructive vascular surgery must raise severe suspicion as to the certainty of existance of SAF unless the diagnostic procedure, mainly exploratory laparotomy, excludes this possibility.
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Case Reports
Concomitant cardiac and pulmonary operation. Pulmonary mechanics and outcome of phrenic nerve injury.
We describe the postoperative respiratory failure due to the phrenic nerve injury in the setting of concomitant cardiac and pulmonary operation. ⋯ Diaphragm dysfunction and an increase in work of breathing may be potential causes of respiratory failure in patients after concomitant cardiac and pulmonary operation. This compromise in respiratory mechanics should not be overlooked in the postoperative care, which may lead to the best management in postoperative respiratory care.
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The use of continuous paravertebral analgesia was studied in 15 children with a mean age of 9.8 years (2-16 years). Nine patients received pre-emptive and postoperative paravertebral analgesia while six children studied earlier in the series received only post operative paravertebral analgesia. ⋯ There were no pulmonary complications and no complications related to the continuous paravertebral infusion of bupivacaine. We conclude that continuous paravertebral block is an effective and safe method for post thoracotomy pain relief in children.