J Cardiovasc Surg
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Review Case Reports
Homograft aortic root replacement for destructive valve endocarditis. The benefit of an in-house homograft bank.
This report concerns the surgical treatment of a 45-year old patient with active staphylococcus-endocarditis of the aortic valve which resulted in an aortic root abscess and consequently in a ventricular aortic discontinuity. A technique of homograft aortic root replacement after removal of all infected and necrotic areas is described. After a six month follow-up, the patient is asymptomatic (New York Heart Association functional class I) and shows no signs of recurrence of endocarditis. This case report makes the benefit of an in-house homograft-bank system obvious.
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One infant, age 19 days, with congenital lobar emphysema whose main symptoms included dyspnea, cyanosis and severe infant Respiratory Distress Syndrome, was presented in this paper. The most reliable diagnostic tool was chest x-ray films with anteroposterior and lateral views. ⋯ The affected lobe was the left upper lobe. Resection of the affected lobe was performed with good results.
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Randomized Controlled Trial Clinical Trial
Efficacy of pre-emptive analgesia and continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics.
Thoracotomy results in severe pain and deleterious changes in pulmonary physiology. The literature suggests that these alterations in pulmonary mechanics are inevitable and can only be minimised but not prevented by effective analgesia. We have re-evaluated this concept and assessed the efficacy of pre-emptive analgesia [preincisional afferent block, premedication with opiate and/or non-steroidal anti-inflammatory drug (NSAID)] in conjunction with postoperative extrapleural continuous intercostal nerve block on postoperative pain and pulmonary function. ⋯ We conclude that a balanced analgesic regime comprising preoperative pain prophylaxis and postoperative maintenance analgesia by NSAID and continuous extrapleural intercostal nerve block will minimise and even reverse the expected decline in lung function after thoracotomy. The postoperative decline in lung function is not obligatory but primarily due to incisional pain and thus is preventable by effective analgesia. An ideal balanced pre-emptive analgesic regime should include preincisional local anaesthetic afferent block and premedication with opiates and a NSAID:
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Case Reports
Bronchoscopy findings and early treatment of patients with blunt tracheo-bronchial trauma.
Five of 238 patients who suffered blunt chest trauna required surgery to repair a tracheobronchial injury. All patients were injured in a motor vehicle accident. ⋯ The Univent tube prevented aspiration of blood by the healthy lung and the development of acute respiratory failure. Improved control over ventilation has the secondary benefit of allowing the surgeon to assess other injuries under less duress in patients with multiple trauma.
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Embolectomy by means of the Fogarty catheter is the therapy of choice in the event of acute occlusions of limb arteries. However, less invasive catheter procedures have become established means to perform embolectomies lately. In order to improve the results after using the above mentioned methods, we have developed a new embolectomy procedure. ⋯ Only in 5 cases (10.6%) we have distal microembolism. Due to the experimental tests, the system turns out to be reliable as far as the technique is concerned. In addition, in the event of clinical application, the system allows the expectation of a reduction of the time interval between diagnosis and therapy, as well as a percutaneous application.