The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 1975
Spotaneous rupture of an intercostal artery in a patient with neurofibromatosis and scoliosis.
A case is reported of spontaneous rupture of an intercostal artery at its origin from the aorta in a patient with neurofibromatosis and scoliosis. The possible role played by each of these conditions in the pathogenesis of the spontaneous rupture is discussed. Comment is made on the unusual radiologic appearances of extrapleural hemorrhage.
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J. Thorac. Cardiovasc. Surg. · May 1975
Case ReportsFatal air embolism during thoracotomy for gunshot injury to the lung. Report of a case.
Fatal coronary air embolism occurred during thoracotomy in a patient with a gunshot wound involving the hilum of the right lung. Embolism was observed during a second period of failure of heart action. Evidently, air entered the pulmonary veins from the bronchus, which was receiving positive-pressure ventilation. The literature contains reports of only 3 similar cases, but we suspect that air embolism may be responsible for death and morbidity in additional cases in which accidental or iatrogenic lung trauma has produced a pathway between the bronchial tree and the pulmonary veins.
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In this report, we shall describe the instantaneous electronic monitoring of the fetal heart rate at 24 weeks' gestation. The mother was undergoing resection of coarctation of the aorta. Because the fetal heart rate reflects by physiological and pharmacologic events, monitoring this rate enabled the anesthesiologists and surgeons to make therapeutic intervention sooner and on a more rational basis.
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J. Thorac. Cardiovasc. Surg. · Mar 1975
Treatment of intercostal neuralgia with 10 per cent ammonium sulfate.
Intercostal nerves were injected with 10 per cent annomium sulfate in 41 patients (52 total sets of injections) for management of intercostal neuralgia from radical mastectomy (six blocks), thoracotomy (20 blocks), or unknown etiology (26 blocks). Five patients failed to return for follow-up evaluation and could not be located. Sixty per cent (28/47) of the treatments produced complete or nearly complete (excellent) relief of pain. ⋯ Postblock neuritis never occurred. We conclude that intercostal nerve block with 10 per cent ammonium sulfate effectively relieves intercostal neuralgia and is not associated with postblock neuritis. We therefore believe that ammonium sulfate nerve blocks should be administered for treatment of intercostal neuralgia before phenol or alcohol nerve blocks or a surgical procedure.
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J. Thorac. Cardiovasc. Surg. · Feb 1975
Surgical management of anomalous left pulmonary artery causing tracheobronchial obstruction. Pulmonary artery sling.
An anomalous left pulmonary artery causing tracheobronchial obstruction is a rare malformation seen in infancy. Sixty-four cases have been described in the literature, with 17 survivors with or without surgical therapy. We reviewed the literature and the 5 cases seen at The Children's Memorial Hospital during the past 20 years. ⋯ The important diagnostic clues are an anterior indentation of the esophagus on esophagography, narrowing of the lower end of the trachea and right bronchus on bronchography, and anomalous origin of the left pulmonary artery from the right on angiography. We prefer to approach this anomaly by a left anterolateral thoracotomy with transection and end-to-end anastomosis of the anomalous left pulmonary artery in front of the trachea. Respiratory complications due to residual tracheomalacia are common after the operation.