Kyobu geka. The Japanese journal of thoracic surgery
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A 86-year-patient who had acute myocardial infarction and critical cardiogenic shock was diagnosed to have the left main trunk (LMT) and triple vessel disease. Emergent coronary artery bypass grafting to the left anterior descending artery was performed using saphenous vein graft without cardiopulmonary bypass through median sternotomy. ⋯ Tl scintigraphy showed remarkable reduction of myocardial ischemia. Hybrid therapy is the effective new strategy for critical cases which cannot be successfully and securely treated by medical or surgical approach alone.
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Clinical Trial
[Dose the serum brain natriuretic peptide (BNP) level after open heart surgery reflect myocardial protection?].
This clinical study was conducted to determine whether the serum BNP level after open heart surgery reflects myocardial protection. The levels of BNP and CPK-MB were measured before and after 12 hours of cardiopulmonary bypass, then 1, 3, and 6 days after open heart surgery, and the relationship between the maximum levels of BNP and the CPK-MB after open heart surgery was examined. ⋯ Moreover, the BNP was significantly increased in the group of patients with a maximum CPK-MB > or = 100 IU/l, compared to that in those with a maximum CPK-MB < 100 IU/l, 12 hours 1 day, and 6 days after open heart surgery (p < 0.01). These findings indicate that the serum level of BNP after open heart surgery can reflect myocardial protection.
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Case Reports
[Clinical experience using percutaneous cardiopulmonary support system for stent replacement].
Three cases of tracheal or mein bronchus stenoses were treated using percutaneous cardiopulmonary support system (PCPS). Case 1 was a 63-year-old male admitted for dyspnea due to stenotic trachea with primary lung cancer invasion. YAG-laser operation and Dynamic stent was inserted to the trachea using PCPS. ⋯ Tracheal and mein bronchus stenoses the trachea of all was dilated after placement of stent. These three cases had no complications during or after these treatment. These results indicated that using PCPS was a very useful, powerful and satisfactory method in the treatment of tracheal or mein bronchus stenoses during the lack of lung ventilation.
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Two patients with postoperative interstitial pneumonia are reported. Preoperative diagnosis was primary lung cancer without idiopathic interstitial pneumonia (IIP). ⋯ Steroid therapy was performed but one was dead. AIP is a fatal complication after pulmonary resection and steroid therapy may be useful in some cases of postoperative AIP.