Kyobu geka. The Japanese journal of thoracic surgery
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Pulmonary injuries include a wide variety of clinical conditions. Most patients with blunt chest trauma can be managed with conservative treatment. Only about 10 to 15% of patients with severe chest injuries require major thoracotomy. ⋯ However, pulmonary injuries sometimes lapse into fatal condition if they are improperly treated. Open thoracotomy is required in cases with persistent massive air leakage or massive bleeding with the use of chest drainage. It is crucial to evaluate the extent and severity of the injuries based on chest X-ray and computed tomography (CT) findings for the proper initial treatment in patients with pulmonary injuries.
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The importance of blood conservation to minimize homologous blood use in cardiac surgery is well-accepted. In addition, it is financially important to minimize unnecessary and avoidable bank blood prepared, because once the blood products were taken into a hospital, it could not be returned to the blood bank in Japan. We tried to safely reduce the amount of bank blood products requested in 185 consecutive adult cardiac operations for 18 months. ⋯ Last 6 months, we prepared no blood products for the patients whose transfusion indexes were more than 700. The amounts of prepared red cell concentrate reduced to 2.1 units per patient, however, additional blood requirements during the operations did not show significant increase. A transfusion index depends on the patient's weight and preoperative hemoglobin is a simple and useful indicator to anticipate blood requirements.
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Chylothorax is a rare complication after general thoracic surgery, but remains challenging for thoracic surgeons. Chylothorax can occur after any type of general thoracic procedures, including esophagectomy, pulmonary resection, and removal of mediastinal tumor. Unless being treated properly, chylothorax leads to high mortality. ⋯ If 10 to 14 days of conservative treatment fails, surgical treatment should be considered. Ligation or clipping of the thoracic duct itself or its tributaries is performed through open thoracotomy or video-assisted thoracoscopic (VATS) approach. The results of reoperation are usually satisfactory.
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In this paper, iatrogenic myocardial infarction resulting from percutaneous catheter intervention (PCI) and cardiac surgery is described. Among the patients who had experienced iatrogenic myocardial infarction in the past 4 years, 6 had undergone emergent coronary artery bypass grafting (CABG). An emergent operation for myocardial infarction was performed on 3 patients, for problems associated with PCI, and 1 patient had died due to cardiac failure. ⋯ Although a postoperative change in the electrocardiogram was considered important, the diagnosis was complicated. In myocardial infarction, cardiogenic shock develops easily, and an emergent CABG is needed in many cases. It is important to decide on an emergent operation promptly after an accurate diagnosis.
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Blunt tracheobronchial injury is rare but crucial injury. We discussed some problems about blunt tracheobronchial injury and presented our experience. To rescue patients with blunt tracheobronchial injury, surgical treatment within 24 hours from injury is recommended when general anesthesia is acceptable. ⋯ We present a 29 year-old male who had blunt tracheobronchial injury and underwent reconstruction of carina in our hospital. Rupture of carina was recognized by bronchscopy and pneumomediastinum was shown in chest computed tomography (CT). Operation was successfully performed 22 hours later from injury and the patient discharged 28 days after from injury.