Kyobu geka. The Japanese journal of thoracic surgery
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The patient was a 45-year-old female, who was emergently hospitalized with presyncope. Brain magnetic resonance imaging (MRI) confirmed an infarct in the left middle cerebral artery area. Echocardiography revealed mobile vegetations on the mitral valve and aortic valve, and the patient was diagnosed as having infective endocarditis. ⋯ The postoperative clinical course was satisfactory, without the complications of bleeding, aggravation of the cranial nerve disorders or recurrence of the infection. Ruptured mycotic cerebral aneurysms are usually associated with a poor prognosis. There are no specific guidelines for the treatment of infective endocarditis with brain complications like in this case, and it is important to select therapies tailored to individual cases.
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We carried out a retrospective evaluation of the early and mid-term outcomes of aortic valve replacement (AVR) for aortic stenosis in hemodialysis patients. Between 2004 and 2012, a total of 40 dialysis patients underwent AVR with or without an additional procedure. Hemodialysis was performed routinely the day before and during the operation. ⋯ Our study demonstrated good early and mid-term outcomes for aortic valve replacement in hemodialysis patients. CUSA was useful for patients with a calcified valve and annulus. A bioprosthetic valve was acceptable for use in elderly patients.
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We retrospectively evaluated the initial clinical experience of intraoperative cardiac output measurement by a new arterial pressure-based cardiac output (APCO:FloTrac/Vigileo) analysis in patients undergoing open heart surgery. Thirty-two patients (mean age 76.4, range 59 to 90)who underwent cardiac surgery under cardiopulmonary bypass( CPB) from July 2008 to September 2009 in our institute were enrolled in this study. There were 14 women and 18 men. ⋯ Before the institution of CPB, 3 of the 6 at T1 and 3 of the 7 at T2 in whom no correlation was shown, had severe aortic valve insufficiency (AVI). From these results, APCO appears to be an acceptable device to evaluate the intraoperative cardiac output measurement compared with CCO, except in patients with LV dysfunction or AVI at some time points. Further studies will be necessary to elucidate the precise clinical evidence to assess the efficacy of this new analysis device.
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An 86-year-old female patient was transported to our hospital because of progressive dyspnea. Computed tomography revealed a 7-cm-diameter low-density mass located in the upper mediastinum behind the trachea. The mass compressed the trachea and caused severe tracheal stenosis. ⋯ The postoperative course was uneventful, and the patient was discharged from the hospital on the 14th postoperative day. The tumor was histologically diagnosed as a bronchogenic cyst. Six months after the operation, she was still asymptomatic.
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A 78-year-old man who fell from a step ladder was transported to our hospital by ambulance under the diagnosis of multiple rib fractures and right hemothorax. Since he was in shock on arrival, endotracheal intubation and tube thoracotomy were immediately performed. Though 2 liters of blood was evacuated, persistent hemorrhage was observed, requiring continuous rapid infusion and blood transfusion. ⋯ Intrathoracic hematoma was evacuated through the 2nd large chest tube. Chest tubes were removed on the 7th day. He was discharged on the 17th day without any complications.