Kyobu geka. The Japanese journal of thoracic surgery
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In contrast to high mortality of open surgery for thoracic aortic catastrophes including ruptured thoracic aortic aneurysm (RTAA) and traumatic aortic injury (TAI), excellent short-term outcomes of thoracic endovascular aortic repair (TEVAR) have recently been reported. We report our single-center experiences with TEVAR for aortic catastrophes. Thirteen patients with thoracic aortic catastrophes (RTAA in 7 patients, TAI in 6 patients) have received TEVAR from February 2004 to June 2010. ⋯ TEVAR for aortic catastrophes seems to be performed safely with acceptable outcomes. Although morphological incompatibility, unstable preoperative haemodynamics and longer time for preparation may become impediments to perform TEVAR, we believe that TEVAR should be the 1st choice for life-threatening aortic catastrophes. However, a careful follow-up is necessary because TEVAR has several unique late complications.
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Thoracolithiasis is a rare condition with only 16 cases of surgically removed nodules reported in the literature in Japan. We report an additional thoracoscopically removed case. ⋯ Video-assisted thoracic surgery (VATS) was performed and a white 11 mm completely free nodule in the left pleural cavity was removed. Pathological findings revealed necrotic fat tissue in the center surrounded by hyalinized fibrous tissue, being consistent with thoracolithiasis.
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A 48-year-old woman was admitted to the hospital for coronary artery bypass grafting (CABG) of ischemic coronary disease, including left main trunk disease. She had a history of moyamoya disease with bilateral internal carotid artery occlusion. Her cerebral blood flow and cerebral vascular reactivity were evaluated by single photon emission computed tomography. ⋯ We performed off-pump CABG supported by intra-aortic ballon pumping to maintain appropriate cerebral blood flow intraoperatively. Moreover, during operation, systolic blood pressure and blood Paco2 level were constantly maintained above 100 mmHg and 40 mmHg. Her postoperative course was uneventful without transient ischemic attacks or stroke.
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A 70-year-old female with severe tricuspid regurgitation and stenosis was admitted to our institution because of watery diarrhea and peripheral edema. The urinary 5-hydroxyindoleacetic acid (5-HIAA) level was 292.9 mg/l (normal, 0.5-5.0 mg/l). Abdominal computed tomography showed enhanced multiple nodules in the liver. ⋯ Cardiac surgery for carcinoid heart disease is complicated by hemodynamic instability secondary to carcinoid crises which can be provoked pharmacologically by administration of vasoactive medications. Octreotide is an effective tool to manage manifestation of carcinoid activity. We could performed surgical treatment of carcinoid heart disease safely in the perioperative presence of octreotide.
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We report a case of delayed massive hemothorax, a 72-year-old women, due to diaphragmatic injury by multiple lower rib fracture on 4th day aftrer traffic injury. We tried to stop bleeding by transcatheter arterial embolization, but the control of bleeding was difficult, necessitating the emergency surgery. ⋯ Patient was discharged on 51th day after injury. Careful observation is important for delayed hemothorax after lower rib fracture.