Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Blunt trauma to the intrapericardial inferior vena cava with concomitant rupture of the pericardium].
We report a rare case of blunt trauma to the intrapericardial inferior vena cava with concomitant rupture of the pericardium, which was successfully managed by surgical treatment. A 77-year-old male was transferred to our hospital for treatment of trauma by a traffic accident. The patient presented with the sign of shock and there were no external injuries. ⋯ A right-sided thoracotomy revealed that a small laceration of intrapericardial inferior vena cava with the pericardial tear was the site of the bleeding. Repair for that injury was done with interrupted sutures without cardiopulmonary bypass. He recovered gradually, and moved to department of orthopaedic surgery in a stable condition on the 25th hospital day.
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Comparative Study
[Clinical analysis of precaution against atrial fibrillation following cardiac surgery: landiolol or amiodarone?].
Atrial fibrillation following cardiac surgery remains as a most common complication. Tachycardia with atrial fibrillation just after the operation could lead to cardiac deterioration. Although we have to control tachycardia, we often have great difficulties in managing these arrhythmias. ⋯ Our investigation confirmed that both landiolol and amiodarone were effective in preventing atrial fibrillation, and that the timing of transition from intravenous administration to oral intake was acceptable. When landiolol was administered, enough attention should be paid to the patients whose left ventricular function was low. The patients in whom atrial fibrillation occurred under landiolol therapy showed tendency of lower heart rate in comparison with the patients under amiodarone therapy.
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We report 2 cases of delayed hemothorax due to blunt chest trauma. A 48-year-old man who fell down and got a blow at the right chest had a checkup with a 1st aid outpatient. By the X-rays at the time of the 1st examination, the hemothorax was not noted. ⋯ The abnormality was not recognized in the chest CT at that time. For the left hemiparesis, he was transported to our hospital the next day. Hemothorax was suggested by CT and chest drainage was enforced.
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A 27-year-old woman was hospitalized by emergency due to multiple blunt trauma by traffic accident. Computed tomography (CT) showed pericardial effusion. Because hematothorax and pericardial effusion appeared alternatively, thoracocentesis and pericardiocentesis were performed. ⋯ The left ventricular rupture was repaired using direct suture technique under no cardiopulmonary bypass. The postoperative course was uneventful. The patient was discharged on the 52th day after the operation.
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Recently, some clinical studies have suggested that beta-blockers may prevent atrial fibrillation after open heart surgery. In this study, we administered a low dose of landiolol (ultra short acting beta 1-blocker) by continuous infusion postoperatively to evaluate the effects on prevention of atrial fibrillation and hemodynamic stabilization in off-pump coronary artery bypass grafting (OPCAB). ⋯ Occurrence of atrial fibrillation within the 1st postoperative week in L group was statistically less than that in C group. Continuous infusion of landiolol in low dose has beneficial effects on hemodynamic stabilization, heart rate control, and prevention of atrial fibrillation in post-OPCAB.