Kyobu geka. The Japanese journal of thoracic surgery
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A newly recognized distinctive fibrous soft tissue lesion called "calcifying fibrous pseudotumor" (CFPT) was recently described in the soft tissue of the extremities, trunk, scrotum, groin, neck, or axilla. But CFPT orgining from the pleura is rare. A 44-year-old woman was admitted to our hospital for an investigation of a chest radiographic abnormality. ⋯ Microscopically, the lesion was mostly composing dense collagenous tissue and scattered calcifications. The postoperative course was uneventful and no recurrence is observed 18 months after operation. We report succsessful surgical treatment for multiple CFPTs.
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Case Reports
[Prosthetic aortic valve dysfunction due to projection of the left ventricular outflow septum].
Prosthetic valve dysfunction at the aortic position is generally caused by either pannus overgrowth or thrombus or both. We encountered a case with prosthetic valve dysfunction who had undergone an aortic valve replacement 4 years and 5 months before, receiving SJM-HP 21 mm. During the initial operation, a prosthetic valve was implanted parallel to the ventricular septum and slightly up toward the non-coronary sinus (Olin technique) because of a narrow aortic annulus. ⋯ After the projecting ventricular septum was excised, SJM-regent 17 mm valve was implanted perpendicular to the septum at the supra-annular position. Postoperative course was uneventful. The postoperative aortic peak pressure gradient decreased to 25 mmHg by Doppler echocardiography.
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The feature of perioperative care for congenital heart surgery in newborn and infant is that the change of environment surrounding the baby should be considered. Especially the baby with anomaly of pulmonary artery, pulmonary vein, relation of the great vessels or patent ductus arteriosus (PDA) dependent heart defects is in a stable condition in the womb. Cardiopulmonary system changes immediately after birth, and symptoms of congenital heart disease will appear. In this part, we describe the pre- and post-operative care in newborn and infant with congenital heart defects.
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Venous thromboembolism (VTE) is the common condition of disease specified as deep vein thrombosis (DVT) or pulmonary embolism (PE), and PE is well known as one of the most important acute and chronic complications after thoracic surgery. Clinical guidelines recommend the use of low dose unfractionated heparins in the treatment and prevention of VTE, in addition to non-pharmacological interventions such as elastic stockings or intermittent sequential pneumatic compression (ISPC) aimed at reducing thrombotic risk. ⋯ In addition, use of inferior vena cava (IVC) filters or thrombolytic agents in patients with surgery also remains controversial. Prophylaxis in patients with VTE has received recommendations in many clinical guidelines, however, when the VTE is suspected, immediate and accurate diagnosis and appropriate treatment become important.
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High incidence of malnutrition is found in esophageal cancer patients. It is well known that to maintain good nutritional preoperative condition is very important to prevent postoperative morbidity and mortality. Hence, preoperative oral or nasogastric feeding is recommended when the patient is malnourished, at a total dose of 30 kcal/kg/day. ⋯ When total parenteral nutrition is used, blood glucose level should be controlled less than 150 mg/dl by pertinently administering insulin or limiting glycemic intake. Immunonutrition is promising nutritional management for critical surgical patients such as those performed esophageal cancer surgery. Continuing immune-enhancing diet at a dose of 750 to 1,000 ml/day for 5 to 7 days before surgery is necessary to bring good postoperative outcome.