Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Preoperative pulseless electrical activity of acute type A aortic dissection; report of a case].
An 80-year-old man with acute type A aortic dissection, who was preoperatively observed in the intensive care unit, suddenly became unresponsive. The patient was immediately intubated, but a pulse check was delayed because the cardiac monitor seemingly showed a normal sinus rhythm. ⋯ After pericardiocentesis, a perfusion rhythm was restored with palpable distal pulse. He successfully underwent a prosthetic graft replacement of the ascending aorta and was discharged after physical rehabilitation.
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A 52-year-old man stabbed in his neck and abdomen by a kitchen knife for the purpose of suicide. He was immediately transferred by ambulance car. Subcutaneous emphysema was not observed. ⋯ The patient died due to suicide by hanging 16 months after surgery. Orotracheal intubation and primary suture were effective in a patient with trachea injury. Prevention of suicide is also important after leaving hospital in patients with history of suicide.
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Case Reports
[Usefulness of dynamic computed tomography for the diagnosis of mediastinal hemangioma].
An asymptomatic 59-year-old female was admitted with an abnormal shadow on her chest radiography. Chest computed tomography (CT) revealed a mass measuring 20 mm in the anterior mediastinum. ⋯ The tumor was completely resected via a median sternotomy, and was histopathologicaly diagnosed as hemangioma. In this case, dynamic CT was very useful for the preoperative diagnosis, and then the enhancement pattern of "peripheral puddles" on dynamic CT may be a conclusive finding for the diagnosis of mediastinal hemangiomas.
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This study reports on a 57-year-old woman who underwent a 3rd mitral valve replacement and presented with complaints of fatigue. Laboratory examination revealed severe hemolytic anemia, and trans-esophageal echocardiography revealed a paravalvular leak (PVL) around the prosthetic valve at the posterior trigone in the mitral position. ⋯ The mitral PVL was successfully repaired with suture closure of the annular defect. The postoperative course was uneventful: postoperative echocardiography revealed no evidence of PVL, and the hemolytic anemia subsided.
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We encountered a case of tracheal stenosis post tracheostomy, so-called cuff stenosis. A 43-year-old man with ventricular septal defect (VSD) was treated by oral endotracheal intubation because of heart-failure and pneumonia, and tracheostomy was performed. He was placed on artificial ventilation for almost 3 months. ⋯ Although the stenotic portion was dilated by an endotracheal tube, 47-days after dilation, the portion was restenosed to almost 7 mm in diameter. Therefore, surgical treatment was necessary and tracheoplasty was performed by end-to-end suture after 2 cm (4 ring) resection of trachea. Tracheoplasty is the most reliable method of treating cuff stenosis after tracheostomy.