Kyobu geka. The Japanese journal of thoracic surgery
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Minimally invasive direct coronary artery bypass grafting via left anterior small thoracotomy (MIDCAB) and coronary artery bypass grafting without cardiopulmonary bypass (OPCAGB) are accepted technique as less invasive than conventional coronary artery bypass grafting (CABG). We reported our experience with these procedures. From 1996 to December 1999, 176 patients underwent MIDCAB or OPCAB with the internal thoracic artery. ⋯ One patient (0.6%) had perioperative myocardial infarction. No patient had cerebrovascular accident and sever wood infection. One-hundred-seventy-four patients (98.8%) had resolution of their angina symptom.
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In thoracic aortic surgery, a large number of homologous transfusions sometimes cause systemic inflammatory response, which may lead to pulmonary dysfunction, renal dysfunction and brain edema. To predict the need for homologous blood transfusion in aortic surgery, we use blood transfusion index (preoperative Ht x body weight) to predict the magnitude of homologous transfusion. ⋯ Blood transfusion index was useful preoperative parameter to predict the need for homologous transfusion.
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Between October, 1991, and October, 2001, 60 patients underwent aortic arch replacement with or without an aortic arch branched graft for atherosclerotic arch aneurysms. Their mean age was 70.1 +/- 8.6 years. Eight (13.3%) patients were operated on an emergency basis because of rupture or impending rupture of aneurysms. ⋯ A subsequent aortic operation was necessary for the treatment of an aortic abnormality distal to the arch in 6 patients. Reoperation free rate was 85.2 +/- 5.8%. In conclusion, cerebral protective effect of antegrade selective cerebral perfusion and total arch replacement with an aortic arch branched graft could substantially reduce in-hospital mortality and postoperative neurologic dysfunction and a satisfactory long-term results could be obtain in patients with atherosclerotic arch aneurysms.
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A laryngeal mask provides maintaining airway with a larger inner diameter of the tube. A little information is available about bronchoscopic treatment for upper tracheal lesions. Three patients undergoing bronchoscopic treatment for upper tracheal lesions with a laryngeal mask were reviewed. ⋯ The treatment was performed under general anesthesia using a laryngeal mask. All cases were successfully treated without operative and postoperative complications related to the use of the laryngeal mask placement. Use of a laryngeal mask may facilitate insertion and retrieval of a flexible bronchoscope and instruments with an excellent manipulation in therapeutic bronchoscopy for subglottic and upper tracheal lesions.
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Case Reports
[Delayed hydrothorax induced by a pericutaneous central venous catheter; report of a case].
We report herein a case of 53-year-old woman who suffered a hydrothorax induced by a central venous catheter which had been placed to facilitate total parenteral nutrition. The central venous catheter was inserted into the superior vena cava through the right subclavian vein. ⋯ Chest X-ray showed massive pleural effusion in the right thorax, and the catheter tip inadvertently turned upward. The continuous mechanical force of the catheter tip against the SVC wall was considered to be the cause of this life-threatening delayed hydrothorax.