Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Traumatic injury of the proximal aortic arch after blunt chest trauma;report of a case].
We report a rare case of an proximal aortic arch injury caused by blunt chest trauma. A 48-year-old woman was transferred to our hospital because of traffic accident. ⋯ An elective surgery for aortic repair was performed because of significant enlargement of the ULP in the aortic arch revealed by follow-up CT. The patient's postoperative course was uneventful, and she was discharged on the 14th postoperative day.
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Case Reports
[Heparin-induced thrombocytopenia developed during the acute phase after left upper lobectomy for lung cancer].
Heparin-induced thrombocytopenia (HIT) is a serious adverse effect of heparin administration. This must not be rarely encountered but is not often reported in Japan compared to Western countries. A 68-year-old woman underwent left upper lobectomy for lung cancer. ⋯ Her platelet count was decreased gradually despite platelet transfusion. Plate factor 4( PF4) antibody against heparin in her blood examination was found, and HIT II was diagnosed. Discontinuation of unfractionated heparin and administration of antithrombin agent improved platelet count, and no additional embolization was identified.
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A 43-year-old man accidentally shot himself with a nail gun. He was seen in the other hospital. Chest computed tomography showed nail penetrating the thorax, and a small amount of pericardial effusion. ⋯ His postoperative course was uneventful and discharged 7 days after the accident. Because penetrating cardiac injuries often cause cardiac tamponade, prompt diagnosis and emergency surgical repair are required. We report a case of nail penetration injury of the right ventricle with a review of the pertinent literature.
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Case Reports
[Successful endovascular repair of a ruptured thoracoabdominal aortic aneurysm with severe mural thrombus].
A 51-year-old man was transferred to our hospital on an emergency basis complaining of a sudden onset of severe left lumbar back pain. An emergency contrasted computed tomography showed a ruptured thoracoabdominal aortic aneurysm( rTAAA:Crawford classification type III). The ruptured site was near the aortic bifurcation, and the aneurysm had a relatively narrow segment with an extensive mural thrombus just below the renal arteries. ⋯ The abdominal part of the thoracoabdominal aortic aneurysm (TAAA) was successfully excluded with a stent graft to obtain complete hemostasis. The postoperative course was uneventful except for the need for hemodialysis. Even though there is a risk of developing late type 1 endoleak, this procedure can be a feasible option as a rescue procedure or a bridge to radical open surgery for ruptured TAAA in a specially anatomical setting like this case.
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Although, tension hemothorax appears along with thoracic injuries in many cases, the incidence is rare and the concept itself has not yet been established. Moreover, reports on tension hemothorax caused by the rupture of thoracic aortic aneurysms are very rare. Herein, we report a case in which thoracic endovascular aortic repair( TEVAR) was carried out following chest drainage in order to treat tension hemothorax accompanying rupture of the descending aortic aneurysm, thus leading to the survival of the patient.