Kyobu geka. The Japanese journal of thoracic surgery
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Randomized Controlled Trial Clinical Trial
[A clinical evaluation of the Hepcon/HMS: a new device of monitoring hemostasis management during cardiopulmonary bypass].
The "Hepcon/HMS", a small, protable console which can instantaneously measure residual whole blood heparin concentration and automatically compute the necessary dose of additional heparin during extracorporeal circulation and also compute the required dose of protamine to reverse the effect of residual heparin. ⋯ By using "Hepcon/HMS", smaller amount of protamine to reverse residual heparin was achieved without no hemostatic derangement nor increase in the amount of postoperative bleeding, irrespective of the fact that the greater amount of heparin was administered during extracorporeal circulation as compared with the conventional anticoagulation protocol. It may help prevent the undesirable side effects of administering excessive amount of protamine, including depression of myocardial function, platelet dysfunction, anaphylactic reaction and catastrophic circulatory collapse.
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Case Reports
[Appropriate early open heart palliation of univentricular atrioventricular connection with subaortic stenosis].
Long-term conventional pulmonary artery banding deteriorates ventricular function in patients who have univentricular atrioventricular connection with subaortic obstruction. Protection of the pulmonary vascular bed and early relief of subaortic stenosis is essential to improve the outcome after Fontan operation. From January 1995 through January 1996, three infants underwent open heart palliation because of univentricular atrioventricular connection with subaortic stenosis. ⋯ It is difficult to adjust appropriate blood flow through a Blalock-Taussing shunt and a surgically isolated pulmonary artery is capable of inducing pulmonary distortion after Damus-Norwoood type operation. Whereas natural regulation of the pulmonary arterial blood flow by a restrictive ventricular outflow tract is come up after a palliative arterial switch operation. Palliative arterial switch operation is an useful alternative open heart palliation for neonates and early infants who had univentricular atrioventricular connection with subaortic stenosis.
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Case Reports
[Chronic expanding hematoma following pneumonectomy managed with a thoracic balloon: a case report].
A 64-year-old male was treated for a chronic expanding hematoma three years after pneumonectomy for left lung cancer (p T2N2M0, Stage IIIA). Two years prior to admission a left pleural effusion shadow was detected on a follow-up chest X ray, and since then there had been a progressive mediastinum shift to the right. The suspected diagnosis on referral was recurrent lung cancer or giant intrathoracic hematoma. ⋯ Surgery was performed because of the severity of symptoms and the progressive nature of the tumor. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. During the operation, it was difficult to achieve hemostasis, but bleeding was effectively managed with a thoracic balloon.
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Three cases of a chronic type B dissecting aneurysm which required abdominal aortic reconstruction are presented. Constriction of the iliac artery due to dissection was found in case 1, in case 2 the left subclavian artery originated from a giant false lumen, and arteriosclerosis obliterans was observed in case 3. The left renal artery originated from a false lumen in all cases. ⋯ The distal arch and descending aorta were then replaced with woven dacron graft. In a chronic type B dissecting aneurysm, the surgical procedure is sometimes complex because of the narrowing of the true lumen and the enlargement of the false lumen or arteries originating from the false lumen to major organs. It is necessary to consider preliminary abdominal reconstruction in cases of 1) dilatation of abdominal aneurysm, 2) obstruction, stenosis or thrombus below the abdominal aorta, or 3) presence of a giant false lumen.
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Tracheobronchial disruption by blunt trauma is relative rate, but clinical course is various and sometimes fatal. A 22-year-old man (case 1) was admitted with traffic accident. Chest CT demonstrated pneumomediastinum and left pneumothorax. ⋯ Pneumomediastinum and left tension pneumothorax were diagnosed, but bronchoscopy could not confirm the tracheobronchial disruption. As bronchial injury, lacerations and contusions of the lingular division were found in the thoracotomy, segmentectomy was carried out. When pneumomediastinum or pneumothorax is recognized in the patient of the blunt trauma, more careful examination of bronchoscopy is necessary to confirm the tracheobronchial disruption.