Kyobu geka. The Japanese journal of thoracic surgery
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Mediastinitis caused by MRSA (Methicillin-Resistant Staphylococcus aureus) remains an intractable infection producing high mortality even in these days of advanced chemotherapy. The authors report a case of mediastinitis due to MRSA complicated with acute renal failure following mitral valve replacement. The patient's mediastinum had been thoroughly cleaned with physiological saline solution with 0.2% povidone iodine, and underwent a chemotherapy regimen of mini-dose vancomycin. ⋯ Our patient's progress confirmed that when chemotherapy using vancomycin is administered in a patient whose condition is complicated with acute renal failure, closely monitoring the vancomycin serum concentration is essential. Intermittent mini-dose intravenous administration is sufficient to maintain an effective vancomycin serum concentration. In our case, vancomycin serum concentration measured before and at completion of dialysis revealed no appreciable decline.
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Case Reports
[A case of traumatic aneurysm of the thoracic aorta with severe chronic compression of the trachea].
A case of successfully treated traumatic aneurysm of the thoracic aorta with severe major air way compression was reported. A 38-year-old man, who had a history of blunt chest trauma in a traffic accident twenty years ago, complained of asthma-like coughing chest CT scan and angiogram showed a saccular aneurysm of desending aorta compressing the isthmus of the trachea and the esophagus severely. Resection of the aneurysm and prosthetic graft replacement was undertaken successfully with the aid of F-F bypass. The trachea and the esophagus were well decompressed and the patient recovered well with no complaints.
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From 1975 to July 1994, twenty patients underwent second or third pulmonary resections for 7 recurrent lung cancers and 14 second primary lung cancers. The initial surgical procedures were lobectomy in 18, pneumonectomy in 1 and bilateral segmentectomy in 1. The procedures at the second operation were completion pneumonectomy in 4, ipsilateral wedge resection in 3, contralateral lobectomy in 1, contralateral segmentectomy in 4, contralateral wedge resection in 7 and resection of left main bronchus in 1. ⋯ Five-year survival rate following second operation in 20 patients was 32.3%, and it was 28.6% for patients with recurrent lung cancers, and 31.2% for multiple primary lung cancers. In conclusion, an aggressive surgical approach for reappearing lung tumor should be performed. At the reoperation, wedge resection for recurrent lung cancers, completion pneumonectomy for ipsilateral primary lung cancers and segmentectomy for contralateral primary lung cancers should be chosen for the standard surgical procedure.
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Twenty-two patients underwent surgical therapy for local recurrence and distant metastasis of lung cancer. Twenty patients were resected the tumor and 2 patients received the operation to improve their quality of life. Seven patients were resected lung metastasis, which were 5 adenocarcinomas and 2 squamous cell carcinomas. ⋯ There were no long-term survivors in 5 patients with bone or soft tissue metastasis. Since the differentiation of lung metastasis from the second primary tumor is impossible, the single lung metastasis should be resected. Resection of single brain metastasis provides better prognosis.
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Comparative Study
[Effect of blood conservation in open-heart surgery: a comparison of 3 different methods].
Conventional blood conservation techniques have been insufficient to decrease blood transfusion requirement in open-heart surgery. Blood conservation and erythropoietin administration were performed to avoid homologous blood transfusion. Intraoperative autotransfusion has been routinely used in cardiac operations with cardiopulmonary bypass in our hospital. ⋯ Homologous blood transfusion was avoided in 83% of group I patients, in 90% of group II, in 82% of group III, and 29% of group IV. In addition, in group II the hemoglobin value at the time of discharge was significantly higher than those of other groups (p < 0.05-0.01). Thus, conventional blood conservation techniques plus subcutaneous administration of erythropoietin was very effective to increase the rate of "non-blood" open-heart surgery.