Cardiovascular surgery (London, England)
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Review Case Reports
Treatment of May-Thurner syndrome with catheter-directed thrombolysis and stent placement, complicated by heparin-induced thrombocytopenia.
May-Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema. We report the case of a 41-year-old female who presented with severe left leg edema present for 1 day. One week earlier she had experienced acute shortness of breath and pleuritic chest pain. ⋯ The endovascular reconstruction remains patent 4 months later. Heparin-induced thrombocytopenia complicating endovascular reconstruction of the iliofemoral venous system in a patient with May-Thurner Syndrome is an uncommon occurrence. This case and a review of the literature are discussed.
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Current studies indicate that portable ultrasound used by trained trauma surgeons in the emergency room can be performed using the focused abdominal sonogram for trauma technique in approximately 2 minutes to evaluate patients with blunt torso trauma. It has been shown to be as accurate as DPL and computed tomography (CT) in the detection of hemoperitoneum following abdominal trauma. It is also very accurate in detecting pericardial fluid and may have a role in the evaluation of penetrating injuries of the thorax, either from stab or gunshot wounds. ⋯ With the use of this new technology, the potential for early diagnosis of victims of trauma and prompt treatment is at hand. One of the greatest challenges remaining is that of training surgeons in the use of ultrasound. The author's experience in conducting ultrasound courses for surgeons at the Uniformed Services University of the Health Sciences is described.
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This study investigated whether or not revascularization to the site of old myocardial infarction can bring beneficial effects on postoperative cardiac function. Thirty-two patients without a history of old myocardial infarction and 71 with a history of old myocardial infarction were included. The mean number of grafts bypassed were 2.7 and 2.8, and the mean duration of aortic clamping was 99 min and 105 min in non-old myocardial infarction and old myocardial infarction patients, respectively. ⋯ There was a significant improvement of summated scores from 8.17 to 6.28 in the low ejection fraction (P < 0.05); however, this was not reflected in the high ejection fraction (3.76 to 3.0; NS). The regional wall motion in the old myocardial infarctions that were heart bypassed to the left anterior ascending artery (n = 67) or to the circumflex artery (n = 40) were significantly improved at regions 2 (P < 0.05), 3 (P < 0.05) and 7 (P < 0.05), and that bypassed to right coronary artery (n = 50) was also improved at regions 3 (P < 0.05), 5 (P < 0.05) and 7 (P < 0.001). This shows that augmentation of regional blood flow by coronary artery bypass grafting will contribute to awakening the hibernated myocardium even in the old myocardial infarction.
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Deep hypothermic cardiocirculatory arrest is the commonest method of brain protection during transverse aortic arch surgery. Its principle drawbacks consist in the limited safe ischemic period and in the coagulative, renal and pulmonary complications related to low body temperatures and prolonged cardiopulmonary bypass time. Different selective cerebral perfusion techniques have recently raised the interest of some surgical teams in an effort to obviate these problems. ⋯ Two chest reexplorations were necessary for bleeding, which were partially related to hemocoagulative disorders. In our experience, the technique of moderately hypothermic cardiopulmonary bypass and selective cerebral perfusion in aortic surgery has provided good results with regard to cerebral protection and organ function preservation. Therefore, allowing a prolonged distal aortic reconstruction period, it may be considered as a safe alternative to profound hypothermia associated with cardiocirculatory arrest in aortic arch surgery.
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Oligo-elements such as zinc (Zn), selenium (Se) and copper (Cu) have a significant influence on the function of the immune system. Various immunological and inflammatory changes are known to occur in patients undergoing cardiopulmonary bypass. The aim of this study was to evaluate changes in serum oligo-elements levels during and following cardiopulmonary bypass. ⋯ This indicates a more profound inflammatory response. Inflammatory parameters responded in the same manner as described earlier by others. These data indicate that severe loss of various oligo elements occur in patients undergoing coronary artery bypass grafting and suggests that a supplementary administration of zinc and perhaps also selenium could be appropriate during cardiopulmonary bypass.