Articles: postoperative.
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Cardiovascular Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: We present a case of progressive hypoxemia with platypnea-orthodeoxia developing after lung resection surgery for lung cancer. ⋯ Symptoms of hypoxemia with platypnea-orthodeoxia are concerning for shunt physiology. The differential diagnosis includes sources of intracardiac (ASD, PFO) and intrapulmonary shunting. He had a prior intracardiac shunt on an earlier echo but not on the post-operative study. He had no evidence of other cardiac causes such as pericardial effusion, constrictive pericarditis or aortic aneurysm. He had an interstitial lung disease by CT scan but this was unchanged radiographically. There was no evidence of other pulmonary causes such as COPD, thromboembolic disease or an intrapulmonary shunt (arteriovenous malformation). He had no history of liver disease with shunt from cirrhosis or history of kyphoscoliosis. Platypnea-orthodeoxia was first described in 1949 and major causes are intracardiac shunts and intrapulmonary shunts. The intracardiac shunts are right-to-left and most often include atrial septal defect, patent foramen ovale or fenestrated atrial aneurysm. Other causes include pericardial effusion, lobectomy, pneumonectomy or upper abdominal surgery. This occurs from preferential blood flow towards the atrial septum that is accentuated by altered intracardiac anatomy, compliances of the right and left heart, pulmonary vascular resistance and transient right to left pressure gradients associated with respiratory and positional changes. This is generally not associated with pulmonary hypertension and atrial right-to-left shunting has been reported despite normal right-sided pressures. A right-to-left shunt is more likely to appear after a right-sided lung resection with most patients having symptoms develop a month to several months afterwards. Noncardiac causes can include intrapulmonary shunting, such as thromboembolic disease and AVMs, or cirrhosis and kyphoscolisoss. The key to diagnosis is clinical suspicion of symptoms of dyspnea and hypoxemia, induced or worsened by an upright posture. In conclusion, interatrial shunting through a PFO or ASD is a rare but clinically significant condition after thoracic surgery. There are several underlying etiologies and can occur in the immediate postoperative period or can be more delayed.Reference #1: Interatrial Shunting After Major Thoracic Surgery: A Rare but Clinically Significant Event. Ann Thorac Surg 2012;93:1647-51Reference #2: Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt. Eur Respir J 2006; 28: 174-181Reference #3: Platypnoea-orthodeoxia syndrome. Heart 2000;83:221-223DISCLOSURE: The following authors have nothing to disclose: Nitin Bhatt, Ulysses MagalangNo Product/Research Disclosure Information.
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OSA PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Obstructive apneas can be a serious perioperative complication. Every anesthesiologist should be aware of the influence of anesthetic medications on the occurrence of such apneas. We studied the effect of an oral premedication with 0.5 mg alprazolam in patients scheduled for day-care colonoscopy. ⋯ The following authors have nothing to disclose: Eric Deflandre, Anne-Catherine Courtois, Stephanie Degey, Jean-Francois Brichant, Pol Hans, Robert Poirrier, Vincent BonhommeNo Product/Research Disclosure Information.
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Bronchology Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Pulmonary aspergilloma is an intractable disease characterized by growth of the Aspergillus fungus to form fungus balls in preformed cavitary lesions of the lungs. Complete elimination of the fungus balls cannot be accomplished by antifungal treatment alone, and surgical pneumonectomy is recommended. We report two cases in which cavernostomy was performed because of recurrent infections of the residual lung and hemoptysis after operation for lung cancer. ⋯ The following authors have nothing to disclose: Ryo Takahashi, Michio Fujino, Taiki Fujiwara, Hisami YamakawaNo Product/Research Disclosure Information.
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Surgery Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Completion pneumonectomy after prior ipsilateral lung resection is associated with higher morbidity and mortality compared to primary pneumonectomy. Robotic-assisted video-thoracoscopic surgery is being used more commonly for pulmonary lobectomy but has rarely been used for pneumonectomy and has not been reported for completion pneumonectomy. ⋯ The following authors have nothing to disclose: Eric Toloza, Anna Cheng, Carla Moodie, Vanessa Prowler, Joseph GarrettNo Product/Research Disclosure Information.
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Cancer CasesSESSION TYPE: Case ReportsPRESENTED ON: Sunday, March 23, 2014 at 09:00 AM - 10:00 AMINTRODUCTION: Cancer has been described as a civil war raging within the body. Advances in cancer treatment has improved survival, but also highlighted the long term adverse effects of treatment. ⋯ Radiation associated sarcomas should be considered in the differential work-up of solitary pulmonary nodule/mass in a patient with previous radiotherapy to the thorax.Reference #1: Laskin, W.B., T.A. Silverman, and F.M. Enzinger, Postradiation soft tissue sarcomas. An analysis of 53 cases. Cancer, 1988. 62(11): p. 2330-40.Reference #2: Wolden, S.L. and K.M. Alektiar, Sarcomas across the age spectrum. Semin Radiat Oncol, 2010. 20(1): p. 45-51Reference #3: Murray, E.M., et al., Postradiation sarcomas: 20 cases and a literature review. Int J Radiat Oncol Biol Phys, 1999. 45(4): p. 951-61DISCLOSURE: The following authors have nothing to disclose: Vinod Aiyappan, Sonja Klebe, Doug Henderson, Anand RoseNo Product/Research Disclosure Information.