ABSTRACT
HIV infection is an extremely serious problem, and the number of HIV-infected patients is increasing in the world. The introduction of highly active antiretroviral therapy (HAART) and protease inhibitors (PI) allows maintenance of the inhibition of viral replication and partial reinstating the immune system in most patients. As HIV has changed from a progressive fatal illness to a chronic condition, many infected patients increasingly require diverse health services including cardiac surgery. We report a case of a 68-year-old man with HIV infection who underwent successful coronary artery bypass grafting using a cardiopulmonary bypass. The operative indication were determined according to the CD 4 count and the amount of HIV-RNA. Standard precautions were taken in the same way as for hepatitis B and hepatitis C cases. There was no percutaneous exposure to HIV infected blood. The postoperative course was uneventful, and the patient was discharged with no complications of HIV. The patient has been quite well without any therapy for HIV over one year.
ABSTRACT
Mycobacterial infection after open-heart surgery is a rare complication. We report 2 cases of cutaneous infection caused by <i>Mycobacterium fortuitum</i> (<i>M. fortuitum</i>). Case 1: A 56-year-old man had wound infection from the 10th postoperative day (POD). The growth of <i>M. fortuitum</i> was detected on the 38th POD. Combination of multiple antibiotic therapy was performed. He was cured after several recurrences of cutaneous ulcer and abscess following 15 months. Case 2: A 26-year-old man had wound infection from the 28th POD. Deep sternal infection with mediastinitis developed. Bacteriological examination revealed the growth of <i>M. fortuitum</i> on the 61st POD. Omentopexy was performed on the 67th POD. Wound infection completely healed, and the patient was discharged from our hospital on the 137th POD. Mycobacterial infection should be considered when the wound infection is resistant to ordina antibiotics.
ABSTRACT
Chylothorax is a serious complication that can jeopardize the outcome of thoracic surgery and prolong hospitalization. We report a 66-year-old man who underwent graft replacement for a distal arch aneurysm, in whom a persistent postoperative chylothorax developed. It was necessary to perform continuous drainage and conservative management. Administration of octreotide sharply decreased the drainage volume and the chylothorax disappeared within 2 weeks. Early administration of octreotide for postoperative chylothorax may shorten the therapeutic period.
ABSTRACT
We report 4 cases of valvular injury following nonpenetrating cardiac trauma in 3 men and 1 woman ranging in age from 24 to 72 years. In all cases the cause of trauma was blunt chest trauma. One patient was operated in 4h, but the other 3 patients were operated on more than 6 months after the accidents. Lacerated aortic cusp was observed in 2 patients, ruptured anterior papillary muscle of mitral valve, and ruptured chordae tendinae of the tricuspid vale were observed in 1 patient each respectively. Three patients underwent valve replacement (2 aortic and 1 mitral valves), and another patient underwent chordoplasty in the tricuspid valve. Their post-operative courses were uneventful. Careful observation, such as echocardiography, were required following the blunt chest trauma.