ABSTRACT
The hemodynamic effects of thyroid hormones which is well established, affect myocardial contractility, heart rate, and myocardial oxygen consumption. The alterations in thyroid function test are frequently seen in patients with nonthyroidal illness and often correlate with the severity of the illness and the prognosis. In this study, thyroid hormone changes were investigated in 20 patients who received cardiopulmonary bypass(CPB). All patients showed a state of biochemical euthyroidism preoperatively. The results were as follows : 1. Serum triiodothyronine(T3) reached to its nadir(30.05+/-17.5ng/dl, p<0.001) at 10 minutes after the start of CPB and remained low(p<0.05) throughout the study period. 2. Serum thyroxine(T4) concentration slightly decreased after CPB, but maintained within normal range. 3. Serum free thyroxine(fT4) concentration slightly increased after CPB, but maintained within normal range. 4. Serum thyroid stimulating hormone(TSH) concentration increased 10 minute after CPB, reached to its nadir(3.37+/-0.81uIU/ml, p<0.001) at 2 hours after CPB. After then, serum TSH concentration decreased and reached its normal levels at 24 hours after CPB. 5. The patients whose postoperative recovery was uneventful(Group 1) had higher serum T3 levels than those who had postoperative complications(Group 2)(p<0.05). Group 1 showed elevating patterns of serum T3 in the fourth day after operation, whereas group 2 did not show such an elevating pattern. These findings are similar to the euthyroid sick syndrome seen in severely ill patients and indicate that patients undergoing open heart surgery have suppression of the pituitary-thyroid axis.
Subject(s)
Humans , Axis, Cervical Vertebra , Euthyroid Sick Syndromes , Heart , Hemodynamics , Myocardial Contraction , Oxygen Consumption , Prognosis , Reference Values , Thoracic Surgery , Thyroid Function Tests , Thyroid Gland , Thyroid HormonesABSTRACT
Pseudoaneurysm of the thoracic aorta is potentially fatal. However, reports of such cases are rare even in large series. We report four csaes of thoracic aortic pseudoaneurysm who underwent surgical repair. The causes were considered as infection in two cases (VSD repair, descending thoracic aortic aneurysm resection) and blunt chest trauma by traffic accident in two patients. The pseudoaneurysms developed on ascending aorta suspected as sites of arterial and cardiolplegic needle insertion in one patient. The others were located at descending thoracic aorta immediatly below the left subclavian artery. One patient died of sepsis associated with bile peritonitis and others were followed up from 10 to 18 months with specific morbidity. This study suggest that the incidence of pseudoaneurysm of the thoracic aorta followed by open heart or aorctic surgery can be repaired succesfuly and careful inspection of associated injury is very important in cases of traumatic thoracic pseudoaneurysm.
Subject(s)
Humans , Accidents, Traffic , Aneurysm, False , Aorta , Aorta, Thoracic , Aortic Aneurysm , Aortic Aneurysm, Thoracic , Bile , Heart , Incidence , Needles , Peritonitis , Sepsis , Subclavian Artery , ThoraxABSTRACT
The management of neonate with long gap atresia without a fistula(typeA) is complex and controversial. Various esophageal reconstruction include use of native esophagus or replacement with colon, stomach and small bowel. A severe premature male, at 28 weeks gestation weighing 1.2kg, was born with type A esophageal atresia in Chonnam University Hospital. Initial treatment consisted of gastrostomy under the local anesthesia and suctioning of proximal pouch, and than underwent delayed esophageal end to end anastomosis. A minimal leakage and mediastinitis ocurred postoperatively, but was treated by adequate drainage and negative suction from the leakage site through the gastrostomy. The patient was discharged in good general condition and normal weight of 5.4kg after 4 months after the surgery.
Subject(s)
Humans , Infant, Newborn , Male , Pregnancy , Anesthesia, Local , Colon , Drainage , Esophageal Atresia , Esophagus , Gastrostomy , Mediastinitis , Stomach , SuctionABSTRACT
Pseudoaneurysm of the thoracic aorta is potentially fatal. However, reports of such cases are rare even in large series. We report four csaes of thoracic aortic pseudoaneurysm who underwent surgical repair. The causes were considered as infection in two cases (VSD repair, descending thoracic aortic aneurysm resection) and blunt chest trauma by traffic accident in two patients. The pseudoaneurysms developed on ascending aorta suspected as sites of arterial and cardiolplegic needle insertion in one patient. The others were located at descending thoracic aorta immediatly below the left subclavian artery. One patient died of sepsis associated with bile peritonitis and others were followed up from 10 to 18 months with specific morbidity. This study suggest that the incidence of pseudoaneurysm of the thoracic aorta followed by open heart or aorctic surgery can be repaired succesfuly and careful inspection of associated injury is very important in cases of traumatic thoracic pseudoaneurysm.
Subject(s)
Humans , Accidents, Traffic , Aneurysm, False , Aorta , Aorta, Thoracic , Aortic Aneurysm , Aortic Aneurysm, Thoracic , Bile , Heart , Incidence , Needles , Peritonitis , Sepsis , Subclavian Artery , ThoraxABSTRACT
The management of neonate with long gap atresia without a fistula(typeA) is complex and controversial. Various esophageal reconstruction include use of native esophagus or replacement with colon, stomach and small bowel. A severe premature male, at 28 weeks gestation weighing 1.2kg, was born with type A esophageal atresia in Chonnam University Hospital. Initial treatment consisted of gastrostomy under the local anesthesia and suctioning of proximal pouch, and than underwent delayed esophageal end to end anastomosis. A minimal leakage and mediastinitis ocurred postoperatively, but was treated by adequate drainage and negative suction from the leakage site through the gastrostomy. The patient was discharged in good general condition and normal weight of 5.4kg after 4 months after the surgery.