ABSTRACT
Myxoma of the aortic valve is an exceedingly uncommon condition. In this article, we report the case of a 72-year-old man with myxoma arising from the aortic valve. We extirpated the mass and repaired the aortic valve with the patient under cardiopulmonary bypass. The postoperative course was uneventful. Histological examination confirmed that the mass was a myxoma.
Subject(s)
Aged , Humans , Aortic Valve , Cardiopulmonary Bypass , MyxomaABSTRACT
Endovascular stent graft placement is a minimally invasive technique that can be applied to treat many diseases of the descending thoracic aorta. For accurate stent graft placement, clear identification of aortic lesion is important and transesophageal echocardiography (TEE) is an ideal imaging tool for descending thoracic aortic aneurysms. Also TEE is able to detect a perigraft leak that cannot be confirmed by angiography. Unlike angiography, TEE image acquisition capability is not dependent on nephrotoxic contrast dye. The analysis of perioperative cardiac function provided by TEE may be helpful in the perioperative anesthetic management. Furthermore, the tip of the transesophageal echocardiographic probe can be used as a marker to guide stent graft positioning. We report a case of endovascular stent graft placement using TEE in a patient with descending thoracic aortic aneurysm under general anesthesia.
Subject(s)
Humans , Anesthesia, General , Angiography , Aorta, Thoracic , Aortic Aneurysm, Thoracic , Echocardiography, Transesophageal , Endoleak , Stents , TransplantsABSTRACT
A coronary artery aneurysm is an uncommon disorder and is seen as a characteristic dilatation of a localized portion of the coronary artery. Clinical manifestation of a coronary artery aneurysm varies from an asymptomatic presentation to sudden death of a patient. Although coronary aneurysms are typically diagnosed by the use of coronary angiography, a new generation of coronary 64-slice multidetector computed tomography (64-MDCT) scanners have successfully been used for evaluating this abnormality in a noninvasive manner. In the present case, we performed coronary 64-MDCT scanning preoperatively and postoperatively on a patient with multiple giant coronary aneurysms. The use of coronary 64-MDCT may provide an evaluation technique not only for diagnosis but also for follow-up after surgery for this condition.
Subject(s)
Aged , Humans , Male , Coronary Aneurysm/pathology , Coronary Angiography , Coronary Artery Bypass , Postoperative Care , Preoperative Care , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
We performed nerve resection and reconstruction of the phrenic nerve in a 63-year-old female patient who underwent complete resection of a malignant thymoma. The left phrenic nerve was completely encased by the tumor for 2 cm. Thus, a 3 cm long piece of phrenic nerve with 5 mm margins of safety on each end was resected and it was directly anastomosed in an end-to-end fashion. At 11 months after reconstruction, fluoroscopy demonstrated adequate and symmetric motion of both hemidiaphragms, which indicated the restoration of phrenic nerve function. The pulmonary function test results were comparable to those obtained preoperatively at 30 months. There has been no evidence of recurrence at the recent follow up visits.
Subject(s)
Female , Humans , Middle Aged , Fluoroscopy , Follow-Up Studies , Phrenic Nerve , Recurrence , Respiratory Function Tests , ThymomaABSTRACT
BACKGROUND: Acute ischemic stroke secondary to aortic dissection (AoD) is challenging in the era of thrombolysis owing to the diagnostic difficulty within a narrow time window and the high risk of complications. CASE REPORT: A 64-year-old woman with middle cerebral artery occlusion syndrome admitted to the emergency room within intravenous recombinant tissue plasminogen activator (rt-PA) time window. Her neurological symptoms improved during thrombolysis, but chest and abdominal pain developed. Repeated history-taking, physical examination, and imaging studies led to the timely diagnosis and surgical treatment of AoD, which produced a successful outcome. CONCLUSIONS: Clinical suspicion is invaluable for the diagnosis of this rare cause of stroke. Considering the stroke mechanism and complications, the risks of thrombolysis might outweigh its benefits.
Subject(s)
Female , Humans , Middle Aged , Abdominal Pain , Emergencies , Infarction, Middle Cerebral Artery , Physical Examination , Stroke , Thorax , Tissue Plasminogen ActivatorABSTRACT
Since the introduction of extracorporeal cardiopulmonary support of cardiac arrest in 1983, emergent cardiopulmonary support has been used to treat cardiac arrest. Acute massive pulmonary embolism is associated with a high mortality rate and it poses a challenge for both the anesthesiologist and the surgeons especially during operations. This report describes the use of the emergent bypass system in the effective management of an intraoperative massive pulmonary embolism and cardiac arrest in a 56-year-old woman. The patient was discharged on warfarin and there was no recurrence of the pulmonary embolism at the follow-up visit.
Subject(s)
Female , Humans , Middle Aged , Follow-Up Studies , Heart Arrest , Pulmonary Embolism , Recurrence , Resuscitation , WarfarinABSTRACT
BACKGROUND: This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease(>75 % stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction<35 %). MATERIAL AND METHOD: One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. RESULT: There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5+/-0.9 vs 3.4+/-0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. CONCLUSION: IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients.
Subject(s)
Humans , Coronary Artery Bypass , Coronary Artery Bypass, Off-Pump , Hemodynamics , Length of Stay , Mortality , Transplants , Ventilators, Mechanical , Ventricular Dysfunction, LeftABSTRACT
Vibrio parahaemolyticus is a gram-negative halophilic organism commonly associated with outbreaks of acute gastroenteritis which also sometimes causes serious wound infection. It is an uncommon cause of bacteremia. We have experienced a case of bacteremia due to Vibrio parahaemolyticus in a 59-year old man who initially presented with edema and dyspnea. He was diagnosed as liver cirrhosis, gastric cancer, and hepatoma. On hospital day 13, Vibrio parahaemolyticus was isolated from blood culture. The isolate showed typical cultural and biochemical characteristics such as salt tolerance and did not ferment lactose. The isolate was intermediate to ampicillin but susceptible to other agents.
Subject(s)
Humans , Middle Aged , Ampicillin , Bacteremia , Carcinoma, Hepatocellular , Disease Outbreaks , Dyspnea , Edema , Gastroenteritis , Lactose , Liver Cirrhosis , Salt Tolerance , Stomach Neoplasms , Vibrio parahaemolyticus , Vibrio , Wound InfectionABSTRACT
Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.
Subject(s)
Adenoma , Classification , Incidence , Japan , Lymph Nodes , Mucous Membrane , Neoplasm Metastasis , Stomach , Stomach NeoplasmsABSTRACT
Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.