ABSTRACT
A 61-year-old woman was admitted with abdominal and low back pain. The patient underwent graft replacement for inflammatory abdominal aortic aneurysm. One month postoperatively, the patient fell into hypovolemic shock with massive melena and hematemesis. Laparotomy and duodenotomy revealed a fistula between the third portion of the duodenum and the distal anastomosis of the vascular prosthesis. The fistula of the aorta was repaired with omentopexy, gastrojejunostomy and Braun's anastomosis. One month later, aortoduodenal fistula recurred. The vascular prosthesis was partially removed and the aorta was closed at the infrarenal level. After the closure of the posterior duodenal defect, a left axillo-femoral bypass was constructed. She fully recovered and discharged.
ABSTRACT
The purpose of this study was to consider the cause of the prolonged inflammatory reaction that sometimes appears after endovascular stent-graft repair for dissecting aortic aneurysm. Endovascular stent-grafting was performed in 12 patients (11 men and 1 woman, mean age 60±9.8). Endovascular stent-grafting was indicated to close the entry of type B dissections in 10 patients and to exclude ulcer-like projections (ULP) in 2 patients. On the 7th postoperative day (POD), aortography showed no endoleak in 7 type B cases (A-group), remaining endoleak in 3 type B cases (B-group), and complete exclusion in 2 ULP cases (C-group). The value of FDP-E in the A-group was high on the first POD and then decreased gradually. FDP-E also increased up to the 7th POD in the B-group, and increased very slightly after the operation in the C-group. The values of WBC and CRP increased up to the 3rd POD in all groups, but in the A-group it was still high on the 7th POD. On contrast-enhanced CT performed after the procedure and on the 7th POD, edema (over 10mm in thickness) around the descending thoracic aorta was demonstrated in 5 out of 7 cases in the A-group, but in none of the cases in the B- and C-groups. A segmental atelectasis in the left lung was detected in 6 out of 7 cases in the A-group, but in none of the cases in the Band C-groups. In the A-group, endovascular stent-grafting influenced thrombus formation, and the thickened edema around the descending thoracic aorta and the atelectasis produced in the left lung were prominent more than in the other groups. These results suggest that the Inflammation around aortic wall induced by thrombosis in the false lumen, might contribute to the development of the edema around the descending thoracic aorta and the atelectasis in the left lung. We conclude that the inflammatory reaction might have prolonged the postoperative course in the A-group patients.
ABSTRACT
Cardiac operations involving cardiopulmonary bypass can cause a systemic inflammatory response such as elevation of inflammatory cytokines, which can cause organ failure. We investigated cytokine production and its inhibition by ulinastatine in patients undergoing elective coronary artery bypass grafting under cardiopulmonary bypass. Thirty-three patients received either ulinastatine (300, 000 units, intracoronary artery injection immediately after aortic closs-clamping, UTI group, <i>n</i>=16) or no ulinastatine (control group, <i>n</i>=17). Arterial blood samples were obtained at aortic closs-clamping, 5 minutes after aortic declamping, and 6, 12 and 18 hours after surgery and there were assayed for interleukin-6 (IL-6), interleukin-8 (IL-8), and polymorphonuclear leukocyte elastase (PMNE). In addition, we examined liver function (GOT, GPT, and total bilirubin), renal function (blood urea nitrogen and serum creatinine), and oxygenatory function (PaO<sub>2</sub>/FIO<sub>2</sub>) postoperatively. IL-8 levels at 5 minutes after aortic declamping and maximum IL-8 levels were significantly lower in the UTI group than in the control group (25.5±12.8 vs. 47.8±38.9pg/dl, <i>p</i><0.05, and 28.6±13.2 vs. 58.4±40.0pg/dl, <i>p</i><0.05). Blood urea nitrogen on the second post operative day (POD) and three POD and creatinine on the second POD were also significantly lower in the UTI group than the control group. Furthermore, IL-8 and PMNE levels significantly correlated positively with blood urea nitrogen and creatinine. There was significant negative correlation between IL-8 and oxygenatory function. These results shows that the ulinastatine can inhibit IL-8 levels following cardiac surgery. To combat the increase of inflammatory cytokines such as IL-8 after cardiopulmonary bypass, the ulinastatine should be used for anticytokine therapy to protect the kidneys, lungs, and other organs, and thereby decrease the risk of complications.
ABSTRACT
A case of chylorrhea arising after median sternotomy for treatment of atrial septal defect was reported. The patient was a 55-year-old male, who had visited our outpatient clinic with a complaint of edema in the bilateral lower legs in June 1990. Under a diagnosis of atrial septal defect, a patch closure was performed in November. On the 5th postoperative day, a full liquid diet was started. Two hours and a half after the food intake, the drainage from a tube inserted into the anterior mediastinum turned milky white. Chylorrhea was diagnosed. The patient was placed in N.P.O. and maintained by an intravenous hyperalimentation. Drainage of 250-350ml/day milky white fluid persisted until the 14th postoperative day, when a 5cm removal of the mediastinal tube resulted in dramatic decrease in drainage. Thus chylorrhea in this case was cured by conservative treatment.
ABSTRACT
The Chiari network is an embryological remnant. It has rarely clinical importance but may very infrequently cause thrombosis and some other complications. Chest pain and pulmonary thrombosis were developed in a 23-year-old man. Cardiac ultrasonography revealed Chiari network in his right atrium, and no other thrombogenic lesions were found. Although anti-coagulant therapy was performed, pulmonary thrombosis were redeveloped. Chiari network was thought the cause of chest pain and pulmonary thrombosis. Operative removal of Chiari networks performed. The patient was postoperatively free from chest pain and pulmonary thrombosis.
ABSTRACT
Aortic valve replacement was carried out for aortic regurgitation in Behçet's disease. A prosthetic valve was fixed using reinforced felt-strip mattress sutures. Difficulty to ensure adequate myocardial protection due to ostial stenosis in the right coronary artery resulted in the occurrence of intraoperative myocardial infarction. Right ventricular assist with the help of a centrifugal pump was employed to obtain successful recovery from right cardiac failure. It was noted that at operation attention should have been paid to the aortic valve and also to abnormalities of the coronary artery and that control of the inflammatory reaction by steroids was essential before and after the operation.