Subject(s)
Echocardiography, Transesophageal/methods , Funnel Chest/surgery , Heart Ventricles/diagnostic imaging , Monitoring, Intraoperative/methods , Thoracotomy/methods , Ventricular Function, Left/physiology , Ventricular Function, Right/physiology , Funnel Chest/physiopathology , Heart Ventricles/physiopathology , Humans , Recovery of Function , Stroke VolumeABSTRACT
Ingestion of liquid nitrogen is rare but carries catastrophic complications related to barotrauma to the gastrointestinal tract. We describe a case of ingestion of liquid nitrogen followed by gastric perforation and respiratory insufficiency and discuss the mechanism of injury and management of this condition. Liquid nitrogen is widely available and is frequently used in classroom settings, in gastronomy, and for recreational purposes. Given the potentially lethal complications of ingestion, regulation of its use, acquisition, and storage may be appropriate.
Subject(s)
Barotrauma/complications , Nitrogen/adverse effects , Stomach Rupture/etiology , Stomach/injuries , Administration, Oral , Adolescent , Barotrauma/diagnosis , Diagnosis, Differential , Follow-Up Studies , Gastrostomy/methods , Humans , Laparotomy , Male , Nitrogen/administration & dosage , Stomach Rupture/diagnosis , Stomach Rupture/surgery , Tomography, X-Ray Computed , Trauma Severity IndicesABSTRACT
Ascending aorta replacement for acute aortic dissection repair was carried out in a 29-year-old man without the use of blood or blood products. Intraoperative blood loss was minimized with the use of biological glues and red cell salvage. Erythropoietic agents were started before surgery and continued during and after operative repair. Postoperatively, oxygen balance was maintained despite very low hemoglobin levels by increasing the cardiac output to compensate for the low oxygen-carrying capacity, thus maximizing oxygen delivery. Only essential laboratory determinations were carried out, which reduced additional blood loss. Repair was successful, and the patient was discharged from the hospital despite a delay in diagnosis and definitive surgical repair.
Subject(s)
Aorta , Aortic Diseases/surgery , Adult , Aortic Diseases/classification , Humans , Hypothermia, Induced , Male , Postoperative Care/methodsSubject(s)
Chest Tubes , Drainage/methods , Pleural Cavity/physiology , Humans , Pleural Diseases/therapy , Pressure , Respiration, ArtificialSubject(s)
Age Factors , Aorta, Thoracic/surgery , Blood Vessel Prosthesis Implantation/mortality , Intraoperative Complications/mortality , Postoperative Complications/mortality , Severity of Illness Index , Aged , Blood Vessel Prosthesis Implantation/methods , Calibration , Discriminant Analysis , Female , Hospital Mortality , Humans , Intraoperative Complications/prevention & control , Male , Middle Aged , ROC Curve , RiskABSTRACT
Complications related to the insertion or removal of permanent pacemakers and implantable cardiac defibrillators are rare events. However, when adverse events occur, their severity may be life threatening. Rapid recognition of a problem followed by prompt consultation with a cardiothoracic surgeon is necessary to stabilize potentially catastrophic events. The immediate availability of surgical instruments as well as a formalized algorithm for management is necessary to control hemorrhagic situations. Four case reports illustrate these points.
Subject(s)
Cardiac Surgical Procedures/methods , Device Removal/adverse effects , Electrodes, Implanted/adverse effects , Heart Failure/etiology , Heart Failure/surgery , Thoracic Surgery/methods , Adult , Aged, 80 and over , Defibrillators, Implantable/adverse effects , Female , Humans , Male , Middle Aged , Pacemaker, Artificial/adverse effectsABSTRACT
Myocardial malondialdehyde concentration (MDA) as an index of membrane lipoperoxidation was measured in previously ischemic isolated rabbit hearts reperfused with Krebs solution equilibrated with different oxygen concentrations. Hearts were subjected to a ischemic period of 30 min at 4 degrees C and then reperfused at 37 degrees C with a Krebs-Henseleit solution equilibrated with 95% oxygen (group 1), 65% oxygen (group 2), or 21% oxygen (group 3). MDA concentration in nanomoles per gram protein (mean +/- SEM) at the end of reperfusion in group 1 (n = 5) was 357 +/- 18; in group 2 (n = 5) 282 +/- 18; and in group 3 (n = 5) 246 +/- 16 (p =.0008, group 1 vs. group 3; p =.0109, group 1 vs. group 2). The results support that oxidative stress after ischemia and reperfusion is modulated by the oxygen concentration of the reperfusate in the crystalloid-perfused isolated rabbit heart such that higher oxygen concentrations are associated with greater oxidative stress.
Subject(s)
Isotonic Solutions/pharmacology , Myocardium/metabolism , Oxygen/pharmacology , Superoxides/metabolism , Animals , In Vitro Techniques , Lipid Peroxidation/drug effects , Malondialdehyde/metabolism , Myocardial Contraction/drug effects , Perfusion , Rabbits , Thiobarbituric Acid Reactive Substances/metabolismABSTRACT
Rupture of a coronary artery aneurysm may result in a contained hematoma and an intramyocardial mass. We present a case of a contained coronary artery aneurysm rupture presenting as a mass in the right ventricle. The mass was suspected in a preoperative transthoracic echocardiogram and identified at the time of elective coronary artery bypass surgery. We discuss the pathophysiology, clinical presentation, diagnostic features, and management of this uncommon clinical presentation.
