ABSTRACT
Chylothorax is a rare but serious complication of coronary artery bypass grafting. We describe a case of double myocardial revascularization with the internal mammary artery developing the complication ten weeks after cardiac surgery. The reasons for late symptomatology of lymphatic injury are analyzed. Conservative treatment with low-fat diet, total parenteral nutrition and pleural drainage was attempted unsuccessfully; chyle leakage of around 500 ml/day and onset of nutritional deficiency made it advisable to seal the thoracic duct surgically.
Subject(s)
Chylothorax/etiology , Myocardial Revascularization , Postoperative Complications/etiology , Aged , Chylothorax/diagnosis , Chylothorax/rehabilitation , Combined Modality Therapy , Electrocardiography , Humans , Male , Postoperative Complications/diagnosis , Postoperative Complications/rehabilitation , Radiography, Thoracic , Thoracotomy , Time FactorsABSTRACT
Lactic acidosis is a severe metabolic disorder with multiple pathogenesis; biguanides increase serum lactate. The authors describe a case of phenformin-associated acidosis enhanced by predisposing conditions (dilated cardiomyopathy, renal failure, hypothyroidism). Causative mechanisms and consequences on production/clearance lactic acid cycle are discussed. The benefits of hemodialysis and inotropic therapy (dobutamine) are emphasized. Treatment of critically ill patients must be designed to avoid increase in serum lactate.
Subject(s)
Acidosis, Lactic/complications , Heart Failure/complications , Hypoglycemic Agents/adverse effects , Phenformin/adverse effects , Shock, Cardiogenic/etiology , Acidosis, Lactic/chemically induced , Acidosis, Lactic/therapy , Acute Kidney Injury/complications , Aged , Biguanides/adverse effects , Cardiomyopathy, Dilated/complications , Dobutamine/therapeutic use , Female , Humans , Renal Dialysis , Shock, Cardiogenic/therapyABSTRACT
Thirty-nine patients with paroxysmal atrial fibrillation or supraventricular tachycardia randomly received amiodarone or propafenone intravenously at home. Fifteen patients received amiodarone and 24 received propafenone; 87.5% of the patients who received propafenone and 40% of the patients who received amiodarone were converted at home to sinus rhythm (P less than .005). The median time of conversion was 10 minutes (range 5 to 35) for propafenone and 60 minutes (range 20 to 130) for amiodarone (P less than 0.005). When either drug failed to terminate atrial tachydysrhythmias at home, the same drug always restored sinus rhythm with subsequent oral treatment during hospitalization. No major side effects were observed after the infusion of either drug. The incidence of minor side effects was not significantly different between the two drugs. Both the drugs are efficacious and safe in the acute management of primary supraventricular tachydysrhythmias. Propafenone showed a greater rapidity of action.
