Simultaneous repair of pectus excavatum and tetralogy of fallot: report of a case.

We report an 18-month-old boy with the association of pectus excavatum and tetralogy of Fallot (TOF). We successfully performed simultaneous pectus repair using sternal elevation without any prosthetic support and total correction of TOF after a prior modified Blalock-Taussig shunt. Retracting a divided costo-sternal complex with a rectus abdominal flap away from the operative field before the cardiac operation provided excellent surgical exposure. The modified Blalock-Taussig shunt prior to the combined repair prevented life-threatening hypoxic spells during dissection of the deformed sternum and costochondral cartilages before institution of cardiopulmonary bypass.

Effects of inhaled FK 506 on the suppression of acute rejection after lung transplantation: use of a rat orthotopic lung transplantation model.

BACKGROUND: FK 506 inhalant was recently developed for localized administration. We investigated its effects on acute lung allograft rejection and compared its efficacy with that of intramuscular administration of FK 506. METHODS: Rats (n = 123) with orthotopic left lung transplantation were divided into 9 groups. Six groups inhaled FK 506 (5 puffs, 10 puffs or 20 puffs per day), or were given intramuscular administration of FK 506 (0.05, 0.1 or 1.0 mg/kg/day). The other groups included rats receiving an isograft, rats with an untreated allograft, and a placebo group. All groups (n = 6 each) were monitored for 14 days post-operatively as an end-point and graft survival time was determined. The remaining animals were killed 4 days after transplantation. The histologic grade of rejection was determined for all groups (n = 6 each). With both (n = 3 each) inhalation therapy and intramuscular administration of FK 506, which showed similar degrees of effectiveness, both blood FK 506 concentration and cytokine expression in the graft and spleen were evaluated. RESULTS: FK 506 inhalation therapy extended allograft survival time and reduced histologic rejection on Day 4 in all groups. Graft survival time and histologic rejection scores at a dose of 10 puffs/day were comparable to those with 0.1 mg/kg/day of intramuscular FK 506. Trough concentrations of FK 506 in blood were detectable with 0.1 mg/kg/day of intramuscular FK 506, but not with 10 puffs/day. The messenger RNA expression levels of interferon-gamma in the lung allograft was suppressed significantly at a dose of 10 puffs/day. CONCLUSIONS: FK 506 inhalant enhances acute lung allograft survival with lower blood concentrations than when using comparable intramuscular administration.

Comparative study of the effect on clinical outcome of the use of an open circuit and the use of a closed circuit in cardiopulmonary bypass for a graft replacement of the descending thoracic or thoracoabdominal aorta.

PURPOSE: We studied the benefits of reduced systemic heparinization in a heparin-coated cardiopulmonary bypass (CPB) system for graft replacement of the descending thoracic (TA) or thoracoabdominal aorta (TAA). METHODS: Fifty-five patients were assigned to two groups: one group in which closed CPB circuits with reduced heparinization by elimination of the hard shell reservoir were used (group A, n = 36) and one group in which open circuits with full heparinization were used (group B, n = 19). RESULTS: The transfusion requirement tended to be greater as the duration of CPB increased, even in group A. The incidences of renal dysfunction in two groups were not significantly different. Only the incidence of pulmonary dysfunction was significantly higher in group B. A reduction of systemic heparinization had no benefit for perioperative bleeding. In the TAA operation, the total amount of hemorrhaging in group A was greater than that in group B, but the difference was not significant. CONCLUSIONS: No beneficial effects of the use of heparin-coated CPB circuits on the amount of perioperative bleeding and postoperative organ damage, including renal dysfunction, were found in this study. However, our findings suggest that it may be better to avoid the use of closed CPB circuits in operations with a prolonged duration of CPB, such as a TAA operation.

Isolated iliac artery aneurysmocolonic fistula with pericolic abscess.

We report the successful management of a 66-year-old man who had common iliac aneurysmosigmoid colon fistula. The initial presentation was abdominal pain, fever, and melena. Digital subtraction angiography showed no evidence of rupture. However, computed tomography scanning revealed fine gas formations in the common iliac artery aneurysm. To reduce the risk of graft infection and prolonged ischemia, we created an extraabdominal femoral-femoral bypass graft, closed the wounds, removed the aneurysm, and closed the colon primarily. The postoperative course and recovery were uneventful.

Retroperitoneal bronchogenic cyst: a case report.

A 46-year-old woman presented with a 1-year history of progressive left-arm numbness. A cyst below the left hemidiaphragm was discovered incidentally when a CT scan was performed to examine the thymus for a suspected tumor. A thymic mass was found. MRI indicated that the cyst contained proteinaceous fluid. The thymoma was approached through a median sternotomy and resected, but the cyst was found to be infradiaphragmatic. A separate, left paraspinal incision was made to access the retroperitoneum, and the cyst was resected. Histologic examination showed that the cyst was bronchogenic in origin. Retroperitoneal bronchogenic cysts are very rare, and only four cases have been reported in the English-language literature.