A controlled trial of substrate-enhanced, warm reperfusion ("hot shot") versus simple reperfusion.

BACKGROUND: Modified reperfusion after aortic cross-clamping is claimed to reduce myocardial injury, thus improving postoperative myocardial performance. METHODS: We measured perioperative release of creatine kinase-MB and troponin-T in 40 patients undergoing valve replacement (combined with coronary grafts in 12 cases) to determine whether infusion of a modified reperfusate before cross-clamp removal reduced myocardial injury. Patients were randomly allocated to one of two groups with minimization for age, surgeon, operation, and ventricular function. The control group received unmodified reperfusion, while the study group received a normothermic reperfusate, enhanced with glutamate and aspartate, for 5 minutes before removal of the cross-clamp. Serial determinations of troponin-T, creatine kinase-MB isoforms, and total creatine kinase-MB activity were made up to 5 days postoperatively. Requirements for inotropic support and evidence of myocardial infarction were documented. RESULTS: Creatine kinase-MB activity, creatine kinase-MB isoforms, and troponin-T were not significantly different between the two groups. There were no differences in the incidence of postoperative myocardial infarction or in inotrope requirement. CONCLUSIONS: Our study did not demonstrate any advantage in using modified reperfusion in this group of patients.

Large tension bronchogenic cyst in an adult mimicking the Swyer-James syndrome.

A case report of a large tension bronchogenic cyst in an adult that appeared as the Swyer-James/Macleod's syndrome is presented. Despite the thorough preoperative examinations the diagnosis was confirmed only after exploratory thoracotomy and histopathological study.

Intramural bronchogenic cyst of the oesophagus: a rare entity.

Bronchogenic cysts are congenital cystic lesions of foregut origin, usually intra-pulmonary or mediastinal in location. Peri-oesophageal bronchogenic cysts are rare, while intra-oesophageal cysts are almost always considered as enterogenous owing to their location and their composition. We report here an unusual case of a young adult with an intramural bronchogenic cyst causing dysphagia. Despite the fact that the cyst was completely embedded in the oesophageal wall, the pathological findings revealed the respiratory origin of the cyst. An extramucosal excision of the cyst was performed establishing the diagnosis and alleviating all our patient's symptoms.

An alternative, non-sleeve technique for reconstruction of main and secondary carina.

A non-sleeve resection technique was used in 15 patients requiring reconstruction of the main or secondary carina because of malignant invasion. The technique, which can be employed only in cases of partial carina invasion, utilizes healthy bronchial tissue to cover the defect after resection. The operations comprised right pneumonectomy with reconstruction of the main carina (11 cases), left lower lobectomy with reconstruction of the secondary carina (2) and right upper lobectomy (1) and right lower bilobectomy (1), both with reconstruction of the upper lobe carina. There were no intraoperative deaths or major complications, except for one bronchopleural fistula. Six patients died after 20-month to 4-year observation, six are alive (2 with and 4 without malignant disease) after 6 months to 3 years, and three have survived for more than 5 years. These initial results that our "modified sleeve resection technique" is a reliable option when the carina is partially invaded.