[Successful Case of Coil Embolization for Repeated Pulmonary Arterial Bleeding in Postoperative Empyema with Bronchopleural Fistula].

A 78-year-old woman underwent right S6 segmentectomy and upper lobe partial resection for adenocarcinoma. About 11 months after the operation, she was diagnosed as having empyema with bronchopleural fistula and open thoracotomy was performed. From the following day, active hemorrhage from the pulmonary artery into the thoracic cavity(500~800 ml) repeated. Tamponade, surgical treatment such as putting hemostasis sheet, or covering with a pedicled latissimus dorsi muscle flap could not prevent rebleeding. Therefore selective pulmonary artery coil embolization was performed, after that the rebleeding did not occur.

[Analgesic efficacy of transversus abdominis plane block after open abdominal aortic aneurysm surgery].

BACKGROUND: Ultrasound (US)-guided transversus abdominis plane (TAP) block is widely-spread analgesic technique for the patients undergoing abdominal surgery and can be provided safely for the patients receiving anticoagulation therapy. We conducted a retrospective comparative trial of analgesic efficacy between the patient who received US-guided TAP block with postoperative continuous iv-fentanyl infusion (group T) and those who received epidural analgesia (group E). METHODS: Twenty three patients who had undergone abdominal aortic replacement were analyzed retrospectively. The number of patients in group T was 12, and those in group E was 11. The postoperative first ambulation day, the postoperative first oral feeding day, the length of hospital stay, the use of rescue analgesic medication, and the incidence of postoperative nausea and vomiting (PONV) were compared between the two groups. P<0.05 was considered significant RESULTS: There were no significant differences in baseline characteristics between the two groups. There were no significant differences in postoperative first ambulation day (P=0.97), the postoperative first oral feeding day (P=0.46), the length of hospital stay (P= 0.32), the number of times of rescue analgesic medication (P=0.55), and the incidence of PONV between the two groups. CONCLUSIONS: US-guided TAP block is a useful option as analgesic technique for patients undergoing abdominal aortic replacement

Markedly elevated procalcitonin in early postoperative period in pediatric open heart surgery: a prospective cohort study.

BACKGROUND: We encountered markedly elevated procalcitonin (PCT) among pediatric patients during the early postoperative period of open heart surgery. The purpose of this study is to investigate what factors are associated with the PCT elevation. METHODS: Fifty-two pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were enrolled. Plasma PCT, aspartate aminotransferase/alanine aminotransferase (AST/ALT), creatinine, lactate, and C-reactive protein (CRP) were measured on admission to ICU and during the postoperative period. The patients were categorized into high (group H) and low (group L) groups according to their peak PCT levels. Aorta cross-clamp (ACC), CPB time, ICU stay, mechanical ventilation period, peak AST/ALT, creatinine, lactate, and CRP levels were compared. RESULTS: ACC and CPB times, ICU stay period, and mechanical ventilation period were significantly longer in group H compared with group L (118.7 ± 51.6 vs. 49.4 ± 43.5 min, 244.5 ± 65.7 vs. 122.9 ± 63.0 min, 7.9 ± 4.6 vs. 4.0 ± 4.5 days, and 6.3 ± 4.1 vs. 2.9 ± 4.2 days, respectively; p < 0.01). Peak AST and creatinine were significantly higher in group H compared with group L (999.0 ± 1,990.3 vs. 88.3 ± 43.0 U/l and 0.84 ± 0.77 vs. 0.41 ± 0.17 mg/dl, respectively; p < 0.05). CONCLUSIONS: ACC and CPB time-related perioperative stress is associated with elevated PCT; an association between ICU stay and mechanical ventilation period, liver enzymes, and creatinine levels was observed. PCT may be a good predictor of postoperative severity and organ dysfunction.