Bullet embolism to the pulmonary artery.

Bullet embolization of the pulmonary artery is a very rare event. When a bullet enters the pulmonary vasculature, it may cause haemorrhage, thrombosis, sepsis, intimal erosion and eventually occlusion. Locating the bullet with several imaging methods is important to confirm the diagnosis. If due care is taken, the appropriate surgical technique for removing the bullet embolus will be uncomplicated and safe. We report our experience of bullet embolism to the left pulmonary artery.

[Single clamp technique in elderly patients undergoing coronary artery surgery]. / Koroner Arter Cerrahisi Uygulanan Yasli Hastalarda Tek Klemp Teknigi.

OBJECTIVE: The results of single clamp and partial clamp techniques were retrospectively compared in elderly patients (>70 years) undergoing coronary artery bypass grafting operation (CABG). METHODS: A total of 244 elderly patients undergoing CABG between January 1995 and March 2002 in our center were studied. Single-clamp technique was used in 32 cases (Group 1) and partial-clamp technique was used in 212 cases (Group 2). All patients had isolated coronary artery lesions and a primary elective coronary bypass grafting surgery was planned for every case. Preoperative, operative and postoperative variables; age, gender, pre- and post-operative neurological status (stroke, amaurosis fugax, aphasia, hemiplegia, hemiparesis), cerebrovascular diseases, diabetes mellitus, hypertension, number of distal grafts, left ventricular score, durations of aortic cross-clamping and cardiopulmonary bypass (CPB) times, perfusion pressure during CPB, and postoperative cardiac status were recorded. Patients with a history of neurological complications were excluded from the study. RESULTS: Overall, mean age was 71.9+/-2.18 years. Patients in Group 1 were significantly older as compared to patients in Group 2 (p< 0.01). Average duration of cross-clamping in Group 1 was significantly longer (p<0.001) compared to Group 2, but there were no differences with regard to the total duration of cardiopulmonary bypass (p=0.535). No patients had neurological complications in Group 1, however 22 patients in Group 2 had neurological complications (p<0.05). CONCLUSION: Although single-clamp technique was associated with a longer cross-clamp time, the duration of CPB was not increased and the incidence of neurological complications was low.