A unusual case of right lung and right atrio-inferiocaval injury caused by stabbing.

Penetrating thoracic injuries can damage more than one intrathoracic structure and frequently require urgent surgical intervention due to life-threatening consequences. These injuries demand extreme awareness and emergency measures. This paper reports on an unusual case with right lung and right atrio-inferiocaval junction injury caused by a knife penetrating through the right paravertebral region of the thorax. The patient was treated by immediate surgical repair under partial cardiopulmonary bypass and discharged successfully. This case emphasizes the fact that right chest paravertebral penetrating injuries may require cardiopulmonary bypass, although this zone has less risk for cardiac injury.

A randomized controlled study evaluating the effects of the temperature of insufflated CO2 on core body temperature and blood gases (an experimental study).

BACKGROUND: Heated carbon dioxide (CO2) was used for pneumoperitoneum (Pp) to prevent hypothermia. This study aimed to investigate the relationship between the temperature of the insufflated CO2 and blood gases together with the core body temperature (CBT). METHODS: A prospective controlled study was performed with 24 pigs weighing approximately 20 kg randomized into four groups of 6 pigs each. A pneumoperitoneum at 12 mmHg of pressure was applied for 60 min with the pig under general anesthesia. The CO2)temperature was 22 degrees C in group 1, 37 degrees C in group 2, and 7 degrees C in group 3. In the "sham" group, pneumoperitoneum was not applied. Arterial blood pH and partial pressure of CO2 (PaCO2) were analyzed before insufflation, every 15 min during the pneumoperitoneum, and 15 min after the desufflation. The CBT was recorded before the insufflation, every 20 min during pneumoperitoneum, and 20 min after the desufflation. Blood gas analyses and CBT records for the "sham" group were performed at the same intervals. RESULTS: Arterial blood pH gradually decreased during pneumoperitoneum. At the 60th minute of pneumoperitoneum, a minimum decrease in arterial blood pH (0.04; p = 0.027) and a minimum increase in PaCO2 (3.67; p = 0.027) were recorded in group 3, whereas a maximum decrease in arterial blood pH (0.18; p = 0.027) and a maximum increase in PaCO2 (17.17; p = 0.027) were recorded in group 2. There was a significant negative correlation between PaCO2 and arterial blood pH in all the groups (r = -0.993; p < 0.01). The mean values of CBT decreases were statistically significant in all the groups: group 1 (p = 0.023), group 2 (p = 0.026), group 3 (p = 0.026), and "sham" group (p = 0.024). CONCLUSIONS: The changes in PaCO2 were directly proportional and the changes in pH contrarily proportional to the temperature of the insufflated CO2. Significant differences in CBT decreases were found between the groups receiving heated gas and room temperature gas and the groups receiving heated gas and gas below room temperature.

Transsternal transpericardial approach for the repair of bronchopleural fistula with empyema.

BACKGROUND: Numerous surgical approaches have been reported for the repair of bronchopleural fistula. Recently the transsternal transpericardial approach has shown great promise with its positive results in cases of bronchopleural fistula complicated with empyema. The aim of this retrospective study was to assess the results of bronchopleural fistula treatment using the transsternal transpericardial approach. METHODS: Bronchopleural fistula developed in 16 of the 172 patients who had pneumonectomy between 1982 and 1996. In one case closure with fibrin sealant by bronchoscopy was tried. In the remaining cases fistula was closed by the transsternal transpericardial approach. RESULTS: The interval between pneumonectomy and fistula occurrence was 10 days or less in 5 patients and 10 days to 1 month in 11 patients. In all patients the empyema space was treated by continued drainage through the thoracostomy tube. Fibrin sealant was tried unsuccessfully for closure of moderate-sized bronchopleural fistula in one case. In three cases of right bronchopleural fistula, carinal resection and anastomosis of the trachea to the left main stem bronchus were performed. In the remaining cases bronchopleural fistula was closed using a hand suture technique. One patient died within 30 days after operation (6.25%) because of renal insufficiency. There was no recurrence of bronchopleural fistula. CONCLUSIONS: Transsternal transpericardial approach seems to be a safe and effective method with an easier technique in cases of bronchopleural fistula complicated with empyema. It has the added advantage of less recurrent fistula formation and enables resection in cases without sufficient bronchial stump.

Surgical treatment of hydatid cysts of the heart: a report of 3 cases and a review of the literature.

Because the clinical signs and symptoms of cardiac hydatid cyst are nonspecific and highly variable, this disease may be difficult to diagnose. In this report, the cases of 3 patients with cardiac hydatid cysts located in the subepicardium are presented. In 2 of the patients the diagnosis was erroneous, and they were operated on for pulmonary hydatid cyst and acute abdomen in provincial hospitals before transfer to our institution. One patient who had an intrapericardially ruptured cardiac hydatid cyst presented with the clinical features of an acute abdomen. A patient with 4 subepicardial cysts had undergone surgery for a cardiac hydatid cyst 10 years before presenting at our hospital. The perforated cyst in this patient was excised while the heart was beating; the 2 other patients were operated on with extracorporeal circulation. The epidemiologic and pathologic features, clinical presentation, complications, diagnostic methods and treatment of cardiac hydatid cyst are discussed in detail in the light of pertinent literature.

Surgical treatment of hydatid cysts of the lung: analysis of 405 patients.

OBJECTIVE: The choice of operation, postoperative success and complications of surgery in patients with pulmonary hydatid cysts. DESIGN: A series of patients seen over 15 years. SETTING: A university clinic. PATIENTS: Four hundred and five patients (209 male, 196 female) ranging in age from 4 to 72 years (mean 29 years). Most (367 patients) had isolated lung cysts; 38 had both liver and lung cysts. INTERVENTIONS: A variety of procedures to remove cysts, including enucleation and capitonnage, wedge resection, segmentectomy, lobectomy and pneumonectomy. Six patients with bilateral cysts were operated on through a median sternotomy approach. Others underwent posterolateral thoracotomy. MAIN OUTCOME MEASURES: Value of diagnostic tests, the most efficacious approach for cyst removal and recurrence and death rates. RESULTS: Chest radiography gave a correct diagnosis in 99% of patients. The Casoni and Weinberg tests were discontinued because of high false-negative rates (up to 35%). Hospital mortality was 1.2% and postoperative complications occurred in 5.2%. The recurrence rate was 1.5%. CONCLUSIONS: Lung-preserving surgical interventions are the treatment of choice for pulmonary hydatid disease. In patients with bilateral cysts, the median sternotomy approach is preferred, and in the patients with right lung disease and coexisting liver cysts the transdiaphragmatic approach is the one of choice to remove cysts in 1 stage.

Aorto-left atrial fistula with bicuspid aortic valve and coronary artery origin anomaly.

Published reports of aorto-left atrial fistula are very rare. We report a 20-year-old man who had an aorto-left atrial fistula with bicuspid aortic valve and coronary artery origin anomaly. Because acquired etiologic factors were not detected, we believe that the lesions were structural defects of congenital origin.