1/23. Extracorporeal right to left atrial bypass to treat right ventricular failure.Graft right ventricular failure after heart transplantation, secondary to preoperative functional pulmonary hypertension, was successfully managed in a 49-year-old patient using an extracorporeal right to left atrial bypass. We comment on the case and discuss the type of mechanical assistance used.- - - - - - - - - - ranking = 1keywords = comment (Clic here for more details about this article) |
2/23. Late lethal secondary hemorrhage after laser supraglottic laryngectomy.Since 1971, a number of articles have been published regarding the complications encountered with laser surgery of the larynx. Most investigations focus on complications such as accidental burns caused by the reflection of the laser beam, endotracheal explosion, special anesthesiologic problems, edema of the mucosa leading to airway obstruction, and abnormal scar formation with functional problems. Secondary hemorrhage has played a subordinate role, and in the few articles that have focused on it, cases requiring postoperative treatment have been reported only sporadically. All of these cases occurred within the first postoperative week, and no case resulting in the death of a patient was reported. We describe a patient in whom a lethal secondary hemorrhage occurred 10 days after a laser supraglottic laryngectomy. Because of the increase of laser applications in the treatment of laryngeal carcinoma, similar complications may be encountered. We comment on possible pathophysiological mechanisms and consequences.- - - - - - - - - - ranking = 1keywords = comment (Clic here for more details about this article) |
3/23. Cerebral salt wasting syndrome following brain injury in three pediatric patients: suggestions for rapid diagnosis and therapy.The association between hyponatremia and intracranial pathology has been well described. When accompanied by natriuresis, hyponatremia has most commonly been attributed to inappropriate secretion of antidiuretic hormone. However, there is growing evidence to suggest that many of these patients may actually have cerebral mediated salt losses, a disorder referred to as the cerebral salt wasting syndrome (CSWS). While this syndrome has been reasonably well described in adults, data regarding CSWS in pediatric-aged patients remains sparse. Since fluid management of these disorders is different, it is important that the clinician be able to rapidly differentiate between them. We report three cases of CSWS in acutely brain-injured children and comment on the role that early quantitation of urine volume and urine sodium concentration had in rapidly establishing the correct diagnosis.- - - - - - - - - - ranking = 1keywords = comment (Clic here for more details about this article) |
4/23. Staphylococcal postoperative subannular left ventricular false aneurysm.A 37-year-old male with acute complicated methicillin-sensitive staphylococcus aureus mitral valve endocarditis underwent urgent valve replacement with a bileaflet prosthesis. The postoperative course was complicated with fever and heart failure. echocardiography showed a large subannular false aneurysm of the left ventricle. Three weeks later resection and closure of the defect with a patch made from a cryopreserved thoracic aorta homograft were performed. The most significant aspects of this rare complication are commented on.- - - - - - - - - - ranking = 1keywords = comment (Clic here for more details about this article) |
5/23. Utilization of unilateral and bilateral stereotactically placed adrenomedullary-striatal autografts in parkinsonian humans: rationale, techniques, and observations.A limited clinical pilot study involving an amalgam of specialized disciplines including neurology, neuropharmacology, neuropsychology, neurosurgery, neuroanesthesia, neuroradiology, surgical pathology, neuropathology, and urological surgery was organized to clarify issues related to patient selection, optimization of grafting materials, design of a safe, effective, standardized, and reproducible surgical technique, and possible modification of clinical patterns. After initial assessment of 82 Parkinsonian patients for periods of 6 to 20 months, 10 (age, 39-68 years) were selected for unilateral or bilateral adrenomedullary autografts to the caudate nucleus with ependymal and cerebrospinal fluid contact, employing image-directed stereotactic methods. Selection was made only after clear definition of clinical pattern and optimization of medication responses. adrenal glands were harvested by a retroperitoneal approach (mean estimated blood loss less than 75 ml). Care was taken to maximize the graft content of medullary tissue. Stereotactic methods afforded standardized, reproducible, precise targeting and transit trajectory with unilateral or bilateral placement of materials within the striatum (tissue volume, 80 mm3) with access to the ventricular fluid of the frontal horn. Considerable variability in satisfactory donor medullary tissue was encountered. One patient did not undergo grafting because of unsatisfactory medullary tissue. No significant surgical complications were noted and all patients were ready for discharge 7 days after surgery. One patient who manifested no apparent clinical change died 6 weeks after bilateral grafting of unrelated causes during a lithotripsy procedure. Postmortem examination disclosed precise graft placement with a paucity of structurally preserved medullary cells. Postoperative observations, including parameters of clinical observation, medication schedules and records, patient and family commentaries, and imaging studies (computed tomograms and single photon emission computed tomograms), have been made for periods from 16 to 20 months. Sustained improvement in preexisting clinical patterns and reduction in drug requirements were observed in 4 of 8 patients. No increased benefit could be ascribed to bilateral graft placement. These observations would indicate a safe, and reproducible surgical method. In addition, the clinical observations indicate favorable alterations in the established pattern of the disorder, which would justify further cautious exploration of alternate donor sources or refinements of biological graft site manipulations.- - - - - - - - - - ranking = 1keywords = comment (Clic here for more details about this article) |
6/23. Thromboembolytic complications during circulatory assistance with a centrifugal pump in patients with valvular prostheses.This article describes two patients with artificial heart valves who suffered thromboembolytic complications during circulatory assistance using a Biomedicus centrifugal pump. The first case involved a 25-year-old man who presented acute blockage of a mechanical aortic valve. Emergency surgery was performed to replace this valve with a bioprosthesis. Postoperatively the patient developed severe left heart insufficiency and a Biomedicus centrifugal pump was placed between the left atrium and the ascending aorta. After 3 days of total left ventricular assistance, weaning was started and successfully completed with explanation on the 5th day. Two days later the patient died of multiple coronary embolism with thrombosis of the valve. The second case involved a 30-year-old man. Six months before, he underwent surgical procedure with placement of Bio-prosthesis for dissecting aortic aneurysm due to annuloectasia. Upon admission for terminal dilated myocardiopathy, the patient was in kidney failure almost requiring dialysis. Because of this patient's size (marfan syndrome), no donor heart was immediately available and left circulatory assistance with a Biomedicus pump had to be initiated. The patient lived without mechanical ventilation, in good clinical condition until day 23 when he presented acute right heart failure due to extensive valvular and coronary thrombosis. From these two cases, several important comments can be made about anticoagulation therapy, partial unloading of left ventricle, or need for biventricular assistance, and efficiency of centrifugal devices in these clinical applications.- - - - - - - - - - ranking = 1keywords = comment (Clic here for more details about this article) |
7/23. Ventricular thrombosis during permanent endocardial pacing in a pediatric patient with hemorrheological disorders.Thrombosis in the right atrium or ventricle is a rare complication of permanent endocardial pacing in adults. To the best of our knowledge, this complication has not been previously reported at all in the pediatric age group. We report on a case of a 7-year-old boy who had large left ventricular thrombi that occurred during permanent endocardial electrical stimulation. Subsequent pulmonary emboli complicated congestive heart failure in this patient. As a diagnostic approach, echocardiography and pulmonary perfusion scintigraphy were used. We comment on possible causes of this serious complication and suggest hemorrheological and platelet activation studies in patients with permanent endocardial pacing.- - - - - - - - - - ranking = 1keywords = comment (Clic here for more details about this article) |
8/23. Commissurotomy in intractable epilepsy: clinical and surgical comment.Two patients suffering from seizures unresponsive to medical treatment underwent two-stage "central" commissurotomy. In one patient anterior callostomy was carried out first; in the other the surgical procedure was performed in the reverse order. The clinical, EEG, and neuropsychological features of the two patients are reported before the operation, between stage 1 and stage 2 of the procedure, and after completion of the commissurotomy. The surgical aspects of the two different procedures and the related clinical pictures are described in detail.- - - - - - - - - - ranking = 4keywords = comment (Clic here for more details about this article) |
9/23. cardiac tamponade due to chylopericardium after cardiac surgery.Chylopericardium as an isolated complication after open-heart surgery is a rare event. We present here a case of postoperative chylopericardium with cardiac tamponade and comment on the clinical course and treatment.- - - - - - - - - - ranking = 1keywords = comment (Clic here for more details about this article) |
10/23. Triple antibiotics for the treatment of infected joint replacements. Case report and commentary.Combination antibiotics are frequently used in the treatment of infected joint arthroplasties to achieve synergistic activity against the infecting organisms. A case is presented in which triple antibiotic therapy was used in the treatment of an infected hip arthroplasty. The antibiotic combination proved to have an antagonistic effect despite documented sensitivities to the individual drugs. serum antimicrobial assays are recommended in the treatment of all prosthetic joint infections.- - - - - - - - - - ranking = 4keywords = comment (Clic here for more details about this article) |
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