Idiopathic bronchial hemorrhage: a rare but catastrophic complication in cardiac surgery.

BACKGROUND: Hemoptysis is a common complication in all kinds of surgery. However, it is rarely critical because it resolves with or without intervention. CASE PRESENTATION: Here the authors present what is believed to be an unprecedented report of a case involving a fatal idiopathic bronchial hemorrhage complication during cardiac surgery. Eighty-five-year-old female with severe aorticvalve stenosis had elective aortic valve replacement. Subsequently, she developed diffuse bilateral severe idiopathic bronchial hemorrhage which required maximum intervention such as external bronchial ligation, V-A ECMO, coil embolization of bronchial artery and internal airway blockage by spigot. CONCLUSIONS: Airway bleeding is not a rare complication in cardiac surgery, but this case should increase awareness of this potentially life threatening perioperative complication.

The use of an anti-fibrinolytic agent to reduce endoleak following endovascular repair of multiple aortic aneurysms.

This paper reports on the therapeutic use of tranexamic acid in an elderly patient with severe comorbidities that precluded even endovascular reintervention. Orally administered tranexamic acid mitigated and partially reversed two and a half years of progressive aneurysmal expansion and closed a persistent endoleak after thoracic endovascular aneurysm repair and endovascular aneurysm repair for coexisting lesions. Reappearance of the endoleak when tranexamic acid was accidentally stopped and its re-closure after the resumption of tranexamic acid treatment confirmed causality. This singular experience extends prior published observations that administration of prophylactic tranexamic acid before thoracic endovascular aneurysm repair and endovascular aneurysm repair resulted in significantly greater shrinkage, particularly if an endoleak or coagulopathy was present.

Thoracic endovascular aortic repair and off-pump coronary artery bypass grafting after renal transplantation: a case report.

Twelve years after receiving a renal transplant, a 50-year-old woman developed asthmatic symptoms. Chest CT revealed a descending thoracic aortic aneurysm. She had undergone percutaneous coronary intervention to treat the left anterior descending artery 10 years earlier. Coronary artery angiography revealed restenosis of the left anterior descending artery (99%, #6 in-stent). Because cardiopulmonary bypass may cause problems for transplanted kidney, we performed off-pump coronary artery bypass grafting (left internal thoracic artery to left anterior descending artery) and thoracic endovascular graft placement to treat the aortic aneurysm. Considering that the artery of the transplanted kidney was attached to the right iliac artery, and then the left common femoral artery was selected as the access root for GORE TAG(®) endografts (34 × 200 and 34 × 150 mm) (stentgrafts were deployed for the descending aortic artery). Postoperative angiography showed a patent bypass graft. Postoperative CT confirmed the absence of endoleaks. The postoperative course was uneventful, and she was discharged without complications. Ischemic heart disease and descending thoracic aortic aneurysm in recipients of kidney transplants can be treated using off-pump coronary bypass grafting and thoracic endovascular graft placement. The transplanted kidney was protected without using cardiopulmonary bypass (CPB).

Abdominal aortic aneurysm repair in a renal transplant recipient using a femoral V-A bypass.

We report a successful repair of an abdominal aortic aneurysm (AAA) in a renal transplant recipient using a femoral V-A bypass to protect the renal allograft during aortic cross-clamping. A 49-year-old male patient with renal failure had received a second allogenic renal transplantation in the right iliac fossa in 2002. Four years later, computed tomography showed an enlargement of the AAA extending to the distal aorta with involvement of the common iliac arteries. He received resection and graft replacement of the AAA through a midline laparotomy using a femoral V-A bypass without cold perfusion or local hypothermia. The postoperative course was uneventful, and he was discharged on the 16th postoperative day with no impairment of renal function. To protect the renal allograft injury during aortic cross-clamping, the femoral V-A bypass is an easy and safe method.

Adamkiewicz artery demonstrated by MRA for operated posterior mediastinal tumors.

In the thoracolumbar region, it is well known that the great anterior medullary artery (the artery of Adamkiewicz: AKA) is the dominant feeder of the spinal cord. During surgery for posterior mediastinal tumor adjacent to the lower thoracic aorta, perioperative distortion of the spinal cord blood supply could lead to neurological complication. To avoid postoperative paralysis, it would be useful to know the level of the intercostal artery from which the AKA originates. Recently, we have attempted to identify the AKA preoperatively using magnetic resonance angiography (MRA).

Social security reform ideas in Japan.

Japan has a complex social security system. This article discusses the demographic and economic situation in Japan as background for understanding the setting in which the social security system functions. Japan has a three-pillar system for retirement income. The first pillar is the social security pension plan; the second pillar is the voluntary occupational pension plan; and the third pillar is personal savings, including the personal pension plan. The most important part of the retirement income system is the social security pension plan, which paid benefits accounting for 64% of the total income of elderly households in 1998. The five Employees' Pension Plans are established on a compulsory social insurance basis. Most large Japanese employers have a mandatory retirement age. Over 90% of all employees, including public sector ones, must retire from their career jobs at age 60.