RESUMO
Aortoenteric fistulas represent a life-threatening complication of abdominal aortic surgery that is becoming increasingly well-recognized. The presentation is often subtle, with a herald bleed followed by a period of grace, followed by an exsanguinating hemorrhage, and resulting in cardiovascular collapse. The diagnosis is often difficult, even with modern modalities of endoscopy, arteriography, and CAT scanning. A high index of suspicion is critical for making a successful diagnosis. The fistulas most commonly occur between the proximal aortic suture line and the duodenum after abdominal aortic surgery for aneurysmal or occlusive disease. Typically they occur years after this procedure. However, over the last several years, we have seen 12 cases with extremely unusual presentations that illustrate the wide spectrum of possible presentations. Included in this group was a primary aortoduodenal fistula, and two fistulas occurring just months after the initial surgery. These cases are reported with attention to the details of the presentation to emphasize the wide range of presentations of this serious complication. A brief review of this literature is also included in the report.
Assuntos
Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Fístula/diagnóstico , Fístula/cirurgia , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirurgia , Idoso , Aorta Abdominal , Duodenopatias/diagnóstico , Duodenopatias/cirurgia , Evolução Fatal , Feminino , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/cirurgia , MasculinoRESUMO
Management of infected pacemakers always presents a problem. This report describes a method of managing infected pacemakers, using the infected unit as a temporary pacer. This method has worked well in four patients.
Assuntos
Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Idoso , Antibacterianos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Infecções Estafilocócicas/etiologiaRESUMO
A method is described for using the Favaloro retractor to provide retraction during dissection of the anterior wall of the heart during reoperative cardiac operations.
Assuntos
Revascularização Miocárdica/instrumentação , Instrumentos Cirúrgicos , Humanos , Revascularização Miocárdica/métodos , ReoperaçãoRESUMO
Time-consuming difficulty is occasionally encountered in finding coronary arteries or previously placed vascular grafts during coronary revascularization procedures. A catheter-tipped, continuous-wave Doppler ultrasonic probe with simple audio output has been shown to be capable of expediting the search for these vessels.