ABSTRACT
A 20-year-old man presented with a femur fracture and epidural hemorrhage (EDH) following a fall. One month after fracture surgery, swelling developed in both legs, and he was diagnosed as having a deep-vein thrombosis and pulmonary embolism. A retrievable inferior vena cava filter (IVCF) was inserted, because EDH is a contraindication to anticoagulants. Four months later, he complained of abdominal pain, and a computed tomography scan showed a fractured IVCF strut. After percutaneous removal failed 3 times, the IVCF was surgically removed by orthopedists using a portable image intensifier without cardiopulmonary bypass.
Subject(s)
Humans , Young Adult , Abdominal Pain , Anticoagulants , Cardiopulmonary Bypass , Femur , Hemorrhage , Leg , Pulmonary Embolism , Vena Cava Filters , Vena Cava, Inferior , Venous ThrombosisABSTRACT
BACKGROUND: Off-pump coronary artery bypass (OPCAB) is performed worldwide, but significant risks are associated with conversion to on-pump surgery. Therefore, we evaluated the composite outcomes between an OPCAB group and a conversion group. METHODS: From January 2008 to December 2012, 100 consecutive patients underwent OPCAB at Hallym University Sacred Heart Hospital, of whom 84 underwent OPCAB without adverse events (OPCAB group), and 16 were converted to on-pump surgery (conversion group). Early morbidity, early and long-term mortality, and major adverse cardiac and cerebrovascular events (MACCEs) were the primary and long-term composite endpoints. RESULTS: The mean follow-up period was 55±26 months, with 93% of the patients completing follow-up. The composite outcomes in the OPCAB and conversion groups were as follows: early morbidity, 2.3% versus 12.5%; early mortality, 4.7% versus 0%; long-term mortality, 14.3% versus 25.0%; and MACCEs, 14.3% versus 18.8%, respectively. No composite endpoints showed statistically significant differences. Preoperative acute myocardial infarction (AMI) was identified as an independent risk factor for conversion (p=0.025). CONCLUSION: The conversion group showed no statistically significant differences in early mortality and morbidity, MACCEs, or long-term mortality compared with the OPCAB group. The preoperative diagnosis of AMI was associated with an increased number of conversions to on-pump surgery.
Subject(s)
Humans , Coronary Artery Bypass , Coronary Artery Bypass, Off-Pump , Coronary Vessels , Diagnosis , Follow-Up Studies , Heart , Mortality , Myocardial Infarction , Risk FactorsABSTRACT
BACKGROUND: Conservation of blood during cardiac surgery is important because of the shortage of donor blood, risks associated with transfusion, and the costs of allogeneic blood products. This retrospective study explored the feasibility of off-pump coronary artery bypass (OPCAB) without transfusion. METHODS: One hundred and two consecutive patients underwent OPCAB from January 2007 to June 2012 at Hallym University Sacred Heart Hospital. Excluding 10 chronic renal failures patients, 102 patients were enrolled. Their characteristics, clinical data, and laboratory data were analyzed. We investigated the success rate of OPCAB without transfusion according to preoperative hemoglobin (Hb), and the cutoff point of the Hb level and the risk factors for transfusion. We implemented multidisciplinary blood-saving protocols. RESULTS: The overall operative mortality and the success rate of OPCAB without transfusion were 2.9% (3/102) and 73.5% (75/102). The success rates in patients with Hb70 years, diagnosis of acute myocardial infarction, preoperative Hb and creatinine levels, and operation time. The events precipitating the need for transfusion were low Hb level in 9 patients and hypotension or excessive bleeding in 18 patients. CONCLUSION: The preoperative Hb level of >11 facilitates OPCAB without transfusion. These results suggest that transfusion-free OPCAB can be performed by modifying the risk factors and correctable causes of transfusion and improving various blood salvage methods.
Subject(s)
Humans , Anemia , Blood Transfusion , Coronary Artery Bypass, Off-Pump , Creatinine , Diagnosis , Heart , Hemorrhage , Hypotension , Mortality , Myocardial Infarction , Renal Insufficiency , Retrospective Studies , Risk Factors , Thoracic Surgery , Tissue DonorsABSTRACT
Myocardial infarction (MI) secondary to coronary artery fistula and the subsequent occlusion of the distal right coronary artery (RCA) after blunt chest trauma is a rare entity. Here, we describe a case of coronary artery fistula and occlusion with an inferior MI that occurred following blunt chest trauma. At the initial visit to the emergency room after a car accident, this patient had been undiagnosed with acute myocardial infarction, readmitted five months after ischemic insult, and revealed to have experienced MI due to RCA-right atrial fistula and occlusion of the distal RCA. He underwent coronary surgery and recovered without complications.
Subject(s)
Humans , Coronary Vessels , Emergency Service, Hospital , Fistula , Myocardial Infarction , ThoraxABSTRACT
An ectopic thyroid is caused by abnormalities in migration of the thyroid during development and rarely occurs in the thoracic cavity or the abdominal cavity. We report the case of a 64-year-old female who had abnormal findings from a thyroid hormone test during follow-up after thyroid cancer surgery. Based on the radioisotope diagnostic test, an ectopic thyroid inside the thoracic cavity was suspected. Through surgical treatment, the patient was diagnosed with ectopic intrapulmonary thyroid. Ectopic intrapulmonary thyroid is reported to be very rare and the case is described along with a literature review.
Subject(s)
Female , Humans , Abdominal Cavity , Diagnostic Tests, Routine , Emigration and Immigration , Follow-Up Studies , Lung Neoplasms , Thoracic Cavity , Thyroid Dysgenesis , Thyroid Gland , Thyroid NeoplasmsABSTRACT
An ectopic thyroid is caused by abnormalities in migration of the thyroid during development and rarely occurs in the thoracic cavity or the abdominal cavity. We report the case of a 64-year-old female who had abnormal findings from a thyroid hormone test during follow-up after thyroid cancer surgery. Based on the radioisotope diagnostic test, an ectopic thyroid inside the thoracic cavity was suspected. Through surgical treatment, the patient was diagnosed with ectopic intrapulmonary thyroid. Ectopic intrapulmonary thyroid is reported to be very rare and the case is described along with a literature review.