RESUMEN
Paralysis and sensory loss of a dominant right arm developed as complications of cannulation of the right internal jugular vein (IJV) in a patient undergoing cardiac surgery. This sequela of IJV cannulation has not been previously reported at the time of this writing.
Asunto(s)
Neuropatías del Plexo Braquial/etiología , Cateterismo Venoso Central/efectos adversos , Hematoma/etiología , Parálisis/etiología , Anciano , Brazo , Neuropatías del Plexo Braquial/diagnóstico , Hematoma/diagnóstico , Humanos , Masculino , Hipotonía Muscular/etiologíaRESUMEN
Contrast-enhanced CT angiography (CTA) currently is considered the diagnostic modality of choice in the diagnosis of acute type A aortic dissection. However, pitfalls associated with acquisition and interpretation of CTA images may result in misdiagnosis. We present examples of false-positive and false-negative interpretations of CTA in emergency situations that underline the importance of intraoperative preincision transesophageal echocardiography (TEE) in the diagnosis and management of this highly lethal entity.
Asunto(s)
Aneurisma de la Aorta Torácica/diagnóstico , Disección Aórtica/diagnóstico , Medios de Contraste , Ecocardiografía Transesofágica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Disección Aórtica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Diagnóstico Diferencial , Resultado Fatal , Estudios de Seguimiento , Humanos , MasculinoRESUMEN
A Jehovah Witness patient with renal failure on dialysis, with low hemoglobin, underwent urgent off-pump coronary artery bypass grafting without systemic heparinization. The pros, cons, and details of the technique used are discussed.
Asunto(s)
Puente de Arteria Coronaria Off-Pump/métodos , Heparina , Testigos de Jehová , Infarto del Miocardio/cirugía , Anticoagulantes/administración & dosificación , Contraindicaciones , Puente de Arteria Coronaria Off-Pump/ética , Estudios de Seguimiento , Heparina/administración & dosificación , Humanos , Inyecciones Intravenosas/ética , Masculino , Persona de Mediana Edad , Infarto del Miocardio/psicologíaRESUMEN
INTRODUCTION: The emergence of minimally invasive thoracic surgery has positively impacted postoperative recovery. Robotic-assisted thoracoscopic surgery (RATS) has been shown to have equivalent short- and long-term outcomes as compared with video-assisted thoracoscopic surgery (VATS). The introduction of RATS offers a three-dimensional high-definition image, improved ergonomics, and wristed movement. The purpose of this paper was to define the learning curve of RATS. METHODS: This study is a retrospective review of a single surgeon's RATS experience in a community hospital. All patients who underwent RATS between December 2011 and April 2014 were included. The cohort was divided into 2 groups: "early" and "late." These groups were created based on the date before or after February 2013, respectively. Data is presented as means and percentages. Significance was defined as a P value < 0.05. All categorical variables were evaluated with Fisher's exact t test and all continuous variables were compared via a paired t test. RESULTS: Seventy-nine patients were identified with a mean age of 59. There were 39 patients in the early group and 40 in the late. Rates of conversion to open thoracotomy (13% vs 10%, P = 0.74) and operative time (180 vs 204 min, P = 0.34) did not demonstrate any statistical significance between the two cohorts. Postoperative morbidity (21% vs 28%, P = 0.60) and mortality (3% vs 0%, P = 1.00) were equivalent between both groups. There was a higher percentage of lobectomies performed during the late group (38% vs 65%, P = 0.02). Furthermore, these lobectomies were performed at a faster rate in the late group. CONCLUSION: Based on our experience, the complexity of the operations that can be performed robotically increased with the number of operations performed without an impact on postoperative morbidity and mortality.