ASCENDING AORTA PSEUDOANEURYSM PRESENTING AS A PRESTERNAL PULSATILE MASS.

Sixteen months after the replacement of the ascending aorta an 80-year-old lady was referred to our center for a presternal pulsatile mass. Computed tomography scan showed an ascending aorta pseudaneurysm extended through the sternum and filling the subcutaneous space. Surgical correction was successful. Specific surgical considerations of this case are discussed.

Floating thrombus in the ascending aorta causing repeated arterial embolisms.

Free-floating thrombus in an otherwise normal ascending aorta is a rare finding. We report the case of a 61-year-old woman admitted for brain and peripheral arterial embolisms. Echocardiography was not able to detect the source of embolus. Computed tomographic scan demonstrated a large floating mass attached to the posterior wall of the distal ascending aorta. The thrombus was successfully removed with the patient under deep hypothermic circulatory arrest. Some aspects regarding pathogenesis, diagnosis and treatment are discussed.

O trombo flutuante na aorta ascendente sem alterações degenerativas basais é um achado raro. Apresenta-se o caso de uma doente de 61 anos admitida por embolias cerebrais e periféricas. No ecocardiograma não foram detetadas alterações. A tomografia computorizada demonstrou uma massa flutuante na parede posterior da aorta ascendente distal. O trombo foi removido com sucesso com o doente em paragem circulatória hipotérmica. São discutidos aspetos relativos à patogénese, diagnóstico e tratamento.

Relation of Skin Flora of Hands with Glove Perforation and Contamination in Cardiac Surgery.

BACKGROUND AND OBJECTIVES: Surgical scrub reduces the number of microorganisms, but fails to sterilize hands, and therefore the use of sterile gloves is recommended. Glove perforation allows bacteria passage from the surgeons´ hands to the patient´s tissues. We analyze the relationship between skin flora of hands, glove perforation and contamination. METHODS: A prospective study comprising 139 patients undergoing open heart surgery through a median sternotomy was conducted. Surgeons´hands were studied. Gloved and ungloved fingertips were placed on culture plates after scrubbing and before sternal closure. Removed gloves were evaluated for perforations. Samples from the surgical wound were taken for culture. Identification of isolated microorganisms was performed by conventional biochemical tests. RESULTS: Culture of fingertips after scrubbing resulted positive in 29.13% of the samples and increased to 34.53% at the end of the procedure. Culture of gloved fingertips before closing the sternum demonstrated contamination of the outer surface in 11.87% of samples. Gloves removed before sternal closure showed perforations in 23.02% of samples. Holes were observed in 33% of contaminated gloves. No relationship between perforation and contamination of gloves was observed. The culture of the sternal wound resulted positive in 7.91% of cases. A significant relationship between the presence of microorganisms in the wound and glove contamination was demonstrated. (P<0,001). CONCLUSIONS: Perforation does not cause significant contamination of the outer surface of surgical gloves. The statistical correlation between glove contamination and surgical wound colonization could be explained by the presence of other sources of contaminating microorganisms.