RESUMO
Background Experience with early postoperative catheter-directed ultrasound-assisted thrombolysis (USAT) in high-risk pulmonary embolism (PE) is limited. A first case of USAT directly after pulmonary surgery is presented. Case Description A 60-year-old female patient with two malignancies (triple negative breast cancer and pulmonary squamous cell carcinoma) underwent video-assisted lobectomy. The second postoperative day, she developed PE with hemodynamic deterioration. Note that 24 mg of alteplase was applied by USAT. After 3 days she was successfully weaned from ventilation and vasopressors. Conclusion USAT for acute PE is possible after major pulmonary resections and seems promising if reperfusion is needed.
RESUMO
PURPOSE: Deep sternal wound infection (DSWI) and mediastinitis are devastating complications after median sternotomy. Previous studies demonstrated an effective prevention of sternal wound infection (SWI) using an external sternal corset in high-risk cardiac surgery patients. The aim of this study is to assess the preventive effect of the Stern-E-Fix corset in high-risk poststernotomy female patients. METHODS: A total of 145 high-risk female patients undergoing cardiac surgery through median sternotomy were retrospectively analyzed. Patients were divided into group A (n = 71), who received the Stern-E-Fix corset (Fendel & Keuchen GmbH, Aachen, Germany), and group B (n = 74), who received the elastic thorax bandage (SanThorax) postoperatively for 6 weeks. The mean follow-up period was 12 weeks. RESULTS: Incidence of SWI was 7% in group A vs. 17.6% in group B (p = 0.025). One patient presented with DSWI in group A vs. seven patients in group B (p = 0.063). No patient developed mediastinitis in group A vs. four patients in group B (p = 0.121). In all, 4.2% of group A patients required operative wound therapy vs. 16.2% of group B patients (p = 0.026). The length of hospital stay was significantly longer in group B (p = 0.006). CONCLUSION: Using an external supportive sternal corset (Stern-E-Fix) yields a significantly better and effective prevention against development of sternal dehiscence, DSWI, and mediastinitis in high-risk poststernotomy female patients.
Assuntos
Braquetes , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Mediastinite/prevenção & controle , Esternotomia/efeitos adversos , Deiscência da Ferida Operatória/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Fechamento de Ferimentos/instrumentação , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Tempo de Internação , Mediastinite/diagnóstico , Mediastinite/microbiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Deiscência da Ferida Operatória/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Fatores de Tempo , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversosRESUMO
Continuous heart rhythm monitoring with cardiac event recorders is increasing in clinical practice and may be helpful in diagnosing a wide range of disorders and pathologies. This case study describes the case of an 80-year-old female patient with a medical history of previous cardiac surgery in which a cardiac event recorder had to be retrieved from the left main pulmonary artery.