https://www.annalsthoracicsurgery.org/article/S0003-4975(09)01925-0/pdf

Management of Alveolar Air Leaks After Pulmonary Resection

Postoperative care of thoracic surgical patients is a very important part of patient recovery and can be very challenging. Pulmonary complications are responsible for significant numbers of deaths and morbidity of patients undergoing thoracotomy. Thoracic surgery impairs postop‐ erative respiratory function resulting in a relatively high risk of developing postoperative pulmonary complications. The incidence (19-59%) is much higher than following upper (16-17%) or lower abdominal surgery (0-5%). The overall incidence of complications following thoracic surgery varies from 15% to 37.5%, primarily due to the type of pulmonary complica‐ tions studied, the clinical criteria used in the definition and the type of surgery included. The clinical and potential economic impact of these complications is marked, with significantly longer hospital and high Dependency unit stay, frequency of ICU admission and number of deaths.

/pdf/postoperative-care-and-complications-after-thoracic-surgery-1boqmdrr0v.pdf

Postoperative Care and Complications After Thoracic Surgery

Postoperative strategies to treat permanent air leaks.

We present the case of a 61-year-old patient with a history of essential thrombocythemia (ET) who was diagnosed as having aortic valve stenosis and dilatation of his ascending aorta. His aortic valve and ascending aorta were replaced under hypothermic circulatory arrest (HCA). No clear guideline exists for preoperative, perioperative, and postoperative management of cardiac surgery using HCA for ET patients. After performing risk assessment, we prescribed preoperative aspirin therapy and postoperative care was planned as usual for cardiovascular surgery in our establishment. Unexpectedly, activated clotting time did not exceed 400 seconds, but the course of treatment was otherwise uneventful.

Cardiac Surgery Using Hypothermic Circulatory Arrest in a Case of Essential Thrombocythemia.

本態性血小板血症(ET)は慢性骨髄増殖性疾患に属し,血栓形成傾向と易出血性傾向の相反する二面を併 せ持つ複雑な病態を有する.本症を合併する症例に対する人工弁置換術の報告はきわめて稀であり,その病 態から術中の出血傾向と術後の血栓症が懸念される.今回,ETを合併した大動脈弁狭窄症(AS)に対し, 生体弁による大動脈弁置換術を経験した.症例は 69歳女性.検診で心雑音を指摘され,近医の心エコー検 査で ASを指摘された.弁口面積は 0.73 cm,左室-上行大動脈の圧較差 113 mmHgの ASであり,手術の 方針となった.入院時血小板数は 70万/μlで,ヒドロキシカルバミドは術直前まで内服し,シロスタゾール は術前 3日に中止し,術前 2日よりヘパリンを開始した.術中はヘパリンで活性化凝固時間(ACT)を 400 秒以上に維持し,生体弁を用いて大動脈弁人工弁置換術を施行した.術中易出血性は認めず問題なく手術終 了した.術後血小板数は 30〜40万/μlで推移し,出血も問題なくドレーンは術後 2日目で抜去可能であっ た.また血栓による合併症も認めず,術後 13日目に退院となった.ET合併例に対して開心術を施行する場 合,周術期の出血と術後の血栓症が問題となり,術前の血小板増多に対する処置と術後の抗血栓療法が重要 となる.日心外会誌 43巻 2号:49-52(2014) キーワード:本態性血小板血症;大動脈弁置換術;開心術;血栓症;出血

Aortic Valve Replacement in a Patient with Essential Thrombocythemia

A case of sustained lung fistula after lung surgery is reported here. This case of a sustained pulmonary fistula was diagnosed by sustained air leak through the chest drain and a positive culture of the drainage fluid. The third re-operation was performed successfully by omentopexy via median sternotomy. Careful postoperative observation with chest radiography, bronchial fiberscopy, and determining whether infection is present in the drainage fluid are important for precise diagnosis and therapy for complications following pulmonary lobectomy.

Omentopexy for empyema due to lung fistula following lobectomy. A case report.

A 62-year-old man with heart murmur and recent cerebral thrombosis was admitted to our hospital. Examination of his heart revealed mitral stenosis and hematological study confirmed the diagnosis of essential thrombocytosis (ET). After 1100 ml pre-operative phlebotomy, mitral valve replacement with a 29 mm Bjork-Shiley prosthesis was performed utilizing routine cardio-pulmonary bypass using only his prestored blood and moderate hypothermia. We had no difficulty in hemostasis at the operation. Acute gastric bleeding began suddenly as much as 1500 ml on the 4th postoperative day. As medical care was in vain, emergent distal gastrectomy was performed. As we used urokinase for fear of thrombosed valve formation, residual gastric bleeding was continued on. Then, we began to use Gabexate-Mesilate (FOY) instead of urokinase. Retrospectively, Gabexate-Mesilate was very useful drug for preventing the left atrium and prosthesis from thrombo-formation until the start of oral intake of Warfarin and Busulfan. To our knowledge, this would be the first case report of open-heart valve replacement surgery in a ET patient in Japan.

[A case report: mitral valve replacement for the patient with essential thrombocythemia].

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Omentopexy for empyema due to lung fistula following lobectomy. A case report.

[A case report: mitral valve replacement for the patient with essential thrombocythemia].