Tümer Ulus

Transsternal transpericardial approach for the repair of bronchopleural fistula with empyema

BACKGROUND Numerous surgical approaches have been reported for the repair of bronchopleural fistula. Recently the transsternal transpericardial approach has shown great promise with its positive results in cases of bronchopleural fistula complicated with empyema. The aim of this retrospective study was to assess the results of bronchopleural fistula treatment using the transsternal transpericardial approach. METHODS Bronchopleural fistula developed in 16 of the 172 patients who had pneumonectomy between 1982 and 1996. In one case closure with fibrin sealant by bronchoscopy was tried. In the remaining cases fistula was closed by the transsternal transpericardial approach. RESULTS The interval between pneumonectomy and fistula occurrence was 10 days or less in 5 patients and 10 days to 1 month in 11 patients. In all patients the empyema space was treated by continued drainage through the thoracostomy tube. Fibrin sealant was tried unsuccessfully for closure of moderate-sized bronchopleural fistula in one case. In three cases of right bronchopleural fistula, carinal resection and anastomosis of the trachea to the left main stem bronchus were performed. In the remaining cases bronchopleural fistula was closed using a hand suture technique. One patient died within 30 days after operation (6.25%) because of renal insufficiency. There was no recurrence of bronchopleural fistula. CONCLUSIONS Transsternal transpericardial approach seems to be a safe and effective method with an easier technique in cases of bronchopleural fistula complicated with empyema. It has the added advantage of less recurrent fistula formation and enables resection in cases without sufficient bronchial stump.

Aorto–Left Atrial Fistula With Bicuspid Aortic Valve and Coronary Artery Origin Anomaly

Published reports of aorto-left atrial fistula are very rare. We report a 20-year-old man who had an aorto-left atrial fistula with bicuspid aortic valve and coronary artery origin anomaly. Because acquired etiologic factors were not detected, we believe that the lesions were structural defects of congenital origin.

Primary Peritracheal Schwannoma: Report of a Case

Posterior mediastinal tumors of neurogenic origin commonly arise from the sympathetic or intercostal nerves. However, anterior mediastinal tumors rarely originate from the vagus nerve, and primary neurogenic tumors of the trachea are extremely uncommon. A 19-year-old man was admitted to an emergency department in sudden acute respiratory distress. A tracheostomy was performed and he was transferred to our Ear Nose and Throat Department for further investigation. A bronchoscopic biopsy was taken of a mass occupying the tracheal lumen and intraoperative frozen section examination suggested a schwannoma, so tracheal resection was performed. Although rare, primary tracheal schwannoma should be considered in the differential diagnosis of sudden respiratory distress of unknown origin.

A rare presentation of cardiac hydatid cyst: stroke and acute aortic occlusion.

Cardiac involvement in hydatid disease is uncommon. We report a case of a surgically treated ruptured left ventricular hydatid cyst, which presented with acute stroke and was later complicated by distal aortic embolism due to perioperative dislodgement of the germinative membrane.

Effects on Reperfusion Injury of Adding Diltiazem to Tepid Blood Cardioplegia

BACKGROUND Although the present techniques of myocardial preservation for limiting ischemia/reperfusion injury in open heart operations yield excellent results for most patients, certain subgroups of patients with advanced coronary artery disease present a challenge in terms of intraoperative safety. METHODS In a prospective, randomized, controlled study, we assessed the myocardial protective effects of a total dose of 150 +/- 150 = 300 microg/kg diltiazem added to induction and terminal (reperfusion) doses of tepid blood cardioplegia. We determined the myocardial morphological (ultrastructural) and enzymatic (serum assays for the cardiospecific isoenzyme of creatine kinase [CK-MB]) changes and functional recovery (atrioventricular [AV]-node recovery time and postoperative need for inotropic support) in patients undergoing elective coronary artery bypass operations. The determinations were made with respect to values for control patients, who received the same cardioplegia but without the addition of diltiazem. RESULTS The mean isoenzyme CK-MB levels and semiquantitative ultrastructural score values of the diltiazem group were significantly less than those of the control group. Although AV-node recovery time was significantly prolonged (P < .05), this factor did not have major clinical impact. CONCLUSIONS We concluded that the addition of 150 +/- 150 microg/kg diltiazem to the induction and terminal doses of tepid cardioplegia enhanced myocardial protection in elective aortocoronary bypass surgery in high-risk patients and presented no significant additional operative risk.

Late infective endocarditis after cholecystectomy in a patient with repaired tetralogy of Fallot: a case report

Late endocarditis after surgical repair of tetralogy of Fallot is rare. We describe a case of endocarditis following cholecystectomy in a 22-year old patient with repaired tetralogy of Fallot. After cholecystectomy, the patient was referred to a cardiology clinic with unexplained fever and suspicion of endocarditis. Echocardiography revealed a large mass at the basal level of interventricular septum. Endocarditis was diagnosed on the basis of clinical and echocardiographic findings and antibiotic treatment was initiated immediately. Nine days later, the clinical status of the patient deteriorated and urgent surgery was performed. Patch dehiscence which mimicked a large vegetation, and multiple vegetations on the patch were found during operation. The patch was removed and ventricular septum defect was repaired with a new dacron patch. Enterobacter agglomerans was isolated in the vegetation cultures.

Endobronchial hamartoma in a case with neurofibromatosis.

A 60-year-old male patient with neurofibromatosis type 1 presented with a right pulmonary mass. Bronchoscopic evaluation revealed an endobronchial mass on the right upper lobe.He was operated on after a bronchial biopsy and a fine-needle aspiration biopsy revealed non-specific findings. Pathological evaluation of right upper lobectomy material was compatible with an endobronchial hamartoma and right upper lobar abscess.Hamartoma is a component of neurofibromatosis syndrome. However, endobronchial hamartoma, as found in our patient, is a rare condition and is the reason for presenting this case.

Electromechanical Effects of Protamine and Verapamil in Rat Papillary Muscle

The electromechanical effects of protamine sulfate and the calcium channel blocker verapamil on rat cardiac and skeletal muscles were studied using isolated left ventricular papillary muscle and phrenic nerve-hemidiaphragm preparations. Protamine produced significant decreases in isometric force in the cardiac tissue and contracture developed at concentrations of 40 and 80 mg·L−1. Isometric force also decreased significantly with verapamil at concentrations of 0.757 and 7.57 mg·L−1. Both drugs caused significant decreases in the contractile force of hemidiaphragm muscle when the tissue was stimulated indirectly. Protamine and verapamil caused the resting membrane potential and the amplitude of the action potential to decrease in cardiac tissue and overshoot failed to develop with 80 mg·L−1 of protamine or 7.57 mg·L−1 of verapamil. These bioelectrical changes developed in a dose-dependent manner. It was concluded that protamine had a similar effect to that of calcium channel blockers and it may act through a reduction of cellular calcium. This effect on cardiac tissue may be mediated through the sarcolemmal ion pumps or channels, leading to changes in calcium homeostasis.

Angina Pectoris Due to Severe Muscular Bridge in Hypertrophic Cardiomyopathy

We report the case of a 39-year-old male with hypertrophic cardiomyopathy who complained of angina pectoris. The patient was treated with a beta blocker and a calcium antagonist without effect. Myocardial scintigraphy revealed anterior ischemia. Cardiac catheterization and ventriculography revealed severe systolic narrowing of the left anterior descending coronary artery and no significant pressure gradient across the left ventricular outflow tract. Myotomy was performed on a muscular bridge over the left anterior descending coronary artery and the patients angina was relieved. In young patients with hypertrophic cardiomyopathy who develop angina refractory to medical therapy, a coexisting muscular bridge should be sought.

Giant Thoracic Aneurysm Associated with Coarctation of the Aorta

A 39-year-old male with low back pain, fatigue, and nausea of 2 years duration was referred with a suspected mass in the left lung. Computed tomography and magnetic resonance imaging showed a giant aneurysm associated with a coarctation of the descending thoracic aorta. A Dacron tube graft was interposed. Histopathologic examination revealed atherosclerosis of the aneurysmal wall.