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1.
Christian Siebers René Schramm Anton Friedmann Thomas Weig 《International journal of surgery case reports》2014,5(2):108-110
INTRODUCTION
Heart failure is the most common cause of death due to infective endocarditis. We report a case of a patient presenting with severe shock due to an infection-associated left-to-right cardiac shunt.PRESENTATION OF CASE
A 62-year-old man, who underwent aortic valve replacement five years previously, was admitted to ICU due to acute hemodynamic deterioration. A few days earlier, he had a septic episode with blood cultures positive for Staphylococcus aureus and clinical features of infective endocarditis. In ICU, transthoracic echocardiography revealed shunting from the aortic root to the right atrium resulting in severe cardiogenic shock.DISCUSSION
This case report describes a near fatal complication of infective endocarditis, detected by routine use of transthoracic echocardiography.CONCLUSION
Our case outlines the relevance of early cardiac surgery strategies in patients with infective endocarditis and we briefly discuss the current literature. 相似文献2.
Linda A. Dultz Brant W. Ullery Huan Huan Sun Tara L. Huston Soumitra R. Eachempati Philip S. Barie Jian Shou 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(1):80-83
Background:
Lipomas are the most common benign mesenchymal tumors of the gastrointestinal tract, with the colon being the most prevalent site. Intestinal lipomas are usually asymptomatic. Tumors >2 cm in diameter may occasionally cause nonspecific symptoms, including change in bowel habits, abdominal pain, or rectal bleeding, but with resection the prognosis is excellent. Herein, we describe the case of an elderly male who presented with painless hematochezia.Methods:
Both colonoscopy and computed tomography of the abdomen and pelvis confirmed the presence of a mass near the ileocecal valve. Because of continuing bleeding, the patient required laparoscopic-assisted right hemicolectomy to resect the mass.Results:
Both gross and microscopic pathology were consistent with lipoma at the ileocecal valve.Conclusion:
Previous cases of ileocecal valve lipomas have been reported in the English literature, with the majority presenting as intussusception or volvulus. We present a rare case of an ulcerated ileocecal valve lipoma presenting as lower gastrointestinal bleeding that was treated successfully with laparoscopic resection. 相似文献3.
D Bouchard L P Perrault M Carrier P Ménasché A Bel L C Pelletier 《Canadian journal of surgery》2000,43(1):39-42
Objective
The aim of the study was to evaluate the technical feasibility and the postoperative course of aortic valve replacement through a ministernotomy.Setting
The Montreal Heart Institute and the Hôpital Lariboisière, Paris, France.Design
A case series from 2 institutions.Patients
Fifty-one patients who underwent aortic valve replacement through a ministernotomy. The sternal incision was started at the level of the sternal notch extending down to the third or fourth intercostal space with a transverse section of the sternum at this level on both sides or limited to the right side (inverted T or L incision). Thirty-nine patients had aortic stenoses, 6 patients were operated for aortic insufficiency and 6 had mixed disease. The mean (and standard deviation) preoperative left ventricular ejection fraction was 0.56 (0.17).Main outcome measures
Cardiac bypass time, complications and outcome.Results
The patients received Carbomedics and St. Jude mechanical valves, Hancock and Carpentier–Edwards bioprostheses. Thirty-eight patients were administered antegrade and retrograde cardioplegia, 10 patients ante-grade and 3 retrograde blood cardioplegia only. The mean (and standard error) cardiopulmonary bypass time and aortic cross-clamp time were 104 (38) minutes and 72 (16) minutes respectively. Two patients (4%) died and 2 patients (4%) showed evidence of a stroke after the procedure. Hospital stay averaged 8 (5) days.Conclusion
We conclude that aortic valve replacement can be done through a ministernotomy approach with perioperative results similar to those obtained through a conventional sternotomy. 相似文献4.
Lance Burns Douglas P. Slakey 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(1):60-63
Background:
Intrahepatic arterial aneurysms are rare and typically related to trauma, transplantation, iatrogenic injury, or infection. They account for approximately 10% of clinically significant hemobilia.Case Report:
We present the case of a 49-year-old man with an intraparenchymal hepatic artery aneurysm that presented as massive hemobilia following a laparoscopic cholecystectomy. The aneurysm could not be managed by interventional embolization and required a left hepatic lobectomy, which was performed laparoscopically.Discussion:
Evaluation of hemobilia requires a multidisciplinary team approach. The diagnosis of hepatic artery aneurysm can be most readily made by MRI or CT scan. Interventional embolization of the aneurysm may be effective treatment but is not always possible due to anatomic considerations. Where indicated, surgical resection in a manner that preserves a maximal amount of normal hepatic parenchyma is the treatment of choice.Conclusion:
This is the first report of laparoscopic liver resection performed for bleeding from a hepatic artery aneurysm and adds an effective treatment modality to the surgical armamentarium. 相似文献5.
Cardiac metastases and tumor embolization: A rare sequelae of primary undifferentiated liver sarcoma
Monica M. Dua Jordan M. Cloyd Francois Haddad Ramin E. Beygui Jeffrey A. Norton Brendan C. Visser 《International journal of surgery case reports》2014,5(12):927-931
INTRODUCTION
Primary hepatic sarcomas are uncommon malignant neoplasms; prognostic features, natural history, and optimal management of these tumors are not well characterized.PRESENTATION OF CASE
This report describes the management of a 51-year-old patient that underwent a right trisectionectomy for a large hepatic mass found to be a liver sarcoma on pathology. He subsequently developed tumor emboli to his lungs and was discovered to have cardiac intracavitary metastases from his primary tumor. The patient underwent cardiopulmonary bypass and resection of the right-sided heart metastases to prevent further pulmonary sequela of tumor embolization.DISCUSSION
The lack of distinguishing symptoms or imaging characteristics that clearly define hepatic sarcomas makes it challenging to achieve a diagnosis prior to pathologic examination. Metastatic spread is frequently to the lung or pleura, but very rarely seen within the heart. Failure to recognize cardiac metastatic disease will ultimately lead to progressive tumor embolization and cardiac failure if left untreated.CONCLUSION
The most effective therapy for primary liver sarcomas is surgery; radical resection should be performed if possible given the aggressive nature of these tumors to progress and metastasize. 相似文献6.
Idris M. Ali Brian Cummings John Sullivan Stewart Francis 《Canadian journal of surgery》1998,41(5):374-378
Objective
To investigate whether the presence of asymptomatic critical carotid stenosis (ASCCS) increases the risk of perioperative stroke during open-heart surgery, which carries a well-established risk of cerebrovascular accidents.Design
A case series.Setting
A university-affiliated hospital that is a major referral centre for cardiovascular surgery.Patients
Forty-six patients with ASCCS who underwent open-heart surgery between January 1992 and January 1996. Of this group, 27 had bilateral and 19 had unilateral critical carotid artery stenosis.Interventions
Various cardiac procedures were performed on the 46 patients: 33 underwent coronary bypass grafting, 12 had valve replacement and 1 had heart transplantation.Main outcome measure
Neurologic deficit.Results
None of the patients had any perioperative neurologic deficit up to the date of discharge.Conclusions
Cardiac procedures, without prior carotid artery surgery, can be done in patients with AS-CCS with no significant added risk of stroke. To achieve this, blood pressure should be kept stable intraoperatively, at slightly higher than normal pressure. 相似文献7.
Do Young Park Hyung-Min Ji Kyu-Sung Kwak Surej Gopinathan Nair Ye-Yeon Won 《Clinics in Orthopedic Surgery》2012,4(3):193-199
Background
Due to its small size, variable shape, and lack of distinct anatomical landmarks, osteoarthritic knees make a precise patellar resection extremely difficult.Methods
We performed virtual patellar resection with digital software using three dimensional computed tomography scans of knees from 49 patients who underwent primary total knee replacement at our hospital. We compared 2 commonly used resection methods, the tendon method (TM) and the subchondral method, to determine an ideal resection plane with respect to the symmetry and thickness of the patellar remnant.Results
The TM gave a thicker resected patella, and a less oval cut surface shape, which gives better coverage for a domed prosthesis. Both methods, however, gave a symmetric resection both superior-inferiorly, as well as mediolaterally.Conclusions
Although TM appears statistically better with respect to the thickness and cut surface shape, only further intraoperative studies with long-term clinical follow-up may provide us with the most appropriate patellar resection method. 相似文献8.
Fotios Mitropoulos George Giannakoulas Alexandros Kallifatidis Meletios Kanakis Maria Kiaffas Andrew C. Chatzis 《International journal of surgery case reports》2014,5(12):1058-1060
INTRODUCTION
Cardiac myxoma is the most common primary cardiac tumour in adulthood and may present in the context of Carney''s complex.PRESENTATION OF CASE
A 32-year-old male with a history of repaired tetralogy of Fallot in childhood was admitted with severe pulmonary valve regurgitation and a mobile mass in the right ventricle. The patient underwent pulmonary valve replacement and mass excision. Pathology examination showed myxoma.DISCUSSION
In the majority of cases myxomas originate in the atria, nevertheless they can also be found in a ventricular cavity. Myxoma is a prevalent feature of Carney''s complex, an inherited, autosomal disease, characterised by multiple tumours in several organs. Tetralogy of Fallot has also been described in association with Carney''s complex.CONCLUSION
Coexistence of tetralogy of Fallot with a cardiac ventricular myxoma in a patient not affected from Carney''s complex or other familial syndrome. 相似文献9.
Amato Antonio Stabile Ianora Michele Telegrafo Fabio Fucilli Arnaldo Scardapane Marco Moschetta 《International journal of surgery case reports》2014,5(4):203-205
INTRODUCTION
Hepatic angio-sarcoma represents an uncommon malignant tumor of the liver with a poor prognosis and a high rate of bleeding complications.PRESENTATION OF CASE
We report a case of hepatic angio-sarcoma with a multi-nodular pattern complicated by intra-hepatic bleeding. The diagnosis was performed by computed tomography (CT). Angiographic procedure was unsuccessfully attempted as a treatment option. Autoptic examination confirmed the vascular nature of the malignant tumor.DISCUSSION
Hepatic angio-sarcoma represents the most common malignant mesenchymal tumor of the liver. The diagnosis is provided by the histological examination and by specific endothelial markers. However, CT examination allows to recognize the disease and to detect intra-abdominal bleeding occurring in one-fourth of cases. Surgical resection represents the only definitive treatment of hepatic angio-sarcoma. In case of haemoperitoneum, trans-catheter arterial embolization represents the primary procedure used to stop the acute arterial bleeding.CONCLUSION
CT represents the reference technique for the diagnosis of hepatic angio-sarcoma and allows to recognize the intra-abdominal bleeding which represents its most common complication. This condition always requires an immediate therapeutic approach. 相似文献10.
Leonida Compostella Nicola Russo Augusto D’Onofrio Tiziana Setzu Caterina Compostella Tomaso Bottio Gino Gerosa Fabio Bellotto 《Brazilian Journal Of Cardiovascular Surgery》2015,30(1):55-62
Introduction
Complete denervation of transplanted heart exerts protective effect against postoperative atrial fibrillation; various degrees of autonomic denervation appear also after transection of ascending aorta during surgery for aortic aneurysm.Objective
This study aimed to evaluate if the level of cardiac denervation obtained by resection of ascending aorta could exert any effect on postoperative atrial fibrillation incidence.Methods
We retrospectively analysed the clinical records of 67 patients submitted to graft replacement of ascending aorta (group A) and 132 with aortic valve replacement (group B); all episodes of postoperative atrial fibrillation occurred during the 1-month follow-up have been reported. Heart Rate Variability parameters were obtained from a 24-h Holter recording; clinical, echocardiographic and treatment data were also evaluated.Results
Overall, 45% of patients (group A 43%, group B 46%) presented at least one episode of postoperative atrial fibrillation. Older age (but not gender, abnormal glucose tolerance, ejection fraction, left atrial diameter) was correlated with incidence of postoperative atrial fibrillation. Only among a subgroup of patients with aortic transection and signs of greater autonomic derangement (heart rate variability parameters below the median and mean heart rate over the 75th percentile), possibly indicating more profound autonomic denervation, a lower incidence of postoperative atrial fibrillation was observed (22% vs. 54%).Conclusion
Transection of ascending aorta for repair of an aortic aneurysm did not confer any significant protective effect from postoperative atrial fibrillation in comparison to patients with intact ascending aorta. It could be speculated that a limited and heterogeneous cardiac denervation was produced by the intervention, creating an eletrophysiological substrate for the high incidence of postoperative atrial fibrillation observed. 相似文献11.
12.
Objective
To critically assess the evidence for long-term survival after hepatic resection and hepatic cryosurgery for metastatic colorectal cancer. The purpose of this review is to determine if a randomized controlled trial comparing these two treatment modalities is justified.Data sources
A review of the medical literature from 1973 to 1995 using the MEDLINE and CAN-CERLIT databases. References were also retrieved from the bibliographies of identified articles and from experts in the field of hepatobiliary and pancreatic surgery.Study selection
One hundred and seventy-eight studies were reviewed. Studies presenting original data on the results of hepatic resection or cryotherapy for colorectal liver metastases were selected. Studies were excluded if they did not present survival data longer than 2 years. Studies pertaining to resection for fewer than 60 patients with colorectal metastases to the liver were excluded.Data extraction
Data forms were designed before studies were examined in detail. All studies that met the inclusion and exclusion criteria were reviewed and the identified data extracted and tabulated.Data synthesis
No controlled studies were identified, only case series. Four reports on hepatic cryosurgery and 9 on hepatic resection met the study criteria. The cryosurgery studies were methodologically poor; the resection studies were larger and more methodologically sound. The median follow-up for cryosurgery ranged from 12 to 28.8 months, that for resection 21 to 69 months. There is clear evidence that hepatic cryosurgery has a role in the management of selected patients with colorectal metastases to the liver. However, valid conclusions cannot be made about the 5-year survival rate. The results of the studies on hepatic resection in patients with colorectal metastases to the liver have greater validity and consistency, with 5-year survival rates of 20% to 40%.Conclusions
Although hepatic cryosurgery offers some unequivocal and other potential advantages over surgical resection for colorectal metastases to the liver, the published data do not support its use in patients with resectable disease outside a clinical trial, and do not yet justify a randomized trial. A study that collects prospective data on 2 groups of patients (resectable v. unresectable) who differ only in the anatomic location of their metastases within the liver is needed. 相似文献13.
Taylan Adademir Eylem Yayla Tuncer Serpil Tas Arzu Antal Donmez Ebru Bal Polat Altug Tuncer 《Brazilian Journal Of Cardiovascular Surgery》2014,29(1):16-24
Objective
We have retrospectively analyzed the results of the operations made for aortic valve endocarditis in a single center in 26 years.Methods
From June 1985 to January 2011, 174 patients were operated for aortic valve endocarditis. One hundred and thirty-eight (79.3%) patients were male and the mean age was 39.3±14.4 (9-77) years. Twenty-seven (15.5%) patients had prosthetic valve endocarditis. The mean duration of follow-up was 7.3±4.2 years (0.1-18.2) adding up to a total of 1030.8 patient/years.Results
Two hundred and eighty-two procedures were performed. The most frequently performed procedure was aortic valve replacement with mechanical prosthesis (81.6%). In-hospital mortality occurred in 27 (15.5%) cases. Postoperatively, 25 (14.4%) patients had low cardiac output and 17 (9.8%) heart block. The actuarial survival rates for 10 and 15 years were 74.6±3.7% and 61.1±10.3%, respectively. In-hospital mortality was found to be associated with female gender, emergency operation, postoperative renal failure and low cardiac output. The long term mortality was significantly associated with mitral valve involvement. Male gender was found to be a significant risk factor for recurrence in the follow-up.Conclusion
Surgery for aortic valve endocarditis has significant mortality. Emergency operation, female gender, postoperative renal failure and low cardiac output are significant risk factors. Risk for recurrence and need for reoperation is low. 相似文献14.
Hac? Bayram Tosun Abuzer Uluda? Sancar Serbest Seyitali Gümü?ta? ?brahim Halil Erdo?du 《International journal of surgery case reports》2014,5(7):419-423
INTRODUCTION
Nonpigmented villonodular synovitis (non-PVNS) is a benign proliferative disease involving the synovium. It is a rare condition that is little recognized. Non-PVNS has been reported as a cause of total knee replacement failure.PRESENTATION OF CASE
We report a case of extensive diffuse non-PVNS in a patient with tibial component loosening after total knee replacement and review the related literature.DISCUSSION
It is reported that pigmented villonodular synovitis (PVNS) occurs less frequently than non-PVNS after knee replacement. However, there are many more case reports of PVNS than non-PVNS after knee arthroplasty in the English-language literature.CONCLUSION
Previously, there were no reported cases of extensive diffuse non-PVNS after total knee arthroplasty (TKA). This case study highlights an unusual case of non-PVNS as a cause of TKA failure. We propose that non-PVNS should be considered as a differential diagnosis in patients after TKA who present with recurrent pain and effusion/hemarthrosis of the knee, and that it is one of the causes of implant loosening after TKA. 相似文献15.
André Mauricio S. Fernandes Felipe da Silva Pereira Larissa Santana Bitencourt Agnaldo Viana Pereira Neto Gabriel Barreto Bastos André Rodrigues Dur?es Roque Aras Jr Igor Nogueira Lessa 《Brazilian Journal Of Cardiovascular Surgery》2014,29(4):559-563
Objective
To evaluate the influence of the type of prosthesis in-hospital mortality in the post-operative period in patients who had valve replacement.Methods
A cross-sectional data, such as gender, origin, age, etiology, echocardiograph data, the type of surgery performed and the prosthesis used in cases of valve replacement were analyzed retrospectively.Results
We reviewed 353 charts of patients who underwent valve replacement surgery. The mean age was 41.87±17.9 years. Regarding gender, 52.8% were female. As for the origin, 61.1% came from small cities within the state. Of all patients, 58.5% suffered from rheumatic disease. Assessing the type of prosthesis implanted, 70% held replace by bioprosthesis and 30% metallic. The hospital mortality in this study was 11%, with no significant difference between the types of prosthesis utilized.Conclusion
The type of implant used had no effect on in-hospital mortality. 相似文献16.
Zhimin Lin Jack Kian Chng Tze Tec Chong Khee Chee Soo 《International journal of surgery case reports》2014,5(8):444-447
INTRODUCTION
Renal squamous cell carcinoma (RSCC) is a rare tumor that is usually diagnosed late as a locally advanced malignancy with adjacent structure involvement. Radical surgical resection with negative margins is the mainstay of treatment, as it is correlated with improved survival, while other modalities of treatment have been shown to have limited efficacy.PRESENTATION OF CASE
We report a case of a 56 year old gentleman with right RSCC with tumor encasing the inferior vena cava (IVC), treated successfully with surgical resection.DISCUSSION
The surgical management of vascular involvement of similar tumors has not been discussed in-depth in the literature. Surgical resection of the IVC without reconstruction can be done successfully in the circumstance of good collateral circulation; otherwise IVC resection with reconstruction will be necessary.CONCLUSION
Radical resection with clear margins of RSCC tumors with vascular involvement is feasible in selected circumstances. 相似文献17.
Haldipur N Devaraj S Shehata A Lewis AK Smith MO Hatton M Nassef A Beard JD 《Annals of the Royal College of Surgeons of England》2011,93(4):301-305
INTRODUCTION
In the North Trent Cancer Network (NTCN) patients requiring retroperitoneal lymphadenectomy for metastatic testicular cancer have been treated by vascular service since 1990. This paper reviews our experience and considers the case for involvement of vascular surgeons in the management of these tumours.PATIENTS AND METHODS
Patients referred by the NTCN to the vascular service for retroperitoneal lymphadenectomy between 1990 and 2009 were identified through a germ cell database. Data were supplemented by a review of case notes to record histology, intraoperative and postoperative details.RESULTS
A total of 64 patients were referred to the vascular service for retroperitoneal lymph node dissection, with a median age of 29 years (16–63 years) and a median follow-up of 4.9 years. Ten patients died: eight from tumour recurrence, one from septicaemia during chemotherapy and one by suicide. Of the 54 who survived, 7 were alive with residual masses and 47 patients were disease-free at the last follow-up. Sixteen patients required vascular procedures: four had aortic repair (fascia), three had aortic replacement (spiral graft), four had inferior vena cava resection, two had iliac artery replacement and two had iliac vein resection.CONCLUSIONS
Retroperitoneal lymph node dissection often involves mobilisation and/or the resection/replacement of major vessels. We recommend that a vascular surgeon should be a part of testicular germ cell multidisciplinary team. 相似文献18.
Ryan J. McColl Abdel Aziz M. Shaheen Balpreet Brar Gilaad Kaplan Robert Myers Francis Sutherland Elijah Dixon 《Canadian journal of surgery》2013,56(4):256-262
Background
Mortality for liver resection has remarkably improved owing to multiple factors. We sought to determine the impact of the various types of fellowship training on patient survival after liver resection.Methods
Patients who underwent hepatic resection between 1995 and 2004 in either the Calgary or Capital health regions (Edmonton) of Alberta, Canada, were identified using ICD-9 and -10 codes. Primary outcomes included in-hospital mortality and patient survival according to surgeon volume and training type (surgical oncology v. hepatobiliary v. others).Results
A total of 1033 patients underwent hepatic resection. Surgeon volume was not predictive of either in-hospital mortality (adjusted odds ratio 0.63, 95% confidence interval [CI] 0.32–1.20) or patient survival (unadjusted hazard ratio 1.11, 95% CI 0.82–1.51). Nonsignificance was also demonstrated for a surgeon’s type of fellowship training.Conclusion
The various modes of fellowship training do not appear to influence inhospital mortality or patient survival after hepatic resection. 相似文献19.
Francis Ting Aditya Bhat Richard Savdie David Ende Tint Tint Shein 《International journal of surgery case reports》2014,5(3):145-148
INTRODUCTION
We present, to the best of our knowledge, the first published case report of a satellite lesion within the bladder from enteric type urachal adenocarcinoma (UA).PRESENTATION OF CASE
Our case report involves a 38-year-old man from the Solomon Islands who underwent open partial cystectomy for UA. However, resection margins were positive due to the novel finding of a satellite lesion on histopathological assessment. Salvage cystectomy was subsequently performed and the patient had an uncomplicated post-operative recovery.DISCUSSION
This case highlights the importance of achieving negative soft tissue and bladder margins on initial resection of UA, as the consequences of incomplete resection can place significant additional morbidity on the patient.CONCLUSION
We aim to highlight the possibility of satellite lesions within the bladder in UA and suggest that further studies looking at this phenomenon are required to establish its incidence and overall impact on management of UA. 相似文献20.
Eliane Roseli Winkelmann Fernanda Dallazen Angela Beerbaum Steinke Bronzatti Juliara Cristina Werner Lorenzoni Pollyana Windm?ller 《Brazilian Journal Of Cardiovascular Surgery》2015,30(1):40-48