Bronchial stenting and high-frequency percussive ventilation treatment of descending aortic aneurysm-induced atelectasis of the left lung

IMPLICATIONS: This case report shows that atelectasis of the left lung-induced by extrinsic compression of the left main bronchus by an aortic aneurysm and persisting despite aggressive conservative treatment-may be effectively treated by bronchial stenting and high-frequency percussive ventilation.     

Intramyocardial Oxygen Monitoring in Coronary Artery Bypass Surgery

OBJECTIVE: In coronary artery bypass surgery various parameters have been used to monitor patients clinical status. Direct monitoring of myocardial oxygenation can be performed by measuring intramyocardial partial oxygen tension pressure (p ti O2). This study was performed to determine the perioperative time course of this parameter in correlation to standard monitoring parameters. METHODS: Twenty-three patients underwent standard coronary artery bypass grafting (CABG). A special polarographic microprobes was inserted into the myocardium in the distribution zone of the left anterior descending artery which was one of the target vessels of myocardial revascularization. Intramyocardial p ti O2 was monitored intra- and up to 12 hours postoperatively. Values were correlated to hemodynamic, oxygenation and procedure associated parameters. RESULTS: Myocardial oxygenation during CABG is characterized by a significant decrease of p ti O2 during cross-clamping and a significant increase after removal of the cross-clamp. The postoperative time course of p ti O2 shows a steady increase of p ti O2 in the first 12 postoperative hours investigated. Preoperative ejection fraction as well as cardio-pulmonary bypass time does not seem to have an influence on the postoperative p ti O2 in these patients. Various standard monitoring parameters show complex influence on intramyocardial p ti O2- CONCLUSIONS: Determination of intramyocardial partial oxygen pressure in patients undergoing bypass surgery shows characteristic changes. Changes in p ti O2 as a direct online parameter of myocardial oxygenation occur immediately after procedures that influence myocardial perfusion and therefore, may help to detect potential complications earlier than standard monitoring parameters in cardiac surgery.     

Essential tremor leading to toxic liver damage successfully treated with deep brain stimulation

Purpose  

We present a patient with severe essential tremor (ET), who underwent thalamic deep brain stimulation (DBS). After previous medical treatment with Propranolol and Primidone failed, the patient resorted to alcohol, which greatly alleviated the symptoms. The downside of this situation, however, was that it led to alcoholism with severely disturbed liver enzymes and hepatic steatosis.     

Efficacy and cost effectiveness of harmonic scalpel compared with electrocautery in posterior instrumentation of the spine

Different methods to reduce blood loss during spinal surgery have been described already. Although the use of the harmonic scalpel (HS), an ultrasonically activated coagulator, has been described in endoscopic spinal surgery, its efficacy in posterior instrumentation of the spine remains unclear. The aim of this study was to determine if blood loss was lower using the HS than electrocauterization (EC) and to evaluate the cost effectiveness of the HS in reducing the need for transfusion in patients undergoing posterior instrumentation of the spine. The two groups were matched in a blinded manner, without knowledge of blood loss and were similar with respect to mean age, diagnosis and operation data. All instrumentations were done by the same surgeon. After matching was completed (HS group n=50, EC group n=50) blood loss and overall costs for blood products were analyzed by independent observers. The following were significantly lower with the HS than with EC: (1) blood loss (1106±985 ml vs 2176±1764 ml, P<0.001), (2) frequency of cell saver use (13 vs 28 patients, P=0.001), (3) average cost of blood products (€72 vs €219, P<0.001), (4) predonation of autologous fresh frozen plasma (2.58±2.78 vs 4.5±2.2 U, P=0.002) and red blood cells (0.38±0.75 vs 0.88±1.1 U, P=0.009). The overall costs, including the costs for the HS, remained neutral. The use of the HS in posterior spinal surgery leads to significantly lower blood loss, and less need for and cost of blood products, compared to EC in cases with major anticipated blood loss.No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.