Coronary artery dissection without acute myocardial infarction

A 57 year-old-man with acute aortic dissection (DeBakey type I) who developed right coronary artery dissection without acute myocardial infarction. He was successful surgically treated and became asymptomatic.     

Reoperative coronary bypass grafting without cardiopulmonary bypass through a small thoracotomy

BACKGROUND: The danger of coronary reoperations is mainly hidden in the reopening of the sternum and in the manipulation of the heart and the old grafts. Therefore, the minimally invasive direct coronary artery bypass procedure seems an ideal technique for coronary reoperations if only the left anterior descending coronary artery needs to be revascularized and the left internal mammary artery has not been used previously. METHOD: From January 1995 until May 1996 we performed 81 minimally invasive direct coronary artery bypass procedures through a small anterolateral thoracotomy in the fifth intercostal space, anastomosing the left internal mammary artery to the left anterior descending coronary artery. Six of these 81 were reoperative minimally invasive direct coronary artery bypass procedures on patients who had previously undergone coronary grafting through a median sternotomy with a vein graft to the left anterior descending coronary artery. RESULTS: Mean operation time was 85.8 +/- 22.2 minutes. Mean length of the mammary pedicles was 13 +/- 2 cm. Mean coronary occlusion time was 9.2 +/- 3.2 minutes. Mean postoperative hospital stay was 5.7 +/- 1.2 days (range, 5 to 8 days). No mortality and no cardiac-related morbidity were recorded. CONCLUSIONS: These results suggest that the technique is safe and promising in selected cases of reoperative coronary operation.     

A new technique of posterolateral thoracotomy with preservation of the latissimus dorsi muscle

The authors present a new posterolateral thoracotomy technique, preserving the integrity of the latissimus dorsi muscle, which in split in the direction of its fibres instead of being sectioned transversely. The exposure is sufficient for all forms of lung resection and pleural surgery and the incision is easily and rapidly repaired. After describing the technique, the authors review their first 70 patients operated via this incision, which was always sufficient to allow the planned operation. Healing was satisfactory and, in the long-term, the functional and painful sequelae appeared to be less than with the classical Crafoord posterolateral thoracotomy, which could be replaced by this new incision.     

A new model for occluding the left coronary artery in the rabbit without thoracotomy

A small, nonmagnetic coil was fluoroscopically guided into the left circumflex coronary artery (LCXA) at the midventricular level via the left femoral artery in seven rabbits. Coronary artery occlusion was confirmed by intracoronary contrast injection, electrocardiographic changes, akinesis of the posterolateral wall distal to the occluded area, and histopathological staining of the myocardium. This new model of a closed-chest coronary artery occlusion in the rabbit may be suitable for acute ischemic myocardium studies that do not require reperfusion.     

Muscle-splitting thoracotomy

Muscle-splitting thoracotomy avoids transection of the latissimus dorsi and the serratus anterior muscles, thereby decreasing post thoracotomy pain and preserving the function and viability of these two muscles. The exposure provided for most intrathoracic procedures is excellent.     

Stroke without dissection from a neck holding manoeuvre in martial arts

Carotid artery trauma is a known cause of stroke in young people. The vessel may occlude, dissect or shower thrombotic emboli into intracranial vessels. This paper reports the use of single photon emission computed tomography (SPECT) imaging in a 29 year old man who developed an embolic stroke after neck holding manoeuvres at a martial arts class. Awareness of the potential consequences of these procedures is matched by the need for rapid and accurate diagnosis of stroke now that thrombolytic and neuroprotective treatments are emerging, which are effective only within a short time window.     

Giant jejunoileal duplication: prenatal diagnosis and complete excision without intestinal resection

A 7-week-old child presented to the pediatrician after persistent vomiting and abdominal distension developed. Intestinal dilatation had been detected in utero. Emergency ultrasonography showed only small bowel dilatation. There were no signs of intestinal obstruction; however, complete intestinal malrotation was demonstrated by an upper gastrointestinal series and barium enema. Intestinal duplication was also suspected, and emergency laparotomy was performed. A 70-cm-long jejunoileal duplication was found and successfully dissected free from the normal small bowel and excised without intestinal resection-anastomosis. The authors describe this unique case and the surgical technique for the treatment of small bowel duplications.     

Lateral rectus whole muscle and motor unit contractile measures with the extraocular muscles intact

Both extracellular and intracellular stimulation of single motoneurons were shown to be similarly effective and consistent in eliciting contractile responses in single lateral rectus muscle motor units. The whole muscle was activated by stimulating the sixth nerve in the brain stem. Both whole muscle and motor unit contractile characteristics, under isometric conditions, were found to remain consistent regardless of whether this extraocular muscle was detached or left attached to the globe. In addition, whole muscle twitch and maximum tetanic tension evoked by sixth nerve stimulation was significantly less than would be predicted by the linear summation of individual motor unit twitch and maximum tetanic tensions.     

Deep vein thrombosis after thoracotomy

In a prospective study of 183 patients undergoing lateral thoracotomy the 125 I fibrinogen uptake test and perioperative heparin prophylaxis for deep-vein thrombosis were investigated. There was an incidence of deep vein thrombosis in 51% in untreated control patients. The heparin prophylaxis effectively reduced the incidence of deep venous thrombosis to 28% (P less than 0.005) without increasing postoperative blood loss. Unilateral thrombosis was found to be significantly more frequent in the leg opposite the side of the thoracotomy (P less than 0.005). The 125I fibrinogen test is essential in assessing methods of prophylaxis but is not recommended as a routine.     

An electromyographic study of masseter muscle activity amongst overdenture and complete denture patients

Recently, several systems of topical antibiotic administration have been investigated. Most systems use sustained release devices to obtain high levels of antibiotics in the deepened periodontal pockets. Metronidazole and tetracycline can be administered without causing systemic side-effects. All systems summarized in this article are to be used after scaling and root planing of the diseased sites to increase the effect of the mechanical treatment.     

In-Plane Lateral Response of a Full-Scale Masonry Subassemblage with and without an Inorganic Matrix-Grid Strengthening System

A full-scale unreinforced masonry (URM) wall with an opening was tested under in-plane lateral loading. The wall was first subjected to monotonically increasing displacements until a moderate damage level was reached. The damaged specimen was then cyclically tested up to almost the same maximum drift attained during the monotonic test to investigate the effects of previous damage on its nonlinear response. Finally, the masonry wall was repaired with inorganic matrix-grid (IMG) composites and subjected to a cyclic displacement-controlled test up to a near-collapse state. Most of the observed damage developed in the spandrel panel affecting both lateral resistance and strength degradation. Rocking of piers governed lateral stiffness and hysteretic response, which was characterized by low residual displacements and recentering behavior. The comparison between the experimental force-displacement curves demonstrated that the IMG strengthening system was able to provide energy dissipation capacity to the spandrel panel, restoring load-bearing capacity of the as-built wall, and delaying strength degradation that was indeed observed at larger displacements. Bilinear idealizations of force-displacement curves allowed the identification of displacement ductility, global overstrength, and strength reduction factor of the tested wall systems.     

Microirrigation Lateral Design using Lateral Discharge Equation

A simple and accurate method is developed for designing single, paired, and tapered microirrigation laterals. The hydraulics of the lateral is evaluated using a lateral discharge equation approach. A simple power equation is used to express the relationship between the inlet flow rate and inlet pressure head of the lateral. Keeping the flow variation within the specified limit, a procedure for designing the length of the tapered section is developed. The lateral is designed using a step-by-step method. The length of the tapered section is determined by the golden section search method.     

Selection of anesthetic agents for thoracotomy

The selection of anesthetic agents for thoracotomy requires consideration of multiple factors. The goals of anesthetic management are to choose an anesthetic plan that will allow not only for appropriate intraoperative conditions but also for rapid extubation and adequate pain control so that the perioperative course will have the least possible associated risk of morbidity and mortality. A patient's pre-existing medical condition must be optimized. Length and type of surgical procedure, as well as the patient's medical status, determine anesthetic technique and agents.     

Influence of complete spinal cord injury on skeletal muscle within 6 mo of injury

This study examined the influence of spinal cord injury (SCI) on affected skeletal muscle. The right vastus lateralis muscle was biopsied in 12 patients as soon as they were clinically stable (average 6 wk after SCI), and 11 and 24 wk after injury. Samples were also taken from nine able-bodied controls at two time points 18 wk apart. Surface electrical stimulation (ES) was applied to the left quadriceps femoris muscle to assess fatigue at these same time intervals. Biopsies were analyzed for fiber type percent and cross-sectional area (CSA), fiber type-specific succinic dehydrogenase (SDH) and alpha-glycerophosphate dehydrogenase (GPDH) activities, and myosin heavy chain percent. Controls showed no change in any variable over time. Patients showed 27-56% atrophy (P = 0.000) of type I, IIa, and IIax+IIx fibers from 6 to 24 wk after injury, resulting in fiber CSA approximately one-third that of controls. Their fiber type specific SDH and GPDH activities increased (P 相似文献   

Quality-of-life following thoracotomy for lung cancer

Contrary to the issues of perioperative morbidity and survival following surgery for lung cancer, little attention has been given to quality-of-life. To address this, quality-of-life was assessed preoperatively and 1, 3, 6 and 9 months postoperatively in a cohort of 117 consecutive subjects who underwent thoracotomy with a certain or presumptive diagnosis of lung cancer. Those with cancer (n = 91) confirmed at thoracotomy were contrasted to those without (n = 26). Moderate to severe dyspnea, reported in 14% preoperatively, increased to 34% at 1 and 3 months (p < 0.005) but returned to approximately 10% at 6 and 9 months. Similarly, activities of daily living were impaired in 11% preoperatively; this disability increased to 21% at 1 month (p < 0.005), and returned to baseline at 6 and 9 months. Those with cancer compared to those without a postoperative diagnosis of cancer had similar quality-of-life preoperatively but deteriorated more in the postoperative period. This study demonstrates that important deterioration in quality-of-life occurs during the first 3 months postoperatively in those with a final diagnosis of cancer but improvement back to baseline can be expected thereafter.     

Surgical correction of complete rupture of the anterior papillary muscle complicating acute myocardial infarction

The authors evaluated small-volume preparation of autologous fibrin glue (AFG) and same day use in postglaucoma filtration surgery patients with Seidel positive bleb leaks and determined fibrinogen concentrations in autologous fibrinogen concentrates (AFCs) from 10 volunteers. Thirty milliliters of blood was centrifuged (5 min, 2400 x g); plasma was frozen (5 min-ethanol and ice), thawed (1-6 C, 30-60 min), and centrifuged (10 min, 5 C, 2800 x g); and the precipitate was transferred to a 1.0-ml tuberculosis syringe. Thrombin (1000 U) was dissolved (0.8 sterile water, 0.2 ml aminocaproic acid) and warmed (37 C). Average preparation time was 90 minutes. Alternating drops of AFC and thrombin were applied to bleb leaks until AFC clotted. Seidel testing with fluorescein determined success. AFC was prepared from 10 volunteers and fibrinogen was measured. AFG was initially successful with two (Seidel negative) eyes; one eye remained negative. AFG was unsuccessful in one briskly Seidel-positive leak. Mean +/- SD fibrinogen concentration in AFCs from the 10 volunteers was 2314 +/- 643 mg/dl (range 1608-3431 mg/dl). AFG may successfully close bleb leaks in outpatient settings. Brisk aqueous flow may impair effectiveness of AFG. Fibrinogen concentrations were comparable with previous reports.     

A procedure for relining a complete or removable partial denture without the use of wax

Various procedures are used to reline removable dentures. Some of these involve the use of wax to seal the denture to the cast for flasking and processing. This necessitates the use of high temperatures for an extended period and involves the risk of warpage of the denture. It is also relatively time-consuming. This article describes a procedure that uses polyvinyl siloxane instead of wax. The procedure is more time efficient and decreases the risk of warpage of the denture.