[Show abstract][Hide abstract] ABSTRACT: Objectives: Post-pneumonectomy bronchopleural fistula (PPBPF) is a severe complication when it is associated with empyema.
Such complicated PPBPF usually results in a prolonged hospital stay, high morbidity and mortality. The objective of the study
was to report our early experience in the initiation of autogenous corticocancellous bone graft in the treatment of complicated
PPBPF. The technique was used with an aim to provide an oeteoinduction to the tracheal mucosa, to minimise the risk of infection.
Methods: Between June 2011 and September 2013, use of autogenous corticocancellous bone graft was initiated in 4 patients
with complicated PPBPF, including 2 patients with primary lung cancers, 1 patient with metastatic renal cancer and 1 patient
with gunshot injury to the pulmonary hilar. All patients had developed empyema after a period of conservative management.
On thoracotomy, an autologous corticocancellous bone graft was harvested from the adjacent ribs and implanted into the defect
in the tracheal mucosa.
Results: The complicated PPPF was successfully closed within a few days of surgery in all patients. Within a mean follow-up
period ranging from 5–33 months, there was neither recurrence nor secondary complication. The thoracostomy tubes could be
removed on average at 4 days (2–7 days). Average length of hospital stay after the procedure was 9 days (6–15 days).
Conclusion: Autologous corticocancellous bone graft is feasible and efficient for the surgical management of complicated PPBPF.
Preview · Article · Oct 2014 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Background
This study aimed to determine the safety and efficacy of intraoperative intensive glycaemic treatment with modified glucose-insulin-potassium solution by hyperinsulinemic normoglycaemic clamp in cardiopulmonary bypass surgery patients. We hypothesised that the treatment would reduce infection rates in this group of patients.MethodsA prospective, randomised, double-blind trial was conducted in cardiopulmonary bypass surgery patients. A total of 199 adult patients (out of a planned 400) were randomly allocated to intensive or conventional treatment with target glucose levels of 4.4–8.3 mmol/l and < 13.8 mmol/l, respectively. The primary outcomes were clinical infection and cytokine levels, including interleukin (IL)-6 and IL-10. The secondary outcomes were morbidity and mortality.ResultsThe study was terminated early because of safety concerns (hypoglycaemia). The clinical post-operative infection rate was 17% in the intensive group and 13% in the conventional group (P = 0.53). The proportion of patients with hypoglycaemia was significantly higher in the intensive group (23%) compared with the conventional group (3%) (P < 0.001). Morbidity and mortality rates were similar for both groups. Anaesthetic duration > 2 h (vs. ≤ 2 h), pre-operative IL-6 level > 15 pg/ml (vs. ≤ 15 pg/ml) and post-operative IL-6 level 56–110 pg/ml (vs. ≤ 55 pg/ml) were independent predictors for post-operative infection.Conclusions
Intraoperative intensive glycaemic treatment significantly increased the risk of hypoglycaemia, but its effect on post-operative infection by clinical assessment could not be determined. Anaesthetic duration, pre-operative and post-operative IL-6 levels can independently predict post-operative infection.
[Show abstract][Hide abstract] ABSTRACT: Deep sternal wound infection (DSWI) is an uncommon life-threatening complication of cardiac surgery performed through median sternotomy. Surgical treatment is considered complicated and challenging. We report our experience with a single-stage omental flap transposition in the treatment of the 14 consecutive patients who were diagnosed with DSWI within 3-16 days after the primary cardiac surgery, between August 2001 and January 2008. The single-stage omental flap transposition was achieved within 70-135 min, at four to eight hours after diagnosis of DSWI. The single-stage omental flap transposition was successfully applied and all 14 patients survived. They displayed a shortened intensive care unit stay (one to nine days) and hospital stay (19-36 days). Follow-up was 100% complete (26-92 months) and demonstrated rapid recovery, complete wound healing without fistula, and no late gastrointestinal complications. However, the very few complications found were slight numbness of anterior chest and minor paradoxical chest movement. We obtained satisfactory outcomes when treating the patients with DSWI by a single-stage omental flap transposition. Based on our solid experience, we recommend this procedure as an option for patients with DSWI, especially those who are not in a state of severe low cardiac output or malnutrition.
Preview · Article · Mar 2011 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Tracheo-innominate artery fistula (TIF) is an uncommon but frequently fatal complication of tracheostomy. Significant airway hemorrhage usually occurs after premonitory bleeding. When massive bleeding occurs, immediate control of arterial bleeding, control of the airway and subsequent definite treatment are the principles for saving lives. Without prompt surgical intervention, the outcome of this complication is grave. Physicians should maintain a high index of suspicion of TIF in any patient with a recent tracheostomy and subsequent tracheal hemorrhage.
No preview · Article · Jan 2007 · Asian cardiovascular & thoracic annals
[Show abstract][Hide abstract] ABSTRACT: Terminal warm blood cardioplegia has had a profound impact on cardiac surgery, especially in coronary artery bypass surgery, but there have been few studies on its use in mitral valve replacement. The purpose of this study was to determine whether terminal warm blood cardioplegia offers any advantages in mitral valve replacement. Forty patients with mitral valve disease were prospectively randomized to one of two groups of 20 with different techniques of myocardial protection: group A had cold blood cardioplegia, and group B had cold blood cardioplegia with terminal warm blood cardioplegia. Intraoperative and postoperative variables were used to assess primary outcomes. Postoperative troponin T release was measured as a secondary outcome. Improved spontaneous recovery of sinus rhythm was observed in group B, but the difference was not significant. The maximum doses of inotropics, duration of inotropic support, intensive care unit stay, and postoperative left ventricular ejection fraction were similar in both groups. Troponin T release at 0 and 6 h postoperatively was not different between the two groups. This study did not find any benefit of terminal warm blood cardioplegia in either clinical outcome or troponin T release after mitral valve replacement.
No preview · Article · May 2006 · Asian cardiovascular & thoracic annals
[Show abstract][Hide abstract] ABSTRACT: The surgical management of tetralogy of Fallot (TOF) has continued to evolve and there are now generally excellent early and long-term results following complete repair.
To investigate the early results of the authors' current surgical management of TOF by assessing the perioperative and early to intermediate follow-up period. The authors paid particular attention to the post-operative ratio of right ventricular to left ventricular systolic pressure (RVSP/LVSP), focusing on the presence of low cardiac output, intensive care unit (ICU) stay, prolonged of inotropic support and ventilation support time.
Between June 2002 and August 2004, 31 consecutive patients underwent complete repair of TOF. Their mean age was 7.7 +/- 5.1 years (range, 2.9 to 25.3). A previous palliative shunt had been performed in 14 (45.2%) patients. Twenty-three patients (74.2%) were in NYHA FC II. Mean hematocrit and oxygen saturation were 50.9 +/- 10.25% and 80.5 +/- 8.6%, respectively. Mean preoperative ratio of RVSP/LVSP was 1.1 +/- 0.15. The operative approach was transatrial/transpulmonary, and 17 (54.8%) patients required a transannular patch. An extracardiac valve conduit was necessary in 3 (9.7%) patients with pulmonary atresia.
There were no operative or late deaths. Two cases were reoperated from cardiac tamponade. Mean postoperative ratio of RVSP/LVSP was 0.53 +/- 0.16. Median ICU and hospital stays were 2.2 and 11 days, respectively. Presence of low cardiac output and prolonged inotropic support were significantly (P < 0.05) related to a RVSP/LVSP ratio of more than 0.5. At median follow-up of 6 months, 29 (93.5%) patients were asymptomatic and all patients were free of significant residual lesion.
The authors' early results in complete repair of TOF patients are acceptable with a low incidence of morbidity. A postoperative RVSP/LVSP ratio of more than 0.5 was significantly associated to adverse outcome. Late complications may, however, develop, and long term follow-up for early detection of any such complications is essential.
Full-text · Article · Feb 2006 · Journal of the Medical Association of Thailand = Chotmaihet thangphaet
[Show abstract][Hide abstract] ABSTRACT: A case of incomplete duplication of the esophagus diagnosed in a 20-month-old girl with an esophageal perforation is presented. X-ray films of the chest showed pneumomediastinum and subcutaneous emphysema. A water soluble contrast esophagogram revealed a contrast leakage from the cervical esophagus to the thoracic inlet. The endoscopic findings are described. Complete resection of the esophageal duplication was effective.
Preview · Article · Sep 2005 · Journal of the Medical Association of Thailand = Chotmaihet thangphaet
[Show abstract][Hide abstract] ABSTRACT: Aneurysms of the extracranial internal carotid artery (ICA) are uncommon. These lesions usually present with symptoms of transient ischemic attacks (TIA) from emboli and cranial nerve dysfunction from compression. The primary objective of treatment is to prevent a permanent neurologic deficit arising as a result of atheroembolism. The resection of an ICA aneurysm with restoration of flow is the preferred method of treatment. The authors present the case of a 32-year-old woman diagnosed with an ICA aneurysm. The patient underwent aneurysmectomy using an autologous saphenous vein graft with ICA blood flow being maintained using a carotid-to-carotid shunt, which was modifiedfrom an intravenous catheter set. This modified carotid shunt is easy to prepare for use and is of low cost. The authors do not expect this shunt to represent the standard commercially available shunt; but in some institutes, where commercial shunts are not available, this shunt may be suitably used.
Preview · Article · May 2005 · Journal of the Medical Association of Thailand = Chotmaihet thangphaet
[Show abstract][Hide abstract] ABSTRACT: Aortic valve repair in children is a challenge. We have adopted a technique of single aortic cusp extension with an autologous pericardial strip in patients diagnosed with severe aortic insufficiency (AI) associated with a ventricular septal defect (VSD). The purpose of this study was to report the short-term outcomes. Seven patients were operated on between January 2002 and December 2003. The mean age was 11.28 +/- 2.1 years (range 8-14 years). The VSD was closed with a synthetic patch. Aortic cusp extension was performed at the right coronary cusp in 6 patients and the remainder had a non-coronary cusp extension. The mean diastolic arterial pressure increased from 35.71 +/- 6.09 to 74.28 +/- 7.31 mm Hg after the operation ( p < 0.001). The postoperative grade of AI was trivial in 4 patients, mild in 1 patient and non-existent in 2 patients. The mean follow-up period was 12.85 +/- 6.12 months (range 2-20 months). This technique is very effective in patients with severe AI associated with a VSD. However, long-term durability will need to be carefully followed.
No preview · Article · Mar 2005 · Asian cardiovascular & thoracic annals
[Show abstract][Hide abstract] ABSTRACT: Surgery for pulmonary cavity associated with fungus ball is challenged by chronic lung disease. The purpose of this report was to review patient data, operative procedures and results of surgery. This was a retrospective study. Twenty patients were operated on between January 1997 and December 2002. Fourteen (70%) patients were male and the mean age was 46.30 +/- 13.10 years (range, 24 to 76 years). The most common underlying pulmonary disorder was tuberculosis (70%). Ninety five percent of the patients had a history of hemoptysis, and 35% presented with massive hemoptysis. Lobectomy was performed in 11 (55%) patients and 6 (30%) patients were operated on by cavernostomy with transposition of muscle flap technique. There was no operative mortality and 8 complications (3 prolonged airleaks, 2 wound infections, 1 postoperative bleeding, 1 seroma and 1 empyema). It was also found that emergency surgery and cavernostomy with transposition of muscle flap compromised the postoperative course. Surgery is very effective in controlling and preventing hemoptysis in patients who have pulmonary cavity associated with fungus ball. Elective surgery and formal pulmonary resection may be the proper option for low risk patients. Cavernostomy with transposition of muscle flap may be suitable for patients who have poor pulmonary reserve.
No preview · Article · Oct 2004 · Asian cardiovascular & thoracic annals
[Show abstract][Hide abstract] ABSTRACT: This retrospective study collected data from 11 patients who underwent TDTA' repair from February 1987 to June 2003, 10 patients were men (90.9%) and 1 was a woman (9.09%) with a mean age of 32 years. All patients had a blunt injury from a violent motor vehicle accident. None of them required thoracotomy at the emergency room. Standard chest x-ray was done in every patient and the widening of the upper mediastinum was mainly found in 10 patients (90.9%), hemothorax in 8 patients, blurred aortic knob in 7 patients, lower left main bronchus in 3 patients, pleural apical cap in 2 patients and pneumothorax in 1 patient, 8 patients were investigated by CT scan and presented a positive study. 3 patients (27.27%) were diagnosed by both aortogram and CT scan anda pseudo-false aneurysm was found Multi organ system injury was mainly found in 10 patients (90.91%). 7 patients (63.64%) had hypovolumic shock on admission, 3 patients died postoperation and 2 of them had experience of postoperative paraplegia. Clamp and sew technique was used in 6 patients (54.54%). The duration of aortic cross clamp time ranged from 19-67 minutes (mean time = 39.30 min.) Pneumonia was the significant postoperative complication found in 3 patients, including acute renal failure, ARDS (all died) and paraplegia in 2 patients. The duration of the aortic cross clamp time that was used in the patients who presented with paraplegia was more than 40 minutes. 1 patient had delayed the aortic repair for 3 weeks resulting from severe brain contusion. 5 patients (45.45%) died in hospital. 1 patient died in the operating theatre, 4 of them (36.36%) died during postoperatively within 24 hours. The mainly cause of death which occurred in every patient was intraoperative cardiac arrest, the others were postoperative bleeding, ARDS and arrhythmias. The mean of length of stay in the intensive care unit was 6.94 days. The period of hospitalization ranged from 11 to 180 days (mean = 62.83 days). The small sample size is the limitation for the present study. The authors plan to do prospective study about the factors which influence the mortality rate and factors related to postoperative paraplegia in TDTA patients at Songklanakarind Hospital.
Preview · Article · Oct 2004 · Journal of the Medical Association of Thailand = Chotmaihet thangphaet