Compression of the superior vena cava by a mediastinal lipoma.

Lipomas are rarely found in the mediastinum. Although they may reach large proportions, they rarely compress vascular structures. We present a case in which a lipoma produced superior vena cava syndrome.

Chest wall resection and reconstruction via a muscle-sparing minithoracotomy for lung cancer.

Five per cent of lung cancers involve the parietal pleura and chest wall. En bloc resections improve survival. Lung resections via muscle-sparing chest incisions have minimized complications and hospital stay.

Recommendations for handling radioactive specimens obtained by sentinel lymphadenectomy. Surgical Pathology Committee of the College of American Pathologists, and the Association of Directors of Anatomic and Surgical Pathology.

Sentinel lymph node biopsy has been shown to be an accurate predictor of axillary nodal status in invasive breast cancer and is a useful alternative to axillary dissection for some patients. Because radioactive materials are often used to identify the sentinel lymph node, concerns have been raised regarding the safe handling of tissue specimens obtained by this technique. The Surgical Pathology Committee of the College of American Pathologists and the Association of Directors of Anatomic and Surgical Pathology have developed recommendations for the safe handling of radioactive specimens obtained by sentinel lymphadenectomy.

Coconut atrium: transmural calcification of the entire left atrium.

Massive calcification of the left atrium usually spares the interatrial septum, which provides a cleavage plane for surgical access to the mitral valve. Endoatriectomy with mitral valve replacement is the currently accepted corrective procedure because it affords maximum exposure while decreasing the risk of embolization and intraoperative hemorrhage. We describe a case in which the entire left atrium, including the septum, was thickly calcified and resembled a coconut shell.

Extrathoracic subclavian internal thoracic artery bypass grafting.

Interval development of a significant stenosis at the origin of the left internal thoracic artery (LITA) after this vessel has been used to revascularize the anterior descending coronary artery may be an indication for reoperation. We present an extrathoracic approach to bypass the proximal segment of the LITA that allows patients with this lesion a quick recovery, short hospital stay, and early resumption of normal activity.

Identification of a channel catfish, Ictalurus punctatus (Rafinesque), leukocyte-specific leucine zipper protein.

Five clones isolated from a channel catfish cDNA library were each reactive with monoclonal antibodies (mAbs) C3-1 and 51A only. The size of the cDNA inserts from C3-1 and 51A positive clones was 2.5 Kb and identical based on sequence analysis.

Evaluation and management of the patient with ulcerative colitis.

Ulcerative colitis is an inflammatory bowel disease that affects the large intestine. Ulcerative colitis is chronic and can be debilitating. The disease process waxes and wanes, which sometimes gives patients a false sense of cure.

Minimally invasive approach for pneumonectomy culminating in an outpatient procedure.

Study Objective: To establish the effects of the use of a clinical pathway that includes a minimally invasive access among patients undergoing pneumonectomy.

Design: Prospective study from February to December of 1997.

Setting: A community hospital.

Muscle-sparing minithoracotomy with intercostal nerve cryoanalgesia: an improved method for major lung resections.

To decrease incisional pain, morbidity, and length of hospital stay (LOS) and, hopefully, to reduce costs, most surgical specialties have turned to minimally invasive procedures to access the body cavities during commonly performed operations. Video-assisted thoracic surgery (VATS) has emerged as the standard approach for a number of diagnostic and therapeutic procedures in thoracic surgery. Major lung resections (lobectomy, bilobectomy, and pneumonectomy), however, can be performed through an incision similar in size to the utility or access thoracotomy used in VATS to remove the specimen.

One-day admission for lung lobectomy: an incidental result of a clinical pathway.

Background: Most complications after lung lobectomy are related to pain, narcotic analgesia, and inactivity. When the operation is performed with the goal of minimizing postoperative pain, and when rapid restoration of activity and patient independence can be achieved, most postoperative complications can be obviated and early discharge can be attained.

Methods: Since March 1996, we have performed 10 consecutive elective major lung resections (8 lobectomies and 2 bilobectomies) for neoplastic (n = 8) and benign inflammatory (n = 2) lesions.

Ventriculotomy repair during revascularization of intracavitary anterior descending coronary arteries.

Optimal revascularization of the rare variant anomolous intracavitary left anterior descending coronary artery requires, by definition, entrance into the right ventricular cavity. We present a simple method to repair the ventriculotomy without risk of obliterating the left anterior descending coronary artery, septal perforators, or diagonal branches.

Vaginal sacrospinous ligament fixation with the Autosuture Endostitch device.

Objective: The purpose of the study was to evaluate a disposable suturing device to facilitate vaginal sacrospinous ligament fixation.

Study Design: Seventeen consecutive patients (mean age 66.3 years) requiring vaginal sacrospinous ligament fixation had the procedure performed with the Autosuture Endostitch device with a braided polyester suture.

Diagnosis of fulminant pulmonary embolism by transthoracic echocardiography.

When pulmonary embolism is severe enough to produce acute cor pulmonale, transthoracic 2-dimensional echocardiography can promptly yield findings highly suggestive of this condition while ruling out competing diagnoses. We present a case diagnosed by transthoracic echocardiography and successfully treated despite a prolonged refractory cardiac arrest.

Severe deformity of a Palmaz-Schatz stent after normal surgical manipulation.

This report describes a case in which normal surgical manipulation during dissection of the heart while performing a repeat revascularization procedure produced a significant deformity in Palmaz-Schatz stents previously implanted in a saphenous vein graft. The graft had shown satisfactory angiographic appearance immediately before the operation, and consideration was given to leaving it in place. Its replacement, however, prevented a major intraoperative mishap.

Effects of surgical manipulation on coronary stents: should surgical strategy be altered?

Background: Coronary artery bypass grafting is usually indicated for those patients who undergo open heart surgical procedures who have previously undergone percutaneous transluminal coronary angioplasty regardless of the absence of stenosis. Occasionally, however, if the treated artery has remained patent for many years and there is a shortage of conduit material or the patient is undergoing a complex operation, the branch is left ungrafted. With the gaining popularity of coronary stent placement, patients with these devices are undergoing open heart operations with increasing frequency.

Percutaneous removal of a surgically inserted intra-aortic balloon catheter.

A simple and safe technique of open sheathless insertion and percutaneous removal of an intra-aortic balloon catheter is described. The insertion can be performed through the common femoral artery or, when necessary, through the external iliac artery. The latter is particularly useful in patients with small-caliber vessels and/or peripheral vascular disease.

Postoperative management of cerebral air embolism: gas physiology for surgeons.

Cerebral gaseous microemboli are present in most, if not all, cardiopulmonary bypass-assisted operations. Fortunately, the great majority are subclinical. Clinically significant cases of cerebral air embolism are largely underdiagnosed, undertreated, and underreported.

Successful myocardial revascularization and neurologic recovery in a patient with prolonged refractory cardiac arrest and a chronically occluded left internal carotid artery.

Heretofore, the longest successfully treated cardiac arrest reported in the literature, secondary to myocardial ischemia, was one that required 45 minutes of cardiopulmonary resuscitation before coronary bypass surgery. We present a unique case of successful resuscitation after a cardiac arrest secondary to myocardial ischemia. The arrest lasted 78 minutes (30 minutes of closed cardiac massage and 48 minutes of open cardiac massage).