Immune heparin-induced thrombocytopenia can be detected preoperatively among patients with a low platelet count or a history of prolonged heparin exposure or both. Cardiac surgery can be safely undertaken using iloprost-induced platelet inhibition during heparinization.
Bronchogenic cysts are congenital cystic lesions of foregut origin, usually intrapulmonary or mediastinal in location. Peri-oesophageal bronchogenic cysts are rare, while intra-oesophageal cysts are almost always considered as enterogenous owing to their location and their composition. We report here an unusual case of a young adult with an intramural bronchogenic cyst causing dysphagia. Despite the fact that the cyst was completely embedded in the oesophageal wall, the pathological findings revealed the respiratory origin of the cyst. An extramucosal excision of the cyst was performed establishing the diagnosis and alleviating all our patient’s symptoms.
A non-sleeve resection technique was used in 15 patients requiring reconstruction of the main or secondary carina because of malignant invasion. The technique, which can be employed only in cases of partial carina invasion, utilizes healthy bronchial tissue to cover the defect after resection. The operations comprised right pneumonectomy with reconstruction of the main carina (11 cases), left lower lobectomy with reconstruction of the secondary carina (2) and right upper lobectomy (1) and right lower bilobectomy (1), both with reconstruction of the upper lobe carina. There were no intraoperative deaths or major complications, except for one bronchopleural fistula. Six patients died after 20-month to 4-year observation, six are alive (2 with and 4 without malignant disease) after 6 months to 3 years, and three have survived for more than 5 years. These initial results that our "modified sleeve resection technique" is a reliable option when the carina is partially invaded.
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