Expanding perigraft seroma after ascending aorta replacement

Background

Perigraft seroma is a persistent and sterile fluid confined within a fibrous pseudomembrane surrounding a graft that develops after graft replacement. Development of perigraft seroma is an uncommon complication that occurs after the surgical repair of the thoracic aorta using woven polyester grafts. mechanism underlying perigraft seroma formation remains unclear.

Case presentation

Herein, we describe the case of 77-year-old man who underwent repeat sternotomy for the treatment of large perigraft seroma 1 year after ascending aorta replacement for acute type A dissection. After removing a cloudy yellow fluid, we covered the prosthetic graft with fibrin glue and wrapped it with a new graft. Bacterial culture and laboratory examination of the fluid confirmed the final diagnosis of perigraft seroma, and there was no evidence of recurrence. The area in which fluid accumulated around the graft shrunk 1 year after surgery.

Conclusions

The cause of a expanding perigraft after repair of the thoracic aorta remains unknown. Physicians should be aware that chronic expanding mediastinal seroma with Dacron grafts is one of the rare postoperative complications of thoracic aortic surgery. Applying fibrin glue to the graft surface might effectively prevent the recurrence of perigraft seroma.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13019-022-02018-y.

Successful treatment of aortic valve endocarditis caused by Enterococcus casseliflavus: a case report

Background

Enterococcus casseliflavus is rarely isolated from human specimens. To the best of our knowledge, there are no reports on its detailed treatment course and prognosis. Here, we present the first known case of E. casseliflavus endocarditis with a detailed treatment course.

Case presentation

An 86-year-old Japanese woman was transferred to the emergency department with dyspnoea, wheezing, and lumbago. Her medical history included hypertension, chronic kidney disease, idiopathic interstitial pneumonia, and rectal carcinoma. Physical examination revealed expiratory wheezes and a diastolic murmur (Levine 2/6) at the 4th right sternal border. Chest radiography revealed bilateral interstitial opacities and slight cardiac dilatation. Transthoracic echocardiography demonstrated the presence of mobile vegetation with perforation, prolapse, and regurgitation of the aortic valve. With a suspicion of infective endocarditis, we started administering intravenous ampicillin/sulbactam. Thereafter, blood cultures identified E. casseliflavus through matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. The antimicrobial treatment was then switched to ampicillin plus gentamicin. The patient underwent aortic valve replacement on the thirteenth hospital day. She was administered intravenous ampicillin and gentamicin for 6 weeks. The patient was discharged 8 weeks after admission.

Conclusions

Our case demonstrated that E. casseliflavus could cause infective endocarditis, which can be successfully treated with a 6-week regimen of ampicillin and gentamicin in combination with proper surgical treatment.

[Giant Left Atrial Myxoma Found with Congestive Heart Failure;Report of a Case]

We report a case of giant left atrial myxoma in a 52-year-old woman who developed congestive heart failure. By echocardiography, not only the myxoma but moderate degree of mitral and tricuspid regurgitation was also found. The tumor was extensively attached to the left atrial endocardium, and was excised completely together with the endocardium. No valve surgery was added. Postoperative echocardiography showed no myxoma and no mitral valve regurgitation. She was discharged in good condition on postoperative day 14.

[Surgical Repair of Giant Coronary Artery Aneurysm Associated with Coronary-pulmonary Artery Fistulae;Report of a Case]

A 61-year-old woman was referred to our hospital with a complaint of chest compression. Coronary angiography revealed a giant coronary artery aneurysm, located in the middle of a coronary-pulmonary artery fistula originating from the right coronary artery. Another fistula was also shown between the left anterior descending artery and the pulmonary artery. Surgical correction was indicated due to the risks of the aneurysmal rupture and coronary events. Under cardiopulmonary bypass, suture-closure of the coronary artery aneurysm and ligations of the fistulae were carried. Postoperative coronary angiography showed no aneurysm or fistula, and she was discharged uneventfully on the 12th postoperative day.

[Severe Calcification on Glutaraldehyde-treated Autologous Pericardium after Mitral Valve Repair by Leaflet Augmentation;Report of a Case]

We report a case of surgical treatment of mitral valve stenosis due to severe calcification on the glutaraldehyde-treated autologous pericardium. A 39-year-old woman presented with progressive dyspnea. She had undergone mitral valve repair by leaflet augmentation with a glutaraldehyde-treated autologous pericardium for mitral regurgitation 3 years before. Transthoracic echocardiography showed mitral valve stenosis with limited movement of the anterior leaflet. At redo surgery, severe calcification was observed of the glutaraldehyde-treated autologous pericardium patch on the anterior mitral leaflet. Mitral valve replacement was performed successfully, and she was discharged on postoperative day 14.

[Surgical Treatment of Right Ventricular Perforation by a Transvenous Electrode Catheter;Report of a Case]

We report a case of surgical treatment of iatrogenic right ventricular perforation. An 86-year-old woman with sick sinus syndrome was treated by insertion of transvenous electrode catheters. She was transferred to our hospital due to chest pain 9 days after the insertion. We found the ventricular electrode catheter had perforated the right ventricle by computed tomography (CT). This perforated lesion was repaired under beating heart using 2-0 monofilament mattress sutures reinforced by felt pledgets. The perforation may have occurred because the apex portion of the right ventricle was fragile. Iatrogenic cardiac trauma is rare, and prompt recognition and treatment are essential.

Cardiac tamponade due to rupture of a giant coronary artery aneurysm with a coronary arteriovenous fistula: a case report

Background

Coronary artery aneurysm (CAA) is defined as dilatation exceeding 1.5 times the width of the normal adjacent coronary artery segments. CAA usually causes few symptoms, and rupture is rare, but can be lethal due to cardiac tamponade when it does occur.

Case presentation

A 79-year-old woman presented with presyncope and back pain. Emergency surgery was performed based on a diagnosis of cardiac tamponade due to either rupture of coronary arteriovenous fistula or CAA. At surgery, a rupture site was located on the wall of the giant CAA, with a diameter of 55 mm, originating from the ostium of the right coronary artery. Suture closure of the inflow and outflow of the aneurysm was performed, and the aneurysmal cavity was obliterated by multiple sutures. The patient made an uneventful recovery and was discharged from hospital on postoperative day 13.

Conclusion

On the basis of this case, we propose considering rupture of a CAA as one of the causes of cardiac tamponade.

[Pulmonary Arterioplasty with Autologous Pericardial Patch for Lung Cancer]

Three patients underwent left upper lobectomy with arterioplasty of left pulmonary artery trunk for lung cancer. For pulmonary arterioplasty, wide wedge resection and patch plasty with autologous pericardium was performed. No in-hospital death or no postoperative complications due to arterioplasty was encountered. The mean follow-up period was 3.6 years and long-term patency of the reconstructed pulmonary artery was confirmed by computed tomography in all patients.

The chemistry of indoles. CVII. A novel synthesis of 3,4,5,6-tetrahydro-7-hydroxy-1H-azepino[5,4,3-cd]indoles and a new finding on Pictet-Spengler reaction

Serotonins were found to produce 3,4,5,6-tetrahydro-7-hydroxy-1H-azepino[5,4,3-cd]indoles by simple heating with amines under an oxygen atmosphere. Serotonins also reacted with various aldehydes to provide 3,4,5,6-tetrahydro-7-hydroxy-1H-azepino[5,4,3-cd]indoles rather than beta-carbolines under basic conditions. In these novel reactions, the presence of the 5-hydroxy group on the indole nucleus was suggested to be essential. Possible mechanisms are discussed.

The chemistry of indoles. CIII. Simple syntheses of serotonin, N-methylserotonin, bufotenine, 5-methoxy-N-methyltryptamine, bufobutanoic acid, N-(indol-3-yl)methyl-5-methoxy-N-methyltryptamine, and lespedamine based on 1-hydroxyindole chemistry

Application of regioselective nucleophilic substitution reactions of 1-hydroxytryptamines to novel and simple syntheses of serotonin (1a), N-methylserotonin (1b), bufotenine (1c), 5-methoxy-N-methyltryptamine (2a), bufobutanoic acid (3a), N-(indol-3-yl)methyl-5-methoxy-N-methyltryptamine (4), and lespedamine (5) are described. Effective syntheses of 5-benzyloxytryptamine and 1-methoxy-2-oxindoles are also reported.

Toxicity of mitomycin C and anti-intoxication by fumaric acid in liver and kidney cellular fine structure

The previous study indicated that the toxic symptoms in ICR mice given two ip injections of 4 mg/kg of mitomycin C at an interval of 48 hr were reduced by the concurrent administration of 40 mg/kg of fumaric acid. In the present study, are described the changes of subcellular components and organella in the liver and kidney at 4 days after the 2nd injection. The liver treated with mitomycin C showed perinuclear irregularity, aggregation of chromatins, and abnormal cytoplasmic organella (e.g., swelling of mitochondria and dilatation of rough endoplasmic reticulum). Focal localization of rough endoplasmic reticulum was noted. The concurrent administration of fumaric acid reduced the incidence of such deleterious changes. Increases in the number of nucleoli and normal cytoplasmic organella were evident. The kidney treated with mitomycin C showed decrease of chromatins and edematous nuclear matrix. The cytoplasmic organella were swollen. The action of fumaric acid against mitomycin C intoxication was more apparent in the kidney. Chromatins and nucleoli developed well and other subcellular organella appeared completely normal.

Perfusion techniques of the canine pancreas for physiological and secretin response studies

In vivo and in situ perfusion techniques of the canine pancreas for physiologic and secretin response to studies are described. We developed these modified techniques to clarify the mechanism of the pancreatic exocrine secretion. An analysis was made of some physiological parameters of the pancreas and our findings were compared with those obtained in secretin stimulation of the pancreas. The composition of secretin induced venous effluent and pancreatic juice was investigated. A decrease of pH, pO2 and (HCO-3) in the venous blood and a temporary efflux of K+ from the cell to the perfusate were observed after secretin stimulation. A temporary decrease of perfusion pressure was observed after secretin stimulation and the change is thought to be due to vascular dilatation. Ultrastructural findings from the pancreas perfused for about 1 hour showed no prominent changes.

Ultrastructural investigation of the effect of mitomycin C on the rat exocrine pancreas

In order to clarify the pathophysiology of digestive disorders which are caused with anticancer agents, Mitomycin C was intravenously administrated to rats and the ultrastructure of the pancreas was studied. The alteration of acinar cells after under 4 daily administrations of 1.0 mg/Kg of Mitomycin C was not remarkable and in an early stage returned to normal structure. In above 8 daily administrations of 1.0 mg/Kg of Mitomycin C, however, pronounced degeneration of acinar cells was induced and acinar cells did not recover to the previous level, but die within one month. The ultrastructural changes induced by Mitomycin C were mainly aggregation of chromatin in the nuclei, tubularly dilatation of the rough endoplasmic reticulum, and swelling of the mitochondria. It was surmised that the biosynthesis and supply of protein such as digestive enzymes were not amply carried on; hence, the ehcmotherapy could give rise to severe digestion disorders. It appeared necessary to further study the dosage and dosage schedule of the anticancer agents, along with the necessity for taking ample care of patients presenting such disorders.

Effects of anticancer agents of the intestinal epithelium. A morphologic study

In order to make clear the pathophysiology of digestive symptoms which are caused with anticancer agents, three anticancer agents, i.e., mitomycin C, 5-FU and cytosine arabinoside were administered pre-operatively, and the ultrastructure of the intestinal epithelium, especially that of absorptive cells, were studied on the specimens collected intra-operatively. In view of the finding that severe degeneration occurred inside cytoplasms, chiefly their nuclei, it was surmised that the biosynthesis and supply of proteins such as digestive enzymes were not amply carried on; hence, the chemotherapy could give rise to severe digestion and absorption disorders. It appeared necessary to further study the dosage and dosage schedule of the anticancer agents, along with the necessity for taking ample care of patients presenting such disorders.