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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Phrenic nerve injury has been reported with the use of iced slush for topical cardiac hypothermia. To study this problem in both valve and coronary procedures, we tried to detect phrenic nerve injury in five groups of patients undergoing cardiac operations in which different techniques of topical hypothermia were used. The results indicate a 24% incidence of left phrenic nerve paresis in patients undergoing coronary bypass with iced slush used for topical hypothermia, 12.5% in patients in whom the cardiac cooling jacket was used in association with cold saline, and 22.9% in patients in whom both the cardiac cooling jacket and iced slush were used in the pericardial sac. There was no phrenic nerve injury when saline alone was used. Phrenic paresis is transient and of no clinical significance except when bilateral. Avoidance of contact of either the cooling jacket or iced slush with the phrenic nerve could avoid this complication.
J Thorac Cardiovasc Surg 1985 Jun
PMID:Phrenic nerve paresis associated with the use of iced slush and the cooling jacket for topical hypothermia. 387 83

Transhiatal esophagectomy without thoracotomy has been performed in 65 adult patients with dysphagia from benign esophageal disease: strictures (30), neuromotor dysfunction (24), acute iatrogenic perforation (five), acute caustic injury (four), and recurrent gastroesophageal reflux (two). Nearly 70% (45) had undergone at least one prior esophageal operation, and 26% (17) had a history of between two and four esophageal operations. The esophagus was replaced with stomach in 53 patients (82%), colon being used only when there was a history of either prior gastric resection or caustic injury to the stomach (10 patients). Intraoperative blood loss averaged 1,050 ml. Intraoperative complications included pneumothorax in 38 patients (58%) and a tracheal laceration in one patient. Postoperative complications included transient recurrent laryngeal nerve paresis (11 patients, 17%), chylothorax (four patients, 6%), anastomotic leak (four patients, 6%), and small bowel obstruction (two patients). There were five hospital deaths (8% mortality), none related to the technique of esophagectomy. Follow-up ranges from 1 to 84 months (average 28 months). Of 46 patients with a cervical esophagogastric anastomosis in the original esophageal bed, 42 have had an excellent functional result although 17 have required at least one postoperative esophageal dilation. Two have developed true anastomotic strictures. Clinically significant gastroesophageal reflux has not occurred. Transhiatal esophagectomy for benign disease is feasible and safe, even after multiple previous esophageal operations. The stomach appears to be a better visceral esophageal substitute than colon, because it allows an initially easier technical operation and superior long-term functional results.
J Thorac Cardiovasc Surg 1985 Nov
PMID:Transhiatal esophagectomy for benign disease. 405 37

Forty adult patients have undergone a 7 to 10 cm cervical esophagomyotomy (from the superior cornu of the thyroid cartilage to behind the clavicle) for cricopharyngeal dysfunction. A Zenker's diverticulum was present in 12 patients (30%) and in five was recurrent. Preoperative symptoms included cervical dysphagia (85%), expectoration of saliva (40%), and intermittent hoarseness (30%). Four patients were being fed through tubes because of total inability to swallow. "Heartburn" was experienced by one half of the patients, but only 12 had acid or food regurgitation. The duration of symptoms ranged from 1 month to 11 years (average 3.9 years). Weight loss had occurred in 15 patients (38%) and ranged from 5.5 to 40.9 kg (average 16 kg). Barium swallows showed no abnormalities in 10 patients. Abnormal findings included a Zenker's diverticulum (12), prominent cricopharyngeal sphincter (11), nasopharyngeal reflux or incoordinated initiation of deglutition, or both (seven), a sliding hiatal hernia (11), and abnormal esophageal motility (seven). Esophageal manometry revealed abnormalities of upper esophageal sphincter (UES) function in only 16 patients. Of 36 patients undergoing standard acid reflux testing, one third had moderate-to-severe gastroesophageal reflux. Seven patients underwent staple resection of a Zenker's diverticulum at the time of cervical esophagomyotomy. Postoperative complications included transient vocal cord paresis (four), vocal cord paralysis (one), and salivary fistula (one). There were no postoperative deaths. After 2 to 48 months (average 16 months) of follow-up, 34 patients (85%) have had a good to excellent result, and six (15%) have not been benefited by operation.
J Thorac Cardiovasc Surg 1980 Nov
PMID:Extended cervical esophagomyotomy for cricopharyngeal dysfunction. 677 51

Of 35 patients operated upon for acute traumatic transection of the upper descending thoracic aorta between 1967 and March 31, 1980, 33 had sufficient information for us to analyze the incidence of spinal cord injury (paraplegia or paresis). This event occurred in eight patients. Multivariate analyses indicated that spinal cord injury was more likely to occur with long aortic cross-clamp times (p = 0.08) when no shunt was employed to perfuse the distal aorta during cross-clamping. The data suggest that if an aortic cross-clamp time exceeding about 30 minutes is anticipated, a shunt should be employed during aortic cross-clamping.
J Thorac Cardiovasc Surg 1981 May
PMID:Incremental risk factors for spinal cord injury following operation for acute traumatic aortic transection. 721 30

The increasing number of patients with extensive aortic and peripheral vascular atherosclerosis or aneurysms who are undergoing cardiac operations present difficult decisions as to the optimal site of arterial cannulation for cardiopulmonary bypass. Femoral artery cannulation is the most common alternative to ascending aortic cannulation, but severe iliofemoral disease or the danger of atheroemboli caused by retrograde perfusion through an atherosclerotic or aneurysmal descending aorta may make this approach impossible or undesirable. We have used axillary artery cannulation for cardiac operations in 35 patients for indications including severe aortic atherosclerosis (n = 16), extensive aortic aneurysms (n = 11), and aortic dissection (n = 8). The cardiac operations performed were coronary artery bypass grafting (n = 9) aortic valve replacement (n = 1), aortic valve replacement and coronary artery bypass grafting (n = 5), repair of mitral valve periprosthetic leak (n = 1), and resection of ascending and/or aortic arch (n = 19). Deep hypothermia with circulatory arrest was used in 26 patients and retrograde cerebral perfusion in 18. All patients awoke from the operation and no patient had a cerebrovascular accident. One patient required axillary artery thrombectomy and one patient had a mild ipsilateral brachial plexus paresis after the operation. Four patients died in the hospital. We conclude that axillary artery cannulation is a safe and effective means of providing antegrade arterial flow during cardiopulmonary bypass in patients with severe atherosclerotic or aneurysmal disease. This strategy may lower the prevalence of stroke associated with cardiopulmonary bypass in these patients.
J Thorac Cardiovasc Surg 1995 May
PMID:Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. 852 96

A papillary fibroelastoma, causing amaurosis fugax and paresis of the right arm, was detected by echocardiography as a free floating mass in the left-ventricular outflow tract. Based on the exact localization of the tumor by intraoperative transesophageal echocardiography the initial indication for ventriculotomy was disregarded and an atraumatic transvalvular approach was chosen.
Thorac Cardiovasc Surg 1993 Aug
PMID:A symptomatic papillary fibroelastoma of the left ventricle removed with the aid of transesophageal echocardiography. 821 33

For a long time, primary tumors arising less than 2 cm distal to the carina have presented a contraindication to surgical excision. Tracheal sleeve pneumonectomy technique allows carinal resection and reconstruction but still carries considerable postoperative complications. From 1983 to 1992 we performed 27 right tracheal sleeve pneumonectomies and one left. Fourteen patients had N0 nodes, nine had N1, and five had N2. No anastomotic complications, either fistula or stenosis, were observed. Successful outcome depends on meticulous attention to surgical details and careful anaesthetic management with a new ventilation tube. One patient died on the twenty-second postoperative day from myocardial infarction. Complications included pneumonia (one), vocal cord paresis (two), and pleural empyema without bronchial fistula (one). Conservative treatment allowed complete recovery from all complications. There are seven patients alive at 4 years after operation and one at 5 years. Six patients have been disease-free for between 1 and 32 months. Two patients died free of disease at 13 and 42 months. Two patients died of mediastinal recurrence and 10 of distant metastases within 6 and 54 months.
J Thorac Cardiovasc Surg 1994 Jan
PMID:Tracheal sleeve pneumonectomy for bronchogenic carcinoma. 763 86

Paresis of the diaphragm (especially left-side paresis) is a relatively frequent finding following cardiac surgery. While, usually, it is a rather benign condition, in exceptional cases it may lead to severe impairment to death of the patient. The supposed causes of damage to the phrenic nerve include: local myocardial cooling by ice slush; opening of the pleural cavity in connection with local cooling; cross clamp length; total hypothermia; central venous cannulation; traction-related damage; mammary artery harvesting. Perhaps the commonest cause of damage to the phrenic nerve, i.e., the effect of local myocardial cooling by ice slush, and the mode of phrenic nerve protection have been studied in considerable detail. The authors focused their attention on the interrelation between the phrenic nerve and the proximal segment of the mammary artery. Using anatomical preparations, the authors demonstrate the very intimate relationship of the above entities. The interrelation of the two anatomical structures basically differs depending on whether the left or right side is concerned. 1) On the left: The phrenic nerve, on entering the thorax, runs between the subclavian artery and vein laterally from the mammary artery crossing it medially; it parts the latter and continues in mediastinal adipose tissue to run on the pericardium toward the diaphragm. 2) On the right: The phrenic nerve passes between the subclavian vein and artery medially from the mammary artery. For another 3-4 cm, it runs along the medial and dorsal edges of the mammary artery.(ABSTRACT TRUNCATED AT 250 WORDS)
J Cardiovasc Surg (Torino) 1993 Dec
PMID:Anatomical interrelation between the phrenic nerve and the internal mammary artery as seen by the surgeon. 830 Jul 14

Two operative approaches for esophageal carcinoma were compared with respect to operative morbidity and mortality by means of multivariable analysis. From 1980 to 1986, 152 patients underwent resection by laparotomy and right-sided anterolateral thoracotomy with an intrathoracic anastomosis. From 1986 to 1989, 141 patients underwent resection by transhiatal blunt dissection with a cervical anastomosis. The stomach was the preferred organ for reconstruction. Paresis of the recurrent laryngeal nerve and leakage of the cervical anastomosis occurred significantly more often in the transhiatal group. Pulmonary complications occurred less frequently in the transhiatal group. In-hospital mortality (9% in the thoracotomy group and 5% in the transhiatal group) increased significantly with advanced age of the patients. Furthermore, it was significantly higher in case of colonic interposition as compared with reconstruction with the stomach. Long-term survival did not differ between the two groups. Especially for carcinomas in the distal part of the esophagus, transhiatal esophageal resection without thoracotomy seems to be an oncologically justifiable operation with a reduced morbidity and mortality.
J Thorac Cardiovasc Surg 1993 May
PMID:Esophagectomy with or without thoracotomy. Is there any difference? 848 68

The relative importance of hereditary and mechanical factors in the pathogenesis of aneurysms remains as controversial today as it was two decades ago. The cases of two patients with unilateral paresis resulting from poliomyelitis who presented with abdominal aortic aneurysms are reported. In addition, each patient had iliofemoral aneurysms contralateral to, and iliofemoral occlusive disease ipsilateral to, their affected extremity. The two cases detailed within this report suggest that hemodynamic forces may alter the pattern of disease in arteries affected by arteriosclerosis.
Cardiovasc Surg 1997 Aug
PMID:Differential patterns of atherosclerotic disease in patients with unilateral hemiparesis resulting from poliomyelitis: case reports demonstrating the possible effect of hemodynamics. 935 Aug 2


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