The Thai Journal of Surgery

Comparison of Procaine and Lidocaine in Cardioplegia for Preventing Ventricular Fibrillation After Aortic Cross-Clamping Release in Coronary Artery Bypass Graft

Fri, 29 Mar 2024 00:00:00 +0700

Background: The use of procaine hydrochloride in cardioplegia has been discontinued due to challenges importing the product from outside the country despite its crucial role in preserving myocardium during heart surgery. However, lidocaine hydrochloride, an anti-arrhythmic medication, functions similarly to procaine hydrochloride. Both medications are compared regarding their effectiveness in preventing ventricular fibrillation, the most common type of heart arrhythmia, after releasing the aortic cross-clamp in cardiac surgery.

Materials and Methods: This is a retrospective study in which data were collected from medical records of patients who were operated on with coronary artery bypass grafts between May 2017 and August 2023. Patient demographics and early outcomes between the two groups were analyzed.

Results: A total of 328 patients who operated on CABG were divided into 2 groups, respectively. Group one was a group of cardioplegia solutions with procaine hydrochloride, and group two was a group of cardioplegia solutions with lidocaine hydrochloride. Most participants were 64.19 years old and 64.24 years old, respectively. The duration of the aortic cross-clamp was significantly different between the two groups, with durations of 76.06 minutes and 87.79 minutes, respectively, showing a p-value of less than 0.01 in statistical analysis. Following the release of aortic cross-clamping, the occurrence of ventricular fibrillation was observed in 37 patients (43%) in the first group and 49 patients (56.9%) in the second group, with no significant difference noted. Subsequent to defibrillation at 10 joules, there were 21 patients (24.4%) in the first group and 13 patients (15.1%) in the second group, indicating a significant difference. Additionally, no significant difference was observed in the duration of the CCU stay between both groups.

Conclusion: Cardioplegic solution containing lidocaine hydrochloride provides the same clinical result as procaine hydrochloride in coronary artery bypass grafting surgery.

Delay Traumatic Chylothorax after Gunshot: A Case Report

Warach Taksinachanekij — Fri, 29 Mar 2024 00:00:00 +0700

Background: Chylothorax is the occurrence of chyle in the pleural space due to damage or obstruction of the thoracic duct. Its etiology can be traumatic or nontraumatic. If left untreated, chylothorax may yield an overall 50% mortality rate.

Objective: To present a case of chylothorax secondary to a gunshot lesion as well as to review current concepts about chylothorax and its treatment.

Materials and Methods: Case report: A 22-year-old Thai man who complaint progressive chest pain and dyspnea on exertion for two weeks after being discharged from a traumatic gunshot with right hemothorax after treatment with pleural drainage and retained gunshot at left lower lung. Cardiovascular examination revealed normal. Chest examination revealed decreased breath sound at the right thorax. The chest X-ray (CXR) showed a massive pleural effusion. Management was based on pleural drainage and pleural fluid analysis to confirm the diagnosis of chylothorax.

Results: Our patient underwent pleural drainage and fasting for about 1 week with parenteral nutrition but failed conservative treatment. Surgical treatment becomes an option in this case. We approached video assisted right minithoracotomy in identifying and ligating the thoracic duct and performed a surgical pleurectomy of the right thorax. Post-operative, the flow rate through pleural drainage decreased, and pleural fluid characteristics were changed to serum fluid. CXR showed no pleural effusion. The patient was discharged from the hospital 1 week after surgery.

Conclusion: In this case report, we emphasize the late traumatic chylothorax after the gunshot. Chylothorax requires a high index of clinical suspicion for diagnosis. This case report demonstrates that timely and appropriate treatment is essential to prevent associated complications.

Felt Sandwich Exclusion for Apical Multiple Muscular Ventricular Septal Defects

Kota Agematsu — Fri, 29 Mar 2024 00:00:00 +0700

Background: Apical multiple muscular ventricular septal defects (VSDs) are difficult to visualize, and closing these VSDs is technically troublesome. For these reasons, the surgical outcome of the lesion is unsatisfactory. Some surgical techniques have been reported to improve the outcome, but they are not definitive.

Case presentation: We present a 5-month-old infant diagnosed with atrial septal defect (ASD) and multiple muscular and perimembranous VSDs. Pulmonary hypertension (PH) due to high pulmonary blood flow was also observed. Symptoms of this patient were dyspnea and poor weight gain. The surgical treatment was needed for the patient. In the first operation during the infantile period, the patient received closure of the perimembranous and muscular VSDs through the right atrium. ASD closure was also performed. However, postoperative pulmonary blood flow was not decreased compared with that before the operation, and PH was not improved. In addition to these lesions, tricuspid valve insufficiency was also observed after the operation. Postoperative computed tomography (CT) showed channels of apical muscular VSDs in the apex of the right ventricle. Surgical re-intervention was planned to reduce pulmonary blood flow. In the second operation, the exclusion of apex muscular VSDs using the felt sandwich exclusion technique and tricuspid valve repair was performed. After closing multiple muscular VSDs during the operation, pulmonary blood flow was significantly decreased, and PH was improved as well. After the second operation, postoperative echocardiography and catheter examination showed decreased VSD shunt and reduced pulmonary blood flow, resulting in improved PH.

Conclusion: Felt sandwich exclusion for apical multiple muscular ventricular septal defects may be one of the surgical options for apical muscular ventricular sepal defects.

Immediate Exploration of The Traumatic Abdominal Wall Disruption in Children: A Case Report

Thanapon Supapon, Chusak Wangruttanasopon — Fri, 29 Mar 2024 00:00:00 +0700

Background: Traumatic abdominal wall disruption in children is a rare but severe diagnosis resulting from blunt abdominal trauma (BAT). The clinical diagnosis is not usually straightforward, and the hernia is often discovered at the time of the surgical exploration for intra-abdominal injuries or by imaging studies.

Presentation of Case: A 13-year-old boy, a restrained male patient, was the victim of a high-speed road traffic accident. Among other injuries, he showed bruising over the lower abdomen and localized right-side peritonitis upon presentation. A contrast-enhanced computed tomography scan of the chest and abdomen demonstrated abdominal wall muscular disruption over the right lower quadrant with herniation of the large bowel. The patients had immediate exploratory laparotomy with hernia repair.

Discussion: Traumatic abdominal wall disruption is a rare form of hernia caused by abdominal wall musculature and fascia disruption. The diagnostic criteria and classification of traumatic abdominal wall disruption are still unclear; furthermore, the ideal timing and method of surgical treatment are still unclear. Herein, we report a case of traumatic abdominal wall disruption and describe the surgical approach used.

Conclusion: Children with traumatic abdominal wall disruption have high rates of concomitant abdominal organ injury requiring operative repair. CT scans have low sensitivity and specificity for detecting associated injuries. A high suspicion of injury and low threshold for exploration must be maintained in traumatic abdominal wall disruption cases.

The Result of Proactive Colorectal Cancer Screening in Lamphun Province

Baramee Boonlert — Fri, 29 Mar 2024 00:00:00 +0700

Background: Colorectal cancer is a highly common cancer and is the cause of death in the world and Thailand. Researcher and leader of the team developing the cancer service system developed a proactive colorectal cancer screening in Lamphun Province 2018 - 2022.

Objective: To study the results of proactive colorectal cancer screening in Lamphun Province.

Materials and Methods: This retrospective study is designed to examine the results of proactive colorectal cancer screening using the FIT, which was considered the first investigation and confirmed by colonoscopy. The target group is the general public aged 50 -70, and the data is analyzed using descriptive statistics.

Results: The results of the proactive screening for colorectal cancer use a fecal immunochemistry test (FIT) cut of 100 ng/ml. Screening by providing services at nearby hospitals when FIT results are positive; registering the colonoscopy appointment on Google Sheets; and performing bowel preparation at the community hospital. Proactive screening found that we were able to screen patients thoroughly in each area, which is not different. Compared with research statistics, there is no statistical significance; the p-value is 0.288. It shows that colorectal cancer screening services are accessible to all areas, even in remote areas, and results from colonoscopy found colonic polyps at 32.09% and cancer at 1.13%. Relevant medical personnel agree that proactive screening methods in Lamphun Province should be used as a standard approach for colorectal cancer screening.

Conclusion: This study demonstrated that proactive colorectal cancer screening has been adjusted from initial screening with the FIT and colonoscopy appointment system. Bowel preparation system. Suitable for the context of Lamphun Province.