It is generally believed that an increase in the diameter of ITA, by whatever means, will lead to... more It is generally believed that an increase in the diameter of ITA, by whatever means, will lead to an increase in its flow. However, in 2017 Satdhabudha and Noppawinyoowong demonstrated that native ITA flow (artery in situ) decreases almost half after harvesting, even with topical administration of papaverine for 5 min.[3] The only explanation for this finding is that, in the particular case of ITA, the amount of its flow is determined by a more important factor than the diameter of the vessel.
Seria dificil hacer el recuento total de los danos que el alcohol ocasiona, tanto en la salud ind... more Seria dificil hacer el recuento total de los danos que el alcohol ocasiona, tanto en la salud individual como colectiva en las sociedades modernas. Baste decir que en America Latina y EE.UU. se calculan unos 40 y 14 millones de alcoholicos respectivamente 1,2 y se ha demostrado su protagonismo en la mitad de todas las fatalidades provocadas por incendios y accidentes del trafico, el 67 % de los homicidios, del 30 - 40 % de las violaciones 2 y el 33 % de los suicidios; como enfermedad, disminuye en once anos la esperanza de vida promedio de la poblacion 3.
RE Morales Valdés Calle 1ra No 67. Rpto. Osvaldo Herrera. Santa Clara CP 50100. Villa Clara, Cu... more RE Morales Valdés Calle 1ra No 67. Rpto. Osvaldo Herrera. Santa Clara CP 50100. Villa Clara, Cuba. E-mail address: rodolfomv@infomed.sld.cu ABSTRACT Axillary thoracotomies are among the most described and modified in the history of surgery. Despite the sustained development of video-assisted thoracic surgery, the role of classic thoracotomies in current surgical practice is unavoidable, especially when minimally invasive options are not available. Extended posterior vertical axillary thoracotomy emerged almost 30 years ago from the introduction of innovative modifications to axillary thoracic incisions previously described. An extensive literature review makes it possible to affirm that an axillary thoracotomy, which contains all the distinctive features that the one presented herein, has never been reported before. Its main advantages are discussed in relation to the decrease in the operating time and complications during and after surgery.
espanolSe presentan imagenes tomograficas de una paciente de 28 anos de edad, operada por insufic... more espanolSe presentan imagenes tomograficas de una paciente de 28 anos de edad, operada por insuficiencia mitral, con una auricula izquierda gigante (82 ´ 54 mm; volumen 465 ml) que produce la impresion de un surco vertical en la porcion media de la pared posterior de la auricula izquierda. Los articulos que han abordado este tema en los ultimos anos asumen que la impresion debe ser provocada por una estructura patologica (aumentada de volumen) dorsal a la auricula. Sin embargo, en nuestro caso, semejante a lo informado en los primeros trabajos relacionados con este tema, la impresion se ha originado por una auricula izquierda dilatada, que se ha proyectado posteriormente para “abrazar” la aorta toracica descendente normal. La aorta ascendente estampa igualmente un surco en la pared anterior del atrio izquierdo, la que –a su vez– comprime (de forma asintomatica) el segmento proximal del tronco de la coronaria izquierda, lo que ocasiona una angulacion recta (cerca de 90°) y un cambio d...
Apropos of the first malleable lung retractor to facilitate extrapleural harvesting of the inter... more Apropos of the first malleable lung retractor to facilitate extrapleural harvesting of the internal thoracic artery
The association of two tumors of different origin in the same patient is becoming more frequent i... more The association of two tumors of different origin in the same patient is becoming more frequent in the current clinical practice. Here is presented a case with a rare association of cardiac myxoma and hypernephroma, previously treated. Due to the presence of neurological symptoms, there was initially set a diagnosis of brain metastasis from the renal tumor; then, with the echocardiographic finding of an intracardiac mass, the possibility of thrombus was considered, therefore a cardiac surgery was decided to be performed urgently in order to resect it. The pathologic examination confirmed the existence of a cardiac myxoma, then, we have a patient with two tumor diseases whose coincidence has been rarely described.
Axillary thoracotomies are among the most described and modified in the history of surgery. Despi... more Axillary thoracotomies are among the most described and modified in the history of surgery. Despite the sustained development of video-assisted thoracic surgery, the role of classic thoracotomies in current surgical practice is unavoidable, especially when minimally invasive options are not available. Extended posterior vertical axillary thoracotomy emerged almost 30 years ago from the introduction of innovative modifications to axillary thoracic incisions previously described. An extensive literature review makes it possible to affirm that an axillary thoracotomy, which contains all the distinctive features that the one presented herein, has never been reported before. Its main advantages are discussed in relation to the decrease in the operating time and complications during and after surgery.
According to published data, myocardial revascularization procedures to improve blood supply bega... more According to published data, myocardial revascularization procedures to improve blood supply began in 1967, based on the procedures carried out by the Argentine Rene Geronimo Favaloro at the Cleveland Clinic. Like many other aspects of cardiac surgery, this fact has also been overshadowed by historical inaccuracies, which have not been adequately clarified; so that the man who performed the first mammary-coronary anastomosis in humans has not been given the credit: Dr. William Polk Longmire Jr. Possibly, the coronary artery bypass began to spring from the seed in the expert hands of Longmire, in Los Angeles on a cold winter morning in 1958. A few years before Favaloro decided to continue watering it at the Cleveland Clinic. This article will hopefully serve as the first of the well-deserved tributes that the undisputed father of coronary surgery will receive this year.
In surgical practice, the evolution of a hemopericardium beyond its acute phase is infrequent, es... more In surgical practice, the evolution of a hemopericardium beyond its acute phase is infrequent, especially when most of these conditions have a traumatic cause. In one way or another, the clinic usually triggers two antagonistic events: the patient dies due to cardiac tamponade or is treated satisfactorily, by pericardiocentesis or thoracotomy with limited access to the middle mediastinum. In any case, once access to the pericardial space is achieved and the heart is examined, there is practically no remaining evidence on its surface –except perhaps the obvious hematoma found on Morgagni's table– due to recent accumulation of blood inside. For these reasons, it is rare to observe –literally– in all its splendor the repercussion of a «chronic» hemopericardium on the heart of a living individual. The image presented shows the deposition and, presumably, the subsequent impregnation of red blood cells contained in a pericardial effusion, on the epicardium of a patient with possible t...
With great interest, we read the article by Ehrhardt et al. [1] and congratulate them for the qua... more With great interest, we read the article by Ehrhardt et al. [1] and congratulate them for the quality of the profound review carried out on the historical evolution of clamshell thoracotomy, which will undoubtedly be widely consulted by cardiothoracic surgeons who love the history of this beautiful specialty. Certainly, it is difficult to accurately identify the first operation in which an anterolateral thoracotomy was converted to a full clamshell. However, we would like to draw attention to an article published in 1909 by Charles H. Peck, where he carried out a comprehensive review of the 158 cases of sutured cardiac wounds reported up to that time [2]. He pointed out that at that time, a common approach to the heart was a left quadrangular flap with internal hinge at the sternal border, which in some cases included transverse divisions of the sternum until its union with right costal cartilages. In more than a dozen of these cases, a surgical procedure on the sternum was necessary. This list highlights a 28-year-old patient who was operated on in 1901 by a surgeon identified as Barth. To suture a stab wound to the left ventricle, he made a flap that included the sternum and the 4th and 5th costal cartilages [2]. Unfortunately, we have not been able to find the original report of this surgery and we do not know more information about the life of Dr. Barth, but in the absence of another previous report, his procedure should probably be considered as the first transverse transection of the sternum with the intention of entering in the thoracic cavity. Theodor Tuffier has a well-deserved place in thoracic surgery history. Milestones of modern medicine are the resection of a pulmonary apex performed on May 5, 1891 [3] and the first operative approach to treat aortic valve stenosis in 1912 [4]. However, although the French surgeon published slightly fewer than 1,400 works during his life [5] it is difficult to find enough scientific evidence to justify naming the transverse sternothoracotomy as Tuffier’s method. Therefore, we consider that a deeper historical investigation is needed to identify the true author of this thoracotomy. Hardly enough, what is related by a 1922 version of the Encyclopaedia Britannica is sufficient merit for this procedure to be known by the name of the famous French surgeon.
It is generally believed that an increase in the diameter of ITA, by whatever means, will lead to... more It is generally believed that an increase in the diameter of ITA, by whatever means, will lead to an increase in its flow. However, in 2017 Satdhabudha and Noppawinyoowong demonstrated that native ITA flow (artery in situ) decreases almost half after harvesting, even with topical administration of papaverine for 5 min.[3] The only explanation for this finding is that, in the particular case of ITA, the amount of its flow is determined by a more important factor than the diameter of the vessel.
Seria dificil hacer el recuento total de los danos que el alcohol ocasiona, tanto en la salud ind... more Seria dificil hacer el recuento total de los danos que el alcohol ocasiona, tanto en la salud individual como colectiva en las sociedades modernas. Baste decir que en America Latina y EE.UU. se calculan unos 40 y 14 millones de alcoholicos respectivamente 1,2 y se ha demostrado su protagonismo en la mitad de todas las fatalidades provocadas por incendios y accidentes del trafico, el 67 % de los homicidios, del 30 - 40 % de las violaciones 2 y el 33 % de los suicidios; como enfermedad, disminuye en once anos la esperanza de vida promedio de la poblacion 3.
RE Morales Valdés Calle 1ra No 67. Rpto. Osvaldo Herrera. Santa Clara CP 50100. Villa Clara, Cu... more RE Morales Valdés Calle 1ra No 67. Rpto. Osvaldo Herrera. Santa Clara CP 50100. Villa Clara, Cuba. E-mail address: rodolfomv@infomed.sld.cu ABSTRACT Axillary thoracotomies are among the most described and modified in the history of surgery. Despite the sustained development of video-assisted thoracic surgery, the role of classic thoracotomies in current surgical practice is unavoidable, especially when minimally invasive options are not available. Extended posterior vertical axillary thoracotomy emerged almost 30 years ago from the introduction of innovative modifications to axillary thoracic incisions previously described. An extensive literature review makes it possible to affirm that an axillary thoracotomy, which contains all the distinctive features that the one presented herein, has never been reported before. Its main advantages are discussed in relation to the decrease in the operating time and complications during and after surgery.
espanolSe presentan imagenes tomograficas de una paciente de 28 anos de edad, operada por insufic... more espanolSe presentan imagenes tomograficas de una paciente de 28 anos de edad, operada por insuficiencia mitral, con una auricula izquierda gigante (82 ´ 54 mm; volumen 465 ml) que produce la impresion de un surco vertical en la porcion media de la pared posterior de la auricula izquierda. Los articulos que han abordado este tema en los ultimos anos asumen que la impresion debe ser provocada por una estructura patologica (aumentada de volumen) dorsal a la auricula. Sin embargo, en nuestro caso, semejante a lo informado en los primeros trabajos relacionados con este tema, la impresion se ha originado por una auricula izquierda dilatada, que se ha proyectado posteriormente para “abrazar” la aorta toracica descendente normal. La aorta ascendente estampa igualmente un surco en la pared anterior del atrio izquierdo, la que –a su vez– comprime (de forma asintomatica) el segmento proximal del tronco de la coronaria izquierda, lo que ocasiona una angulacion recta (cerca de 90°) y un cambio d...
Apropos of the first malleable lung retractor to facilitate extrapleural harvesting of the inter... more Apropos of the first malleable lung retractor to facilitate extrapleural harvesting of the internal thoracic artery
The association of two tumors of different origin in the same patient is becoming more frequent i... more The association of two tumors of different origin in the same patient is becoming more frequent in the current clinical practice. Here is presented a case with a rare association of cardiac myxoma and hypernephroma, previously treated. Due to the presence of neurological symptoms, there was initially set a diagnosis of brain metastasis from the renal tumor; then, with the echocardiographic finding of an intracardiac mass, the possibility of thrombus was considered, therefore a cardiac surgery was decided to be performed urgently in order to resect it. The pathologic examination confirmed the existence of a cardiac myxoma, then, we have a patient with two tumor diseases whose coincidence has been rarely described.
Axillary thoracotomies are among the most described and modified in the history of surgery. Despi... more Axillary thoracotomies are among the most described and modified in the history of surgery. Despite the sustained development of video-assisted thoracic surgery, the role of classic thoracotomies in current surgical practice is unavoidable, especially when minimally invasive options are not available. Extended posterior vertical axillary thoracotomy emerged almost 30 years ago from the introduction of innovative modifications to axillary thoracic incisions previously described. An extensive literature review makes it possible to affirm that an axillary thoracotomy, which contains all the distinctive features that the one presented herein, has never been reported before. Its main advantages are discussed in relation to the decrease in the operating time and complications during and after surgery.
According to published data, myocardial revascularization procedures to improve blood supply bega... more According to published data, myocardial revascularization procedures to improve blood supply began in 1967, based on the procedures carried out by the Argentine Rene Geronimo Favaloro at the Cleveland Clinic. Like many other aspects of cardiac surgery, this fact has also been overshadowed by historical inaccuracies, which have not been adequately clarified; so that the man who performed the first mammary-coronary anastomosis in humans has not been given the credit: Dr. William Polk Longmire Jr. Possibly, the coronary artery bypass began to spring from the seed in the expert hands of Longmire, in Los Angeles on a cold winter morning in 1958. A few years before Favaloro decided to continue watering it at the Cleveland Clinic. This article will hopefully serve as the first of the well-deserved tributes that the undisputed father of coronary surgery will receive this year.
In surgical practice, the evolution of a hemopericardium beyond its acute phase is infrequent, es... more In surgical practice, the evolution of a hemopericardium beyond its acute phase is infrequent, especially when most of these conditions have a traumatic cause. In one way or another, the clinic usually triggers two antagonistic events: the patient dies due to cardiac tamponade or is treated satisfactorily, by pericardiocentesis or thoracotomy with limited access to the middle mediastinum. In any case, once access to the pericardial space is achieved and the heart is examined, there is practically no remaining evidence on its surface –except perhaps the obvious hematoma found on Morgagni's table– due to recent accumulation of blood inside. For these reasons, it is rare to observe –literally– in all its splendor the repercussion of a «chronic» hemopericardium on the heart of a living individual. The image presented shows the deposition and, presumably, the subsequent impregnation of red blood cells contained in a pericardial effusion, on the epicardium of a patient with possible t...
With great interest, we read the article by Ehrhardt et al. [1] and congratulate them for the qua... more With great interest, we read the article by Ehrhardt et al. [1] and congratulate them for the quality of the profound review carried out on the historical evolution of clamshell thoracotomy, which will undoubtedly be widely consulted by cardiothoracic surgeons who love the history of this beautiful specialty. Certainly, it is difficult to accurately identify the first operation in which an anterolateral thoracotomy was converted to a full clamshell. However, we would like to draw attention to an article published in 1909 by Charles H. Peck, where he carried out a comprehensive review of the 158 cases of sutured cardiac wounds reported up to that time [2]. He pointed out that at that time, a common approach to the heart was a left quadrangular flap with internal hinge at the sternal border, which in some cases included transverse divisions of the sternum until its union with right costal cartilages. In more than a dozen of these cases, a surgical procedure on the sternum was necessary. This list highlights a 28-year-old patient who was operated on in 1901 by a surgeon identified as Barth. To suture a stab wound to the left ventricle, he made a flap that included the sternum and the 4th and 5th costal cartilages [2]. Unfortunately, we have not been able to find the original report of this surgery and we do not know more information about the life of Dr. Barth, but in the absence of another previous report, his procedure should probably be considered as the first transverse transection of the sternum with the intention of entering in the thoracic cavity. Theodor Tuffier has a well-deserved place in thoracic surgery history. Milestones of modern medicine are the resection of a pulmonary apex performed on May 5, 1891 [3] and the first operative approach to treat aortic valve stenosis in 1912 [4]. However, although the French surgeon published slightly fewer than 1,400 works during his life [5] it is difficult to find enough scientific evidence to justify naming the transverse sternothoracotomy as Tuffier’s method. Therefore, we consider that a deeper historical investigation is needed to identify the true author of this thoracotomy. Hardly enough, what is related by a 1922 version of the Encyclopaedia Britannica is sufficient merit for this procedure to be known by the name of the famous French surgeon.
Uploads
Papers by Yoandy López de la Cruz