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Matsune Y, Aoki T, Tashiro Y. Diaphragmatic and pericardial reconstruction using a Gore-Tex ® patch in a patient with an invasive liver malignancy. Clin J Gastroenterol 2024:10.1007/s12328-024-02017-7. [PMID: 39042239 DOI: 10.1007/s12328-024-02017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
The Gore-Tex® polytetrafluoroethylene patch is one of the most used prostheses for diaphragm, vessel, and pericardial reconstruction. It is strong, flexible, and relatively inexpensive and can be fitted to match the size of the resected area. In addition, it can be used to reconstruct the pericardium and diaphragm following resection to treat diffuse malignant pleural mesothelioma or repair large hiatal hernias. However, the use of polytetrafluoroethylene for hepatocellular carcinoma with diaphragmatic and pericardial invasion has not yet been reported. We report the case of a 72-year-old man with hepatocellular carcinoma with diaphragmatic and pericardial invasion. Subsequently, laparotomic liver subsegmentectomy of segment 3 and resection of the diaphragm and pericardium were performed. The defects were successfully reconstructed using the polytetrafluoroethylene patch, without postoperative complications. This is the first report describing a case of invasive liver malignancy that required simultaneous diaphragmatic and pericardial reconstruction using a polytetrafluoroethylene patch, indicating that the polytetrafluoroethylene patch could effectively and directly treat invasive liver malignancies.
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Affiliation(s)
- Yusuke Matsune
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Takeshi Aoki
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
| | - Yoshihiko Tashiro
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
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Bordoni B, Mapelli L, Toccafondi A, Di Salvo F, Cannadoro G, Gonella M, Escher AR, Morici N. Post-Myocardial Infarction Rehabilitation: The Absence in the Rehabilitation Process of the Diaphragm Muscle. Int J Gen Med 2024; 17:3201-3210. [PMID: 39070222 PMCID: PMC11277820 DOI: 10.2147/ijgm.s470878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Myocardial infarction (MI) is one of the leading causes of death worldwide. There can be many reasons that cause MI, such as a sedentary lifestyle, a disordered diet, harmful habits such as smoking and alcoholism, concomitant congenital or acquired systemic pathologies. Patients who survive the acute event suffer a functional alteration of multiple body systems. The various cardiology associations recommend starting a rehabilitation process, pursuing the main objective of improving the patient's health status. A negative consequence that can be linked to MI is the dysfunction of the main breathing muscle, the diaphragm. The diaphragm is essential not only for respiratory mechanisms but also for adequate production of cardiac pressures. Post-MI patients present a reduction in the performance of the diaphragm muscle, and this condition can become a risk factor for further relapses or for the onset of heart failure. The article reviews the rehabilitation path for post-MI patients, to highlight the absence given to the diaphragm in the recovery of the patient's health status. The text reviews the post-MI diaphragmatic adaptation to highlight the importance of including targeted training for the diaphragm muscle in the rehabilitation process.
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Affiliation(s)
- Bruno Bordoni
- Dipartimento di Cardiologia, Fondazione Don Carlo Gnocchi IRCCS, Istituto di Ricovero e Cura, S Maria Nascente, Milano, 20100, Italy
| | - Luca Mapelli
- Dipartimento di Cardiologia, Fondazione Don Carlo Gnocchi IRCCS, Istituto di Ricovero e Cura, S Maria Nascente, Milano, 20100, Italy
| | - Anastasia Toccafondi
- Dipartimento di Cardiologia, Fondazione Don Carlo Gnocchi IRCCS, Istituto di Ricovero e Cura, S Maria Nascente, Milano, 20100, Italy
| | - Francesca Di Salvo
- Dipartimento di Cardiologia, Fondazione Don Carlo Gnocchi IRCCS, Istituto di Ricovero e Cura, S Maria Nascente, Milano, 20100, Italy
| | - Gianmarco Cannadoro
- Dipartimento di Cardiologia, Fondazione Don Carlo Gnocchi IRCCS, Istituto di Ricovero e Cura, S Maria Nascente, Milano, 20100, Italy
| | - Matteo Gonella
- Dipartimento di Cardiologia, Fondazione Don Carlo Gnocchi IRCCS, Istituto di Ricovero e Cura, S Maria Nascente, Milano, 20100, Italy
| | - Allan R Escher
- Department of Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Nuccia Morici
- Dipartimento di Cardiologia, Fondazione Don Carlo Gnocchi IRCCS, Istituto di Ricovero e Cura, S Maria Nascente, Milano, 20100, Italy
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Bordoni B, Kotha R, Escher AR. Symptoms Arising From the Diaphragm Muscle: Function and Dysfunction. Cureus 2024; 16:e53143. [PMID: 38288323 PMCID: PMC10823461 DOI: 10.7759/cureus.53143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 01/31/2024] Open
Abstract
There can be many reasons that damage the function of the diaphragm, either transiently or permanently, involving one hemilate or both muscle portions. The diaphragm is associated only with breathing, but many other functions are related to it. The patient is not always aware of the presence of diaphragmatic dysfunction, and it is not always immediate to identify non-respiratory diaphragmatic symptoms. Pseudoanginal pain, night sweats, difficulty memorizing, or muscular and visceral problems of the pelvic floor are just some of the disorders linked to reduced diaphragmatic contractility. A decline in respiratory contractile force can be the basis for further pathological conditions that can increase the rate of mortality and morbidity. The article reviews the possible symptoms that may be presented by the patient, which are not necessarily related to lung function.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Rohini Kotha
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
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Akatsuka M, Nakajima T, Miyagishima S, Iba Y, Masuda Y. Diaphragmatic paralysis following open-heart surgery in an adult. Oxf Med Case Reports 2023; 2023:omad140. [PMID: 38145262 PMCID: PMC10735543 DOI: 10.1093/omcr/omad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Masayuki Akatsuka
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tomohiro Nakajima
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Saori Miyagishima
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Nicolotti D, Grossi S, Nicolini F, Gallingani A, Rossi S. Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review. J Clin Med 2023; 12:jcm12020497. [PMID: 36675426 PMCID: PMC9867514 DOI: 10.3390/jcm12020497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Respiratory weaning after cardiac surgery can be difficult or prolonged in up to 22.7% of patients. The inability to wean from a ventilator within the first 48 h after surgery is related to increased short- and long-term morbidity and mortality. Risk factors are mainly non-modifiable and include preoperative renal failure, New York Heart Association, and Canadian Cardiac Society classes as well as surgery and cardio-pulmonary bypass time. The positive effects of pressure ventilation on the cardiovascular system progressively fade during the progression of weaning, possibly leading to pulmonary oedema and failure of spontaneous breathing trials. To prevent this scenario, some parameters such as pulmonary artery occlusion pressure, echography-assessed diastolic function, brain-derived natriuretic peptide, and extravascular lung water can be monitored during weaning to early detect hemodynamic decompensation. Tracheostomy is considered for patients with difficult and prolonged weaning. In such cases, optimal patient selection, timing, and technique may be important to try to reduce morbidity and mortality in this high-risk population.
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Affiliation(s)
- Davide Nicolotti
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-703286
| | - Silvia Grossi
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Francesco Nicolini
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Alan Gallingani
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Sandra Rossi
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
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