Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2008
Bilateral thoracoscopic sympathectomy: results and long-term follow-up.
The aim of this study is to evaluate the efficacy of bilateral thoracoscopic sympathectomy in alleviating symptoms and improving quality of life in patients with hyperhidrosis or facial blushing and to investigate the occurrence, severity and possible underlying factors to compensatory sweating after surgery. One hundred and sixty-three patients in a single institution underwent bilateral thoracoscopic sympathectomy with a mean follow-up period of 51 (5-140) months. Indications were for palmar hyperhidrosis (41%), axillary hyperhidrosis (17%), combined palmar and axillary hyperhidrosis (27%) and facial blushing+/-facial hyperhidrosis (15%). ⋯ Recurrence rates were palmar 4.6%, axillary 7.4%, palmar and axillary 9.3% and facial blushing+/-facial hyperhidrosis 4.7% at a mean of 22 (3-72) months. An improvement in quality of life was seen in 85% and a diminution of quality of life was noted in 5% due to compensatory sweating. This large mature series demonstrates that bilateral thoracoscopic division of the sympathetic chain as opposed to resection can be performed effectively in patients with success rates higher than 90% and low recurrence rates.
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Interact Cardiovasc Thorac Surg · Feb 2008
Comparative StudyDo patients after off-pump coronary artery bypass grafting need the intensive care unit? A prospective audit of 85 patients.
With limited resources, cardiac surgery is frequently cancelled due to lack of ICU beds. Immediate postoperative extubation (UFT) is performed in our hospital setting. The aim of the present study is to report patients undergoing off-pump aortocoronary bypass grafting (OPCABG) with immediate extubation and no ICU stay. ⋯ The cost from leaving the OR until the patient reached the cardiac ward was 1265$ for ICU bypass patients vs. 6405$ for ICU patients, the difference representing 5140$ per patient. ICU bypass after OPCABG is safe. By avoiding ICU, this protocol reduces costs, improves resource utilization and may reduce OR cancellation due to ICU bed shortages.
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Interact Cardiovasc Thorac Surg · Feb 2008
Comparative StudyQuality of life evolution after surgery for primary or secondary spontaneous pneumothorax: a prospective study comparing different surgical techniques.
The objective of the present study is to evaluate quality of life (QoL) evolution after video-assisted thoracic surgery (VATS) and anterolateral thoracotomy (AT) for primary and secondary spontaneous pneumothorax, which has not been studied prospectively until now. From January 2003 to December 2004, QoL was prospectively recorded in 20 consecutive patients, using the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and the lung specific module LC-13. Questionnaires were administered before surgery and 1, 3, 6 and 12 months postoperatively (MPO) with response rates of 100%, 85%, 80%, 65% and 60%, respectively. ⋯ Comparing VATS and AT in QoL evolution, significant differences are seen in thoracic pain evolution in favour of VATS (6 MPO P=0.037). After surgery, AT and VATS are comparable in QoL subscales with exception of a significant difference at 1 MPO in favour of VATS. Dyspnoea and coughing improved after surgery.