Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2009
ReviewDoes lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Does lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients?' Altogether 225 papers were found using the reported search, of which nineteen represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ Segmental resection is comparable to lobectomy for small peripheral tumors. Sublobar resection is associated with shorter hospital stay. For bronchioalveolar carcinoma sublobar resection is recommended provided intra-operative pathologic consultation confirms pure bronchioalveolar histology without evidence of invasion, and surgical margins are free of disease.
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Interact Cardiovasc Thorac Surg · Mar 2009
Comparative StudyScreening methods for delirium: early diagnosis by means of objective quantification of motor activity patterns using wrist-actigraphy.
Delirium after cardiac surgery is a risk factor for adverse outcome and even death. Disturbance of motor activity is a core feature of delirium, but hypoactive delirium often remains unrecognized. We explored wrist-actigraphy as a tool to objectively quantify postoperative recovery of 24-h rest-activity patterns to improve the early recognition of delirium after surgery. ⋯ The delirious patients showed lower mean activity levels during the first postoperative night (P<0.05), reduced restlessness during the first day (P<0.05), and a lower mean activity of the 5 h with lowest activity within the first 24 h (P=0.01), as compared to the non-delirious patients. Already at a very early stage after cardiac surgery, a difference in motor activity was observed between patients with and without a delirium. As an unobtrusive method, actigraphy has the potential to be a screening method that may lead to early diagnosis and treatment of delirium.
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Interact Cardiovasc Thorac Surg · Mar 2009
Surgical treatment of catamenial pneumothorax: a single centre experience.
We retrospectively reviewed our experience with catamenial pneumothorax (CP) in terms of treatment and follow-up. From 1993 to 2008, ten women presented at our department with CP. CP was right-sided in all patients: seven presented diaphragmatic defects including one endometriosis, five had apical bulla or blebs that in three patients were the only pathological findings. ⋯ At the time of surgery the diaphragm should be carefully inspected for defects and/or endometriosis. Standard pleurodesis may not suffice and we suggest apical resection and apical pleurectomy associated with a diaphragmatic procedure when indicated. Hormonal treatment with GnRH agonist seems to improve the outcome.
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Interact Cardiovasc Thorac Surg · Feb 2009
Comparative StudyUse of steel bands in sternotomy closure: implications in high-risk cardiac surgical population.
A retrospective-prospective descriptive and comparative study of two sternal closure techniques in a population of 621 patients divided into: group A, steel band closure (n=300) and group B, conventional technique closure (n=321), was carried out between January 2005 and December 2007 in order to describe and compare the results of both techniques in high-risk patients for sternal dehiscence and mediastinitis. Differences between both groups and association with risk factors were obtained using non-parametric tests for statistical analysis. No complications or mortality related to the use of the steel sternal bands were found. ⋯ Sternal dehiscence was found to be a risk factor for mediastinitis. This study demonstrates that the use of steel bands for median sternotomy closure is a safe, reliable and reproducible technique. The frequency of sternal dehiscence significantly decreases with this technique in high-risk patients.