Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2004
Extended rethymectomy in the treatment of refractory myasthenia gravis: original video-assisted technique of resternotomy and results of the treatment in 21 patients.
The aim of the study was to analyze the impact of extended rethymectomy in patients with myasthenia gravis. Additionally, an original technique of resternotomy is described. Extended rethymectomy was performed on 21 patients with refractory myastenic symptoms after a previous transsternal thymectomy. In 8 patients the original video-assisted technique of complete longitudinal resternotomy with the aid of a special sternal retractor elevating the sternum from above and below was used. Severe intraoperative haemorrhage from the lacerated left innominate vein occurred in 3/13 patients operated on before the video-assisted technique of resternotomy had been introduced. In none of the 8 patients operated on with video-assisted resternotomy such a complication was noted. ⋯ retained thymic lobe (4/21 patients), ectopic foci of thymic tissue (13/21 patients) no thymic tissue (4/21 patients). Results of follow-up: complete remission (11.8%), improvement (64.7%); no improvement (35.3%) during the follow-up period (mean 3.4 years). There was neither deterioration of myasthenia nor mortality during follow-up in this group. We conclude that described technique of video-assisted resternotomy reliably prevents the laceration of the heart and great vessels, and that complete remission and improvement rates in patients operated on with the extended rethymectomy are relatively low but deterioration of myasthenia is prevented.
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Interact Cardiovasc Thorac Surg · Mar 2004
Low dose (renal dose) dopamine in the critically ill patient.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether low dose (renal dose) dopamine in the critically ill patient prevents acute renal failure. ⋯ The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that there is no evidence to support the use of low-dose dopamine to treat acute renal failure in critically ill patients.
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Interact Cardiovasc Thorac Surg · Dec 2003
Towards evidence-based medicine in cardiothoracic surgery: best BETS.
Cardiothoracic surgeons are faced with the dilemma that many clinical questions in their daily practice to do not have universally agreed answers, but patients increasingly demand the 'best practice' from their doctors. In addition time pressures mean that clinicians are unable to keep up with the full spectrum of published research and current resources that collate evidence for clinicians have few if any resources for cardiothoracic surgeons. We have adopted an approach pioneered in emergency medicine, namely the Best Evidence Topic or BestBET. ⋯ To add confidence to the quality of the search a second author and then an Evidence Based Journal Club checks the BET to ensure that no relevant evidence is missed. These BETs will then be posted on the ICVTS website prior to publication for widespread commentary. The resulting BETs, written by practising cardiothoracic surgeons, will then provide robust evidence-based answers to important clinical questions asked during our daily practice.
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Interact Cardiovasc Thorac Surg · Dec 2003
Evaluation of a new temperature management system during off-pump coronary artery bypass.
We evaluated the performance of a new temperature management system (Arctic Sun, Medivance, Inc.) in maintaining normothermia during off-pump coronary artery bypass (OPCAB). ⋯ The Arctic Sun system significantly outperformed conventional techniques in achieving and maintaining normothermia during off-pump coronary artery bypass.
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Interact Cardiovasc Thorac Surg · Dec 2003
Successful surgical treatment of a right atrial myxoma complicated by pulmonary embolism.
We report on a rare case of a 65-year-old woman who was admitted with orthopnea (NYHA class IV) and a single syncopal episode. A transthoracic echocardiography examination showed a 7x6x6-cm mass located in the right atrium and perfusion lung scan showed embolization. ⋯ Six months clinical and echocardiographical follow-up showed a satisfactory exercise tolerance, a normal right atrium and a good ventricular function. Thirteen years later, the patient remains well and no recurrence could be observed.