Chest
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In order to assess the role of a staging fiberoptic bronchoscopy in the preoperative assessment of an indeterminate solitary pulmonary nodule (SPN), we reviewed our experience in 33 SPNs identified among 1,269 bronchoscopies performed at the Albert Einstein Medical Center between 1985 and 1989. All lesions were less than 4 cm in greatest diameter and were not associated with symptoms of weight loss, chest pain, hemoptysis, localized wheezing, or hoarseness. ⋯ We recommend the abandonment of a staging bronchoscopy in the evaluation of a patient with an indeterminant SPN in whom history, physical examination, laboratory, and imaging studies fail to document contraindications to surgery. No additional useful information is derived and a substantial cost savings to the patient can be realized if the procedure is eliminated.
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Case Reports
Worsening tricuspid regurgitation following pericardiectomy for constrictive pericarditis.
We describe two cases of worsening tricuspid regurgitation following surgical pericardiectomy for constrictive pericarditis. Both patients demonstrated hemodynamic profiles characteristic of constrictive pericarditis on cardiac catheterization. ⋯ The worsening tricuspid regurgitation observed was a result of postoperative right ventricular dilatation. These cases demonstrate the importance of determining tricuspid valvular function in patients with constrictive pericarditis prior to pericardiectomy; however, the hemodynamic changes that result in worsening tricuspid regurgitation may not be present for weeks.
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To define normal profiles of cardiac structure, function, and hemodynamics postcardiac transplantation using Doppler echocardiography. ⋯ Cardiac transplantation recipients commonly display the following: (1) trivial or mild degrees of mitral regurgitation; (2) as much as moderate tricuspid regurgitation; (3) septal hypokinesis; and (4) small pericardial effusions. There is an association between the presence of right ventricular enlargement and moderate tricuspid regurgitation.