The Annals of thoracic surgery
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Progression of empyema, with the development of fibrinous adhesions and loculations, makes simple drainage difficult or impossible. The appropriate management remains controversial. Intrapleural fibrinolytic treatment to facilitate drainage of loculated empyema instead of open thoracotomy has been advocated since the 1950s. The aim of this study was to assess the effectiveness of intrapleural fibrinolytic treatment in postpneumonic pediatric empyemas. ⋯ In all patients with loculations except those with a bronchopleural fistula, intrapleural fibrinolytic treatment should be tried. Thus, the majority of children with loculated empyemas can be treated successfully without invasive interventions, such as thoracoscopic debridements or open surgery.
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Meta Analysis
Sleeve lobectomy or pneumonectomy: optimal management strategy using decision analysis techniques.
The choice between sleeve lobectomy and pneumonectomy is controversial for patients with early-stage lung cancer and who have acceptable lung function. ⋯ In patients with anatomically appropriate early-stage lung cancer, sleeve lobectomy offers better long-term survival and quality of life than does pneumonectomy and is more cost effective.
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Calcifying fibrous pseudotumor is a rare lesion recently reported in the literature. We report a new case occurring in the pleura, which is an unusual location. The patient, a 38-year-old woman, had a left pleural mass revealed by chest roentgenograms. ⋯ The pathogenesis is discussed but remains uncertain. Tumor resection appears to be the best option and the clinical course is benign. However, the number of cases to date is insufficient to establish therapeutic recommendations.
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Patients with penetrating cardiac injuries have a high mortality. The utilization of sonography in these patients may lead to earlier diagnosis and definitive surgical intervention. ⋯ Early diagnosis and management using surgeon performed sonography may reduce the high mortality associated with penetrating cardiac injury.
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Historical Article
The development and use of extracorporeal membrane oxygenation in neonates.
Extracorporeal membrane oxygenation (ECMO) is the utilization of a modified heart-lung machine to provide temporary support for patients with severe respiratory or cardiac failure. In contrast to patients managed with traditional cardiopulmonary bypass, patients on ECMO undergo cannulation of relatively accessible blood vessels, are maintained at normal body temperature, and only require partial anticoagulation with heparin. ⋯ Since 1974, over 17,000 infants have received ECMO with a 78% survival rate. There is a 15%-20% incidence of neurodevelopmental disabilities among ECMO survivors.