The Annals of thoracic surgery
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We sought to determine whether or not there are differences in disease progression after radical or nonradical (debulking) surgical procedures for malignant pleural mesothelioma. ⋯ Extrapleural pneumonectomy may be preferable to debulking surgery in malignant pleural mesothelioma to delay disease progression and give greater control of local disease. Involvement of N2 nodes is associated with accelerated disease progression and is therefore a contraindication to extrapleural pneumonectomy.
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Comparative Study
Trainees operating on high-risk patients without cardiopulmonary bypass: a high-risk strategy?
The safety of teaching off-pump coronary artery bypass grafting to trainees is best tested in high-risk patients, who are more likely to experience significant morbidity after surgery. This study compared outcomes of off-pump coronary artery bypass grafting operations performed by consultants and trainees in high-risk patients. ⋯ Off-pump coronary artery bypass grafting surgery in high-risk patients can be safely performed by trainees.
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Ideal perfusion during ascending aorta-arch surgery should allow easy implementation of antegrade cerebral perfusion while avoiding atheroembolization or false lumen perfusion in dissections. We report favorable experience with direct axillary artery cannulation. ⋯ Our results suggest that axillary artery cannulation, successful in 95% of patients, may be the optimal technique for reducing perfusion-related morbidity and adverse outcome in operations for acute dissection, atherosclerotic, and degenerative aneurysmal disease. It deserves serious consideration in all patients older than 65 requiring cardiopulmonary bypass.
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Case Reports
Successful therapy of severe pneumonia-associated ARDS after pneumonectomy with ECMO and steroids.
Pneumonia and acute respiratory distress syndrome are life-threatening complications after pneumonectomy carrying high mortality. Because pulmonary reserve is inadequately low, an effective therapeutic strategy is needed to treat hypoxia. ⋯ We report a case of successful extracorporeal membrane oxygenation therapy in a patient with pneumonia-associated acute respiratory distress syndrome after pneumonectomy. Methylprednisolone therapy caused a dramatic improvement of pulmonary and systemic organ function.
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We report the experience of a single institution with the minimally invasive resection of mediastinal masses using the da Vinci robotic surgical system. ⋯ These preliminary results of our series suggest that application of the da Vinci robotic surgical system for resection of selected mediastinal masses is technically feasible and safe. It provides an alternative to open approaches and "conventional" thoracoscopy. Nevertheless, this new technique requires further investigation in larger series and longer follow-up.