The Annals of thoracic surgery
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Thoracoscopic sympathectomy has been used for the treatment of sympathetic dysfunction since it was first described in the 1940s. With the advent of video-assisted thoracic surgery, the procedure has become more widely applied. ⋯ This article presents a review of existing approaches and techniques as well as the author's summary and preferences. The review of the articles on thoracoscopic sympathectomy only included those from the English literature.
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Small body size, female gender, and transfusions are traditionally considered morbidity and mortality risk factors in coronary surgery. Because these clinical conditions are interrelated, we designed a study to investigate their respective roles in determining adverse outcomes after coronary operations. ⋯ Female gender and small body surface area are associated with severe intraoperative hemodilution, and this may trigger blood transfusions, which are true determinants of adverse outcomes. A large body surface area in women is frequently associated with obesity (68%) and may prolong the intensive care unit stay, whereas it is not a risk factor in men. Conversely, a small body surface area is accompanied by a prolonged intensive care unit stay in men but not in women.
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In order to optimize the Fontan circulation, a technique for direct superior and inferior cavopulmonary connections was devised. Such pathways retain growth potential, obviate suture lines within the right atrium, and avoid prosthetic implants. They thus enable definitive, single-stage ventricular unloading, regardless of patient size or great artery position.
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The treatment of primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) with cisplatin-based chemotherapy, followed by surgical resection of residual disease, has been established. We reviewed our institution's 25-year experience in the cisplatin era to determine surgical risks and predictors of survival after surgery for PMNSGCT. ⋯ Operative risks for PMNSGCT appear to be improved with the use of chemotherapy regimens that do not contain bleomycin. Patients pathologically demonstrating complete tumor necrosis in the residual mass after chemotherapy have excellent long-term survival, with decreasing survival after resection of teratoma and persistent germ cell or nongerm cell cancer. Patients pathologically demonstrating persistent germ cell or nongerm cell cancer have poor but possible long-term survival, which justifies an aggressive surgical approach in patients who are deemed operable.
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As thoracic surgery moves towards more minimally invasive procedures, such as video-assisted thoracic surgery (VATS) lobectomy, conversion from a VATS to open thoracotomy has been required for a sleeve resection. This article reports a large experience of VATS sleeve lobectomy. ⋯ In experienced centers, VATS sleeve lobectomy is possible with acceptable morbidity and mortality as well as short length of stay.