The Annals of thoracic surgery
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Comparative Study
Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage I lung cancer.
Previous comparative reports of stereotactic body radiotherapy (SBRT) and surgery for non-small cell lung cancer (NSCLC) suffered from short follow-up, mixed extents of resection and inclusion of benign lesion. We aimed to make comparisons of long-term outcomes between a pure series of video-assisted thoracoscopic surgery (VATS) lobectomy and SBRT for biopsy-proven clinical stage I NSCLC. ⋯ Our results suggest VATS lobectomy may offer significantly more favorable long-term outcomes than SBRT in potentially operable patients with biopsy-proven clinical stage I NSCLC.
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Comparative Study Observational Study
Elevated procalcitonin in patients after cardiac surgery: a hint to nonocclusive mesenteric ischemia.
Nonocclusive mesenteric ischemia (NOMI) can occur after cardiac surgery, commonly in conjunction with use of cardiopulmonary bypass. Some evidence suggests that serum procalcitonin (PCT) levels are increased in patients with mesenteric ischemia; however, an association between PCT and NOMI has not yet been studied. The current study investigates whether elevated serum PCT levels are found in patients exhibiting NOMI. ⋯ Postoperative measurement of PCT seems useful to improve the clinical and noninvasive identification of patients with NOMI after cardiac surgery.
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Clinical practice in the United States has no restrictions in allocating lungs from adult donors to pediatric recipients. ⋯ Adult donor lung allografts appear not to negatively affect survival in pediatric lung transplant recipients when considering confounders, and do not influence survival through an increased hazard for the development of BOS.
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Although periprocedural myocardial infarction frequently occurs with the robustness of percutaneous coronary intervention, the prognosis of the periprocedural myocardial infarction has been known to be relatively good compared with that of spontaneous myocardial infarction. We present a patient with a postinfarction ventricular septal defect, with cardiogenic shock, that developed 7 days after a percutaneous coronary intervention. Emergency surgical repair combined with coronary artery bypass grafting saved the patient, without complications.
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Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of lipoproteinaceous material in the terminal airways. Whole lung lavage (WLL) remains the gold standard treatment but may be particularly challenging in cases of severe hypoxemia. We present a 3-step strategy that was used in a patient with PAP-associated refractory hypoxemia and that combined venovenous extracorporeal membrane oxygenation (vvECMO), double-lumen orotracheal intubation, and bilateral multisegmental sequential lavage (MSL). The procedure was well tolerated and permitted weaning from the ventilator.