The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Feb 1998
Case ReportsVideo-assisted thoracoscopy in single-stage resection of a para-aortic posterior mediastinal dumbbell tumor.
We report the successful single-stage thoracoscopic resection of a neurogenic mediastinal dumbbell tumor close to the aortic arch, using a combined posterior approach. A 63-year-old asymptomatic male was referred to our hospital for evaluation of an abnormal round shadow in the left thoracic cavity on a chest radiograph. ⋯ Surgery combined both a laminectomy and thoracoscopic tumor resection. The tumor was lysed as deeply as possible via a posterior approach, then with the patient in the right lateral position the pleura around the tumor on the aortic side was clipped and cauterized thorocoscopically, freeing the tumor completely and allowing it to be extracted in toto.
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Thorac Cardiovasc Surg · Feb 1998
Randomized Controlled Trial Clinical TrialPreconditioning enhances myocardial protection in patients undergoing open heart surgery.
To date, ischemic preconditioning is regarded as the most powerful form of endogenous myocardial protection. For the purpose of surgical myocardial protection, a few clinical studies have investigated the effects of ischemic preconditioning in conjunction with hypothermia or blood cardioplegia during open heart surgery, but the results were controversial. We now tested the hypothesis that preconditioning improves myocardial protection in patients undergoing cold crystalloid cardioplegic arrest. 36 patients needing mitral prosthetic valve replacement for rheumatic heart disease were studied. ⋯ The results indicated that there was a significant reduction of ST-segment shifting (ST-segment elevation, 0.07 +/- 0.02 vs 0.22 +/- 0.07 mV, p < 0.05, at 4 hours post reperfusion) and smaller release of creatine kinase-MB (87 +/- 11.5 vs 143 +/- 17.2 IU/L, p < 0.05, at 12 hours post reperfusion) in the preconditioning group. Preconditioning also enhanced myocardial contractility (dp/dtmax = 1490 +/- 75 vs 1280 +/- 88 mmHg/sec, at 30 minutes post reperfusion, p < 0.05) and promoted early postoperative recovery. The present study suggests that ischemic preconditioning reduces ischemia-reperfusion injury in human hearts even when combined with cold crystalloid cardioplegia.