The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Feb 2006
Randomized Controlled TrialCoagulation factor XIII reduces postoperative bleeding after coronary surgery with extracorporeal circulation.
One cause of diffuse bleeding after cardiac operations may be a low plasma concentration of coagulation Factor XIII, which is essential for coagulation but is not covered by standard coagulation monitoring. ⋯ Factor XIII administration reduces postoperative blood loss and the extent of blood transfusion after coronary surgery, however administration is only helpful if plasma levels are below the normal value. Measurement of plasma levels is recommended before Factor XIII substitution.
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Thorac Cardiovasc Surg · Feb 2006
Comparative StudyPrognostic significance of subcarinal station in non-small cell lung cancer with T1-3 N2 disease.
Surgical resection may continue to offer the best chance of long-term survival for patients with non-small cell lung cancer (NSCLC). Generally, patients with N2 NSCLC have a poor prognosis. However, the surgical treatment of patients with N2 remains controversial as in these patients, some N2 subgroups have better prognoses than others. The objective of the current study was to evaluate the factors associated with N2, and to determine whether such factors are reliable predictors of survival. ⋯ Surgery for patients with T1-3 N2 NSCLC might be acceptable if subcarinal lymph node metastasis is predicted to be absent.
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Thorac Cardiovasc Surg · Feb 2006
Tracheal rupture after endotracheal intubation: experience with management in 13 cases.
Tracheal rupture is a rare complication of endotracheal intubation. Potential causes, diagnosis, management, and outcome of cases treated at an university hospital are analysed. ⋯ Prognosis of tracheal ruptures depends both on the underlying disease and general condition of the patient and on the rapidity of diagnosis and treatment. Surgical therapy is preferred as it allows reconstruction of the trachea and drainage of the mediastinum. Conservative management appears to be justified for small ruptures in the upper third of the trachea without mediastinitis.
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Thorac Cardiovasc Surg · Feb 2006
Case ReportsPerforation of the ascending aorta: a late complication of superior vena cava stenting.
Intravascular stenting of the superior vena cava (SVC) is an established therapy in patients with SVC syndrome. Late complications include re-occlusion, stent infection, migration, and perforation. ⋯ Surgical therapy included excision of the aortic lesion and pericardial patch repair. This case illustrates successful management of a complication after palliative stenting of the SVC.
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Thorac Cardiovasc Surg · Feb 2006
Current management of late failure after classic Fontan modifications: Fontan conversion.
Re-establishment of Fontan circulation by eliminating the drawbacks of classic Fontan modifications has been proposed recently to improve the functional class and quality of life of patients with failed Fontan circulation. ⋯ We suggest that Fontan conversion should be considered in patients with previous atrio-pulmonary anastomosis, when right atrial dilatation or intractable atrial arrhythmias with deteriorating functional status develops. Redirection of hepatic venous flow to lungs induces regression of pulmonary arteriovenous fistulas and improves arterial saturation in patients with previous Kawashima operation.