The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 2006
Comparative StudyMalignant pleural effusion treatment outcomes: pleurodesis via video-assisted thoracic surgery (VATS) versus tube thoracostomy.
Video-assisted thoracic surgery (VATS) has been widely used in the diagnosis and management of various thoracic diseases. The objective of this retrospective study was to compare the effectiveness of patients undergoing pleurodesis through VATS versus tube thoracostomy for malignant pleural effusion (MPE). Study design was a retrospective review of patients treated in medical centers and hospitals in Taiwan. ⋯ VATS treatment for MPE appears to be superior to tube thoracostomy for diagnostic accuracy and effectiveness in preventing effusion recurrence; however, the role of these treatments for MPE is palliative, and does not significantly prolong survival time.
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Thorac Cardiovasc Surg · Aug 2006
Prediction of and risk factors for surgical wound infection in the saphenous vein harvesting leg in patients undergoing coronary artery bypass.
Surgical wound infection (SWI) of the leg after saphenous vein harvesting is an important complication of coronary artery bypass graft (CABG) procedures. SWIs may restrict mobility in the postoperative period and increase costs of postoperative hospitalisation and antibiotic treatment. ⋯ The choice of suture and suturing technique is important to prevent SWI following saphenous vein harvesting. More precise definitions of wound signs are necessary if they are to be used as predictors of SWI.
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The difficulties in diagnosing traumatic diaphragmatic rupture (TDR) at the first admission are the most common causes of morbidity and mortality. The purpose of this study was to review our experience with the management of TDR in order to identify the factors contributing to diagnostic delay and associated morbidity and mortality. ⋯ Diaphragmatic rupture should be suspected in all blunt or penetrating traumas of the thorax and abdomen, and the presence of such an injury should be excluded before terminating the exploratory procedure.
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Thorac Cardiovasc Surg · Aug 2006
Diabetes mellitus increases adverse neurocognitive outcome after coronary artery bypass grafting surgery.
Cognitive dysfunction is a well known problem in the postoperative period in cardiac surgery. We hypothesised that the incidence of postoperative cognitive dysfunction in patients with diabetes mellitus is higher than in the nondiabetic patient. ⋯ The cognitive outcome in the early postoperative period is worse in diabetic patients compared to nondiabetics. Speed-related cognitive functions are mainly affected. Probably, this reflects a different physiology of cerebral perfusion during extracorporeal circulation. Optimising perfusion strategies to improve the outcome of diabetic patients should be the next topic of study.
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Thorac Cardiovasc Surg · Aug 2006
Cardiopulmonary effects of intravenous prostaglandin E1 during experimental one-lung ventilation.
One-lung ventilation greatly improves operating conditions during thoracic surgery. Serious disadvantages of one-lung ventilation are hypoxaemia and increased pulmonary vascular resistance. Prostaglandins, like prostaglandin I2 (PGI2), are potent pulmonary vasodilators but may also influence venous admixture and systemic circulation. Since the lung is capable of extensive degradation of prostaglandin E1 (PGE1) but not of PGI2, PGE1 might affect systemic circulation to a lesser degree. Hence, we studied the effects of intravenous PGE1 on systemic and pulmonary circulation and on oxygenation during one-lung ventilation. ⋯ During one-lung ventilation in the pig, infusion of PGE1 significantly decreased pulmonary vascular resistance and pulmonary artery pressure but failed to achieve selective pulmonary vasodilation.