The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Mar 2010
Modified technique for thoracomyoplasty after posterolateral thoracotomy.
Thoracomyoplasty after prior posterolateral thoracotomy (PLT) remains a challenge for the thoracic surgeon. Thoracodorsal artery division after PLT impairs the vascularization supply of the latissimus dorsi muscle (LDM) resulting in muscle mass reduction due to distal atrophy. This makes adequate filling of residual empyema space and/or surgical closure of bronchial stump insufficiency more difficult, and they require alternative surgical procedures. We present an alternative approach using a four-muscle flap technique to include the infraspinatus, the subscapularis and the teres major muscle group, all pedicled from the subscapular artery as a part of a modified thoracomyoplasty technique for closing residual empyema space and bronchial stump insufficiency. ⋯ Division of the LDM and its vascular supply after posterolateral thoracotomy results in a reduction of muscle mass. The shoulder girdle muscles offer an adequate alternative to fill residual empyema space with acceptable long-term results and restriction in shoulder motion. In all cases with bronchial fistula, bronchial stump closure with a pedicled subscapular muscle was an effective alternative operative technique.
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Thorac Cardiovasc Surg · Mar 2010
Factors leading to obstructive granulation tissue formation after ultraflex stenting in benign tracheal narrowing.
This retrospective study aimed to determine the factors leading to obstructive granulation tissue formation after the placement of a self-expandable metallic stent (SEMS) in patients with benign tracheal disease. ⋯ Obstructive granulation tissue formation is not uncommon after SEMS implantation and structural airway obstruction prior to SEMS implantation is an independent predictor. Although SEMS implantation should be restricted to a select population, it may be placed in patients not suitable for surgical intervention or rigid bronchoscopy with anesthesia because of poor pulmonary function.
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Thorac Cardiovasc Surg · Mar 2010
Very important histopathological factors in patients with resected non-small cell lung cancer: necrosis and perineural invasion.
The current staging system provides an anatomical classification of lung tumors; its secondary purpose is to allow the prognostic stratification of patients into homogeneous groups after surgery. In this work, intratumoral perineural invasion, lymphatic and blood vessel invasion together with the necrosis content of the tumor exclusive of the non-small cell cancer staging system were studied. ⋯ Perineural invasion and the presence of necrosis independently indicated a dismal prognosis and their prognostic power is comparable to those of the TNM classification. These factors could be candidates for better survival stratification and the indicators of the need for adjuvant therapy in early stage lung cancer patients.
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Thorac Cardiovasc Surg · Mar 2010
Case ReportsMetastasis after resection of huge primary pericardial pleomorphic liposarcoma with cardiopulmonary bypass.
Liposarcoma is the most commonly diagnosed soft tissue sarcoma in adults and occurs predominantly in the lower limbs or retroperitoneal area. However, of the five types of liposarcoma, primary pleomorphic liposarcoma originating in the pericardium is extremely rare. ⋯ However, there is no previous report warning of the possible dangerous effect of cardiopulmonary bypass. We present a rare case of huge malignant primary pericardial pleomorphic liposarcoma with early postoperative multiple metastases which may be due to cardiopulmonary bypass.
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Thorac Cardiovasc Surg · Mar 2010
Valve-sparing operation for aortic root aneurysm in patients with Marfan syndrome.
We report our experience with aortic valve-sparing procedures in patients with Marfan syndrome and aortic root aneurysm. ⋯ The early and mid-term results of the valve-sparing operations were favorable, and the durability of the preserved valve should encourage use of this technique in patients with Marfan syndrome.