The Thoracic and cardiovascular surgeon
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Video-assisted and thermometrically controlled thoracoscopic sympathectomy demonstrates new ways in the treatment of upper-limb hyperhidrosis. An anatomical portrayal of the sympathetic chain is possible as a result of the improved visualization and magnification of the operative area provided by the video-optic technique. The difference in temperature, registered by means of a thermometric sensor in the palm of the hand, indicates that the sympathetic nerves responsible for the hyperhidrotic segments have been severed. ⋯ Neither intraoperative nor postoperative complications were recorded. One patient complained of increased compensatory sweating of the trunk. Thermometrically controlled thoracoscopic sympathectomy is expected to improve the various forms of treatment available for sympathetic reflex dystrophies in the future.
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Thorac Cardiovasc Surg · Jun 1993
Case ReportsCombined transection of the trachea and esophagus following cervical blunt trauma.
The successful management of a patient with combined transection of the cervical trachea and esophagus following blunt trauma is reported. This type of injury was rare in the past, but is gradually increasing at the present time because of the increased use of motorcycles. Immediate primary closure of the transected trachea and esophagus offers the best chance for a good result.
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Thorac Cardiovasc Surg · Feb 1993
Case ReportsAortobronchial fistula: a late complication of coarctation repair by patch aortoplasty.
A case of aortobronchial fistula occurring 13 years after coarctation repair by patch aortoplasty is presented. Correct diagnosis was established by computed tomographic scanning and magnetic resonance imaging. Surgical treatment consisted of simple closure of the bronchial defect and interposition of a Dacron graft under partial extracorporeal bypass.
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Thorac Cardiovasc Surg · Feb 1993
Surgery for tricuspid insufficiency: long-term follow-up after De Vega annuloplasty.
Between 1975 and 1991, 97 consecutive patients underwent De Vega tricuspid annuloplasty either isolated or in combination with mitral, aortic, or mitral and aortic valve procedures. Preoperatively 96.9% of the patients were in New York Heart Association functional class III or IV. Causes of tricuspid insufficiency were functional tricuspid ring dilatation and a combination of dilatation and different organic tricuspid valve lesions. ⋯ Ten patients required reoperation (2.2%/patient-year), of whom 8 were associated with tricuspid regurgitation (1.7%/patient-year). Although in all patients but one the De Vega annuloplasty was intact, the tricuspid ring was dilated; 4 patients had additional tricuspid organic valve lesions. 6 of the 8 patients had concomitant mitral valve or mitral prosthesis dysfunction. 26 patients died late (5.6%/patient-year) due to chronic cardiac failure in 50% and after reoperation in 7% of the patients. 4 patients had implantation of a permanent pacemaker (0.9%/patient-year). 54 patients (67.5%) are still alive, with 43% having no and 17.5% having only mild residual tricuspid regurgitation. De Vega annuloplasty is indicated with tricuspid insufficiency due to functional ring dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Thorac Cardiovasc Surg · Feb 1993
Low-dose anticoagulant management of patients with St. Jude Medical mechanical valve prostheses.
Between February 1984 and December 1990, 622 St. Jude Medical valves were implanted in 548 patients. There were 382 males (69.7%) and 166 females (30.3%) with a mean age of 32.3 +/- 11.9 years (range 9-68 years). ⋯ Valve thrombosis occurred in 4 patients (0.30% py): 3 in the MVR group (0.94% py) and 1 in the AVR group (0.11% py). Hemorrhage occurred in 19 patients (1.44% py) with 11 fatal outcomes (0.83% py). It is concluded that a random daily dose of 2.5 mg warfarin with 225 mg dipyridamole and 250 mg aspirin is sufficient for safe anticoagulation without the need for serial prothrombin-time adjustments.