The Thoracic and cardiovascular surgeon
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Thymectomy is a well-established indication for management of myasthenia gravis and it represents the most effective treatment for thymic tumors. The traditional surgical approach is median sternotomy. More recently, different less-invasive surgical approaches for thymectomy have been proposed as an alternative to open surgery. This article discusses the main technical aspects and results of literature.
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Thorac Cardiovasc Surg · Feb 2015
ReviewThe predictive value of platelet function point-of-care tests for postoperative blood loss and transfusion in routine cardiac surgery: a systematic review.
Excessive bleeding after cardiopulmonary bypass (CPB) operations remains to be a persistent problem and weak platelet function certainly contributes to bleeding diathesis. Antiplatelet therapy (APT) is an integral component of perioperative management in patients undergoing cardiac surgery procedures, both with and without use of CPB. In addition to individual variability in platelet function, different preoperative APT administration/discontinuation management further affects platelet function, which in turn may reflect bleeding tendency. ⋯ Herein, we reviewed the available evidence on the association between platelet function testing values and the extent of bleeding and transfusion requirements in early perioperative period. Currently, the association between platelet function measured by ex vivo assay and the occurrence of bleeding events remains uncertain. The intent of this review is to provide comprehensive literature insight into published evidence, investigating the possibility of platelet function tests to predict bleeding extent as well as transfusion requirements in cardiac surgery patients.
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Thorac Cardiovasc Surg · Feb 2015
Multiple electrode aggregometry for the assessment of acquired platelet dysfunctions during extracorporeal circulation.
There have been many reports on how the usage of extracorporeal circulation (ECC) is independently associated with the induction of platelet dysfunctions. The aim of the present investigation was to study the capability of the multiple electrode aggregometry (MEA) using the Multiplate (Roche AG, Grenzach, Germany) device to reflect the extent of ECC-associated platelet dysfunctions. ⋯ Data from the present study indicate that ex vivo ADP-induced platelet aggregation in MEA reflects the time-dependent extent of ECC-induced platelet dysfunction.
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Thorac Cardiovasc Surg · Feb 2015
Progressive chest wall bleeding caused by bronchial stump nails after lobectomy.
Postoperative intrathoracic active bleeding is a serious complication after general thoracic surgery. Yet, progressive chest wall bleeding caused by a bronchial stump nail after lobectomy has rarely been reported. The purpose of this report was to review the causes, surgical treatment, and prevention of progressive chest wall bleeding caused by a bronchial stump nail in patients after lobectomy. ⋯ Performing surgery carefully and understanding the risk from bronchial stump nails are keys to preventing progressive postoperative bleeding.