The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Apr 2013
Comparative StudyCollagen gentamicin for prevention of sternal wound infection: effective or not?
Prophylactic local application of collagen-gentamicin sponges for prevention of sternal wound infections (SWI) after cardiac surgery has been used routinely in risk patients for several years at our center. However, a recent US study failed to show a significant reduction in SWI with the prophylaxis. Therefore, a systematic reevaluation of the effect of local collagen gentamicin was conducted. ⋯ The use of local collagen-gentamicin prophylaxis was associated with an approximately 70% reduction in the rate of SWI compared with standard intravenous antibiotic prophylaxis alone.
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Thorac Cardiovasc Surg · Apr 2013
Comparative StudyTiming of heparin and thrombus formation in donor lungs after cardiac death.
Heparin is routinely administered to brain-dead donors before cardiac arrest, although it is not universally allowed for donation after cardiac death (DCD) donors due to concerns that death may be hastened. The lack of heparin may lead to thrombosis and compromised graft function. We evaluated the impact of timing of heparin administration and thrombi formation in a DCD pig model. ⋯ Delayed heparin administration after cardiac death does not affect thrombus formation in an animal model of lung procurement after cardiac death. Concern about clinically significant thrombosis occurring when heparin is not given before cardiac arrest appears unfounded. These findings suggest that DCD lungs can be used regardless of antemortem heparin administration.
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Thorac Cardiovasc Surg · Mar 2013
Comparative StudyComplete mediastinal lymph node dissection in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy.
Although video-assisted thoracic surgery (VATS) lobectomy has been used more and more frequently for the treatment of patients with early-stage lung cancer, controversies are mainly focused on whether the complete mediastinal lymph node dissection (MLND) can be achieved by VATS. This retrospective study aimed to compare the validity of MLND between VATS and open thoracotomy. ⋯ Our early experience suggests that, with regard to the number of the dissected lymph nodes, VATS lobectomy can achieve complete MLND, compared with the traditional approach. MLND by VATS is technically feasible and safe for early-stage lung cancer.
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Thorac Cardiovasc Surg · Mar 2013
Case ReportsPresurgical planning using a three-dimensional pulmonary model of the actual anatomy of patient with primary lung cancer.
Video-assisted thoracoscopic surgery (VATS) for both lobectomy and segmentectomy has been used widely for early stage nonsmall cell lung cancer (NSCLC). The objective of this study was to investigate the clinical feasibility of surgical planning using patient's actual three-dimensional (3D) pulmonary model for the thoracoscopic surgical treatment of early stage NSCLC. ⋯ Presurgical planning based on patient's actual 3D pulmonary model is useful for patients with stage IA NSCLC ≤ 2 cm in diameter and for selecting an appropriate VATS lung resection for an individual.
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Thorac Cardiovasc Surg · Mar 2013
Comparative StudyDoes dose matter? Effect of two different neoadjuvant protocols in advanced NSCLC.
For stage III, NSCLC neoadjuvant protocols have been intensified up to full dose protocols but up till now the effect of more intensive protocols in a trimodal setting could not be compared directly because of different selection criteria or experience of involved facilities in different studies or multicenter studies. We analyzed our experience with two different neoadjuvant protocols, consistent selection criteria, and surgical teams over 17-year time period. ⋯ The median survival benefit of 9 months is evident but (probably still) not significant. The more aggressive protocol 2 shows a significant better downstaging effect concerning N- and UICC-stage if R0-resection can be achieved. Insofar dose does matter!