The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Feb 2003
Predictors of homologous blood transfusion for patients undergoing open heart surgery.
It has become very important to avoid homologous blood transfusions in today's cardiac surgery. We performed a retrospective analysis to find out preoperative factors to predict the risk for transfusion of red-cell concentrate in cardiac surgery. ⋯ We could show that there is normally no need for blood transfusion in (2/3) of the patients in cardiac surgery according to this study's results. Furthermore, it was obvious that some patient variables can be used predict the risk for perioperative transfusion. Based on these results, the prophylactic administration of aprotinin or the use of a cell saver could be useful in selected patients.
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Thorac Cardiovasc Surg · Dec 2002
Comparative StudyOutcome of patients after cardiac surgery transferred to other hospitals following prolonged intensive care stay.
The steady rise in complex cardiac procedures as well as the increase in comorbidity often result in a prolonged intensive care unit (ICU) stay. As a consequence, considerable numbers of patients have to be transferred to other hospitals so that the primary institution can maintain its capacity. The purpose of this study was to investigate the outcome of these patients. ⋯ Transferral of patients after prolonged intensive care stay to external hospitals carries significant risks for early death and impaired outcome. However, transferral to cardiac ICUs appears to be an adequate option. Further studies may identify potential subgroups of patients who do not benefit from transferral.
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Thorac Cardiovasc Surg · Dec 2002
Prognostic significance of p53 status in non-small cell lung cancer in correlation with postoperative adjuvant therapy.
Significant factors in the prognosis of p53 status in non-small cell lung cancer (NSCLC) remain controversial; some clinical studies have documented that p53 abnormality is a significant factor in predicting poor prognosis, and others failed. In the present study, we examined whether or not adjuvant therapy may influence the prognostic significance. ⋯ This study demonstrates that postoperative survival is improved by UFT administration in patients with normal p53 function, but not in those without normal p53 function.
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Surgical management is different for Jehovah's Witnesses than in customary operations. Preoperative measures primarily aim at an optimal hematological condition, whereas intraoperative activities are directed towards minimizing blood loss. However, physicians taking care of Jehovah's Witnesses are not only faced with the difficulties of adequate treatment, but also by psychological and legal issues. Since the German legal system does not offer clear-cut legislation with regard to the Jehovah's Witnesses transfusion issue, guidelines have been offered on how to encounter his issue.