European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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During a 14-year period (1980-1993) second primary lung cancer or relapse was treated in 44 consecutive patients. Thirty-seven patients had synchronous (n = 18) or metachronous (n = 19) second primary lung cancer. Ten synchronous tumors were ipsilateral and treated contemporarily with five pneumonectomies, three lobectomies and two double wedge resections. ⋯ The actuarial overall 5-year survival rate for patients with relapse was 38.1% with a median survival time of 37 months. We may conclude that an aggressive surgical approach is safe, effective and warranted in patients with either a second primary lung cancer or relapse from their primary lung cancer. Moreover, for early detection of the second lesions, follow-up at a maximum of 6-monthly intervals should be continued for more than 5 years after the first resection.
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A 90 degree bent two-stage venous cannula for cardiopulmonary bypass is presented and discussed. Its main advantages, compared to similar straight ones, are that it is out of the way of the surgeon, by being placed under the right sternum and also that the venous return seems uninfluenced by displacement of the heart when operating on the posterior side of the heart. No major drawbacks for the cannula have been noticed so far.
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsLeg ischaemia following bilateral internal thoracic artery and inferior epigastric artery harvesting.
There is increasing evidence that the use of arterial conduits for coronary artery bypass grafting provides superior long-term results when compared to using saphenous veins alone. Major complications of using internal thoracic arteries (ITAs) and inferior epigastric arteries (IEAs) are uncommon. ⋯ The enormous size of these conduits found at operation suggested their role. Management strategies to avoid such a serious complication are discussed.
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Eur J Cardiothorac Surg · Jan 1995
Comparative StudySurgery for acute ascending aortic dissection: closed versus open distal aortic repair.
One hundred twelve consecutive patients with acute ascending aortic dissection and submitted to immediate surgery were retrospectively analyzed with regard to perioperative mortality and morbidity. The patients were divided into two groups according to whether distal aortic repair was carried out by the open procedure (using deep hypothermic circulatory arrest, group A: 68 patients) or by the closed technique (without circulatory arrest, group B: 44 patients). Patients' ages ranged from 24 to 78 years (mean 57.4 years). ⋯ The trend towards a higher mortality in group A mainly reflected the more severe and complex anatomical characteristics and could not be attributed to the circulatory arrest per se. The period of deep hypothermic circulatory arrest in the survivors (25 min) was similar to that of the group with lethal outcome (32 min). Among the non-lethal complications, however, group A patients more frequently showed clinical signs consistent with cerebral injury: apart from the transient symptoms suggestive in reversible diffuse cerebral damage, five patients in group A had a permanent focal neurological deficit (versus one patient in group B).(ABSTRACT TRUNCATED AT 250 WORDS)
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsExtra-pleural haematoma secondary to blunt chest trauma. An unusual presentation.
The case history is described of a young man who presented with an apparent splenic rupture following thoracic compression during a rugby tackle. The actual diagnosis was that of an extra-pleural haematoma following transection of the internal mammary artery. This case is discussed within the context of the rarity of such a presentation--both in the site of the haematoma and the cause of the transection; and the problems posed in making the initial diagnosis.