European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Apr 2004
Should cervical ultrasonography be a routine staging investigation for lung cancer patients with impalpable cervical lymph nodes?
Detection of cervical N3 lymph nodes is currently not a routine preoperative investigation for lung cancer patients. We designed a study to assess if the frequency and accuracy of detection of metastatic cervical lymph nodes using cervical ultrasonography (US) and fine needle aspiration (FNA) justify their routine use in all lung cancer patients with impalpable cervical lymph nodes. ⋯ Cervical US and FNA is a safe and cost-effective method of evaluating the status of impalpable cervical lymph nodes in lung cancer patients. Further study is warranted to establish the role of cervical US and FNA in lung cancer staging algorithms.
-
Eur J Cardiothorac Surg · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialDiltiazem provides higher internal mammary artery flow than nitroglycerin during coronary artery bypass grafting surgery.
Perioperative internal mammary artery (IMA) vasospasm in patients undergoing coronary artery bypass grafting (CABG) surgery may lead to morbidity and mortality. Surgical stimulus is one of the common causes of IMA vasospasm. Preventive measures, beside treatment should be taken into consideration to obtain vasospasm free IMA. The effect of a pharmacologic agent on IMA flow when it is administered before harvesting the artery has not been documented. We designed a prospective randomized clinical study to compare the IMA free blood flows in patients receiving either diltiazem or nitroglycerin, starting infusion of study drugs before a surgical stimulus was applied to the IMA region and continuing throughout the isolation period. ⋯ Diltiazem infusion which started prior to harvesting provided higher IMA blood flow compared to nitroglycerin infusion. Considering the percentage of increases in flows after resection of distal segment, the most prone part to vasospasm, we assume that a certain amount of spasm occurred in IMA in spite of infusion of study drugs, such that less with diltiazem and more with nitroglycerin. Diltiazem plays more important role than nitroglycerin in the prevention of vasospasm.
-
Eur J Cardiothorac Surg · Apr 2004
Weaning from ventilator after cardiac operation using the Ciaglia percutaneous tracheostomy.
To determine the predictors of weaning from mechanical ventilation after cardiac operation with the Ciaglia percutaneous dilatational tracheostomy (PDT) in our preliminary experience in the use of this technique. ⋯ Early PDT was a safe and effective method to wean from mechanical ventilation the cardiosurgical patients of this series.
-
Eur J Cardiothorac Surg · Apr 2004
Effect of training on outcomes following coronary artery bypass graft surgery.
We examined our coronary artery bypass surgery (CABG) experience to assess the effect of training on mortality and morbidity outcomes. ⋯ After adjusting for case-mix, with careful case selection, training does not adversely affect the early and mid-term outcomes of CABG.
-
In this study, we evaluate the incidence of and analyse the pre and intraoperative risk factors for the development of postoperative renal dysfunction (PRD), and the impact of such an event on perioperative mortality and on hospital length of stay. In addition, we sought to investigate the influence of a mildly increased serum creatinine (1.3-2.0 mg/dl) on perioperative mortality and morbidity. ⋯ Although the likelihood of PRD in patients without pre-existing renal dysfunction is relatively low, it dramatically increases mortality, morbidity and length of stay after CABG. Mildly elevated (>1.2 mg/dl) preoperative serum creatinine level significantly increases the perioperative mortality and morbidity.