European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2005
Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results.
In the last decade, cardiac surgery in octogenarians is becoming a routinely performed procedure in our Western countries. The functional benefit of this surgery had already been proved. The aim of this study was to evaluate operative mortality, to identify pre- and post-operative risk factors of early and late mortality, to assess the Euroscore count in this high-risk group of patient and to evaluate late results of this surgery. ⋯ Valvular surgery in octogenarians is a safe and low risk procedure compared to functional benefit and long-term survival. Our data how that logistic Euroscore overestimates the mortality in this high-risk group of patients.
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Eur J Cardiothorac Surg · Feb 2005
Incidence of chest wall paresthesia after needlescopic video-assisted thoracic surgery for palmar hyperhidrosis.
Chest wall paresthesia is a reported sequela of thoracotomy and Video-Assisted Thoracic Surgery (VATS) which is distinct from wound pain. Although needlescopic VATS confers less post-operative pain and better cosmesis, the incidence of paresthesia after needlescopic VATS has not been quantified. ⋯ Chest wall paresthesia affects a significant but previously overlooked proportion of patients following needlescopic VATS, but has minimal impact on post-operative satisfaction. Needlescopic VATS offers no apparent advantage over conventional VATS with regard to paresthesia.
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Hemodynamic abnormalities and refractory atrial arrhythmias in patients late after the Fontan operation result in significant morbidity and mortality. We reviewed our experience with Fontan conversion and concomitant arrhythmia surgery. ⋯ Fontan conversion with concomitant arrhythmia surgery and permanent pacemaker placement is safe, improves New York Heart Association functional class, and has a low incidence of recurrent arrhythmias. In most patients, concomitant permanent pacemakers are needed.
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To determine the optimum management of anastomotic leaks after oesophagectomy. ⋯ Diagnosis of anastomotic leakage after oesophagectomy is difficult due to its variable presentation and the unreliability of contrast swallow. Gastric tip necrosis is by far the most common cause. We feel our preferred strategy of immediate surgical treatment of symptomatic leaks is justified by the favourable outcome in the majority of patients.
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Eur J Cardiothorac Surg · Feb 2005
Anatomical variations of rami communicantes in the upper thoracic sympathetic trunk.
The aim of this study was to clearly delineate the anatomical variations of the communicating rami in the upper thoracic sympathetic nervous system and to help develop better surgical method for essential palmar hyperhidrosis. ⋯ On the basis of this study, the anatomical variations of communicating rami could explain some surgical failures and recurrences. Moreover, in addition to the conventional surgical methods (sympathectomy, sympathicotomy, clipping of sympathetic chain and ramicotomy), dividing the inconstant sympathetic pathways (nerve of Kuntz, ascending or descending rami communicantes) on the second, the third and the fourth ribs will help to get better surgical effect.