European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2006
Comparative StudyBronchial stump reinforcement with the intercostal muscle flap without adverse effects.
Bronchopleural fistula is a serious complication of pulmonary resection. For anatomical reasons, lower lobectomy is thought to carry a higher risk for bronchopleural fistula. We investigated the efficacy of bronchial stump reinforcement with a pedicled intercostal muscle flap after lower lobectomy and compared the responses in patients treated with the flap, without the flap, and with other types of flap. We also investigated whether harvesting the intercostal muscle flap leads to an increase in blood loss during surgery and whether the type of flap influences chest-tube volume and pain after surgery. ⋯ Bronchial stump reinforcement with the intercostal muscle flap after pulmonary resection is safe and effective when performed during lower and lower-middle lobectomy and does not increase the risk of complications.
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Eur J Cardiothorac Surg · Oct 2006
Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients.
Extracorporeal membrane oxygenation (ECMO) has been used as initial, biventricular circulatory support for patients with severe postcardiotomy cardiogenic shock (PCS). Due to its aggressiveness and limited weaning quote, concerns have been raised about maintenance of ECMO support regarding duration. However, it is frequently hazardous for physicians to make an individualized decision, whether and when discontinuation of ECMO support should be considered. We tried to find measurable values during ECMO support that could predict the patient mortality on ECMO support. ⋯ For adult non-transplantation patients with postcardiotomy cardiogenic shock, the CK-MB relative index 48 h after ECMO initiation can be a predictor of mortality on ECMO support. This might be a useful tool for considering a patient either for discontinuation of ECMO support or further treatment.
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Eur J Cardiothorac Surg · Oct 2006
Case ReportsSurgery for tumour recurrence in a pneumonectomy space.
Reoperative surgery through a previous pneumonectomy space focuses on the management of postpneumonectomy empyemas and bronchopleural fistulae. There are reports of elective tracheal resections done through the pneumonectomy space. We report two cases of successful excision of recurrent tumours (leiomyosarcoma and carcinoid) performed through the previous pneumonectomy space 2 and 13 years, respectively, after the primary surgical resection.