European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · May 2006
Clinical TrialThe use of gabapentin for post-operative and post-traumatic pain in thoracic surgery patients.
The pain following thoracic surgery and trauma is often refractory to conventional analgesic strategies. However, it shares key characteristics with neuropathic pain which gabapentin, an anticonvulsant, has been proven to effectively treat. To our knowledge, this is the first prospective study assessing the use of gabapentin in cardiothoracic surgery patients. ⋯ Gabapentin appears safe and well tolerated when used for persistent post-operative and post-traumatic pain in thoracic surgery patients, although minor side effects do occur. Gabapentin may relieve refractory chest wall pain in some of these patients, particularly those with more severe pain. Further studies are warranted to define the role of gabapentin in cardiothoracic surgical practice.
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Eur J Cardiothorac Surg · May 2006
Review Meta AnalysisThe evidence on the effectiveness of management for malignant pleural effusion: a systematic review.
The aim of this study was to review systematically the available evidence on pleurodesis for malignant effusion, focusing on the choice of the agents, route of delivery and other strategies to improve outcomes. Four electronic databases (MEDLINE, EMBASE, Web of Science and Cochrane Controlled Trials Register) were searched, reference lists checked and letters requesting details of unpublished trials and data sent to authors of previous trials. Studies of malignant pleural effusion in humans were selected with no language restrictions applied. ⋯ Talc appears to be effective and should be the agent of choice for pleurodesis. Thoracoscopic talc insufflation is associated with fewer recurrences of effusions compared with bedside talc slurry, but this is based on two small studies. Where thoracoscopy is unavailable bedside talc pleurodesis has a high success rate and is the next best option.
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Eur J Cardiothorac Surg · May 2006
Randomized Controlled Trial Comparative StudyComparison of the inflammatory response between miniaturized and standard CPB circuits in aortic valve surgery.
One of the complications of CPB is the systemic inflammatory response syndrome (SIRS). Recent developments tend to minimize the biological impact of CPB in using miniaturized closed circuit with reduced priming volume and less blood-air interface. The benefit of these miniaturized closed circuits in terms of inflammatory response has been proved in coronary surgery. However, in open heart surgery, the CPB circuit is no more closed and the benefit of the miniaturized set-up could disappear. The aim of the study is to compare the SIRS between standard and miniaturized circuits in aortic surgery. ⋯ This study demonstrates in aortic surgery, the lesser inflammatory response of a miniaturized CPB compared to a standard CPB. However, there is always some inflammation after CPB and a small bio-reactive free perfusion circuit is still to be found in open heart surgery.
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Eur J Cardiothorac Surg · May 2006
Video-assisted right supradiaphragmatic thoracic duct ligation for non-traumatic recurrent chylothorax.
Chylothorax is an uncommon disorder with respiratory, nutritional and immunological manifestations. Surgical management is indicated in case of recurrence or failure after conservative treatment. We report our experience with video-assisted right-sided supradiaphragmatic thoracic duct ligation for non-traumatic, non-postoperative persistent or recurrent chylothorax. ⋯ Recurrent or persistent non-traumatic chylothorax may be successfully treated by video-assisted right supradiaphragmatic thoracic duct ligation.
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Eur J Cardiothorac Surg · May 2006
Impact of avoiding cardiopulmonary bypass for coronary surgery on perioperative cardiac enzyme release and survival.
This study examines the association between avoiding the use of cardiopulmonary bypass (CPB) for coronary surgery and postoperative cardiac enzyme (CE) release, and its subsequent impact on survival. ⋯ Avoiding cardiopulmonary bypass significantly reduces early cardiac enzyme release following coronary artery bypass grafting (CABG). However, it does not result in improved survival compared to coronary surgery using cardiopulmonary bypass. This absence of survival benefit may be due to higher mortality rates experienced by the fewer patients with high (>6 times the upper limit of range) cardiac enzyme release following coronary artery bypass surgery without cardiopulmonary bypass.