European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Apr 2010
Case ReportsSupplementation of C1-esterase inhibitor concentrates for a patient suffering from hereditary angioedema undergoing complex open-heart surgery.
Hereditary angioedema (HAE) is an autosomal dominantly inherited deficiency of C1-inhibitor, and it is an extremely rare condition. During surgery, oedema can be induced by a variety of stresses, and a high mortality rate has been reported. ⋯ Perhaps for this reason, the only reports to date of cases of open-heart surgery have been cases of short-term cardiopulmonary bypass or off-pump coronary artery bypass grafting (CABG). We provide the first report of long-term cardiopulmonary bypass (longer than 5h) for open-heart surgery in a patient with HAE that did not result in any postoperative decline in respiratory function, systemic oedema, laryngeal oedema or similar complications, and a favourable outcome was obtained.
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Eur J Cardiothorac Surg · Apr 2010
Predictive value of B-type natriuretic peptide for postoperative atrial fibrillation following pulmonary resection for lung cancer.
To evaluate the usefulness of atrial natriuretic peptide (ANP) and brain B-type natriuretic peptide (BNP) for predicting postoperative atrial fibrillation (AF), we determined the changes in perioperative ANP and BNP levels in patients undergoing pulmonary resection for lung cancer. ⋯ Preoperative BNP level seems to be an appropriate predictor of AF after pulmonary resection.
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Eur J Cardiothorac Surg · Apr 2010
Comparative StudyDiscordant findings in patients with non-small-cell lung cancer: absolutely normal bone scans versus disseminated bone metastases on positron-emission tomography/computed tomography.
At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. The objective of our study was to compare the sensibility of the 2-deoxy-2-[18F] fluoro-d-glucose positron emission tomography/computed tomography (F-18 FDG PET/CT) for the detection of bone metastasis in patients with non-small-cell lung cancer (NSCLC) whose technetium 99m methylenediphosphonate (Tc-99m MDP) bone scans were absolutely normal. ⋯ Discordant findings of skeletal metastasis between Tc-99m MDP bone scans and F-18 FDG PET/CT imaging may be seen in 20% of the patients with NSCLC. F-18 FDG PET/CT could detect metastatic bone involvement more accurately than bone scintigraphy. Bone scans are insensitive to early bone marrow neoplastic infiltration. Assessment of glucose metabolism with FDG PET/CT can represent a more powerful tool to detect early bone metastases in lung cancer than with traditional bone scans.
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Eur J Cardiothorac Surg · Apr 2010
Multicenter Study Comparative StudyResults of staged total cavopulmonary connection for functionally univentricular hearts; comparison of intra-atrial lateral tunnel and extracardiac conduit.
This study aims to compare the outcome of the two co-existing modifications of staged total cavopulmonary connection (TCPC) - the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC). ⋯ Outcome after staged ILT- and ECC-type Fontan operations is good, with comparable freedom from late re-operations and freedom from Fontan failure at 6-year follow-up. The incidence of arrhythmias was significantly lower in the ECC group. Right ventricular morphology was identified as a risk factor for arrhythmias.
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Eur J Cardiothorac Surg · Apr 2010
Case ReportsLung transplantation following 107 days of extracorporeal membrane oxygenation.
Severe adult respiratory distress syndrome (ARDS) is associated with failure to maintain adequate gas exchange. There is increasing success using extracorporeal membrane oxygenation (ECMO) for respiratory failure; the longest reported surviving patient has been supported by ECMO for 57 days. At best about 50% wean from ECMO and should weaning fail their course is fatal. ⋯ He survived for 351 days post-transplantation and died from Pseudomonas aeruginosa pneumonia. ECMO can be used for prolonged intervals to support patients with severe ARDS without complications that preclude lung transplantation. As ECMO use becomes more frequent, it becomes critical to determine criteria that would optimise patient selection for transplantation from ECMO.