European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2012
Ectopic thymic tissue in the mediastinum: limitations for the operative treatment of myasthenia gravis.
The aim of the study was to investigate the distribution of ectopic thymic tissue in the mediastinum and to evaluate the possible relevance of this distribution to the therapeutic yield of thymectomies in patients with myasthenia gravis. ⋯ The incidence of ectopic thymic tissue in the mediastinum is common. Although some improvements in the results of thymectomies may be expected with more extensive dissection, the frequent presence of thymic foci in anatomical locations hardly accessible to surgical intervention may be the true limitation for surgical treatment of myasthenia.
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Eur J Cardiothorac Surg · Jul 2012
Clinical TrialFalse-negative rate after positron emission tomography/computer tomography scan for mediastinal staging in cI stage non-small-cell lung cancer.
To assess the false-negative (FN) rate of positron emission tomography (PET)-chest computed tomography (CT) scan in clinical non-central cIA and cIB non-small-cell lung cancer (NSCLC) for mediastinal staging. ⋯ Composite results for non-invasive mediastinal staging (CT scan, PET-CT) showed 11% of FNs in cI stage (7.6% in non-central cIA and 14.8% in cIB). In tumours≤1 cm, NPV makes surgical staging unnecessary. In women with adenocarcinoma and non-central cIB, however, the high FN rate makes invasive staging necessary, particularly in pT2b to decrease the incidence of unexpected pN2 in thoracotomy.
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Eur J Cardiothorac Surg · Jul 2012
Established markers of renal and hepatic failure are not appropriate to predict mortality in the acute stage before extracorporeal life support implantation.
End-organ function, especially of the kidney and liver, actual inflammation and acid-base balance affect the outcome in extracorporeal life support (ECLS) patients. However, the often unexpected necessity of ECLS implies that information on patients is scarce. Even established global scores are not always useful in the rapid decision process for ECLS. Therefore, we evaluated laboratory parameters for kidney or liver function and for inflammation and acid-base balance with regard to outcome. ⋯ Our data indicate that renal and hepatic insufficiency, increased inflammatory state and deranged acid-base balance as determined by pre-operative laboratory data are not associated with poor outcome of ECLS. Further, survival is not related to indications for ECLS. In a number of patients, ECLS allows for successful bridging to other treatment options.
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Eur J Cardiothorac Surg · Jul 2012
Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting.
Although the association between chronic obstructive pulmonary disease (COPD) and adverse surgical outcomes has been previously demonstrated, the impact of COPD severity on postoperative mortality and morbidity remains unclear. Our objective was to analyse the prognostic implication of COPD stages as defined by the Global Initiative for Chronic Obstructive Lung Disease. ⋯ The severity of COPD as defined by spirometry can be a prognostic marker in patients undergoing CABG. Spirometric criteria may help refining currently used operative risk scores.
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Eur J Cardiothorac Surg · Jul 2012
Clinical TrialEffect of age on exercise capacity and cardiac reserve in patients with pulmonary atresia with intact ventricular septum after biventricular repair.
In patients with pulmonary atresia with intact ventricular septum (PAIVS), biventricular repair is considered to be the optimal treatment option in the absence of significant right ventricular (RV) hypoplasia. However, long-term clinical outcome studies are limited. We evaluated exercise capacity and cardiac function during pharmacological stress in children and young adults with PAIVS after biventricular repair. ⋯ In PAIVS patients after biventricular repair exercise capacity and cardiac reserve decrease with age. These findings appear to be related to impaired diastolic RV function and decreased RV filling, indicating that the function of the relatively small RV deteriorates with time.