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 2010
The effect of a multidisciplinary thoracic malignancy conference on the treatment of patients with lung cancer.
There is a paucity of data evaluating whether a multidisciplinary conference coordinating surgery, chemotherapy and radiation therapy translates into better patient care. This article compares the experiences of patients with lung cancer before and after the formation of a prospective, multidisciplinary thoracic malignancy care conference (TMC). ⋯ A multidisciplinary thoracic malignancy conference increased the percentage of patients receiving complete staging, a multidisciplinary evaluation and adherence to nationally accepted care guidelines while decreasing the interval from diagnosis to treatment significantly. While the ultimate goal of treatment is to improve patient survival, the surrogate variables examined in this review indicate that patients with non-small-cell lung cancer benefit from being evaluated in a prospective, multidisciplinary care conference.
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Eur J Cardiothorac Surg · Jul 2010
Prediction of mortality in intensive care unit cardiac surgical patients.
The purpose of this study was to develop a specific postoperative score in intensive care unit (ICU) cardiac surgical patients for the assessment of organ dysfunction and survival. To prove the reliability of the new scoring system, we compared its performance to existing ICU scores. ⋯ Most of general ICU scoring systems use extensive data collection and focus on the first day of ICU stay. Despite this fact, general scores do not perform well in the prediction of outcome in cardiac surgical patients. Our new 10-variable risk index performs very well, with calibration and discrimination very high, better than general severity systems, and it is an appropriate tool for daily risk stratification in ICU cardiac surgery patients. Thus, it may serve as an expert system for diagnosing organ failure and predicting mortality in ICU cardiac surgical patients.
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Eur J Cardiothorac Surg · Jul 2010
Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer.
Surgical resection is the treatment of choice to cure patients with non-small-cell lung cancer (NSCLC); nevertheless, the assessment of the lower limit of surgical tolerance remains difficult. Ventilatory inefficiency (measured as the ventilation to CO(2) production ratio (V'(E)/V'(CO2) slope) is a survival predictor in pulmonary hypertension (PH) and chronic heart failure (CHF) and is considered a marker of PH in chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the role of V'(E)/V'(CO2) slope as preoperative mortality and morbidity predictor in COPD patients submitted to lung resection for NSCLC and considered operable according to current standards. ⋯ In COPD patients, a high V'(E)/V'(CO2) slope before lung resection is an independent mortality predictor even in the presence of an acceptable cardiopulmonary performance. COPD patients with high V'(E)/V'(CO2) slope before surgery must be carefully screened to exclude pulmonary hypertension, especially before surgical procedures with large parenchymal exeresis.
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Eur J Cardiothorac Surg · Jul 2010
Clinical TrialOral sildenafil for persistent pulmonary hypertension early after congenital cardiac surgery in children.
Sildenafil is a strong pulmonary vasodilator that increases the intracellular cyclic guanosine monophosphate concentration through inhibition of phosphodiesterase-5. We assessed the benefit of oral sildenafil for persistent pulmonary hypertension early after congenital cardiac surgery in paediatric patients. ⋯ Our results suggest that oral sildenafil is a safe and effective alternate for persistent pulmonary hypertension following congenital heart surgery in children.