European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Thoracoscopic (video-assisted thoracoscopic surgery (VATS)) lobectomy is a safe and effective method for treating early-stage lung cancer. Despite this, it is still not widely practised, which could be due to a shallow learning curve. We have evaluated the surgical outcome in a training programme at an institution with an established VATS lobectomy programme. We present the surgical data and outcome of the first 50 intended VATS lobectomies performed by a consultant in training as the primary surgeon. ⋯ With careful selection of patients, VATS lobectomy can be taught safely in a surgical institution experienced in VATS lobectomies. Using statistical analysis, the surgical outcome for the training consultant was acceptable in comparison to the outcome of the experienced consultant. The consultant in training did spend more time in the operating theatre (p<0.0001) and we recommend taking that into account when planning future training programmes in VATS lobectomy.
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Eur J Cardiothorac Surg · Mar 2010
Validation of a clinical score to determine the risk of acute renal failure after cardiac surgery.
Preoperative assessment of risk factors for postoperative acute renal failure (ARF) is a key point in the management of cardiac surgery patients. A reliable evaluation of individual risk permits the efficient application of prophylactic and therapeutic measures to patients with increased risk of ARF. In 2005, Thakar published a scoring system to determine the ARF risk prior to surgery. The score allowed calculation of the incidence of postoperative ARF requiring dialysis (ARF-D) with a high level of precision. ⋯ The correlation between score values and incidence of ARF-D shows that the Thakar score is qualitatively transferable to cardiac surgery patients from other centres. Though the score allows the discrimination between patients with higher or lower risks of ARF-D within the Goettingen collective, it was not suitable to estimate the real incidence of postoperative ARF-D with sufficient precision.
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Eur J Cardiothorac Surg · Mar 2010
Neuroprotective effects of erythropoietin during deep hypothermic circulatory arrest.
Permanent mild-to-severe brain injury with neurologic sequelae remains a significant source of postoperative morbidity in cardiovascular surgery. There is increasing evidence that erythropoietin confers neuroprotective effects in various conditions of neuronal damage, such as hypoxia and cerebral ischaemia. Using a surviving porcine model, this study evaluates whether systemic treatment with erythropoietin induces brain protection in deep hypothermic circulatory arrest (DHCA). ⋯ These results suggest some beneficial neuroprotective effects of erythropoietin in this model of global brain ischaemia induced by 1h of hypothermic circulatory arrest.
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Eur J Cardiothorac Surg · Feb 2010
Randomized Controlled Trial Comparative StudyA comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management.
Thoracotomy is a surgical procedure associated with severe pain. Operative morbidity rates reduce by effective postoperative pain control. The aim of this study is to compare the effectiveness of the thoracic epidural blockade (TEB) and the paravertebral blockade (PVB) methods in relieving the pain caused by a thoracotomy incision. ⋯ PVB catheterisation can be easily performed and placed in a short span perioperatively. Therefore, it might be the preferred method over TEB which has a high incidence of adverse effects and complication rates.