European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 2002
Comparative Study Clinical TrialHemodynamic effects of inhaled aerosolized iloprost and inhaled nitric oxide in heart transplant candidates with elevated pulmonary vascular resistance.
An elevated pulmonary vascular resistance (PVR) is described as a predictor of postoperative right heart failure and increased mortality in patients undergoing orthotopic heart transplantation. The use of intravenous vasodilators is limited by their systemic effects. We evaluated the pulmonary and systemic hemodynamic effects of inhaled nitric oxide (NO) and inhaled aerosolized iloprost (IP) in heart transplant candidates with elevated PVR. ⋯ Inhaled iloprost induces pulmonary vasodilation which is significantly greater than the effects of 10 and 30 ppm NO. The results of our study show, that inhaled iloprost induces a reliable hemodynamic response in the evaluation of heart transplant candidates. Further advantages of iloprost inhalation are the lack of adverse reactions and toxic side effects and an easier administration. Due to this facts we recommend iloprost as a routine screening drug for vascular reactivity in HTx-candidates. Based on our results it would be of great interest to investigate the role of iloprost in management of postoperative right heart insufficiency following cardiac transplantation.
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Eur J Cardiothorac Surg · Nov 2002
Risk of morbidity and in-hospital mortality in obese patients undergoing coronary artery bypass surgery.
Obesity is often perceived to be a risk factor for adverse outcomes following coronary artery bypass graft (CABG) surgery. Several studies have been unclear about the relationship between obesity and the risk of adverse outcomes. The aim of this study was to examine the relationship between obesity and in-hospital outcomes following CABG, while adjusting for confounding factors. ⋯ Obese patients are not associated with an increased risk of in-hospital mortality following coronary artery bypass surgery. In contrast, there is a significant increased risk of morbidities and post-operative length of stay in obese patients compared to non-obese patients.
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Eur J Cardiothorac Surg · Nov 2002
Invasive staging of non-small cell lung cancer--a prospective study.
Clinical prognosis and treatment schedules of non-small cell lung cancer (NSCLC) are dependent on tumor stage. This explains the importance of an exact pretreatment staging of the primary tumor and lymph nodes especially in locally advanced NSCLC, to differentiate between resectable and non-resectable disease. To assess the lymph node status of the upper mediastinum, the diagnostic value of mediastinoscopy is accepted to be superior to radiological methods. In contrast, thoracoscopy is not yet established as a standard staging tool. ⋯ Of the 73 prospectively studied patients with locally advanced NSCLC, 12 (16.4%) have been staged too low and 13 (17.8%) too high. If exclusively staged by radiological methods, about 34% of lung cancers have been classified incorrectly. Therefore, these tools are not a sufficient basis for diagnosis of stage III NSCLC disease. Mediastinoscopy with consecutive thoracoscopy is an essential part of the therapeutic planning in locally advanced NSCLC, and results are significantly superior to clinical staging.
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Eur J Cardiothorac Surg · Nov 2002
Recurrence-free survival and prognostic factors in resected pN2 non-small cell lung cancer.
We sought to evaluate recurrence pattern and prognostic factors of recurrence-free survival in surgically resected N2 non-small cell lung cancer. ⋯ Complete resection and responsiveness to neoadjuvant therapy were the most important favorable prognostic factors in recurrence-free survival. Postoperative chemotherapy was also a favorable prognostic factor but not statistically significant in recurrence-free survival in pN2 non-small cell lung cancer.
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Eur J Cardiothorac Surg · Nov 2002
Case ReportsTraumatic cardiogenic shock due to massive air embolism. A possible role for cardiopulmonary bypass.
Systemic arterial embolism is a potentially lethal complication of bronchopulmonary venous fistula in trauma patients with blunt chest trauma or isolated penetrating lung injury on positive pressure ventilation. A high index of suspicion, early diagnosis and management in specialized centres are keys to a successful outcome.