Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Jun 2011
Randomized Controlled TrialStreptokinase for malignant pleural effusions: a randomized controlled study.
Effective palliative treatment in malignant pleural effusion can only be carried out when the lung is fully expanded after drainage of effusion. We investigated the efficacy of intrapleural fibrinolytics for lysing fibrin deposits and improving lung reexpansion in patients with malignant pleural effusion. We randomly allocated 47 patients with malignant pleural effusion into 2 groups: a fibrinolytic group of 24 were given 3 cycles of 250,000 U intrapleural streptokinase; the control group of 23 received pleural drainage only. ⋯ Lung reexpansion was adequate for performing talc pleurodesis in 96% of patients in the fibrinolytic group and 74% in the control group. In the fibrinolytic group, the mean volume of daily pleural drainage before streptokinase administration was 425 mL, and it increased significantly to 737 mL after streptokinase infusion. Intrapleural administration of streptokinase is advisable for patients with malignant pleural effusion.
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Asian Cardiovasc Thorac Ann · Jun 2011
N1 non-small-cell lung cancer. A 20-year surgical experience.
N1 non-small-cell lung cancer has heterogeneous prognosis in relation to node descriptors. There is no agreement on the ideal type of resection. A new classification of N1 descriptors was proposed in the 7(th) edition of the TNM staging system. ⋯ Multivariate analysis showed that the number of N1 zones and type of resection were independent prognostic factors. Patients with hilar nodal, multiple-level, or multiple-zone involvement had poor prognosis. Standard lobectomy remains the procedure of choice, but in cases of fixed nodes in the hilar zone, sleeve resection or even pneumonectomy should be considered.
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Asian Cardiovasc Thorac Ann · Jun 2011
Mitral valve prosthesis implanted in atrial wall over huge calcified annulus.
We describe an alternative technique for mitral valve replacement in patients with severe mitral annular calcification, in whom conventional techniques are not feasible. A new annulus that allows supra-annular prosthetic implantation is created.
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Between July 1997 and August 2004, 92 patients with irreparable mitral valves underwent replacement with a pulmonary autograft. This report brings the follow-up data of these patients up to date. Eighty-eight patients had a successful Ross II operation; 4 were lost to follow-up. ⋯ These data compare favorably with those of mitral valve replacement using modern bioprostheses. This procedure remains an option for the relatively young patient when life-long anticoagulation is contraindicated or impractical. It is also an option to consider in infants with complex irreparable mitral valve disease.