J Cardiovasc Surg
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Case Reports
Tuberculous aortitis, ruptured 48 years after therapeutic implantation of synthetic balls.
A case of tuberculous aortitis, ruptured 48 years after an implantation of synthetic balls into the extrapleural space was reported. Those balls were implanted as a therapeutic alternative to artificial pneumothorax for treating pulmonary tuberculosis. Free perforation was triggered by debridement of an expanding cold abscess. A tuberculous abscess adjacent to the arterial wall should be carefully managed even in the absence of the blood flow by image analysis.
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Hemothorax may be immediately life-threatening or lead to complications like empyema and fibrothorax. The first step of management is the placement of a tube thoracostomy which is efficacious in more than 80% of cases. Continuous bleeding and retained blood, instead, require surgical treatment. ⋯ Videothoracoscopy seems to be safe and effective in the treatment of hemothorax. To avoid prolonged operations, conversions to thoracotomy and complications, it should be performed as soon as possible. Actually only massive hemorrhages justify the thoracotomic approach.
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The purpose of this study, was to assess the incidence of and predictors for mortality and morbidity in patients who required postoperative intra-aortic balloon pump (IABP) support. ⋯ The incidence of IABP insertion in our institution was 1.5%. Mortality rate is similar to mortality of other studies in which the IABP has been inserted in the postoperative period. We have found that timing of IABP insertion, thrombocytopenia, presence of peripheral vascular disease and the redo intervention are independent predictors of mortality. We also found that female sex, diabetes, history of cigarette smoking and preoperative use of antiplatelet drugs are independent predictors of limb ischemia. The following factors are instead independent predictors of renal insufficiency: postoperative ejection fraction lower than 40% and non use of dobutamine in the postoperative period.
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Randomized Controlled Trial Comparative Study Clinical Trial
Surgical tracheostomy versus percutaneous dilatational tracheostomy. A prospective-randomized study with long-term follow-up.
To compare surgical tracheostomy (ST) versus percutaneous dilatational tracheostomy (PDT) in terms of complication rates. In particular we specifically studied the late tracheal complications of both methods by means of endoscopic controls of patients up to 6 months after the procedures. ⋯ This study confirms that PDT is a simpler and quicker procedure than ST and that it has a lower rate of early postoperative complications. Late tracheal complications were more frequent, although the difference was not statistically-significant, in the PDT group. Further investigations of long-term outcome following PDT are therefore necessary.
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Randomized Controlled Trial Clinical Trial
Renal dose dopamine in open heart surgery. Does it protect renal tubular function?
This prospective, randomized study assessed the effect of dopamine on renal tubular function in patients who had coronary artery bypass grafting. ⋯ Consequently, in patients with normal preoperative renal and cardiac function scheduled for elective coronary artery bypass grafting, renal dose dopamine infusion alone may not provide sufficient protection on tubular function and increases renal tubular injury during the early postoperative period.