J Cardiovasc Surg
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Comparative Study
Apolipoprotein E4 genotype increases the risk of postoperative cognitive dysfunction in patients undergoing coronary artery bypass graft surgery.
The aim of this study was to investigate the association between the presence of ApoE4 and the incidence of postoperative cognitive dysfunction (POCD) after cardiac surgery. ⋯ This study suggests an association between ApoE4 and early POCD, but further studies are needed to clarify a causative association. Such new studies should include a more homogenous patient sample and a longer follow-up.
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Lung transplantation has had increasing success worldwide and it became an acceptable treatment modality in end-stage pulmonary diseases. The insufficient supply of donor lungs, resulting in prolonged waiting time, and the significant rise of patients on the waiting list, have forced the most experienced transplantation centers to redefine the acceptable lung donor criteria including marginal allografts. ⋯ Recent studies have demonstrated that the use of marginal donors did not affect early and late recipient outcome, and significantly increased the number of transplants performed. The aim of this paper is to review how the main lung donor selection criteria have been changed and how they influence the recipient outcome.
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Randomized Controlled Trial
Thoracoscopic localization techniques for patients with solitary pulmonary nodule: radioguided surgery versus hookwire localization.
The aim of this study is to compare 2 different methods for localization of peripheral pulmonary lesions requiring thoracoscopic resection: radioguided surgery (still considered an innovative method) and computed tomography-guided hookwire localization. ⋯ On the basis of our experience, the conclusion is drawn that this methods has been proven efficacious in the diagnosis of SPN, and video-assisted thoracoscopy allows for the removal of pulmonary nodules without complications.
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Randomized Controlled Trial
General anesthesia with thoracic epidural anesthesia in the cardiopulmonary bypass surgery reduces apoptosis by upregulating antiapoptotic protein Bcl-2.
The aim of the paper was to investigate whether thoracic epidural anesthesia (TEA) together with general anaesthesia (GA) play a role on apoptosis in humans before cardiopulmonary bypass (CPB), before aortic cross clamp (ACC) and at 15 min after ACC release (after ischemia and reperfusion). ⋯ The result of the present study indicate that TEA plus GA in coronary surgery had preserved cardiac function during intraoperative and postoperative period by means of reduced apoptosis, improved hemodynamic function and reduced arrhythmias after release of the ACC.
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With an aging population, atherosclerotic manifestations are steadily increasing. Beside the anatomical and pathophysiological preoperative risk-factors accompanying perioperative risk-factors like patient's age, length of operation, blood loss and skill of the surgeon, all need to be accounted for when assessing the risk of morbidity and mortality after vascular surgery. The demand for cost effectiveness may make a risk-score system useful. The aim of the present study was, therefore, to prospectively apply various scoring systems in order to estimate outcome in patients undergoing aortobifemoral surgery due to arterial occlusive disease at the aorto-iliac level. ⋯ It can be concluded that none of the systems analyzed separately was useful for determining morbidity and mortality. We still lack a system, that can be used preoperatively in an individual case and the vascular surgeon still has to build up his own clinical judgement or to transfer a clinical judgement.