The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2012
Early readmission for congestive heart failure predicts late mortality after cardiac surgery.
Early readmission in patients hospitalized for medical congestive heart failure is common, expensive, and associated with a worse late survival. Our objective was to compare late survival in patients' readmission for congestive heart failure with readmission for other causes in patients undergoing cardiac surgery. ⋯ Readmission within 30 days after cardiac surgery for congestive heart failure predicts late mortality. Targeted postoperative management may be warranted in patients with surgical congestive heart failure.
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Laparoscopic fundoplication for gastroesophageal reflux disease has been associated with excellent symptom control. Compared with medical treatment, laparoscopic Nissen fundoplication has shown favorable control of typical reflux symptoms. However, in approximately 2% to 17% of patients, surgical treatment fails. The role of reoperative repair for reflux disease and the factors that contribute to it are examined.
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The biomolecular era is rapidly becoming shaped around the supreme interest in targeted therapy for patients with non-small cell lung cancer. Tissue analysis has become crucial in the definition of biomarkers and genomic signatures able to predict the response to treatment or even survival. ⋯ When needed for immunohistochemical characterization, investigators are ready to request "research biopsies" to consolidate tissue availability for clinical trials, translational research, and in biobanks. With unique and diverse tools in the surgical armamentarium, the thoracic surgeon plays a central role in this new multidisciplinary professional environment, actively participating in creating the foundations of the biomolecular era.
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Repetitive deliberate practice results in the development of professional expertise. In training thoracic surgeons, this concept was incorporated by long hours and years of training. Today, the landscape has changed, and residents are no longer allowed to work such hours. ⋯ The incorporation of simulation into resident education will allow us to increase the hours of practice for a given technique and develop expertise before needing it in the operating room. Currently, very few models are available for these purposes. However, the increasing interest in the development and validation of these models to support the education of our residents will allow for progress in the near future.