Cardiovascular surgery (London, England)
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Clinical Trial
Treatment of thoracic outlet syndrome with combined scalenectomy and transaxillary first rib resection.
Of a total of 225 patients with suspected thoracic outlet syndrome, 37 (16.4%) underwent surgery. Some eight patients required bilateral operations. One patient had a cervical rib and one a prominent C7 transverse process. ⋯ Similar results were achieved in the patients' subjective evaluation with approximately 50% reporting an excellent outcome, about 40% good and 10% fair. A poor result was not recorded in those who underwent combined scalenectomy and transaxillary first rib resection. A radical surgical approach combining scalenectomy and transaxillary first rib resection is advocated to minimize the recurrence rate and improve results.
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This study evaluated the use of monitoring blood levels of the isoenzyme of creatine phosphokinase, troponin T (tnT) and myosin in the detection of perioperative myocardial damage after coronary artery surgery. Serial blood samples were collected in 24 patients undergoing myocardial revascularization. The patients were retrospectively divided into three groups: group A with no changes in their electrocardiogram; group B showing non-specific signs of perioperative myocardial infarction such as deep and permanent T wave inversion; and group C with definite electrocardiographic signs of perioperative myocardial infarction (new persistent Q-waves and loss of R-waves). ⋯ Peak values of troponin T and myosin in groups B and C were statistically different from those in group A (P < 0.001). These results suggest that troponin T and myosin are reliable indicators of perioperative myocardial damage. In particular, troponin T may allow the differentiation of reversible from irreversible myocardial injury.