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Cardiothoracic AND surgery

Honggang Xia, Pengzhi Zhu, Jing Li, Deqing Zhu, Zhongyi Sun, Limin Deng, Yongmin Zhang, Dongbin Wang
This study aimed to investigate the feasibility of applying thoracoscope combined with internal support system of chest wall (ISSW) in minimally invasive internal fixation for rib fracture on patients with multiple rib fractures. A total of 84 patients undergoing open reduction and internal fixation for rib fracture from January 2017 to December 2017 in the Department of Cardiothoracic Surgery, Tianjin Hospital were selected into the study, and retrospective analyses were carried out. The clinical data, pain score, operating time, intraoperative blood loss, indwelling time of thoracic tube, total drainage volume of thoracic tube for 3 days after operation, indwelling time of wound drainage tube, total drainage volume of wound drainage tube, length of stay, hospitalization costs, postoperative complications, C-reactive protein (CRP) and pulmonary function of patients in the groups were compared...
December 2018: Experimental and Therapeutic Medicine
Damian Gimpel, Satya Shanbhag, Tushar Srivastava, Melanie MacLeod, Paul Conaglen, Nand Kejriwal, Nicholas Odom, Zaw Lin, David J McCormack, Adam El-Gamel
BACKGROUND: Enhanced recovery programs within cardiothoracic surgery are a well described benefit to patient postoperative outcomes. We describe our Australasian unit's experience of a day zero discharge enhanced recovery unit from the intensive care department. METHODS: A retrospective study was conducted on a prospectively maintained database at Waikato Cardiothoracic Unit from September 2014 till October 2017 with 1,739 patients undergoing cardiac surgery. Twenty-two (22) patients were excluded as deaths either intraoperative or in the intensive care unit (ICU) and therefore never discharged...
November 17, 2018: Heart, Lung & Circulation
Eric E C de Waal, Bas van Zaane, Marnix M van der Schoot, Albert Huisman, Faiz Ramjankhan, Wilton A van Klei, Nandor Marczin
BACKGROUND: Vasoplegia after routine cardiac surgery is associated with severe postoperative complications and increased mortality. It is also prevalent in patients undergoing implantation of pulsatile flow left ventricular assist devices (LVAD). However, less is known regarding vasoplegia after implantation of newer generations of continuous flow LVADs (cfLVAD). We aim to report the incidence, impact on outcome and predictors of vasoplegia in these patients. METHODS: Adult patients scheduled for primary cfLVAD implantation were enrolled into a derivation cohort (n = 118, 2006-2013) and a temporal validation cohort (n = 73, 2014-2016)...
December 8, 2018: BMC Anesthesiology
Jian Chen, Mingjiu Chen
To explore the changes of serum microRNA-183 levels in patients with esophageal squamous cell carcinoma (ESCC) and its clinical significance.
 Methods: Fifty-one patients with ESCC and 55 healthy subjects from Department of Cardiothoracic Surgery, Second Xiangya Hospital, Central South Unicersity were selected for this study. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to determine the level of miRNA-183 in serum samples. Chi-square test and correlation analysis were used to investigate the relationship between serum miRNA-183 level and clinical and pathological parameters of ESCC...
October 28, 2018: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
Kristen Overton, Vidthyia Mennon, Nomvuyo Mothobi, Blake Neild, Elena Martinez, Jeffrey Masters, Peter Grant, Zakir Akhunji, Wei-Yuen Su, Adrienne Torda, Claudia M Whyte, Andrew Lloyd, Chris Weatherall, Ann Hofmeyr, Hong Foo, Kim Brookes, Debbie Marriott, Vitali Sintchenko, Kate Clezy, Pam Konecny, Jeffrey J Post
There is a global outbreak of infections due to Mycobacterium chimaera associated with cardiac surgery. The most serious infections involve prosthetic material implantation, and all have followed surgical procedures involving cardiopulmonary bypass. We describe a cluster of four cases following cardiac surgery at a tertiary referral centre in Sydney, Australia. We report novel clinical findings, including haemolysis and kidney rupture possibly related to immune reconstitution inflammatory syndrome. The positive effect of corticosteroids on haemodynamic function in two cases and the failure of currently recommended antimicrobial therapy to sterilise prosthetic valve material in the absence of surgery despite months of treatment are also critically examined...
December 2018: Internal Medicine Journal
Magda Campins Martí, Blanca Borrás Bermejo, Lluis Armadans Gil
Mycobacterium chimaera (M. chimaera) is a non-tuberculous mycobacterium of the Mycobacterium avium complex. Between 2013 and April 2018, more than 140 cases of severe infection have been identified, all of them in patients who had undergone cardiothoracic surgery with extracorporeal circulation. The epidemiological investigations have shown that the majority of infections have a common source: contaminated normo-hypothermia modules. These devices have a water circuit inside and cooling fans that produce an aerosol, which can be contaminated with M...
November 30, 2018: Medicina Clínica
A C Panayi, A R Orkaby, D Sakthivel, Y Endo, D Varon, D Roh, D P Orgill, R L Neppl, H Javedan, S Bhasin, I Sinha
IMPORTANCE: Age has historically been used to predict negative post-surgical outcomes. The concept of frailty was introduced to explain the discrepancies that exist between patients' chronological and physiological age. The efficacy of the modified frailty index (mFI) to predict surgical risk is not clear. OBJECTIVE: We sought to synthesize the current literature to quantify the impact of frailty as a prognostic indicator across all surgical specialties. DATA SOURCES: Pubmed and Cochrane databases were screened from inception to 1 January 2018...
November 27, 2018: American Journal of Surgery
Subhasis Chatterjee, Jay G Shake, Rakesh C Arora, Daniel T Engelman, Michael S Firstenberg, Charles M Geller, Hitoshi Hirose, Vassyl A Lonchyna, Francis T Lytle, Rita K C Milewski, Rainer G H Moosdorf, Joseph Rabin, Rohan Sanjanwala, Marianne Galati, Glenn J Whitman
No abstract text is available yet for this article.
November 27, 2018: Annals of Thoracic Surgery
Jason M Ali, Sara Volpi, Pradeep Kaul, Giuseppe Aresu
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: Do patients undergoing pulmonary lobectomy using the non-intubated anaesthetic technique have superior clinical outcomes? Altogether, 324 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated...
November 27, 2018: Interactive Cardiovascular and Thoracic Surgery
Joseph A Dearani, Todd K Rosengart, M Blair Marshall, Michael J Mack, David R Jones, Richard L Prager, Robert J Cerfolio
The appropriate implementation of new technology, root cause analysis of "imperfect" outcomes and the continuous reappraisal of postgraduate training are needed to improve the care of tomorrow's patients. Healthcare delivery remains one of the most expensive sectors in the United States and the application of new and expensive technology that is necessary for the advancement of this complex specialty must be aligned with providing the best care for our patients. There are a several pathways to innovation; one is partnering with industry and the other is the investigational laboratory...
November 21, 2018: Annals of Thoracic Surgery
Yu-Feng Lin, Tao-Min Huang, Shuei-Liong Lin, Vin-Cent Wu, Kwan-Dun Wu
Objective: Prompt assessment of perioperative complications is critical for the comprehensive care of surgical patients. Acute kidney injury requiring dialysis (AKI-D) is associated with high mortality, yet little is known about how long-term outcomes of patients have evolved. The association of AKI-D with postsurgical outcomes has not been well studied. Methods: We investigated patients from the National Health Insurance Research Database and validated by the multicenter Clinical Trial Consortium for Renal Diseases cohort...
2018: Clinical Epidemiology
Elena Bignami, Francesco Saglietti, Antonio Di Lullo
Mechanical ventilation during surgery is a highly complex procedure, particularly in cardiothoracic surgery, where patients need to undergo substantial hemodynamic management, involving large fluid exchanges and pharmacological manipulation of vascular resistance, as well as direct manipulation of the lungs themselves. Cardiothoracic surgery is burdened by a high rate of postoperative pulmonary complication (PPC), comorbidity, and mortality. Recent trials have examined various techniques to preserve lung function, although consensus on best practice has yet to be reached...
October 2018: Annals of Translational Medicine
Zeliha Cengiz, Meral Özkan
The purpose of this study was to compare the abdominal and arm areas in the patients using subcutaneous heparin in terms of pain, hematoma, and ecchymosis development. As a result of subcutaneous heparin injections, complications such as pain, ecchymosis, and hematoma may develop in the injection site. The injection site chosen for injection is one of the factors that are effective on complications. This quasi-experimental study was conducted with 54 patients at orthopedics-traumatology and cardiothoracic surgery clinics of a university hospital...
December 2018: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
Emily Mary O'Brien, David Law, David Celermajer, Peter Watson Grant, Jon Waites
OBJECTIVE: The number of adults with congenital heart disease has increased with improvements in surgical and medical management, posing a challenge for regional and rural settings, which might have difficulties accessing specialised professionals with congenital heart disease services. This study aims to ascertain the demographics and management of adults with congenital heart disease seen by a cardiology practice in regional Australia to better understand the needs of regional adults with congenital heart disease...
November 19, 2018: Australian Journal of Rural Health
Huiting Chen, Rishi M Reddy, Sarah W Palmer, Dawn M Coleman, John R Hoch, Paul D DiMusto, John E Rectenwald
BACKGROUND: Attrition in surgical programs remains a significant problem resulting in trainee dissatisfaction and wasted time and educational dollars. Attrition rates in general surgery training programs approximate 5% per year (30% cumulative). Attrition rates in cardiovascular surgery training for the traditional vascular surgery fellowship (VSF), the vascular surgery residency (VSR), and the corresponding programs in cardiothoracic surgery have yet to be described, although they are assumed to be similar to those associated with general surgery training...
November 16, 2018: Journal of Vascular Surgery
Sherief Garrana, Santiago Martínez-Jiménez
Various disease processes may affect the ascending thoracic aorta, aortic arch, and/or descending thoracic aorta, including aneurysms, dissections, intramural hematomas, penetrating atherosclerotic ulcers, and aortic transection/rupture. Many of those conditions require surgical intervention for repair. Multiple open and endovascular techniques are used for treatment of thoracic aortic pathology. It is imperative that the cardiothoracic radiologist have a thorough knowledge of the surgical techniques available, the expected postoperative imaging findings, and the complications that may occur to accurately diagnose life-threatening pathology when present, and avoid common pitfalls of misinterpreting normal postoperative findings as pathologic conditions...
January 2019: Radiologic Clinics of North America
Heidi-Mari P Myllykangas, Paula K Mustonen, Jari K Halonen, Leena T Berg
Objectivs There are multiple treatment strategies and flap options to cover defects after deep sternal wound infections and other similar sternal defects. The choice of flap is made according to surgeons' preferences and the size and location of the defect. Our aim is to introduce a new option to cover these kinds of defects with an internal mammary artery perforator flap combined with a pectoralis major muscle flap mostly raised with a muscle-sparing technique. Design We treated 13 patients with a sternal defect after cardiothoracic operations with this technique between 2010-2016...
November 17, 2018: Scandinavian Cardiovascular Journal: SCJ
Mariya Geube, Balaram Anandamurthy, Jean-Pierre Yared
Perioperative management of patients undergoing lung transplantation is one of the most complex in cardiothoracic surgery. Certain perioperative interventions, such as mechanical ventilation, fluid management and blood transfusions, use of extracorporeal mechanical support, and pain management, may have significant impact on the lung graft function and clinical outcome. This article provides a review of perioperative interventions that have been shown to impact the perioperative course after lung transplantation...
January 2019: Critical Care Clinics
Dean Kerenick, Josh Clore, Julian Jakubowski
A healthy, 42-year-old woman presented to a local community hospital with abdominal pain and left arm pain after laser stone ablation and ureteral stenting performed earlier that day. She was diagnosed with a spontaneous aortic thrombus and embolization of the radial, ulnar and splenic arteries and transferred to a tertiary care facility for cardiothoracic surgery evaluation. This case report discusses her emergency department course, disposition, and one-year outcome.
November 2018: Clinical practice and cases in emergency medicine
Linda J Demma, David Faraoni, Anne M Winkler, Toshiaki Iba, Jerrold H Levy
: We evaluated clinical and laboratory biomarkers of disseminated intravascular coagulation (DIC) following cardiac surgery in the cardiothoracic surgical ICU (CTICU) to predict mortality. We retrospectively analyzed CTICU patients with suspected DIC identified from the hospital laboratory database, and calculated International Society on Thrombosis and Haemostasis (ISTH) and the Japanese Association for Acute Medicine (JAAM) DIC scores to predict DIC-related mortality. The predictive accuracy of the JAAM and ISTH DIC scoring system were then assessed by logistic regression analysis and receiver operative characteristics analysis, and compared to other potential predictors of mortality (e...
November 13, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
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