Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2011
Case ReportsA ruptured mature teratoma in which follow-up computed tomography observation at short intervals was useful for a definitive diagnosis.
Rupture of mature mediastinal teratomas occasionally occurs, necessitating prompt surgical treatment. However, the clinical presentation of a ruptured teratoma can resemble that of pneumonia and/or pleuritis. We report a case of mediastinal teratoma rupture, in which follow-up computed tomography (CT) a short-interval after the first CT was useful for definitive diagnosis. ⋯ Eighteen hours later, a repeat CT-revealed an increase in the soft tissue area of the chest wall adjacent to the tumor, which led to the definitive diagnosis of ruptured teratoma, and immediate resection was performed. The histological diagnosis was a mature teratoma, and rupture was confirmed by the high lipase level in the pleural fluid. The patient's postoperative course was uneventful.
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Interact Cardiovasc Thorac Surg · May 2011
ReviewWhat is the best treatment for malignant pleural effusions?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether chemical pleurodesis is superior to catheter drainage or pleuroperitoneal shunts (PPS) in the management of patients with pleural effusions. Overall 161 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. ⋯ Pleurodesis success rates varied from 57.1% to 95% with a complication rate of 14.8%. PPSs were shown to produce lower success rates (57.1% vs. 92.3%), shorter survival lengths (4.3 ± 1.9 vs. 6.7 ± 2.1 months) and higher complication rates (14.3% vs. 2.8%) than talc pleurodesis. Overall, chemical pleurodesis is the optimal treatment option for MPE with use of chronic intrapleural catheters reserved in cases where talc pleurodesis is not possible.
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Interact Cardiovasc Thorac Surg · May 2011
ReviewShould double lung transplant be performed with or without cardiopulmonary bypass?
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether double lung transplantation should be performed with or without cardiopulmonary bypass (CPB) in order to improve postoperative clinical outcomes. Altogether 386 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. ⋯ Those papers suggesting no deleterious effects of CPB generally measured similar postoperative outcomes to those mentioned above, with one study also assessing incidence of primary graft failure, which was not significantly different (P = 0.37). We conclude that CPB should continue to be used where clinically indicated for a specific reason (for example, where there is pulmonary hypertension or a requirement for concomitant cardiac repair). However, given that the evidence for using CPB for all elective cases is relatively weak, and the fact that there are strong arguments in the literature for both methods, either approach would be clinically acceptable.
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Interact Cardiovasc Thorac Surg · May 2011
ReviewIs pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether pleurectomy/decortication (P/D) is superior to palliative care in the treatment of patients with malignant pleural mesothelioma (MPM). Overall 80 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. ⋯ Prolonged air-leak and postoperative empyema complicated 9.8% and 4% of patients, respectively. P/D is a morbid operation that is associated with significant perioperative mortality and complication rates. Although a number of retrospective studies have shown a small benefit in survival with P/D, the heavily documented similarity in patient outcomes between P/D and extrapleural pneumonectomy along with the results of the Mesothelioma and Radical Surgery trial, should induce the surgical community to consider the use of P/D only in patients with malignant mesothelioma enrolled in prospective trials.
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Interact Cardiovasc Thorac Surg · May 2011
ReviewDoes positron emission tomography offer prognostic information in malignant pleural mesothelioma?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether positron emission tomography is useful in the diagnosis and prognosis of malignant pleural mesothelioma (MPM). Altogether 136 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. ⋯ Overall, PET accurately diagnoses MPM, predicts survival and disease recurrence. It can guide further management by predicting the response to chemotherapy and excluding surgery in patients with extrathoracic disease. Combined PET-CT has additional benefits in accurately staging disease.