The Annals of thoracic surgery
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We report an 8-year-old girl whose unilateral pulmonary arteriovenous fistula (PAVF) disappeared after we redirected hepatic venous blood to the affected lung. This case provides strong evidence that formation of a PAVF depends only on the presence or absence of hepatic venous blood in the pulmonary circulation.
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Hemodilution continues to be widely used during cardiopulmonary bypass (CPB) for both adults and children. Previous studies with nonbypass models have suggested that an increase in cerebral blood flow (CBF) compensates for the reduced oxygen-carrying capacity; however, this increased CBF is achieved by an increase in cardiac output. We hypothesized that even with the fixed-flow perfusion of CPB, CBF would be increased during hemodilution. ⋯ Hemodilution is associated with decreased perfusion pressure, increased CBF and increased the cerebral metabolic rate of oxygen during hypothermic CPB.
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Off-pump coronary artery bypass grafting (OPCAB) has gained wide acceptance in tandem with the development of the stabilizer and associated operative techniques. However bypass grafting to the small branches of a beating heart is technically demanding and remains controversial. In the present study we evaluated the graft patency and quality of anastomoses to small coronary arteries by early postoperative angiography. ⋯ OPCAB to small coronary artery branches with arterial grafts provided satisfactory graft patency and stenosis free rates.
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Computed tomography (CT) is the most common method of staging lung cancer. We have previously shown endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) to be highly accurate in staging patients with nonsmall cell lung cancer (NSCLC) who have enlarged mediastinal lymph nodes on CT scan. In this study we report the accuracy and yield of EUS-FNA in staging patients without enlarged mediastinal lymph nodes by CT. ⋯ Endoscopic ultrasound guided fine needle aspiration can detect advanced mediastinal disease and avoid unnecessary surgical exploration in almost one of four patients who have no evidence of mediastinal disease on CT scan. In addition to previously reported results in patients with enlarged lymph nodes on CT, these data suggest that all potentially operable patients with nonmetastatic NSCLC may benefit from EUS staging.
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Case Reports
Surgical resection of recurrent bilateral mediastinal liposarcoma through the clamshell approach.
Primary mediastinal liposarcoma is an unusual variant of mediastinal neoplasms. We describe a long-term survivor who underwent repeated operations. ⋯ The patient is currently well 16 years after the first operation. Aggressive surgical intervention whenever possible appears to improve the quality of life and prolong the survival of patients with mediastinal liposarcoma.