The Annals of thoracic surgery
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Case Reports
Successful therapy of severe pneumonia-associated ARDS after pneumonectomy with ECMO and steroids.
Pneumonia and acute respiratory distress syndrome are life-threatening complications after pneumonectomy carrying high mortality. Because pulmonary reserve is inadequately low, an effective therapeutic strategy is needed to treat hypoxia. ⋯ We report a case of successful extracorporeal membrane oxygenation therapy in a patient with pneumonia-associated acute respiratory distress syndrome after pneumonectomy. Methylprednisolone therapy caused a dramatic improvement of pulmonary and systemic organ function.
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We report the experience of a single institution with the minimally invasive resection of mediastinal masses using the da Vinci robotic surgical system. ⋯ These preliminary results of our series suggest that application of the da Vinci robotic surgical system for resection of selected mediastinal masses is technically feasible and safe. It provides an alternative to open approaches and "conventional" thoracoscopy. Nevertheless, this new technique requires further investigation in larger series and longer follow-up.
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S100beta has been used in cardiac surgery to identify patients with postoperative neurologic complications. However, extracranial proteins may falsely elevate measurements of serum S100beta;. Objectives of this study were (1) to quantify S100 beta levels in serum and pericardial cavity during coronary artery bypass grafting (CABG), and (2) to identify proteins recognized by standard immunodetection as S100beta. ⋯ S100beta immunoassays are not specific for S100a and give a falsely elevated reading due to contaminants from the surgical field that cross react with the assay's antibody. This does not appear to be an issue in nonsurgical patients. Caution must be exerted when evaluating immunodetection results for low-abundance proteins under conditions where contamination of the sample is likely.
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The outcome in patients treated by conventional coronary artery bypass grafting (CABG) for coronary artery disease is negatively influenced by the presence of diabetes. The relative effect of diabetes in patients undergoing isolated minimally invasive revascularization of the left anterior descending artery (LAD) using the internal thoracic artery (ITA) has as yet not specifically been looked at. Thus, this study sought to evaluate the impact of diabetes on mid-term outcome following minimally invasive coronary artery bypass grafting (MIDCAB). ⋯ The results support diabetes to be an independent risk factor for outcome in patients with MVD undergoing a MIDCAB procedure in analogy to those undergoing CABG procedures. Diabetics with isolated disease of the LAD, however, benefit out of proportion from this treatment modality.