The Annals of thoracic surgery
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There is little objective evidence concerning the outcome of thoracic surgical patients who suffer postoperative complications. We assessed the outcome and cost of care for patients admitted to the intensive care unit after initial recovery from pulmonary resection in a high dependency unit. ⋯ Patients who suffer complications after lung resection and require salvage intensive care, particularly mechanical ventilation, have a poor prognosis. In the light of this data the onset of two-organ failure should prompt an informed discussion as to whether escalation of treatment is in the patient's best interest.
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Inadequate data exist regarding the management of acute major pulmonary embolism. Various modalities that are used, including thrombolytics and embolectomy, have not been shown to conclusively improve mortality when compared to heparin. In the past, open pulmonary embolectomy was reserved for patients with severe hemodynamic instability because of its high mortality rate. Our objective was to analyze our experience with early embolectomy as an alternative for the treatment of major pulmonary embolism. ⋯ Open pulmonary embolectomy can be performed in patients with major pulmonary embolism with minimal mortality and morbidity. It may prevent the development of chronic thromboembolic pulmonary hypertension and should be a part of the algorithm in the treatment of major pulmonary embolism.
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Although chemokines are functionally important in models of ischemia-reperfusion injury, little is known about their role in lung ischemia-reperfusion injury (LIRI). This study examined the role of the beta-chemokines, macrophage inflammatory protein (MIP)-1alpha, monocyte chemoattractant protein (MCP)-1, and regulated upon activation normal T cells expressed and secreted (RANTES) in LIRI. ⋯ MIP-1alpha is functionally significant in the development of LIRI. It likely exerts its effects in part by mediating the expression of proinflammatory and antiinflammatory cytokines and influencing tissue neutrophil recruitment. MCP-1 and RANTES seem to play relatively minor roles in the development of direct LIRI.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial.
To evaluate hospital mortality and morbidity after myocardial revascularization in a prospective and multicenter study, comparing on-pump versus off-pump in a special subset of patients with lesions in the left descending artery, alone or associated with the right coronary artery. ⋯ We did not find any statistical difference in hospital mortality and morbidity using on-pump or off-pump techniques for low-risk patients.