The Annals of thoracic surgery
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Comparative Study
Cardiac surgery in Jehovah's Witness patients: ten-year experience.
Cardiac surgery in Jehovah's Witnesses poses unique challenges. We have developed a comprehensive multimodality program for these patients and have obtained excellent results. ⋯ Bloodless cardiac surgery in Jehovah's Witness patients can be performed with excellent outcomes in both elective and urgent situations. Mortality rates for isolated coronary artery bypass graft surgery and isolated aortic valve replacement are within the expected 95% confidence intervals of STS predicted mortality.
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Acute kidney injury (AKI) after cardiac surgery confers a significant increased risk of death. Several risk models have been developed to predict postoperative kidney failure after cardiac surgery. This systematic review evaluated the available risk models for AKI after cardiac surgery. ⋯ A validated score to predict AKI not requiring dialysis is lacking. Further studies are required to develop risk models to predict milder AKI not requiring dialysis after cardiac surgery. Standardizing risk factor and AKI definitions will facilitate the development and validation of risk models predicting AKI.
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Comparative Study
High-dose tranexamic acid is an independent predictor of early seizure after cardiopulmonary bypass.
Risk factors associated with early seizure after cardiopulmonary bypass (CPB) were examined. The role of tranexamic acid in seizure development was evaluated. ⋯ High-dose tranexamic acid (≥100 mg/kg) is independently associated with an increased risk of early seizure. Future tranexamic acid trials should assess the blood-conserving effect of tranexamic acid at a lower dosage and specifically monitor for seizure occurrence.
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Histoplasmosis in the mediastinum is an uncommon diagnosis that presents similarly to other benign and neoplastic conditions encountered in the chest. Here we describe a 36-year-old woman who presented with dyspnea secondary to a large anterior mediastinal mass that was biopsy and culture negative for neoplasm or infection. Video-assisted thoracoscopic surgery biopsy confirmed a large anterior mediastinal mass adherent to the aorta, which contained foci of histoplasmosis species. She is currently undergoing a long postoperative course of itraconozole and an empiric course of oral steroids to prevent development of fibrosing mediastinitis.