The Annals of thoracic surgery
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Comparative Study
Early and late results of graft replacement for dissecting aneurysm of thoracoabdominal aorta in patients with Marfan syndrome.
When treating dissecting aneurysm of the thoracoabdominal aorta surgically in patients with Marfan syndrome, we have usually performed graft replacement- including the entire thoracoabdominal aorta and reconstruction of all visceral branches, even if dilatation is mild in some segments-to avoid further aortic operations in the follow-up period. ⋯ Graft replacement for dissecting aneurysm of the thoracoabdominal aorta in Marfan syndrome offers good early and long-term results. We believe total aortic replacement including the entire thoracoabdominal aorta and reconstruction of all visceral arteries should be recommended for selected patients with Marfan syndrome.
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Metastatic pulmonary angiosarcomas frequently present with pneumothorax, especially those arising from the scalp. The metastases on chest radiographs are initially subtle and easily missed. ⋯ We report a patient who presented with pneumothorax and lung cysts before his primary scalp angiosarcoma was diagnosed. This case highlights the sometimes ominous nature of innocuous-looking, thin-walled cystic pulmonary lesions.
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Recent literature suggests that a restrictive approach to red blood cell transfusions is associated with improved outcomes in cardiac surgery patients. Even in the absence of bleeding, intravascular fluid shifts cause hemoglobin levels to drift postoperatively, possibly confounding the decision to transfuse. The purpose of this study was to define the natural progression of hemoglobin levels in postoperative cardiac surgery patients. ⋯ In this report of hemoglobin drift after cardiac surgery, although all postoperative patients experienced downward hemoglobin drift, 79% of patients exhibited hemoglobin recovery before discharge. Physicians should consider the eventual upward hemoglobin drift before administering red blood cell transfusions.
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Multicenter Study Comparative Study
Potts shunt in children with idiopathic pulmonary arterial hypertension: long-term results.
Idiopathic pulmonary arterial hypertension (IPAH) remains a progressive fatal disease. Palliative Potts shunt has been proposed in children displaying suprasystemic IPAH. ⋯ Palliative Potts shunt constitutes a new alternative to lung transplantation in severely ill children with suprasystemic IPAH, carrying a prolonged survival and persistent improvement in functional capacities.
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Comparative Study
The role of consolidation therapy for stage III non-small cell lung cancer with persistent N2 disease after induction chemotherapy.
Persistent pathologic mediastinal nodal involvement after induction chemotherapy and surgical resection is a negative prognostic factor for stage III-N2 non-small cell lung cancer patients. This population has high rates of local-regional failure and distant failure, yet the effectiveness of additional therapies is not clear. We assessed the role of consolidative therapies (postoperative radiation therapy and chemotherapy) for such patients. ⋯ Aggressive consolidative therapies may improve outcomes for patients with persistent N2 disease after induction chemotherapy and surgery.