The Annals of thoracic surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Cefamandole versus cefonicid prophylaxis in cardiovascular surgery: a prospective study.
We randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. Three hundred fifty-seven patients were evaluable for prophylactic efficacy. ⋯ Twenty-five miscellaneous postoperative infections (urinary tract infection, pneumonia, intravenous site infection, bacteremia, sepsis, Clostridium difficile diarrhea) occurred in 16 patients (9.19%) in the cefonicid group and four in 4 patients (2.19%) in the cefamandole group (p = 0.003). These data indicate that cefamandole is superior to cefonicid in preventing both surgical wound infections and miscellaneous nonsurgical infections after cardiovascular operations.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intraoperative cryoanalgesia for postthoracotomy pain relief.
In a randomized study, 63 patients were investigated for the benefits of cryoanalgesia after thoracotomy. Analgesia and its dependent effects such as enhancement of mobility, respiratory function, and reduced need of narcotics were evaluated. ⋯ However, moderate to severe neuralgia was found in a number of patients in the cryoanalgesia group in the late postoperative period. Cryoanalgesia for pain relief after thoracotomy is not recommended.
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Randomized Controlled Trial Clinical Trial
Mitral valve annuloplasty: the effect of the type on left ventricular function.
This study was undertaken to determine whether rigid-ring annuloplasty and flexible-ring annuloplasty have the same effect on left ventricular function in patients with chronic mitral regurgitation secondary to degenerative disease of the mitral valve. Twenty-five patients who underwent isolated mitral valve repair and required annuloplasty were randomized into two groups: rigid-ring and flexible-ring annuloplasty. Left ventricular function was assessed by echocardiography and radionuclide angiography on the day before operation and 2 to 3 months later. ⋯ The left ventricular end-systolic diameter and volume decreased significantly only in patients with a flexible annuloplasty ring. Left ventricular systolic function as assessed by pressure-volume relationships was significantly better in patients with a flexible ring (p less than 0.02 by analysis of covariance), and left ventricular performance measured by stroke volume-end-diastolic volume relationships was also better in these patients (p less than 0.05 by analysis of covariance). These data indicate that patients with a flexible annuloplasty ring have better left ventricular systolic function than patients with a rigid annuloplasty ring 2 to 3 months after mitral valve reconstruction for chronic mitral regurgitation secondary to degenerative disease of the mitral valve.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antibiotic prophylaxis in open-heart surgery: a comparison of cefamandole, cefuroxime, and cefazolin.
We undertook a prospective randomized evaluation of cefamandole nafate, cefuroxime sodium, and cefazolin sodium as prophylaxis in open-heart operations. A total of 903 patients having an elective procedure were enrolled in the study, and 620 of them were eventually considered evaluable. There were no significant differences between the three study groups. ⋯ The presence of multiple severe underlying conditions was a risk factor for infection, independent of the antibiotic used. We conclude that there are no differences in the efficacies of the three agents in preventing postoperative infections in patients having open-heart operation. Cefuroxime, principally because of its every-12-hour dose, is far less expensive than cefamandole or cefazolin.
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Randomized Controlled Trial Clinical Trial
The effect of transcutaneous electrical nerve stimulation on pain after thoracotomy.
The effect of postoperative transcutaneous electrical nerve stimulation (TENS) was evaluated in 24 patients in two randomly selected groups who underwent thoracotomy. The patients in one group received TENS through periincisional electrodes, and the remaining patients were treated with sham stimulator setups. ⋯ Patients in the TENS group had significantly lower pain scores during the first 24 hours postoperatively (p = 0.014), shorter recovery room stays (p = 0.013), and better tolerance of chest physical therapy on both day 1 (p = 0.018) and day 2 (p = 0.006). No respiratory complications occurred in either group.