The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Apr 2013
Comparative StudyCollagen gentamicin for prevention of sternal wound infection: effective or not?
Prophylactic local application of collagen-gentamicin sponges for prevention of sternal wound infections (SWI) after cardiac surgery has been used routinely in risk patients for several years at our center. However, a recent US study failed to show a significant reduction in SWI with the prophylaxis. Therefore, a systematic reevaluation of the effect of local collagen gentamicin was conducted. ⋯ The use of local collagen-gentamicin prophylaxis was associated with an approximately 70% reduction in the rate of SWI compared with standard intravenous antibiotic prophylaxis alone.
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Thorac Cardiovasc Surg · Apr 2013
Comparative StudyTiming of heparin and thrombus formation in donor lungs after cardiac death.
Heparin is routinely administered to brain-dead donors before cardiac arrest, although it is not universally allowed for donation after cardiac death (DCD) donors due to concerns that death may be hastened. The lack of heparin may lead to thrombosis and compromised graft function. We evaluated the impact of timing of heparin administration and thrombi formation in a DCD pig model. ⋯ Delayed heparin administration after cardiac death does not affect thrombus formation in an animal model of lung procurement after cardiac death. Concern about clinically significant thrombosis occurring when heparin is not given before cardiac arrest appears unfounded. These findings suggest that DCD lungs can be used regardless of antemortem heparin administration.
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Thorac Cardiovasc Surg · Mar 2013
Intrathoracic muscular transposition in chronic tuberculous empyema.
The effective management of chronic tuberculous empyema requires an evacuation of pus and a re-expansion of the lung or an obliteration of the empyema space such as closed thoracostomy, decortication, or open window thoracostomy (OWT) followed by intrathoracic muscular transposition (IMT). However, the most effective management of chronic tuberculous empyema is still debatable. ⋯ This study suggests that IMT may be an effective option to control infection or BPF in chronic tuberculous empyema.
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Thorac Cardiovasc Surg · Mar 2013
Comparative StudyComplete mediastinal lymph node dissection in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy.
Although video-assisted thoracic surgery (VATS) lobectomy has been used more and more frequently for the treatment of patients with early-stage lung cancer, controversies are mainly focused on whether the complete mediastinal lymph node dissection (MLND) can be achieved by VATS. This retrospective study aimed to compare the validity of MLND between VATS and open thoracotomy. ⋯ Our early experience suggests that, with regard to the number of the dissected lymph nodes, VATS lobectomy can achieve complete MLND, compared with the traditional approach. MLND by VATS is technically feasible and safe for early-stage lung cancer.
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Thorac Cardiovasc Surg · Mar 2013
Severity of chronic obstructive pulmonary disease and its relationship to lung cancer prognosis after surgical resection.
The purpose was to determine the rates of postoperative pulmonary complications, and to clarify the impact of COPD on long-term survival in lung cancer patients after surgical resection. ⋯ Higher COPD grades had higher rates of postoperative pulmonary complications and poorer long-term survivals because of higher rates of cancer-related deaths.