The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Dec 2010
Case ReportsResection of giant typical carcinoid tumor with cardiopulmonary bypass support.
Carcinoids, defined as well-differentiated neuroendocrine tumors, are classified as typical or atypical based on their microscopic pathological features. Typical carcinoids have a favorable prognosis after complete resection, with 10-year survival rates of up to 90%. We present the surgical strategy used to achieve a left pneumonectomy and the indications for cardiopulmonary bypass (CPB) support in a patient with a huge typical carcinoid tumor.
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Thorac Cardiovasc Surg · Dec 2010
Comparative StudyPeripheral versus central cannulation for extracorporeal membrane oxygenation: a comparison of limb ischemia and transfusion requirements.
Extracorporeal membrane oxygenation (ECMO) can be instituted centrally, through the right atrium and ascending aorta, or peripherally, most commonly using the femoral artery and vein. We sought to investigate the impact of the mode of cannulation on the incidence of limb ischemia, perfusion and overall morbidity. ⋯ Our results suggest that there is comparable tissue perfusion and limb ischemia with both cannulation techniques. Central cannulation is associated with a higher incidence of bleeding, higher transfusion rates, a greater need for reoperation and greater resource utilization. Therefore, peripheral cannulation is safe and may be advantageous in certain clinical scenarios.
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Thorac Cardiovasc Surg · Oct 2010
Case ReportsCavitating lymph node metastasis demonstrated by endobronchial ultrasound.
Cavitation of primary non-small cell lung carcinoma (NSCLC) occurs in a small number of patients. We report a case of cavitation of lymph node metastases in NSCLC. ⋯ Cystic necrosis was only demonstrable by EBUS. The incidence of such findings is unknown, however with the increasing use of EBUS for evaluation of the mediastinum such images may be more commonly encountered in the future.
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Thorac Cardiovasc Surg · Oct 2010
Prognostic value of daily cardiac surgery score (CASUS) and its derivatives in cardiac surgery patients.
We aimed to validate the usefulness of CASUS derivatives for cardiac surgery patients and their reliability for daily decision making. ⋯ CASUS derivatives including δ CASUS have a good prognostic value for cardiac surgery patients with regard to the prediction of mortality and survival during ICU stay, with the exception of total CASUS which was not informative.
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Thorac Cardiovasc Surg · Oct 2010
Comparative StudyEarly reintubation after cardiac operations: impact of nasal continuous positive airway pressure (nCPAP) and noninvasive positive pressure ventilation (NPPV).
Due to an increasing number of comorbidities there is still a significant incidence of respiratory failure after primary postoperative extubation in patients who undergo cardiosurgery. We wanted to study whether nCPAP could improve pulmonary oxygen transfer and avoid the necessity for reintubation after cardiac surgery. Additionally, we compared this protocol to noninvasive positive pressure ventilation (NPPV). ⋯ We conclude that reintubation after cardiac operations should be avoided since nCPAP and NPPV are safe and effectively improve arterial oxygenation in the majority of patients with nonhypercapnic oxygenation failure. However, it is of great importance to pay special care to sternal wound complications in these patients.