European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsModification of minitracheostomy technique to limit bleeding complications.
Minitracheostomy is a commonly performed procedure usually carried out by junior medical staff. Though there are few problems associated with the technique of minitracheostomy, bleeding is often encountered. We now present a brief case report demonstrating the problems associated with bleeding. We also outline an alteration in insertion technique with the 'Minitrach' designed to diminish the risks of serious bleeding, and report on our results with this technical modification.
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Eur J Cardiothorac Surg · Jan 1995
Randomized Controlled Trial Clinical TrialSuppressed fibrinolysis after administration of low-dose aprotinin: reduced level of plasmin-alpha2-plasmin inhibitor complexes and postoperative blood loss.
Various clinical investigation have shown that aprotinin therapy reduces bleeding after open-heart operations. In this study low-dose aprotinin, 30,000 KIU/kg in the cardiopulmonary bypass (CPB) priming volume and 7,500 KIU/kg intravenously each hour during CPB, was used in ten patients undergoing primary myocardial revascularization or surgery for valvular diseases. Another ten patients served as controls. ⋯ The levels of plasmin inhibitor were significantly reduced during CPB in the control group. The alpha 2-plasmin inhibitor-plasma complex levels, indicating the plasmin activity, were significantly reduced in the aprotinin group. These results confirmed that low-dose aprotinin reduced blood loss with the prevention of hyperfibrinolysis during CPB and demonstrated improved hemostasis.
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Eur J Cardiothorac Surg · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous amiodarone vs propafenone for atrial fibrillation and flutter after cardiac operation.
The safety and efficacy of amiodarone and propafenone in converting atrial fibrillation or flutter after cardiac surgery were compared in a randomized double-blind trial. Eighty-four patients with sustained atrial tachyarrhythmias of more than 30 min' duration, stable hemodynamic status and neither preoperative atrial arrhythmias nor treatment with other antiarrhythmis drugs, were randomized to receive amiodarone (46 patients: 5 mg/kg over 15 min and then 15 mg/kg over the subsequent 24 h for non-converting) or propafenone (38 patients: 2 mg/kg over 15 in and then 10 mg/kg over the subsequent 24 h for non-converting). Nine of the 46 patients (19.5%) receiving amiodarone converted to sinus rhythm within 1 h following bolus injection compared with 17 of 38 patients (44.7%) treated with propafenone (P < 0.05). ⋯ A significantly progressive reduction in ventricular response, already evident at 10th min from the start of treatment, was achieved in both groups of patients. Side effects occurred in six patients given propafenone (15.7%) and in five given amiodarone (10.8%) (P = NS). The two drugs were equally effective in converting postoperative atrial fibrillation and/or flutter after 24 h although propafenone was superior within the first hour.
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Eur J Cardiothorac Surg · Jan 1995
The Edinburgh Cardiac Surgery Score survival prediction in the long-stay ICU cardiac surgical patient.
Predictors of outcome in long-stay patients following cardiac surgery have hitherto been ill defined. The aims of this study were to test the Parsonnet pre-operative scoring system and to define a scoring system for inhospital mortality applicable post-operatively to strengthen the clinical decision-making process. Following case note review of 262 consecutive patients who stayed 7 days or more in intensive care, a total of 110 pre-, intra- and post-operative factors were documented. ⋯ Univariate analysis identified significant association between mortality in the Intensive Care Unit (ICU) and the following: inotrope days, (defined as number of inotropes times number of days) ventilation, units of platelets (P = < 0.00001), chest reopening, fresh frozen plasma units (P < 0.002), total parenteral nutrition, noradrenaline, Parsonnet score (P = 0.005), dopamine, bypass time, vasodilators, intra-aortic balloon counterpulsation, enteral nutrition and other major surgery (P < 0.05). Stepwise logistic regression on these significant factors was used to produce the Edinburgh Cardiac Surgery Score (ECS) applicable from Day 10 onwards in the intensive care unit: ECS Score = (Inotrope days) +2 (Ventilation) + (Platelets) + (Parsonnet) -3. The ECS score may be a useful predictor of ICU mortality probability for cardiac surgical patients requiring 10 days or more intensive care and is presently undergoing prospective evaluation in our centre.
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During a 14-year period (1980-1993) second primary lung cancer or relapse was treated in 44 consecutive patients. Thirty-seven patients had synchronous (n = 18) or metachronous (n = 19) second primary lung cancer. Ten synchronous tumors were ipsilateral and treated contemporarily with five pneumonectomies, three lobectomies and two double wedge resections. ⋯ The actuarial overall 5-year survival rate for patients with relapse was 38.1% with a median survival time of 37 months. We may conclude that an aggressive surgical approach is safe, effective and warranted in patients with either a second primary lung cancer or relapse from their primary lung cancer. Moreover, for early detection of the second lesions, follow-up at a maximum of 6-monthly intervals should be continued for more than 5 years after the first resection.