European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2004
Case ReportsEndovascular repair for multiple Salmonella mycotic aneurysms of the thoracic aorta presenting with Cardiovocal syndrome.
Salmonella mycotic thoracic aortic aneurysm is a rare but life-threatening condition. We report a 59-year-old man with two Salmonella mycotic thoracic aortic aneurysms, presented with fever and chills associated with hoarseness due to left vocal cord palsy (Cardiovocal syndrome). ⋯ Subsequent computed tomography at 12 months after the operation confirmed exclusion of the two pseudoaneurysms with no endoleak. With potent antibiotics and careful surveillance program, endovascular repair is a possible alternative to conventional open surgery in the management of mycotic thoracic aortic aneurysms, especially in high-risk patients.
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Eur J Cardiothorac Surg · Jul 2004
The significance of associated pre-invasive lesions in patients resected for primary lung neoplasms.
To evaluate the prevalence and clinico/prognostic significance of the presence of pre-invasive lesions in patients resected for primary lung neoplasm. ⋯ Associated pre-invasive lesions in patients resected for primary lung neoplasms are not infrequent. AAH is associated with adenocarcinoma, CIS with squamous cell carcinoma, DIPNECH with typical carcinoid tumours. Our experience indicates that in these patients histology, stage distribution and survival do not differ from the total population of resected patients with lung tumors.
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Eur J Cardiothorac Surg · Jul 2004
Hypothermic circulatory arrest with and without cold selective antegrade cerebral perfusion: impact on neurological recovery and tissue metabolism in an acute porcine model.
Clinically, selective antegrade cerebral perfusion (SACP) seems to be associated with a better neurological outcome compared to hypothermic circulatory arrest (HCA) alone, but the pathophysiological mechanisms are not well understood. Therefore, this study was undertaken to assess the effects of HCA with and without SACP on the cerebral integrity using multimodal neurophysiological monitoring. ⋯ Cold SACP is associated with better neurophysiological recovery and less cerebral edema, indicated by lower intracranial pressures during reperfusion. Neurophysiological recovery correlated well with the rise in ICP. HCA alone causes prolonged acidosis in the brain tissue during reperfusion. From these data, SACP appears to be superior to HCA alone, but further studies have to elucidate the optimal regimes for SACP.
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Eur J Cardiothorac Surg · Jul 2004
Editorial CommentQuality evaluation in congenital heart surgery.
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Clopidogrel has become the standard of care to prevent thrombotic complications following cardiological interventions, in particular intracoronary stenting. In addition, patients with aspirin intolerance and those with carotid and peripheral vascular disease are also increasingly treated with clopidogrel. Platelet inhibition may become a concern for hemostasis in patients treated with clopidogrel who need emergency and undelayed surgery. ⋯ Clopidogrel exposure 3 days or less prior to CABG surgery significantly increases the risk of postoperative bleeding, the need for perioperative transfusion and the incidence of re-exploration. Surgery should be performed using standard heparinization and anti-fibrinolytic strategies but aggressive correction of platelets dysfunction is required before chest closure.