European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Mar 2010
Multicenter StudyDoes induction treatment increase the risk of morbidity and mortality after pneumonectomy? A multicentre case-matched analysis.
The objective of this investigation was to compare postoperative morbidity and early and late mortality in patients after pneumonectomy for non-small-cell lung cancer (NSCLC) with or without induction neo-adjuvant therapy. ⋯ Current regimens of induction treatment do not seem to increase the risk of morbidity, early mortality and late mortality after pneumonectomy in properly selected patients. This study warrants confirmation from future multicentre prospective randomised trials powered on early outcomes.
-
Eur J Cardiothorac Surg · Mar 2010
Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients.
Spontaneous pneumomediastinum is uncommon and is traditionally considered a benign, self-limited disorder that usually occurs in young adults without any apparent precipitating factor or disease. The purpose of this study is to present 47 new cases because of their different clinical behaviours. ⋯ (1) It is known that occasional consumption of cocaine causes diffuse alveolar damage, haemorrhage, etc. The cause-effect relationship consumption-appearance in a few hours of spontaneous pneumomediastinum leads us to appreciate this form of consumption as a causal factor rather than a predisposing/precipitating factor as it appears in the literature on the topic. (2) Spontaneous pneumomediastinum is considered a benign disorder but, as shown by our series, a bad outcome may represent an immediate life-threatening condition, forcing an invasive manoeuvre. We always recommend performing a chest CT scan on admission to predict the evolution.
-
Eur J Cardiothorac Surg · Mar 2010
Does chronic obstructive pulmonary disease affect postoperative quality of life in patients undergoing lobectomy for lung cancer? A case-matched study.
The objective of this investigation was to assess the quality of life (QoL) before and after pulmonary lobectomy in patients with chronic obstructive pulmonary disease (COPD) and to compare these values with a case-matched population of patients with normal respiratory function. ⋯ The evidence of an acceptable QoL in COPD patients may help both patients and physicians in the surgical decision-making process in the face of high rates of complications.
-
Eur J Cardiothorac Surg · Mar 2010
Surgical treatment of benign tracheo-oesophageal fistulas with tracheal resection and oesophageal primary closure: is the muscle flap really necessary?
Nowadays, despite the advances of the low-pressure high-volume cuffs, post-intubation tracheo-oesophageal fistula (TEF) still poses a major challenge to thoracic surgeons. The original technique includes interposition of muscle flaps between suture lines to avoid recurrence. It is not clear if this manoeuvre is indispensable and, in fact, we and others have faced problems with it. Our aim is to present our experience with TEF management in a consecutive group with no muscle interposition. ⋯ The single-staged repair with tracheal resection and anastomosis with oesophageal closure provides good short- and mid-term results for TEF management. The interposition of a muscle flap between suture lines may not be crucial to prevent recurrence.
-
Eur J Cardiothorac Surg · Mar 2010
Acute respiratory dysfunction after surgery for acute type A aortic dissection.
Acute respiratory dysfunction (ARD) can occur after acute type A aortic dissection, but relatively little is known about ARD in such patients. This study aims to analyse the clinical impact of ARD after surgery for acute type A aortic dissection and to assess possible treatment options. ⋯ ARD is a relatively common complication of surgery for acute type A dissection and is associated with increased morbidity and resource utilisation. Patients with preoperative malperfusion are at increased risk for development of ARD. Prone positioning is a viable treatment option that significantly improves pulmonary oxygenation.