European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Chronic post-thoracotomy pain is a continuous dysaesthetic burning and aching in the general area of the incision that persists at least 2 months after thoracotomy. It occurs in approximately 50% of patients after thoracotomy and is usually mild or moderate. However, in 5% the pain is severe and disabling. ⋯ The most likely cause is intercostal nerve damage, although the precise mechanism for this is not known. Future work needs to examine surgical technique in detail. Until then, patients need to be adequately warned of this sequela of thoracotomy.
-
Eur J Cardiothorac Surg · Nov 1999
Review Comparative StudyInterventional cardiology versus minimally invasive cardiac surgery.
Comparing interventional cardiology with minimally invasive cardiac surgery 1998 goes back to the early 80s when cardiologists treated coronary artery disease patients with balloon angioplasty under a permanent observation of cardiac surgeons who could offer to the patient the well established Conventional CABG, which already had proven to be safe, effective, durable, reproducible, and complete. At that time some critics predicted PTCA would remain the hobby of some cardiologists. During the last two decades, however, an explosive proliferation in the number of PTCA procedures has occurred, which soon exceed the number of CABG procedures. ⋯ Within the last 5 years the minimally invasive cardiac surgery has progressed, which allows the performance of even complex cardiac surgery through small incisions with (port-access technique) or without (MIDCAB technique) cardiopulmonary bypass. The rationale of enthusiastic users of these new techniques leads to improved cosmetic results, less surgical trauma, decreased length of hospital stay, reduced cost, and comparable long-term results with respect to conventional CABG. Similar to the prediction about PTCA two decades ago, some critics say that minimally invasive cardiac surgery would remain the hobby of some cardiac surgeons.
-
Eur J Cardiothorac Surg · Sep 1999
ReviewVideothoracoscopic debridement of the postpneumonectomy space in empyema.
Simple irrigation has proven to be an efficient method to treat postpneumonectomy empyema provided that bronchopleural fistula is not present or successfully closed. However, with this treatment modality, infected material inside the thoracic cavity is not removed and this can be a potential source of empyema recurrence if the patient's immune system is compromised. The removal of the infected material should result in a lower recurrence rate. ⋯ Videothoracoscopic debridement of the postpneumonectomy space with postoperative antibiotic irrigation of the pleural space is an efficient method to treat postpneumonectomy empyema, provided that a concomitant bronchopleural fistula can be closed successfully. No early empyema or fistula recurrence were observed. However, late recurrence may occur many years after operation, therefore close follow-up is indicated.
-
Eur J Cardiothorac Surg · Dec 1998
Review Case ReportsDiagnosis and management of entrapped embolus through a patent foramen ovale.
The diagnosis of impending paradoxical embolus by echocardiography is exceptional and its management remains unclear. Through a personal case, we performed an exhaustive review of the medical literature of this rare finding. Since the first report, only 43 cases have ever been reported. ⋯ The early mortality rate is high (21%). In addition, recurrent embolisms are reported when a medical treatment is chosen. The cumulative results of each possibility are described.
-
This review discusses the phenomenon of ischaemic preconditioning and its potential application to cardiac surgery. The biology of ischaemic preconditioning is explained and the more limited evidence suggesting that the human heart can be preconditioned is discussed. ⋯ Preconditioning is a powerful and reproducible method of protecting the myocardium from irreversible ischaemic injury. There is now evidence indicating that the human heart can be preconditioned. However, more trials are necessary in patients undergoing cardiac surgery before the role of preconditioning as a means of myocardial protection can be assessed.