European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jun 2008
Does endoesophageal ultrasound-guided fine-needle aspiration replace mediastinoscopy in mediastinal staging of thoracic malignancies?
To determine the impact of endoesophageal ultrasound-guided fine-needle aspiration (EUS-FNA) on management of thoracic malignancies. ⋯ EUS-FNA sensitivity depends on the localisation of the primary tumour, and extent and location of mediastinal disease. For left-sided tumours, EUS-FNA improves mediastinal staging by assessing stations 5 and 6 inaccessible to conventional mediastinoscopy. For extended mediastinal disease, mediastinoscopy can be avoided or spared for restaging after neoadjuvant therapy. Exclusion of mediastinal involvement requires mediastinoscopy or open lymphadenectomy. Beyond mediastinal nodal staging, EUS-FNA may detect T4 and M1 situations. Thus, EUS-FNA is a useful supplement to and not the replacement of mediastinoscopy.
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Eur J Cardiothorac Surg · Jun 2008
The role of airway stenting in pediatric tracheobronchial obstruction.
Tracheobronchial obstruction is infrequent in the pediatric age group but it is associated with significant morbidity and mortality. The purpose of this study is to review the results of a single institution experience with endoscopic stent placement in children with benign tracheobronchial obstruction, and with special concern on safety and clinical effectiveness. ⋯ Although the results were based on a small series, placement of stents in the pediatric airway to treat tracheobronchial obstruction seems to be safe and effective. Stenting is a satisfactory therapeutic option when other procedures have failed or are not indicated.
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Eur J Cardiothorac Surg · Jun 2008
Temporary neurological dysfunction after surgery of the thoracic aorta: a predictor of poor outcome and impaired quality of life.
Transient neurological dysfunction (TND) consists of postoperative confusion, delirium and agitation. It is underestimated after surgery on the thoracic aorta and its influence on long-term quality of life (QoL) has not yet been studied. This study aimed to assess the influence of TND on short- and long-term outcome following surgery of the ascending aorta and proximal arch. ⋯ The neurological outcome following surgery of the ascending aorta and proximal aortic arch is of paramount importance. The impact of TND on short- and long-term outcome is underestimated and negatively affects the short- and long-term outcome.
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Eur J Cardiothorac Surg · Jun 2008
Intraoperative device closure of large secundum atrial septal defects; a safe alternative to transcatheter closure.
The aim of this study is to report our short and mid-term results of intraoperative device closure (IODC) in large secundum atrial septal defects (ASD), to evaluate its safety and to determine the impact of 'short' rim on the results. ⋯ IODC is a safe and feasible technique in closing large ASDs. It has the advantages of cost savings, cosmetic results, and less trauma. Early and mid-term results are encouraging. In patients with ASD of a short rim, a larger device is recommended which does not influence the success rate of IODC.
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Eur J Cardiothorac Surg · Jun 2008
Case ReportsSuccessful emergency resuscitative thoracotomy and thoracoscopy in an injured patient with impending death.
A 23-year-old man was bilaterally stabbed with knife creating 10 cm wide wounds similar to minithoracotomy incisions. Initially, the patient had no cardiac or respiratory activity. Emergency resuscitative thoracotomy was hastily performed on the right side. ⋯ The wound was explored, the hemothorax was evacuated, and a superficial non-bleeding parenchymal pulmonary laceration was discovered. The postoperative course was uneventful and the patient was discharged home 10 days later, and returned to his physically demanding work after 5 weeks. It is concluded that VATS can be cautiously performed on the less severely injured side in patients with bilateral thoracic penetrating trauma in extremis following successful emergency resuscitative thoracotomy.