The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2014
ReviewAre children undergoing cardiac surgery receiving antibiotics at subtherapeutic levels?
Perioperative antibiotics have decreased-but not eradicated-postoperative infections. In patients undergoing cardiac surgery with cardiopulmonary bypass, the dilutional effect of the priming and any additional volume given during the procedure may lead to subtherapeutic antibiotic levels. Our aim was to determine if children undergoing cardiac surgery with cardiopulmonary bypass receive perioperative antibiotics at subtherapeutic levels. ⋯ Our model predicts which patients undergoing cardiac surgery with cardiopulmonary will have subtherapeutic cefuroxime levels. This nomogram enables providers to determine when to administer additional antibiotics in patients receiving large additional volumes during cardiac surgeries. This rational approach to perioperative antibiotic dosing may result in a reduction in postoperative infection in this vulnerable patient population.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer?
The role of combined endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with a single bronchoscope is poorly understood. The purpose of the present study was to elucidate the roles of EBUS-TBNA and EUS-FNA with a single bronchoscope in the preoperative hilar and mediastinal staging of non-small cell lung cancer (NSCLC). ⋯ The combined endoscopic approach with EBUS-TBNA and EUS-FNA is a safe and accurate method for preoperative hilar and mediastinal staging of NSCLC, with better results than with each technique by itself.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Clinical experience with CorMatrix extracellular matrix in the surgical treatment of mitral valve disease.
To determine the clinical utility of an acellular bioscaffold as a structural material for mitral valve repair (MVr). ⋯ The ECM bioscaffold is a satisfactory material for MVr in a variety of surgical situations, including endocarditis. It appears to resist calcification and infection. Additional studies are warranted to determine the long-term durability of repairs made with ECM, and its appropriate use in patients who have previously undergone radiotherapy or chemotherapy.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
A clinicopathologic prediction model for postoperative recurrence in stage Ia non-small cell lung cancer.
Controversy remains over the appropriate postoperative management for patients with stage Ia non-small cell lung cancer who underwent complete surgical resection as a result of a heterogeneous prognosis. We aimed to identify the predictive factors for recurrence in these patients to aid in the decision making. ⋯ We developed a clinicopathologic prediction model for postoperative recurrence in stage Ia non-small cell lung cancer. This model can help with the selection of appropriate postoperative therapeutic strategies for these patients.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Selective use of cardiac computed tomography angiography: an alternative diagnostic modality before second-stage single ventricle palliation.
To assess the accuracy and risk of substituting cardiac computed tomography for cardiac catheterization in select patients for evaluation of anatomy before second-stage single ventricle palliation. ⋯ Cardiac computed tomography and cardiac catheterization are equally accurate for evaluation of anatomy before second-stage single ventricle palliation when compared with surgical findings. Computed tomography may be the preferred test in select patients because of decreased vascular access and anesthesia risk, lower radiation and contrast exposure, and fewer adverse events.