Turkish Journal of Trauma and Emergency Surgery, 2013
Esophageal foreign object ingestion is frequently seen in all ages. Failure to treat can cause se... more Esophageal foreign object ingestion is frequently seen in all ages. Failure to treat can cause serious complications such as esophageal perforation. The aims of this study were to characterize the clinical features related to foreign objects in the esophagus and to analyze the results of commonly used methods for their removal. METHODS We analyzed 20 years of records from Siyami Ersek Hospital, Istanbul and identified 512 cases of foreign objects enlodged in the esophagus. RESULTS In pediatric patients, the majority were aged between 2-5 years (34.4%), while in adult patients, the majority were above 55 years (38.7%). Coins were the most common foreign object detected in children (68.8%), whereas meat impaction was most common in adults (87.4%). The most common location of the foreign object was the cervical esophagus in children (78.2%), and the thoracic esophagus in adults (66.4%). In 30.8% of adults, there was esophageal or systemic disease. Objects were removed with a Magill clamp in 48.3% of children. Rigid endoscopy was the main treatment in adult patients. Perforation due to endoscopy developed in three patients. Surgical repair was performed on these patients but all died due to mediastinitis. CONCLUSION Underlying esophageal or systemic diseases may predispose adults to foreign object ingestion in the esophagus. Improved endoscopic experience and clinical management of thoracic surgeons led to reduced morbidity and mortality in recent years.
Solitary fibrous tumor of the pleura is a rare, usually benign, and slow-growing neoplasm. Comple... more Solitary fibrous tumor of the pleura is a rare, usually benign, and slow-growing neoplasm. Complete surgical resection for giant tumor of the pleura is challenging because of poor exposure and a large blood supply. We report the case of a giant hypervascular fibrous tumor that filled nearly the entire left hemithorax and anterior mediastinum, and its preoperative management. A 59-year-old woman presented to us with exertional dyspnea and chest pain. A chest radiograph showed the right hemithorax completely opaque and a mediastinal shift to the left hemithorax. A tomography scan of the thorax showed a giant mass that almost completely filled the right hemithorax and compressed the mediastinum to the left. Because of excessive bleeding during dissection, the operation was terminated after a biopsy specimen was obtained. The biopsy was diagnosed as a benign fibrous tumour. A thoracic computed tomography angiogram showed that the mass was supplied by multiple intercostal arteries as well as an aberrant artery that branches off the celiac trunk in the subdiaphragmatic region. Due to the many arteries that needed to be embolized, the final decision was to control the bleeding following resection by inducing total circulatory arrest with the help of cardiopulmonary bypass. The bleeding could not be controlled under cardiopulmonary bypass and the patient's death was confirmed. We report this case to emphasize the necessity of preoperative embolization; the use of cardiopulmonary bypass and total circulatory arrest is not a valid alternative method to control the bleeding.
Background: In this study we aimed to evaluate the long-term outcome of diaphragmatic plication f... more Background: In this study we aimed to evaluate the long-term outcome of diaphragmatic plication for symptomatic unilateral diaphragm paralysis. Methods: Thirteen patients who underwent unilateral diaphragmatic plication (2 patients had right, 11 left plication) between January 2003 and December 2006 were evaluated. One patient died postoperatively due to sepsis. The remaining 12 patients [9 males, 3 females; mean age 60 (36-66) years] were reevaluated with chest radiography, flouroscopy or ultrasonography, pulmonary function tests, computed tomography (CT) or magnetic resonance imaging (MRI), and the MRC/ATS dyspnea score at an average of 5.4 (4-7) years after diaphragmatic plication. Results: The etiology of paralysis was trauma (9 patients), cardiac by pass surgery (3 patients), and idiopathic (1 patient). The principle symptom was progressive dyspnea with a mean duration of 32.9 (22-60) months before surgery. All patients had an elevated hemidiaphragm and paradoxical movement radiologically prior to surgery. There were partial atelectasis and reccurent infection of the lower lobe in the affected side on CT in 9 patients. Atelectasis was completely improved in 9 patients after plication. Preoperative spirometry showed a clear restrictive pattern. Mean preoperative FVC was 56.7 ± 11.6% and FEV1 65.3 ± 8.7%. FVC and FEV1 improved by 43.6 ± 30.6% (p < 0.001) and 27.3 ± 10.9% (p < 0.001) at late follow-up. MRC/ATS dyspnea scores improved 3 points in 11 patients and 1 point in 1 patient at long-term (p < 0.0001). Eight patients had returned to work at 3 months after surgery. Conclusions: Diaphragmatic plication for unilateral diaphragm paralysis decreases lung compression, ensures remission of symptoms, and improves quality of life in long-term period.
Annals of Thoracic and Cardiovascular Surgery, 2012
Purpose: To evaluate long-term results of decortications in patients with symptomatic restrictive... more Purpose: To evaluate long-term results of decortications in patients with symptomatic restrictive pleurisy and trapped lung after coronary bypass grafting. Methods: Twenty consecutive patients undergoing lung decortications for trapped lung after coronary bypass grafting were prospectively evaluated. Pulmonary function tests were used as objective criteria, and quality of life was assessed by the Medical Research Council dyspnea scale. A p value <0.05 was considered significant. Results: Twenty patients, 3 women and 17 men, with a median age of 59 years were evaluated. The median time interval between coronary bypass grafting and decortications was 9.3 months. The mean preoperative forced expiratory volume in one second and forced vital capacity were 63.8% ± 7.4% and 50.5% ± 6.6% of the predicted value, respectively, and the improvement rates after decortications were 14.97% ± 6.3% and 17.62% ± 6.38%, respectively. Dyspnea scores improved after decortications (p <0.05). The median follow-up was 25 months. After surgery, 3 patients developed superficial wound infections, and out of 7 patients with prolonged air leaks, 2 underwent re-operation. After surgery, one patient died on day 34 and another, after 3 years. Conclusion: Lung decortications, re-expanding the affected lung, ensures symptom remission and improves quality of life of patients with trapped lung after coronary bypass grafting in the long-term.
The Journal of Thoracic and Cardiovascular Surgery, 2014
Objective: Our aim was to compare systemic chemotherapy (CT) with drainage and with pericardial w... more Objective: Our aim was to compare systemic chemotherapy (CT) with drainage and with pericardial window in the treatment of neoplastic pericarditis in patients with various malignancies included in the International Neoplastic Pericarditis Treatment study. Methods: Patients treated with systemic CT alone (Group A), CT plus drainage (Group B), or CT plus pericardial window (Group C) were included. Treatment response was defined as complete response (ie, no more pericardial effusion or masses), partial response (ie, reduced total score, without requiring further treatments), stable disease (ie, unchanged total score), or progressive disease (ie, increased total score). Patients with partial or complete response were considered responders. Results: This preliminary report included 175 patients (56.6% male) with a mean age of 54.21 AE 14.26 years. Gender distribution, age, and follow-up duration was similar for all groups (P>.05). Prevalent cancer types were lung cancer (50.9%), breast cancer (14.9%), and lymphoma/leukemia (14.9%). Overall, 22.3%, 42.9%, and 34.9% of patients were in treatment group A, B, and C, respectively. There were 132 responders (75.3%). The rate of responders significantly differed between groups (P <.001); it was significantly higher in Group B than in Group A (P <.05) and in Group C than in Group B (P ¼ .006). The significant factors affecting response were therapy (P ¼ .002) and extent of effusion (P ¼ .037). Kaplan-Meier analysis showed that patients in Group C had a significantly better survival rate than patients in the other groups (P ¼ .001). Conclusions: Systemic CT plus pericardial window is a more effective treatment option compared with systemic CT alone and systemic CT plus drainage in patients with malignant effusions.
Benign pleural effusions are rarely treated with pleurodesis. We report a case of left-sided pleu... more Benign pleural effusions are rarely treated with pleurodesis. We report a case of left-sided pleurodesis in a patient with rightsided destroyed lung. A 83-year-old man with right-sided destroyed lung was hospitalized because of reccurent left-sided massive pleural effusion due to cardiomyopathy. The patient was treated with left pleurodesis. He was then discharged from hospital and given diuretics therapy. At the one-year follow-up examinations, dyspnea and effusion had not recorded.
Catamenial pneumothorax is a rare condition in which spontaneous pneumothorax is recurrent. The i... more Catamenial pneumothorax is a rare condition in which spontaneous pneumothorax is recurrent. The incidence of catamenial pneumothorax has been underestimated for a few number of reasons. Recently, the etiology of catamenial pneumothorax has been more accurately diagnosed because of increased awareness and interest in the disease. Common and effective use of VATS technique contributed to better understanding of the disease. The management of the disease is difficult because of high recurrence rate. Operative and nonoperative interventions should be practiced more to prevent recurrences. Hormonal therapy should be added to treatment in selected cases. In this chapter, we will discuss all aspects of catamenial pneumothorax from diagnosis to treatment.
The purpose of this study is to show how a tertiary care center in Turkey operating mainly in car... more The purpose of this study is to show how a tertiary care center in Turkey operating mainly in cardiology initiated Six Sigma principles to reduce the number of complications occuring during coronary stent insertion process. A Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) model for coronary stent insertion is suggested. Data were collected for 24-months. Twenty-two Critical-to-Quality (CTQ) factors were identified for successful coronary stent insertion. The most frequent causes of complications in the process were found to be patients with previous bypass surgery or PCI, inexperience of staff members, highly damaged vessel structure, thin and/or long vessel diameter, inappropriate selection of stent type, inappropriate selection of balloon type and poor image quality.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2011
Osteoporosis, a major risk factor for sternum-related morbidity after median sternotomy, is quite... more Osteoporosis, a major risk factor for sternum-related morbidity after median sternotomy, is quite prevalent among the elderly. In this prospective study, we investigated the potential of sternal protection by use of the "sternal wrapping method" in elderly osteoporotic patients who were undergoing median sternotomy.For this study, we chose 100 elderly osteoporotic patients who were scheduled to undergo median sternotomy. During surgery, we wrapped the sternal edges with polyvinyl chloride tubing in 50 patients (group 1) and omitted the sternal wrapping in the remaining 50 patients (group 2). We then compared the groups with regard to postoperative pain, bleeding, early and late sternum-related morbidity, sternal fractures, and duration of hospitalization.Sternal wrapping was associated with fewer sternal fractures, less chest pain, and shorter hospital stays. Overall sternal morbidity was significantly less common among patients with sternal wrapping (4% vs. 20%, P = 0.03)...
Background: Surgical drainage is a rapid and effective treatment for pericardial tamponade in can... more Background: Surgical drainage is a rapid and effective treatment for pericardial tamponade in cancer patients. We aimed to investigate the effectiveness of pericardial window formation via mini-thoracotomy for treating pericardial tamponade in cancer patients, and to evaluate clinical factors affecting long-term survival. Methods: Records of 53 cancer patients with pericardial tamponade treated by pericardial window formation between 2002 and 2008 were examined. Five patients were excluded due to insufficient data. Kaplan-Meier and Cox regression analysis were used for analysis. Results: Forty-eight patients (64.7% male), with a mean age of 55.20 ± 12.97 years were included. Patients were followed up until the last control visit or death. There was no surgery-related mortality and the 30-day mortality rate was 8.33%; all died during postoperative hospitalization. Morbidity rate was 18.75%. Symptomatic recurrence rate was 2.08%. Cancer type and nature of the pericardial effusion were the major factors determining long-term survival (P <0.001 and P <0.004, respectively). Overall median survival was 10.41 ± 1.79 months. One-and 2-year survival rates were 45 ± 7% and 18 ± 5%, respectively. Conclusion: Pericardial window creation via minithoracotomy was proven to be a safe and effective approach in surgical treatment of pericardial tamponade in cancer patients. Cancer type and nature of pericardial effusion were the main factors affecting long-term survival.
Neoplastic pericarditis due to lung cancer is the most frequent cause of cardiac tamponade Seve... more Neoplastic pericarditis due to lung cancer is the most frequent cause of cardiac tamponade Several treatments are used to prevent recurrence of tamponade after drainage, but studies comparing the outcome of different approaches are lacking Purpose of the study is to compare the outcome of 196 lung cancer patients pts) (141 m, 55 f) with neoplastic pericarditis (all requiring pericardial drainage, with cytology positive effusion) Treated according to the usual care in each Institution Steroids and/or local sclerosing agents, no CT (n=16) Systemic CT (n=50) (PC+ST) Local (pericardial) chemo-or radiotehrapy (n=25) (PC+LT) Systemic plus local therapy (n=61) (PC+ST+LT) Pericardial window plus systemic CT (n=44) (PW+ST) 0 10 20 30 40 50 60 70 80 90 100 PC+ST PC+LT PC+ST+LT PW+ST
A b s t r a c t Introduction: To compare postoperative prophylactic use of two positive end-expir... more A b s t r a c t Introduction: To compare postoperative prophylactic use of two positive end-expiratory pressure (PEEP) levels in order to prevent postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery. Material and methods: Sixty patients undergoing an elective off-pump CABG operation were included in this prospective, nonrandomized clinical trial. Patients were divided into two groups as receiving either 5 cm H 2 O (group 1) or 8 cm H 2 O PEEP (group 2) after the operation until being extubated. Chest tube outputs, use of blood products and other fluids, postoperative hemoglobin levels, accumulation of pleural and pericardial fluid after the removal of chest tubes, and duration of hospital stay were recorded and compared. Results: Low-and high-pressure PEEP groups did not differ with regard to postoperative chest tube outputs, amounts of transfusions and crystalloid/ colloid infusion requirements, or postoperative hemoglobin levels. However, low-pressure PEEP application was associated with significantly higher pleural (92 ±37 ml vs. 69 ±29 ml, p = 0.03) and pericardial fluid (17 ±5 ml vs. 14 ±6 ml, p = 0.04) accumulation. On the other hand, high-pressure PEEP application was associated with significantly longer duration of hospitalization (6.25 ±1.21 days vs. 5.25 ±0.91 days, p = 0.03). Conclusions: Prophylactic administration of postoperative PEEP levels of 8 cm H 2 O, although safe, does not seem to reduce chest-tube output or transfusion requirements in off-pump CABG when compared to the lower level of PEEP. Further studies with larger sample sizes are warranted to confirm the benefits and identify ideal levels of PEEP administration in this group of patients.
Turkish Journal of Trauma and Emergency Surgery, 2013
Esophageal foreign object ingestion is frequently seen in all ages. Failure to treat can cause se... more Esophageal foreign object ingestion is frequently seen in all ages. Failure to treat can cause serious complications such as esophageal perforation. The aims of this study were to characterize the clinical features related to foreign objects in the esophagus and to analyze the results of commonly used methods for their removal. METHODS We analyzed 20 years of records from Siyami Ersek Hospital, Istanbul and identified 512 cases of foreign objects enlodged in the esophagus. RESULTS In pediatric patients, the majority were aged between 2-5 years (34.4%), while in adult patients, the majority were above 55 years (38.7%). Coins were the most common foreign object detected in children (68.8%), whereas meat impaction was most common in adults (87.4%). The most common location of the foreign object was the cervical esophagus in children (78.2%), and the thoracic esophagus in adults (66.4%). In 30.8% of adults, there was esophageal or systemic disease. Objects were removed with a Magill clamp in 48.3% of children. Rigid endoscopy was the main treatment in adult patients. Perforation due to endoscopy developed in three patients. Surgical repair was performed on these patients but all died due to mediastinitis. CONCLUSION Underlying esophageal or systemic diseases may predispose adults to foreign object ingestion in the esophagus. Improved endoscopic experience and clinical management of thoracic surgeons led to reduced morbidity and mortality in recent years.
Solitary fibrous tumor of the pleura is a rare, usually benign, and slow-growing neoplasm. Comple... more Solitary fibrous tumor of the pleura is a rare, usually benign, and slow-growing neoplasm. Complete surgical resection for giant tumor of the pleura is challenging because of poor exposure and a large blood supply. We report the case of a giant hypervascular fibrous tumor that filled nearly the entire left hemithorax and anterior mediastinum, and its preoperative management. A 59-year-old woman presented to us with exertional dyspnea and chest pain. A chest radiograph showed the right hemithorax completely opaque and a mediastinal shift to the left hemithorax. A tomography scan of the thorax showed a giant mass that almost completely filled the right hemithorax and compressed the mediastinum to the left. Because of excessive bleeding during dissection, the operation was terminated after a biopsy specimen was obtained. The biopsy was diagnosed as a benign fibrous tumour. A thoracic computed tomography angiogram showed that the mass was supplied by multiple intercostal arteries as well as an aberrant artery that branches off the celiac trunk in the subdiaphragmatic region. Due to the many arteries that needed to be embolized, the final decision was to control the bleeding following resection by inducing total circulatory arrest with the help of cardiopulmonary bypass. The bleeding could not be controlled under cardiopulmonary bypass and the patient's death was confirmed. We report this case to emphasize the necessity of preoperative embolization; the use of cardiopulmonary bypass and total circulatory arrest is not a valid alternative method to control the bleeding.
Background: In this study we aimed to evaluate the long-term outcome of diaphragmatic plication f... more Background: In this study we aimed to evaluate the long-term outcome of diaphragmatic plication for symptomatic unilateral diaphragm paralysis. Methods: Thirteen patients who underwent unilateral diaphragmatic plication (2 patients had right, 11 left plication) between January 2003 and December 2006 were evaluated. One patient died postoperatively due to sepsis. The remaining 12 patients [9 males, 3 females; mean age 60 (36-66) years] were reevaluated with chest radiography, flouroscopy or ultrasonography, pulmonary function tests, computed tomography (CT) or magnetic resonance imaging (MRI), and the MRC/ATS dyspnea score at an average of 5.4 (4-7) years after diaphragmatic plication. Results: The etiology of paralysis was trauma (9 patients), cardiac by pass surgery (3 patients), and idiopathic (1 patient). The principle symptom was progressive dyspnea with a mean duration of 32.9 (22-60) months before surgery. All patients had an elevated hemidiaphragm and paradoxical movement radiologically prior to surgery. There were partial atelectasis and reccurent infection of the lower lobe in the affected side on CT in 9 patients. Atelectasis was completely improved in 9 patients after plication. Preoperative spirometry showed a clear restrictive pattern. Mean preoperative FVC was 56.7 ± 11.6% and FEV1 65.3 ± 8.7%. FVC and FEV1 improved by 43.6 ± 30.6% (p < 0.001) and 27.3 ± 10.9% (p < 0.001) at late follow-up. MRC/ATS dyspnea scores improved 3 points in 11 patients and 1 point in 1 patient at long-term (p < 0.0001). Eight patients had returned to work at 3 months after surgery. Conclusions: Diaphragmatic plication for unilateral diaphragm paralysis decreases lung compression, ensures remission of symptoms, and improves quality of life in long-term period.
Annals of Thoracic and Cardiovascular Surgery, 2012
Purpose: To evaluate long-term results of decortications in patients with symptomatic restrictive... more Purpose: To evaluate long-term results of decortications in patients with symptomatic restrictive pleurisy and trapped lung after coronary bypass grafting. Methods: Twenty consecutive patients undergoing lung decortications for trapped lung after coronary bypass grafting were prospectively evaluated. Pulmonary function tests were used as objective criteria, and quality of life was assessed by the Medical Research Council dyspnea scale. A p value <0.05 was considered significant. Results: Twenty patients, 3 women and 17 men, with a median age of 59 years were evaluated. The median time interval between coronary bypass grafting and decortications was 9.3 months. The mean preoperative forced expiratory volume in one second and forced vital capacity were 63.8% ± 7.4% and 50.5% ± 6.6% of the predicted value, respectively, and the improvement rates after decortications were 14.97% ± 6.3% and 17.62% ± 6.38%, respectively. Dyspnea scores improved after decortications (p <0.05). The median follow-up was 25 months. After surgery, 3 patients developed superficial wound infections, and out of 7 patients with prolonged air leaks, 2 underwent re-operation. After surgery, one patient died on day 34 and another, after 3 years. Conclusion: Lung decortications, re-expanding the affected lung, ensures symptom remission and improves quality of life of patients with trapped lung after coronary bypass grafting in the long-term.
The Journal of Thoracic and Cardiovascular Surgery, 2014
Objective: Our aim was to compare systemic chemotherapy (CT) with drainage and with pericardial w... more Objective: Our aim was to compare systemic chemotherapy (CT) with drainage and with pericardial window in the treatment of neoplastic pericarditis in patients with various malignancies included in the International Neoplastic Pericarditis Treatment study. Methods: Patients treated with systemic CT alone (Group A), CT plus drainage (Group B), or CT plus pericardial window (Group C) were included. Treatment response was defined as complete response (ie, no more pericardial effusion or masses), partial response (ie, reduced total score, without requiring further treatments), stable disease (ie, unchanged total score), or progressive disease (ie, increased total score). Patients with partial or complete response were considered responders. Results: This preliminary report included 175 patients (56.6% male) with a mean age of 54.21 AE 14.26 years. Gender distribution, age, and follow-up duration was similar for all groups (P>.05). Prevalent cancer types were lung cancer (50.9%), breast cancer (14.9%), and lymphoma/leukemia (14.9%). Overall, 22.3%, 42.9%, and 34.9% of patients were in treatment group A, B, and C, respectively. There were 132 responders (75.3%). The rate of responders significantly differed between groups (P <.001); it was significantly higher in Group B than in Group A (P <.05) and in Group C than in Group B (P ¼ .006). The significant factors affecting response were therapy (P ¼ .002) and extent of effusion (P ¼ .037). Kaplan-Meier analysis showed that patients in Group C had a significantly better survival rate than patients in the other groups (P ¼ .001). Conclusions: Systemic CT plus pericardial window is a more effective treatment option compared with systemic CT alone and systemic CT plus drainage in patients with malignant effusions.
Benign pleural effusions are rarely treated with pleurodesis. We report a case of left-sided pleu... more Benign pleural effusions are rarely treated with pleurodesis. We report a case of left-sided pleurodesis in a patient with rightsided destroyed lung. A 83-year-old man with right-sided destroyed lung was hospitalized because of reccurent left-sided massive pleural effusion due to cardiomyopathy. The patient was treated with left pleurodesis. He was then discharged from hospital and given diuretics therapy. At the one-year follow-up examinations, dyspnea and effusion had not recorded.
Catamenial pneumothorax is a rare condition in which spontaneous pneumothorax is recurrent. The i... more Catamenial pneumothorax is a rare condition in which spontaneous pneumothorax is recurrent. The incidence of catamenial pneumothorax has been underestimated for a few number of reasons. Recently, the etiology of catamenial pneumothorax has been more accurately diagnosed because of increased awareness and interest in the disease. Common and effective use of VATS technique contributed to better understanding of the disease. The management of the disease is difficult because of high recurrence rate. Operative and nonoperative interventions should be practiced more to prevent recurrences. Hormonal therapy should be added to treatment in selected cases. In this chapter, we will discuss all aspects of catamenial pneumothorax from diagnosis to treatment.
The purpose of this study is to show how a tertiary care center in Turkey operating mainly in car... more The purpose of this study is to show how a tertiary care center in Turkey operating mainly in cardiology initiated Six Sigma principles to reduce the number of complications occuring during coronary stent insertion process. A Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) model for coronary stent insertion is suggested. Data were collected for 24-months. Twenty-two Critical-to-Quality (CTQ) factors were identified for successful coronary stent insertion. The most frequent causes of complications in the process were found to be patients with previous bypass surgery or PCI, inexperience of staff members, highly damaged vessel structure, thin and/or long vessel diameter, inappropriate selection of stent type, inappropriate selection of balloon type and poor image quality.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2011
Osteoporosis, a major risk factor for sternum-related morbidity after median sternotomy, is quite... more Osteoporosis, a major risk factor for sternum-related morbidity after median sternotomy, is quite prevalent among the elderly. In this prospective study, we investigated the potential of sternal protection by use of the "sternal wrapping method" in elderly osteoporotic patients who were undergoing median sternotomy.For this study, we chose 100 elderly osteoporotic patients who were scheduled to undergo median sternotomy. During surgery, we wrapped the sternal edges with polyvinyl chloride tubing in 50 patients (group 1) and omitted the sternal wrapping in the remaining 50 patients (group 2). We then compared the groups with regard to postoperative pain, bleeding, early and late sternum-related morbidity, sternal fractures, and duration of hospitalization.Sternal wrapping was associated with fewer sternal fractures, less chest pain, and shorter hospital stays. Overall sternal morbidity was significantly less common among patients with sternal wrapping (4% vs. 20%, P = 0.03)...
Background: Surgical drainage is a rapid and effective treatment for pericardial tamponade in can... more Background: Surgical drainage is a rapid and effective treatment for pericardial tamponade in cancer patients. We aimed to investigate the effectiveness of pericardial window formation via mini-thoracotomy for treating pericardial tamponade in cancer patients, and to evaluate clinical factors affecting long-term survival. Methods: Records of 53 cancer patients with pericardial tamponade treated by pericardial window formation between 2002 and 2008 were examined. Five patients were excluded due to insufficient data. Kaplan-Meier and Cox regression analysis were used for analysis. Results: Forty-eight patients (64.7% male), with a mean age of 55.20 ± 12.97 years were included. Patients were followed up until the last control visit or death. There was no surgery-related mortality and the 30-day mortality rate was 8.33%; all died during postoperative hospitalization. Morbidity rate was 18.75%. Symptomatic recurrence rate was 2.08%. Cancer type and nature of the pericardial effusion were the major factors determining long-term survival (P <0.001 and P <0.004, respectively). Overall median survival was 10.41 ± 1.79 months. One-and 2-year survival rates were 45 ± 7% and 18 ± 5%, respectively. Conclusion: Pericardial window creation via minithoracotomy was proven to be a safe and effective approach in surgical treatment of pericardial tamponade in cancer patients. Cancer type and nature of pericardial effusion were the main factors affecting long-term survival.
Neoplastic pericarditis due to lung cancer is the most frequent cause of cardiac tamponade Seve... more Neoplastic pericarditis due to lung cancer is the most frequent cause of cardiac tamponade Several treatments are used to prevent recurrence of tamponade after drainage, but studies comparing the outcome of different approaches are lacking Purpose of the study is to compare the outcome of 196 lung cancer patients pts) (141 m, 55 f) with neoplastic pericarditis (all requiring pericardial drainage, with cytology positive effusion) Treated according to the usual care in each Institution Steroids and/or local sclerosing agents, no CT (n=16) Systemic CT (n=50) (PC+ST) Local (pericardial) chemo-or radiotehrapy (n=25) (PC+LT) Systemic plus local therapy (n=61) (PC+ST+LT) Pericardial window plus systemic CT (n=44) (PW+ST) 0 10 20 30 40 50 60 70 80 90 100 PC+ST PC+LT PC+ST+LT PW+ST
A b s t r a c t Introduction: To compare postoperative prophylactic use of two positive end-expir... more A b s t r a c t Introduction: To compare postoperative prophylactic use of two positive end-expiratory pressure (PEEP) levels in order to prevent postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery. Material and methods: Sixty patients undergoing an elective off-pump CABG operation were included in this prospective, nonrandomized clinical trial. Patients were divided into two groups as receiving either 5 cm H 2 O (group 1) or 8 cm H 2 O PEEP (group 2) after the operation until being extubated. Chest tube outputs, use of blood products and other fluids, postoperative hemoglobin levels, accumulation of pleural and pericardial fluid after the removal of chest tubes, and duration of hospital stay were recorded and compared. Results: Low-and high-pressure PEEP groups did not differ with regard to postoperative chest tube outputs, amounts of transfusions and crystalloid/ colloid infusion requirements, or postoperative hemoglobin levels. However, low-pressure PEEP application was associated with significantly higher pleural (92 ±37 ml vs. 69 ±29 ml, p = 0.03) and pericardial fluid (17 ±5 ml vs. 14 ±6 ml, p = 0.04) accumulation. On the other hand, high-pressure PEEP application was associated with significantly longer duration of hospitalization (6.25 ±1.21 days vs. 5.25 ±0.91 days, p = 0.03). Conclusions: Prophylactic administration of postoperative PEEP levels of 8 cm H 2 O, although safe, does not seem to reduce chest-tube output or transfusion requirements in off-pump CABG when compared to the lower level of PEEP. Further studies with larger sample sizes are warranted to confirm the benefits and identify ideal levels of PEEP administration in this group of patients.
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