A bstract Eight patients (4 men, 4 women), mean age 51 years, referred to our Institution for left atrial myxoma underwent removal of the tumor through a superior transseptal approach. All patients in sinus rhythm with normal conduction time. The myxomas were localized in the fossa ovalis (3 cases), interatrial septum (2 cases), left appendage (2 cases), and mitral annulus (1 case). One patient died in hospital after emergency operation for low-output syndrome complicated by septic shock. All other patients had an uneventful postoperative course. Atrial arrhythmias did not represent a major postoperative complication. Transient PR interval elongation was occasionally seen. Electrophysiological studies showed normal sinus node function. At 6 months following operation, patients were evaluated with transeso-phageal echocardiography. There was no tumor recurrence. There were no episodes of arrhythmia in 24-hour electrocardiographic monitoring, and all patients were in NYHA Class I. We believe that the superior transseptal approach gives optimal exposure of the left atrial cavity, overcoming all difficulties related to a small left atrium which is an usual pattern in left atrial myxomas. 相似文献
This summarizes the incidence of septo-octogenarian patients in our robotic mitral experience and provides comparative outcomes to STS predicted models of mortality, stroke, and shortened length of stay, demonstrating that elderly patients (≥70 years) matched STS benchmarks and outperforming STS predicted short length of stay in this study population. LOS, length of stay; NYHA, New York Heart Association; PCI, percutaneous coronary intervention; STS, Society of Thoracic Surgeons.
Ten patients with cardiac myxoma were reviewed. They ranged from 23 months to 60 years old. Echocardiography was the most helpful noninvasive diagnostic technique. The tumor was demonstrated by angiocardiography, left atrial myxomas frequently migrating to the left ventricle in diastole. Hemodynamically, left atrial myxomas were associated with moderately severe pulmonary hypertension and simulated mitral stenosis or insufficiency and right atrial myxomas, with right atrial hypertension. There were 7 myxomas in the left atrium, 2 in the right atrium, and 1 in the right ventricle.Eight patients underwent open-heart operation with removal of the myxoma, 1 had concomitant tricuspid valve replacement, and 1 had biopsy of the right ventricle only. The other patient was a Jehovah's Witness and refused operation. One patient died of cardiac arrest intraoperatively, and another died of a bilateral cerebral infarct. One patient had recurrence requiring reoperation. Postoperative hemodynamic and clinical improvement was more striking in patients with a left atrial myxoma presumably due to a normal mitral valve in contradistinction to the tricuspid valve. 相似文献
Abstract Carney's complex is an autosomal dominant syndrome characterized by recurrent atrial myxomas with concurrent endocrinopathies and characteristic dermatologic features. We present the case of a woman who presented with a recurrent atrial myxoma after two previous resections for myxomas through median sternotomies. As a consequence, we utilized a minimally invasive right thoracotomy approach. We discuss the clinical and pathologic features of Carney complex and the importance of identifying individuals and families with this condition for treatment and counseling. . (J Card Surg 2010;25:519‐521)相似文献
Transaxillary thyroidectomy (TAT) has gained popularity in East Asian countries; however, to date there have been no attempts to evaluate the preferences regarding TAT in the US population. The aim of this study is to assess the preferences and considerations associated with TAT in an American cohort.
Methods
Self-administered surveys were distributed to 966 adults at various locations in a single state. Questions assessed preferences for the surgical approach, acceptable risks and extra costs, and willingness to pursue TAT despite reduced cancer treatment efficacy.
Results
The response rate was 84 %, with a mean age of 40 ± 17 years. The majority of respondents were female. Of the respondents, 82 % preferred TAT to a cervical thyroidectomy (CerT), all risks being equal; 51 % of the respondents were willing to accept a 4 % complication rate with TAT, and 16 % stated they would agree to pay up to an additional $US5,000 for the TAT approach. When presented with thyroid cancer, 20 % of all respondents still preferred TAT, even if it would not cure their disease. Patients preferring TAT over CerT were younger, female, more willing to accept complications and spend additional money, and, most significantly, preferred the TAT approach, even if it was less likely to cure their cancer.
Conclusions
Although this survey presents a hypothetical question for people who do not have thyroid disease, the majority of respondents preferred TAT over CerT. Furthermore, a substantial number were willing to accept higher complication rates and increased costs for TAT. 相似文献
OBJECTIVES: the aim of this study was to illustrate how a Bayesian hierarchical modelling approach can aid the reliable comparison of outcome rates between surgeons. DESIGN: retrospective analysis of prospective and retrospective data. MATERIALS: binary outcome data (death/stroke within 30 days), together with information on 15 possible risk factors specific for CEA were available on 836 CEAs performed by four vascular surgeons from 1992-99. The median patient age was 68 (range 38-86) years and 60% were men. METHODS: the model was developed using the WinBUGS software. After adjusting for patient-level risk factors, a cross-validatory approach was adopted to identify "divergent" performance. A ranking exercise was also carried out. RESULTS: the overall observed 30-day stroke/death rate was 3.9% (33/836). The model found diabetes, stroke and heart disease to be significant risk factors. There was no significant difference between the predicted and observed outcome rates for any surgeon (Bayesian p -value>0.05). Each surgeon had a median rank of 3 with associated 95% CI 1.0-5.0, despite the variability of observed stroke/death rate from 2.9-4.4%. After risk adjustment, there was very little residual between-surgeon variability in outcome rate. CONCLUSIONS: Bayesian hierarchical models can help to accurately quantify the uncertainty associated with surgeons' performance and rank. 相似文献
The purpose of this study was to audit our results after implementation of a standardized operative approach to laparoscopic surgery for rectal cancer within a fast-track recovery program.
Methods:
From January 2009 to February 2011, 100 consecutive patients underwent laparoscopic surgery on an intention-to-treat basis for rectal cancer. The results were retrospectively reviewed from a prospectively collected database. Operative steps and instrumentation for the procedure were standardized. A standard perioperative care plan was used.
Results:
The following procedures were performed: low anterior resection (n=26), low anterior resection with loop-ileostomy (n=39), Hartmann''s operation (n=14), and abdominoperineal resection (n=21). The median length of hospital stay was 7 days; 9 patients were readmitted. There were 9 cases of conversion to open surgery. The overall complication rate was 35%, including 6 cases (9%) of anastomotic leakages requiring reoperation. The 30-day mortality was 5%. The median number of harvested lymph nodes was 15 (range, 2 to 48). There were 6 cases of positive circumferential resection margins. The median follow-up was 9 (range, 1 to 27) months. One patient with disseminated cancer developed port-site metastasis.
Conclusions:
The results confirm the safety of a standardized approach, and the oncological outcomes are comparable to those of similar studies. 相似文献
