Neonatal endocarditis requiring surgery

A case of infective endocarditis in a neonate is reported. Echocardiography demonstrated a large (1 X 1.5 cm) vegetation on the anterior mitral leaflet protruding into the ventricle during diastole. The left atrium was enlarged and Doppler showed mitral regurgitation. Excision of the vegetation during effective antibiotic treatment involved no complications. Although histologically the endocarditis was in the early stage of healing, surgical removal of large, floppy vegetations is advocated because of the unpredictable risk of catastrophic embolization.     

Thoracic aortic injury

Most traumatic aortic injuries are the result of penetrating causes, whereas blunt aortic injury is less common. The initial treatment is determined by the patient's condition. Diagnostic studies include catheter arteriography, computed tomography, and transesophageal echo cardiography. This article summarizes the initial evaluation and management of patients with an aortic injury and describes the various treatment options such as delayed selective management, endovascular solutions, and surgical repair.     

Thoracic great vessel injury

Thoracic great vessel injury may be secondary to blunt, penetrating, blast, or iatrogenic trauma. A surgeon should be the initial evaluator of and decision maker for these patients, and the aortogram remains the gold standard for specific diagnosis of the arterial injuries except in those patients requiring emergency thoracotomy. Two general types of incisions are employed for these injuries: resuscitative and elective.     

Thoracic outlet syndrome. Thoracic surgery perspective.

We have attempted throughout this review to identify the issues surrounding thoracic outlet syndrome as well as to highlight their origins. It should be clear that many aspects of TOS remain controversial from the definition of the entity through pathogenesis, diagnosis, and treatment. The conflicts surrounding TOS are underlined most poignantly in the many letters to the editor of the New England Journal of Medicine in response to Urschel's 1972 publication. It is incumbent upon those of us who treat patients with TOS to dispel the ignorance surrounding this syndrome with astute, accurate, and reproducible observations. We must clearly define TOS as a clinical entity such that we may analyze the characteristics of the patients we treat. We must continue to search for innovative and specific diagnostic criteria. We must quantitatively and reproducibly measure subjective end points of pain severity and quality of life. The use of these methods will provide yardsticks for therapeutic success and act as determinants for the natural history of TOS. The objectives of treatment will remain the alleviation of symptoms and the restoration of function. We have applied these principles to the formulation of a protocol in which we record, in a prospective manner, both routine and innovative clinical parameters. With quantification of subjective end points, we may be able to correlate clinical presentation with outcome. We also may be able to define with some accuracy this entity we call thoracic outlet syndrome.     

Thoracic surgery in 2030

Introduction Thoracic surgery has evolved at an exponential pace since the first clinical lung resection in 1882. The first pneumonectomy was performed in 1895,...     

Thoracic surgery in children

Anesthesia for thoracic surgery in children covers a wide range of ages, associated disease processes, and surgical pathology. Therefore, the anesthetist must be prepared to deal with a diverse group of patients of all ages along the pediatric spectrum, combining knowledge regarding both pediatric and thoracic anesthesia. The following article reviews the anesthetic care of infants and children during thoracic surgery with emphasis on: (i) preoperative assessment; (ii) techniques for one-lung ventilation; (iii) anesthetic implications of specific procedures including laryngoscopy/bronchoscopy, thoracoscopic procedures, and open thoracotomy; and (iv) postoperative considerations including pain management.     

Thoracic surgery in children--pain control after surgery

In the postoperative phase after thoracic surgery in children patients can suffer considerable pain. The repertoire of analgesic treatments consist of basic treatment with non-opioid analgesics such as paracetamol or ibuprofen, as well as need-determined treatments with opioids given under intensive care monitoring. In addition, local and regional anaesthetic methods are an important part of the big picture of effective pain control after thoracic surgery in children.     

Thoracic surgery in children.

OBJECTIVE: Children rarely undergo thoracic surgery. When they do, the procedures fall into five main groups: oncologic indications, immune defects, malformations, infections and trauma. In addition to considerations associated with the underlying indication, the different proportions of the anatomical structures in children require special modifications in both diagnostics and surgical technique compared to corresponding procedures in adults. METHODS: Of a total 2137 thoracic surgical procedures performed between 1992 and 2001, 49 were performed in children (n = 37; age: 3 months-15 years; median age: 8 years). Indications for surgery included underlying oncologic disease (n = 20), immunodeficiency (n = 5), thoracic or pulmonary malformation (n = 6) and trauma (n = 3). Patients' postoperative clinical course was analyzed retrospectively for all 49 procedures. Pre- and postoperative pulmonary function test results are available for 16 children. Data regarding quality of life were documented in 24 children. RESULTS: The following procedures were performed: 27 atypical resections, seven lobectomies, one pneumonectomy, three decortications, four mediastinotomies or mediastinoscopies and seven other procedures. Six procedures represented second or third procedures in the same patient. Two of six patients with immune defects died during the perioperative period. Eleven of 20 oncologic patients (55%) have remained free of recurrent disease. Quality of life, as assessed by the Karnowski index in 24 children, was at least 80%. CONCLUSIONS: Thoracic surgical procedures in children with underlying benign disease are associated with a good prognosis and high quality of life scores. Surgical treatment of pulmonary metastases is a feasible component of the overall oncologic therapy concept and can offer the only opportunity for curation for a selected group of patients. Because of high postoperative mortality, however, the indication for diagnostic thoracotomies in children with immunodeficiencies and poor general health should be weighed critically.     

Coronary surgery in patients requiring chronic hemodialysis

BACKGROUND: In uremic patients coronary surgery and the entire perioperative management is demanding. METHODS: We analyzed retrospectively data from all patients requiring chronic hemodialysis who under went coronary artery bypass grafting (CABG) between January 1 2001 and December 31 2004 at the Deutsches Herzzentrum Berlin and compared them to those of a randomized nonuremic control group (n = 68), which consisted of patients who underwent CABG during the same period. RESULTS: During the study period 6315 patients underwent coronary artery bypass grafting at the Deutsches Herzzentrum Berlin. Among these patients, we identified 71 chronic dialysis patients (1.12%). Among dialysis patients, we recorded a perioperative mortality of 5.6%. One-year survival rate was 87.7% among uremic patients and 91.0% in the control group; the corresponding 4-year survival rates were 56.7 and 88.0%, respectively. The incidence of peripheral artery disease was significantly higher in the dialysis group. Uremic patients showed significantly lower hemoglobin serum levels at the time of admission compared to the control group (11.4 +/- 1.62 vs. 13.3 +/- 1.81 mg/dl). These patients received significantly higher numbers of blood transfusions (6.7 +/- 5.6 vs. 2.75 +/- 3.8), and platelet transfusions. CONCLUSION: Our preliminary study indicates that coronary surgery can be performed with acceptable mid-term results when the specific requirements of this patient group are taken into account.