65 research outputs found
Are Extensive Open Lung Resections for Elderly Patients with Lung Cancer Justified?
No full textBackground: Older patients with malignancies are more comorbid than younger ones and are usually undertreated only because of their age. The aim of this study is to investigate the safety of open anatomical lung resections for lung cancer in elderly patients. Methods: We retrospectively analyzed all patients who underwent lung resection for lung cancer in our institution and categorized them into two groups: the elderly group (≥70 years old) and the control (p = 0.037), higher differentiated tumors (12.6% vs. 6.4%, p = 0.014), and at an earlier stage (stage I: 55.6% for elderly vs. 36.6%, p = 0.002). Elderly patients were more vulnerable to postoperative pneumonia (3.7% vs. 0.8%, p = 0.034), lung atelectasis (7.4% vs. 2.9%, p = 0.040), and pleural empyema (3.2% vs. 0%, p = 0.042), however, with no increased 30-day-mortality (5.2% for elderly vs. 2.7%, p = 0.168). Survival was comparable in both groups (43.4 vs. 45.3 months, p = 0.579). Conclusions: Elderly patients should not be excluded from open major lung resections as the survival benefit is not reduced in selected patients
SURGICAL PROBLEMS IN THE ELDERLY
No full textIN A PROSPECTIVE CONTROLLED TRIAL BASED ON CLINICAL AND LABORATORY DATE, 510 PTS OF THE THIRD AGE WERE STUDIED AS WELL AS 60 PTS AGED 40-60 AS A CONTROL GROUP. THE PREOPERATIVE AND INTRA- POSTOPERATIVE PROBLEMS WERE RECORDED AND STORED AND PROCESSED BY COMPUTER. THE MAIN RESULTS ARE: -1/2 - 1/3 OF THE DRUGS USED INTHE ELDERLY SURGICAL PTS ARE IRRELEVANT. A POSITIVE CORRELATION EXIST BETWEEN THE PREOPERATIVE PROBLEM AND THE POST-OPERATIVE MORBIDITY (23%) AND MORTALITY (10,2%). THE HOSPITAL STAY IS STATISTICAL INCREASED IN THE THIRD AGE. ONE OUT OFTHREE ELDERLY UNDERGOES SURGERY URGENTLY AND THE MAIN INDICATION ARE BILIARY TREE DISEASES FOLLOWED BY HERNIAR AND V.G.I. INTRAABDOMINAL SEPIN IN THE MAIN COURSE OF DEATH, THE MOST SUFFERING ORGANS ARE THE RESPIRATORY SYSTEM AND THE KIDNEYS. ONE OUT OF TEN WILL DIE IN THE FIRST 30 DAYS FOLLOWING OPERATION, 1:10 REQUIRES I.C.V., AND 1:10 LEAVES THE HOSPITAL WITH SOME DEGREE OF DISABILITY. THEPROFILACTIN ANTIBIOTICS REDUCE THE INCIDENCE OF INFECTION. THE SURGICAL SKILNESS AND EXPERIENCE DON'T INFLUENCE THE MORTALITY. THE URGENT SURGERY, THE WRONG INITIAL DIAGNOSIS AND THE MALIGNANCY INCREASE THE MORBIDITY AND MORTALITY. THERE IS NO CONTRAINDUATION IN PERFORM SURGERY IN THE THIRD AGE.ΜΕ ΠΡΟΟΠΤΙΚΗ ΕΛΕΓΧΟΜΕΝΗ ΜΕΘΟΔΟ ΜΕΛΕΤΗΘΗΚΑΝ 510 ΑΣΘΕΝΕΙΣ 3ΗΣ ( > 65 ΧΡ.) ΗΛΙΚΙΑΣΚΑΙ 60 ΑΣΘΕΝΕΙΣ (40-60 ΧΡ.) ΠΟΥ ΑΠΟΤΕΛΕΣΑΝ ΤΗΝ ΟΜΑΔΑ ΜΑΡΤΥΡΩΝ. ΟΛΟΙ ΟΙ ΑΡΡΩΣΤΟΙ ΧΕΙΡΟΥΡΓΗΘΗΚΑΝ ΣΕ ΔΙΑΣΤΗΜΑ 18 ΜΗΝΩΝ (83-84) ΚΑΙ ΤΑ ΣΤΟΙΧΕΙΑ ΤΗΣ ΜΕΛΕΤΗΣ ΚΑΤΑΓΡΑΦΗΚΑΝ ΚΑΙ ΕΠΕΞΕΡΓΑΣΤΗΚΑΝ ΜΕ ΗΛΕΚΤΡΟΝΙΚΟ ΥΠΟΛΟΓΙΣΤΗ. ΚΥΡΙΟΤΕΡΑ ΣΥΜΠΕΡΑΣΜΑΤΑ ΤΗΣ ΜΕΛΕΤΗΣ ΕΙΝΑΙ: - ΤΟ 1/2 - 1/3 ΤΩΝ ΦΑΡΜΑΚΩΝ ΠΟΥ ΧΡΗΣΙΜΟΠΟΙΟΥΝ ΟΙ ΥΠΕΡΗΛΙΚΕΣ ΔΕΝ ΕΙΝΑΙ ΑΝΑΓΚΑΙΟ. - ΜΟΝΟ 1:4 ΔΕΝ ΠΑΡΟΥΣΙΑΖΕΙ ΕΠΙΣΗΜΟ ΣΟΒΑΡΟ ΠΡΟΕΓΧΕΙΡΗΤΙΚΟ ΠΡΟΒΛΗΜΑ. - ΥΠΑΡΧΕΙ ΘΕΤΙΚΗ ΣΥΣΧΕΤΙΣΗ ΑΝΑΜΕΣΑ ΣΤΑ ΠΡΟΒΛΗΜΑΤΑ ΚΑΙ ΣΤΗ ΜΕΤΕΓΧΕΙΡΗΤΙΚΗ ΘΝΗΣΙΜΟΤΗΤΑ (10,2%) ΚΑΙ ΝΟΣΗΡΟΤΗΤΑ (23%). - ΟΙ ΗΜΕΡΕΣ ΝΟΣΗΛΕΙΑΣ ΕΙΝΑΙ ΣΤΑΤΙΣΤΙΚΑ ΑΥΞΗΜΕΝΕΣ ΣΤΗ 3Η ΗΛΙΚΙΑ. - 1:3 ΥΠΗΡΗΛΙΚΕΣ ΧΕΙΡΟΥΡΓΕΙΤΑΙ ΕΠΕΙΓΟΝΤΩΣ ΚΑΙ Η ΚΥΡΙΑ ΕΝΔΕΙΞΗ ΧΕΙΡΟΥΡΓΕΙΩΝ ΕΙΝΑΙ ΤΑ ΧΟΛΗΦΟΡΑ ΚΑΙ ΑΚΟΛΟΥΘΟΥΝ ΟΙ ΚΗΛΕΣ ΜΕ ΤΟ ΑΝΩΤΕΡΟ ΠΕΠΤΙΚΟ. - 1:10 ΚΑΤΑΛΗΓΕΙ, 1:10 ΕΧΕΙ ΑΝΑΓΚΗ Μ.Ε.Θ. (ΜΟΝΑΔΑ ΕΝΤΑΤΙΚΗΣ ΘΕΡΑΠΕΙΑΣ)ΚΑΙ 1:10 ΕΜΦΑΝΙΖΕΙ ΜΟΝΙΜΗ ΑΝΑΠΗΡΙΑ. - Η ΕΝΔΟΚΟΙΛΙΑΚΗ ΣΗΨΗ ΕΙΝΑΙ Η ΚΥΡΙΑ ΑΙΤΙΑ ΘΑΝΑΤΟΥ ΚΑΙ ΤΑ ΚΥΡΙΑ ΠΑΣΧΟΝΤΑ ΟΡΓΑΝΑ ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ ΕΙΝΑΙ ΤΟ ΑΝΑΠΝΕΥΣΤΙΚΟ ΚΑΙ ΤΟ ΝΕΦΡΙΚΟ. - Η ΠΡΟΛΗΠΤΙΚΗ ΑΝΤΙΒΙΩΣΗ ΕΛΑΤΤΩΝΕΙ ΤΗ ΔΙΑΓΝΩΣΗ ΤΡΑΥΜΑΤΟΣ ΚΑΙ Η ΧΕΙΡΟΥΡΓΙΚΗ ΕΜΠΕΙΡΙΑ ΔΕΝ ΕΠΗΡΡΕΑΖΕΙ ΤΗ ΜΕΤΕΓΧΕΙΡΗΤΙΚΗ ΘΝΗΣΙΜΟΤΗΤΑ. - ΤΟ ΕΚΤΑΚΤΟ ΧΕΙΡΟΥΡΓΕΙΟ, Η ΛΑΘΟΣ ΔΙΑΓΝΩΣΗ ΚΑΙ Η ΚΑΚΟΗΘΕΙΑ ΑΥΞΑΝΟΥΝ ΤΗ ΝΟΣΗΡΟΤΗΤΑ. - Η ΗΛΙΚΙΑ ΔΕΝ ΑΠΟΤΕΛΕΙ ΑΝΤΕΝΔΕΙΞΗ ΧΕΙΡΟΥΡΓΕΙΟΥ
A statistical model that predicts the length from the left subclavian artery to the celiac axis; towards accurate intra aortic balloon sizing
No full textAbstract Background Ideally the length of the Intraaortic balloon membrane (22-27.5 cm) should match to the distance from the left subclavian artery (LSA) to the celiac axis (CA), (LSA - CA). By being able to estimate this distance, better guidance regarding IABP sizing could be recommended. Methods Internal aortic lengths and demographic values were collected from a series of 40 cadavers during autopsy. External somatometric measurements were also obtained. There were 23 males and 17 females. The mean age was 73.1+/-13.11 years, weight 56.75+/-12.51 kg and the height 166+/-9.81 cm. Results Multiple regression analysis revealed the following predictor variables (R2 > 0.70) for estimating the length from LSA to CA: height (standardized coefficient (SRC) = 0.37, p = 0.004), age (SRC = 0.35, p Recommendations: If LSA-CA 26.3 cm use 50 cc IABP. However if LSA-CA = 21.9- 26.3 cm use 40 cc, but be aware that it could be "aortic length-balloon membrane length" mismatching. Conclusions Routinely, IABP size selection is being dictated by the patient's height. Inevitably, this leads to pitfalls. We reported a mathematical model of accurate intraaortic balloon sizing, which is easy to be applied and has a high predictive value.</p
Mitral valve repair of isolated posterior leaflet prolapse: resect or respect?: Table 1:
No full textCoronary Artery bypass grafting and/or valvular surgery in patients with previous pneumonectomy
No full textAbstract There is a lack of data regarding heart surgery on patients who have been previously pneumectomized. These patients pose unique challenges and surgical management may necessitate deviations from standard methods in the perioperative course. To summarize the available knowledge and to assess the optimal methods, we reviewed all reported patients with prior pneumonectomy who were subjected to coronary artery bypass grafting and/or valve surgery. In a Medline search from 1966 to May 2011 carefully undertaken, we identified 22 articles, including 29 patients who underwent 30 operations: CABG 70%, valvular surgery 23%, and combination 7%. Severe morbidity was 37% and 30-day mortality 13%. Although postoperative morbidity and mortality remain higher in previously pneumectomized patients undergoing coronary artery bypass grafting and valvular surgery, the gathered experience up to date suggests that a carefully planned surgical strategy, along with the use of advanced modern techniques may reduce morbidity and improve final outcome.</p
Atrial septal defect repair in the age of transcatheter devices
No full textThe aim of this review is to discuss the management of atrial septal defects (ASD) in the adult patient paying special attention to the elderly population and the most recent transcatheter advancements. ASDs are characterized by the following categories: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects; though multiple defects may exist concurrently. Intervention for closure of ASDs are indicated with the development of right ventricular volume overload, or in the clinical context of paradoxical embolic stroke. Previously, there was significant disagreement regarding the timing of ASD closure in adult patients, but there is now general consensus that adult patients with clinical evidence of right ventricular overload should undergo closure of ASDs at the time of presentation. The present review describes the typical presentation of patients with symptomatic ASD’s, medical management, and whether surgical or percutaneous approach should be pursued. We will also discuss other important considerations for patient selection and potential early and late complications of transcatheter ASD closure such as congestive heart failure, device embolization, and tissue erosion. At the time of this writing, there are currently three FDA-approved devices for percutaneous VSD closure including the AmplatzerTM Septal Occluder (ASO, St. Jude Medical, St. Paul, MN), Gore HELEXTM Septal Occluder (W.L. Gore and Associates, Newark, NJ), and Gore CARDIOFORMTM Septal occluder (GCSO, W.L. Gore and Associates, Newark, NJ) devices. Many premarket approvals were granted for devices that never went to market due to poor investigational study performance. Likewise, the HELEX device has since been discontinued upon bringing the GCSO device to market. We will focus primarily on the ASO device with a brief review of current investigations into the GCSO device, both of which carry an indication for closure small to medium sized ASDs in the ostium secundum position. Additionally, this review covers the safety of transcatheter closure of ASDs with currently available devices, review studies associated with devices available outside the United States, and perioperative considerations for transcatheter intervention. Obstacles to device employment and countermeasures to overcome operational challenges will also be discussed. To this end, variations or similarities of currently approved devices will be emphasized throughout this discussion where possible. Lastly, we will offer insights into device evolution trends with the expectation of new device developments on the horizon. We will briefly discuss up and coming areas of active research, including the emerging fields of novel biomaterials and gene therapy
An unexpected cause of acute ST-elevation: An unconsciously swallowed sewing needle migrating to the heart
No full textAdding Inflammation to the Perfect Cytokine Storm: Concerns Related to Extracorporeal Membrane Oxygenation for COVID-19 Patients
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