445 research outputs found
Severe thrombosis after chemotherapy for metastatic choriocarcinoma of the testis maintaining complete remission for a long period
No full textWe report the favourable outcome of a patient who suffered from severe arterial and venous thrombosis during chemotherapy for testicular pure choriocarcinoma. An increased paraneoplastic stimulus of HCG secondary to the marker surge phenomenon is suggested as responsible for transient hypercoagulability and subsequent thromboembolism
Myasthenia gravis, psychiatric disturbances, idiopathic thrombocytopenic purpura, and lichen planus associated with cervical thymoma
No full text[No abstract available
sj-pdf-1-jao-10.1177_03913988241237701 – Supplemental material for External validation of the PC-ECMO score in postcardiotomy veno-arterial extracorporeal membrane oxygenation
No full textSupplemental material, sj-pdf-1-jao-10.1177_03913988241237701 for External validation of the PC-ECMO score in postcardiotomy veno-arterial extracorporeal membrane oxygenation by Fausto Biancari, Tatu Juvonen, Sung-Min Cho, Francisco J Hernández Pérez, Camilla L’Acqua, Amr A Arafat, Mohammed M AlBarak, Mohamed Laimoud, Ilija Djordjevic, Robertas Samalavicius, Marta Alonso-Fernandez-Gatta, Sebastian D Sahli, Alexander Kaserer, Carmelo Dominici and Timo Mäkikallio in The International Journal of Artificial Organs</p
Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic review and meta-analysis of comparative studies
No full textBACKGROUND: The objective was to evaluate the early outcome after adult cardiac surgery in Jehovah's Witnesses (JWs) compared with controls not refusing blood transfusions. STUDY DESIGN AND METHODS: A literature review was performed through PubMed, Scopus, and Google Scholar to identify any comparative study evaluating the outcome of JWs and patients not refusing blood transfusion after adult cardiac surgery. RESULTS: Six studies comparing the outcome of 564 JWs and 903 controls fulfilled the inclusion criteria of this study. All series included a matched control cohort. Baseline characteristics of these two cohorts were similar, but JWs had higher hemoglobin (Hb) levels as reported in three studies. Pooled analysis of postoperative outcomes showed that JWs had higher postoperative levels of Hb (data from four studies: mean, 11.5 g/L vs. 9.8 g/L; p < 0.001) and significantly less postoperative blood loss (mean, 402 mL vs. 826 mL; p < 0.001) compared to controls. JWs and controls had similar early outcome. However, JWs had a nonsignificant trend toward decreased early mortality (2.6% vs. 3.6%; p = 0.318), reoperation for bleeding (3.2% vs. 4.7%; p = 0.070), atrial fibrillation (9.9% vs. 14.3%; p = 0.056), stroke (2.2% vs. 3.1%; p = 0.439), myocardial infarction (0.4% vs. 1.4%; p = 0.203), and length of stay in the intensive care unit (1.5 days vs. 2.0 days; p = 0.081). CONCLUSION: JWs undergoing adult cardiac surgery have a nonsignificant trend toward better early outcome than controls receiving or not blood transfusions. The suboptimal quality of available studies prevents conclusive results on the possible benefits of a transfusion-free strategy in patients not refusing blood transfusion
High rate of recurrence after lobectomy for solitary thyroid nodule
No full textObjective: To evaluate the long-term outcome of patients treated by lobectomy for solitary thyroid nodule. Design: Retrospective study. Setting: University hospital, Patients: 83 patients admitted with a clinical diagnosis of solitary thyroid nodule. Interventions: Preoperative ultrasonography showed a solitary nodule in 32 patients and this finding was confirmed intraoperatively in 24 cases (77%). 59 patients with multinodular goitres were treated by total thyroidectomy and 24 with solitary nodule by lobectomy. Main outcome measures: Postoperative complications and freedom from nodule recurrence and/or parenchymal irregularity. Results: One patient after lobectomy and 3 after total thyroidectomy developed temporary recurrent laryngeal nerve injury. Postoperative temporary hypoparathyroidism occurred in 13 patients (22%) after total thyroidectomy and in no patient after lobectomy (p = 0.02). Neither permanent recurrent laryngeal nerve injury nor permanent hypoparathyroidism occurred after either procedure. Among patients who underwent lobectomy. 6 had an adenoma and IS had a nodular hyperplasia. At 4-year follow-up, the freedom rate from any thyroid nodule recurrence or parenchymal irregularity was 44.7%. and the freedom rate from nodular recurrence was 74%. Men tended to have a 4-year freedom rate from nodular relapse poorer than women (48% vs. 87%, p = 0.07). Nodular recurrence occurred in one patient operated on for an adenoma. and all the other recurrences occurred in patient,. with nodular hyperplasia, Conclusions: The mid-term freedom rate from thyroid nodule recurrence or parenchymal irregularity after lobectomy for solitary nodule of the thyroid is unsatisfactory. This observation calls for a better evaluation of long-term results after lobectomy for this condition and identification of risk factors predictive of recurrence. This would enable a more appropriate preoperative selection of patients undergoing lobectomy, indicating total thyroidectomy for those patients with solitary nodule at high risk of recurrence
Pooled estimates of immediate and late outcome of mitral valve surgery in octogenarians: a meta-analysis and meta-regression
No full textObjective: The authors evaluated the outcome of patients >= 80 years undergoing mitral valve (MV) surgery.Design: Systematic review of the literature and meta-analysis.Setting: None.Participants: None.Interventions: None.Main Results: Twenty-four studies reporting on 5,572 patients 80 years of age who underwent MV surgery were included in this analysis. Pooled proportion of operative mortality was 15.0% (95% confidence interval [CI] 11.9-18.1), stroke was 3.9% (95% Cl 2.6-5.2), and dialysis was 2.7% (95% Cl 0.5-4.9). Early date of study (p = 0.014), increased age (p = 0.006), MV replacement (p = 0.008), procedure other than isolated MV surgery (p = 0.010), MV surgery associated with coronary artery surgery (p = 0.029), aortic cross-clamping time (p < 0.001), and cardiopulmonary bypass time (p < 0.001) were associated significantly with increased operative mortality. MV repair had lower operative mortality compared with MV replacement (7.3% v 14.2%, relative risk 0.573, 95% Cl 0.342-0.962). Random-effects metaregression showed that prolonged aortic cross-clamping time (p = 0.005) was the only determinant of increased operative mortality, even when adjusted (p < 0.001) for date of study (p = 0.004). Operative mortality was significantly higher in studies reporting a mean cross-clamp time >90 minutes (17.0% v 7.4%, p < 0.001). Survival rates at 1, 3, and 5 years were 76.1%, 67.7%, and 56.5%, respectively.Conclusions: MV surgery in patients >= 80 years of age is associated with operative mortality, which has decreased significantly during recent years. Prolonged aortic cross-clamp time is a major determinant of operative mortality. MV repair may achieve better results than MV replacement in the very elderly. Five-year survival of these patients is good and justifies surgical treatment of MV diseases in octogenarians. (C) 2013 Elsevier Inc. All rights reserved
AN INITIAL COMPARISON OF SAPIEN XT VERSUS SAPIEN 3 PROSTHESIS: RESULTS FROM A META-ANALYSIS
No full text
A 3D computational modeling of a novel cerebral perfusion strategy for complex surgery of the aortic arch
No full textMeta-analysis on the performance of the EuroSCORE II and the Society of Thoracic Surgeons Scores in patients undergoing aortic valve replacement
No full textObjective: To evaluate the performance of the EuroSCORE II (ESII) and the Society of Thoracic Surgeons (STS) scores in surgical (SAVR) or transcatheter aortic valve replacement (TAVR). Design: Systematic review of the literature and meta-analysis. Setting: University hospitals. Participants: Studies reporting data on the performance of ESII and STS scores in patients undergoing SAVR or TAVR. Interventions: SAVR or TAVR. Measurements and Main Results: Ten studies validated these scores in 13,856 patients who underwent either TAVR or SAVR. Operative mortality was 5.9% (SAVR 3.1%; TAVR 9.6%). ESII-expected mortality was 5.1% (O/E ratio: 1.15, SAVR, O/E ratio 0.94; TAVR, O/E ratio 1.23) and STS-expected mortality was 6.3% (O/E ratio: 0.94, SAVR, O/E ratio 0.84; TAVR, O/E ratio 1.13). The area under the ROC curve for ESII was 0.70 and for STS was 0.70 (SAVR patients: 0.73 for ESII and 0.75 for STS; TAVR patients; 0.66 for ESII and 0.63 for STS). The difference between observed/expected mortality was not significant for ESII (Peto's OR 0.99, p = 0.88) and was significant for STS (Peto's OR 0.86, p = 0.008). ESII (Peto's OR 1.35, p < 0.00001) and STS (Peto's OR 1.23, p < 0.00001) significantly underestimated the mortality risk in TAVR patients. The STS (Peto's OR 0.74, p < 0.0001) and, to a lesser extent, the ESII (Peto's OR 0.86, p = 0.0.04) overestimated the mortality risk in SAVR patients. Conclusions: The ESII and STS scores have good O/E ratios for either TAVR or SAVR patients, but both scores significantly underpredicted the risk of TAVR patients. ESII seemed to be accurate in predicting the risk of SAVR patients
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