Abstract:

We have introduced a number of modifications to minimize the deleterious effects of cardiopulmonary bypass (CPB) by reducing the surface of the extracorporeal circulation (ECC), the length of the ECC circuit, the contact surface of the oxygenator, and the volume of priming solution, in addition to employing biocompatible systems and isolation of excess blood volumes of venous reservoirs in transfusion bags very early in CPB. Encouraged by the results of our initial "Compact ECC," we have decided to improve it by implementing other techniques such as controlled hemodilution of the patient by reducing the diameter of ECC venous tubing (from 1/2 in. to 3/8 in.), limiting contact surface of the oxygenator and venous reservoir, positioning the oxygenator and venous reservoir at the level of the patient's shoulder, and employing venous cannulae adapted to vacuum assisted venous drainage (VAVD) to replace venous drainage by gravity. The purpose of this study is to evaluate postoperative outcomes of Compact ECC. Three groups of patients undergoing coronary artery bypass graft (CABG) are compared. Our new Compact ECC shows improved outcomes through reduced postoperative ventilation time, blood loss, intensive care stay, need for blood transfusion, and levels of lactate dehydrogenase despite the patients' pathologies and surgeries being more complex.

Authors:

Umberto Borrelli, C.C.P., St-Joseph Hospital, Gilly, Belgium; Nawwar Al-Attar, F.R.C.S., F.E.T.C.S., M.Sc., Hopital Bichat, Paris, France; Marc Detroux, M.D., St-Joseph Hospital, Gilly, Belgium; Remi Nottin, M.D., Hospital Marie Lannelongue, Paris, France; Stéphane Nikis, M.D., St-Joseph Hospital, Gilly, Belgium; Serge Jennes, M.D., St-Joseph Hospital, Gilly, Belgium; Pierre Nackers, M.D., St-Joseph Hospital, Gilly, Belgium; Geert Baert, M.D., St-Joseph Hospital, Gilly, Belgium; Benoit Colinet, M.D., St-Joseph Hospital, Gilly, Belgium; Christian Miesse, M.D., St-Joseph Hospital, Gilly, Belgium; Jaroslaw Fijakowski, C.C.P., St-Joseph Hospital, Gilly, Belgium; François Perron, Hospital St-Paul, Vancouver, Canada

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Abstract:

Varicose veins are a widespread problem, and are encountered by various medical specialists. Symptoms can appear from mild, such as tiredness of the legs, to severe chronic ulcers. Varicose veins are generally caused by the reflux of an incompetent saphenofemoral junction and long saphenous vein. In the presence of reflux, the treatment should be directed at the ablation of the hydrostatic forces of the reflux. Conventional surgical treatment consists of a high ligation of the saphenofemoral junction and stripping of the saphenous vein. In the era of minimally invasive surgery, various endovenous techniques have been developed, including endovenous laser therapy. This technique is relatively cheap and can be performed under only local anesthesia. During endovenous laser therapy, energy is delivered to the vein wall, causing it to shrink and eventually occlude. Currently, the mechanisms of action involved in laser treatment are not fully understood. Clinical studies have shown occlusion rates to be very competitive to conventional high ligation and stripping and superior cosmetics. Complications may include mild to moderate pain, ecchymosis, induration, hematoma, and phlebitis. All of these are generally self-limiting. In the challenge of finding the correct balance between a low incidence of varicose vein recurrence and complications and optimal cosmetic results, endovenous laser therapy is a promising modality. However, controlled studies that assess the effectiveness of endovenous laser therapy in comparison to saphenofemoral ligation with saphenous vein stripping are crucial before considering endovenous laser therapy as the new standard treatment.

Authors:

Michel M.P.J. Reijnen, M.D., Ph.D., Alysis Zorggroep, Rijnstate, Arnhem, The Netherlands; Ben C.V.M. Disselhoff, M.D., Mesos Medical Center, Utrecht, The Netherlands; Clark J. Zeebregts, M.D., Ph.D., University Medical Center Groningen, Groningen, The Netherlands

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Abstract:

Venous thromboembolism (VTE) has proven to be one of the major causes for increasing morbidity among general medical and surgical patients. VTE may have a major role after cardiac surgery by increasing morbidity related to hospital stay, economic burden, discharge planning, complications associated with anticoagulation therapy, and mortality when it ends as a fatal pulmonary embolism (PE). However, patients who undergo cardiac procedures or surgeries pose unique challenges in prevention and treatment of VTE. Clinical diagnosis is always difficult in these patients due to non-specific symptoms or because the patient is asymptomatic. Among the cardiology and cardiac surgery population, thrombosis risk appears to be inherent as a result of multiple co-morbidities as well as direct trauma to the vasculature. Prevention of VTE by prophylactic measures remains the most economical and effective method in current clinical practice. However, many modalities used for VTE prophylaxis have been restricted to the general surgical orthopedic population and can be difficult to apply, especially in patients following cardiac surgery.

Authors:

Girish Mood, M.D., Cleveland Clinic Foundation; W. H. Wilson Tang, M.D., F.A.C.C., Cleveland Clinic Lerner College of Medicine, Cleveland Ohio, USA

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Abstract:

Long-term control of malignant pleural effusion is an important goal of therapy in patients with pleural dissemination. The authors have carried out limited operations combined with parietal pleurectomy (PL) for non-small cell lung cancer patients with pleural dissemination, based on the hypothesis that the most effective target area for controlling malignant pleural effusion is the parietal pleura. In our 25 years of experience, 54 patients with pleural dissemination (26 also had malignant pleural effusion) have undergone this surgical treatment. The operative procedures used for resection of lung parenchyma were partial resection in 25 patients, lobectomy in 24, bilobectomy in two, segmentectomy in two, and no parenchymal resection (PL only) in one. Postoperative intrapleural chemotherapy and systemic chemotherapy (2-4 cycles) also were applied in 43 patients. The pathological stages were IIIB in 44 patients and IV in ten. The overall three-, five-, and ten-year survival rates were 29.0%, 15.0%, and 7.5%, respectively. Twenty patients survived for more than two years. Recurrent malignant pleural effusion developed in only two of 30 patients whose recurrent patterns could be clearly identified. Although this was not a clinical randomized comparative study, multimodality treatment that included the use of PL appears to be a useful option for treatment of this disease in appropriately selected patients.

Authors:

Yasuhiko Ohta, M.D., Kanazawa University School of Medicine, Kanazawa, Japan; Makoto Oda, M.D., Kanazawa University School of Medicine, Kanazawa, Japan; Junzo Shimizu, M.D., KKR Hokuriku Hospital, Kanazawa, Japan; Go Watanabe, M.D., Kanazawa University School of Medicine, Kanazawa, Japan

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