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Journal and News Scan
This multcenter UK review identified 57 patients who underwent indwelling pleural catheter (IPC) insertion for benign causes, primarily hepatic hydrothorax and non-infectious pleuritis. Infection occurred in 3.5% and successful pleurodesis was achieved in 33% at a median of 71 days. Hepatic hydrothorax was associated with a much lower rate of pleurodesis.
Outcomes and biochemical parameters following cardiac surgery: effects of transfusion of residual blood using centrifugation and multiple-pass hemoconcentration
This article compares 2 methods of residual blood treatment after cardiopulmonary bypass. Multipass hemoconcentration led to higher concentrations of platelets and fibrinogen when compared with centrifugation. Clinical outcomes - weight gain, use of vaso-active agents - were reduced in the hemoconcentration group. Further investigation into methods of treatment of residual blood is warranted.
General Surgery Residency Inadequately Prepares Trainees for Fellowship: Results of a Survey of Fellowship Program Directors
This study examines whether graduating general surgery residents are adequately prepared for fellowship with implications for work hour restrictions.
This experimental study in swine investigated the feasibility of using the right and left upper lobes to perform a left unilateral lung transplant. They found the technique is feasible and may permit use of bilateral upper lobes in donors whose lungs were rejected because of isolated lower lobe issues.
Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography
The authors studied outcomes of using a standard algorithm for weaning venoarterial ECMO using continuous transesophageal echo that employed a miniature probe. 6 of 21 pts had RV and LV recovery, 7 had nonrecoverable LV and RV function, and 8 had RV recovery without LV recovery and underwent LVAD. RV function was maintained in the latter 8 pts. The positive predictive value for ventricular recovery was 100% using echo monitoring.
Hybrid total arch repair without deep hypothermic circulatory arrest for acute type A aortic dissection
Outcomes of 21 pts undergoing hybrid total arch repair without deep hypothermic circulatory arrest for Type A dissection were reviewed. 1 and 12 month survival rates were 95% and 90%. There was no evidence for caudal migration of the endograft, and only one patient experienced a type I endoleak that was corrected surgically. No late rupture or paraplegia occurred.
Deep hypothermic circulatory arrest during the arterial switch operation is associated with reduction in cerebral oxygen extraction but no increase in white matter injury
This study compared short periods of deep hypothermic arrest to bypass alone in 18 infants undergoing arterial switch to assess neurophysiologic outcomes and white matter injury. Deep hypothermic arrest was associated with reduced oxygen extraction and transient EEG suppression but there was no difference between the groups in white matter injury.
Pattern of Ascending Aortic Dimensions Predicts the Growth Rate of the Aorta in Patients With Bicuspid Aortic Valve
Interesting retrospective study evaluating the risk factors affecting the progression of ascending aorta dilatation in 133 patients with bicuspid aortic valve, focusing on aortic morphology and cusp fusion pattern. Dilatation at the level of the sinuses of Valsalva rather than no dilatation or dilatation confined to the ascending aorta appears to be a marker of more rapid progression.
The trial was a randomised, prospective, non-blinded, multi-institutional study of patients undergoing surgery for severe ischaemic mitral regurgitation with or without coronary revascularisation,” Dr Acker reported. A total of 251 patients were recruited, with approximately half undergoing mitral valve repair and half undergoing replacement. While there was no difference in efficacy or main safety outcomes, there was a difference in the percentage of patients experiencing a recurrence of IMR - 32.6% in the repair group versus 2.3% in the replacement group (p<0.001).
This study examined the rate of overdiagnosis (detection rate of indolent tumors) of lung cancer in the NLST. They found that 18% of all lung cancers detected were of the indolent type, and nearly 79% of the bronchioalveolar cancers were likely indolent.