Comments on " Impact of type of procedure and surgeon on EuroSCORE operative risk validation... more Comments on " Impact of type of procedure and surgeon on EuroSCORE operative risk validation " Dear Editor, We read with great interest the article by Atik et al.: " Impact of type of procedure and surgeon on EuroSCORE operative risk validation " , published recently in the Brazilian Journal of Cardiovascular Surgery [1]. The issue is very relevant especially in the current era of continuous quality improvement and increasing societal demand for consistent performance assessment and monitoring. We would like to take the chance to add some thoughts about the use of risk stratification models for the prediction of hospital mortality after adult cardiac surgery. The EuroSCORE in its original version (ES I) firstly introduced in 1999 [2] was a simple and easily applicable risk assessment tool adopted by many surgical units and cardio-thoracic surgery societies worldwide. The system performance was highly successful for a decade, but it became less well calibrated, du...
Thoracic trauma due to blunt or penetrating injury is a major cause of hospitalization worldwide,... more Thoracic trauma due to blunt or penetrating injury is a major cause of hospitalization worldwide, associated with high mortality rates ranging from 15 to 77%. The majority of thoracic injuries requiring surgical intervention are due to penetrating mechanisms of injury such as gunshot wounds, stab wounds, and shotgun wounds. We present a case of a gunshot-induced thoracic trauma with a way of the bullet predominantly through the right lung, managed, despite the extensive course through the chest cavity, fortunately only by tubal thoracostomy. In addition we provide a thorough review of the literature regarding penetrating thoracic traumas, and specifically those caused by gunshots.
Clinical research in cardiology : official journal of the German Cardiac Society, 2015
Cardiogenic shock due to acute myocardial infarction, postcardiotomy syndrome following cardiac s... more Cardiogenic shock due to acute myocardial infarction, postcardiotomy syndrome following cardiac surgery, or manifestation of heart failure remains a clinical challenge with high mortality rates, despite ongoing advances in surgical techniques, widespread use of primary percutaneous interventions, and medical treatment. Clinicians have, therefore, turned to mechanical means of circulatory support. At present, a broad range of devices are available, which may be extracorporeal, implantable, or percutaneous; temporary or long term. Although counter pulsation provided by intra-aortic balloon pump (IABP) and comprehensive mechanical support for both the systemic and the pulmonary circulation through extracorporeal membrane oxygenation (ECMO) remain a major tool of acute care in patients with cardiogenic shock, both before and after surgical or percutaneous intervention, the development of devices such as the Impella or the Tandemheart allows less invasive forms of temporary support. On t...
Objective. To evaluate the association of BNP and CRP with the development of postoperative atria... more Objective. To evaluate the association of BNP and CRP with the development of postoperative atrial fibrillation following coronary artery bypass grafting surgery. Methods. The series consists of 125 patients (aged 65 ± 9 years), who underwent isolated CABG-surgery. BNP and CRP levels were measured pre- and 24 hours postoperatively and their correlation to the development of postoperative AF was analyzed. Results. Forty-four patients (35%) developed AF postoperatively. They were significantly older (68 ± 8 versus 63 ± 9, P = 0.01) and predominantly nonsmokers (18% versus 46%, P = 0.004), compared to the non-AF cases. In addition they showed significant higher preoperative mean BNP levels of 629 versus 373 pg/mL (P = 0.019). Postoperative BNP levels were significantly higher in both groups (AF-group: 1032 pg/mL versus non-AF group: 705 pg/mL; P < 0.001), while there was a trend of more increased postoperative levels in AF-cases (P = 0.065). AF-episodes appeared significantly more f...
The Journal of Thoracic and Cardiovascular Surgery, 1995
Bacterial endocarditis after heart-lung transplantation has not been described. We report Staphyl... more Bacterial endocarditis after heart-lung transplantation has not been described. We report Staphylococcus aureus bacterial endocarditis in a 12-year-old boy after heart-lung transplantation. He was found to have an apparently free vegetation in his left ventricle, which was surgically removed. After a stormy postoperative period, he successfully recovered and remains well after 6 months.
Abstract Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical ... more Abstract Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical entity, with a reported incidence ranging from 0.22% to 10% among various series. However, the presence of cutaneous metastasis as the first sign of a clinically silent visceral cancer is exceedingly rare. We describe here a case of an asymptomatic male patient who presented with a solitary scalp metastasis as the initial manifestation of an underlying small-cell lung cancer. Diagnostic evaluation revealed advanced disease. We conclude that the possibility of metastatic skin disease should always be considered in the differential diagnosis in patients with a history of smoking or lung cancer presenting with cutaneous nodules. Physicians should be aware of this rare clinical entity, and appropriate investigation should be arranged for early diagnosis and initiation of the appropriate treatment. The prognosis for most patients remains poor.
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
Comments on &amp;amp;quot; Impact of type of procedure and surgeon on EuroSCORE operative ris... more Comments on &amp;amp;quot; Impact of type of procedure and surgeon on EuroSCORE operative risk validation &amp;amp;quot; Dear Editor, We read with great interest the article by Atik et al.: &amp;amp;quot; Impact of type of procedure and surgeon on EuroSCORE operative risk validation &amp;amp;quot; , published recently in the Brazilian Journal of Cardiovascular Surgery [1]. The issue is very relevant especially in the current era of continuous quality improvement and increasing societal demand for consistent performance assessment and monitoring. We would like to take the chance to add some thoughts about the use of risk stratification models for the prediction of hospital mortality after adult cardiac surgery. The EuroSCORE in its original version (ES I) firstly introduced in 1999 [2] was a simple and easily applicable risk assessment tool adopted by many surgical units and cardio-thoracic surgery societies worldwide. The system performance was highly successful for a decade, but it became less well calibrated, du...
Clopidogrel application before diagnostic or therapeutical percutaneous coronary intervention has... more Clopidogrel application before diagnostic or therapeutical percutaneous coronary intervention has become the standard for stent thrombosis prevention. Irreversible platelet inhibition causes increasing bleeding complications if urgent coronary artery bypass grafting is necessary. This study evaluates the effect on bleeding complications of clopidogrel in urgent CABG using bilateral internal thoracic artery (ITA) and saphenous veins in all patients. We retrospectively analyzed 128 patients (operated between January 2000 and September 2002) undergoing urgent or emergent CABG using both ITAs, and compared 64 patients with previous clopidogrel and aspirin application (within 5 days) to 64 patients without clopidogrel. We evaluated chest tube output, re-exploration rate and necessity of blood products, ventilation time and ICU stay. Both groups were comparable in age, gender, number of performed anastomoses (mean 4/patient). Chest tube output (24 h) was higher in the clopidogrel group at 977+/-628 ml vs. 788+/-389 ml (p=0.046), as was re-exploration rate with 7.81% (5 of 64) vs. 0% (0 of 64) (p&lt;0.005). The number of blood products amounted to 2.7+/-1.9 U in the clopidogrel group vs. 1.9+/-1.6 U (p=0.013) for red cells, 0.05+/-0.9 U vs. 0.03+/-0.25 (p=0.0003) for platelets, and 0.5+/-1.3 U vs. 0.2+/-1.0 U (p=0.14) for fresh frozen plasma. Mechanical ventilation time was 11.9+/-9.7 h vs. 9.6+/-5.9 h (p=0.10), ICU stay 32.6+/-22.1 h vs. 27.8+/-18.2 h (p=0.19). Previous application of clopidogrel in combination with aspirin before urgent CABG induces increased chest tube output, re-exploration rate and necessity of blood products, especially platelets. Nevertheless, routine use of both ITAs in patients after clopidogrel exposure can be performed with acceptable bleeding complications.
The occurrence of severe carotid artery disease in more than 12 % of patients requiring CABG resu... more The occurrence of severe carotid artery disease in more than 12 % of patients requiring CABG results in a discrepancy concerning the best treatment for both diseases. We reviewed the early outcome of patients with CABG and/or valve replacement and simultaneous carotid endarterectomy (CEA). We evaluated retrospectively 244 patients operated simultaneously between 7/94 and 10/2001. 209 patients received CABG; 35 patients CABG and/or valve replacement. Mean age was 68 years. 188 patients were male. We analyzed risk factors, morbidity, incidence of neurological complications and 30 day mortality. Perioperative stroke with hemiplegia occurred in 3.3 % (8 patients). 4 of these patients showed contralateral carotid artery occlusion, 2 contralateral severe stenosis. 2 patients (0.8 %) experienced prolonged reversible ischemic neurological deficit (PRIND), 4 patients (1.6 %) transient ischemic attack (TIA). 30-day lethality was 4.5 %. 3 patients died due to low cardiac output, 6 patients due to extracardial reasons, 2 patients (0.8 %) developed a cerebral death. Simultaneous CEA and cardiac surgery can be performed with an acceptable risk for neurological complications and mortality. Occlusion of contralateral carotid artery could be identified as an evident predictor for increased neurological complications. Compared to two-stage procedures, combined operations yield a reduction of hospital costs.
The occurrence of severe carotid artery disease in more than 12% of patients requiring ACB result... more The occurrence of severe carotid artery disease in more than 12% of patients requiring ACB results in a discrepancy concerning the best treatment for both diseases. We reviewed the early outcome of patients with ACB and/or valve replacement and simultaneous carotid endarterectomy (TEA). We evaluated retrospectively 244 patients operated simultaneously between 7/94 and 10/2001: 209 patients received ACB, 35 patients ACB and/or valve replacement. Mean age was 68 years. 188 patients were male. We analyzed risk factors, morbidity, incidence of neurological complications and 30 day mortality. Perioperative stroke with hemiplegia occurred in 3.3% (8 patients). Of these patients, 4 showed contralateral carotid artery occlusion, 2 contralateral severe stenosis. Two patients (0.8%) experienced prolonged reversible ischemic neurological deficit (PRIND), 4 patients (1.6%) transient ischemic attack (TIA). 30-day morbidity was 4.5%. Three patients died due to low cardiac output, 6 patients due to extracardial reasons, 2 patients (0.8) due to cerebral death. Simultaneous TEA and cardiac surgery can be performed with an acceptable risk for neurological complications and mortality. Occlusion of the contralateral carotid artery could be identified as an evident predictor for increased neurological complications. Compared to two-stage procedures, combined operations yield a reduction of hospital costs.
Comments on " Impact of type of procedure and surgeon on EuroSCORE operative risk validation... more Comments on " Impact of type of procedure and surgeon on EuroSCORE operative risk validation " Dear Editor, We read with great interest the article by Atik et al.: " Impact of type of procedure and surgeon on EuroSCORE operative risk validation " , published recently in the Brazilian Journal of Cardiovascular Surgery [1]. The issue is very relevant especially in the current era of continuous quality improvement and increasing societal demand for consistent performance assessment and monitoring. We would like to take the chance to add some thoughts about the use of risk stratification models for the prediction of hospital mortality after adult cardiac surgery. The EuroSCORE in its original version (ES I) firstly introduced in 1999 [2] was a simple and easily applicable risk assessment tool adopted by many surgical units and cardio-thoracic surgery societies worldwide. The system performance was highly successful for a decade, but it became less well calibrated, du...
Thoracic trauma due to blunt or penetrating injury is a major cause of hospitalization worldwide,... more Thoracic trauma due to blunt or penetrating injury is a major cause of hospitalization worldwide, associated with high mortality rates ranging from 15 to 77%. The majority of thoracic injuries requiring surgical intervention are due to penetrating mechanisms of injury such as gunshot wounds, stab wounds, and shotgun wounds. We present a case of a gunshot-induced thoracic trauma with a way of the bullet predominantly through the right lung, managed, despite the extensive course through the chest cavity, fortunately only by tubal thoracostomy. In addition we provide a thorough review of the literature regarding penetrating thoracic traumas, and specifically those caused by gunshots.
Clinical research in cardiology : official journal of the German Cardiac Society, 2015
Cardiogenic shock due to acute myocardial infarction, postcardiotomy syndrome following cardiac s... more Cardiogenic shock due to acute myocardial infarction, postcardiotomy syndrome following cardiac surgery, or manifestation of heart failure remains a clinical challenge with high mortality rates, despite ongoing advances in surgical techniques, widespread use of primary percutaneous interventions, and medical treatment. Clinicians have, therefore, turned to mechanical means of circulatory support. At present, a broad range of devices are available, which may be extracorporeal, implantable, or percutaneous; temporary or long term. Although counter pulsation provided by intra-aortic balloon pump (IABP) and comprehensive mechanical support for both the systemic and the pulmonary circulation through extracorporeal membrane oxygenation (ECMO) remain a major tool of acute care in patients with cardiogenic shock, both before and after surgical or percutaneous intervention, the development of devices such as the Impella or the Tandemheart allows less invasive forms of temporary support. On t...
Objective. To evaluate the association of BNP and CRP with the development of postoperative atria... more Objective. To evaluate the association of BNP and CRP with the development of postoperative atrial fibrillation following coronary artery bypass grafting surgery. Methods. The series consists of 125 patients (aged 65 ± 9 years), who underwent isolated CABG-surgery. BNP and CRP levels were measured pre- and 24 hours postoperatively and their correlation to the development of postoperative AF was analyzed. Results. Forty-four patients (35%) developed AF postoperatively. They were significantly older (68 ± 8 versus 63 ± 9, P = 0.01) and predominantly nonsmokers (18% versus 46%, P = 0.004), compared to the non-AF cases. In addition they showed significant higher preoperative mean BNP levels of 629 versus 373 pg/mL (P = 0.019). Postoperative BNP levels were significantly higher in both groups (AF-group: 1032 pg/mL versus non-AF group: 705 pg/mL; P < 0.001), while there was a trend of more increased postoperative levels in AF-cases (P = 0.065). AF-episodes appeared significantly more f...
The Journal of Thoracic and Cardiovascular Surgery, 1995
Bacterial endocarditis after heart-lung transplantation has not been described. We report Staphyl... more Bacterial endocarditis after heart-lung transplantation has not been described. We report Staphylococcus aureus bacterial endocarditis in a 12-year-old boy after heart-lung transplantation. He was found to have an apparently free vegetation in his left ventricle, which was surgically removed. After a stormy postoperative period, he successfully recovered and remains well after 6 months.
Abstract Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical ... more Abstract Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical entity, with a reported incidence ranging from 0.22% to 10% among various series. However, the presence of cutaneous metastasis as the first sign of a clinically silent visceral cancer is exceedingly rare. We describe here a case of an asymptomatic male patient who presented with a solitary scalp metastasis as the initial manifestation of an underlying small-cell lung cancer. Diagnostic evaluation revealed advanced disease. We conclude that the possibility of metastatic skin disease should always be considered in the differential diagnosis in patients with a history of smoking or lung cancer presenting with cutaneous nodules. Physicians should be aware of this rare clinical entity, and appropriate investigation should be arranged for early diagnosis and initiation of the appropriate treatment. The prognosis for most patients remains poor.
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
Comments on &amp;amp;quot; Impact of type of procedure and surgeon on EuroSCORE operative ris... more Comments on &amp;amp;quot; Impact of type of procedure and surgeon on EuroSCORE operative risk validation &amp;amp;quot; Dear Editor, We read with great interest the article by Atik et al.: &amp;amp;quot; Impact of type of procedure and surgeon on EuroSCORE operative risk validation &amp;amp;quot; , published recently in the Brazilian Journal of Cardiovascular Surgery [1]. The issue is very relevant especially in the current era of continuous quality improvement and increasing societal demand for consistent performance assessment and monitoring. We would like to take the chance to add some thoughts about the use of risk stratification models for the prediction of hospital mortality after adult cardiac surgery. The EuroSCORE in its original version (ES I) firstly introduced in 1999 [2] was a simple and easily applicable risk assessment tool adopted by many surgical units and cardio-thoracic surgery societies worldwide. The system performance was highly successful for a decade, but it became less well calibrated, du...
Clopidogrel application before diagnostic or therapeutical percutaneous coronary intervention has... more Clopidogrel application before diagnostic or therapeutical percutaneous coronary intervention has become the standard for stent thrombosis prevention. Irreversible platelet inhibition causes increasing bleeding complications if urgent coronary artery bypass grafting is necessary. This study evaluates the effect on bleeding complications of clopidogrel in urgent CABG using bilateral internal thoracic artery (ITA) and saphenous veins in all patients. We retrospectively analyzed 128 patients (operated between January 2000 and September 2002) undergoing urgent or emergent CABG using both ITAs, and compared 64 patients with previous clopidogrel and aspirin application (within 5 days) to 64 patients without clopidogrel. We evaluated chest tube output, re-exploration rate and necessity of blood products, ventilation time and ICU stay. Both groups were comparable in age, gender, number of performed anastomoses (mean 4/patient). Chest tube output (24 h) was higher in the clopidogrel group at 977+/-628 ml vs. 788+/-389 ml (p=0.046), as was re-exploration rate with 7.81% (5 of 64) vs. 0% (0 of 64) (p&lt;0.005). The number of blood products amounted to 2.7+/-1.9 U in the clopidogrel group vs. 1.9+/-1.6 U (p=0.013) for red cells, 0.05+/-0.9 U vs. 0.03+/-0.25 (p=0.0003) for platelets, and 0.5+/-1.3 U vs. 0.2+/-1.0 U (p=0.14) for fresh frozen plasma. Mechanical ventilation time was 11.9+/-9.7 h vs. 9.6+/-5.9 h (p=0.10), ICU stay 32.6+/-22.1 h vs. 27.8+/-18.2 h (p=0.19). Previous application of clopidogrel in combination with aspirin before urgent CABG induces increased chest tube output, re-exploration rate and necessity of blood products, especially platelets. Nevertheless, routine use of both ITAs in patients after clopidogrel exposure can be performed with acceptable bleeding complications.
The occurrence of severe carotid artery disease in more than 12 % of patients requiring CABG resu... more The occurrence of severe carotid artery disease in more than 12 % of patients requiring CABG results in a discrepancy concerning the best treatment for both diseases. We reviewed the early outcome of patients with CABG and/or valve replacement and simultaneous carotid endarterectomy (CEA). We evaluated retrospectively 244 patients operated simultaneously between 7/94 and 10/2001. 209 patients received CABG; 35 patients CABG and/or valve replacement. Mean age was 68 years. 188 patients were male. We analyzed risk factors, morbidity, incidence of neurological complications and 30 day mortality. Perioperative stroke with hemiplegia occurred in 3.3 % (8 patients). 4 of these patients showed contralateral carotid artery occlusion, 2 contralateral severe stenosis. 2 patients (0.8 %) experienced prolonged reversible ischemic neurological deficit (PRIND), 4 patients (1.6 %) transient ischemic attack (TIA). 30-day lethality was 4.5 %. 3 patients died due to low cardiac output, 6 patients due to extracardial reasons, 2 patients (0.8 %) developed a cerebral death. Simultaneous CEA and cardiac surgery can be performed with an acceptable risk for neurological complications and mortality. Occlusion of contralateral carotid artery could be identified as an evident predictor for increased neurological complications. Compared to two-stage procedures, combined operations yield a reduction of hospital costs.
The occurrence of severe carotid artery disease in more than 12% of patients requiring ACB result... more The occurrence of severe carotid artery disease in more than 12% of patients requiring ACB results in a discrepancy concerning the best treatment for both diseases. We reviewed the early outcome of patients with ACB and/or valve replacement and simultaneous carotid endarterectomy (TEA). We evaluated retrospectively 244 patients operated simultaneously between 7/94 and 10/2001: 209 patients received ACB, 35 patients ACB and/or valve replacement. Mean age was 68 years. 188 patients were male. We analyzed risk factors, morbidity, incidence of neurological complications and 30 day mortality. Perioperative stroke with hemiplegia occurred in 3.3% (8 patients). Of these patients, 4 showed contralateral carotid artery occlusion, 2 contralateral severe stenosis. Two patients (0.8%) experienced prolonged reversible ischemic neurological deficit (PRIND), 4 patients (1.6%) transient ischemic attack (TIA). 30-day morbidity was 4.5%. Three patients died due to low cardiac output, 6 patients due to extracardial reasons, 2 patients (0.8) due to cerebral death. Simultaneous TEA and cardiac surgery can be performed with an acceptable risk for neurological complications and mortality. Occlusion of the contralateral carotid artery could be identified as an evident predictor for increased neurological complications. Compared to two-stage procedures, combined operations yield a reduction of hospital costs.
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