http://www.cardiothoracicsurgery.org The latest research articles published by Journal of Cardiothoracic Surgery 2010-09-02T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Background: To report our experience of a rather uncommon drug interaction, resulting in hemolytic uremic syndrome (HUS). Methods: Two consecutive cases of hemolytic uremic syndrome were diagnosed in our service. In both patients the use of macrolides in patients taking Tacrolimus, resulted in high levels of Tacrolimus. Results: The first patient was a 48 years old female with Bilateral emphysema. She underwent Single Sequential Lung Transplantation. She developed reperfusion injury requiring prolonged stay. Tacrolimus introduced (Day 51). The patient remained well up till 5 months later; Erythromycin commenced for chest infection. High Tacrolimus levels and a clinical diagnosis of HUS were made. She was treated with plasmapheresis successfully. The second case was a 57 years old female with Emphysema & A1 Antithrypsin deficiency. She underwent Right Single Lung Transplantation. A2 rejection with mild Obliterative Bronchiolitis diagnosed 1 year later and she switched to Tacrolimus. She was admitted to her local Hospital two and a half years later with right middle lobe consolidation. The patient commenced on amoxicillin and clarithromycin. Worsening renal indices, high Tacrolimus levels, hemolytic anemia & low Platelets were detected. HUS diagnosed & treated with plasmapheresis. Conclusions: There are 21 cases of HUS following lung transplantation in the literature that may have been induced by high tacrolimus levels.Macrolides in patients taking Cyclosporin or Tacrolimus lead to high levels. Mechanism of action could be glomeruloconstrictor effect with reduced GFR increased production of Endothelin-1 and increased Platelet aggregation. http://www.cardiothoracicsurgery.org/content/5/1/70 Haralabos Parissis Kate Gould John Dark Journal of Cardiothoracic Surgery 2010, 5:70 2010-09-02T00:00:00Z doi:10.1186/1749-8090-5-70 Journal of Cardiothoracic Surgery 1749-8090 5 70 2010-09-02T00:00:00Z PDF We report an extremely rare case of Synchronous primary intrapulmonary and mediastinal thymoma in a Chinese patient. We describe the histological and radiological findings, which support the possibility of multicentric thymoma. Resection of the mass in the left anterior superior mediastinum and a upper lobectomy of right lung were performed, with lymph Nodes clearance, superior vena cava, left and right brachiocephalic veins resection, reconstruction of left brachiocephalic vein to right auricle and reconstruction of right brachiocephalic vein to superior vena cava. http://www.cardiothoracicsurgery.org/content/5/1/69 Zuoqing Song Xiaohong Xu Shujun Li Sen Wei Jun Chen Qinghua Zhou Journal of Cardiothoracic Surgery 2010, 5:69 2010-08-28T00:00:00Z doi:10.1186/1749-8090-5-69 Journal of Cardiothoracic Surgery 1749-8090 5 69 2010-08-28T00:00:00Z PDF Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener's syndrome was reffered to our department due to 3-vessel coronary disease. An off-pump coronary artery bypass operation was performed using both internal thoracic arteries and a saphenous vein graft. We performed a literature review for cases with Kartagener's syndrome, coronary surgery and dextrocardia. Although a few cases of dextrocardia were found in the literature, no case of Kartagener's syndrome was mentioned. http://www.cardiothoracicsurgery.org/content/5/1/68 Ioannis Bougioukas Dimitrios Mikroulis Bernhard Danner Lukman Lawal Savvas Eleftheriadis George Bougioukas Vassilios Didilis Journal of Cardiothoracic Surgery 2010, 5:68 2010-08-26T00:00:00Z doi:10.1186/1749-8090-5-68 Journal of Cardiothoracic Surgery 1749-8090 5 68 2010-08-26T00:00:00Z PDF Background: Limited published data are available on how patients are mobilized and exercised during the postoperative hospital stay following cardiac surgery. The aim of this survey was to determine current practice of physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. Methods: A prospective survey was carried out among physiotherapists treating adult cardiac surgery patients. A total population sample was identified and postal questionnaires were sent to the 33 physiotherapists currently working at the departments of thoracic surgery in Sweden. In total, 29 physiotherapists (response rate 88%) from eight hospitals completed the survey. Results: The majority (90%) of the physiotherapists offered preoperative information. The main rationale of physiotherapy treatment after cardiac surgery was to prevent and treat postoperative complications, improve pulmonary function and promote physical activity. In general, one to three treatment sessions were given by a physiotherapist on postoperative day 1 and one to two treatment sessions were given during postoperative days 2 and 3. During weekends, physiotherapy was given to a lesser degree (59% on Saturdays and 31% on Sundays to patients on postoperative day 1). No physiotherapy treatment was given in the evenings.The routine use of early mobilization and shoulder range of motion exercises was common during the first postoperative days, but the choice of exercises and duration of treatment varied. Patients were reminded to adhere to sternal precautions. There were great variations of instructions to the patients concerning weight bearing and exercises involving the sternotomy. All respondents considered physiotherapy necessary after cardiac surgery, but only half of them considered the physiotherapy treatment offered as optimal. Conclusions: The results of this survey show that there are small variations in physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. However, the frequency and duration of exercises and recommendations for sternal precautions reinforced for the healing period differ between physiotherapists. This survey provides an initial insight into physiotherapy management in Sweden. Comparison with surveys in other countries is warranted to improve the physiotherapy management and postoperative recovery of the cardiac surgery patient. http://www.cardiothoracicsurgery.org/content/5/1/67 Elisabeth Westerdahl Margareta Moller Journal of Cardiothoracic Surgery 2010, 5:67 2010-08-25T00:00:00Z doi:10.1186/1749-8090-5-67 Journal of Cardiothoracic Surgery 1749-8090 5 67 2010-08-25T00:00:00Z PDF Background: Cogan's syndrome is a rare disorder of unknown origin characterized by inflammatory ocular disease and vestibuloauditory symptoms. Systemic vasculitis is found in about 10% of cases.Case presentationA 46-year-old female with Cogans's syndrome and a history of arterial hypertension presented with severe chest pain caused by an aneurysm of the ascending aorta with a dissection membrane located a few centimeters distal from the aortic root. After surgery, histopathological analysis revealed that vascular matrix integrity and expression of the major matrix molecules was characterized by elastolysis and collagenolysis and thus a dramatic loss of structural integrity. Remarkably, exceeding matrix deterioration was associated with massively increased levels of granulocyte macrophage colony stimulating factor (GM-CSF). Conclusion: Our data suggest that the persistently increased secretion of the inflammatory mediator GM-CSF by resident inflammatory cells but also by SMC may be the trigger of aortic wall structural deterioration. http://www.cardiothoracicsurgery.org/content/5/1/66 Gabriele Weissen-Plenz Omer Sezer Christian Vahlhaus Horst Robenek Andreas Hoffmeier Tonny Tjan Hans Scheld Jurgen Sindermann Journal of Cardiothoracic Surgery 2010, 5:66 2010-08-21T00:00:00Z doi:10.1186/1749-8090-5-66 Journal of Cardiothoracic Surgery 1749-8090 5 66 2010-08-21T00:00:00Z XML It is common knowledge that cocaine has been linked to the development of various acute and chronic cardiovascular complications including acute coronary syndromes. We present a young, male patient, drug abuser who underwent CABG due to anterolateral myocardial infarction. Our presentation is one of the very rare cases reported in literature regarding acute thrombosis of left main coronary artery related to cocaine use, in a patient with normal coronary arteries, successfully operated. Drug-abusers seem to have increased mortality and morbidity after surgery and high possibility for stent thrombosis after percoutaneous coronary interventions, because of their usually terrible medical compliance and coexistent several problems of general health. There are no specific guidelines about treatment of thrombus formation in coronary arteries, as a consequence of cocaine use. So, any decision making concerning the final treatment of these patient is a unique and individualized approach. We strongly recommend that all these patients should be treated surgically, especially patients with thrombus into the left main artery. http://www.cardiothoracicsurgery.org/content/5/1/65 Efstratios Apostolakis Grigorios Tsigkas Nikolaos Baikoussis Ioanna Koniari Dimitrios Alexopoulos Journal of Cardiothoracic Surgery 2010, 5:65 2010-08-19T00:00:00Z doi:10.1186/1749-8090-5-65 Journal of Cardiothoracic Surgery 1749-8090 5 65 2010-08-19T00:00:00Z XML Background: Plate and screw fixation is a recent addition to the sternal wound treatment armamentarium. Patients undergoing cardiac and major vascular surgery have a higher risk of postoperative arrest than other elective patients. Those who undergo sternotomy for either cardiac or major vascular procedures are at a higher risk of postoperative arrest. Sternal plate design allows quick access to the mediastinum facilitating open cardiac massage, but chest compressions are the mainstay of re-establishing cardiac output in the event of arrest. The response of sternal plates and the chest wall to compressions when plated has not been studied. The safety of performing this maneuver is unknown. This study intends to demonstrate compressions are safe after sternal plating. Methods: We investigated the effect of chest compressions on the plated sternum using a human cadaveric model. Cadavers were plated, an arrest was simulated, and an experienced physician performed a simulated resuscitation. Intrathoracic pressure was monitored throughout to ensure the plates encountered an appropriate degree of force. The hardware and viscera were evaluated for failure and trauma respectively. Results: No hardware failure or obvious visceral trauma was observed. Rib fractures beyond the boundaries of the plates were noted but the incidence was comparable to control and to the fracture incidence after resuscitation previously cited in the literature. Conclusions: From this work we believe chest compressions are safe for the patient with sternal plates when proper plating technique is used. We advocate the use of this life-saving maneuver as part of an ACLS resuscitation in the event of an arrest for rapidly re-establishing circulation. http://www.cardiothoracicsurgery.org/content/5/1/64 Douglas McKay Hosam Fawzy Kathryn McKay Romy Nitsch James Mahoney Journal of Cardiothoracic Surgery 2010, 5:64 2010-08-18T00:00:00Z doi:10.1186/1749-8090-5-64 Journal of Cardiothoracic Surgery 1749-8090 5 64 2010-08-18T00:00:00Z XML Background: Previous reports have suggested that the appearance of pleural effusions (i.e., the presence or absence of blood) might help to establish the etiology of the effusions. This study explores the relationship between pleural fluid appearance and the results of chemical and cytological analyses in a group of patients with recurrent symptomatic pleural effusions and a diagnosis of cancer. Methods: Medical records were reviewed from all 390 patients who were diagnosed with cancer, who underwent thoracentesis before placement of an intrapleural catheter (IPC) between April 2000 and January 2006. Adequate information for data analysis was available in 365 patients. The appearance of their pleural fluid was obtained from procedure notes dictated by the pulmonologists who had performed the thoracenteses. The patients were separated into 2 groups based on fluid appearance: non-bloody and bloody. Group differences in cytology interpretation were compared by using the chi square test. Cellular counts, chemical laboratory results, and survival after index procedure were compared by using the student's t test. Results: Pleural fluid cytology was positive on 82.5% of the non-bloody effusions and on 82.4% of the bloody ones. The number of red blood cells (220.5 × 103/μL vs. 12.3 × 103/μL) and LDH values (1914 IU/dl vs. 863 IU/dl) were statistically higher in bloody pleural effusions. Conclusion: The presence or absence of blood in pleural effusions cannot predict their etiology in patients with cancer and recurrent symptomatic pleural effusions. http://www.cardiothoracicsurgery.org/content/5/1/63 Bulent Ozcakar Carlos Martinez Rodolfo Morice Georgie Eapen David Ost Mona Sarkiss Hsienchang Chiu Carlos Jimenez Journal of Cardiothoracic Surgery 2010, 5:63 2010-08-18T00:00:00Z doi:10.1186/1749-8090-5-63 Journal of Cardiothoracic Surgery 1749-8090 5 63 2010-08-18T00:00:00Z XML IntroductionAcute respiratory dysfunction syndrome (ARDS), defined as acute hypoxemia accompanied by radiographic pulmonary infiltrates without a clearly identifiable cause, is a major cause of morbidity and mortality after pulmonary resection. The aim of the study was to determine the pre and intraoperative factors associated with ARDS after pulmonary resection retrospectively. Methods: Patients undergoing elective pulmonary resection at Adnan Menderes University Medical Faculty Thoracic Surgery Department from January 2005 to February 2010 were included in this retrospective study. The authors collected data on demographics, relevant co-morbidities, the American Society of Anesthesiologists (ASA) Physical Status classification score, pulmonary function tests, type of operation, duration of surgery and intraoperative fluid administration (fluid therapy and blood products). The primary outcome measure was postoperative ARDS, defined as the need for continuation of mechanical ventilation for greater than 48-hours postoperatively or the need for reinstitution of mechanical ventilation after extubation. Statistical analysis was performed with Fisher exact test for categorical variables and logistic regression analysis for continuous variables. Results: Of one hundred forty-three pulmonary resection patients, 11 (7.5 %) developed postoperative ARDS. Alcohol abuse (p=0.01, OR=39.6), ASA score (p=0.001, OR: 1257.3), resection type (p=0.032, OR=28.6) and fresh frozen plasma (FFP)(p=0.027, OR=1.4) were the factors found to be statistically significant. Conclusion: In the light of the current study, lung injury after lung resection has a high mortality. Preoperative and postoperative risk factor were significant predictors of postoperative lung injury. http://www.cardiothoracicsurgery.org/content/5/1/62 Serdar Sen Selda Sen Ekrem Senturk Nilgun Kuman Journal of Cardiothoracic Surgery 2010, 5:62 2010-08-17T00:00:00Z doi:10.1186/1749-8090-5-62 Journal of Cardiothoracic Surgery 1749-8090 5 62 2010-08-17T00:00:00Z PDF ObjectiveThe aim of the present study was to evaluate the efficacy of autologous blood pleurodesis in the management of persistent air leak in spontaneous pneumothorax.Patients and methodsA number of 15 patients (10 male and 5 female) were included in this prospective study between March 2005 and December 2009. The duration of the air leak exceeded 7 days in all patients. The application of blood pleurodesis was used as the last preoperative conservative method of treatment in 12 patients. One patient refused surgery and two were ineligible for operation due to their comorbidities. A blood sample of 50 ml was obtained from the patient's femoral vein and immediately introduced into the chest tube. Results: A success rate of 27% was observed having the air leak sealed in 4 patients in less than 24 hours. Conclusion: Despite our disappointingly poor outcome, the authors believe that the procedure's safety, convenience and low cost establish it as a worth trying method of conservative treatment for patients with the aforementioned pathology for whom no other alternative than surgery would be a choice. http://www.cardiothoracicsurgery.org/content/5/1/61 Dimos Karangelis Georgios Tagarakis Marios Daskalopoulos Georgios Skoumis Nicholaos Desimonas Vasileios Saleptsis Theocharis Koufakis Athanasios Drakos Dimitrios Papadopoulos Nikolaos Tsilimingas Journal of Cardiothoracic Surgery 2010, 5:61 2010-08-17T00:00:00Z doi:10.1186/1749-8090-5-61 Journal of Cardiothoracic Surgery 1749-8090 5 61 2010-08-17T00:00:00Z XML