Early Video-assisted Thoracoscopic Surgery or Intrapleural Enzyme Therapy in Pleural Infection: A Feasibility Randomized Controlled Trial. The Third Multicenter Intrapleural Sepsis Trial-MIST-3.

Assessing the early use of video-assisted thoracoscopic surgery (VATS) or intrapleural enzyme therapy (IET) in pleural infection requires a phase III randomized controlled trial (RCT). To establish the feasibility of randomization in a surgery-versus-nonsurgery trial as well as the key outcome measures that are important to identify relevant patient-centered outcomes in a subsequent RCT. The MIST-3 (third Multicenter Intrapleural Sepsis Trial) was a prospective multicenter RCT involving eight U.

Post-medistinoscopy chylopericardium.

Isolated Chylopericardium (without chylothorax) is a rare clinical disorder that may happen idiopathically or secondary to trauma, radiotherapy, lymphatic anomalies, infections or mediastinal neoplasm. We present a case of middle-aged male with no past medical history of note prior to developing heavy sweating, loss of weight and cough. A series of investigations were done including chest computed tomography which showed enlarged mediastinal lymph nodes leading to uncomplicated mediastinoscopy and lymph node biopsy.

Single crossclamp: Safe training tool for coronary artery bypass grafting.

Objective: The single-crossclamp technique for coronary artery bypass grafting is recognized to reduce manipulation of the ascending aorta, and thereby improve neurological outcomes. However, there is a perceived disadvantage of long cardiopulmonary bypass and crossclamp times. Our objective was to evaluate outcomes with this technique and determine whether it is safe for training.

Salvage therapy with topical antifungal for Aspergillus fumigatus empyema complicating extrapleural pneumonectomy.

We describe an unusual case of Aspergillus fumigatus empyema and bronchopleural fistulae after extrapleural pneumonectomy (EPP) and chemoradiotherapy (CRT), which was treated successfully under salvage conditions with debridement, an innovative topical antifungal application and supplemented systemic antifungal therapy and which went on for a definitive surgical procedure. Combinations of CRT and EPP have been recommended in a select group of patients with malignant mesothelioma. Irrespective of the combination, EPP is associated with mortality in the range of 4-15% and a complication rate as high as 62%.

A prospective audit of endoscopic vein harvesting for coronary artery bypass surgery.

Introduction: The objectives of this study were to: (i) assess the feasibility of minimally invasive endoscopic harvesting of the long saphenous vein or radial artery for use as conduit during coronary artery bypass surgery in the NHS setting; and (ii) investigate the results of endoscopic vein harvesting with regards to postoperative complications, ability to mobilise, and patient satisfaction.

Patients And Methods: In this prospective audit, 25 consecutive patients, aged 52-90 years, undergoing either coronary artery bypass grafting alone or together with valve surgery or atrial fibrillation ablation were studied. All data were entered in purpose-designed proforma.

A simple reproducible method of preventing lobar torsion.

Torsion of remaining lobes after pulmonary resection is a potentially serious complication with high reported morbidity and mortality. A range of additional procedures has been described, we have used a simple, effective, quick and easy to reproduce minor procedure to prevents torsion.

Should patients post-cardiac surgery be given low molecular weight heparin for deep vein thrombosis prophylaxis?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of prophylactic postoperative low molecular weight heparin (LMWH) or unfractionated heparin after cardiac surgery would significantly reduce morbidity by reducing the incidence of deep vein thromboses (DVTs) and pulmonary emboli (PEs). Altogether 390 papers were identified on Medline.

Do coronary artery bypass grafts using cephalic veins have a satisfactory patency?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether using the cephalic vein from the arm for coronary artery bypass grafts achieves an adequate patency rate. Only 219 papers were identified on Medline using the reported search and hand-searching of reference lists.

Truncus arteriosus communis: early and midterm results of early primary repair.

Background: Repair of truncus arteriosus communis (TAC) in the neonatal and early infant period has become standard practice in many centers. We report our experience on early primary repair of TAC, with a focus on early and midterm results.

Methods: From July 1993 to December 2005, 29 patients with median age 28 days (range, 11 to 127), and median body weight 3.

Intra-aortic balloon pumping in children undergoing cardiac surgery: an update of the Liverpool experience.

Objective: Intra-aortic balloon pumping in children remains a rarity. We report our experience in supporting pediatric cardiac surgical patients with intra-aortic balloon pumping.

Methods: We reviewed the cases of 24 children supported with intra-aortic balloon pumping after cardiac surgery in our institution from 1994 through 2003.

Sutureless fixation of temporary pacing wire.

A simple sutureless technique of fixing ordinary straight insulated temporary pacing wire is described by creating a floret of the insulation of the wire. It can be easily accomplished and reproduced.

Total extracardiac cavopulmonary connection: an alternative technique of fenestration.

Fenestrating an extracardiac conduit used for total cavopulmonary connection normally requires an additional incision on the right-sided atrium and is time consuming. Herein we describe an alternative technique that may be used to facilitate this process, which consists of creating the fenestration by using part of the atrial incision resulting from the disconnection of the inferior vena cava from the right atrium. The advantages of this technique are avoidance of an extra incision and suture line on the atrium, and the ease of construction.

Contegra bovine jugular vein right ventricle to pulmonary artery conduit in Ross procedure.

Background: In the Ross procedure a valved conduit, most commonly pulmonary or aortic homograft, is used in place of autotransplanted pulmonary valve. Increasing demand and diminishing supply of homografts has resulted in a search for alternatives. A biological conduit from the valved segment of bovine jugular vein (Contegra) has been used successfully as an alternative.