Mcfarlandnieves0120

0 [1.5, 4.0] °C/hr. Median ICU and hospital length of stay were 8 [2, 16] and 17 [10, 36] days, respectively. In-hospital mortality was 19.1% (9/47). Median discharge GCS was 15 [15, 15] with minor long-term cognitive impairments noted in 6/47 (19.4%) patients. Survival was significantly associated with potassium on presentation (p less then 0.0001), initial body temperature (p less then 0.0001) and ECLS rewarming rate (p less then 0.0001). Conclusions ECLS is a viable cardiac support option for rewarming patients with accidental hypothermia, while initial potassium level, initial body temperature and ECLS rewarming rate appear to be significantly associated with survival.Chylothorax is defined as the accumulation of chyle in the pleural space, mainly by damaging to the thoracic duct. 99mTc-dextran, is a relatively new tracer for lymphoscintigraphy. A 40-year-old woman who had recurrent chylothoraxes after thymoma resection and ligation of the thoracic duct due to intraoperative suspected thoracic duct injury. She underwent lymphoscintigraphies using 99mTc-sulphur colloid and 99mTc-dextran respectively to identify the possible leakage site of the thoracic duct. The images showed increased 99mTc-dextran but unimpressive 99mTc-sulphur colloid activity at the leakage site. Based on the results, this patient received surgery of anastomosing the thoracic duct and the azygos vein.The COVID-19 pandemic has necessitated that operating room procedures be modified to ensure the safety of staff and patients. Specifically, procedures that have the potential to create aerosolization must be reassessed, given the risk of viral transmission via aerosolization. We present the use of a non-sealed endoscopic vessel harvesting(EVH) approach during coronary surgery that does not necessitate the use of CO2 insufflation and utilizes suction through an ultra low particulate filter, thus mitigating the risk of possible viral transmission via aerosolization or surgical smoke production. This approach is technically feasible and can minimize the risk of viral transmission during EVH.Although the use of robot-assisted thoracoscopic surgery (RATS) is increasing rapidly, it allows only a limited visual field on the head side because the RATS camera port is usually placed in the eighth or ninth intercostal space. Because the visual field on the intrathoracic head side is critical during lung cancer surgery, such as when peeling off the first branches of the pulmonary artery (right truncus superior artery or left upper ventral lobe branch), a poor visual field could be fatal. We therefore devised a new port arrangement, the "Hamamatsu method," which ensures a good visual field.Background Most mediastinal biopsy patients are managed with an overnight inpatient stay and chest drainage. We sought to determine the safety, accuracy, and cost of outpatient thoracoscopic mediastinal biopsy by reviewing operative techniques, peri-operative outcomes, and admission charges for this procedure. Methods This single institution retrospective study reviewed all patients who underwent elective thoracoscopic mediastinal biopsy between 2012 and 2017. Patients were assigned to outpatient or inpatient management preoperatively based on surgeon judgment and preference. The procedures were performed in the supine or lateral decubitus position using ports only. Patients discharged on postoperative day 0 (outpatient) were compared to those discharged on postoperative day 1 or greater (inpatient). Results A total of 46 patients were included. Thirty-one patients were outpatients and 15 were admitted. The outpatient cohort was younger than the inpatient group (48 vs 66 years; P = 0.001). There was no statistically significant difference in other baseline characteristics. The operative time was longer (P = 0.001) and the total charges were higher (P = 0.003) in the inpatient cohort. One patient in each group had a non-diagnostic procedure. One patient in the outpatient group returned to the emergency department for pain but was discharged. There were no complications. Conclusions Outpatient thoracoscopic mediastinal biopsy is a safe and effective procedure that has lower charges compared to inpatient management and should be considered for patients undergoing this procedure.Background Learning curves and skill attrition with aging have been reported to impair outcomes in select surgical subspecialties, but their role in complex cardiac surgery remains unknown. Methods From 1986 to 2019, 2,314 patients underwent reoperative cardiac surgery coronary artery bypass grafting (n=543), valve (n=1,527), or combined coronary bypass grafting and valve (n=244). Thirty-four different surgeons in practice between 1 and 39 years were included. Standardized mortality ratio (SMR, observed-to-expected) was determined for all surgeons in each post-training year of experience. Results Risk-adjusted cumulative sum change-point analysis was used to define five distinct career phases 0-4 years, 5-8 years, 9-17 years, 18-28 years, and 29-39 years. With 5-8 years and 18-28 years of experience, SMR was near unity (0.95 and 1.05, respectively) and lowest with 9-17 years of experience (0.78, p=0.03). In the youngest experience group (0-4 years), observed and expected mortality were both highest, and SMR was elevated at 1.29, which approached statistical significance (p=0.059). In the oldest experience group (29-39 years), expected mortality was low compared to most other groups, but observed mortality increased yielding a significantly elevated SMR at 1.53 (p=0.032). Conclusions Standardized mortality ratios with reoperative cardiac surgery were highest early and late in a surgeon's career and lowest mid-career. As surgeons gain experience, outcomes improve through the first two career decades, then stabilize in the third decade before declining in the fourth decade.AngioVac system (AngioDynamics, Latham, NY) has already proved to be effective and safe in the treatment of thrombotic and endocarditic formations concerning the venous district and the tricuspid valve. We describe an innovative use of the Angio-Vac system to treat a left-sided heart mass. In a high-surgical risk patient, we used a micro-invasive transapical access and a modified ECMO circuit to remove the mass from the mitral bioprosthesis without having to replace it. Further experiences are required to confirm the safety of this technique in high-risk patients.The Rastelli operation is a useful technique for treating the transposition of the great arteries. However, conduit stenosis of the right ventricular outflow tract is a late complication of the procedure. We report a case of a 35-year-old man for whom an arterial switch operation was performed to treat conduit stenosis and improve ventricular arterial alignment 28 years after he underwent a Rastelli operation to treat transposition of the great arteries with a ventricular septal defect. In the eight years that followed the operation, he was asymptomatic and was treated with warfarin.Background Contemporary outcomes of open repair of thoracoabdominal aortic (TAAAs) and descending thoracic aortic aneurysms (DTAs) have not been analyzed in an inclusive meta-analysis. Methods Following a systematic literature search, studies from 2008 to 2018 reporting outcomes of open repair of descending thoracic aortic aneurysms or thoracoabdominal aortic aneurysms were pooled in a single-arm meta-analysis performed using the generic inverse variance method. The primary outcome was operative mortality. Secondary outcomes were late mortality, and postoperative stroke, permanent and temporary spinal cord injury, renal failure, respiratory failure, and myocardial infarction. Results Fifty-four studies with 12,245 patients were included. The pooled operative mortality for open repair was 10.4% (95% confidence interval (CI) 8.3-12.8) 6.6% (95%CI 3.7-11.6) for DTA and 10.5% (95%CI 7.5-14.5) for TAAA. The pooled incidence rate of late mortality was 0.6% (95%CI 0.5-0.8) per person-year. The pooled rates for postoperative outcomes were 4.9%(95%CI 3.9-6.1) for stroke, 5.7%(95%CI 4.3-7.5) and 3.0%(95%CI 2.1-4.2) for permanent and temporary spinal cord injury respectively, 13.2%(95%CI 9.9-17.3) for renal failure, 23.3%(95%CI 17.5-30.4) for respiratory failure, and 2.7%(95%CI 1.8-4.1) for myocardial infarction. At meta-regression, year of publication, use of the clamp-and-sew technique and use of the cerebrospinal fluid drain were associated with lower operative mortality. Ruptured aneurysms were associated with higher operative mortality. Conclusions Despite improvement, open repair of descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms continues to be associated with a considerable risk of operative death and perioperative complications. The use of the cerebrospinal fluid drain is associated with better outcomes.Objective/background To evaluate the efficacy and outcome of adding low-dose fractionated radiotherapy (LDFRT) to induction chemotherapy plus concurrent chemoradiation in locally advanced nasopharyngeal carcinoma (LANPC). Methods A single-institute, phase II-III, prospectively controlled randomized clinical trial was performed at King Faisal Specialist Hospital and Research Centre. Patients aged 18-70 years with WHO type II and III, stage III-IVB nasopharyngeal carcinoma, Eastern Cooperative Oncology Group performance score of 0-2, with adequate hematological, renal, and hepatic function were eligible. In total, 108 patients were enrolled in this trial. All patients received two cycles of induction docetaxel and cisplatin (75 mg/m2 each) chemotherapy on Days 1 and 22, followed by concurrent chemoradiation therapy. Radiation therapy consisted of 70 Gy in 33 fractions, with concurrent cisplatin 25 mg/m2 for 4 days on Days 43 and 64. Patients were randomly assigned to either adding LDFRT (0.5 Gy twice daily 6 hours apart for 2 days) to induction chemotherapy in the experimental arm (54 patients) or induction chemotherapy alone in the control arm (54 patients). Results There was no significant difference in the post-induction response rates (RRs) or in toxicity between the two treatment arms. The 3-year overall survival (OS), locoregional control (LRC), and distant metastases-free survival (DMFS) rates for experimental arm and control arm were 94% versus 93% (p = .8), 84.8% versus 87.5% (p = .58), and 84.1% versus 91.6% (p = .25), respectively. Conclusion The results showed no benefit from adding LDFRT to induction chemotherapy in terms of RR, OS, LRC, and DMFS.Avian haemosporidians (Haemosporida) represent a globally distributed, species-rich multiparasite-multihost host-parasite system. Each year, many of these parasite lineages are carried between temperate and tropical regions by migratory birds. While several factors can limit the transmission of avian haemosporidians to new areas, recent studies have shown that some abundant parasites can sometimes disperse and be transmitted in new areas to become emerging infectious diseases. In this study, we investigated the prevalence and diversity of avian haemosporidian parasites in Sultan Marshes National Park (SMNP), a major stopover site in the eastern Mediterranean flyway, and we evaluated the potential for avian haemosporidians in SMNP to be transmitted to areas outside of their known distributions. We sampled a total of 565 migratory and resident birds belonging to 39 species and 23 families. We applied both molecular and microscopic methods to detect and identify avian haemosporidian infections and also quantified the frequency of potential abortive infections.