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36 records – page 1 of 4.

[Application of trans-sternum occlusion of the main bronchus stump using transdiaphragmatic omentopexy for post-pneumonectomy bronchial fistula]

https://arctichealth.org/en/permalink/ahliterature53944
Source
Klin Khir. 2000 May;(5):56-7
Publication Type
Article
Date
May-2000

[A transsternal method for stopping pulmonary hemorrhage in patients with superior-lobe destructive pulmonary tuberculosis]

https://arctichealth.org/en/permalink/ahliterature69484
Source
Lik Sprava. 1998 Aug;(6):113-4
Publication Type
Article
Date
Aug-1998
Author
Iu F Savenkov
Source
Lik Sprava. 1998 Aug;(6):113-4
Date
Aug-1998
Language
Ukrainian
Publication Type
Article
Keywords
Adult
Chronic Disease
English Abstract
Hemorrhage - etiology - surgery
Hemostasis, Surgical - methods
Humans
Lung Diseases - etiology - surgery
Male
Pneumonectomy
Sternum
Tuberculosis, Pulmonary - complications - surgery
Abstract
A less traumatic and safe way was sought for the superlobular bronchus and artery occlusion that permits the hemostatic effect to be quickly achieved, the risk and duration of the operation to be minimized. The approach consists in the use of transsternal approach instead of a conventional intercostal approach in 5 patients with superlobular fibrotic cavernous pulmonary tuberculosis, its positive effects being lessening of traumatic harm, improving of safety of operation, together with reduction of intraoperative time.
PubMed ID
9844892 View in PubMed
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Changes in the appearance and treatment of deep sternal infections.

https://arctichealth.org/en/permalink/ahliterature53739
Source
J Hosp Infect. 2002 Apr;50(4):298-303
Publication Type
Article
Date
Apr-2002
Author
A. Tegnell
B. Isaksson
H. Granfeldt
L. Ohman
Author Affiliation
Division of Infectious Diseases, Department of Health and Environment, Faculty of Health Sciences, Linköping University, S-581 85 Linköping, Sweden. Anders.Tegnell@inf.liu.se
Source
J Hosp Infect. 2002 Apr;50(4):298-303
Date
Apr-2002
Language
English
Publication Type
Article
Keywords
Aged
Anti-Bacterial Agents - therapeutic use
Female
Heart Diseases - surgery
Humans
Male
Reoperation
Research Support, Non-U.S. Gov't
Sternum - microbiology
Surgical Wound Infection - drug therapy - pathology - surgery
Sweden
Abstract
The Department of Thoracic Surgery at the University Hospital, Linköping, Sweden, has actively followed up infectious complications of cardiac surgery since 1989. The aim of this study was to investigate whether changes occurred during the 1990s in the appearance and the management of deep infections. This was done by studying patients undergoing surgical revision of infected wounds. We studied 42 patients during 1990-94 and 49 during 1997-98 (total number of operations in these periods, 3075 and 1646, respectively). Pre-operative and intra-operative variables were recorded for the two patient populations. The proportion of cardiac surgery procedures followed by a surgical revision for an infection in the sternal wound increased between the two periods (1.4% vs. 3.0%). Variables associated with the surgical procedures preceding the infection remained unchanged. In the later period, treatment was started earlier (64 vs. 24 days), and the length of antibiotic treatment was decreased (115 vs. 72 days). The incidence of osteomyelitis of the sternal bone was lower (61% vs. 27%). It appears that as the proportion of patients undergoing surgical revision increased, management of the infections became more effective, with aggressive surgical and antibiotic treatment policies and shorter treatment periods. This indicates that in order to evaluate the overall impact of measures designed to reduce infections after cardiac surgery, not only the incidence of infection needs to be followed up but other factors also need to be taken into account.
PubMed ID
12014904 View in PubMed
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Collagen gentamicin for prevention of sternal wound infection: effective or not?

https://arctichealth.org/en/permalink/ahliterature119672
Source
Thorac Cardiovasc Surg. 2013 Apr;61(3):185-93
Publication Type
Article
Date
Apr-2013
Author
Örjan Friberg
Lennart Bodin
Author Affiliation
Department of Cardiovascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden. orjan.friberg@orebroll.se
Source
Thorac Cardiovasc Surg. 2013 Apr;61(3):185-93
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Administration, Topical
Aged
Anti-Bacterial Agents - administration & dosage
Cardiac Surgical Procedures - adverse effects
Collagen - administration & dosage
Drug Combinations
Female
Follow-Up Studies
Gentamicins - administration & dosage
Heart Diseases - surgery
Humans
Incidence
Male
Odds Ratio
Retrospective Studies
Risk factors
Sternotomy - adverse effects
Sternum - surgery
Surgical Sponges
Surgical Wound Infection - epidemiology - prevention & control
Sweden - epidemiology
Treatment Outcome
Abstract
Prophylactic local application of collagen-gentamicin sponges for prevention of sternal wound infections (SWI) after cardiac surgery has been used routinely in risk patients for several years at our center. However, a recent US study failed to show a significant reduction in SWI with the prophylaxis. Therefore, a systematic reevaluation of the effect of local collagen gentamicin was conducted.
A complete follow-up of all cardiac surgery patients 2 months postoperatively was achieved. All SWIs were recorded. The effect of the prophylaxis was analyzed, and differences in risk factors were compensated for using multiple logistic regression analyses and Coarsened Exact Matching (CEM).
A total of 950 patients were included. Established risk factors for SWI were confirmed. The use of collagen-gentamicin prophylaxis was independently associated with a highly significant reduction in SWI (odds ratio [OR] = 0.30, 95% confidence interval = 0.16 to 0.57; p
PubMed ID
23081834 View in PubMed
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Collagen-gentamicin implant for prevention of sternal wound infection; long-term follow-up of effectiveness.

https://arctichealth.org/en/permalink/ahliterature150178
Source
Interact Cardiovasc Thorac Surg. 2009 Sep;9(3):454-8
Publication Type
Article
Date
Sep-2009
Author
Orjan Friberg
Lars-Göran Dahlin
Jan Källman
Erik Kihlström
Bo Söderquist
Rolf Svedjeholm
Author Affiliation
Department of Cardiothoracic Surgery and Anesthesiology, Orebro University Hospital, SE 70185 Orebro, Sweden.
Source
Interact Cardiovasc Thorac Surg. 2009 Sep;9(3):454-8
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - administration & dosage
Antibiotic Prophylaxis
Chemistry, Pharmaceutical
Collagen
Drug Carriers
Drug Implants
Drug Resistance, Multiple, Bacterial
Female
Gentamicins - administration & dosage
Humans
Male
Mediastinitis - microbiology - prevention & control
Middle Aged
Penicillins - administration & dosage
Staphylococcus aureus - isolation & purification
Sternum - surgery
Surgical Sponges
Surgical Wound Infection - microbiology - prevention & control
Sweden
Time Factors
Treatment Outcome
Young Adult
Abstract
In a previous randomized controlled trial (LOGIP trial) the addition of local collagen-gentamicin reduced the incidence of postoperative sternal wound infections (SWI) compared with intravenous prophylaxis only. Consequently, the technique with local gentamicin was introduced in clinical routine at the two participating centers. The aim of the present study was to re-evaluate the technique regarding the prophylactic effect against SWI and to detect potential shifts in causative microbiological agents over time. All patients in this prospective two-center study received prophylaxis with application of two collagen-gentamicin sponges between the sternal halves in addition to routine intravenous antibiotics. All patients were followed for 60 days postoperatively. From January 2007 to May 2008, 1359 patients were included. The 60-day incidences of any SWI was 3.7% and of deep SWI 1.5% (1.0% mediastinitis). Both superficial and deep SWI were significantly reduced compared with the previous control group (OR=0.34 for deep SWI, P
PubMed ID
19541691 View in PubMed
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The cost of vacuum-assisted closure therapy in treatment of deep sternal wound infection.

https://arctichealth.org/en/permalink/ahliterature158804
Source
Scand Cardiovasc J. 2008 Feb;42(1):85-9
Publication Type
Article
Date
Feb-2008
Author
Arash Mokhtari
Johan Sjögren
Johan Nilsson
Ronny Gustafsson
Malin Malmsjö
Richard Ingemansson
Author Affiliation
Department of Cardiothoracic Surgery, Lund University Hospital, Lund, Sweden. arash.mokhtari@med.lu.se
Source
Scand Cardiovasc J. 2008 Feb;42(1):85-9
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Aged
Anti-Bacterial Agents - economics - therapeutic use
Coronary Artery Bypass - adverse effects - economics
Cost-Benefit Analysis
Costs and Cost Analysis
Female
Hospital Costs
Humans
Male
Mediastinitis - economics - etiology - mortality - therapy
Middle Aged
Negative-Pressure Wound Therapy - economics
Registries
Sternum - surgery
Surgical Wound Infection - economics - mortality - therapy
Sweden - epidemiology
Time Factors
Treatment Outcome
Abstract
Surgical sites infections are very expensive and the total costs for coronary artery bypass grafting (CABG) surgery followed by deep sternal wound infection (DSWI) with conventional therapy are estimated to be 2.8 times that for normal, CABG surgery. Promising results have been reported with vacuum-assisted closure (VAC) therapy in patients with DSWI. This study presents the cost of VAC therapy in patients with DSWI after CABG surgery.
Thirty-eight CABG patients with DSWI, between 2001 and 2005, were treated with VAC therapy. The cost of surgery, intensive care, ward care, laboratory tests and other costs were analyzed.
No three-month mortality or recurrent infection was observed. The average cost of CABG procedure and treatment of DSWI was 2.5 times higher than the mean cost of CABG alone. No significant correlations were found between the preoperative EuroSCORE and the cost of DSWI therapy.
VAC therapy for patients who underwent CABG surgery followed by DSWI seems to be cost effective, and has low mortality rate.
PubMed ID
18273735 View in PubMed
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The diabetic disadvantage: historical outcomes measures in diabetic patients undergoing cardiac surgery -- the pre-intravenous insulin era.

https://arctichealth.org/en/permalink/ahliterature164375
Source
Semin Thorac Cardiovasc Surg. 2006;18(4):281-8
Publication Type
Article
Date
2006
Author
Jeremiah R Brown
Fred H Edwards
Gerald T O'Connor
Cathy S Ross
Anthony P Furnary
Author Affiliation
Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Lebanon, NH, USA. Jeremiah.R.Brown@Dartmouth.edu
Source
Semin Thorac Cardiovasc Surg. 2006;18(4):281-8
Date
2006
Language
English
Publication Type
Article
Keywords
Aortic Valve - surgery
Canada - epidemiology
Coronary Artery Bypass
Coronary Artery Disease - mortality - surgery
Diabetes Mellitus - drug therapy - mortality
Heart Valve Diseases - mortality - surgery
Heart Valve Prosthesis Implantation
Humans
Hypoglycemic agents - therapeutic use
Infusions, Intravenous
Insulin - therapeutic use
Length of Stay
Longitudinal Studies
Mitral Valve - surgery
New England - epidemiology
Registries
Sternum - surgery
Stroke - etiology - mortality
Surgical Wound Infection - etiology - mortality
Survival Analysis
Time Factors
Treatment Outcome
United States - epidemiology
Abstract
Seven percent of the United States population is diabetic. However, diabetics are two to five times more likely to develop cardiovascular disease and therefore populate 30% of open heart procedures in this country. In addition, it has been well documented that diabetic cardiac surgery patients are further disadvantaged with worse outcomes following those procedures. This has been termed the "Diabetic Disadvantage." To benchmark these specific disadvantages, we evaluated the short- and long-term outcomes for diabetics and nondiabetics undergoing coronary artery bypass graft (CABG), CABG/valve, and aortic or mitral valve replacement surgery before the broader acceptance and use of intravenous insulin infusions in this patient population in 2001. All such patient records (n = 1,369,961) from the Society of Thoracic Surgeons national database operated on between 1990 and 2000 were assessed for short-term outcomes. Ten-year survival was evaluated among 36,835 patients from the Northern New England Cardiovascular Disease Study Group longitudinal registry. The diabetic population was found to have higher rates of 30-day mortality, deep sternal wound infection, stroke, and longer length of stay than the nondiabetic population. In addition, diabetic patients had approximately two-fold worse 10-year survival. All differences were statistically significant (P
PubMed ID
17395023 View in PubMed
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Effect of an implantable gentamicin-collagen sponge on sternal wound infections following cardiac surgery: a randomized trial.

https://arctichealth.org/en/permalink/ahliterature99221
Source
JAMA. 2010 Aug 18;304(7):755-62
Publication Type
Article
Date
Aug-18-2010
Author
Elliott Bennett-Guerrero
T Bruce Ferguson
Min Lin
Jyotsna Garg
Daniel B Mark
Vincent A Scavo
Nicholas Kouchoukos
John B Richardson
Renee L Pridgen
G R Corey
Author Affiliation
Division of Perioperative Clinical Research, Duke Clinical Research Institute, Duke University Medical Center, PO Box 3094, Durham, NC 27710, USA. Elliott.BennettGuerrero@Duke.edu
Source
JAMA. 2010 Aug 18;304(7):755-62
Date
Aug-18-2010
Language
English
Publication Type
Article
Keywords
Aged
Anti-Bacterial Agents - administration & dosage
Cardiac Surgical Procedures - instrumentation
Female
Gentamicins - administration & dosage
Humans
Male
Middle Aged
Prostheses and Implants
Single-Blind Method
Sternum - surgery
Surgical Sponges
Surgical Wound Infection - prevention & control
Treatment Outcome
Abstract
CONTEXT: Despite the routine use of prophylactic systemic antibiotics, sternal wound infection still occurs in 5% or more of cardiac surgical patients and is associated with significant excess morbidity, mortality, and cost. The gentamicin-collagen sponge, a surgically implantable topical antibiotic, is currently approved in 54 countries. A large, 2-center, randomized trial in Sweden reported in 2005 that the sponge reduced surgical site infection by 50% in cardiac patients. OBJECTIVE: To test the hypothesis that the sponge prevents infection in cardiac surgical patients at increased risk for sternal wound infection. DESIGN, SETTING, AND PARTICIPANTS: Phase 3 single-blind, prospective randomized controlled trial, 1502 cardiac surgical patients at high risk for sternal wound infection (diabetes, body mass index >30, or both) were enrolled at 48 US sites between December 21, 2007, and March 11, 2009. INTERVENTION: Single-blind randomization to insertion of 2 gentamicin-collagen sponges (total gentamicin of 260 mg) between the sternal halves at surgical closure (n = 753) vs no intervention (control group: n = 749). All patients received standardized care including prophylactic systemic antibiotics and rigid sternal fixation. MAIN OUTCOME MEASURES: The primary end point was sternal wound infection occurring through 90 days postoperatively as adjudicated by a clinical events classification committee blinded to study treatment group. The primary study comparison was done in the intent-to-treat population. Secondary outcomes included (1) superficial wound infection (involving subcutaneous tissue but not extending down to sternal fixation wires), (2) deep wound infection (involving the sternal wires, sternal bone, and/or mediastinum), and (3) score for additional treatment, presence of serous discharge, erythema, purulent exudate, separation of the deep tissues, isolation of bacteria, and duration of inpatient stay (ASEPSIS; minimum score of 0 with no theoretical maximum). RESULTS: Of 1502 patients, 1006 had diabetes (67%) and 1137 were obese (body mass index >30) (76%). In the primary analysis, there was no significant difference in sternal wound infection in 63 of 753 patients randomized to the gentamicin-collagen sponge group (8.4%) compared with 65 of 749 patients randomized to the control group (8.7%) (P = .83). No significant differences were observed between the gentamicin-collagen sponge group and the control group, respectively, in superficial sternal wound infection (49/753 [6.5%] vs 46/749 [6.1%]; P = .77), deep sternal wound infection (14/753 [1.9%] vs 19/749 [2.5%]; P = .37), ASEPSIS score (mean [SD], 1.9 [6.4] vs 2.0 [7.2]; P = .67), or rehospitalization for sternal wound infection (23/753 [3.1%] vs 24/749 [3.2%]; P = .87). CONCLUSION: Among US patients with diabetes, high body mass index, or both undergoing cardiac surgery, the use of 2 gentamicin-collagen sponges compared with no intervention did not reduce the 90-day sternal wound infection rate. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00600483.
PubMed ID
20716738 View in PubMed
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Emerging role of Candida in deep sternal wound infection.

https://arctichealth.org/en/permalink/ahliterature147214
Source
Ann Thorac Surg. 2009 Dec;88(6):1905-9
Publication Type
Article
Date
Dec-2009
Author
Ivy S Modrau
Tove Ejlertsen
Bodil S Rasmussen
Author Affiliation
Department of Cardiovascular and Thoracic Surgery, Cardiothoracic Section, Aarhus University Hospital Skejby, Aarhus, Denmark. modrau@mail1.stofanet.dk
Source
Ann Thorac Surg. 2009 Dec;88(6):1905-9
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Candida - isolation & purification
Candidiasis - epidemiology - microbiology
Cardiac Surgical Procedures - adverse effects
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Morbidity - trends
Prognosis
Retrospective Studies
Risk factors
Sternotomy - adverse effects
Sternum - microbiology - surgery
Surgical Wound Infection - epidemiology - microbiology
Survival Rate - trends
Abstract
This study evaluated the overall incidence, prognosis, and risk factors for microbiologically documented Candida deep sternal wound infection (DSWI) after cardiac operations.
A retrospective observational study was performed at Aalborg Hospital, Aarhus University Hospital, Denmark, from January 1999 through November 2006. Included were all 83 of 4222 cardiac surgical patients with microbiologically documented DSWI requiring surgical revision. Various potential risk factors in patients with Candida DSWI were compared with those of patients with non-Candida DSWI. We compared markers of morbidity, in-hospital mortality, and 1-year mortality to evaluate the prognosis of the disease.
DSWI developed in 2% of all patients, of whom, 17 (20.5%) had Candida DSWI, and 66 (79.5%) had non-Candida etiology. Candida was the primary causative organism in 11 of 17 Candida DSWI cases. No Candida DSWI was found during the first 3 years of the study. In-hospital and 1-year mortality were doubled in patients with Candida DSWI compared with patients with non-Candida DSWI. Candida DSWI was associated with significantly longer stay in the intensive care unit and need of prolonged mechanical ventilation. Risk factors for Candida etiology were Candida colonization in tracheal secretions or urine and reoperation before diagnosis of DSWI.
Candida was a frequent causative agent of DSWI in our series and was associated with a very high morbidity and mortality. Cardiothoracic patients on mechanical ventilation when colonized with Candida were identified as a high-risk population for subsequent development of Candida DSWI.
Notes
Comment In: Ann Thorac Surg. 2009 Dec;88(6):190919932260
PubMed ID
19932259 View in PubMed
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36 records – page 1 of 4.