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Wang G, Yu Z, Zhang C, Zang H, Monti L, Jeong JY, Schmid RA, Pilegaard HK, Liu H. Pectus excavatum requiring temporary pacemaker implantation before Nuss procedure: a case report. J Thorac Dis 2020; 12:4985-4990. [PMID: 33145072 PMCID: PMC7578454 DOI: 10.21037/jtd-20-2312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pectus excavatum is the most common chest wall deformity, and some patients also have it combined with cardiac arrhythmias. It is a rare occurrence for there to be a severe conduction block that requires a temporary pacemaker implantation before the surgical correction. Here we reported a case of pectus excavatum with a second-degree atrial-ventricular (AV) block (Mobitz II) who had temporary pacemaker implantation before the Nuss procedure. The young patient had a chest wall deformity for 6 years and it got worse with age. The Haller index was 4.21, and we evaluated that he should receive the Nuss procedure. An AV block was found during the preoperative electrocardiogram examination; furthermore, Holter monitor proved that he had first-degree AV block and a second-degree AV block (Mobitz II). After consultation with the anesthesiologist and cardiologist, we suggested that a temporary pacemaker placement should be performed under local anesthesia before the minimally invasive operation and removed as soon as the patient revived from general anesthesia. A postoperative Holter monitor was implemented, and the conduction defect disappeared shortly after the operation. However, the Holter monitor showed that the conduction defect was still existed during the follow-up period, which indicated that severe conduction defects should be originated from the conduction system itself, rather than the compression to the heart. The temporary pacemaker was essential to ensure the conducting of the operation went smoothly.
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Affiliation(s)
- Gebang Wang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Zhanwu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Chenlei Zhang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hongyun Zang
- Department of Cardiology, Air Force Hospital of North Military Command PLA, Shenyang, China
| | - Lorenzo Monti
- Radiology Department, Humanitas Research Hospital, Milan, Italy
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ralph A Schmid
- Division of General Thoracic Surgery, University Hospital Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus and Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
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Monti L, Montini O, Voulaz E, Maagaard M, Morenghi E, Pilegaard HK, Infante M. Cardiovascular magnetic resonance assessment of biventricular changes during vacuum bell correction of pectus excavatum. J Thorac Dis 2020; 11:5398-5406. [PMID: 32030258 DOI: 10.21037/jtd.2019.12.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Evidence of cardiac dysfunction in patients with pectus excavatum (PE) remains controversial. A growing number of studies report increased exercise tolerance following surgery. Nevertheless, many consider the correction of PE a cosmetic intervention, with post-operative changes ascribed to the concurrent growth of the young patient population. No studies have investigated non-invasively the immediate cardiac changes following relief of the deformity. The aim of this study was to assess cardiac function before and during temporary sternal elevation using the non-invasive vacuum bell (VB) device on young adults with PE. Methods Adult patients scheduled for surgical correction of PE underwent cardiac magnetic resonance imaging (CMRI) before and during the application of the VB. Steady-state free precession sequences were used for the evaluation of biventricular volume and function. Phase contrast sequences measured the aortic and pulmonary flow to calculate stroke index (SI). Scans were analyzed post hoc by the same investigator. A control group of healthy individuals was assessed in the same way. Results In total, 20 patients with PE (mean age 23±10 years) and 10 healthy individuals (mean age 25±6 years) underwent CMR before and during VB application. Before intervention, baseline cardiac volumes and function were similar between the groups, with patient-values in the low-to-normal range. Following VB application, PE patients revealed a 10% increase in biventricular SI. Furthermore, left ventricular end-diastolic volume index (LV EDVI) improved by 8% and right ventricular ejection fraction (RV EF) increased by 7%. These findings were not mirrored in the healthy individuals. No correlations were found between improved cardiac parameters and the baseline Haller index (HI) of PE patients. Conclusions Non-invasive, momentary correction of PE is associated with an immediate improvement in SI, RV EF and LV EDVI, not observed in controls. The findings suggest that sternal depression in PE patients affects cardiac function.
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Affiliation(s)
- Lorenzo Monti
- Department of Radiology ¸ Humanitas Research Hospital, Milan, Italy.,Department of Cardiology ¸ Humanitas Research Hospital, Milan, Italy
| | - Orsola Montini
- Department of Radiology ¸ Humanitas Research Hospital, Milan, Italy.,Department of Cardiology ¸ Humanitas Research Hospital, Milan, Italy
| | - Emanuele Voulaz
- Department of Thoracic Surgery¸ Humanitas Research Hospital, Milan, Italy
| | - Marie Maagaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Maurizio Infante
- Department of Thoracic Surgery¸ Humanitas Research Hospital, Milan, Italy.,Dipartimento Cardiovascolare e Toracico Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Knudsen MV, Pilegaard HK, Grosen K. Pain and sensory disturbances following surgical repair of pectus carinatum. J Pediatr Surg 2018; 53:733-739. [PMID: 28893382 DOI: 10.1016/j.jpedsurg.2017.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/26/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to assess the characteristics of persistent postoperative pain and sensory disturbances following surgical repair of pectus carinatum. METHODS Using a prospective observational design, 28 patients were assessed before, 6 weeks and 6 months after a modified Ravitch operation for pectus carinatum. Postoperative pain was assessed using the Short Form McGill Pain Questionnaire. Sensory testing was conducted to detect brush-evoked allodynia and pinprick hyperalgesia. Additionally, generic and disease-specific quality of life was assessed using the Short Form-36 Health Survey and the Nuss Questionnaire Modified for Adults before and after surgery. RESULTS Six weeks after surgery, ten patients reported mild pain or discomfort. Six months after surgery, four patients reported only mild pain. Allodynia was detected in two patients 6 weeks and 6 months after surgery. Hyperalgesia was detected in eight patients 6 weeks after surgery, and in six patients 6 months after surgery. Generic quality of life was significantly improved over time. CONCLUSIONS The study showed no significant pain problems, a tendency to reduced sensory disturbances and significant improvements in quality of life 6 months after surgical repair of pectus carinatum. Future studies should include a longer follow-up period to determine if these positive results are persistent. LEVELS OF EVIDENCE 1 (Prognosis Study).
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Affiliation(s)
- Marie Veje Knudsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Kasper Grosen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; Danish Pain Research Centre, Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, 8000 Aarhus C, Denmark.
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Ticchi D, Eisinger RS, Pilegaard HK, Torre M, Sesia SB, Infante M, Voulaz E, Quesada MA, Sisask M. Evaluating interest in narrative therapy for decision making about pectus excavatum treatment. Interact Cardiovasc Thorac Surg 2018; 26:271-275. [PMID: 29049840 DOI: 10.1093/icvts/ivx308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/13/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The decision to proceed with surgical treatment for pectus excavatum (PE) is rarely clear-cut. Patients interested in treatment are referred for evaluation by numerous different specialists, but psychosocial counselling is currently not included in this process. Our objective was to assess whether PE patients would be interested in formal assistance with the decision-making process surrounding PE surgery using narrative therapy principles. METHODS Ninety-seven untreated PE patients at 5 different institutions in 4 countries completed a questionnaire consisting of 13 questions, with 3 questions specifically evaluating interest in narrative therapy. RESULTS Eighty-two percent of participants were interested in narrative therapy to assist with the decision-making process surrounding PE surgery. Individuals most interested in narrative therapy tend to be more interested in correction (P < 0.05) to improve the way they feel about their body (P < 0.05). CONCLUSIONS The majority of PE patients are interested in narrative therapy to aid the decision-making process about treatment. We propose that narrative therapy should be offered to PE patients during the treatment evaluation process to address the psychosocial difficulties associated with PE and the surgical decision-making process overall. Future studies should assess the effectiveness of this interdisciplinary model.
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Affiliation(s)
- Davide Ticchi
- School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | | | - Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michele Torre
- Unit of Pediatric Surgery and Airway Team, Istituto Giannina Gaslini, Genova, Italy
| | - Sergio B Sesia
- Division of General Thoracic Surgery, University Hospital Berne/Inselspital, Berne, Switzerland
| | - Maurizio Infante
- Department of Thoracic Surgery, University Hospital Borgo Trento, Verona, Italy
| | - Emanuele Voulaz
- Department of Thoracic Surgery, Humanitas Research Hospital, Rozzano, Italy
| | | | - Merike Sisask
- School of Governance, Law and Society, Tallinn University, Tallinn, Estonia.,Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
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Pilegaard HK. Preface. Ann Cardiothorac Surg 2016. [DOI: 10.21037/acs.2016.09.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Jensen LS, Pilegaard HK, Puho E, Pahle E, Melsen NC. Outcome after Transthoracic Resection of Carcinoma of the Oesophagus and Oesophago-Gastric Junction. Scand J Surg 2016; 94:191-6. [PMID: 16259166 DOI: 10.1177/145749690509400303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: To assess the postoperative morbidity and mortality, length of stay and long-term survival after resection of carcinoma of the oesophagus and gastro-oesophageal junction, after establishment of a new surgical team unit between thoracic and gastroenterologic surgeons. Methods: We analysed the prospective collected data of 166 consecutive patients who underwent a transthoracic oesophageal resection between June 1997 and December 2003. Results: There were 119 men and 47 women. The median age was 63 years (range 36–81). Fifty-five patients (33 %) had squamous cell carcinoma and 111 (67 %) had adenocarcinoma. Postoperative complications occurred in a total of 60 patients (36 %). Ten patients (6 %) died postoperatively, eight (4.8 %) due to medical and two (1.2 %) due to surgical complications. The median postoperative length of stay was 11 days (range 6–75). The overall 3- and 5- years survival was 35.6 % and 30.6 % respectively. Survival was adversely affected by patient age and tumor stage. Conclusions: Concentrating resection for carcinoma of the oesophagus and oesophagogastric junction to a dedicated team of specialists, including both gastrointestinal and thoracic surgeons as well as thoracic-anaesthesiological know-how, results in acceptable complication rates as well as low mortality rates especially due to surgical complications.
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Affiliation(s)
- L S Jensen
- Department of Gastrointestinal Surgery, Aarhus University Hospital, Aarhus, Denmark.
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8
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Eckerström F, Maagaard M, Pilegaard HK. Successful resection of oesophageal adenocarcinoma 16 years after heart transplantation-a case report. Int J Surg Case Rep 2016; 21:26-8. [PMID: 26896743 PMCID: PMC4802192 DOI: 10.1016/j.ijscr.2016.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION With improving results of heart transplantation and subsequently increasing survival, long-term complications such as neoplastic malignancies are more often being discovered. PRESENTATION OF CASE In this report, we present a unique case of successful oesophagus resection with gastric pull-up, on a heart-transplanted patient diagnosed with oesophageal adenocarcinoma. DISCUSSION With the growing number of long-term surviving heart transplanted patients, the number of neoplasia in this patient-group will subsequently grow. Since physical condition and quality of life in long-term surviving heart transplanted patients is comparable to the general population, and since surgical treatment remains the mainstay of treatment for localised oesophageal carcinoma in non-heart transplanted patients, a larger subgroup of heart transplanted patients will most likely be considered for cancer surgery. CONCLUSION Our case demonstrates the possibility of operating on the heart transplanted patient-group, and supports the option, that well-managed heart transplantation not should be a limiting factor, when deciding whether a patient is a candidate for surgical intervention or not.
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Affiliation(s)
- Filip Eckerström
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark.
| | - Marie Maagaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark
| | - Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark
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Katballe N, Moeller LB, Olesen WH, Litzer MM, Andersen G, Nekrasas V, Licht PB, Bach P, Pilegaard HK. A Novel Device for Accurate Chest Tube Insertion: A Randomized Controlled Trial. Ann Thorac Surg 2015; 101:527-32. [PMID: 26409714 DOI: 10.1016/j.athoracsur.2015.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/03/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Optimal positioning of a large-bore chest tube is in the part of the pleural cavity that needs drainage. It is recommended that the chest tube be positioned apically in pneumothorax and basally for fluids. However, targeted chest tube positioning to a specific part of the pleural cavity can be a challenge. METHODS A new medical device, the KatGuide, was developed for accurate guiding of a chest tube (28F) to an intended part of the pleural cavity. The primary end point of this randomized, controlled trial was optimal position of the chest tube. The optimal position in pneumothorax was apical (above the aortic arch), and the optimal position in hemothorax, hydrothorax, chylothorax, or empyema was basal (2 cm above the diaphragm or lower). The patients were randomized for the KatGuide method or the conventional forceps method, and rates of optimal position were compared. RESULTS A total of 109 patients were enrolled (KatGuide: n = 49; conventional: n = 60). Chest tubes were optimally position in 41 (84%) in the KatGuide group vs 32 (53%) in the conventional group (p = 0.001). Experienced operators (>50 previous chest tube insertions) inserted 39 of the chest tubes, of which, 15 of 17 (88%) were optimally positioned in the KatGuide group vs 11 of 22 (50%) in the conventional group (p = 0.02). Two chest tubes (4%) were misplaced in the KatGuide group vs 11 (18%) in the conventional group (p = 0.04). No adverse device effects were observed. CONCLUSIONS The KatGuide significantly improves the probability of optimal chest tube position and reduces the risk of misplacement compared with the conventional method. ClinicalTrial.gov Trial Registration Number: NCT01522885.
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Affiliation(s)
- Niels Katballe
- Department of Cardiothoracic and Vascular Surgery and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Lars B Moeller
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Winnie H Olesen
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Marina M Litzer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gratien Andersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Vytautas Nekrasas
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Peter B Licht
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Peter Bach
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Knudsen MV, Grosen K, Pilegaard HK, Laustsen S. Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem. J Pediatr Surg 2015; 50:1472-6. [PMID: 25783317 DOI: 10.1016/j.jpedsurg.2014.11.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/29/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to assess the effects of surgical correction of pectus carinatum on health-related quality of life and self-esteem. METHODS Between May 2012 and May 2013, a prospective observational single-center cohort study was conducted on consecutive patients undergoing surgical correction of pectus carinatum at our institution. Patients filled in questionnaires on health-related quality of life and self-esteem before and six months after surgery. RESULTS Disease-specific health-related quality of life was improved by 33% (95% CI: 23; 44%) according to responses to the Nuss Questionnaire modified for Adults. The improvement for generic mental health-related quality of life was 7% (95% CI: 3; 12%) in responses to the Short Form-36 Questionnaire. The improvement in self-esteem was 9% (95% CI: 2; 17%) as assessed with the Rosenberg Self-Esteem Scale. A Single Step Questionnaire supported the improvements in health-related quality of life and self-esteem six months postsurgery. CONCLUSION This study confirms positive effects of surgical correction of pectus carinatum on health-related quality of life and self-esteem. Patients were to a greater extent self-satisfied about chest appearance following surgery, indicating this to be a step in the right direction toward improved body image, mental health and self-esteem.
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Affiliation(s)
- Marie Veje Knudsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark; Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Denmark; Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark.
| | - Kasper Grosen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark; Department of Rheumatology, Aarhus University Hospital, Denmark.
| | - Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark.
| | - Sussie Laustsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark; Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark.
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Abstract
BACKGROUND Pectus excavatum (PE) is the most common anomaly of the anterior chest wall. Prior PE was corrected by a modified Ravitch operation, but since Nuss published his minimal technique in 1998, most surgeons have preferred this technique. METHODS Since 2001 the modified Nuss procedure has routinely been used for correction of more than 1,500 patients at Aarhus University Hospital. In the time period between January 1, 2011 and January 31, 2015, 675 patients have been corrected. The median age was 16 years (range, 11-58 years). All patients had preoperatively an epidural catheter and the operations were done in general anaesthesia. The postoperative pain treatment was planned for 4-5 weeks and the patients were routinely seen in the outpatient clinic 6 weeks after surgery and the bars removed after 3 years. RESULTS Four hundred-and-fifty patients had one bar, 216 patients with two bars and nine patients with three bars inserted. The median length of the bar was 10 inch. The median duration of the operation was 29 minutes. The median postoperative stay was 3 days. No death, cardiac perforation or deep infection occurred and only 5% of the patients experienced a complication. CONCLUSIONS The Nuss procedure should still be considered in the treatment of PE. To my opinion, it should be the choice for correction of PE. The short bar should be used to achieve the best stability of the system, to obtain a good cosmetic result, a reduced dysfunction motion of the chest wall and an increased cardiac performance.
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Affiliation(s)
- Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, Aarhus University Hospital, Denmark
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Maagaard M, Udholm S, Hjortdal VE, Pilegaard HK. Right ventricular outflow tract obstruction caused by a displaced pectus bar 30 months following the Nuss procedure. Eur J Cardiothorac Surg 2014; 47:e42-3. [DOI: 10.1093/ejcts/ezu394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Riber LP, Christensen TD, Pilegaard HK. Reply to Patel and Hunt. Eur J Cardiothorac Surg 2014; 47:393. [PMID: 24787475 DOI: 10.1093/ejcts/ezu172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lars P Riber
- Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, Odense University Hospital, Odense, Denmark
| | - Thomas D Christensen
- Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Pilegaard HK. Invited commentary. Ann Thorac Surg 2014; 97:1028. [PMID: 24580915 DOI: 10.1016/j.athoracsur.2013.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 12/09/2013] [Accepted: 12/18/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Hans K Pilegaard
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, Denmark DK-8200.
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Grosen K, Vase L, Pilegaard HK, Pfeiffer-Jensen M, Drewes AM. Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study. PLoS One 2014; 9:e90185. [PMID: 24587268 PMCID: PMC3935997 DOI: 10.1371/journal.pone.0090185] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 01/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. METHODS Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2-5. Pain was reevaluated at six months postoperatively. RESULTS Patients reporting persistent pain at six months follow-up (n = 15) were not significantly different from pain-free patients (n = 16) concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3) or level of catastrophizing (Z = 0.4, P = 1.0). In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007) whereas conditioned pain modulation predicted morphine consumption (β = -0.005, P = 0.001). CONCLUSIONS Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute postoperative phase. These findings may have important implications for developing strategies to treat or prevent acute postoperative pain in selected patients. Pain may be predicted and the malfunctioning pain inhibition mechanism as tested with CPM may be treated with suitable drugs augmenting descending inhibition.
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Affiliation(s)
- Kasper Grosen
- The Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Lene Vase
- The Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- The Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Hans K. Pilegaard
- The Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Asbjørn M. Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Bygstad E, Terkelsen AJ, Pilegaard HK, Hansen J, Mølgaard H, Hjortdal VE. Thoracoscopic sympathectomy increases efferent cardiac vagal activity and baroreceptor sensitivity. Eur J Cardiothorac Surg 2013; 44:e193-9. [PMID: 23847183 DOI: 10.1093/ejcts/ezt356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Thoracoscopic sympathectomy at levels T2 or T2-T3 is a treatment for focal hyperhidrosis and facial blushing. These levels of the sympathetic trunk innervate the heart, and consequently, the procedure is reported to change the heart rate variability due to changes in efferent cardiac autonomic activity. Our objective was to investigate the effects of thoracoscopic sympathectomy on global autonomic control, including baroreceptor sensitivity. METHODS Eight patients (6 F, median age 28 years [range 20-58 years]) were exposed to the tilt-table test and cardiopulmonary exercise test before, and 3 months after, thoracoscopic sympathectomy. Eight healthy age-, gender- and BMI-matched controls were used as controls and underwent the same tests once. During tilt-table testing electrocardiogram, blood pressure, impedance cardiography and respiration were measured continuously, and efferent cardiac autonomic balance was estimated. RESULTS The heart rate measured during orthostatic stress test was lowered after thoracoscopic sympathectomy (between-group; P = 0.01) due to a change in autonomic tone, with increased vagal (high-frequency power n.u.; P = 0.001), and reduced sympathetic efferent cardiac activity (low-frequency power n.u.; P < 0.001). Baroreceptor sensitivity measured during rest was increased (26 ± 13 vs 44 ± 19 ms/mmHg; P = 0.01), and diastolic blood pressure reduced after surgery (P = 0.01). The increases in systolic blood pressure and the sympathetic marker CCV-LF in response to orthostatic stress were higher before sympathectomy, with almost no increases post-surgically (condition × group interaction; P = 0.01 and P = 0.001, respectively). We found no change in post-procedure exercise capacity, although patients had a lower peak VO2 and maximal cardiac index than controls. CONCLUSIONS Thoracoscopic sympathectomy changes the autonomic tone towards increased vagal activity; this is potentially cardioprotective. To our knowledge, this is the first study to show increased baroreceptor sensitivity after thoracoscopic sympathectomy.
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Affiliation(s)
- Elisabeth Bygstad
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
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Knudsen MR, Nyboe C, Hjortdal VE, Pilegaard HK. Routine postoperative chest X-ray is unnecessary following the Nuss procedure for pectus excavatum. Interact Cardiovasc Thorac Surg 2013; 16:830-3. [PMID: 23439441 DOI: 10.1093/icvts/ivt052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pneumothorax is the most common complication after the Nuss procedure for pectus excavatum. The majority of pneumothoraces are small, and the patients have no symptoms. The aim of this study was to evaluate the necessity for routine chest X-ray immediately after surgery. METHODS Group I consists of 644 patients who were operated on with a Nuss procedure for pectus excavatum between 2001 and 2009 (85% male, median age 16 [range 7-48 years]) at Aarhus University Hospital. The standard procedure included chest X-ray immediately after surgery and before discharge. Group II consists of 294 patients (88% male, median age 16 [range 11-54 years]) who had a Nuss procedure in the period January 2011 to October 2012, where the standard procedure only included chest X-ray before discharge. RESULTS In Group I, pneumothorax was found on the chest X-ray obtained immediately after surgery in 333 (52%) patients. Fifteen (4.5%) were treated with chest-tube drainage. Six of these patients had no symptoms, but a 2- to 3-cm pneumothorax, 2 had progression of the pneumothorax and 7 had respiratory symptoms. The median size of those drained was 3 (range 2-6 cm). At the normal 6-week control, no pneumothorax remained. Group II: Among the 294 patients, 1 (0.3%) had a chest tube. CONCLUSIONS Only patients with respiratory symptoms after the Nuss procedure need a chest X-ray. A routine chest X-ray can be limited to the time of discharge where the position of the bar(s) is also checked.
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Affiliation(s)
- Mette Reinholdt Knudsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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Pilegaard HK, Maagaard M. Editorial comment: Is it possible to detect postoperative improvements in cardiac function through magnetic resonance imaging in patients with pectus excavatum--at rest? Eur J Cardiothorac Surg 2013; 43:1114-5. [PMID: 23288876 DOI: 10.1093/ejcts/ezs654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
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Harders SW, Madsen HH, Hjorthaug K, Rehling M, Rasmussen TR, Pedersen U, Pilegaard HK, Meldgaard P, Baandrup UT, Rasmussen F. Limited value of ⁹⁹mTc depreotide single photon emission CT compared with CT for the evaluation of pulmonary lesions. Br J Radiol 2012; 85:e307-13. [PMID: 22745210 DOI: 10.1259/bjr/10438644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES A contrast-enhanced multidetector CT (MDCT) scan is the first choice examination when evaluating patients with suspected lung cancer. However, while the clinical focus is on CT, research focus is on molecular biological methods whereby radiolabelled pharmaceuticals are injected into participants and target malignant lung tumours. We examined whether a contrast-enhanced MDCT scan supplied with an additional non-contrast enhanced high-resolution CT scan, or a newer but more expensive (99m)Tc depreotide single photon emission CT (SPECT) scan, was the better first-choice examination for the work-up of pulmonary lesions. Furthermore, we examined whether a (99m)Tc depreotide SPECT scan was an appropriate second-choice examination for patients with indeterminate lesions. METHODS 140 participants were included in the analysis. CT images were given a malignancy potential rating of 1, 2 or 3 with higher rating being indicative of disease. (99m)Tc depreotide SPECT images were graded either positive or negative. Histopathology and CT follow-up were used as reference standard. Sensitivity, specificity and diagnostic accuracy were calculated. RESULTS Overall sensitivity, specificity and diagnostic accuracy of CT were 97%, 30% and 84%, respectively. Overall sensitivity, specificity and diagnostic accuracy of (99m)Tc depreotide SPECT were 94%, 58% and 76%, respectively. For indeterminate lesions sensitivity, specificity and diagnostic accuracy of (99m)Tc depreotide SPECT were 71%, 68% and 69%, respectively. CONCLUSION Both CT and (99m)Tc depreotide SPECT made valuable contributions to the evaluation of pulmonary lesions. (99m)Tc depreotide SPECT results were not superior to CT results and did not contribute further to the diagnostic work-up. Regarding indeterminate lesions,( 99m)Tc depreotide SPECT sensitivity was too low.
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Affiliation(s)
- S W Harders
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
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Riber LP, Christensen TD, Jensen HK, Hoejsgaard A, Pilegaard HK. Amiodarone Significantly Decreases Atrial Fibrillation in Patients Undergoing Surgery for Lung Cancer. Ann Thorac Surg 2012; 94:339-44; discussion 345-6. [DOI: 10.1016/j.athoracsur.2011.12.096] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 12/12/2011] [Accepted: 12/14/2011] [Indexed: 11/26/2022]
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Petersen GL, Finnerup NB, Nørskov KN, Grosen K, Pilegaard HK, Benedetti F, Price DD, Jensen TS, Vase L. Placebo manipulations reduce hyperalgesia in neuropathic pain. Pain 2012; 153:1292-1300. [DOI: 10.1016/j.pain.2012.03.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/01/2012] [Accepted: 03/09/2012] [Indexed: 12/01/2022]
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Licht PB, Pilegaard HK, Ladegaard L. Sympathicotomy for isolated facial blushing: a randomized clinical trial. Ann Thorac Surg 2012; 94:401-5. [PMID: 22633477 DOI: 10.1016/j.athoracsur.2012.03.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/25/2012] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Facial blushing is one of the most peculiar of human expressions. The pathophysiology is unclear, and the prevalence is unknown. Thoracoscopic sympathectomy may cure the symptom and is increasingly used in patients with isolated facial blushing. The evidence base for the optimal level of targeting the sympathetic chain is limited to retrospective case studies. We present a randomized clinical trial. METHODS 100 patients were randomized (web-based, single-blinded) to rib-oriented (R2 or R2-R3) sympathicotomy for isolated facial blushing at two university hospitals during a 6-year period. Quality of life (QOL) was investigated preoperatively and after 12 months by Short Form 36. Local effects and side effects were assessed by questionnaire. RESULTS The male/female ratio was 27/73. The median age was 29 years (range, 18-56 years. The response rate was 93%. QOL increased significantly in all social and mental domains in both groups. Overall, 85% of the patients had an excellent or satisfactory result, with no significant difference between the R2 procedure and the R2-R3 procedure. Mild recurrence of facial blushing occurred in 30% of patients within the first year. One patient experienced Horner's syndrome. Compensatory sweating occurred in 93% of patients, gustatory sweating 36%, and dry hands in 66%; 13% of patients regretted the operation despite thorough preoperative selection and information. CONCLUSIONS There were no significant differences in local effects or side effects between R2 and R2-R3 sympathicotomy for isolated facial blushing. Both were effective, and QOL increased significantly. Despite very frequent side effects, the vast majority of patients were satisfied. Surprisingly, many patients experienced mild recurrent symptoms within the first year; this should always be discussed with patients preoperatively.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
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Grosen K, Laue Petersen G, Pfeiffer-Jensen M, Hoejsgaard A, Pilegaard HK. Persistent post-surgical pain following anterior thoracotomy for lung cancer: a cross-sectional study of prevalence, characteristics and interference with functioning†. Eur J Cardiothorac Surg 2012; 43:95-103. [DOI: 10.1093/ejcts/ezs159] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nyboe C, Knudsen MR, Pilegaard HK. Elective pectus bar removal following Nuss procedure for pectus excavatum: a single-institution experience. Eur J Cardiothorac Surg 2011; 39:1040-2. [DOI: 10.1016/j.ejcts.2010.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 09/28/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022] Open
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Pilegaard HK. Extending the use of Nuss procedure in patients older than 30 years. Eur J Cardiothorac Surg 2011; 40:334-7. [PMID: 21232968 DOI: 10.1016/j.ejcts.2010.11.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 11/07/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The Nuss procedure was originally thought to be the method to correct pectus excavatum in children and teenagers. It is now a well-established technique, and is also used in older patients. The aim of this study was to investigate the results in patients ≥ 30 years of age. METHODS Since 2001, we have routinely used the Nuss procedure for correction of pectus excavatum in more than 700 patients. The indication for surgery has been disabling cosmetic appearance. All operations have been performed by the same surgeon. Patient records were retrospectively analyzed. RESULTS The study included fifty-two patients, who were ≥ 30 years or older (range 30-53 years), with median age 37 years; and 85% were males. There was no operative mortality. Nearly three-quarters (70%) needed two bars or more to obtain a satisfactory perioperative result. The median operating time was 60 min (range 18-104 min). The median postoperative stay was 4 days (range 3-29 days). Postoperative complications were few; one patient developed deep infection after re-operation caused by lateral dislocation of the bars. CONCLUSION The Nuss procedure can be used in older patients with excellent results. The operation time in their case is longer than in young patients because more patients need two bars; but the postoperative stay is equivalent to that in young patients.
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Affiliation(s)
- Hans K Pilegaard
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Aarhus N, Denmark.
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Jensen LS, Nielsen H, Mortensen PB, Pilegaard HK, Johnsen SP. Enforcing centralization for gastric cancer in Denmark. Eur J Surg Oncol 2010; 36 Suppl 1:S50-4. [PMID: 20598495 DOI: 10.1016/j.ejso.2010.06.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 06/09/2010] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Population-based data on the early postoperative outcome after surgery for gastric cancer are very sparse. We examined the development in the quality of surgery and early postoperative outcomes in Denmark following centralization of gastric cancer surgery and implementation of national clinical guidelines. METHODS All patients in Denmark who underwent resection with curative intent for gastric cancer between 1st July 2003 and 31st December 2008 in one of five university hospitals were registered in a national database. Data on surgical quality and mortality were obtained from the database and compared with the results from the period before centralization (1999-2003). RESULTS A total of 416 patients underwent resection in the study period. The risk of anastomotic leakages for the whole period was 5.0% (95%CI; 3.2-7.7) compared to 6.1% (95%CI; 4.3-8.6) before centralization, whereas the 30-days hospital mortality was 2.4% (95%CI; 1.2-4.4) compared to 8.2% (95%CI; 6.0-10.4) before centralization. In addition, the percentage of patients with at least 15 lymph nodes removed increased during the study period from 19 in 2003 to 76 in 2008. CONCLUSIONS Centralization of gastric cancer surgery in Denmark and implementation of national clinical guidelines monitored by a national database was associated with improvements in surgical quality and substantially lower in-hospital mortality.
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Affiliation(s)
- L S Jensen
- Department of Surgery, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark.
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Pilegaard HK, Grosen K. Postoperative pain location following the Nuss procedure--what is the evidence and does it make a difference? Eur J Cardiothorac Surg 2010; 38:208-9. [PMID: 20346691 DOI: 10.1016/j.ejcts.2010.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 02/04/2010] [Accepted: 02/11/2010] [Indexed: 11/24/2022] Open
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Jacobsen EB, Thastum M, Jeppesen JH, Pilegaard HK. Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum. Eur J Pediatr Surg 2010; 20:85-91. [PMID: 20112187 DOI: 10.1055/s-0029-1243621] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study evaluated health-related quality of life (HRQoL) in children and adolescents undergoing cosmetic surgery for pectus excavatum (PE) compared to a group of healthy children. METHODS The Intervention Group consisted of 172 children and adolescents undergoing surgery for PE between 2003 and 2005, aged 8-20 years; 86% were males. A postoperative follow-up study was conducted one to three years after surgery. None of the children had had the metal bar removed when they answered the questionnaires. The Control Group consisted of healthy schoolchildren (n=387), 201 females and 186 males (9-20 years).The generic health-related quality of life questionnaires, the Child Health Questionnaire CHQ-CF87 (child version), and CHQ-PF50 (parent version) were used in both groups. A Nuss assessment questionnaire modified for Adults (NQ-mA) and a single-step questionnaire (SSQ) on quality of life and health status were only used in the Intervention Group; these questionnaires also included questions about the remembered preoperative status. The response rates in the Intervention and Control Groups were 69% and 70%, respectively. RESULTS The HRQol was significantly better in the Intervention Group compared to the Control Group in 9 out of 14 subscales (CHQ-CF 87): General Health (p<0.05), Physical Functioning, Self-Esteem, Emotional Role, Role Functioning-Physical (p<0.01) and Mental Health, Family Activities, Bodily Pain, Role Functioning-Behavioral (p<0.001). The scores of the children and the parents correlated well in all subscales (rho range from 0.19-0.55, p<0.05-0.001) except for the Role Functioning-Physical scale (rho=0.17). Significant differences between the parent and child scores were found in six scales. The children reported significantly lower scores in Global Behavior, Global Health, Behavior (p<0.05), Bodily Pain (p<0.01), and Mental Health (p<0.001). The parents reported significantly lower scores in the Self Esteem scale (p<0.01). Self-esteem and body concept scored significantly higher postoperatively (p<0.001) in NQ-mA and SSQ. CONCLUSION HRQol was significantly better in the Intervention Group compared to healthy controls at the same age. In five subscales Self-Esteem, Behavior, Emotional Role, Mental Health and Family Activities, the PE group had a better HRQoL.
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Affiliation(s)
- E Brammer Jacobsen
- Aarhus University Hospital, Cardiothoracic and Vascular T, Aarhus, Denmark.
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Pedersen TAL, Pilegaard HK. Reconstruction of the thorax with Ley prosthesis after resection of the sternum. Ann Thorac Surg 2009; 87:e31-3. [PMID: 19324116 DOI: 10.1016/j.athoracsur.2008.12.096] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 12/17/2008] [Accepted: 12/30/2008] [Indexed: 11/27/2022]
Abstract
The Ley prosthesis is a titanium plate, which has been used in the past few years for sternum stabilization after postoperative mediastinitis and sternal dehiscence. There is no previous description of the use of this device in chest wall reconstruction after tumor resection. We describe the surgical technique for reconstruction of the skeletal defects with the Ley prosthesis in 3 patients operated on for a sternal chondrosarcoma. We propose the application of the Ley prosthesis for optimal reconstruction of skeletal tissue after sternal resection.
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Affiliation(s)
- Thais A L Pedersen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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Pilegaard HK, Licht PB. Can absorbable stabilizers be used routinely in the Nuss procedure? Eur J Cardiothorac Surg 2009; 35:561-4. [PMID: 19162502 DOI: 10.1016/j.ejcts.2008.10.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 10/22/2008] [Accepted: 10/28/2008] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE During minimal invasive surgical correction of pectus excavatum the metal bar is rotated 180 degrees and fixed by one or two stabilisers. Previously, all stabilisers were made from metal, but they often caused chronic pain and had to be removed. Recently, a slowly absorbable stabiliser made from Lactosorb has been introduced. METHODS From 2001 to 2008 a total of 507 patients underwent minimally invasive repair of pectus excavatum at Aarhus University Hospital. Since February 2007 we routinely used absorbable stabilisers made by Lactosorb. We always used shorter pectus bars than originally suggested and always placed one stabiliser close to the entry in the thoracic cavity on the left side. All operations were performed by the same surgeon and all patients were seen 6 weeks after surgery. Patient records were reviewed for retrospective analysis. RESULTS In 422 patients we used a metal stabiliser while 85 patients received a Lactosorb stabilizer. Seven patients received two stabilisers. During the follow-up period one metal stabiliser broke after 2(1/2) years (0.2%), but within 6 weeks after surgery three Lactosorb stabilizers broke (3.5%) and another three dislocated laterally (3.5%). CONCLUSIONS Absorbable stabilisers may be used for minimal invasive surgery for pectus excavatum but they are more vulnerable and break easier than metal stabilisers. This is likely a consequence of high stress forces that may be more pronounced in patients who receive a shorter pectus bar, but further research is needed.
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Affiliation(s)
- Hans K Pilegaard
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark
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Pilegaard HK, Licht PB. Routine use of minimally invasive surgery for pectus excavatum in adults. Ann Thorac Surg 2008; 86:952-6. [PMID: 18721589 DOI: 10.1016/j.athoracsur.2008.04.078] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 04/20/2008] [Accepted: 04/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Nuss operation, a minimally invasive repair of pectus excavatum, is considered the treatment of choice in children. It is controversial in adults, but smaller series have been published. We have used the Nuss operation routinely in adults since 2003. METHODS The indication for operation was a patient-described disabling cosmetic appearance. We modified the operation by using a shorter pectus bar, which appears to be more stable. All patient records were available and analyzed retrospectively. RESULTS Operations for pectus excavatum were done in 475 patients (89% men) at Aarhus University Hospital. 180 patients (38%) were aged 18 years or older, median patient age was 22 years (range, 18 to 43 years). All but one patient achieved an excellent cosmetic result. Two pectus bars were required in 57 patients (32%), and 2 patients required 3 pectus bars. The median duration of the procedure was 41 minutes (range, 16 to 119 minutes), which was significantly longer compared with younger patients, but the difference was not clinically relevant (6 minutes). Pneumothorax occurred in 86 patients (48%), but only 4 (2%) required chest tube drainage. In 3 patients the pectus bar dislocated during follow-up. CONCLUSIONS Minimally invasive repair for pectus excavatum can be performed safely in adults, with excellent immediate cosmetic results. Adults often require more than 1 pectus bar. From the results of this large series, we conclude that patients aged younger than 50 years are eligible for minimally invasive surgical correction of pectus excavatum.
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Affiliation(s)
- Hans K Pilegaard
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby Aarhus, Denmark.
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Pedersen T, Pilegaard HK. [Surgical correction of pectus carinatum]. Ugeskr Laeger 2008; 170:2769-2772. [PMID: 18761868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Pectus carinatum (PC) is a protrusion of the sternum due to overgrowth of the costal cartilages. It can have considerable psychological and somatic impact on the patient. Many physicians are unaware of the beneficial effects and low comorbidity related to surgical correction and therefore erroneously advise patients against the operation. MATERIALS AND METHODS We report the preliminary experience with 26 consecutive patients operated for PC at our Department between 1 April 2006 and 1 April 2007. Surgery was performed by a modified Ravitch and Welch technique. The mean age was 15 years (13-21), and 92% of the patients were boys. RESULTS We obtained excellent cosmetic results in the majority of patients (92%), no major complications, no major pain complaints and short hospital stays for all patients. CONCLUSION Patients who are psychologically or physically impaired by this deformity should be referred for surgical evaluation.
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Affiliation(s)
- Thais Pedersen
- Arhus Universitetshospital, Skejby, Hjerte-lunge-karkirurgisk Afdeling T, Arhus N.
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Abstract
Patients complaining of facial blushing should be investigated by a dermatologist or an internist to rule out serious underlying disorders. Patients with emotionally triggered blushing should be encouraged to try nonsurgical options as the first line of treatment. Provided there is still an indication for treatment, facial blushing may be treated effectively by thoracoscopic sympathectomy. The type of blushing likely to benefit from sympathectomy is mediated by the sympathetic nerves and is the uncontrollable, rapidly developing blush typically elicited when one receives attention from other people. Side effects are frequent, but most patients are satisfied with the operation. In the short term, the key to success in sympathetic surgery for facial blushing lies in a meticulous and critical patient selection and in ensuring that the patient is thoroughly informed about the high risk of side effects. In the long term, the key to success in sympathetic surgery for facial blushing lies in more quality research comparing surgical, pharmacologic, and psychotherapeutic treatments.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark.
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Licht PB, Jørgensen OD, Ladegaard L, Pilegaard HK. Thoracoscopic sympathectomy for axillary hyperhidrosis: the influence of T4. Ann Thorac Surg 2006; 80:455-9; discussion 459-60. [PMID: 16039185 DOI: 10.1016/j.athoracsur.2005.02.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 02/07/2005] [Accepted: 02/14/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent data suggest that severe compensatory sweating after sympathectomy for hyperhidrosis is more common than previously reported. In particular, T2-T4 sympathectomy for axillary hyperhidrosis leads to significantly more disabling sweating compared with T2-T3 sympathectomy for palmar hyperhidrosis. However, it is not known whether this is a result of the additional transection of the T4 segment or if patients with primary axillary hyperhidrosis are more prone to experience disabling compensatory sweating. METHODS A follow-up study by questionnaire was made of 100 consecutive patients who underwent thoracoscopic sympathectomy for axillary hyperhidrosis at two university hospitals. Patients underwent T2-T3 sympathectomy (n = 35) or T2-T4 sympathectomy (n = 65) depending on the surgeon's preference. RESULTS The questionnaire was returned by 91% of patients after a median of 31 months. Compensatory sweating occurred in 90% of patients and was so severe in 61% that they often had to change clothes during the day. There were no significant differences in occurrence or severity of compensatory sweating between the two extents of sympathectomy. Surgical outcome, however, was significantly better after T2-T4 sympathectomy. CONCLUSIONS In contrast with previous reports, the incidence of compensatory sweating was not significantly related to the extent of sympathectomy for axillary hyperhidrosis. This result suggests that patients with primary axillary hyperhidrosis are more prone to experience compensatory sweating. Although the majority of patients with axillary hyperhidrosis were satisfied after thoracoscopic sympathectomy, many regret the operation. Patients should undergo surgery only if medical treatments fail; and provided there is an indication, we recommend T2-T4 sympathectomy.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark.
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Rasmussen K, Madsen HH, Rasmussen F, Rasmussen TR, Baandrup U, Pilegaard HK, Pedersen U, Palshof T, Rehling M. The value of HRCT and Tc-depreotide in the evaluation of pulmonary lesions. J Thorac Oncol 2006; 1:296-301. [PMID: 17409873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Karin Rasmussen
- Department of Clinical Physiology and Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
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Abstract
BACKGROUND Facial blushing is one of the most peculiar of human expressions and has become a cardinal symptom of social phobia. The pathophysiology is unclear and the prevalence is unknown. Thoracoscopic sympathectomy may cure the symptom, but very few surgeons treat patients with isolated facial blushing. The literature is limited, and there are few long-term follow-up studies. METHODS A follow-up study by questionnaire in 180 consecutive patients who underwent thoracoscopic sympathectomy for isolated facial blushing at two Danish university hospitals during a 6-year period. Patients routinely underwent T2 sympathectomy at the university hospital in Aarhus (n = 101) and T2-T3 sympathectomy at the university hospital in Odense (n = 79). RESULTS The questionnaire was returned by 96% of the patients after a median follow-up time of 20 months. Overall, 90% of the patients had some effect from the operation, and the result was excellent or satisfactory in 75%. There was no significant difference between the two extents of sympathectomy. Compensatory sweating occurred in 88% of all patients and was significantly more frequent after T2-T3 sympathectomy (p = 0.02) Ten percent of our patients regretted the operation because of side effects or no effect of the operation. CONCLUSIONS This study demonstrates that thoracoscopic sympathectomy is an effective treatment for isolated facial blushing. The majority of patients achieve an excellent or satisfactory long-term result. Our results suggest that a T2 sympathectomy is superior for patients with isolated facial blushing because side effects are lower compared with a T2-T3 sympathectomy.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
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Rasmussen K, Madsen HH, Rasmussen F, Rasmussen TR, Baandrup U, Pilegaard HK, Pedersen U, Palshof T, Rehling M. The Value of HRCT and Tc-Depreotide in the Evaluation of Pulmonary Lesions. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)31584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Buus NH, Simonsen U, Pilegaard HK, Mulvany MJ. Intracellular smooth muscle [Ca2+] in acetylcholine and nitric oxide-mediated relaxation of human small arteries. Eur J Pharmacol 2006; 535:243-7. [PMID: 16522319 DOI: 10.1016/j.ejphar.2006.01.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 01/12/2006] [Accepted: 01/20/2006] [Indexed: 11/28/2022]
Abstract
In human resistance arteries the role of intracellular calcium during receptor agonist and nitric oxide (NO)-mediated vasorelaxation is almost unknown. We examined changes in smooth muscle calcium concentration ([Ca2+]i) caused by acetylcholine and the NO donor S-nitroso-N-acetylpenicillamine (SNAP) in isolated human subcutaneous small arteries. In arteries constricted with 50 mM KCl, acetylcholine and SNAP induced relaxation without any change in [Ca2+]i, whereas in noradrenaline constricted vessels, both acetylcholine and to a lesser degree also SNAP-mediated relaxation were associated with a decrease in [Ca2+]i. Furthermore incubation with SNAP (1 microM) induced a rightward shift in the [Ca2+]i-force relationship. These results suggest that relaxation mediated by endothelium derived hyperpolarizing factors (EDHF) is associated with reduction in [Ca2+]i, whereas NO-mediated relaxation can take place without changes in [Ca2+]i. This finding seems to be, at least partly, due to NO-mediated desensitization of the contractile apparatus to calcium.
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Affiliation(s)
- Niels H Buus
- Department of Pharmacology, University of Aarhus, University Park 240, DK-8000 Aarhus C, Denmark.
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40
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Abstract
BACKGROUND Compensatory sweating is a frequent side effect after thoracoscopic sympathectomy for primary hyperhidrosis. Gustatory sweating is less commonly reported. It is defined as facial sweating when eating certain foods (particularly spicy food or acidic fruits) and has no generally accepted pathophysiologic explanation. We decided to investigate this phenomenon in patients who underwent thoracoscopic sympathectomy for primary hyperhidrosis and analyze whether the occurrence was influenced by the extent of sympathectomy. METHODS During an 8-year period (1997 to 2005) a total of 238 patients were treated by thoracoscopic sympathectomy for primary hyperhidrosis or blushing. Sympathectomy was performed bilaterally at T2 for facial hyperhidrosis or blushing (n = 97), T2-T3 for palmar hyperhidrosis (n = 76), and T2-T4 for axillary hyperhidrosis (n = 65). All patients received the same questionnaire at follow-up. RESULTS The questionnaire was returned by 96% of patients after a median of 17 months. Overall, gustatory sweating occurred in 32% of patients, and the incidence was significantly associated with extent of sympathectomy (p = 0.04). However, because the extent of sympathectomy was always decided by the location of primary hyperhidrosis, the latter may also explain the risk of gustatory sweating. CONCLUSIONS Gustatory sweating is a frequent side effect after thoracoscopic sympathectomy. This is the first study to report that its incidence is significantly related to the extent of sympathectomy or the location of primary hyperhidrosis. Although there is no pathophysiologic explanation of gustatory sweating, these findings should be considered before planning thoracoscopic sympathectomy and patients should be thoroughly informed.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark.
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Licht PB, Pilegaard HK. [Compensatory sweating after sympathectomy for hyperhidrosis--secondary publication]. Ugeskr Laeger 2005; 167:2526-8. [PMID: 16008010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Peter B Licht
- Arhus Universitetshospital, Skejby Sygehus, Hjerte-lunge-karkirurgisk Afdeling.
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Abstract
BACKGROUND Compensatory sweating is a well-known side effect after sympathectomy for hyperhidrosis. It is often claimed to correlate with the extent of sympathectomy, but results from the literature are conflicting, and few have actually considered differences in the intensity of compensatory sweating. METHODS A total of 158 patients underwent thoracoscopic sympathectomy for primary hyperhidrosis or blushing, or both. Sympathectomy was performed bilaterally at Th2 for facial hyperhidrosis/blushing (n = 49), Th2-3 for palmar hyperhidrosis (n = 62), and Th2-4 for axillary hyperhidrosis (n = 47). RESULTS Follow-up by questionnaire was possible in 94% of patients after a median of 26 months. Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation. CONCLUSIONS Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis. We found no significant difference between the level of sympathectomy and the occurrence of compensatory sweating. However, it appears that this is the first study to demonstrate that severe sweating is significantly more frequent after Th2-4 sympathectomy for axillary hyperhidrosis. We encourage informing patients thoroughly about these side effects before surgery.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark.
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Eiskjaer H, Egeblad H, Nielsen-Kudsk JE, Mølgaard H, Pilegaard HK, Klaaborg KE, Wierup PN, Kure HHO, Lindskov C, Severinsen IK, Nielsen EM, Kirkegaard H, Sørensen KE. [Ten years' experiences with heart transplantation at Skejby hospital]. Ugeskr Laeger 2003; 165:4730-3. [PMID: 14708379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Hans Eiskjaer
- Kardiologisk Afdeling B, Skejby Sygehus, Arhus Universitetshospital, DK-8000 Arhus
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Pilegaard HK. [Lung cancer. The Danish Society of Thoracic Surgery]. Ugeskr Laeger 2003; 165:1257. [PMID: 12701307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Hans K Pilegaard
- Hjerte-lungekarkirurgisk Afdeling T, Skejby Sygehus, Arhus Universitetshospital, DK-8200 Arhus N
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Lund O, Nielsen SL, Arildsen H, Ilkjaer LB, Pilegaard HK. [St Jude's bi-leaflet aortic valve prosthesis throughout two decades. Quality profile and risk factors]. Ugeskr Laeger 2001; 164:55-60. [PMID: 11810799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
INTRODUCTION The St Jude standard aortic bi-leaflet disc valve is still the most widespread. With almost 20 years of follow-up, the present material may describe the quality profile of the valve and the relevant risk factors throughout the remainder of most patients' lives. MATERIAL AND METHODS A 100% complete follow-up was conducted of 694 adult patients who had an aortic valve replacement with the St Jude valve during 1980-1993. The Cox regression analysis was used to identify independent risk factors. RESULTS Survival was 79%, 58%, 39%, and 37% at 5, 10, 15, and 18 years, respectively. Only 12% of the deaths (0.60%/patient-year) were valve-related with a 15-year freedom of 91%. Embolism (1.18%/patient-year) and anticoagulant-related bleeding (2.24%/patient-year) were the dominant complications with 15-year freedoms of 80% and 72%. Valve thrombosis was noted in two patients (0.04%/patient-year) who were off anticoagulation. Mechanical failure was not observed. Endocarditis (0.42%/patient-year) had a 15-year freedom of 92% compared with 72% and 54%, respectively, for major valve (2.33%/patient-year) and all valve-related complications together (4.33%/patient-year) and 96% for aortic valve reoperation (0.36%/patient-year). Age of the patient and heart-related variables were identified as independent risk factors for mortality and valve-related complications. CONCLUSION With a follow-up of almost two decades showing a low incidence of valve-related deaths, acceptable thrombogenicity, and absence of mechanical failure, the St Jude bi-leaflet aortic disc valve sets the standard for contemporary mechanical valves.
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Affiliation(s)
- O Lund
- Arhus Universitetshospital, Skejby Sygehus, hjerte-lunge-karkirurgisk afdeling og hjertemedicinsk afdeling
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Christensen TD, Attermann J, Pilegaard HK, Andersen NT, Maegaard M, Hasenkam JM. Self-management of oral anticoagulant therapy for mechanical heart valve patients. SCAND CARDIOVASC J 2001; 35:107-13. [PMID: 11405485 DOI: 10.1080/140174301750164772] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Self-management of oral anticoagulant therapy (OAT) has shown good results on a short-term basis. We hypothesize that self-management of OAT provides a better quality of treatment than conventional management also on a long-term basis. The aim of this study was to assess the quality of self-management of OAT in patients with mechanical heart valve prostheses on a 4-year perspective in a prospective, non-randomized study. DESIGN Twenty-four patients with mechanical heart valves and on self-managed OAT were followed for up to 4 years. A matched, retrospectively selected group of conventionally managed heart valve patients (control group) was used as reference. RESULTS The median observation time was 1175 days (range: 174-1428 days). The self-managed patients were within therapeutic INR target range for a mean of 78.0% (range: 36.1%-93.9%) of the time compared with 61.0% (range 37.4%-2.9%) for the control group. CONCLUSION Self-management of OAT is a feasible and safe concept for selected patients with mechanical heart valve prostheses also on a long-term basis. It provides at least as good and most likely better quality of anticoagulant therapy than conventional management assessed by time within the therapeutic International Normalized Ratio (INR) target range.
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Affiliation(s)
- T D Christensen
- Department of Cardiothoracic and Vascular Surgery, and Institute of Experimental Clinical Research, Skejby Sygehus, Aarhus University Hospital, Denmark
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Abstract
BACKGROUND The standard St. Jude disc valve has been in use for 20 years and remains the dominant mechanical valve of today. With nearly 19 years of follow-up, the present large series could indicate the performance profile and its determinants in the very long term. METHODS A detailed follow-up was performed to a maximum of 18.6 years in 694 patients aged 15 to 83 years who undervent aortic valve replacement (AVR) with the standard St. Jude valve during 1980 to 1993. The Cox regression analysis was used to identify independent determinants of outcome in the aortic stenosis (n = 490) and regurgitation (n = 204) groups. RESULTS Overall survival was 58%, 39%, and 37% at 10, 15, and 18 years, respectively. Only 12% of deaths (0.60%/ patient-year) were related to the valve with a 15-year freedom of 91%. Embolism (1.18%/patient-year) and anticoagulant-related bleeding (2.24%/patient-year) were the dominant complications with 10-year/15-year freedoms of 90%/80% and 85%/72%, respectively. Only 24% of bleeding events were classified as major. Valve thrombosis occurred in 2 patients (0.04%/patient-year): 1 did not receive vitamin K antagonist treatment and International Normalized Ratio was below target level in the other. There were no mechanical failures. Endocarditis (0.42%/patient-year) and paravalvular leak (0.42%/ patient-year) occurred with 15-year freedoms of 92% and 96%, respectively, with a relation between the latter (but not the former) and preoperative endocarditis in the regurgitation group. Freedom from serious complications (2.33%/patient-year) and all complications joined (4.33%/ patient-year) were 72% and 54%, respectively, at 15 years with a 96% freedom from redo AVR (0.36%/patient-year). Age- and heart-related variables were independent risk factors for mortality, thromboembolism, bleeding, serious complications, and all complications joined. Small valve (19 and 21 mm) adversely affected serious and all complications in the regurgitation group. CONCLUSIONS With a follow-up approaching 2 decades and exhibiting a low rate of valve-related deaths, acceptable low thrombogenicity, and absence of mechanical failure, the standard aortic St. Jude disc valve sets the standard for contemporary mechanical valves.
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Affiliation(s)
- O Lund
- Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Denmark.
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Buus NH, Simonsen U, Pilegaard HK, Mulvany MJ. Nitric oxide, prostanoid and non-NO, non-prostanoid involvement in acetylcholine relaxation of isolated human small arteries. Br J Pharmacol 2000; 129:184-92. [PMID: 10694219 PMCID: PMC1621136 DOI: 10.1038/sj.bjp.0703041] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The main purpose of the study was to clarify to which extent nitric oxide (NO) contributes to acetylcholine (ACh) induced relaxation of human subcutaneous small arteries. Arterial segments were mounted in myographs for recording of isometric tension, NO concentration and smooth muscle membrane potential. In noradrenaline-contracted arteries, ACh induced endothelium-dependent relaxations. The NO synthase inhibitor, N(G)-nitro-L-arginine (L-NOARG) had a small significant effect on the concentration-response curves for ACh, and in the presence of L-NOARG, indomethacin only caused a small additional rightward shift in the ACh relaxation. The NO scavenger, oxyhaemoglobin attenuated relaxations for ACh and for the NO donor S-nitroso-N-acetylpenicillamine (SNAP). Inhibition of guanylyl cyclase with 1H-[1,2,4]oxadiazolo[4,3-a]quinoxaline-1-one (ODQ), and inhibition of protein kinase G with beta-phenyl-1, N2-etheno-8-bromoguanosine- 3', 5'- cyclic monophosphorothioate, Rp-isomer, slightly attenuated ACh relaxation, but abolished SNAP induced relaxation. ACh induced relaxation without increases in the free NO concentration. In contrast, for equivalent relaxation, SNAP increased the NO concentration 32+/-8 nM. ACh hyperpolarized the arterial smooth muscle cells with 11.4+/-1.3 mV and 10.5+/-1.3 mV in the absence and presence of L-NOARG, respectively. SNAP only elicited a hyperpolarization of 1.6+/-0.9 mV. In the presence of indomethacin and L-NOARG, ACh relaxation was almost unaffected by lipoxygenase inhibition with nordihydroguaiaretic acid, or cytochrome P450 inhibition with 17-octadecynoic acid or econazole. ACh relaxation was strongly reduced by the combination of charybdotoxin and apamin, but small increments in the extracellular potassium concentration induced no relaxations. The study demonstrates that the NO/L-arginine pathway is present in human subcutaneous small arteries and to a limited extent is involved in ACh induced relaxation. The study also suggests a small contribution of arachidonic acid metabolites. However, ACh relaxation is mainly dependent on a non-NO, non-prostanoid endothelium dependent hyperpolarization. British Journal of Pharmacology (2000) 129, 184 - 192
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Affiliation(s)
- N H Buus
- Department of Pharmacology, University of Aarhus, 8000 Aarhus C, Denmark. Department of Thoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
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Lund O, Pilegaard HK, Ilkjaer LB, Nielsen SL, Arildsen H, Albrechtsen OK. Performance profile of the Starr-Edwards aortic cloth covered valve, track valve, and silastic ball valve. Eur J Cardiothorac Surg 1999; 16:403-13. [PMID: 10571086 DOI: 10.1016/s1010-7940(99)00249-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The Starr-Edwards aortic ball valve has passed 30 years of clinical follow-up. A detailed account of the long-term performance from a large series could thus give valuable guidance in managing patients who are still alive, depict the total remaining life-span after aortic valve replacement (AVR) for the average patient, and set a record yet to be matched by modern disc valves. METHODS A detailed follow-up to a maximum of 31.1 years was performed for 717 patients who underwent their first AVR during 1965-1993 with a Starr-Edwards silastic ball valve (N = 355), a cloth covered valve (N = 164) or a track valve (N = 198) with a total of 7254 patient-years at risk. RESULTS Patients who received a silastic ball valve were older (average 60 vs. 58 years), had more endocarditis (9%) and more secondary kidney failure (24%) preoperatively than the other patients. The three valve types did not differ as regards long-term survival or freedom from complications and only 15% of late deaths were related to the valve. For the silastic ball valve cumulative freedoms at 10 and 25 years were 59 and 20% from all deaths (crude survival), 85 and 80% from thromboembolism, 87 and 70% from bleeding, 98 and 94% from endocarditis, 96 and 95% from redo AVR and 68 and 51% from all valve related complications joined. There were no instances of structural failure apart from wear of the cloth covering the cage struts of the cloth covered valves. Incidences of haemolysis (0.10%/patient-year) and valve thrombosis (0.06%/patient-year) were low for the silastic ball valve. Analysis of relative survival for the silastic ball valve indicated excess mortality relative to a matched background population only during 1st and 13th postoperative year. Apart from heart related factors and age, independent incremental risk factors for mortality and the various complications included, not valve type, but valve size index (valve size divided by body surface area) < or = 13 mm/m2. CONCLUSIONS The Starr-Edwards aortic ball valves, not least the currently available silastic ball valve, are durable through the remaining life time of the patients and able to secure near normal age and sex specific survival provided valve and patient size mismatch is avoided.
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Affiliation(s)
- O Lund
- Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital in Skejby, Denmark.
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Hasenkam JM, Kimose HH, Grønnesby H, Andersen NT, Halborg J, Attermann J, Knudsen L, Christensen TD, Pedersen AM, Lyngbak M, Pilegaard HK. [Self management of peroral anticoagulant therapy in patients with artificial heart valves]. Ugeskr Laeger 1998; 160:6811-5. [PMID: 9835790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Twenty-one heart valve operated patients (age 19-70 years) were trained in self-managed oral anticoagulant therapy using a home coagulometer (CoaguChek). Twenty patients accomplished between eight and 29 (median 24) months of self management and were fully capable of self management after 30 weeks of training. No patients experienced major bleeds or thrombo-embolic events. A control group of 20 patients from our department was matched, retrospectively, to the study group. The self-managing patients were within the therapeutic INR range 78% of the study period compared to 54% for the control patients. All self-managing patients had their median INR-value within the therapeutic range, versus only 14 in the control group. Self-management of oral anticoagulant therapy seems feasible for selected patients.
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Affiliation(s)
- J M Hasenkam
- Arhus Universitetshospital, Skejby Sygehus, hjerte-lunge-karkirurgisk afdeling T.
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