scholarly journals Conducting Dermatological Operations in Patients Who Have Previously Undergone Cardiac Surgery

Author(s):  
Argen Nabievich Irmatov ◽  
Ravan Seyfeddin Ogly Shukyurli ◽  
Rukizhat Gasbulakhovna Kurbanmagomedov ◽  
Diana Taymazovna Amirchupanova ◽  
Pavel Vladimirovich Nasonov ◽  
...  

Thoracic surgical procedures and the use of cardiac devices such as pacemakers are becoming increasingly common in the population. Therefore, dermatologists may be more likely to encounter previously implanted or discarded surgical material during a dermatological operation on the chest wall. A basic understanding of the types of wires and tunneling paths used in such procedures is essential to accurately predict the presence of these wires and effectively manage any chance encounters. Dermatologists should be aware that temporary epicardial pacemaker electrodes and pacemaker electrodes often remain in the chest wall of many patients. All patients with a history of cardiac surgery should be asked about the possible presence of temporary epicardial electrodes in their body, and if such materials are found during the operation, it is necessary to immediately stop the procedure and do not undertake further manipulations with them until the material from which it is made is determined. Specialists in cardiology and cardiothoracic surgery need to document any abandoned wire in the patient's list of problems and inform the patient about the abandoned wire so that he or she can be an important source of clinical information. Trying to pull out the remaining pacemaker electrodes is a serious risk, so dermatologist surgeons should not attempt it under any circumstances. When detecting wire material, it is necessary to determine the type and location of the material before any manipulation or pulling attempts. Once it is established that this is a non-functional, abandoned wire, it is necessary to apply the correct technique for removing it, which consists in gently pulling and securing the wire at the exit point. Accurate identification of the material is required in order not to interfere with the operation of the active device and not to abandon the operation unnecessarily. The aim of the work is to consider the implementation of dermatological operations in patients who have previously undergone cardiac surgery.

2014 ◽  
Vol 62 (S 01) ◽  
Author(s):  
L. Tewarie ◽  
A.K. Moza ◽  
A. Goetzenich ◽  
R. Zayat ◽  
R. Autschbach

2011 ◽  
Vol 1 (1) ◽  
pp. 3 ◽  
Author(s):  
Dawn E. Jaroszewski ◽  
Jason D. Fraser ◽  
Patrick A. DeValeria

Pectus excavatum (PE) deformity is present in the majority of Marfan patients. Many have not had PE repair and present as adults with aortic and valve pathology requiring operative intervention. We present our preliminary report of simultaneous cardiac surgery and repair of the chest wall deformity. Utilizing this modified minimally invasive excavatum repair provided quick, safe repairs with good cosmetic results.


2020 ◽  
Author(s):  
Matthias Gijsen ◽  
Chao-yuan Huang ◽  
Marine Flechet ◽  
Ruth Van Daele ◽  
Peter Declercq ◽  
...  

Abstract Background Augmented renal clearance (ARC) might lead to subtherapeutic plasma levels of drugs with predominant renal clearance. Early identification of ARC remains challenging for the intensive care unit (ICU) physician. We developed and validated the ARC predictor, a clinical prediction model for ARC on the next day during ICU stay, and made it available via an online calculator. Its predictive performance was compared with that of two existing models for ARC. Methods A large multicenter database including medical, surgical and cardiac surgery ICU patients (n = 33258 ICU days) from three Belgian tertiary care academic hospitals was used for the development of the prediction model. Development was based on clinical information available during ICU stay. We assessed performance by measuring discrimination, calibration and net benefit. The final model was externally validated (n = 10259 ICU days) in a single-center population. Results ARC was found on 19.6% of all ICU days in the development cohort. Six clinical variables were retained in the ARC predictor: day from ICU admission, age, sex, serum creatinine, trauma and cardiac surgery. External validation confirmed good performance with an area under the curve of 0.88 (95% CI 0.87 – 0.88), and a sensitivity and specificity of 84.1 (95% CI 82.5 – 85.7) and 76.3 (95% CI 75.4 – 77.2) at the default threshold probability of 0.2, respectively. Conclusion ARC on the next day can be predicted with good performance during ICU stay, using routinely collected clinical information that is readily available at bedside. The ARC predictor is available at www.arcpredictor.com .


2018 ◽  
Vol 22 (4) ◽  
pp. 403-406 ◽  
Author(s):  
Habib Srour ◽  
Komal Pandya ◽  
Alex Flannery ◽  
Kevin Hatton

This article is the first reported case describing the off-label use of enteral immediate-release guanfacine, a long-acting α-2 adrenergic agonist most commonly used in the treatment of attention-deficit hyperactivity disorder, for sedation in a patient with severe anxiety and agitation limiting mechanical ventilation weaning several days after cardiac surgery. In this case, after several days of unsuccessful attempts to control his agitation and anxiety with conventional therapies, guanfacine therapy was initiated, and the patient was rapidly weaned from all other sedatives and mechanical ventilation shortly thereafter. The patient was weaned from guanfacine therapy without evidence of bradycardia, hypotension, or rebound syndrome. Enteral guanfacine therapy should be further studied as a potentially useful and cost-effective sedative therapy for patients with severe anxiety and/or agitation in the intensive care unit following cardiac and thoracic surgical procedures.


Author(s):  
V. M. Zakharevich ◽  
V. A. Mitish ◽  
T. A. Khalilulin ◽  
A. R. Zakiryanov ◽  
D. S. Ivanov ◽  
...  

Deep wound infection of the anterior chest wall tissues in patients after transsternal cardiac surgery despite intensive developments in surgical techniques and improvement of antibacterial chemotherapy, remains a genuine concern worldwide [1]. The incidence of this complication in the general population ranges from 0.5 to 4% [2, 3]. Despite developed approaches in the treatment of cardiac surgery patients, the treatment of deep sternal wound infection and surrounding tissues following a heart transplantation still remains a rather serious and pressing challenge. This paper presents a clinical observation of a heart transplant recipient, complicated by deep postoperative wound infection. The strategy of staged surgical treatment of sternal osteomyelitis consisted of surgical wound debridement, local wound debridement with vacuum dressings, and reconstructive surgery at the final stage (sternal reosteosynthesis, plasty of the anterior chest wall wound with displaced skin and fascial flaps).


2012 ◽  
Vol 8 (2) ◽  
pp. 88 ◽  
Author(s):  
Bosede A Afolabi ◽  
Fred M Kusumoto ◽  
◽  

There has been a rapid growth in the number of patients with cardiovascular implantable electronic devices (CIEDs), due to the consistent good results from large randomised trials and changing worldwide demographics with progressive ageing in all developed countries. Early generations of CIEDs provided only basic operations and stored only rudimentary data, but the evolution of all types of CIEDs (pacemakers, defibrillators, cardiac resynchronisation devices, implantable monitors) has led to their increased complexity and the development of a myriad of specialised features. As an outgrowth of this increased sophistication, once implanted, CIEDs can provide significant amounts of important clinical information, allowing to identify the presence of significant arrhythmias, assess drug efficacy, evaluate heart failure status and continuously monitor device function. With the advent of new methods of remote monitoring, the information recorded by these devices can be accessible in real time and thus lead to more timely clinical decision-making. This article summarises the impact of remote monitoring on clinical practice today and how the use of remote monitoring may evolve to affect the practice of medicine in the future.


2020 ◽  
Vol 34 (11) ◽  
pp. 3168-3169
Author(s):  
Michael Essandoh ◽  
Nasir Hussain ◽  
Yousef Alghothani ◽  
Sujatha Bhandary

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