Asunto(s)
Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Sarcoma Sinovial/diagnóstico , Vena Cava Inferior , Adulto , Procedimientos Quirúrgicos Cardíacos , Diagnóstico Diferencial , Atrios Cardíacos , Neoplasias Cardíacas/cirugía , Humanos , Imagen por Resonancia Cinemagnética , Masculino , Sarcoma Sinovial/cirugíaRESUMEN
BACKGROUND: Post-surgical pericardial adhesions pose an increased risk of complications during redo sternotomies. Adhesive tissue formation is a normal response to tissue injury and involves complex patho-physiological processes including the actions of prostaglandins to cause plasma leakage and fibrin formation. The purpose of this study was to assess the ability of two non-steroidal anti-inflammatory agents (Indomethacin and Rofecoxib) and a barrier (Coseal, a polyethylene glycol) to limit adhesion formation following cardiac surgery in a pig model. METHODS: Forty-four piglets were allocated equally to four treatment groups: Group 1: Control, Group 2: intramuscular Indomethacin, Group 3: oral Rofecoxib and Group 4: Coseal sprayed on the heart. A full median sternotomy was performed on each animal and the heart exposed. Adhesions were induced by rubbing tissues with gauze, applying sutures and leaving blood in the pericardial sac before chest closure. Plasma inflammatory markers including prostaglandin E(2) and thromboxane B(2) were measured preoperatively and on Days 2, 5 and 10 after surgery. Eight animals from each group were slaughtered after 12 weeks and 3 after 25 weeks. Adhesions were assessed macroscopically and microscopically. RESULTS: Compared to the Control group, the extent of adhesions was significantly less in all other groups whilst adhesion density was least in the Indomethacin and Coseal groups. Indomethacin and less so Rofecoxib, inhibited the synthesis of prostaglandin E(2) and thromboxane B(2) but there were no significant changes in other inflammatory markers. CONCLUSIONS: We conclude that systemic Indomethacin, and locally applied Coseal are suitable methods to markedly reduce pericardial and retrosternal adhesions.
Asunto(s)
Indometacina , Lactonas , Pericardio , Polietilenglicoles , Complicaciones Posoperatorias , Sulfonas , Adherencias Tisulares , Animales , Disponibilidad Biológica , Biomarcadores , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Inhibidores de la Ciclooxigenasa 2/farmacocinética , Dinoprostona/sangre , Modelos Animales de Enfermedad , Monitoreo de Drogas , Indometacina/administración & dosificación , Indometacina/farmacocinética , Inflamación/sangre , Lactonas/administración & dosificación , Lactonas/farmacocinética , Pericardio/efectos de los fármacos , Pericardio/patología , Periodo Perioperatorio/métodos , Polietilenglicoles/administración & dosificación , Polietilenglicoles/farmacocinética , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Esternotomía/efectos adversos , Esternotomía/métodos , Sulfonas/administración & dosificación , Sulfonas/farmacocinética , Tensoactivos/administración & dosificación , Tensoactivos/farmacocinética , Porcinos , Tromboxano B2/sangre , Adherencias Tisulares/sangre , Adherencias Tisulares/etiología , Adherencias Tisulares/patología , Adherencias Tisulares/prevención & control , Resultado del TratamientoRESUMEN
BACKGROUND: Primary solitary mass lesions of the mediastinum, although relatively uncommon, encompass an interesting spectrum of pathologies. METHODS: A comprehensive retrospective review was undertaken of all cases of mediastinal lesions that presented to the two major thoracic surgical centres in North Queensland, Australia, over a 7-year period. RESULTS: Thirty-seven mediastinal mass lesions were managed over the period of the review. Over one-quarter of all cases were clinically silent, the pathology having been discovered incidentally during investigation for other reasons. Malignant thymoma was the single most common pathology, being present in 13 (35.1%) cases. A variety of other pathologies were encountered, including thymic cyst, bronchogenic cyst, neurofibroma, parathyroid adenoma, and lymphoma. Expeditious surgical resection of the lesions, once discovered, afforded good medium-term survival, even for those patients with malignant pathology. CONCLUSIONS: Prompt thoracic surgical referral with view to aggressive, early resection optimizes clinical outcome in the short and medium-term for patients presenting with mass lesions of the mediastinum.