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De Leyn P.,University Hospitals Leuven | Muller M.-R.,Otto Wagner Hospital | Oosterhuis J.W.A.,VU Medisch Centrum | Schmid T.,Universitatsklinik Landeskrankenhaus Innsbruck | And 3 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2011

Objectives: We sought to evaluate the efficacy and safety of a synthetic bioresorbable pleural sealant (PleuraSeal; Covidien, Bedford, Mass) to treat air leaks after pulmonary resection. Methods: Patients with air leaks after lung resection were randomized to treatment with pleural sealant on air leak sites after standard methods of lung closure or standard lung closure only. The primary outcome variable was the percentage of patients remaining air leak free until discharge. The secondary outcome variables were the proportion of patients with successful intraoperative air leak sealing, time to last air leak, and durations of chest tube drainage and hospitalization. Results: The sealant group comprised 62 subjects, and the control group comprised 59 subjects. Most patients (98.3%) underwent open lobectomy for bronchogenic carcinoma. The overall success rates for intraoperative air leak sealing were as follows: sealant group, 71.0%; control group, 23.7% (P < .001). For grade 2 and 3 air leaks (n = 77), the intraoperative sealing rates were as follows: sealant group, 71.7%; control group, 9.1% (P < .001). More patients with grade 2 and 3 air leaks had their leaks remain sealed in the sealant group (43.5% vs 15.2%, P = .013). The median time from skin closure to last observable air leak was 6 hours (sealant group) versus 42 hours (control group, P = .718). No treatment-related complications were reported. No differences in drainage or hospitalization were observed. Conclusions: In this multicenter study the pleural sealant was safe and effective treatment for intraoperative air leaks after lung resection. Significantly fewer patients with surgically relevant intraoperative air leaks had postoperative air leaks when the pleural sealant was applied. © 2011 by The American Association for Thoracic Surgery.

Anliker M.,Institute For Klinische Transfusionsmedizin Und Immungenetik Ulm | Anliker M.,Universitatsklinik Landeskrankenhaus Innsbruck | Hammerer-Lercher A.,Universitatsklinik Landeskrankenhaus Innsbruck | Falkner A.,Universitatsklinik Landeskrankenhaus Innsbruck | And 6 more authors.
LaboratoriumsMedizin | Year: 2013

The laboratory examination of hematologic diseases has made great progress in the last 30 years and is now based on a four-fold strategy: cytomorphology, flow cytometry, cytogenetics, and molecular genetics. Cytomorphology is still the crucial first step, and then it usually followed by flow cytometric immunophenotyping and of relevant cell population. Both investigations require a highly expert laboratory team and, often, an exchange of information among the clinicians. It is a challenge for small specialized laboratories to reach quality standards and economic efficiency nowadays, even with highly specialized personnel. One solution is the collaboration among institutes of laboratory medicine (usually a central laboratory), smaller laboratories specialized in hematology, and usually residents in departments of hematologic diseases, as is the practice in the Interdiscipline Hematologic Competence Center (IHK) of Innsbruck since 2008. Thus, in Innsbruck, this competence center concentrates the whole expertise in the hematology laboratory of the hospital based on cytomorphology and flow cytometry. Besides the clarification of already identified hematologic diseases, the IHK has optimal conditions not only for the specific and prompt first-time diagnosis of hematologic diseases (e.g., additional diagnostic findings) but also for the screening of blood samples, from tertiary care hospitals, that require further diagnostic workup for specific disease clarification based on numeric and morphologic abnormalities. For the further progression of the IHK, the integration of cytogenetic and molecular genetic diagnostics is essential. The interdisciplinary collaboration of specialists in laboratory medicine, hematology, cytogenetics and molecular genetics improves the knowledge tranfer and expertise of all members and enhances the efficiency and quality level of such a collaborating laboratory division. Further advantages can be achieved in important laboratory development processes (e.g., laboratory accreditation, implementation of expensive laboratory equipment, such as ten-color flow cytometers, introduction of modern laboratory information systems, or image-archiving systems), with a high potential of synergetic effects stemming from the collaboration. The establishment of interdisciplinary competence centers for hematologic diagnostics is therefore a milestone in modern laboratory diagnostics. © 2013 by Walter de Gruyter Berlin Boston 2013.

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