Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability
Objective In the cancer population, pericardial effusions are a common and potentially life-threatening occurrence. Although decompression benefits most patients, paradoxical hemodynamic instability (PHI) develops in some, with hypotension and shock in the immediate postoperative period. This study...
Gespeichert in:
| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2011, Vol.141 (1), p.34-38 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 38 |
|---|---|
| container_issue | 1 |
| container_start_page | 34 |
| container_title | The Journal of thoracic and cardiovascular surgery |
| container_volume | 141 |
| creator | Wagner, Patrick L., MD McAleer, Eileen, MD Stillwell, Elizabeth, PhD Bott, Matthew, MD Rusch, Valerie W., MD Schaffer, Wendy, MD, PhD Huang, James, MD |
| description | Objective In the cancer population, pericardial effusions are a common and potentially life-threatening occurrence. Although decompression benefits most patients, paradoxical hemodynamic instability (PHI) develops in some, with hypotension and shock in the immediate postoperative period. This study examines paradoxical hemodynamic instability after pericardial window and identifies prognostic factors in patients with cancer who are treated for pericardial effusion. Methods Retrospective review of 179 consecutive pericardial windows performed for pericardial effusion in a tertiary cancer center over a 5-year period (January 2004 through March 2009). Demographic, surgical, pathologic, and echocardiographic data were analyzed for the end points of paradoxical hemodynamic instability (pressor-dependent hypotension requiring intensive care unit admission) and overall survival. Results The most common malignancies were lung (44%), breast (20%), hematologic (10%), and gastrointestinal (7%). Overall survival for the group was poor (median, 5 months); patients with hematologic malignant disease fared significantly better than the others (median survival 36 months; P = .008). Paradoxical hemodynamic instability occurred in 19 (11%) patients. These patients were more likely to have evidence of tamponade on echocardiogram (89% vs 56%; P = .005), positive cytology/pathology (68% vs 41%; P = .03), and higher volume drained (674 mL vs 495 mL; P = .003). Overall survival was significantly shorter in those in whom paradoxical hemodynamic instability developed (median survival 35 vs 189 days; hazard ratio = 3; P |
| doi_str_mv | 10.1016/j.jtcvs.2010.09.015 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_820788222</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022522310010603</els_id><sourcerecordid>820788222</sourcerecordid><originalsourceid>FETCH-LOGICAL-c554t-7f0fb642731b0a4463f72a3f3d72ee60b4b4b0df88608db1bda54c130a76abc73</originalsourceid><addsrcrecordid>eNqFkkuLFDEUhYMoTk_rLxAkG3FV7U1ST0FBBkeFAQdUcBdSeTgpq5IySc3YP8N_bGq6feBGsggk3zlczrkIPSKwI0DqZ8NuSPI67ijkF-h2QKo7aEOga4q6rT7fRRsASouKUnaCTmMcAKAB0t1HJzRTtOvYBv241MFKEZQVI9bGLNF6F7F1OF1pLIWTOuDZz8soUv55ji-D_-J8TFZiI2TyIWJh0gr9ZXRjnfI3WDh1a2OnOaPYGzyLIJT_nsERX-nJq70TU7ayLibR29Gm_QN0z4gx6ofHe4s-nb_-ePa2uHj_5t3Zq4tCVlWZisaA6euSNoz0IMqyZqahghmmGqp1DX2ZDyjTtjW0qie9ElUpCQPR1KKXDduipwffOfhvi46JTzZKPY7Cab9E3lJo2pbm9LaIHUgZfIxBGz4HO4mw5wT4WgUf-G0VfK2CQ8dzFVn1-Oi_9JNWvzW_ss_AkyMgYs7DhBy2jX841rG2qVfuxYHTOY1rqwOP0upcjLJBy8SVt_8Z5OU_ejlat1bwVe91HPwSXA6aEx4pB_5h3Zp1aQhkkxoY-wl1gMEX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>820788222</pqid></control><display><type>article</type><title>Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Wagner, Patrick L., MD ; McAleer, Eileen, MD ; Stillwell, Elizabeth, PhD ; Bott, Matthew, MD ; Rusch, Valerie W., MD ; Schaffer, Wendy, MD, PhD ; Huang, James, MD</creator><creatorcontrib>Wagner, Patrick L., MD ; McAleer, Eileen, MD ; Stillwell, Elizabeth, PhD ; Bott, Matthew, MD ; Rusch, Valerie W., MD ; Schaffer, Wendy, MD, PhD ; Huang, James, MD</creatorcontrib><description>Objective In the cancer population, pericardial effusions are a common and potentially life-threatening occurrence. Although decompression benefits most patients, paradoxical hemodynamic instability (PHI) develops in some, with hypotension and shock in the immediate postoperative period. This study examines paradoxical hemodynamic instability after pericardial window and identifies prognostic factors in patients with cancer who are treated for pericardial effusion. Methods Retrospective review of 179 consecutive pericardial windows performed for pericardial effusion in a tertiary cancer center over a 5-year period (January 2004 through March 2009). Demographic, surgical, pathologic, and echocardiographic data were analyzed for the end points of paradoxical hemodynamic instability (pressor-dependent hypotension requiring intensive care unit admission) and overall survival. Results The most common malignancies were lung (44%), breast (20%), hematologic (10%), and gastrointestinal (7%). Overall survival for the group was poor (median, 5 months); patients with hematologic malignant disease fared significantly better than the others (median survival 36 months; P = .008). Paradoxical hemodynamic instability occurred in 19 (11%) patients. These patients were more likely to have evidence of tamponade on echocardiogram (89% vs 56%; P = .005), positive cytology/pathology (68% vs 41%; P = .03), and higher volume drained (674 mL vs 495 mL; P = .003). Overall survival was significantly shorter in those in whom paradoxical hemodynamic instability developed (median survival 35 vs 189 days; hazard ratio = 3; P < .001), and the majority of them (11/19, 58%) did not survive their hospitalization. Conclusions Postoperative hemodynamic instability after pericardial window portends a grave prognosis. Evidence of tamponade, larger effusion volumes, and positive cytologic findings may predict a higher risk of paradoxical hemodynamic instability and anticipate a need for invasive monitoring and intensive care postoperatively.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2010.09.015</identifier><identifier>PMID: 21092993</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Chi-Square Distribution ; Diseases of the pericardium ; Female ; Heart ; Hemodynamics ; Hospital Mortality ; Humans ; Hypotension - etiology ; Hypotension - physiopathology ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Neoplasms - complications ; Neoplasms - mortality ; Neoplasms - physiopathology ; New York City ; Pericardial Effusion - etiology ; Pericardial Effusion - mortality ; Pericardial Effusion - physiopathology ; Pericardial Effusion - surgery ; Pericardial Window Techniques - adverse effects ; Pericardial Window Techniques - mortality ; Pneumology ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Shock - etiology ; Shock - physiopathology ; Survival Rate ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2011, Vol.141 (1), p.34-38</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2011 The American Association for Thoracic Surgery</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c554t-7f0fb642731b0a4463f72a3f3d72ee60b4b4b0df88608db1bda54c130a76abc73</citedby><cites>FETCH-LOGICAL-c554t-7f0fb642731b0a4463f72a3f3d72ee60b4b4b0df88608db1bda54c130a76abc73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522310010603$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,4010,27900,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23938763$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21092993$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wagner, Patrick L., MD</creatorcontrib><creatorcontrib>McAleer, Eileen, MD</creatorcontrib><creatorcontrib>Stillwell, Elizabeth, PhD</creatorcontrib><creatorcontrib>Bott, Matthew, MD</creatorcontrib><creatorcontrib>Rusch, Valerie W., MD</creatorcontrib><creatorcontrib>Schaffer, Wendy, MD, PhD</creatorcontrib><creatorcontrib>Huang, James, MD</creatorcontrib><title>Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective In the cancer population, pericardial effusions are a common and potentially life-threatening occurrence. Although decompression benefits most patients, paradoxical hemodynamic instability (PHI) develops in some, with hypotension and shock in the immediate postoperative period. This study examines paradoxical hemodynamic instability after pericardial window and identifies prognostic factors in patients with cancer who are treated for pericardial effusion. Methods Retrospective review of 179 consecutive pericardial windows performed for pericardial effusion in a tertiary cancer center over a 5-year period (January 2004 through March 2009). Demographic, surgical, pathologic, and echocardiographic data were analyzed for the end points of paradoxical hemodynamic instability (pressor-dependent hypotension requiring intensive care unit admission) and overall survival. Results The most common malignancies were lung (44%), breast (20%), hematologic (10%), and gastrointestinal (7%). Overall survival for the group was poor (median, 5 months); patients with hematologic malignant disease fared significantly better than the others (median survival 36 months; P = .008). Paradoxical hemodynamic instability occurred in 19 (11%) patients. These patients were more likely to have evidence of tamponade on echocardiogram (89% vs 56%; P = .005), positive cytology/pathology (68% vs 41%; P = .03), and higher volume drained (674 mL vs 495 mL; P = .003). Overall survival was significantly shorter in those in whom paradoxical hemodynamic instability developed (median survival 35 vs 189 days; hazard ratio = 3; P < .001), and the majority of them (11/19, 58%) did not survive their hospitalization. Conclusions Postoperative hemodynamic instability after pericardial window portends a grave prognosis. Evidence of tamponade, larger effusion volumes, and positive cytologic findings may predict a higher risk of paradoxical hemodynamic instability and anticipate a need for invasive monitoring and intensive care postoperatively.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Chi-Square Distribution</subject><subject>Diseases of the pericardium</subject><subject>Female</subject><subject>Heart</subject><subject>Hemodynamics</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Hypotension - etiology</subject><subject>Hypotension - physiopathology</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - mortality</subject><subject>Neoplasms - physiopathology</subject><subject>New York City</subject><subject>Pericardial Effusion - etiology</subject><subject>Pericardial Effusion - mortality</subject><subject>Pericardial Effusion - physiopathology</subject><subject>Pericardial Effusion - surgery</subject><subject>Pericardial Window Techniques - adverse effects</subject><subject>Pericardial Window Techniques - mortality</subject><subject>Pneumology</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Shock - etiology</subject><subject>Shock - physiopathology</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkkuLFDEUhYMoTk_rLxAkG3FV7U1ST0FBBkeFAQdUcBdSeTgpq5IySc3YP8N_bGq6feBGsggk3zlczrkIPSKwI0DqZ8NuSPI67ijkF-h2QKo7aEOga4q6rT7fRRsASouKUnaCTmMcAKAB0t1HJzRTtOvYBv241MFKEZQVI9bGLNF6F7F1OF1pLIWTOuDZz8soUv55ji-D_-J8TFZiI2TyIWJh0gr9ZXRjnfI3WDh1a2OnOaPYGzyLIJT_nsERX-nJq70TU7ayLibR29Gm_QN0z4gx6ofHe4s-nb_-ePa2uHj_5t3Zq4tCVlWZisaA6euSNoz0IMqyZqahghmmGqp1DX2ZDyjTtjW0qie9ElUpCQPR1KKXDduipwffOfhvi46JTzZKPY7Cab9E3lJo2pbm9LaIHUgZfIxBGz4HO4mw5wT4WgUf-G0VfK2CQ8dzFVn1-Oi_9JNWvzW_ss_AkyMgYs7DhBy2jX841rG2qVfuxYHTOY1rqwOP0upcjLJBy8SVt_8Z5OU_ejlat1bwVe91HPwSXA6aEx4pB_5h3Zp1aQhkkxoY-wl1gMEX</recordid><startdate>2011</startdate><enddate>2011</enddate><creator>Wagner, Patrick L., MD</creator><creator>McAleer, Eileen, MD</creator><creator>Stillwell, Elizabeth, PhD</creator><creator>Bott, Matthew, MD</creator><creator>Rusch, Valerie W., MD</creator><creator>Schaffer, Wendy, MD, PhD</creator><creator>Huang, James, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2011</creationdate><title>Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability</title><author>Wagner, Patrick L., MD ; McAleer, Eileen, MD ; Stillwell, Elizabeth, PhD ; Bott, Matthew, MD ; Rusch, Valerie W., MD ; Schaffer, Wendy, MD, PhD ; Huang, James, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c554t-7f0fb642731b0a4463f72a3f3d72ee60b4b4b0df88608db1bda54c130a76abc73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Chi-Square Distribution</topic><topic>Diseases of the pericardium</topic><topic>Female</topic><topic>Heart</topic><topic>Hemodynamics</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Hypotension - etiology</topic><topic>Hypotension - physiopathology</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasms - complications</topic><topic>Neoplasms - mortality</topic><topic>Neoplasms - physiopathology</topic><topic>New York City</topic><topic>Pericardial Effusion - etiology</topic><topic>Pericardial Effusion - mortality</topic><topic>Pericardial Effusion - physiopathology</topic><topic>Pericardial Effusion - surgery</topic><topic>Pericardial Window Techniques - adverse effects</topic><topic>Pericardial Window Techniques - mortality</topic><topic>Pneumology</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Shock - etiology</topic><topic>Shock - physiopathology</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wagner, Patrick L., MD</creatorcontrib><creatorcontrib>McAleer, Eileen, MD</creatorcontrib><creatorcontrib>Stillwell, Elizabeth, PhD</creatorcontrib><creatorcontrib>Bott, Matthew, MD</creatorcontrib><creatorcontrib>Rusch, Valerie W., MD</creatorcontrib><creatorcontrib>Schaffer, Wendy, MD, PhD</creatorcontrib><creatorcontrib>Huang, James, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wagner, Patrick L., MD</au><au>McAleer, Eileen, MD</au><au>Stillwell, Elizabeth, PhD</au><au>Bott, Matthew, MD</au><au>Rusch, Valerie W., MD</au><au>Schaffer, Wendy, MD, PhD</au><au>Huang, James, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2011</date><risdate>2011</risdate><volume>141</volume><issue>1</issue><spage>34</spage><epage>38</epage><pages>34-38</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objective In the cancer population, pericardial effusions are a common and potentially life-threatening occurrence. Although decompression benefits most patients, paradoxical hemodynamic instability (PHI) develops in some, with hypotension and shock in the immediate postoperative period. This study examines paradoxical hemodynamic instability after pericardial window and identifies prognostic factors in patients with cancer who are treated for pericardial effusion. Methods Retrospective review of 179 consecutive pericardial windows performed for pericardial effusion in a tertiary cancer center over a 5-year period (January 2004 through March 2009). Demographic, surgical, pathologic, and echocardiographic data were analyzed for the end points of paradoxical hemodynamic instability (pressor-dependent hypotension requiring intensive care unit admission) and overall survival. Results The most common malignancies were lung (44%), breast (20%), hematologic (10%), and gastrointestinal (7%). Overall survival for the group was poor (median, 5 months); patients with hematologic malignant disease fared significantly better than the others (median survival 36 months; P = .008). Paradoxical hemodynamic instability occurred in 19 (11%) patients. These patients were more likely to have evidence of tamponade on echocardiogram (89% vs 56%; P = .005), positive cytology/pathology (68% vs 41%; P = .03), and higher volume drained (674 mL vs 495 mL; P = .003). Overall survival was significantly shorter in those in whom paradoxical hemodynamic instability developed (median survival 35 vs 189 days; hazard ratio = 3; P < .001), and the majority of them (11/19, 58%) did not survive their hospitalization. Conclusions Postoperative hemodynamic instability after pericardial window portends a grave prognosis. Evidence of tamponade, larger effusion volumes, and positive cytologic findings may predict a higher risk of paradoxical hemodynamic instability and anticipate a need for invasive monitoring and intensive care postoperatively.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>21092993</pmid><doi>10.1016/j.jtcvs.2010.09.015</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-5223 |
| ispartof | The Journal of thoracic and cardiovascular surgery, 2011, Vol.141 (1), p.34-38 |
| issn | 0022-5223 1097-685X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_820788222 |
| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiology. Vascular system Cardiothoracic Surgery Chi-Square Distribution Diseases of the pericardium Female Heart Hemodynamics Hospital Mortality Humans Hypotension - etiology Hypotension - physiopathology Kaplan-Meier Estimate Logistic Models Male Medical sciences Middle Aged Neoplasms - complications Neoplasms - mortality Neoplasms - physiopathology New York City Pericardial Effusion - etiology Pericardial Effusion - mortality Pericardial Effusion - physiopathology Pericardial Effusion - surgery Pericardial Window Techniques - adverse effects Pericardial Window Techniques - mortality Pneumology Proportional Hazards Models Retrospective Studies Risk Assessment Risk Factors Shock - etiology Shock - physiopathology Survival Rate Time Factors Treatment Outcome |
| title | Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T08%3A27%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Pericardial%20effusions%20in%20the%20cancer%20population:%20Prognostic%20factors%20after%20pericardial%20window%20and%20the%20impact%20of%20paradoxical%20hemodynamic%20instability&rft.jtitle=The%20Journal%20of%20thoracic%20and%20cardiovascular%20surgery&rft.au=Wagner,%20Patrick%20L.,%20MD&rft.date=2011&rft.volume=141&rft.issue=1&rft.spage=34&rft.epage=38&rft.pages=34-38&rft.issn=0022-5223&rft.eissn=1097-685X&rft.coden=JTCSAQ&rft_id=info:doi/10.1016/j.jtcvs.2010.09.015&rft_dat=%3Cproquest_cross%3E820788222%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=820788222&rft_id=info:pmid/21092993&rft_els_id=S0022522310010603&rfr_iscdi=true |