SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: The Annals of thoracic surgery

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Quantitative analysis of specific exhaled carbonyl compounds (ECCs) has shown promise for the detection of lung cancer. The purpose of this study is to demonstrate the normalization of ECCs in patients after lung cancer resection.

Concepts: Epidemiology, Cancer, Metastasis, Lung cancer, Cancer staging, Tobacco smoking

28

Prediction of the age at aortic dissection for family members of aortic dissection patients would enhance early detection and clinical management. We sought to determine whether these dissections tend to cluster by age in family members of the dissection patients.

Concepts: Biology, Aortic dissection, Family therapy

28

Valve-sparing aortic root reconstruction (VSRR) is an accepted method to treat patients with aortic root dilation. The role of the VSRR is less well defined for patients with bicuspid aortic valve, severe aortic valve insufficiency, congenital heart defects, and type A aortic dissection. We studied the clinical outcome of patients who underwent VSRR for expanded indications.

Concepts: Aortic aneurysm, Aortic dissection, Aorta, Congenital heart defect, Congenital heart disease, Aortic valve, Aortic insufficiency, Bicuspid aortic valve

28

The classic cut and sew maze is thought to reduce stroke, in part because of left atrial appendage (LAA) elimination. Multiple LAA elimination techniques have evolved with the introduction of new surgical treatment options for atrial fibrillation (AF), but the impact on stroke remains unknown. We studied the rate of late neurologic event (LNE) in the era of contemporary AF surgery.

Concepts: Medicine, Hospital, Atrial fibrillation, Surgery, Neurosurgery, Atrial flutter, Left atrial appendage occlusion, Left atrial appendage

28

BACKGROUND: We compared the surgical outcomes in patients with clinical N0 and pathologic N2 (cN0-pN2) non-small cell lung cancer (NSCLC) who underwent video-assisted thoracoscopic surgery (VATS) lobectomy and open thoracotomy to evaluate the role of VATS lobectomy for cN0-pN2 disease. METHODS: Between March 2006 and August 2011, 1,456 patients with clinical N0 NSCLC disease underwent lobectomy with systematic node dissection (SND) at Shanghai Chest Hospital. Of those patients, 157 were shown to have cN0-pN2 NSCLC. Of those, 67 patients underwent VATS lobectomy, and 90 patients underwent open lobectomy. SND was performed in all 157 patients. Clinicopathologic factors, local recurrence rates, and survival rates were compared. RESULTS: The two groups were similar in age, sex, and pulmonary function. The VATS approach was associated with significantly shorter chest tube duration and postoperative stay than was the thoracotomy approach. Operative mortality, morbidity, and recurrence did not differ between the two groups. There was no significant difference between the two types of operation in numbers of total lymph nodes removed (17.4 ± 6.1 in the VATS group vs 18.1 ± 7.2 in the open group, p = 0.78) and mediastinal lymph nodes removed (11.7 ± 5.6 in the VATS group vs 12.0 ± 5.1 in the open group, p = 0.84). Similarly, the two groups were not significantly different with regard to stations of total lymph nodes removed (7.6 ± 1.9 in the VATS group vs 7.8 ± 2.3 in the open group, p = 0.81) and mediastinal lymph nodes removed (4.5 ± 1.1 in the VATS group vs 4.7 ± 1.3 in the open group, p = 0.71). The rates of overall survival and disease-free 5-year survival were not significantly different between the two groups. CONCLUSIONS: The clinical outcomes of thoracoscopic lobectomy were comparable to those of thoracotomy for patients with cN0-pN2 NSCLC. Single-station N2 is a good prognostic factor for disease-free survival in these patients.

Concepts: Cancer, Disease, Lung cancer, Non-small cell lung carcinoma, Lymph node, Thoracic surgery, VATS lobectomy, Video-assisted thoracoscopic surgery

28

Markedly higher hospital and long-term mortality after coronary artery bypass grafting (CABG) have been reported in hemodialysis (HD)-dependent patients. We tried to identify the predictors for short-term and long-term outcomes after CABG, which have not been well studied.

Concepts: Atherosclerosis, Angina pectoris, Coronary artery disease, Artery, Coronary circulation, Coronary artery bypass surgery

27

BACKGROUND: The clinical variables leading to postoperative thrombotic occlusion of a modified Blalock-Taussig shunt (mBTS) remain elusive. In this investigation, we assess several perioperative variables to determine associations with postoperative in-hospital shunt occlusion. METHODS: We retrospectively reviewed the medical records of infants receiving a mBTS as a first operation between March 1, 2005, and December 31, 2011. Numerous perioperative variables were collected, focusing on those that would increase resistance to blood flow through the shunt or alter coagulation. RESULTS: In all, 207 neonates fit our criteria. In-hospital shunt occlusion occurred in 14 patients (6.8%); 3 patients (21.4%) subsequently died during their hospitalization. Pulmonary atresia/ventricular septal defect with or without major aortopulmonary collateral arteries was the most common diagnosis associated with shunt occlusion (57.1%). Of the collected perioperative variables, pulmonary artery size was significantly associated with shunt occlusion (p = 0.03). Preoperative coagulation values were significantly reduced in those patients who experienced shunt occlusion. Additionally, the immediate postoperative activated partial thromboplastin time was significantly reduced in the occlusion group although values remained well above normal as all infants were treated postoperatively with a heparin infusion. CONCLUSIONS: We found that a patient’s anatomy (pulmonary atresia/ventricular septal defect with or without major aortopulmonary collateral arteries) and the size of the pulmonary artery being shunted had a significant impact in predicting postoperative in-hospital shunt occlusion. These results emphasize that technical skills and a low resistance to blood flow are necessary for successful shunt function. Although some perioperative coagulation values were significantly reduced in infants who were destined to experience shunt occlusion, they would be difficult to detect clinically.

Concepts: Blood, Myocardial infarction, Heart, Artery, Vein, Pulmonary artery, Heparin, Prothrombin time

27

The incidence of pulmonary vein stenosis after correction of a cardiac total anomalous pulmonary venous connection in neonates may be underestimated because of the small population of patients; however, it is associated with significant mortality and morbidity. This report describes a primary sutureless repair and anterior translocation of the atrial septum to create a large left atrial cavity and avoid post-repair pulmonary vein stenosis.

Concepts: Blood, Lung, Heart, Blood vessel, Circulatory system, Vein, Pulmonary artery, Total anomalous pulmonary venous connection

27

Pulmonary glomus tumors are extremely rare, with only 19 cases having been reported worldwide. The glomus body is considered to be related to the regulation of body temperature, but the reported cases were not associated with hyperpyrexia. Here, we describe a 28-year-old man with hyperpyrexia and anemia complicated with a coin lesion of the right lung. After resection of the upper lobe of the right lung by video-assisted thoracoscopic surgery, all of the patient’s symptoms disappeared. The pathologic analysis reported a rare pulmonary glomus tumor. The disease had not recurred by 1 year after operation.

Concepts: Cancer, Oncology, Lung, Medical signs, Video-assisted thoracoscopic surgery, Glomus tumor

27

With implantable cardiac assist devices increasingly proving their effectiveness as therapeutic options for end-stage heart failure, it is important for clinicians to understand the unique physiology of device-assisted circulation. Preload sensitivity as it relates to cardiac assist devices is derived from the Frank-Starling relationship between human ventricular filling pressures and ventricular stroke volume. In this review, we stratify the preload sensitivity of 17 implantable cardiac assist devices relative to the native heart and discuss the effect of preload sensitivity on left ventricular volume unloading, levels of cardiac support, and the future development of continuous-flow total artificial heart technology.

Concepts: Blood, Cardiology, Heart, Avicenna, End-diastolic volume, Stroke volume, Artificial heart, Frank-Starling law of the heart