The influence of open-heart surgery on survival of patients with co-existent surgically amenable lung cancer (stages I and II)

Objective: The evaluation of the influence of open-heart surgery on the survival of patients with co-existent surgically amenable lung cancer stages I and II. Methods: A retrospective, observational study was conducted in a tertiary centre for cardiothoracic surgery. From 1988 to 1995, 121 consecutive patients underwent pulmonary resection for stages I–II primary non-small cell bronchogenic carcinoma. Eighty seven of them had merely a lung carcinoma necessitating resection, 34 had in addition defined coronary-artery disease and consequently were also subjected to open-heart surgery. Results were statistically computed. Results: Follow-up was complete in 117/121 patients, 96.7% (83/87, 95.4% and 34/34, 100% in respective groups). Both groups were matched with regard to preoperative features possibly influencing survival. Median long term survival time was 4.3 years overall, 5.8 years for patients merely undergoing lung resection and 4.2 years for them undergoing open-heart surgery as well; this difference was not statistically significant (log-rank test: χ² 0.92, df=1, P=0.34), indicating no or limited influence of open-heart surgery on survival of patients with surgically amenable co-existent lung carcinoma. No relationship was found between survival and age, tumour stage, and histopathology. However, metastatic disease as cause of death was significantly increased in patients undergoing open-heart surgery (5/8 vs. 10/33, P=0.0898), indicating a possible promotion of metastatic spread of co-existent lung carcinoma by this procedure. Overall perioperative mortality rate was 10/121, 8.3%, for the greater part the result of a relatively high mortality rate in the group of patients undergoing heart as well as lung surgery (6/34, 17.6%), underscoring the great risks involved in these patients, the mortality rate for lung resection alone being comparably low 4/87, 4.6% (P=0.0191). Conclusion: Open-heart surgery for defined coronary-artery disease in patients with surgically amenable lung carcinoma carries a substantially higher perioperative risk, but has no influence on long term results. Metastatic spread is possibly promoted by open-heart surgery. Optimal treatment, consisting of complete revascularization and appropriate lung resection, is therefore sufficiently justified by these results.     

The value of 201thallium-SPECT imaging in childhood brainstem gliomas

Objective. To compare ²⁰¹thallium (T1) uptake and SPECT with MRI in children with brainstem gliomas. Materials and methods. Ten children with brainstem gliomas were prospectively evaluated by ²⁰¹Tl-SPECT and MRI. Histological verification was obtained in eight children – two died prior to surgery. Quantitative thallium uptake index (UI) was obtainable in five cases and was compared to tumour grade. In addition, two patients with known benign brainstem lesions (neurofibromatosis and tuberculoma) were similarly prospectively evaluated. Results. All children with brainstem glioma accumulated thallium. (Mean U1 3.23, 100 % sensitivity). The single patient with brainstem tuberculoma also accumulated thallium (UI 2.80, 91.7 % specificity). There was no correlation between thallium uptake and tumour grade. Uptake could not be conclusively correlated with the following MR features: gadolinium enhancement, exophytic or intrinsic gliomas, necrosis and location of glioma within the brainstem. Conclusions. ²⁰¹Tl-SPECT is a promising imaging adjunct in the assessment of childhood brainstem gliomas. Received: 23 May 1997 Accepted: 16 January 1998     

A gestation- and postnatal age-based reference chart for assessing renal function in extremely premature infants

OBJECTIVE: A single value of plasma creatinine cannot be used to define renal dysfunction in premature babies, as levels are influenced by gestation and postnatal age. The aim of this study was to create reference ranges for plasma creatinine in cohort of extremely premature infants. STUDY DESIGN: Retrospective analysis of plasma creatinine levels in the first 8 weeks of life from 161 consecutively admitted premature infants 28 weeks gestation. RESULT: Babies were divided into three groups according to gestation. Peak (10th, 90th percentiles) creatinine levels were 132 (106,162) in 22 to 24 weeks gestational infants, 127 (89,151) in those from 25 to 26 weeks and 110 (87,134) in those from 27 to 28 weeks (P<0.001). Creatinine at birth was similar across the groups with levels increasing during the first few days. It decreases thereafter before reaching stable levels by 5 weeks of age. CONCLUSION: Gestation- and age-based reference charts should be used for interpretation of creatinine values in extremely premature babies.     

Prevalence and risk factors for diabetic neuropathy and painful diabetic neuropathy in primary and secondary healthcare in Qatar

Aims/IntroductionThis study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN) and painful DPN (pDPN) in patients with type 2 diabetes in primary healthcare (PHC) and secondary healthcare (SHC) in Qatar.Materials and MethodsThis was a cross‐sectional multicenter study. Adults with type 2 diabetes were randomly enrolled from four PHC centers and two diabetes centers in SHC in Qatar. Participants underwent assessment of clinical and metabolic parameters, DPN and pDPN.ResultsA total of 1,386 individuals with type 2 diabetes (297 from PHC and 1,089 from SHC) were recruited. The prevalence of DPN (14.8% vs 23.9%, P = 0.001) and pDPN (18.1% vs 37.5%, P < 0.0001) was significantly lower in PHC compared with SHC, whereas those with DPN at high risk for diabetic foot ulceration (31.8% vs 40.0%, P = 0.3) was comparable. The prevalence of undiagnosed DPN (79.5% vs 82.3%, P = 0.66) was comparably high, but undiagnosed pDPN (24.1% vs 71.5%, P < 0.0001) was lower in PHC compared with SHC. The odds of DPN and pDPN increased with age and diabetes duration, and DPN increased with poor glycemic control, hyperlipidemia and hypertension, whereas pDPN increased with obesity and reduced physical activity.ConclusionsThe prevalence of DPN and pDPN in type 2 diabetes is lower in PHC compared with SHC, and is attributed to overall better control of risk factors and referral bias due to patients with poorly managed complications being referred to SHC. However, approximately 80% of patients had not been previously diagnosed with DPN in PHC and SHC. Furthermore, we identified a number of modifiable risk factors for PDN and pDPN.     

The untold story of Dabigatran etexilate: alveolar hemorrhage in an elderly patient with interstitial pulmonary fibrosis

We report an 85-year-old male, with history of interstitial pulmonary fibrosis (IPF), who was presented with progressive dyspnea, hypoxia, and anemia of 2 months duration. Six months before presentation, the patient was placed on Dabigatran etexilate (Dabigatran) (110 mg BID) for atrial fibrillation. His prior anemia workup included a negative upper endoscopy and colonoscopy. Bronchoscopy revealed copious amounts of bloody secretions. The bronchial tree was washed and Dabigatran was discontinued. The patient’s medical condition improved and was subsequently discharged home. Our case illustrates the failure of current literature to predict the isolated bronchoalveolar bleed secondary to Dabigatran therapy.