Additional pulmonary resections after pneumonectomy: actual long-term survival and functional results

Objective: Pulmonary resections after pneumonectomy due to metastases or metachronous non-small cell lung cancer (NSCLC) are rare because of the high potential risk of the second procedure and uncertain long-term results. On the basis of our series (largest in Europe) we tried to assess the long-term survival of patients treated in stage IV NSCLC. Methods: Retrospective analysis was carried out on 18 patients treated at our department by pneumonectomy followed by additional resection in the years 1981-2002 (15 males and 3 females, 44-69 years, mean 57). Eleven pneumonectomies were performed on the right side and seven on the left. Twelve squamous cell carcinomas and six adenocarcinomas were diagnosed. All patients were staged postoperatively as IIB-IIIA (four were N2). Their WHO status ranged between 0 and 1. The second surgical procedure (16 wedge resections, 2 chest wall resections) was performed 4-106 months later (mean 26). The patients staged N2 were radiated postoperatively. Results: There were no early postoperative deaths. The morbidity rate after second surgery was comparable to that observed after ordinary wedge resection. Histology of the lesions removed during the second operation was the same as after pneumonectomy in all patients. The pulmonary function tests (PFT) results worsened significantly but still reached 56-63% of the predicted values. Sixteen resected tumors of the remaining lung were staged T1 (<3cm), 2 - T3 (<3cm but infiltration of the parietal pleura on an area of 2-4cm(2)). Three patients revealed N2 disease (they were all N0 after pneumonectomy). All patients were considered M1 after second surgery. WHO status after the second procedure remained the same in 8 patients (44%) and worsened in 10 patients (56%). The survival rates were as follows: 11 patients survived 2 years (61%) while 8 patients survived 5 years (44%). The majority of patients died due to lung cancer (70%) but all the rest (30%) due to circulatory or respiratory insufficiency. There was a significant difference (p<0.05) in 5-year survival for N0-N1 vs N2 status (63% vs 14% - 1 patient) and also regarding the time interval between surgeries: less than 12 months vs more than 12 months (0% vs 63%). Conclusions: Pulmonary resections performed after pneumonectomy due to NSCLC are rare procedures but with an acceptable perioperative risk. The second procedure should be limited to wedge resection. The prognosis is poor for patients with N2 status and for those treated by second surgery earlier than 12 months after the first procedure.     

Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy

OBJECTIVE: Delayed gastric emptying after esophageal operations occurs in up to 50% of patients. A good quality of life, in long-term survivors after esophagectomy, may depend on both dietary adaptation and the improvement of intrathoracic gastric motility itself. The objective of this study was to investigate the effect of pyloric balloon dilatation on the sustained delay of gastric emptying after esophagectomy. METHODS: Two hundred and fifty-seven patients underwent esophagectomy with a gastric conduit from January 2003 to December 2006. A gastric drainage procedure was routinely performed during the esophagectomy. The intrathoracic gastric emptying of solid food was evaluated by radioisotope imaging. A 50% gastric emptying time over 180 min was defined as delayed. We assessed the changes of the intrathoracic gastric emptying time, and the symptoms after balloon dilatation of the pylorus, associated with delayed gastric emptying. RESULTS: Balloon dilatation of the pylorus was performed in 21 patients (8%) who had sustained symptoms of delayed gastric emptying after esophagectomy for esophageal cancer despite the use of prokinetics. The symptoms associated with delayed gastric emptying were improved after balloon dilatation of the pylorus in all patients. Pyloric balloon dilatation was performed twice in two patients. In seven of 19 patients (37%), who had a follow-up gastric emptying study, the delayed gastric emptying rate for 180 min was improved from 30% to 88%. Six patients had slightly improved results, and six patients had no increase in the rate of gastric emptying compared with the previous gastric emptying study. CONCLUSIONS: After balloon dilatation of the pylorus, two thirds of patients with delayed gastric emptying show increased rates of gastric emptying as measured by radioisotope imaging. Mechanical balloon dilatation of the pylorus is a useful method to treat sustained delay of intrathoracic gastric emptying after esophagectomy.     

Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function.

Previous studies have shown that donor hypernatremia and possibly recipient hyponatremia negatively impact graft function after orthotopic liver transplant (OLT). The purpose of this retrospective investigation was to determine whether measured differences in serum sodium values between cadaveric donors and OLT recipients (DeltaNa(+)) influence immediate postoperative allograft function and short-term patient outcomes. Two hundred and fifty patients that underwent OLT from January 2001 to December 2005 were included in this study. The DeltaNa(+) for each donor recipient pair was correlated with standard postoperative liver function tests as well as recipient length of intensive care unit stay (LOICUS), length of hospital stay (LOHS) and recipient survival. The relationship between donor hypernatremia (serum sodium >or= 155 mEq/mL), recipient hyponatremia (serum sodium level 相似文献   

Aesthetic reconstruction of lower leg defects using a new anterolateral lower leg perforator flap.

Our objective in this study was to report on the successful clinical use of a new perforator flap obtained from the proximal quarter of the anterolateral lower leg. Eight patients had the procedure either as a result of trauma (seven patients) or to treat Marjolin's ulcer (one patient). During the procedure, a line was drawn from the anterior fibular head to the anterior lateral malleolus. Then, using Doppler, a septocutaneous perforator from the fibular head to the proximal quarter point of the line was identified. The subfascial dissection was continued to the detected perforator. Along the perforator in the anterior intermuscular (peroneal) septum, a deep dissection was performed. The perforator was then separated and the flap harvested. The septocutaneous perforator was the perforator of the superficial peroneal nerve accessory artery in three cases, the perforator of the superior lateral peroneal artery in one case, and the perforator originating directly from the anterior tibial artery in four cases. Seven of eight cases were treated successfully. The results obtained were satisfactory, both aesthetically and functionally. This flap is a valuable alternative to the various perforator flaps from the lower leg. This flap has the advantage of being very thin, which makes it suitable for reconstruction of defects in the foot, ankle, pretibial area, and knee. However, one limitation of this procedure is that the diameter of the perforator was approximately 0.6-1.2 mm.     

Isola spinal instrumentation system for idiopathic scoliosis

Since the definition of three-dimensional components of the scoliotic deformity, there have been important improvements in the surgical treatment of the problem. A derotation maneuver was proposed as a treatment option with CD instrumentation, but the reports of imbalance and decompensation with this system repopularized sublaminar wiring and translation as a corrective maneuver. Isola spinal instrumentation is one of the modern systems that utilizes vertebral translation instead of rod rotation. This study analyzes the results of 24 patients with idiopathic scoliosis who had been followed up for at least 2 years, and were surgically treated with titanium Isola Spinal Instrumentation in the Department of Orthopaedics and Traumatology, Ankara Social Security Hospital. Patients were grouped according to the King-Moe classification. Patients with type III, IV or V curves received only posterior instrumentation while this procedure followed anterior release and discectomy in the same session in patients with type I or II curves. A translation maneuver was utilized in the correction of scoliotic curves using the cantilever technique, either alone or supplemented by sublaminar wiring with Songer multifilament titanium cables. This study aimed to elucidate the effects of this technique in the frontal and sagittal plane curves and the trunk balance. The balance was analyzed clinically and radiologically by measurement of the lateral trunk shift (LT), shift of stable vertebra (SS), and shift of head (SH) in vertebral units (VU). The postoperative correction was significant in the frontal plane for all types of curves (p < 0.05). The postoperative correction was 80.9% +/- 9.5% in type III curves. Overall, the mean Cobb angle of the major curve value in the frontal plane was 66.9 degrees +/- 18.8 degrees, and it was corrected by 62.8% +/- 20.1%. The correction loss of Cobb angles in the frontal plane was 5.4 degrees +/- 5.5 degrees at the last follow-up visit. A normal physiologic thoracic contour (30 degrees - 50 degrees) was achieved in 83.3% of the patients and normal lumbar contour (40 degrees - 60 degrees) in 66.7% of the patients in the sagittal plane. The correction was found to be significant in all balance values (p < 0.05). The postoperative correction in LT values correlated with the correction of the Cobb angle values in the frontal plane. All patients had complete balance (SH: 0 VU and SS: 0 VU) or balanced curves (0 VU < SH, SS < 0.5 VU).Finally, the study concluded that the translation maneuver, especially when used with the cantilever technique, resulted in high correction rates in the frontal plane. Additionally, the technique was also successful in obtaining normal sagittal contours and correcting balance values.     

Real-time PCR assay compared with antigenemia assay for detecting cytomegalovirus infection in kidney transplant recipients

Human cytomegalovirus (CMV) infection is a major cause of morbidity and mortality among kidney transplant recipients. The CMVpp65 antigenemia assay has been used for preemptive therapy. Real-time polymerase chain reaction (PCR) technology for CMV DNA quantification in blood has demonstrated a good correlation with the currently employed CMV antigenemia assay. In this study, 90 renal transplant recipients were prospectively enrolled from July 2004 and May 2005. Monitoring of CMV infection was routinely performed with CMV antigenemia and real-time PCR assays. Real-time plasma PCR and CMV antigenemia assays were assessed on 797 samples. CMV antigenemia correlated with a positive CMV PCR (chi(2) = 78.05; P < .0001). Not only the positive rate but also the number of positive cells correlated with the number of PCR DNA copies (F = 26.07, r(2) = .25, P < .0001). To define an optimal cutoff value of CMV DNA load to initiate treatment in kidney transplant patients, we considered a CMV antigenemia titer of >50 positive cells per 400,000 leukocytes as the gold standard in our previous study. The optimal cutoff value for the quantitative real-time PCR assay was predicted to be 86 copies/microL. Thus, we observed that CMV real-time PCR assay would not completely replace antigenemia assay in kidney transplant recipients, but can be used complementarily to screen antigenemia and monitor preemptive therapy.     

Left atrial approach to close the atrial septal defect type II in case of right lung agenesis with extreme dextroversion

This paper presents a case of a rare combination of right lung agenesis and atrial septal defect type II (ASD II). Successful surgical repair of ASD II was performed at the age of six years with total circulatory arrest (TCA) and deep hypothermia, because of difficult approach. Computed tomography and intraoperative findings are described. From patho-embryological consideration, defects in the primitive respiratory apparatus in embryo stages were presumably responsible for agenesis of the lung. The patient was found to have a very short stump of the right pulmonary artery, but this malformation seems to be secondary.     

Management of cervical and lumbar stenosis]

Spinal stenosis is most common in elderly patients and is defined as narrowing of the spinal canal and (or) lateral nerve root canals. The underlying processes leading to spinal stenosis are degenerative changes in facet joints and intervertebral discs and buckling of the ligamentum flavum. Spinal stenosis can occur in both the cervical and the lumbar spine. Cervical stenosis mayleat to the development of radiculopathy and (or) myelopathy. The majority of patients respond to nonoperative management. Degenerative lumbar spinal stenosis presents with back and (or) leg paints of valuing severity and duration. Nonoperative treatment associated with lumbar spinal stenosis consists of restituting and avoiding those maneuvers that reproduce pain. Surgical treatment of cervical and lumbar stenosis includes decompressive lamine ctomy, often fusion and instrumentation.     

Cemented THR in the treatment of femoral shaft fractures with coexisting osteoarthritis. The report of two cases]

The aim of the study was clinical and X-ray evaluation of two patients treated because of fractures of shaft of femur with coexisting hip joint osteoarthritis with cemented THR. Both patients were treated just after the injury. Reduction of fractures were made to both patients. Stabilization of fracture in one patient was made with metal plate and cables, stabilization with only cables was made to second patient. Exeter THR with standard stem was implanted to first patient, and with long stem to the second one. Both patients have good clinical results - 90 and 92 pts. in Harris Hip Score after 36 and 48 months accordingly. The fracture healed in the first patient. The evidence of fracture healing of the second patient was impossible to examine because of lack of X-ray. Conclusions. 1) The use of THR in the treatment of femoral shaft fractures with coexisting osteoarthritis gives a chance of simultaneous fracture treatment and joint replacement. 2) Fracture stabilization requires the use of metal plates and cables.     

Avantage double mobility press--fit cup in total hip arthroplasty]

The Avantage double mobility press-fit cup was devised by Dr. Bousquet in the 70's to bring reasonable response to a problem of recurrent dislocation after total hip arthroplasty. The cup is attached to the femoral head by a bipolar polyethylene liner. The polyethylene liner moves freely inside a shiny--polished metal cup. The angular range of motion before impingement is increased by the mobility of the liner. The double connection (cup-liner, liner-head) reduces the stress on the metal cup and improve the stability of the prosthesis. The solution has proved to be efficient in reducing dislocation risk and maintains at the same time the appropriate range of motion. Between January 2004 and November 2005, 113 hip arthroplasties in 108 women with use of the double mobility cup were performed. The cemented version of the Avantage cup was inserted in 15 patients (mean age--76.9 years). Uncemented, HA coated implant was used in 98 patients (with mean age of 55 years). The mean follow-up was 20.4 months. No one patient was lost to follow-up. No postoperative dislocation was observed during follow-up. There was no unwanted leg lengthening greater than 1 cm. The Avantage cup may be indicated in any primary total hip arthroplasty especially in those with increased risk of postoperative dislocations. This cup enables a correct balance of the hip without a need of the unwanted lengthening of the leg.