Factors associated with cardiac rhythm disturbances in the early post-pneumonectomy period: a study on 259 pneumonectomies.

OBJECTIVE: To identify predisposing factors associated with cardiac rhythm disturbances during the early post-pneumonectomy period (first 7 postoperative days). MATERIALS AND METHODS: During the study period (1995-1999), 259 pneumonectomies were performed for malignant (244 cases) or benign disease (15 cases). Postoperative monitoring of patients included continuous arterial pressure - rhythm monitoring and pulse oximetry. Cardiac rhythm disturbances during the intensive care unit stay were detected on the monitor screen and recorded with a 12-lead electrocardiogram. Cardiac rhythm disturbances associated with electrolytes or fluid balance abnormality, mediastinal deviation or surgical postoperative complications were excluded from the study. Age of patients, preexisting cardiac disease, side of pneumonectomy, intrapericardial procedures, stage of the malignant disease, expected postoperative FEV(1)<1200 ml, intraoperative transfusions of packed red cells, elevated right heart pressures, low postoperative serum magnesium levels and long operative times were considered as predisposing factors for the development of post-pneumonectomy cardiac rhythm disturbances. Statistical analysis has been made using logistic regression analysis, Student t-test and chi-square test. RESULTS: Cardiac rhythm disturbances were detected in 49 patients (18.91%). Atrial fibrillation/flutter (31 cases), supraventricular tachycardia (14 cases), and premature ventricular contractions (four cases) were the observed rhythm disturbances. Right pneumonectomy versus left pneumonectomy (P<0.0001) and intrapericardial pneumonectomy versus standard pneumonectomy (P<0.0001) were identified as strong predisposing factors for the establishment of post-pneumonectomy cardiac rhythm disturbances. Patients who established post-pneumonectomy cardiac rhythm disturbances had significantly higher (P=0.024) right ventricular systolic pressure (42.50+/-15.50 mmHg) when compared with patients who had postoperative sinus rhythm (29.07+/-7.71 mmHg) and had also longer operative times than patients who did not develop rhythm disturbances (P=0.015). Mortality rate in patients who developed post-pneumonectomy rhythm disturbances was 20.40%. CONCLUSIONS: Cardiac rhythm disturbances observed early after pneumonectomy are mainly of supraventricular origin, complicating right and intrapericardial pneumonectomies, patients with elevated right heart pressures and long operative times, and are associated with high mortality rates.     

Chest wall hydatidosis as the unique location of the disease: Case report and review of the literature.

The chest wall is a rare location of secondary hydatidosis, but secondary hydatidosis may occur from the rupture of a lung cyst, from a liver cyst invading the diaphragm into the pleural cavity, following previous thoracic surgery for hydatidosis, or by hematogenous spread. This report describes a case of chest wall hydatidosis, which was the primary disease site in the patient, who had no previous history or current disease (hydatidosis) at other sites. The cyst invaded and partially destroyed the 9th and 10th ribs and the 10th thoracic vertebra, and protruded outside the pleural cavity through the 9th intercostal space. Preoperative albendazole administration for 10 days, surgical resection of the disease through a posterolateral thoracotomy incision, and postoperative albendazole treatment resulted in a cure with no evidence of local recurrence or disease at other sites in four years of follow-up.     

Pericardial patch repair of an extensive longitudinal iatrogenic rupture of the intrathoracic membranous trachea

An iatrogenic, longitudinal rupture of the membranous trachea, which extended from the thoracic inlet to 2.0 cm above the carina, was found intra-operatively, during the thoracic stage of a three-stage esophagectomy, in a female, 80-year-old patient. Tracheal rupture was the result of tracheal intubation with a 35-F double-lumen endotracheal tube. Tracheal rupture was successfully repaired by suturing a free pericardial patch at the edges of tracheal rupture, by application of BioGlue on the external patch surface and by covering tracheal repair with a pedicled serratus anterior muscle flap. The patient had a 25-day intensive care unit stay and video-bronchoscopy performed at the 25th postoperative day showed absence of granulation tissue formation and an acceptable tracheal lumen. The overall hospital stay was 83 days because of abdominal complications; no problems concerning the tracheal repair were observed during the prolonged postoperative period.     

High-resolution CT findings in mild pulmonary fat embolism

OBJECTIVE: The aim of this article is to describe the high-resolution CT (HRCT) findings in mild cases of fat embolism syndrome (FES). MATERIAL AND METHODS: Nine patients with FES were examined with HRCT of the lungs (collimation, 1 mm/edge-enhancement algorithm). The median age of the patients was 26 years (range, 17 to 35 years). Five cases were included prospectively, and four cases were reviewed retrospectively. Of the major clinical criteria for FES, respiratory signs were present in six patients, CNS signs were present in two patients, and petechiae was present in six patients. HRCT patterns were recorded and analyzed. The type of injury and FES-associated clinical findings were also recorded. RESULTS: HRCT findings included ground-glass opacities in seven patients, associated with thickened interlobular septa in five patients and a patchy distribution resulting in a geographic appearance in four patients. A nodular pattern was observed in two patients. Resolution of the abnormalities occurred within 16.4 days (range, 7 to 25 days). CONCLUSION: The HRCT findings of mild fat embolism consist of bilateral ground-glass opacities and thickening of the interlobular septa. Centrilobular nodular opacities are present in some patients.     

Cyanobacterial Toxins and Peptides in Lake Vegoritis,Greece

Cyanotoxins (CTs) produced by cyanobacteria in surface freshwater are a major threat for public health and aquatic ecosystems. Cyanobacteria can also produce a wide variety of other understudied bioactive metabolites such as oligopeptides microginins (MGs), aeruginosins (AERs), aeruginosamides (AEGs) and anabaenopeptins (APs). This study reports on the co-occurrence of CTs and cyanopeptides (CPs) in Lake Vegoritis, Greece and presents their variant-specific profiles obtained during 3-years of monitoring (2018–2020). Fifteen CTs (cylindrospermopsin (CYN), anatoxin (ATX), nodularin (NOD), and 12 microcystins (MCs)) and ten CPs (3 APs, 4 MGs, 2 AERs and aeruginosamide (AEG A)) were targeted using an extended and validated LC-MS/MS protocol for the simultaneous determination of multi-class CTs and CPs. Results showed the presence of MCs (MC-LR, MC-RR, MC-YR, dmMC-LR, dmMC-RR, MC-HtyR, and MC-HilR) and CYN at concentrations of <1 μg/L, with MC-LR (79%) and CYN (71%) being the most frequently occurring. Anabaenopeptins B (AP B) and F (AP F) were detected in almost all samples and microginin T1 (MG T1) was the most abundant CP, reaching 47.0 μg/L. This is the first report of the co-occurrence of CTs and CPs in Lake Vegoritis, which is used for irrigation, fishing and recreational activities. The findings support the need for further investigations of the occurrence of CTs and the less studied cyanobacterial metabolites in lakes, to promote risk assessment with relevance to human exposure.