Showing papers by "Glenfield Hospital published in 2008"
TL;DR: Cluster analysis offers a novel multidimensional approach for identifying asthma phenotypes that exhibit differences in clinical response to treatment algorithms, and is specific to refractory asthma.
Abstract: Rationale: Heterogeneity in asthma expression is multidimensional, including variability in clinical, physiologic, and pathologic parameters. Classification requires consideration of these disparate domains in a unified model.Objectives: To explore the application of a multivariate mathematical technique, k-means cluster analysis, for identifying distinct phenotypic groups.Methods: We performed k-means cluster analysis in three independent asthma populations. Clusters of a population managed in primary care (n = 184) with predominantly mild to moderate disease, were compared with a refractory asthma population managed in secondary care (n = 187). We then compared differences in asthma outcomes (exacerbation frequency and change in corticosteroid dose at 12 mo) between clusters in a third population of 68 subjects with predominantly refractory asthma, clustered at entry into a randomized trial comparing a strategy of minimizing eosinophilic inflammation (inflammation-guided strategy) with standard care.Mea...
1,515 citations
TL;DR: Breathing training resulted in improvements in asthma-specific health status and other patient-centred measures but not in asthma pathophysiology, and such exercises may help patients whose quality of life is impaired by asthma, but they are unlikely to reduce the need for anti-inflammatory medication.
Abstract: Background: The effect of breathing modification techniques on asthma symptoms and objective disease control is uncertain. Methods: A prospective, parallel group, single-blind, randomised controlled trial comparing breathing training with asthma education (to control for non-specific effects of clinician attention) was performed. Subjects with asthma with impaired health status managed in primary care were randomised to receive three sessions of either physiotherapist-supervised breathing training (n = 94) or asthma nurse-delivered asthma education (n = 89). The main outcome was Asthma Quality of Life Questionnaire (AQLQ) score, with secondary outcomes including spirometry, bronchial hyper-responsiveness, exhaled nitric oxide, induced sputum eosinophil count and Asthma Control Questionnaire (ACQ), Hospital Anxiety and Depression (HAD) and hyperventilation (Nijmegen) questionnaire scores. Results: One month after the intervention there were similar improvements in AQLQ scores from baseline in both groups but at 6 months there was a significant between-group difference favouring breathing training (0.38 units, 95% CI 0.08 to 0.68). At the 6-month assessment there were significant between-group differences favouring breathing training in HAD anxiety (1.1, 95% CI 0.2 to 1.9), HAD depression (0.8, 95% CI 0.1 to 1.4) and Nijmegen (3.2, 95% CI 1.0 to 5.4) scores, with trends to improved ACQ (0.2, 95% CI 0.0 to 0.4). No significant between-group differences were seen at 1 month. Breathing training was not associated with significant changes in airways physiology, inflammation or hyper-responsiveness. Conclusion: Breathing training resulted in improvements in asthma-specific health status and other patient-centred measures but not in asthma pathophysiology. Such exercises may help patients whose quality of life is impaired by asthma, but they are unlikely to reduce the need for anti-inflammatory medication.
135 citations
TL;DR: It is indicated, for the first time, that ACTC 1 mutations or reduced ACTC1 levels may lead to ASD without signs of cardiomyopathy.
Abstract: Atrial septal defect (ASD) is one of the most frequent congenital heart defects (CHDs) with a variable phenotypic effect depending on the size of the septal shunt. We identified two pedigrees comprising 20 members segregating isolated autosomal dominant secundum ASD. By genetic mapping, we identified the gene-encoding alpha-cardiac actin (ACTC1), which is essential for cardiac contraction, as the likely candidate. A mutation screen of the coding regions of ACTC1 revealed a founder mutation predicting an M123V substitution in affected individuals of both pedigrees. Functional analysis of ACTC1 with an M123V substitution shows a reduced affinity for myosin, but with retained actomyosin motor properties. We also screened 408 sporadic patients with CHDs and identified a case with ASD and a 17-bp deletion in ACTC1 predicting a non-functional protein. Morpholino (MO) knockdown of ACTC1 in chick embryos produces delayed looping and reduced atrial septa, supporting a developmental role for this protein. The combined results indicate, for the first time, that ACTC1 mutations or reduced ACTC1 levels may lead to ASD without signs of cardiomyopathy.
132 citations
TL;DR: Injection of autologous BMCs directly into the scar or into the artery supplying the scar is safe but does not improve contractility of nonviable scarred myocardium, reduce scar size, or improve left ventricular function more than CABG alone.
Abstract: Background Studies of the transplantation of autologous bone marrow cells (BMCs) in patients with chronic ischemic heart disease have assessed effects on viable, peri-infarct tissue. We conducted a single-blinded, randomized, controlled study to investigate whether intramuscular or intracoronary administration of BMCs into nonviable scarred myocardium during CABG improves contractile function of scar segments compared with CABG alone. Methods Elective CABG patients (n = 63), with established myocardial scars diagnosed as akinetic or dyskinetic segments by dobutamine stress echocardiography and confirmed at surgery, were randomly assigned CABG alone (control) or CABG with intramuscular or intracoronary administration of BMCs. The BMCs, which were obtained at the time of surgery, were injected into the mid-depth of the scar in the intramuscular group or via the graft conduit supplying the scar in the intracoronary group. Contractile function was assessed in scar segments by dobutamine stress echocardiography before and 6 months after treatment.
104 citations
TL;DR: The findings support an association betweenAirways disease and inflammatory bowel disease, particularly non-asthmatic airways disease with productive cough, and the association was particularly strong for conditions associated withproductive cough.
67 citations
TL;DR: If a patient with epithelioid MPM is fit enough to tolerate a thoracotomy then macroscopic clearance of the tumour is the preferred option as part of a multimodality regime including chemotherapy.
Abstract: Objective: To identify the optimal debulking procedure in patients with malignant pleural mesothelioma who are not suitable for extrapleural pneumonectomy (EPP). Methods: We reviewed 102 consecutive patients (93 male; 9 female, mean age 63 years) who were not suitable for EPP because of either advanced tumour stage or suboptimal fitness. Patients underwent either a non-radical tumour decortication to obtain lung expansion (group NR) or latterly a radical pleurectomy/decortication to obtain macroscopic tumour clearance (group R). We analysed the comparative perioperative courses and long-term survival. Results: The two groups were similar for age and gender distribution but epithelioid type was morepredominant in group R: 78% compared to 55% epithelioid in group NR. Thirty-day mortality was similar(5.9% in group R and 9.8% in the group NR,p = 0.36) but 90-daymortality wassignificantlyhigher in the group NR (29.4% vs9.8% in group R,p = 0.012). More patientsin group R received adjuvant chemotherapy (65% vs 28%, p = 0.000) and radiotherapy (65% vs 26%, p = 0.000). Median survival for all cell types was significantly higher in group R (15.3 months vs 7.1 months, p < 0.000). Group R survival rates at 1, 2, 3 and 4 years were 53, 41, 25 and 13%, respectively while for group NR they were 32, 9.6, 2 and 0%, respectively. For epithelioid cell type there was still a significant median survival advantage in group R (25.4 months vs 10.2 months, p < 0.000), but there was no difference for sarcomatoid (9.3 months vs 3.2 months, p = 0.16) or biphasic cell types (9.4 months vs 7 months, p = 0.38). Conclusion: If a patient with epithelioid MPM is fit enough to tolerate a thoracotomy then macroscopic clearance of the tumour is the preferred option as part of a multimodality regime including chemotherapy. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
65 citations
TL;DR: V VATS decortication should be considered in the therapeutic strategy for MPM, based on perioperative morbidity and mortality and long-term survival data.
Abstract: Objective: Extrapleural pneumonectomy (EPP) has high mortality and morbidity; radical pleurectomy decortication (P/D) carries less mortality but still significant morbidity. This surgery is not suitable for many patients with malignant pleural mesothelioma (MPM) for whom video assisted thoracic surgery (VATS) offers a minimally invasive alternative. We aimed to assess the role of VATS decortication for MPM. Methods: Over a 9-year period 208 patients underwent therapeutic surgery for MPM in our unit. One hundred and twelve of the patients underwent EPP, 29 had a P/D and 67 had VATS decortication. Sixty-three of the 208 patients (EPP n = 13, P/D n = 8 and VATS decortication n = 42) were 65 years of age or older at the time of the operation (57 males and 6 females, age 70 (65—80) years). In this group we analyzed perioperative morbidity and mortality and long-term survival data using the Kaplan—Meier method. Results: Postoperative stay and 30-day mortality was significantly lower for VATS P/D than for EPP (14.3 days vs 36.6 days, p < 0.05 and mortality 7.1% vs 23%, respectively). There was no significant difference in the overall mean survival between the two groups (11.5 months for EPP and 14 months for VATS P/D, p = 0.6). Conclusion: VATS decortication should be considered in the therapeutic strategy for MPM. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
65 citations
TL;DR: The use of prone ventilation is associated with improved oxygenation and may be associated with an increased incidence of pressure sores, which is not associated with a reduction in mortality, pneumonia, or ICU stay.
55 citations
TL;DR: It is suggested that bronchopulmonary hygiene physical therapy can lead to a significant improvement in cough-related quality of life.
44 citations
TL;DR: It is suggested that it is possible to evaluate non-technical skills in operating theatre teams, but further work is needed to improve the reliability and accuracy of the measurement methods.
Abstract: We examined the measurement of non-technical skills for surgical teams using a framework derived from aviation. Twenty four paediatric cardiac surgical and 20 orthopaedic operations were studied by a single observer. Predefined intraoperative failures were recorded, from which it was possible to derive measures of technical errors, threats, and non-technical errors (NTEs). A second non-technical scoring (NTS) method was used which required the observer to give a score from 1 to 4 on the four dimensions of the scale for three stages of each operation. There was a significant positive relationship between NTEs and operative duration in orthopaedic surgery (p < 0.01). In paediatric cardiac surgery, the ranked NTS measures correlated positively with the number of threats (p < 0.005) and with operative duration (p < 0.005). Non-technical skills measures (ranked NTS and NTEs) were also significantly positively correlated (p < 0.01). This suggests that it is possible to evaluate non-technical skills in operating theatre teams, but further work is needed to improve the reliability and accuracy of the measurement methods.
40 citations
TL;DR: This study aims to study the feasibility and efficacy of video‐assisted thoracoscopic placement of the left ventricular pacing lead for cardiac resynchronization therapy (CRT) where the conventional transvenous coronary sinus approach has failed.
Abstract: Background: To study the feasibility and efficacy of video-assisted thoracoscopic (VAT) placement of the left ventricular pacing lead for cardiac resynchronization therapy (CRT) where the conventional transvenous coronary sinus approach has failed.
Methods: Seventeen patients underwent the VAT procedure. Indications for CRT were ischemic cardiomyopathy in six patients and nonischemic cardiomyopathy in 11. The procedure was performed under general anesthesia with single-lung ventilation. Three 2-cm incisions were used on the left chest wall to place the screw-in lead near the obtuse marginal arteries high on the lateral wall of the left ventricle (LV).
Results: The VATS approach was successful in 13/17 (76%) patients. Median procedure time was 75 minutes (range 55–135). A learning curve was observed that appeared to plateau at 75 minutes procedure time after four cases. Median length of hospital stay was 2 days (range 2–8) with one patient requiring intensive care. Satisfactory thresholds and impedances of 2.3 ± 0.9 V/0.5 ms and 560 ohms, respectively, were achieved at mean follow-up of 226 days. All patients reported symptomatic benefit with reduction in New York Heart Association score from III preoperatively to II postoperatively.
Conclusions: VAT placement of the epicardial pacing lead is feasible, safe, and efficacious. It should be considered in cases where the transvenous route has failed or as an alternative in prolonged or hazardous transvenous procedures.
TL;DR: This case report describes two sisters that experienced eruption failure in the permanent dentition, most notably of the first and second molars, with greater severity in the younger sister.
Abstract: Primary failure of eruption is a condition where there is eruption failure in the permanent dentition with no obvious mechanical cause. It has previously been reported in the literature as a cause of posterior openbite, with a varying degree of familial inheritance. This case report describes two sisters that experienced eruption failure in the permanent dentition, most notably of the first and second molars, with greater severity in the younger sister. Teeth were exposed in both patients and orthodontic traction was applied with little or no success. The report provides further evidence of the genetic contribution to the aetiology of this condition and also highlights the problems in attempting treatment, including exposing to the oral environment teeth that are infra-occluded and difficult to clean effectively.
TL;DR: It is suggested that eosinophil growth factors are likely to be required for eos inophil migration within the bronchial mucosa, and this involves signal transduction pathways distinct from those used by G protein-associated chemoattractants.
Abstract: Asthma is a common disease that causes considerable morbidity. Increased numbers of airway eosinophils are a hallmark of asthma. Mechanisms controlling the entry of eosinophils into asthmatic lung have been intensively investigated, but factors regulating migration within the tissue microenvironment are less well understood. We modeled this by studying chemoattractant and growth factor-mediated human eosinophil migration within a three-dimensional collagen matrix. Stimulation with GM-CSF induced dose-dependent, random migration with a maximum of 77 +/- 4.7% of cells migrating. In contrast, CCL11 and C5a caused a more modest although significant degree of migration (19 +/- 1.8% and 20 +/- 2.6%, respectively). Migration to GM-CSF was partially dependent on Ca(2+) and alpha(M)beta(2) integrins. The Rho family of small GTPases regulates intracellular signaling of cell migration. GM-CSF-induced migration was only partially dependent on Rho kinase/Rho-associated kinase (ROCK) and was independent of RhoA activation. In contrast, CCL11-induced migration was fully dependent on both RhoA and ROCK. Activation of RhoA was therefore neither necessary nor sufficient to cause eosinophil migration in a three-dimensional collagen environment. This study suggests that eosinophil growth factors are likely to be required for eosinophil migration within the bronchial mucosa, and this involves signal transduction pathways distinct from those used by G protein-associated chemoattractants.
TL;DR: Practical implications from this study are that grip endurance training can be undertaken with the elbow in 90° of flexion or full extension, and no statistical significance was found for elbow positions for grip endurance and peak gip strength.
Abstract: Background
The aim of our study was twofold The first was to investigate the optimum position of the elbow while measuring grip endurance The second was to investigate the optimum position of the elbow while measuring peak grip strength The American Society of Hand Therapists advocate estimation of grip strength with the elbow flexed at 90° with the subject in the sitting position As far as we are aware, there have been no reports in English literature regarding studies done to evaluate the position of the elbow while measuring grip endurance
TL;DR: In this review, essential background information on the use of FENO in clinical practice is outlined and some recent work evaluating the clinical value of this technique is discussed.
Abstract: It has recently become clear that airways disease associated with eosinophilic airway inflammation, but not other patterns of inflammation, is closely associated with favourable short-and long-term responses to corticosteroid therapy, irrespective of the clinical context in which it occurs. Moreover, a raised exhaled nitric oxide (FE(NO)) is a reasonable marker of eosinophilic airway inflammation, which has a number of advantages as a diagnostic and monitoring tool. In this review we outline essential background information on the use of FE(NO) in clinical practice and discuss some recent work evaluating the clinical value of this technique.
TL;DR: A paediatric patient who developed fatal thrombosis with the use of rFVIIa whilst on extracorporeal membrane oxygenation is reported and the possible factors that lead to fatal thROMbosis are discussed.
Abstract: Bleeding remains a potential complication for patients requiring extracorporeal life support systems. Recombinant activated factor VII (rFVIIa) is one of the drugs used in controlling bleeding. Its use is generally found to be safe. We report a paediatric patient who developed fatal thrombosis with the use of rFVIIa whilst on extracorporeal membrane oxygenation and discuss the possible factors that lead to fatal thrombosis.
TL;DR: A new technique combining these objectives via a single cervical incision using the videomediastinoscope is presented and its clinical benefits include reduction in postoperative pain, risk of biopsy site tumour seeding, and preoperative delay to radical surgery.
Abstract: Objectives: In the preoperative workup for radical surgery for malignant pleural mesothelioma (MPM), mediastinal lymph node staging, diagnostic pleural biopsies and effusion control with talc pleurodesis are required. We present a new technique combining these objectives via a single cervical incision using the videomediastinoscope and demonstrate its clinical benefits. Methods: Video-assisted cervical thoracoscopy (VACT) was attempted in 15 patients (13 male, mean age 57 years), who were potential candidates for radical surgery. Following conventional cervical videomediastinoscopy, a 5 mm thoracoscope was advanced into the relevant pleural cavity through the mediastinoscope via a mediastinal pleurotomy. Pleural biopsies were taken followed by talc insufflation and cervical tube drainage. The clinical outcome was compared with 26 patients undergoing a staged preoperative workup during the same period.Results:VACTwas successful in 10 patients (66.6%). Infive patients (three right and two left), thoracoscopy was abandoneddue to excessive mediastinal fat (1), thick pleura (2) and inabilityto enter the left hemithorax (2). Mean operative time was 71 (65—90) min and hospital stay 4 (3—7) days. One patient suffered recurrent laryngeal nerve palsy and one had persistent air leak. Ten patients subsequently underwent radical surgery. Time to radical surgery was significantly reduced by nearly 2 months in VACT patients (28 17 days vs 87 56 days, p < 0.001). Conclusions: The benefits of this approach include reduction in postoperative pain, risk of biopsy site tumour seeding, and preoperative delay to radical surgery. VACTis feasible in right-sided mesothelioma but has not yet been validated on the left. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
TL;DR: Assessment of graded prevalence of corneal arcus with age for 81 males and 73 females suffering from heterozygous familial hypercholesterolaemia at presentation and for 280 male and 353 female unselected patients attending a country general practice found premature arcus potentially alerting to HFH to be broadly defined.
Abstract: Premature corneal arcus may identify individuals with hyperlipidaemia and increased cardiovascular risk. We have attempted to quantitate relationships through determination of graded prevalence of corneal arcus with age for 81 males and 73 females suffering from heterozygous familial hypercholesterolaemia (HFH) at presentation, and for 280 male and 353 female unselected patients (age range 16 76 years) attending a country general practice. Some degree of arcus affected 50% of HFH patients by age 31-35 years, and 50% of practice patients by age 41-45 years. Complete full ring arcus affected 50% of the familial hypercholesterolaemia (FH) group by age 50 years, with only 5° similarly affected in the non-FH group. Arcus grade with age was advanced by some 5 years in males versus females, Premature arcus potentially alerting to HFH can be broadly defined for males and females combined, as heavy full ring by age 50 years, or any degree of arcus by age 30 35 years, Arcus grade was not related to the presence of coronary disease. Accelerated development of corneal arcus with age is an indicator of HFH, but premature arcus is not an additional marker of premature coronary disease for individual cases of HFH.
01 May 2008
TL;DR: An automated system is proposed for preventing over-tightening of pre-tapped and self-tapping screws when attaching a surgical plate to a sheep tibia in vitro.
Abstract: The use of power screwdrivers and drills for tapping and screw insertion in surgery is becoming more common. It has been established from clinical observations that the use of a small air drill for inserting self-tapping screws provides improved coaxial alignment and precision, and that the drill should be stopped before the screw head is completely seated on the plate, presumably to reduce the risk of over-tightening. The risk of overrun and over-tightening during tapping and screw insertion is increased with the use of power tools. Prevention of over-tightening is dependent upon when the surgeon detects the onset of tightening, both visually and from the feel of the rapid increase in torque. If detection is too late, then over-tightening or stripping can occur. This study is concerned with using a mechatronic screwdriver to control the tapping depth and to prevent the over-tightening of screws. The effects of various parameters upon the torque profile during tapping and screw insertion have been investigated in synthetic bone and sheep tibia. An automated system is proposed for preventing over-tightening of pre-tapped and self-tapping screws when attaching a surgical plate to a sheep tibia in vitro. The system was used to attach a plate to a sheep tibia using self-tapping screws. The mean torque of the screws inserted using the automated system was 35 per cent of the stripping torque.
TL;DR: The plasma ammonia response to exercise in chronic obstructive pulmonary disease was examined and the relationship between plasma ammonia concentration and muscle adenine nucleotide metabolism was explored, and ammonia change with incremental and constant-work rate exercise strongly correlated in COPD subjects.
Abstract: The plasma ammonia response to exercise in chronic obstructive pulmonary disease (COPD) was examined and the relationship between plasma ammonia concentration and muscle adenine nucleotide metabolism was explored. In total, 25 stable COPD patients and 13 similar-aged controls underwent incremental and constant-work rate cycle exercise tests. Arterialised venous blood was sampled at rest, at 1-min intervals during exercise and
TL;DR: From diagnosis to response, PET/CT to molecular bioprobes, volumetric analysis to computerized tumor assessment, imaging promises to provide valuable insight for patients with mesothelioma and the physicians who treat them.
TL;DR: It is concluded that the cribriform Amplatzer device can be successfully and safely used in patients with F-ASDs and may take up to 6 months to complete closure.
Abstract: Fenestrated atrial septal defects (F-ASDs) may pose a challenge to device closure; recently, a cribriform device with a minimal connecting intrawaist diameter and large, equal left- and right-sided discs has been designed to cover more than one adjacent defect This study demonstrates the feasibility and technical aspects of closing F-ASDs using this new device Sixteen patients between August 2003 and January 2006 were included in this study The inclusion criterion was the presence of a F-ASD diagnosed by transesophageal echocardiography One of the three available cribriform ASD device sizes (18, 25, or 35 mm) was implanted Patients were followed for at least 1 year after the procedure Thirteen patients had successful cribriform ASD device implantation (median age and weight, 125 years and 36 kg, respectively) Ten patients (62%) had an associated atrial septal aneurysm The mean procedure time was 756 +/- 285 min and the mean fluoroscopy time 148 +/- 63 min The RVEDD was significantly reduced, from a mean of 242 mm to 210 (p < 005) One patient developed atrial tachycardia requiring cardioversion during the procedure There were no embolic events, heart block, or mortality Complete closure was 10 of 13 (77 %) the next day and 12 of 13 (92%) at 6 and 12 months We conclude that the cribriform Amplatzer device can be successfully and safely used in patients with F-ASDs Complete closure may take up to 6 months
TL;DR: The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost -utility over a predicted lifetime.
Abstract: Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis. Given the high cost of treatment, ECMO is considered an expensive technology for many funding systems. However, conventional treatment for severe respiratory failure is also one of the more costly forms of care in any health system. The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost-utility over a predicted lifetime. Resources used by patients in the trial are identified. Resource use data are collected from clinical report forms and through follow up interviews with patients. Unit costs of hospital intensive care resources are based on parallel research on cost functions in UK NHS intensive care units. Other unit costs are based on published NHS tariffs. Cost effectiveness analysis uses the outcome: survival without severe disability. Cost utility analysis is based on quality adjusted life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity analysis is planned to vary assumptions about transport costs and method of costing intensive care. Uncertainty will also be expressed in analysis of individual patient data. Probabilities of cost effectiveness given different funding thresholds will be estimated. In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain. The CESAR trial registration number is ISRCTN47279827.
TL;DR: Although the role of exercise training is well established, the authors are only just beginning to appreciate the importance of behavior change and patient self-management in contributing to improved health and diminished healthcare resource utilisation.
TL;DR: It is demonstrated that, following a learning curve of “optimal cases,” successful PAVR is also possible in diffusely diseased peripheries of borderline small size or with focal aortoiliofemoral disease amenable to a separate intervention beforehand.
Abstract: Percutaneous aortic valve replacement (PAVR) offers considerable promise in treating high risk patients with aortic valve disease. Two devices are currently clinically available for transfemoral delivery: the Edwards-Sapien balloon-expandable bioprosthesis and the Corevalve self-expanding bioprosthesis, both of which require careful sizing of the peripheral vasculature. Through a case based discussion, we illustrate that these limits of PAVR technology can be stretched in cases of extraordinary clinical need. We demonstrate that, following a learning curve of "optimal cases," successful PAVR is also possible in diffusely diseased peripheries of borderline small size or with focal aortoiliofemoral disease amenable to a separate intervention beforehand.
TL;DR: Cases of the most common abdominal presentations of neurofibroma, malignant peripheral nerve sheath tumor, pheochromocytoma, carcinoid, gastrointestinal stromal tumor, and seminoma are presented.
Abstract: The purpose of this review is to illustrate, with examples, the abdominal manifestations of neurofibromatosis type 1 (NF1) on imaging, with emphasis on computed tomography. Mutations of the NF1 gene lead to abnormal tumor suppression. Consequently, NF1 is a complex disease, with patients having an increased prevalence of benign and malignant neoplasms throughout the body. We present cases of the most common abdominal presentations: neurofibroma, malignant peripheral nerve sheath tumor, pheochromocytoma, carcinoid, gastrointestinal stromal tumor, and seminoma.
TL;DR: TAC is an excellent method of establishing cardiopulmonary bypass as it is quick, provides a more physiological method of delivering antegrade arterial flow and is the only method to assure perfusion of the true lumen.
Abstract: Aortic dissection is the most frequently diagnosed lethal disease of the aorta. Half of all patients with acute type-A aortic dissection die within 48 hours of presentation. There is still debate as to the optimal site of arterial cannulation for establishing cardiopulmonary bypass in patients with type-A aortic dissection. Femoral artery cannulation with retrograde perfusion is the most common method but because of the risk of malperfusion of vital organs and atheroembolism related to it different sites such as the axillary artery, the innominate artery and the aortic arch are used. Cannulation of these sites is not without risks of atheroembolism, neurovascular complications and can be time consuming. Another yet to be popularised option is the transapical aortic cannulation (TAC) described in this article. TAC consists of the insertion of the arterial cannula through the apex of the left ventricle and the aortic valve to lie in the sinus of Valsalva. Trans-oesophageal guidance is necessary to ensure correct placement of the cannula. TAC is an excellent method of establishing cardiopulmonary bypass as it is quick, provides a more physiological method of delivering antegrade arterial flow and is the only method to assure perfusion of the true lumen.
TL;DR: It is suggested that surgery is indicated in treating localised MPM even in T4 (diffuse chest wall involvement) tumours but pleuropneumonectomy is not necessary.
Abstract: Objective:Localisedmalignant pleuralmesotheliomas areveryrare andalthoughthere aresporadicreports inthe literatureshowing thatthey have a different biological behaviour compared to diffuse MPM there is no major series published demonstrating results of surgical treatment. We present our experience in treatingthese tumours.Methods:Over an 8-year periodwe performed radical or debulkingsurgery in 218 patients with MPM. Ten of these patients had localised chest wall tumours and a biopsy either highly suspicious or confirming malignant pleural mesothelioma. Theywere all male withan averageageof 65.9(56—80)years. Threeof the tumourswere epithelioid, three biphasicandthree sarcomatoid. They all had chest wall resections, with limited lung resections where the tumours were infiltrating the lung and reconstruction using a double prolene mesh and orthopaedic cement. Perioperative events and long-term survival were analysed and survival was compared to survival following operations for diffuse malignant pleural mesothelioma. Results: There was no 30-day mortality with only two patients suffering from pleural collections that required ultrasound guided drainage 2 and 8 weeks after the operation. Two patients died from disease progression 3 and 10 months after the operation. Using Kaplan—Meier analysis the mean survival was 56 months. Conclusion: Our results suggest that surgery is indicated in treating localised MPM even in T4 (diffuse chest wall involvement) tumours but pleuropneumonectomy is not necessary. These tumoursseemto have a different biologicalbehaviourcomparedto diffuseMPMbut furtherresearch, includingidentification ofpossiblydifferent biological markers is necessary. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
TL;DR: A case was repaired by using a combination of minithoracotomy and video-assistance through the minithOracotomy wound to treat post-traumatic lung herniation through a defect in the chest wall.
Abstract: Post-traumatic lung herniation through a defect in the chest wall is an uncommon injury, with only about 300 reported in the literature. Various methods of treatment and repair have been described, including both purely thoracoscopic to full open techniques. We repaired a case by using a combination of minithoracotomy and video-assistance through the minithoracotomy wound. The patient did well and there was minimal postoperative pain.
TL;DR: The technique has been shown to replicate the prescribed in vivo kinematics in a reproducible and repeatable manner and change in volume calculated gravimetrically was seen to be the most repeatable measure of patellar wear in vitro.