Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial.

Background: Malignant pleural mesothelioma incidence continues to rise, with few available evidence-based therapeutic options. Results of previous non-randomised studies suggested that video-assisted thoracoscopic partial pleurectomy (VAT-PP) might improve symptom control and survival. We aimed to compare efficacy in terms of overall survival, and cost, of VAT-PP and talc pleurodesis in patients with malignant pleural mesothelioma.

If at first you do not succeed, think again!

The authors describe a case of platypnoea orthodeoxia syndrome in an 83-year-old man with a fenestrated atrial septal defect and severe coronary artery disease. The patient had been admitted to hospital six times in the previous year with acute breathlessness, attributed to paroxysmal atrial fibrillation. The patient's symptoms resolved completely following surgical repair of the defect and coronary artery bypass grafting.

Predicting survival in potentially curable lung cancer patients.

Lung cancer is the most common cause of cancer death with unchanged mortality for 50 years. Only localized nonsmall-cell lung cancer (NSCLC) is curable. In these patients it is essential to accurately predict survival to help identify those that will benefit from treatment and those at risk of relapse.

Single-lung transplant complicated by unexpected explant carcinoma: a management dilemma.

Interstitial pneumonia is well known to increase the risk of lung cancer. We describe a young man who underwent single-lung transplantation for confirmed usual interstitial pneumonia and who was unexpectedly found to have multifocal adenocarcinoma in the explanted lung. Induction immunosuppression therapy was decreased and full screening for further tumor development was undertaken.

Lithium-induced nephrogenic diabetes insipidus after coronary artery bypass.

We present a case of nephrogenic diabetes insipidus that occurred after on-pump coronary artery bypass grafting in a patient taking long-term lithium carbonate. Lithium toxicity (2.79 mmol/L) was identified on postoperative day 9.

The effect of lung resection on pulmonary function and exercise capacity in lung cancer patients.

Objective: Prospectively to evaluate the effects of lung resection on lung function (as measured via spirometry) and exercise capacity (as measured via shuttle-walk test) in lung cancer patients.

Methods: We conducted pulmonary function tests and the shuttle-walk test with 110 consecutive patients, before and 1 month, 3 months, and 6 months after lobectomy (n = 73) or pneumonectomy (n = 37). All the patients underwent a standard posterolateral thoracotomy.

The incidence and impact of low body mass index on patients with operable lung cancer.

Background & Aims: To prospectively assess the nutritional status of patients referred for lung cancer surgery, as well as to assess the prognostic value of nutritional status in determining the surgical outcome.

Methods: One hundred and forty-six patients with potentially operable lung cancer were recruited. Loss of appetite and weight loss were recorded.

Mesothelioma with non-pleural malignancy: a red herring or just an uncommon pairing?

Malignant pleural mesothelioma (MPM) is a highly aggressive cancer of the pleura with a well-established male predominance and causative link with asbestos exposure. We report four cases of female patients with MPM referred for palliation of symptoms thought to be due to previous non-pleural malignancy.With emerging novel treatments for MPM, this article discusses four unusual cases of MPM occurring in the setting of other malignancy, highlights the importance of considering a primary diagnosis of MPM even in patients with other malignancy, and reinforces the benefits of video-assisted surgical biopsy which allows simultaneous diagnosis and treatment.

Ventilation-perfusion scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing pneumonectomy.

Objective: The American College of Chest Physicians (ACCP) recommends using quantitative perfusion scintigraphy to predict postoperative lung function in lung cancer patients with borderline pulmonary function tests who will undergo pneumonectomy. However, previous scintigraphic data were gathered on small cohorts more than a decade ago, when surgical populations were significantly different with respect to age and sex compared with typical lung cancer patients undergoing pneumonectomy in 2005. We therefore revisited the use of V/Q scintigraphy in pneumonectomy patients in predicting postoperative pulmonary function and the appropriateness of current clinical guidelines.

VATS lung biopsy in suspected, diffuse interstitial lung disease provides diagnosis, and alters management strategies.

Objectives: In patients with suspected diffuse interstitial lung disease, open lung biopsy is associated with high mortality (16%). This risk is only acceptable if diagnosis is made and management enhanced. We reviewed the role of VATS techniques in this group to determine the morbidity, mortality and outcomes in terms of diagnosis and enhanced management.

The use of vacuum-assisted closure in the treatment of post-transplant wound infections: a case series.

We present 6 cases of the successful use of vacuum-assisted closure dressings as the primary treatment of wound infection after thoracic organ transplantation. In a series of 160 successive transplant operations, deep wound infections developed in 6 patients (3.7%).

Cardiopulmonary exercise tests and lung cancer surgical outcome.

Study Objectives: Surgical resection remains the treatment of choice for anatomically resectable non-small cell lung cancer. However, the presence of associated comorbid conditions increases the risk of death and surgical complications. Several studies have evaluated the usefulness of preoperative exercise testing for predicting postoperative morbidity and mortality.

Relationship of shuttle walk test and lung cancer surgical outcome.

Objective: Surgery remains the treatment of choice in patients with potentially resectable lung carcinoma. Both the British Thoracic Society and American Chest Physician guidelines for the selection of patients with lung cancer surgery suggest the use of a shuttle walk test to predict outcome in patients with borderline lung function. The guidelines suggest that if the patient is unable to walk 250 m during a shuttle walk test, they are high risk for surgery.

Use of quantitative lung scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing lobectomy.

Background: In patients with non-small cell lung cancer, the only realistic chance of cure is surgical resection. However, in some of these patients there is such poor respiratory reserve that surgery can result in an unacceptable quality of life. In order to identify these patients, various pulmonary function tests and scintigraphic techniques have been used.

Clinical outcome versus post-mortem finding in thoracic surgery: a 10-year experience.

Objectives: The role of post-mortem following thoracic surgery has not been previously studied. Most importantly, the clinical diagnosis of thoracic surgical mortality cannot be certain unless post-mortem analysis has been performed.

Methods: Consecutive post-mortem data were collected on 110 patients between 1992 and 2001 (66.

The surgical treatment of bronchial carcinoma.

This article considers the current place of surgery in the treatment of bronchial carcinoma. Aspects of the diagnosis of this condition will be covered, but the main focus falls on the surgical procedures, their complications and the outlook for these patients according to tumour stage.

Vacuum-assisted closure as a treatment modality for infections after cardiac surgery.

Objective: Wound infections after cardiac surgery carry high morbidity and mortality. A plethora of management strategies have been used to treat such infections. We assessed the impact of vacuum-assisted closure on the management of sternal wound infections in terms of wound healing, duration of vacuum-assisted closure, and cost of treatment.

Intraoperative confirmation of ulnar collateral blood flow during radial artery harvesting using the "squirt test".

Hand ischemia is a major concern after radial artery harvesting for coronary revascularization. Although a number of preoperative tests have been described to assess the adequacy of ulnar collateral blood flow, many of them are subjective and unreliable. In addition, the presence of arterial connections between the radial and ulnar systems in the elbow and forearm and variability in forearm angiology imply that assessment of alternative blood supply to the hand can only be made once collateral branches of the radial artery have been divided.