Dynamic four-dimensional computed tomography for preoperative assessment of lung cancer invasion into adjacent structures†.

Objectives: The 320-slice computed tomography (CT) provides three-dimensional and dynamic imaging resulting in the ability to assess motion analysis between two adjacent structures (the fourth dimension). Differential movements between two adjacent structures would indicate that there is no fixation between the two structures.

Methods: Eight patients with non-small-cell lung cancers located adjacent to vital structures (e.

Acute pulmonary embolectomy.

Acute pulmonary embolism (PE) is a common condition frequently associated with a high mortality worldwide. It can be classified into non-massive, sub-massive and massive, based on the degree of haemodynamic compromise. Surgical pulmonary embolectomy, despite having been in existence for over 100 years, is generally regarded as an option of last resort, with expectedly high mortality rates.

Decision making and algorithm for the management of pleural effusions.

Pleural effusions can be catagorised in to transudative effusions or exudative effusions. Causes include cardiovascular disease, infection and neoplasm. Diagnosis is the key to determining what management is required.

Anatomy and pathophysiology of the pleura and pleural space.

Pleural effusions are most often secondary to an underlying condition and may be the first sign of the underlying pathologic condition. The balance between the hydrostatic and oncotic forces dictates pleural fluid homeostasis. The parietal pleura has a more significant role in pleural fluid homeostasis.

Survival after surgical repair of ischemic ventricular septal rupture.

Objectives: We reviewed our results and experience over a 14-year period to identify predictors of outcome following surgical repair of postinfarction ventricular septal rupture.

Methods: A retrospective review was carried over a 14-year period. All patients had surgical repair of a postinfarction ventricular septal rupture.

Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations.

Background: The aim of this study was to examine the impact of prolonged intensive care unit (ICU) stay on in-hospital mortality and long-term survival.

Methods: Prospectively collected data from 6,101 consecutive patients who underwent surgery between 2003 and 2007 were analyzed. Prolonged ICU stay was defined as a total duration of ICU stay of 3 days or more postoperatively, including readmissions; patients with an ICU stay less than 3 days were identified as controls.

The value of post mortems in cardiac surgery: learning from the dead.

Background: Little information is available regarding the role of post-mortem in cardiac surgery. The cause of death by clinical presumption can be misleading. The aim is evaluate the role of post-mortem following cardiac surgery by comparing clinically attributed causes of death versus post-mortem findings.

Prospective European multicenter randomized trial of PleuraSeal for control of air leaks after elective pulmonary resection.

Objectives: We sought to evaluate the efficacy and safety of a synthetic bioresorbable pleural sealant (PleuraSeal; Covidien, Bedford, Mass) to treat air leaks after pulmonary resection.

Methods: Patients with air leaks after lung resection were randomized to treatment with pleural sealant on air leak sites after standard methods of lung closure or standard lung closure only. The primary outcome variable was the percentage of patients remaining air leak free until discharge.

Emphysema quantification in inflation-fixed lungs using low-dose computed tomography and 3He magnetic resonance imaging.

Objective: To evaluate the use of inflation-fixed lung tissue for emphysema quantification with computed tomography (CT) and He magnetic resonance (MR) diffusion imaging.

Methods: Fourteen subjects representing a range of chronic obstructive pulmonary disease severity who underwent complete or lobar lung resection were studied. Computed tomographic measurements of lung attenuation and MR measurements of the hyperpolarized 3He apparent diffusion coefficient (ADC) in resected specimens fixed in inflation with heated formalin vapor were compared with measurements obtained before fixation.

Effects of CT section thickness and reconstruction kernel on emphysema quantification relationship to the magnitude of the CT emphysema index.

Rationale And Objectives: Computed tomography (CT) section thickness and reconstruction kernel each influence CT measurements of emphysema. This study was performed to assess whether their effects are related to the magnitude of the measurement.

Materials And Methods: Low-radiation-dose multidetector CT was performed in 21 subjects representing a wide range of emphysema severity.

Transannular pulmonary enlargement and bioprostheses for carcinoid disease.

A diminutive pulmonary artery and right ventricular outflow tract in a 46-year-old woman with a 10-year history of carcinoid syndrome required transannular pulmonary patch enlargement to allow replacement of the pulmonary and tricuspid valves with bioprostheses. The avoidance of anticoagulation permitted further hepatic arterial embolization without an increased risk of bleeding.

Effects of diffusion time on short-range hyperpolarized (3)He diffusivity measurements in emphysema.

Purpose: To characterize the effect of diffusion time on short-range hyperpolarized (3)He magnetic resonance imaging (MRI) diffusion measurements across a wide range of emphysema severity.

Materials And Methods: (3)He diffusion MRI was performed on 19 lungs or lobes resected from 18 subjects with varying degrees of emphysema using three diffusion times (1.6 msec, 5 msec, and 10 msec) at constant b value.

Airway bypass treatment of severe homogeneous emphysema: taking advantage of collateral ventilation.

Airway bypass is being investigated as a new form of minimally invasive therapy for the treatment of homogeneous emphysema. It is a bronchoscopic catheter-based procedure that creates transbronchial extra-anatomic passages at the bronchial segmental level. The passages are expanded, supported with the expectation that the patency is maintained by paclitaxel drug-eluting airway bypass stents.

Combined cardiac and lung volume reduction surgery.

Coronary artery disease is prevalent in patients who have severe emphysema and who are being considered for lung volume reduction surgery (LVRS). Significant valvular heart diseases may also coexist in these patients. Few thoracic surgeons have performed LVRS in patients who have severe cardiac diseases.

Concomitant lung cancer resection and lung volume reduction surgery.

Patients who are offered concomitant surgery are highly selected and must satisfy the strict criteria set out for both LVRS and cancer surgery. Several evaluative processes have been reported for the selection of suitable patients. These various evaluative processes, together with the physical condition of the patient and the surgeon's experience, help to best select patients suitable for combined surgical resection.

Severe triple vessel coronary artery disease and aneurysms in a young white man: disease progression of childhood Kawasaki disease.

Kawasaki disease usually affects younger age groups, but cardiac sequelae of 'missed' (incomplete) childhood Kawasaki disease may first present in adult life. We report a case of a 28-year-old white man presenting with ST elevation myocardial infarction and later found to have triple vessel coronary artery aneurysmal disease, probably secondary to childhood Kawasaki disease for which he underwent cardiac bypass surgery. The patient has remained well and asymptomatic at 1-year follow-up.

Airway bypass improves the mechanical properties of explanted emphysematous lungs.

Rationale: By creating artificial communications through bronchial walls into the parenchyma of explanted lungs (airway bypass), we expect to decrease the amount of gas trapped and to increase the rate and volume of air expelled during forced expirations.

Objectives: To describe the mechanism by which airway bypass improves the mechanical properties of the emphysematous lung.

Methods: Lung compartments and mechanics were measured before and after airway bypass, which was created by placement of three or four stent-supported fenestrations in 10 emphysematous lungs removed at transplantation surgery.

A surgeon's case volume of oesophagectomy for cancer strongly influences the operative mortality rate.

Objective: To assess if individual case volume of oesophagectomy for cancer influences the risk of mortality and long-term survival.

Methods: Between January 1994 and December 2005, 195 resections for oesophageal cancer were performed by nine surgeons in a single institution. Operative mortality, defined as in hospital death, was compared between the high-volume and low-volume surgeons.

Management of concomitant congenital tracheo-oesophageal fistula and cancer of the oesophago-gastric junction in an adult.

Congenital tracheo-oesophageal fistula in the adult is rare, and there have only been 16 such reported cases in the English literature. The concomitant presence of a cancer of the oesophago-gastric junction however has not been previously reported, and presents a treatment dilemma as to whether a staged or simultaneous surgical treatment should be performed. We report such a case that was successfully treated by staged surgical therapy.