Protection of human muscle acetylcholinesterase from soman by pyridostigmine bromide.

Introduction: Pretreatment with pyridostigmine bromide (PB) of human intercostal muscle fibers exposed to the irreversible acetylcholinesterase (AChE) inhibitor soman was investigated.

Methods: Muscles were pretreated with 3 × 10(-6) M PB or saline for 20 minutes, then exposed to 10(-7) M soman for 10 minutes.

Results: AChE of muscles treated with soman alone was inhibited >95%.

Mediastinoscopy might not be necessary in patients with non-small cell lung cancer with mediastinal lymph nodes having a maximum standardized uptake value of less than 5.3.

Objective: Accurate pretreatment staging in non-small cell lung cancer remains tantamount in formulating an appropriate treatment plan. The maximum standardized uptake value obtained with integrated fluorodeoxyglucose-positron emission tomography/computed tomography has been proposed to be a predictor of malignancy in mediastinal lymph nodes. A recent study has also suggested that accuracy of integrated fluorodeoxyglucose-positron emission tomography/computed tomography might be improved by increasing the maximum standardized uptake value used for calling a lymph node positive from 2.

A phase II study of paclitaxel, carboplatin, and radiation with or without surgery for esophageal cancer.

Background: Cisplatin-based chemoradiotherapy (CRT) has been a standard treatment for patients with locally advanced esophageal cancer. However, cisplatin is associated with significant toxicity. We conducted a phase II clinical trial of concurrent paclitaxel, carboplatin, and radiation with or without surgery as an alternative to the standard cisplatin-based CRT for localized and metastatic esophageal cancer.

Advances in positron emission tomography technology have increased the need for surgical staging in non-small cell lung cancer.

Objectives: Pretreatment staging of patients with non-small cell lung cancer is critically important in determining an appropriate treatment plan. As positron emission tomography (PET) and computed tomography (CT) are proven complementary modalities in clinical staging, recent advances in PET technology have brought forth integrated PET/CT as the new standard. We tested the hypothesis that improvements in PET technology have not increased the sensitivity or specificity of PET in the staging of non-small cell lung cancer to an extent that surgical staging is no longer required.

Resection of multifocal non-small cell lung cancer when the bronchioloalveolar subtype is involved.

Objective: Bronchioloalveolar lung cancer is commonly multifocal and can also present with other non-small cell types. The staging and treatment of multifocal non-small cell cancer are controversial. We evaluated the current staging of multifocal bronchioloalveolar carcinoma and the therapeutic effectiveness of resection when this tumor type is involved.

Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures.

Background: Transhiatal and transthoracic esophagectomy are common approaches for esophageal resection. The literature is limited regarding the combined thoracoscopic and laparoscopic approach to esophagectomy. The aim of this study was to evaluate the outcomes of combined thoracoscopic and laparoscopic esophagectomy for the treatment of benign and malignant esophageal disease.

Aggressive management of lung donors classified as unacceptable: excellent recipient survival one year after transplantation.

Objective: A dire shortage of lungs for transplantation exists. We hypothesized that aggressive organ procurement organization management of lungs usually rated as unacceptable (ratio of Pao(2) to inspired oxygen fraction <150) might make them acceptable for transplantation. We also hypothesized that lungs from donors who died of trauma could be used for transplantation with recipient survival comparable with that seen with lungs from donors who died of nontraumatic causes.

Selective overexpression of inflammatory molecules in hearts from brain-dead rats.

Background: Inflammatory processes that occur before, during, and after surgery may contribute to damage of transplanted hearts and their ability to withstand acute and chronic rejection.

Methods: We determined the expression of mRNA for 10 inflammatory indicator molecules in hearts from brain-dead animals in which stable circulation was maintained. To produce brain death in male rats (n = 11), we inflated an intracranial balloon with saline (245 microl +/- 27 microl) to produce apnea and areflexia.

Advantages of positron emission tomography over computed tomography in mediastinal staging of non-small cell lung cancer.

Background: New treatment algorithms in early stage non-small cell lung cancer (NSCLC) involving preoperative chemotherapy require accurate clinical staging of the mediastinum. This study compares the accuracy of 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) scanning with that of computed tomography (CT) scanning in the clinical staging of non-small cell lung cancer.

Materials And Methods: A retrospective review was performed on 52 patients with NSCLC who were evaluated with both CT and PET scans.

Evaluation of minimally invasive surgical staging for esophageal cancer.

Background: Conventional imaging studies (computed tomography and endoscopic esophageal ultrasonography) used for preoperative evaluation of patients with esophageal cancer can be inaccurate for detection of small metastatic deposits. We evaluated the efficacy of minimally invasive surgical (MIS) staging as an additional modality for evaluation of patients with esophageal cancer.

Methods: Between December 1998 and February 2001, 33 patients with esophageal cancer were evaluated for surgical resection.

Thymectomy in the treatment of ocular myasthenia gravis.

Background: Thymectomy is an effective and accepted treatment for myasthenia gravis, but thymectomy for ocular myasthenia gravis (Osserman stage I) is controversial.

Objective: To assess the efficacy and propriety of thymectomy for the treatment of ocular myasthenia gravis.

Methods: We conducted a review and follow-up of all patients who had thymectomy for the treatment of ocular myasthenia gravis between 1970 and 1998 at the University of California, Davis, Medical Center, and the University of Rome, "La Sapienza," Rome, Italy.

Four-dimensional aortic blood flow patterns in thoracic aortic grafts.

Time-resolved cardiac gated three-directional velocity data obtained with magnetic resonance velocity-encoded phase contrast sequences were used to study blood flow patterns in thoracic aortic grafts. Twelve patients were studied, 6 with traumatic descending aortic pseudoaneurysms, 3 with atherosclerotic aneurysms, and 3 with dissecting aneurysms. All grafts had an inflow jet; outflow jet; and/or vortices proximal, in, or distal to the graft.

Minimally invasive Ivor Lewis esophagectomy.

Ivor Lewis esophagectomy consists of a laparotomy and right thoracotomy for resection of the intrathoracic esophagus. Recent advances in minimally invasive surgical technology have allowed surgeons to apply laparoscopy and thoracoscopy to perform esophagectomy. However, there have been few reports that describe a totally minimally invasive Ivor Lewis esophagectomy.

Comparison of functional state between bilateral lung volume reduction surgery and pulmonary rehabilitation: a six-month followup study.

Study Objective: The effectiveness of bilateral lung volume reduction surgery (BLVRS) in the improvement of functional state in severe chronic obstructive pulmonary disease (COPD) has not been reported. This study examined the effects of BLVRS on subjective and objective measures of functional state (FS) and compared these effects with those gained from pulmonary rehabilitation (PR).

Methods: Twenty-eight consecutive patients were studied.

Factors associated with false-positive staging of lung cancer by positron emission tomography.

Background: Positron emission tomography imaging is gaining popularity as a noninvasive staging tool in non-small cell lung cancer. Nonmalignant processes can also affect radio-tracer uptake. This study seeks to identify factors associated with false-positive staging of mediastinal metastases.

Laparoscopy or thoracoscopy for achalasia.

Achalasia is an esophageal motor disorder of unknown etiology. Typical manometric findings include aperistalsis of the esophageal body coupled with elevated pressure and incomplete relaxation of the lower esophageal sphincter during swallowing. Medical treatments consist of pneumatic dilatation or injections of botulinum toxin.

Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy.

Hypothesis: Minimally invasive esophagectomy can be performed as safely as conventional esophagectomy and has distinct perioperative outcome advantages.

Design: A retrospective comparison of 3 methods of esophagectomy: minimally invasive, transthoracic, and blunt transhiatal.

Setting: University medical center.

Simultaneous antegrade and retrograde reperfusion after cardioplegic arrest for coronary artery bypass.

Retrograde coronary sinus reperfusion with warm blood during proximal anastomoses permits completion of myocardial revascularization under a single cross-clamp application. Reperfusion with both antegrade (via arterial and vein grafts) and retrograde (via coronary sinus catheter) warm blood has raised concerns about maldistribution of perfusate or overpressurization of capillary beds. This prospective, randomized design compares postcardioplegic myocardial recovery among patients receiving retrograde reperfusion only and patients receiving simultaneous antegrade/retrograde reperfusion.

Use of cardiopulmonary bypass to salvage patients with multiple-chamber heart wounds.

Background: The need for cardiopulmonary bypass in the treatment of penetrating heart injuries is debated.

Objectives: To review our experience with penetrating heart injuries and determine the indications and outcome for cardiopulmonary bypass.

Design: Retrospective review.