Pre-treatment optimisation with pulmonary rehabilitation of elderly lung cancer patients with frailty for surgery.

Objective: Frailty develops as a result of age-related decline in many physiological systems and is associated with increased vulnerability to adverse outcomes following thoracic surgery. We prospectively tested our hypothesis that pre-operative pulmonary rehabilitation (Prehab) improves frailty, as suggested by a frailty index > 3 (FI > 3) and fitness, and thereby reduces the risk of post-surgical complications and death in vulnerable elderly lung cancer patients.

Methods: 221 surgical patients, 80 with FI > 3 vs.

3D Printing Technology for Chest Wall Reconstruction With a Sternum-Ribs-Cartilage Titanium Implant: From Ideation to Creation.

Objective: We describe the use of 3-dimensional (3D) printing technology to plan and reconstruct the sternum, adjoining cartilages, and ribs with a custom-made, anatomically designed, 3D-printed titanium implant for an isolated sternal metastasis complicated with a pathological fracture.

Methods: We imported submillimeter slice computed tomography scan data into Mimics Medical 20.0 software and by manual bone threshold segmentation created a 3D virtual model of the patient's chest wall and tumor.

Chest Wall Reconstruction With 3D Printing: Anatomical and Functional Considerations.

Large chest wall defects, as a result of wide local excision of chest wall pathology, require skeletal and soft-tissue reconstruction to restore the anatomical shape, structure, and respiratory function of the thorax. Reconstruction is challenging and requires the surgical reconstructive team to understand the anatomic and physiologic morbidity related to the defect and the choice of reconstructive techniques available to restore form and function. Rapidly emerging 3-dimensional (3D) printing technology allows the reconstructive surgical team to customize the therapeutic process of skeletal reconstruction by accurately mimicking the shape and structure of the chest wall being replaced.

An adult with episodic retrosternal chest pain: an unusual presentation of congenital pulmonary airway malformation - case report.

Background: Congenital pulmonary airway malformation (CPAM) with partial anomalous pulmonary venous connection presenting as episodic retrosternal chest pain on exertion in an adult has not been described.

Case Presentation: A 21-year-old female, non-smoker, presented with a 4-year history of sharp, episodic, retrosternal chest pains brought on with exercise. A contrast-enhanced computed tomography (CT) scan showed a grossly overinflated left lower lobe with partial anomalous pulmonary venous drainage into the left hemi-azygos vein.

Pre-treatment optimization with pulmonary rehabilitation in lung cancer: Making the inoperable patients operable.

Background: Anatomical lung resection offers the best prospect of long-term survival in patients with non-small cell lung cancer (NSCLC). However, some patients with significant dyspnoea, impaired performance status (PS), borderline or poor pulmonary function are considered inoperable and instead referred for radiotherapy, chemotherapy or palliative care. The aims of the study were to determine whether pre-operative pulmonary physiotherapy (Prehab), by improving clinical parameters, (i) makes patients suitable for surgery who were considered inoperable on subjective criteria of dyspnoea >3 and PS >2, and objective criteria of diffusing capacity for carbon monoxide (DLCO) <50%; and (ii) thereby allows them to safely receive curative surgery with reduced morbidity and mortality.

Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant.

Background: Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant.

Impact of preoperative pulmonary rehabilitation on the Thoracoscore of patients undergoing lung resection.

Objectives: Patients with dyspnoea who are suitable for lung resection have a higher in-hospital mortality following surgery as predicted by the Thoracoscore. We evaluated the role of preoperative pulmonary rehabilitation (PPR) in improving preoperative dyspnoea, performance status and thereby the Thoracoscore and reducing the risk of postoperative mortality, complications and length of stay in such patients.

Methods: From June 2013 until May 2014, we prospectively and sequentially identified high-risk patients in our outpatient clinic with dyspnoea grade ≥2 and performance status ≥1 for lung resection and recruited them for PPR.

Coronary revascularisation with Genous stent helps reduce the waiting time for lung resection.

Patients suitable for lung resection for primary lung cancer and with myocardial ischaemia due to significant coronary artery stenosis, despite optimal medical therapy, are considered for either percutaneous or surgical revascularisation prior to thoracic surgery. Percutaneous coronary intervention (PCI) with bare metal stent (BMS) requires patients to initially receive dual anti-platelet therapy of clopidogrel and aspirin for at least 6 weeks, which delays the waiting time for curative lung resection. We report the successful use of the Genous endothelial progenitor cell (EPC) capture stent in two patients requiring PCI for significant coronary artery disease prior to lung resection.

Predictors of individual visual memory decline after unilateral anterior temporal lobe resection.

Background: Different types of neuropsychological visual memory tasks have been created to quantify deficits associated with right hemisphere dysfunction. There are reports of visual memory impairment after right anterior temporal lobe resection (ATR) compared to left ATR for the processing of faces, abstract designs, and spatial locations, but there are also studies showing no between-group differences. One potential reason for the conflicting results is the use of group mean changes, which mask individual differences.

Cortical resection tailored to awake, intraoperative ictal recordings and motor mapping in the treatment of intractable epilepsia partialis continua: technical case report.

Objective: Epilepsia partialis continua (EPC) is a form of status epilepticus that is characterized by continuous simple partial seizures and can occur as a manifestation of a variety of underlying pathological processes. Because these seizures typically take onset within or close to motor cortex, the treatment of refractory EPC with resective surgery risks significant postoperative deficits.

Clinical Presentation: We describe our experience using ictal recordings obtained intraoperatively during awake craniotomy, in conjunction with direct cortical stimulation mapping, to tailor surgical resections in 2 patients with refractory EPC.

Changes in individual and group spatial and verbal learning characteristics after anterior temporal lobectomy.

Purpose: To evaluate the effects of anterior temporal lobectomy (ATL) on individual and group spatial and verbal learning and memory abilities as a function of side of surgery and seizure control outcome.

Methods: We evaluated pre- and postsurgical learning and memory abilities of 75 left-hemisphere language dominant individuals who underwent ATL (33 left, 42 right) using the 8-trial Nonverbal Selective Reminding test and the 12-trial Verbal Selective Reminding test.

Results: Reliable change index methods indicated that 40.

Memory, emotional and vocational impairments before and after anterior temporal lobectomy for complex partial seizures.

Purpose: To assess the pre- and postsurgical frequency of memory, emotional, and vocational impairments in patients who underwent anterior temporal lobectomy (ATL), and to assess the relationship between emotional disturbance and memory abilities after ATL.

Methods: Retrospective analysis of data was performed on 90 patients with medically intractable complex partial seizures who underwent ATL between 1981 and 2003. Patients were evaluated an average of 5 months before surgery and 11.

Aspire porcine bioprosthesis: ten years' experience.

Background And Aim Of The Study: Clinical results of this multicenter study of the Aspire porcine valve were reported previously at eight years; the present report provides an update of valve performance to 10 years postoperatively.

Methods: A total of 749 patients (60% males; mean age 73+/-7 years) underwent implantation with the Aspire (Tissuemed) porcine bioprosthesis between 1991 and 2002, at three institutions. Follow up was complete for 98% of the cohort.

A prospective study of changes in the quality of life of patients following mitral valve repair and replacement.

Objective: The primary aim of medical care and surgery for mitral valve disease is to improve the overall functional capacity and health of patients.

Aim: To assess whether there was an actual improvement in quality of life (QOL) of patients 3 months following primary mitral valve repair (MRr) or mitral valve replacement (MVR).

Methods: Prospective study of 61 consecutive patients (34 males, mean age 64+/-12) who underwent primary, isolated mitral valve repair (MRr, n=40) or mitral valve replacement (MVR, n = 21) from April 1997 to October 1998.

Fifteen-year experience with the mitral Carpentier-Edwards PERIMOUNT pericardial bioprosthesis.

Background: This multicenter study concerning the mitral PERIMOUNT valve previously reported clinical results at 12 years; this report updates the performance to 15 years postoperatively.

Methods: The 435 patients (mean age 60.7+/-11.

Midterm evaluation of the Tissuemed (Aspire) porcine bioprosthesis: 493 patients, 506 bioprostheses.

Background: Valve durability has been a major concern with bioprostheses, and the Tissuemed (Aspire) porcine bioprosthesis was designed to provide a solution to structural valve failure. Because bioprostheses tend to fail by 8 years, the aim of our study was to determine its midterm durability and performance.

Methods: We reviewed 506 prostheses that were implanted in 493 patients (287 men; mean age 73 +/- 6 years) between 1991 and 1999.

A prospective study of changes in patients' quality of life after aortic valve replacement.

Background And Aim Of The Study: After aortic valve replacement (AVR), 90% of survivors are in NYHA class I or II, and most return to work after three months. It is unclear, however, whether at that time patients have an improved quality of life (QOL), are able to perform physical and social activities, and live independently.

Methods: To assess this situation, 62 patients (39 males, 23 females; mean age 68.