Thoracic Operations for Pulmonary Nodules Are Frequently Not Futile in Patients with Benign Disease

IntroductionPulmonary nodules often require operative resection to obtain a diagnosis. However, 10 to 30% of operations result in a benign diagnosis. Our purpose was to determine whether negative thoracic operations are futile by describing the pathological diagnoses; determining new diagnoses and treatment changes initiated based on operative findings; and assessing morbidity, mortality, and cost of the procedure.MethodsAt our academic medical center, 278 thoracic operations were performed for known or suspected cancer between January 1, 2005, and April 1, 2009. We collected and summarized data pertaining to preoperative patient and nodule characteristics, pathologic diagnosis, postoperative treatment changes resulting from surgical resection, perioperative morbidity and mortality, and hospital charges for patients with benign pathology.ResultsTwenty-three percent (65/278) of patients who underwent surgical resection for a suspicious nodule had benign pathology. We report granulomatous disease in 57%, benign tumors in 15%, fibrosis in 12%, and autoimmune and vascular diseases in 9%. Definitive diagnosis or treatment changes occurred in 85% of cases. Surgical intervention led to a new diagnosis in 69%, treatment course changes in 68% of benign cases, medication changes in 38%, new consultation in 31%, definitive treatment in 9%, and underlying disease management in 34%. There was no intraoperative, in-hospital, or 30-day mortality. Postoperative in-hospital events occurred in seven patients. The mean total cost was $25,515 with a mean cost per day of$7618.ConclusionsPatients with a benign diagnosis after surgical resection for a pulmonary nodule received a new diagnosis or had a treatment course change in 85% of the cases

Research Progress Reports: Fruit and Vegetable Processing and Technology Division, Department of Horticulture [1967]

Evaluation of snap bean varieties for processing / Wilbur A. Gould and William Hildebolt -- Evaluation of various grape cultivars for processing. I. Table wines ; Recommended fruit varieties for canning and freezing / J. F. Gallander -- Evaluation of tomato varieties for processing / W. A. Gould, J. R. Geisman, C. S. Parrott, J. H. McClelland and W. N. Brown -- The effect of different levels of sugar and acid on the quality of apple fruit juice blends / James Gallander and Harold Stammer -- Epidermal sloughing of snap beans as influenced by processing variables / William Hildebolt and W. A. Gould -- Effect of stannous chloride on the color of glass packed kraut / J. R. Geisman -- Proteins and enzymes in the apple fruit in relation to variety and maturation ; Proteins and enzymes in tomato fruits / Robert L. Clements -- Effect of food additives on quality of canned tomatoes / Wilbur A. Gould -- Effects of selective herbicides on the composition and quality of tomatoes / W. A. Gould, J. R. Geisman, E. K. Alban and John Deppen -- Trace levels of pesticide residues in agricultural commodities in marketing channels / W. A. Gould, J. R. Geisman, E. K. Alban, John Deppen, and P. van Pottlesberghe -- Removal of DDT residues by unit operations in preparing and processing spinach / J. R. Geisman, John Deppen and Benita Yao -- The use of chlorine dioxide in handling and holding mechanically harvested tomatoes / J. R. Geisman, Winston D. Bash, Edwin Schmidt, Jr., Linda Hamrick and W. A. Gould -- Effect of mechanical harvesting and handling of tomatoes on quality of canned tomatoes / Wilbur A. Gould, J. R. Geisman, Edwin Schmidt, Jr., John McClelland and W. N. Brow

Evidence-based PET for thoracic tumours

AbstractFluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a robust imaging tool that is currently used in daily clinical practice for the evaluation of thoracic malignancies. This chapter provides an overview of the current evidence-based data on the usefulness of PET/CT for the evaluation of patients with thoracic tumours including lung cancer, pleural and thymic tumours, and esophageal cancer

Programme de remédiation cognitive pour patients présentant une schizophrénie ou un trouble associé (Recos) : résultats préliminaires [Cognitive remediation program for individuals living with schizophrenia (Recos): preliminary results].

BACKGROUND: Nowadays, cognitive remediation is widely accepted as an effective treatment for patients with schizophrenia. In French-speaking countries, techniques used in cognitive remediation for patients with schizophrenia have been applied from those used for patients with cerebral injury. As cognitive impairment is a core feature of schizophrenia, the Département de psychiatrie du CHUV in Lausanne (DP-CHUV) intended to develop a cognitive remediation program for patients with a schizophrenia spectrum disease (Recos-Vianin, 2007). Numerous studies show that the specific cognitive deficits greatly differ from one patient to another. Consequently, Recos aims at providing individualized cognitive remediation therapy. In this feasibility trial, we measured the benefits of this individualized therapy for patients with schizophrenia. Before treatment, the patients were evaluated with a large battery of cognitive tests in order to determine which of the five specific training modules - Verbal memory, visuospatial memory and attention, working memory, selective attention, reasoning - could provide the best benefit depending on their deficit. OBJECTIVES: The study was designed to evaluate the benefits of the Recos program by comparing cognitive functioning before and after treatment. METHOD: Twenty-eight patients with schizophrenia spectrum disorders (schizophrenia [n=18], schizoaffective disorder [n=5], schizotypal disorder [n=4], schizophreniform disorder [n=1], DSM-IV-TR) participated in between one and three of the cognitive modules. The choice of the training module was based on the results of the cognitive tests obtained during the first evaluation. The patients participated in 20 training sessions per module (one session per week). At the end of the training period, the cognitive functioning of each patient was reevaluated by using the same neuropsychological battery. RESULTS: The results showed a greater improvement in the cognitive functions, which were specifically trained, compared to the cognitive functions, which were not trained. However, an improvement was also observed in both types of cognitive functions, suggesting an indirect cognitive gain. CONCLUSION: In our view, the great heterogeneity of the observed cognitive deficits in schizophrenia necessitates a detailed neuropsychological investigation as well as an individualized cognitive remediation therapy. These preliminary results need to be confirmed with a more extended sample of patients

Schizophrenia connectivity investigation by DTI Tractography

Multiple lines of evidence suggest that schizophrenia is associated with abnormalities in neural circuitry and impaired structural connectivity. Although largely investigated by imaging studies, very few results have been published on in-vivo image-based connectivity investigations, and those published report often contradictory findings. In this study, we propose to conduct a group study to evaluate the differences in structural connectivity between schizophrenic patients and control subjects using Diffusion MRI. The proposed methodology is based on Tractography, a technique inferring the main neural fiber tracks from Diffusion MRI data. We study mainly the thalamo-frontal fiber-tracts, supposed to be involved in schizophrenia

Cancer Screening: The Journey from Epidemiology to Policy

Purpose: Cancer screening procedures have brought great benefit to the public's health. However, the science of cancer screening and the evidence arising from research in this field as it is applied to policy is complex and has been difficult to communicate, especially on the national stage. We explore how epidemiologists have contributed to this evidence base and to its translation into policy. Methods: Our essay focuses on breast and lung cancer screening to identify commonalities of experience by epidemiologists across two different cancer sites and describe how epidemiologists interact with evolving scientific and policy environments. Results: We describe the roles and challenges that epidemiologists encounter according to the maturity of the data, stakeholders, and the related political context. We also explore the unique position of cancer screening as influenced by the legislative landscape where, due to recent healthcare reform, cancer screening research plays directly into national policy. Conclusions: In the complex landscape for cancer screening policy, epidemiologists can increase their impact by learning from past experiences, being well prepared and communicating effectively. © 2012 Elsevier Inc