Multiple Lung Transplant in a Patient Within 25 Years: A Case Report

With survival after retransplant improving over the years, issues regarding multiple retransplant have emerged. Here, we report the 25-year follow-up of a 16-year-old male patient who received 4 successful lung transplant procedures in 1990, 1991, 1995, and 2005

Surgical Stabilization for Multiple Rib Fractures: Whom the Benefit? -A Prospective Observational Study

Background: Surgical repair has demonstrated a beneficial effect on outcome for patients presenting with flail chest or with multiple rib fractures. We hypothesized that benefit on outcome parameters concerns predominantly patients being extubated within 24 hours post-operatively. Methods: We prospectively recorded all patients presenting with chest traumatism eligible for surgical repair with anticipated early extubation according to our institutional consensus (flail chest, major deformity, poor pain control, associated lesions requiring thoracotomy). We compared outcomes of patients extubated within 24 hours post-operatively to those who required prolonged ventilator support. We tested predictive factors for prolonged intubation with univariate and multivariate analysis. Results: From 2010 to 2014, 132 patients required surgical repair. Two thirds were extubated within 24 hours following surgical repair. Pneumonia was the main complication and occurred in 30.3% of all patients. Patients extubated within 24 hours following surgical repair had significantly shorter ICU stay and shorter in-hospital stay (P<0.0001 both). Pneumonia occurred significantly more often in patients with longer mechanical ventilation (over 24 hours) (P<0.0001) and the overall post-operative complications rate was higher (P=0.0001). Main independent risk factors for delayed extubation were bilateral chest rib fractures and initially associated pneumothorax. Conclusions: We conclude that patients extubated within 24 hours after repair have an improved outcome with reduced complication rate and shorter hospital stay. The initial extent of the trauma is an important risk factor for delayed extubation and high complication rate despite surgical stabilization

Case Rep Oncol

The pretreatment detection of an activating mutation of EGFR is now routinely performed in metastatic nonsquamous non-small cell lung cancer (NSCLC). The therapeutic impact of such a detection is major, as patients with advanced NSCLC exhibiting a mutation of exon 19 or 21 will benefit from EGFR-tyrosine kinase inhibitors (TKI). The presence of an EGFR resistance mutation, such as T790M in EGFR-TKI-naïve patients, is seldom looked for and is related either to a germinal mutation or to somatically mutated subclones. It has a negative predictive impact. We present the case of a patient with a lung papillary adenocarcinoma and miliary intrapulmonary metastases whose tumor displays a somatic complex heterozygous EGFR mutation, combining L858R (exon 21) and a primary resistance mutation T790M (exon 20), both detected by direct sequencing

European Respiratory Society Statement on Thoracic Ultrasound

Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures, and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training, and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multi-centre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound

European guidelines on structure and qualification of general thoracic surgery

OBJECTIVE To update the recommendations for the structural characteristics of general thoracic surgery (GTS) in Europe in order to provide a document that can be used as a guide for harmonizing the general thoracic surgical practice in Europe. METHODS A task force was created to set the structural, procedural and qualification characteristics of a European GTS unit. These criteria were endorsed by the Executive Committee of the European Society of Thoracic Surgeons and by the Thoracic Domain of the European Association for Cardio-Thoracic Surgery and were validated by the European Board of Thoracic Surgery at European Union of Medical Specialists. RESULTS Criteria regarding definition and scope of GTS, structure and qualification of GTS unit, training and education and recommendations for subjects of particular interest (lung transplant, oesophageal surgery, minimally invasive thoracic surgery, quality surveillance) were developed. CONCLUSIONS This document will hopefully represent the first step of a process of revision of the modern thoracic surgeons' curricula, which need to be qualitatively rethought in the setting of the qualification process. The structural criteria highlighted in the present document are meant to help and tackle the challenge of cultural and language barriers as well as of widely varying national training programme

Migration von /sw vom AFS ins DCE/DFS

/sw ist eine verteilte Softwarebereitstellung mit dem Ziel, jedem Benutzer Software zentral zur Verfügung zu stellen, ohne daß er sich darum kümmern muß, woher er seine Software bekommt. Für eine Außenstehenden ergibt sich somit das Bild eines großen Softwarepools, aus dem er sich fertig installierte Software für seine Plattform herunterladen kann. Voraussetzung dafür ist, daß ein Benuzter an seiner Workstation über AFS (Andrew File System), DFS (Distributed File System) oder ftp verfügt. Zur Zeit werden vom /sw für 18 verschiedenen Unix-Plattformen 594 Programme in 1024 verschiedenen Installationen angeboten. Die meisten Architekturen vom /sw liegen im AFS, bis auf die Architekturen DEC ALPHA, IRIX 4.0 und Linux, die im NFS liegen. In Zukunft wird es für die gesamte /sw Software nur noch eine Quelle geben, das DFS. Mit der Migration von /sw aus dem AFS ins DFS entfällt dann die Trennung von /sw in einen AFS-Teil und einem NFS-Teil und damit auch der AFS/NFS-Translators, der recht unstabil läuft. Die gesamte Software von /sw wurde aus dem AFS bzw. NFS ins DFS migriert, so daß für alle vom /sw unterstützten Architekturen nur noch eine Quelle zur Verfügung steht, die Stuttgarter DCE-Zelle. Jeder AFS-Klient hat über den AFS/DFS-Translator Zugriff auf /sw und für die NFS-Klienten wird das /sw-Fi-lesystem exportiert, so daß jeder NFS-Klient die Möglichkeit hat das DFS-Filesystem /sw zu mounten. Eine Workstation kann sowohl AFS- als auch DCE/DFS-Klient sein

Perforations de l'oesophage (A propos d'une série rétrospective de 37 patients; Résultats)

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