A Prognostic Model for the Thirty-day Mortality Risk after Adult Heart Transplantation

Objective: To develop a prognostic model for the thirty-day mortality risk after adult heart transplantation. Methods: In this report we developed a prediction model for the 30-day mortality risk after adult heart transplantation. Logistic regression analysis was used to develop the model in 1,262 adult patients undergoing primary heart transplantation. We evaluated the accuracy of the prediction model; the agreement between the predicted probability and the observed mortality (calibration); and the ability of the model to correctly discriminate between the discordant survival pairs (discrimination). The internal validity of the prediction model was evaluated using the bootstrapping procedures. Results: Recipients age and sex, pre-transplant diagnosis, transplant status, waiting time, cardiopulmonary bypass time, donors age and sex, donor-recipient mismatch for BMI and blood type were independent predictors for 30-day mortality risk after adult heart transplantation. The model showed a good calibration and reasonable discrimination (the corrected area under the receiver operating characteristic curve was 0.71). The internal validity of the prediction model was acceptable. For practical use, we converted the prediction model to score chart. Conclusion: The accuracy and the validity of the prediction model were acceptable. This easy-to-use instrument for predicting the 30-day mortality risk after adult heart transplantation would benefit decision-making by classifying recipients according to their mortality risk and allowing optimal allocation of a donor to a recipient for heart transplantation

Solitary metastatic adenocarcinoma of the sternum treated by total sternectomy and chest wall reconstruction using a Gore-Tex patch and myocutaneous flap: a case report

<p>Abstract</p> <p>Introduction</p> <p>The consequences of bone metastasis are often devastating. Although the exact incidence of bone metastasis is unknown, it is estimated that 350,000 people die of bone metastasis annually in the United States. The incidence of local recurrences after mastectomy and breast-conserving therapy varies between 5% and 40% depending on the risk factors and primary therapy utilized. So far, a standard therapy of local recurrence has not been defined, while indications of resection and reconstruction considerations have been infrequently described. This case report reviews the use of sternectomy for breast cancer recurrence, highlights the need for thorough clinical and radiologic evaluation to ensure the absence of other systemic diseases, and suggests the use of serratus anterior muscle flap as a pedicle graft to cover full-thickness defects of the anterior chest wall.</p> <p>Case presentation</p> <p>We report the case of a 70-year-old Caucasian woman who was referred to our hospital for the management of a retrosternal mediastinal mass. She had undergone radical mastectomy in 1999. Computed tomography and magnetic resonance imaging revealed a 74.23 × 37.7 × 133.6-mm mass in the anterior mediastinum adjacent to the main pulmonary artery, the right ventricle and the ascending aorta. We performed total sternectomy at all layers encompassing the skin, the subcutaneous tissues, the right pectoralis major muscle, all the costal cartilages, and the anterior part of the pericardium. The defect was immediately closed using a 0.6 mm Gore-Tex cardiovascular patch combined with a serratus anterior muscle flap. Our patient had remained asymptomatic during her follow-up examination after 18 months.</p> <p>Conclusion</p> <p>Chest wall resection has become a critical component of the thoracic surgeon's armamentarium. It may be performed to treat either benign conditions (osteoradionecrosis, osteomyelitis) or malignant diseases. There are, however, very few reports on the results of full-thickness complete chest wall resections for locally recurrent breast cancer with sufficient safety margins, and even fewer reports that describe the operative technique of using the serratus anterior muscle as a pedicled flap.</p

Studies of the collimation system for the TTF FEL at DESY

A collimation scheme for the protection of the undulators at the TESLA Test Facility phase 2 (TTF2) is discussed. The transverse and energy collimation, and the protection against off-energy and mis-steered bunches are proposed in a beam line which, besides the collimation elements, integrates the fast feedback system and matches the beam to the undulator entrance

Studies of the collimation system for the TTF FEL at DESY

A collimation scheme for the protection of the undulators at the TESLA Test Facility phase 2 (TTF2) is discussed. The transverse and energy collimation, and the protection against off-energy and mis-steered bunches are proposed in a beam line which, besides the collimation elements, integrates the fast feedback system and matches the beam to the undulator entrance

Near-wall wakefields for optimized geometry of TTF 2 collimator

Wakefields excited in the small aperture collimators may damage the beam. As pointed out by K. Bane and P. Morton the wakefields can be reduced considerably by tapering the steps and using the “step+taper” collimator geometry. The optimisation of this kind of geometry for TTF 2 collimators with different apertures is carried out in the paper. For the optimal geometries the non-linear near-wall wakefields are calculated. The numerical results are confirmed by comparison with analytical estimations for the fully tapered collimator in inductive regime

The quality of the coronary arteries influences the outcome of bypass surgery [6] (multiple letters)

10.1016/j.athoracsur.2003.08.078Annals of Thoracic Surgery7841515-1517ATHS