Operative complications and early mortality after induction therapy for lung cancer

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Magnetic resonance-fluoroscopy as long-term follow-up examination in patients with narrow gastric tube reconstruction after radical esophagectomy

Objective: To evaluate the functionality and morphology of neo-esophagus in subjects who underwent narrow gastric tube (NGT) reconstruction after total esophagectomy using magnetic resonance (MR)-fluoroscopy with Turbo-FLASH sequences acquired during positive oral contrast agent administration. Methods and materials: Ten patients, who underwent NGT reconstruction after total esophagectomy between 2002 and 2004, were studied using a 1.5 T magnet (Magnetom Avanto: Siemens, Erlangen, Germany, featuring total imaging matrix-TIM (R) technology), equipped with surface phased-array and integrated spine coils. Imaging protocol included TRUFI and Turbo-FLASH sequences (TR = 600 ms; TE = 1.3 ms; Flip Angle 8 degrees; Thickness 20 mm; FoV 350; Matrix 128 x 256; N. acquisition 120; TA = 50 s) acquired on sagittal. and axial planes to achieve motility evaluation during oral administration of positive contrast agent (yoghurt + Gd-DTPA 0.5 M, 1:100 boluses). Results: Good quality images were obtained in all patients, with adequate lumen contrast and a frame rate of 2.5 frames per second (fps). Three patients had completely re-established motility of NGT, six patients had mild to moderate alterations including raised transit time, reflux and contrast agent stasis; one patient had severe alterations with grossly dilated NGT, severe reflux and stasis. Conclusions: MR-fluoroscopy approach represents a promising radiation-free modality in the evaluation of functionality and morphology of NGT Further investigation in the evaluation of post-surgery patients is necessary. (c) 2006 Elsevier B.V. All rights reserved

Cystic fibrosis and the thoracic surgeon

Indications for thoracic surgery in patients with cystic fibrosis (CF) are principally represented by pleural diseases including pneumothorax, pleural effusion, and empyema and by parenchymal lung diseases including bronchiectasis, hemoptysis, and pulmonary abscess. Moreover, lung transplantation has proved a viable therapeutic option for progressive respiratory failure due to end-stage CF. Main surgical experiences in this setting are reviewed and discussed. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B. V. All rights reserved

Thoracoscopic resection of mediastinal bronchogenic cysts in adults

Objective: Bronchogenic cysts are uncommon congenital anomalies of foregut origin usually located within the mediastinum and the lung and rarely diagnosed in adults. Surgical excision is recommended to establish diagnosis based on histologic examination, alleviate symptoms if present, and prevent future complications. Thoracoscopic approach is becoming the primary therapeutic option. Methods: Between January 1995 and July 2008, 30 patients with mediastinal bronchogenic cyst (MBC) underwent thoracoscopic operation (19 mate, 11 female with a mean age of 39 years, range 19-59 years). Symptoms were present in 11 patients (37). Results: The cysts averaged 5.2 cm in their greatest diameter (range 3-10.5 cm). In two cases thoracoscopy was converted to thoracotomy because of major pleural adhesions. There were no operative deaths and no intra-operative complications. Postoperative course was uneventful in all cases and the 28 patients who underwent thoracoscopy were discharged after a mean of 3.7 days (range 2-5 days). Conclusions: Considering the low conversion and complication rate, thoracoscopic excision of bronchogenic mediastinal cyst should be considered the primary therapeutic option. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Long-term Doppler echocardiographic evaluation of the right heart after major lung resections

Objective: The effects of major lung resections on cardiac function in the medium and long term have not been thoroughly evaluated. We have studied right heart function with serial Doppler echocardiography in patients undergoing lobectomy and pneumonectomy during 4 years of follow-up after surgery. Methods: Thirty-six patients undergoing lobectomy and 15 receiving pneumonectomy were evaluated with one- and two-dimensional Doppler standard transthoracic echocarchography before surgery and 1 week, 3 months, 6 months, 1 year, and 4 years postoperatively. We have studied the right midventricular diastolic diameter (RVDD), the right ventricle free wait thickness, the tricuspid valve insufficiency (TVI) and regurgitation jet (TRJ), and the pulmonary artery systolic pressure (PASP). Results: None of the patients died within the first postoperative year. After lobectomy there were no significant modifications of any variable at any time. RVDD progressively increased after pneumonectomy (26.5 +/- 2.2 mm preoperatively vs 34.3 +/- 7.6 at 4 years; p < 0.001). Four years after surgery all. patients undergoing pneumonectomy had moderate TVI while only 55% of patients receiving lobectomy showed it (tow grade in 50% and moderate in 5%). In this group of patients PASP increased from 26.1 +/- 2.6 mmHg preoperatively to 34.3 7.6 mmHg at 4 years (p < 0.00001). Conclusions: Right ventricle modifications are clearly evident after pneumonectomy and even if they do not show a clear clinical impact they should not be neglected. (C) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

A Europe-South America network for climate change assessment and impact studies

International audienceThe goal of the CLARIS project was to build an integrated European-South American network dedicated to promote common research strategies to observe and predict climate changes and their consequent socio-economic impacts taking into account the climate and societal peculiarities of South America. Reaching that goal placed the present network as a privileged advisor to contribute to the design of adaptation strategies in a region strongly affected by and dependent on climate variability (e. g. agriculture, health, hydro-electricity). Building the CLARIS network required fulfilling the following three objectives: (1) The first objective of CLARIS was to set up and favour the technical transfer and expertise in earth system and regional climate modelling between Europe and South America together with the providing of a list of climate data (observed and simulated) required for model validations; (2) The second objective of CLARIS was to facilitate the exchange of observed and simulated climate data between the climate research groups and to create a South American high-quality climate database for studies in extreme events and long-term climate trends; (3) Finally, the third objective of CLARIS was to strengthen the communication between climate researchers and stakeholders, and to demonstrate the feasibility of using climate information in the decision-making process. © Springer Science + Business Media B.V. 2009