Role of systemic inflammation scores in pulmonary metastasectomy for colorectal cancer

Background: Patients with pulmonary metastases from colorectal cancer can benefit from surgical removal.However, the biological determinants of postsurgical outcome are not completely elucidated. We evaluated the role of host systemic inflammation status in this setting. Methods: The modified Glasgow prognostic score (based on serum C-reactive protein and albumin levels) and the neutrophil-to-lymphocyte (NTL) ratio were obtained from 44 patients who received curative-intent metastasectomy, and were used as indicators of systemic inflammation status.We tested the impact of both of these parameters on overall survival (OS) and progression-free survival (PFS), as well as their correlation with other well-known prognosticators. Results: Five-year PFS and OS rates were 18% and 49%, respectively. At univariate analysis,multiple metastases, disease-free interval <36 months, and a Glasgow score of 2 (P = 0.031)were significantly associated to aworse PFS rate.A NTL ratio >3 predicted disease progression in the short-term(P = 0.036), but the effect on late events was weaker (P = 0.079). Factors associated with worse OS were multiple metastasis (P = 0.002), elevated carcinoembryonic antigen (P = 0.009), a Glasgowscore of 2 (P = 0.029), and a faster metastasis growth (P = 0.008).At Cox regression analysis, neither a Glasgow score of 2, nor elevated NTL ratio showed an independent effect on survival rates. Conclusions: Systemic inflammation scores did not perform well as independent survival prognosticators in patients undergoing curative-intent pulmonary metastasectomy. Further investigation is warranted to evaluate whether these measurements could still be useful when restricting the analysis to specific patient subcategories or to diverse postoperative phases

Eddington limited starbursts in the central 10pc of AGN, and the Torus in NGC1068

We present results from a survey of nearby AGN using the near infrared adaptive optics integral field spectrograph SINFONI. These data enable us to probe the distribution and kinematics of the gas and stars at spatial resolutions as small as 0.085arcsec. We find strong evidence for recent but short lived starbursts residing in very dense nuclear disks. On scales of less than 10pc these would have reached Eddington-limited luminosities when active, perhaps accounting for their short duration. In addition, for NGC1068 at a resolution of 6pc, we present direct observations of molecular gas close around the AGN which we identify with the obscuring torus.Comment: Conference proceedings to appear in "The Central Engine of Active Galactic Nuclei", ed. L. C. Ho and J.-M. Wang (San Francisco: ASP

Duration of air leak is reduced after awake nonresectional lung volume reduction surgery

OBJECTIVE: Prolonged air leak occurs frequently after lung volume reduction surgery (LVRS) and can negatively affect both morbidity and hospital stay. We hypothesised that awake nonresectional LVRS could reduce the duration of air leak in emphysema patients. METHODS: This analysis included 66 patients undergoing awake, unilateral plication of the most emphysematous lung regions under sole epidural anaesthesia. Primary outcome measure was the rate of prolonged (>7 days) air leak; secondary outcome measures included the mean duration of air leak, hospital stay and early discharges (<or=4 days). All results were retrospectively compared with those of a similar control group undergoing resectional LVRS under general anaesthesia. RESULTS: Intergroup comparisons showed that demographics and baseline data were well matched. Prolonged air leak occurred in 12 patients (18%) in the awake group versus 27 patients (40%) in the control group (p=0.007) with a mean duration of 5.2+/-6.5 days versus 7.9+/-7.6 days (p<0.0002). Mean hospital stay was significantly shorter in the awake group (6.3+/-2.8 days vs 9.2+/-5.6 days, p<0.0001). At univariate analysis, resectional LVRS (p=0.007), higher severity of emphysema (p<0.0001) and lower diffusion capacity for carbon monoxide (p=0.0001) correlated with occurrence of prolonged air leak; however, logistic regression indicated high severity of emphysema as the most important factor predicting prolonged air leak (odds ratio=4.85, p<0.0001). At 6 months, dyspnoea index, FEV1 and 6 min walking test improved significantly in both study groups. CONCLUSIONS: In this study, awake nonresectional LVRS was associated with a lower rate of prolonged air leak and a shorter hospital stay than the standard resectional technique

Near IR diffraction-limited integral-field SINFONI spectroscopy of the Circinus galaxy

Using the adaptive optics assisted near infrared integral field spectrometer SINFONI on the VLT, we have obtained observations of the Circinus galaxy on parsec scales. The morphologies of the H_2(1-0)S(1) 2.12um and Br_gamma 2.17um emission lines are only slightly different, but their velocity maps are similar and show a gradient along the major axis of the galaxy, consistent with rotation.Since V_rot/sigma is approximately 1 suggests that random motions are also important, it is likely that the lines arise in a rotating spheroid or thickened disk around the AGN. Comparing the Br_gamma flux to the stellar continuum indicates that the star formation in this region began almost 10^8 yr ago. We also detect the [SiVI] 1.96um,[AlIX] 2.04um and [CaVIII] 2.32um coronal lines. In all cases we observe a broad blue wing, indicating the presence of two or more components in the coronal line region. A correlation between the ionisation potential and the asymmetry of the profiles was found for these high excitation species.Comment: 6 pages, 5 figures, Submitted to the Proceedings of the IFS Workshop, Jul 4-8 2005, Durham, Englan

Simultaneous Bilateral Spontaneous Pneumothorax Revealed Birt-Hogg-Dube Syndrome

Simultaneous bilateral spontaneous pneumothorax is a very rare clinical event, comprising approximately 1% of all spontaneous pneumothoraces. Clinical signs and symptomsmay vary frommild chest pain and dyspnea to severe respiratory failure; nevertheless immediate treatment is mandatory as this condition can deteriorate and progress to tension pneumothorax. An underlying lung disease has been commonly described; in most istances primary or secondary tumors, interstitial diseases, and infectious diseases. Birt-Hogg-Dube syndrome is a rare inherited disorder clinically characterized by multiple fibrofolliculomas, renal tumors, lung cysts, and, in similar to 24% of the patients, occurrence of spontaneous pneumothorax. In this case, we firstly report the concurrence of these rare conditions, as a patient presenting a simultaneous bilateral spontaneous pneumothorax was diagnosed with Birt-HoggDube syndrome based on the typical radiological findings and genetic testing of the folliculin gene located on chromosome 17

Landslide damming hazard susceptibility maps: a new GIS-based procedure for risk management

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Talc pleurodesis for malignant pleural effusion: efficacy and factors predicting recurrence

Objectives: To identify potential factors predicting recurrence after talc pleurodesis for malignant pleural effusion. Methods: Retrospective study of two cohorts of consecutive patients undergoing surgery for malignant pleural effusion (T VATS/talc pleurodesis number of procedures n = 41, IPC VATS/indwelling pleural catheter n = 41). Data analysed: ASA, performance status, underlying histology, amount of effusion drained at initial procedure, morbidity, recurrence of effusion (RecEff), redo surgery due to recurrence. The definition of RecEff was based on imaging (at least CxR) and related report issued by a senior radiologist. Median radiological follow-up of both groups was identical (8 months). Statistical analysis was done through SPSS ver 21. Results: The RecEff rate was 20% in the IPC group and 32% in the T group. Fifty percent (4/8) of patients with failed pleurodesis in the IPC group required redo surgery compared to 92% (12/13) in the T group, which was significant. Median time to recurrence in the IPC group was 9 months, in the T group 4 months. In the T group the only relevant factor associated with recurrence was lung cancer histology (P = 0.055). The statistical significance of ASA score >2 (P = 0.042) and performance status 2 (P = 0.019) in this context is difficult to interpret. There were no significant differences between cohorts in age (69.5 years [60-78.2]), gender (41 males and 41 females), ASA (3 [2-3]), performance status (1 [1-2]), millilitres of effusion drained (1600 [1000-2550]), site of primary (mesothelioma 32% of patients, lung Ca 21%) and morbidity (7%). Conclusions: The recurrence rate after talc pleurodesis was notably higher compared to the IPC group in our study and a significant number of patients affected required redo surgery. Lung cancer histology was the only clinically relevant predictor of recurrence in the talc group, potentially favouring the choice of a primary IPC insertion for these patients rather than chemical pleurodesis