Long-term results after carinal resection for carcinoma: Does the benefit warrant the risk?

ObjectiveWe sought to determine whether the benefit warrants the risk in patients undergoing carinal resection for carcinoma.MethodsThis was a retrospective single-center study.ResultsBetween June 1981 and August 2004, 119 patients underwent carinal resection for carcinoma in our institution. Carinal pneumonectomy was performed in 103 cases (96 right and 7 left pneumonectomies), carinal resection plus right upper lobectomy in 3, carinal resection after left pneumonectomy in 2, and carinal resection without pulmonary resection in 11. Superior vena caval resection was combined with carinal pneumonectomy in 25 patients with bronchogenic carcinoma (13 patients had complete superior vena caval resection with graft interposition). Nine (7.6%) patients died in the hospital or within 30 days of the operation. Follow-up was complete for 117 (98%) patients up to August 2004 or to the date of death. The 5- and 10-year survivals were 44% and 25%, respectively, for patients with bronchogenic carcinoma (n = 100). However, survival was significantly better in patients with N0 or N1 disease (n = 73) than in those with N2 or N3 disease (n = 27; 53% vs 15% at 5 years, respectively). The 5- and 10-year survivals in the remaining 19 patients reached 66% and 48%, respectively, and were best in patients with neuroendocrine carcinoma (100% survival at 10 years) and adenoid cystic carcinoma (69% survival at 10 years).ConclusionsSurgical intervention for carcinoma involving the carina is feasible, with acceptable mortality and good long-term survival in selected patients. The presence of positive N2 disease should, however, be considered a potential contraindication to carinal resection in patients with bronchogenic carcinoma because of the poor long-term survival

En bloc resection of non-small cell lung cancer invading the thoracic inlet and intervertebral foramina

AbstractObjective: In patients with non-small cell lung cancer invading the thoracic inlet, the transcervical approach does not permit removal of tumor in the intervertebral foramina. We report a variant that lifts this limitation. Methods: Through the transcervical approach, resectability was assessed and tumor-bearing structures were removed, leaving tumor-free margins. Standard upper lobectomy was performed, leaving the lobe in place. A posterior midline approach was used for multilevel unilateral laminectomy, nerve root division inside the spinal canal, and vertebral body division along the midline. The tumor was removed en bloc with the lung, ribs, and vessels through the posterior incision. Fixation of the spine was performed. Medical charts of patients treated with this technique between October 1994 and April 2001 were reviewed retrospectively. Results: Seventeen patients (mean age 45 years) were treated. Resection of the upper lobe and T1 root was done in all 17 cases; 3- and 4-level hemivertebrectomies were done in 13 and 3 cases, respectively; 2-level total vertebral body resection and 2-level hemivertebrectomy were done in 1 case; and resections of the phrenic nerve and subclavian artery were done in 7 and 6 patients, respectively. There were no perioperative deaths or residual neurologic impairments. Postoperative complications were pneumonia (n = 6), cerebrospinal fluid leakage (n = 1), wound breakdown (n = 1), and bleeding necessitating reoperation (n = 1). The overall 3- and 5-year survivals were 39% and 20%, respectively. Conclusions: Non-small cell lung cancers invading the thoracic inlet and intervertebral foramina can be removed completely through a combined anterior transcervical and posterior midline approach, with good results.J Thorac Cardiovasc Surg 2002;123:676-8

Stark effect in a wedge-shaped quantum box

The effect of an external applied electric field on the electronic ground state energy of a quantum box with a geometry defined by a wedge is studied by carrying out a variational calculation. This geometry could be used as an approximation for a tip of a cantilever of an atomic force microscope. We study theoretically the Stark effect as function of the parameters of the wedge: its diameter, angular aperture and thickness; as well as function of the intensity of the external electric field applied along the axis of the wedge in both directions; pushing the carrier towards the wider or the narrower parts. A confining electronic effect, which is sharper as the wedge dimensions are smaller, is clearly observed for the first case. Besides, the sign of the Stark shift changes when the angular aperture is changed from small angles to angles theta>pi. For the opposite field, the electronic confinement for large diameters is very small and it is also observed that the Stark shift is almost independent with respect to the angular aperture.Comment: 23 pages, 9 figures, 1 tabl

Development of a Multivariate Prediction Model for Early-Onset Bronchiolitis Obliterans Syndrome and Restrictive Allograft Syndrome in Lung Transplantation.

Chronic lung allograft dysfunction and its main phenotypes, bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), are major causes of mortality after lung transplantation (LT). RAS and early-onset BOS, developing within 3 years after LT, are associated with particularly inferior clinical outcomes. Prediction models for early-onset BOS and RAS have not been previously described. LT recipients of the French and Swiss transplant cohorts were eligible for inclusion in the SysCLAD cohort if they were alive with at least 2 years of follow-up but less than 3 years, or if they died or were retransplanted at any time less than 3 years. These patients were assessed for early-onset BOS, RAS, or stable allograft function by an adjudication committee. Baseline characteristics, data on surgery, immunosuppression, and year-1 follow-up were collected. Prediction models for BOS and RAS were developed using multivariate logistic regression and multivariate multinomial analysis. Among patients fulfilling the eligibility criteria, we identified 149 stable, 51 BOS, and 30 RAS subjects. The best prediction model for early-onset BOS and RAS included the underlying diagnosis, induction treatment, immunosuppression, and year-1 class II donor-specific antibodies (DSAs). Within this model, class II DSAs were associated with BOS and RAS, whereas pre-LT diagnoses of interstitial lung disease and chronic obstructive pulmonary disease were associated with RAS. Although these findings need further validation, results indicate that specific baseline and year-1 parameters may serve as predictors of BOS or RAS by 3 years post-LT. Their identification may allow intervention or guide risk stratification, aiming for an individualized patient management approach

Recent Advances in Tracheal Surgery

Sacha Mussot of the Marie Lannelongue Hospital in Le Plessis-Robinson, France, discusses tracheal resection. He focuses on advances in replacing or reconstructing the trachea in cases where too much tissue is removed for a tracheal anastomosis to be possible.<div>This presentation was originally given during the SCTS Ionescu University program at the 2017 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of <a href="https://scts.org/">SCTS</a>. Please <a href="https://sctsed.org/">click here</a> for more information on SCTS educational programs.<br></div

Hémoptysies dans l hypertension artérielle pulmonaire post-embolique avant et après thrombo-endartériecomie pulmonaire

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Hydatidose artérielle pulmonaire chronique

National audienc