Neoadjuvant therapy reduces cardiopulmunary function in patients undegoing oesophagectomy

Neoadjuvant therapy (NAT) for oesophageal cancer may reduce cardiopulmonary function, assessed by cardiopulmonary exercise testing (CPEX). Impaired cardiopulmonary function is associated with mortality following esophagectomy. We sought to assess the impact of NAT on cardiopulmonary function using CPEX and assessing the clinical relevance of any change in particular if changes were associated with post-operative morbidity. This was a prospective, cohort study of 40 patients in whom CPEX was performed before and after NAT. Thirty-eight patients underwent surgery and follow-up with perioperative outcomes measured. The primary variables derived from CPEX were the anaerobic threshold (AT) and peak oxygen uptake (V˙Opeak). There were significant reductions in the AT (pre-NAT: 12.4 ± 3.0 vs. post-NAT 10.6 ± 2.0 mL kg.min; p = 0.001). This reduction was also evident for V˙Opeak (pre-NAT: 16.6 ± 3.6 vs. post-NAT 14.9 ± 3.7 mL kg.min; p = 0.004). The relative reduction in V˙Opeak was greater in chemotherapy patients who developed any peri-operative morbidity (p = 0.04). For patients who underwent chemoradiotherapy, there was a significantly greater relative reduction in AT (p = 0.03) for those who encountered a respiratory complication. Cardiopulmonary function significantly declined as a result of NAT prior to oesophagectomy. The reduction in AT and V˙Opeak was similar in both the chemotherapy and chemoradiotherapy groups

Associations of statins and diabetes with diagnosis of ulcerated cutaneous melanoma

Ulcerated primary melanomas are associated with an inflammatory tumor microenvironment. We hypothesized that systemic proinflammatory states and anti-inflammatory medications are also associated with a diagnosis of ulcerated melanoma. In a cross-sectional study of 787 patients with newly diagnosed clinical stage IB or II melanoma, we estimated odds ratios for the association of proinflammatory factors (high body mass index, diabetes, cardiovascular disease, hypertension, and smoking) or the use of anti-inflammatory medications (statins, aspirin, corticosteroids, and nonsteroidal anti-inflammatory drugs), with ulcerated primary melanoma using regression models and subgroup analyses to control for melanoma thickness and mitotic rate. On the basis of information from 194 patients with ulcerated and 593 patients with nonulcerated primary melanomas, regular statin users had lower likelihood of a diagnosis of ulcerated primary melanoma (odds ratio 0.67, 95% confidence interval 0.45-0.99), and this association remained after adjusting for age, sex, thickness, and mitosis. When analysis was limited to melanomas that wer

Successful management of an aortoesophageal fistula caused by a fish bone – case report and review of literature

We report a case of aortoesophageal fistula (AEF) caused by a fish bone that had a successful outcome. Aortoesophageal fistula is a rare complication of foreign body ingestion from which few patients survive. Over one hundred cases of AEF secondary to foreign body ingestion have been documented but only seven, including our case, have survived over 12 months. Treatment involved stabilising the patient with a Sengstaken-Blakemore tube and insertion of a thoracic aortic endovascular stent-graft. Unfortunately the stent became infected and definitive open surgical repair involved removing the stent, replacing the aorta with a homograft and coverage with a left trapezius flap while under deep hypothermic arrest

Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial - the MIRO trial

<p>Abstract</p> <p>Background</p> <p>Open transthoracic oesophagectomy is the standard treatment for infracarinal resectable oesophageal carcinomas, although it is associated with high mortality and morbidity rates of 2 to 10% and 30 to 50%, respectively, for both the abdominal and thoracic approaches. The worldwide popularity of laparoscopic techniques is based on promising results, including lower postoperative morbidity rates, which are related to the reduced postoperative trauma. We hypothesise that the laparoscopic abdominal approach (laparoscopic gastric mobilisation) in oesophageal cancer surgery will decrease the major postoperative complication rate due to the reduced surgical trauma.</p> <p>Methods/Design</p> <p>The MIRO trial is an open, controlled, prospective, randomised multicentre phase III trial. Patients in study arm A will receive laparoscopic-assisted oesophagectomy, i.e., a transthoracic oesophagectomy with two-field lymphadenectomy and laparoscopic gastric mobilisation. Patients in study arm B will receive the same procedure, but with the conventional open abdominal approach. The primary objective of the study is to evaluate the major postoperative 30-day morbidity. Secondary objectives are to assess the overall 30-day morbidity, 30-day mortality, 30-day pulmonary morbidity, disease-free survival, overall survival as well as quality of life and to perform medico-economic analysis. A total of 200 patients will be enrolled, and two safety analyses will be performed using 25 and 50 patients included in arm A.</p> <p>Discussion</p> <p>Postoperative morbidity remains high after oesophageal cancer surgery, especially due to major pulmonary complications, which are responsible for 50% of the postoperative deaths. This study represents the first randomised controlled phase III trial to evaluate the benefits of the minimally invasive approach with respect to the postoperative course and oncological outcomes in oesophageal cancer surgery.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00937456">NCT00937456</a> (ClinicalTrials.gov)</p

Writing in Britain and Ireland, c. 400 to c. 800

No abstract available

Data from: Dissecting the contributions of plasticity and local adaptation to the phenology of a butterfly and its host plants

Phenology affects the abiotic and biotic conditions that an organism encounters and consequently its fitness. For populations of high latitude species, spring phenology often occurs earlier in warmer years and regions. Here we apply a novel approach to decompose spatiotemporal covariation between spring temperature and the phenology of two flowering plants, Cardamine pratensis and Alliara petiolata, and a Lepidopteran herbivore, Anthocharis cardamines, across the UK, into the contributions of plasticity and local adaptation. All three species overlap in the time-window over which mean temperatures best predict variation in phenology and we find little evidence that the position of time-windows varies latitudinally, as expected if they were initiated by day-length. The focal species show pronounced temperature-mediated phenological plasticity of similar magnitude. While we find no evidence for local adaptation in the flowering times of the plants, geographic variation in the phenology of the butterfly reveals countergradient local adaptation. Geographic variation in the butterfly's phenology appears to be more sensitive to variation in temperature than the flowering times of the host plants and we find no evidence that coevolution has generated geographic variation in adaptive phenological plasticity

Trans Tracheal Approach to the Oesophagus: Case Report

Hypopharyngeal squamous cell carcinoma (SCC) is a rare form of malignancy and treatment approach is most commonly with chemo-radiotherapy or total pharyngolaryngoesophagectomy. We report a case of hypopharyngeal SCC managed with local resection and larynx preservation in a 77-year-old-woman. Total pharyngolaryngoesophagectomy renders patients with an alteration in both voice and ability to swallow hence carrying signifi cant post-operative morbidity. We review the literature for similar larynx-preserving operations and illustrate a novel approach to the management of this rare malignancy.</p