Localization over complex-analytic groupoids and conformal renormalization

We present a higher index theorem for a certain class of etale one-dimensional complex-analytic groupoids. The novelty is the use of the local anomaly formula established in a previous paper, which represents the bivariant Chern character of a quasihomomorphism as the chiral anomaly associated to a renormalized non-commutative chiral field theory. In the present situation the geometry is non-metric and the corresponding field theory can be renormalized in a purely conformal way, by exploiting the complex-analytic structure of the groupoid only. The index formula is automatically localized at the automorphism subset of the groupoid and involves a cap-product with the sum of two different cyclic cocycles over the groupoid algebra. The first cocycle is a trace involving a generalization of the Lefschetz numbers to higher-order fixed points. The second cocycle is a non-commutative Todd class, constructed from the modular automorphism group of the algebra.Comment: 38 pages. v2: some inconsistencies with the use of pseudogroups have been fixe

Surgical approaches to apical thoracic malignancies

ObjectiveSeveral surgical approaches have been described to access apical thoracic malignancies extending into the thoracic inlet. However, most publications have focused on a specific approach and considered the thoracic inlet as 1 entity. In the present analysis, we divided the thoracic inlet into 5 different zones requiring specific surgical considerations to identify the best approach for each zone.MethodsA review of 22 consecutive patients undergoing surgery for apical thoracic malignancies extending into the thoracic inlet from January 2005 to November 2011 was performed.ResultsDifferent surgical approaches were used for each zone. The first (anterolateral) zone required a subclavicular approach to open the costoclavicular space and expose the subclavian vein with or without elevating or removing the clavicle (n = 4). The second (anterocentral) zone required a transverse supraclavicular approach with or without extension to a partial (trapdoor) or full sternotomy (n = 10). The third (posterosuperior) zone located between the top of the subclavian artery and the T1 vertebra along the posterior superior border of the first rib was the most difficult area to access (n = 5). The transclavicular approach was ideally suited to expose this zone in our experience. The fourth (posteroinferior) zone and fifth (inferolateral) zone located posteriorly and laterally along the inferior border of the first rib were accessed using a posterolateral and posterotransaxillary approach, respectively (n = 3).ConclusionsThe thoracic inlet could be divided into 5 zones requiring specific surgical considerations and different approaches. Division of the thoracic inlet into these zones could provide more clarity and guidance for thoracic surgeons to select the correct surgical approach

Plasma Cytokines and Chemokines in Primary Graft Dysfunction Post-Lung Transplantation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72208/1/j.1600-6143.2008.02497.x.pd

Early improvement of respiratory function after surgical plication for unilateral diaphragmatic paralysis

We reported an unusual case of symptomatic diaphragmatic paralysis in an elderly patient with progressive respiratory-dependent limitation of her daily activities. Surgical plication of the affected hemidiaphragm resulted in early clinical and physiological improvement

Time trend in the surgical management of patients with lung carcinoma

Objective: The goal of the study was to analyze the histological and clinical trends in lung carcinoma and their influence upon the preoperative evaluation, surgical procedures and survival. Methods: We retrospectively reviewed the charts of 1079 consecutive patients who underwent surgery for primary lung carcinoma between 1977 and 1996 in our institution. Patients were divided into five equal 4-year periods according to the year of surgery (1977-1980; 1981-1984; 1985-1988; 1989-1992; 1993-1996). Results: Between 1977-1980 and 1993-1996, the incidence of squamous cell carcinoma significantly declined, whereas the incidence of adenocarcinoma and bronchioloalveolar carcinoma increased. During the same period, the proportion of squamous cell carcinoma visualized at bronchoscopy and the rate of preoperative histological diagnosis significantly decreased. An increasing proportion of lobectomy and less extended resection was associated with an increasing number of patients with stage I carcinoma. Meanwhile, the operative mortality significantly declined from 9 to 4% and the 5-year survival improved from 25 up to 40%. Conclusion: Over the last two decades, the shift in histological distribution was associated with an increasing proportion of patients with stage I disease, a lower operative mortality and a better 5-year surviva

Spontaneous hemorrhage of thymus and thymoma in adults

Spontaneous hemorrhage from the thymus is extremely rare. In adults, it may occur in patients without underlying coagulopathy and mimic aortic dissection. To the best of our knowledge, only three previous adult cases have been reported in the English literature. This report presents two additional adult patients who were admitted in our institution with different clinical presentations of spontaneous thymic hemorrhag

Pulmonary blastoma: report of five cases and identification of clinical features suggestive of the disease

Objective: Identification of clinical features suggestive of pulmonary blastoma (PB) through a retrospective comparison with cases of non-small cell lung cancer (NSCLC) operated during the same period. Methods: Between 1977 and 1999, five patients were operated for PB at Geneva University Hospital (four women and one man, aged 32-46 years - mean 36.8) versus 1913 consecutive patients (1558 men and 355 women, mean age 61.2) for primary NSCLC. In the PB subgroup (0.3%), the pulmonary tumor was single, located in an upper lobe in all but one instance, and measured between 5 and 13 cm (mean 9.6), whereas in the total NSCLC group, 27% of patients had tumors <3 cm (T1), evenly distributed in both lungs. All but one PB patients were symptomatic, compared to 45% in the NSCLC group. Results: The five patients with PB underwent curative pulmonary excisions (lobectomy in three and pneumonectomy in two) with mediastinal lymph node sampling. Pathological examination revealed extensive tumor necrosis in four, and N2 lymph node metastases in four (in the total NSCLC group, N2 disease was diagnosed in 21%). Postoperatively, three PB patients received radio- and/or chemotherapy. Four patients died between six and 30 months after the operation (mean 15), whereas 5-year survival in the NSCLC group was 32%, with a median survival of 3.7 years; the fifth patient is alive 28 months later, without any sign of recurrence. Conclusions: Compared to operated NSCLC, PB are rare, large, and symptomatic tumors; they affect younger patients and carry a worse prognosi

Carinal Reconstruction and Sleeve Right Upper Lobectomy Assisted with Extracorporeal Membrane Oxygenator for Non-small Cell Lung Cancer - A case report -

Bronchogenic carcinoma involving the carina has remained a challenging problem for thoracic surgeons. Carinal resection and reconstruction is limitedly indicated because this aggressive surgical approach has been reported to be associated with significant morbidity and mortality while long-term outcome has not been determined. Wesuccessfully performed carinal reconstruction and sleeve right upper lobectomy assisted with ECMO for a 60-year-old male with squamous cell carcinoma in the right upper lobe extending to the carina