Background Preoperative localization of pulmonary nodules is sometimes necessary when they are too small or distant from the surface of the visceral pleura to be detected during video-assisted ...thoracoscopic surgery. This study aims to present the criteria for localization and to evaluate the accuracy of the criteria. Methods From April 2001 to March 2008, 178 patients with 224 nodules who underwent wedge resection of pulmonary metastatic nodules by video-assisted thoracoscopic surgery were reviewed retrospectively. Thirty-one patients (17.4%) including 35 nodules underwent thoracoscopic resection immediately after computed tomography–guided localization using hook wires. Criteria for preoperative localization were (1) maximum diameter of the nodule of 5 mm or less, (2) maximum diameter to minimum distance between the visceral pleura and inferior border of nodule of 0.5 or less, and (3) nodule with low-density image by computed tomography after chemotherapy. The accuracy of these inclusion criteria was statistically evaluated. Results All 224 nodules were removed by wedge resection or additional segmentectomy. Nineteen nodules (54.3%) were detected in the thoracic cavity with preoperative localization. Sensitivity, specificity, positive predictive value, and negative predictive value were 11.1%, 99.5%, 66.7%, and 92.8%; 88.9%, 93.2%, 53.3%, and 99.0%; and 88.9%, 90.8%, 45.7%, and 98.9% in each preoperative finding of which a nodule met all (3 nodules), two or more (30 nodules), and one or more (35 nodules) of the three criteria, respectively. Conclusions This study suggests that preoperative localization should be considered before video-assisted thoracoscopic surgery operation if the pulmonary nodule meets two or more of our criteria.
Abstract Background Recombinant human soluble thrombomodulin (rTM) protects against disseminated intravascular coagulopathy by inhibiting coagulation, inflammation, and apoptosis. This study tests ...the hypothesis that rTM is hepatoprotective after extensive hepatectomy (Hx) and investigates the mechanisms underlying this effect. Materials and methods Experiment 1: rats (15 per group) were injected with rTM (1.0 or 2.0 mg/kg) or saline just before 95% Hx and their 7-d survival assessed. Experiment 2: rats were assigned to either a treated (2.0 mg/kg rTM just before Hx) or control group ( n = 5 per group). Five rats per group were euthanized immediately after surgery, and at 1, 3, 6, 12, and 24 h postoperatively; serum and liver remnant samples were collected for biochemical and histologic analysis, as well as reverse-transcription polymerase chain reaction and Western blotting. Results All saline-injected rats died within 52 h of Hx, whereas injection of 2.0 mg/kg rTM prolonged survival ( P = 0.003). rTM increased the number of Ki67-positive cells and reduced the number of terminal deoxynucleotidyl transferase dUTP nick-end labeling-positive cells. The number of myeloperoxidase-positive cells and the expression of high-mobility group box 1 protein did not differ. Reverse-transcription polymerase chain reaction revealed that rTM significantly enhanced protease-activated receptor-1 and sphingosine kinase 1 messenger RNA expression and significantly reduced plasminogen activator inhibitor-1 and Bax messenger RNA expression. Immunohistochemistry and Western blotting demonstrated that protease-activated receptor-1 expression 24 h after Hx was significantly higher in rTM-treated than in control rats. Conclusions rTM may improve survival after extensive Hx by inhibiting apoptosis and promoting liver regeneration.
The Synergy Between PCI With TAXUS and Cardiac Surgery (SYNTAX) score is effective in predicting clinical outcome after percutaneous coronary intervention (PCI). However, its prediction ability is ...low because it reflects only the coronary characterization. We assessed the predictive value of combining the ankle-brachial index (ABI) and SYNTAX score to predict clinical outcomes after PCI. The ABI-SYNTAX score was calculated for 1,197 patients recruited from the Shinshu Prospctive Multi-center Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention (SHINANO) registry, a prospective, observational, multicenter cohort study in Japan. The primary end points were major adverse cardiovascular and cerebrovascular events (MACE; all-cause death, myocardial infarction, and stroke) in the first year after PCI. The ABI-SYNTAX score was calculated by categorizing and summing up the ABI and SYNTAX scores. ABI ≤0.49 was defined as 4, 0.5 to 0.69 as 3, 0.7 to 0.89 as 2, 0.9 to 1.09 as 1, and 1.1 to 1.5 as 0; an SYNTAX score ≤22 was defined as 0, 23 to 32 as 1, and ≥33 as 2. Patients were divided into low (0), moderate (1 to 2), and high (3 to 6) groups. The MACE rate was significantly higher in the high ABI-SYNTAX score group than in the lower 2 groups (low: 4.6% vs moderate: 7.0% vs high: 13.9%, p = 0.002). Multivariate regression analysis found that ABI-SYNTAX score independently predicted MACE (hazards ratio 1.25, 95% confidence interval 1.02 to 1.52, p = 0.029). The respective C-statistic for the ABI-SYNTAX and SYNTAX score for 1-year MACE was 0.60 and 0.55, respectively. In conclusion, combining the ABI and SYNTAX scores improved the prediction of 1-year adverse ischemic events compared with the SYNTAX score alone.
Abstract Background It has been reported that there are regional differences in the incidence of acute myocardial infarction (AMI) in Japan. The purpose of this study was to investigate trends in ...regional differences in AMI incidence and dyslipidemia between coastal and inland areas. Methods We investigated trends in AMI incidence and risk factors in 5325 first-ever AMI patients residing in a coastal area ( n = 1817), a rural inland area ( n = 1959), or an urban inland area ( n = 1549) for the periods 1994–2002, and 2003–2010, using data from the Yamagata AMI Registry. Results Patients in the coastal area were significantly older than those in rural and urban inland areas and had a lower prevalence of dyslipidemia. The age-adjusted incidence rate of AMI was significantly lower in coastal and rural inland areas patients than those from urban inland area (males: 43.3, 42.2, and 51.3/105 person-years; females: 17.4, 20.0, and 23.7/105 person-years, respectively) during 2 observation periods. Due to a large increase in AMI incidence in younger males of the coastal area and a decrease in AMI incidence in late elderly females of the urban inland area, no significant regional differences in the age-adjusted incidence rates of AMI were observed during the 2003–2010 period in both genders. The increase in AMI incidence in males in the coastal area was associated with an increasing prevalence of dyslipidemia. Conclusion There were no longer any regional differences observed in AMI incidence, which was considered to be associated with increased dyslipidemia especially in the coastal area.
Summary Background Little is known about depressive symptoms in heart failure with preserved ejection fraction (HFpEF, EF ≥50%). We aimed to assess the prevalence of depression, to clarify the impact ...of depressive symptoms upon clinical outcomes, and to identify factors associated with these symptoms in HF with reduced EF (HFrEF, EF <50%) and HFpEF. Methods and results A total of 106 HF outpatients were enrolled. Of them, 61 (58%) had HFpEF. Most patients were male (HFrEF 80%, HFpEF 70%) and the mean of plasma B-type natriuretic peptide (BNP) level in the HFrEF group was similar to that in the HFpEF group (164.8 ± 232.8 vs. 98.7 ± 94.8 pg/mL). HFrEF patients were treated more frequently with beta-blockers compared with HFpEF patients (71% vs. 43%, p = 0.004). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The prevalence of depression (CES-D score ≥16), and CES-D score did not significantly differ between HFrEF and HFpEF (24% vs. 25%, 14.1 ± 8.3 vs. 12.1 ± 8.3, respectively). During the 2-year follow-up, depressed patients had more cardiac death or HF hospitalization in HFrEF (55% vs. 12%, p = 0.002) and HFpEF (35% vs. 11%, p = 0.031). Cox proportional hazard analysis revealed that a higher CES-D score, indicating increased depressive symptoms, predicted cardiac events independent of BNP in HFrEF hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.01–1.13 and HFpEF (HR 1.09, 95%CI 1.04–1.15). Multiple regression analyses adjusted for BNP showed that independent predictors of depressive symptoms were non-usage of beta-blockers and being widowed or divorced in HFrEF. On the other hand, usage of warfarin was the only independent risk factor for depressive symptoms in HFpEF (all, p < 0.05). Conclusions Depressive symptoms are common and independently predict adverse events in HFrEF/HFpEF patients. This study suggests that beta-blockers reduce depressive symptoms in HFrEF. In contrast, treatment for depression remains to be elucidated in HFpEF.
Is lung cancer resection indicated in patients with idiopathic pulmonary fibrosis? Watanabe, Atsushi, MD, PhD; Higami, Tetsuya, MD, PhD; Ohori, Syunsuke, MD ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
11/2008, Letnik:
136, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Objective The purpose of this study was to determine the implication of idiopathic pulmonary fibrosis on the surgical treatment for primary lung cancer. Methods Between January 1994 and June 2006, ...870 patients with primary lung cancer were surgically treated. Fifty-six (6.4%) of 870 patients had complications with idiopathic pulmonary fibrosis, and their data were retrospectively reviewed. There were 50 men and 6 women with an average age of 68 years. The incidence of squamous cell carcinoma was 28 (50.0%). Surgical procedures consisted of 7 wedge resections of the lung, 5 segmentectomies, 43 lobectomies, and 1 bilobectomy. Results Surgery-related hospital mortality was higher in patients with idiopathic pulmonary fibrosis than in patients without (7.1% vs 1.9%; P = .030). Four (7.1%) of these 56 patients had acute postoperative exacerbation of pulmonary fibrosis and died because of this complication. No factors such as pulmonary function, serologic data, operative data, and histopathologic data were considered predictive risk factors for the acute exacerbation. The postoperative 5-year survival for pathologic stage I lung cancer was 61.6% for patients with idiopathic pulmonary fibrosis and 83.0% for patients without ( P = .019). The causes of late death were the recurrence of cancer or respiratory failure owing to idiopathic pulmonary fibrosis. Conclusions Although idiopathic pulmonary fibrosis causes high mortality after pulmonary resection for lung cancer and poor long-term survival, long-term survival is possible in patients with these two fatal diseases. Therefore, in selected patients, idiopathic pulmonary fibrosis may not be a contraindication to pulmonary resection for stage I lung cancer.
Abstract Background and purpose Many patients with atrial fibrillation (AF) and coronary artery stent deployment are given both antiplatelet drug and warfarin. Little information is available as to ...the relationship between the antithrombotic therapies in the late phase after stenting and the clinical outcomes of these patients. We examined the clinical outcomes of AF patients 12 months after coronary artery stenting. Methods We retrospectively examined 146 patients and classified them into three groups according to the antithrombotic therapies dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT) plus warfarin, and DAPT plus warfarin 12 months after stenting. We defined the primary endpoint as Thrombolysis in Myocardial Infarction major bleeding and the secondary endpoint as a composite of adverse events (CAE: all-cause death, nonfatal myocardial infarction, intracranial bleeding, and cerebral infarction). Results During a median follow-up of 37 months, major bleeding and CAE were observed in 14 (9.6%) and 46 (31.5%) patients, respectively. DAPT plus warfarin was an independent risk factor for major bleeding in a multivariate Cox hazard regression model after adjustment for age, gender, and the type of AF (hazard ratio: 4.20; 95% confidence interval: 1.13–17.27; p = 0.033). No significant clinical variables were found for CAE. Conclusions Prolonged use of DAPT with warfarin significantly increases the risk of major bleeding in AF patients after coronary artery stenting. Individualized antithrombotic treatment is required in these patients to prevent major bleeding.
Background Ganglionated plexi ablation during atrial fibrillation surgery is not technically standardized for precise ganglionated plexi locations or ablation sequence. We aimed to identify precise ...active ganglionated plexi locations in patients with structural heart disease and explore the feasibility of anatomic ganglionated plexi ablation without prior mapping in patients with atrial fibrillation. Methods Thirty patients with valvular disease-associated atrial fibrillation underwent ganglionated plexi ablation and a modified maze procedure. In 20 patients, ganglionated plexi mapping was performed to identify active plexi. According to mapping results, anatomically determined plexi were ablated without mapping in the final 10 patients. Ganglionated plexi ablation outcomes with and without prior mapping were compared between perioperative and early postoperative periods. Results Active ganglionated plexi common to more than 20% of patients were identified in the superior and inferior right pulmonary veins, superior left pulmonary vein, interatrial groove, and inferior left atrium. Inferior left atrial plexi ablation resulted in maximum vagal modulation. Compared with ablation using mapping, anatomic ablation yielded more vagal modulation in heart rate variability and decreased the requisite cardiopulmonary bypass time. Conclusions The sequential pacing and ablation technique identified an optimal ablation sequence that best ensured vagal reflex elimination from all ganglionated plexi. Anatomic ablation using a predetermined ganglionated plexi map may be a viable alternative to individual plexus mapping before ablation.
Pneumorrhachis refers to the clinical presentation of air within the spinal canal, and it is rarely associated with pneumomediastinum, particularly in young children. Pneumorrhachis associated with ...pneumomediastinum is generally asymptomatic. Here we report 2 unusual cases involving very young children with pneumorrhachis secondary to pneumomediastinum and present a review of the relevant literature. Case 1 involved a 4-year-old girl who presented with wheezing, violent coughing, and dyspnea associated with bronchiolitis. Case 2 involved a 3-year-old boy who presented with wheezing, violent coughing, and dyspnea associated with interstitial pneumonia possibly caused by graft-versus-host disease with human herpesvirus 6 infection after allogeneic hematopoietic stem cell transplantation. In both cases, pneumorrhachis improved with oxygen inhalation therapy and treatment of the underlying disease. Pneumorrhachis is rarely associated with neurological problems; however, decompressive laminectomy may be indicated to relieve the air block. Because pneumorrhachis is rare in children and neurological sequelae may be difficult to identify, close clinical, and radiographic observations are necessary. Plain radiography is not sufficient, and computed tomography should be performed to rule out intraspinal air.
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