It has been reported, but not proven, that perioperative blood transfusions have a detrimental effect on the survival of patients undergoing surgery for lung cancer.
A prospective study was carried ...out on the patients undergoing lobectomy for stage I lung cancer at our department from 1995 to 2000. The criteria for exclusion included previous cases of malignancy, autoimmune diseases, and any other relevant comorbidity.
Two hundred eighty-one patients were observed, 24.6% of whom received transfusions. The only significant difference between the transfused and nontransfused patients was their preoperative hemoglobin (Hb) concentration (12.5 ± 1.20 g/dL vs 13.3 ± 1.22 g/dL, p < 0.001). The disease-free interval of the transfused patients was significantly lower than that of the nontransfused patients (53% vs 78% at 73 months, p < 0.005), as was also the case for actuarial survival (52% vs 71% at 73 months, p < 0.02). Blood transfusion was significantly predictive of tumor relapse according to the Cox model adjusted for the T state, preoperative Hb concentration, sex, age, histologic type, and grading (hazard ratio, 2.3; p = 0.017).
Our data show that perioperative blood transfusion is significantly correlated to worse prognosis in patients undergoing surgery for stage I lung cancer.
The utility of buttressing an endoscopic mechanical stapler with strips of bovine pericardium in resection of pulmonary bullous areas was evaluated by comparing the duration of air leakage in two ...randomized patient groups, one with and one without buttressing. The duration of air leakage was not related to bulla size in either group but showed a linear relation with the radiologic emphysema score in both groups (p < 0.001) and was shorter when the stapler had been fitted with bovine pericardium, but significantly reduced (p = 0.019) only in patients with a high emphysema score. The duration of air leakage was thus related to emphysema score, and in patients with high scores was shortened by application of bovine pericardium to the stapler.
Bilocular pericardial cyst in an aberrant location Raveglia, Federico; Baisi, Alessandro; Calati, Angelo Maria ...
Interactive cardiovascular and thoracic surgery,
01/2009, Letnik:
8, Številka:
1
Journal Article
Recenzirano
Odprti dostop
a Division of Thoracic Surgery, Università degli Studi di Milano, Azienda Ospedaliera San Paolo, Milano, Italy
b Division of Thoracic Surgery, University of Pennsylvania School of Medicine, ...Philadelphia, PA, USA
*Corresponding author. Piazza L. da Vinci 7, 20133, Milan, Italy. Tel.: +39-3381336071; fax: +39-022666185. E-mail address : ravegliafederico{at}tiscali.it (F. Raveglia).
Pericardial cysts classically are found in the right or left cardiophrenic angle and rarely are located outside of this location. An 82-year-old man presented with an asymptomatic cystic mass on chest CT-scan located in the upper right mediastinum and measuring 7 x 6 x 4 cm. A follow-up chest CT-scan 12 months later showed that the cyst had increased in size to where it now measured 10 x 9 x 8 cm and was noted to be dislocating and compressing the superior vena cava. The patient underwent surgical excision because of the uncertain diagnosis and the compression of contiguous organs. Two cystic masses were able to be completely excised intact. A definitive diagnosis of double pericardial cyst was histopathologically confirmed. Radiological findings of a pericardial cyst in the upper mediastinum are extremely rare. In particular there have been no reports of bilocular or double pericardial cysts.
Key Words: Pericardial cyst; Mediastinum
Tracheobronchial injury (TBI) after blunt trauma of the chest is a rare life-threatening entity that can be successfully managed by surgery if there is an early diagnosis. A 18-year-old man was ...injured in a motocycle accident. Three consecutive flexible bronchoscopies risulted negative for tracheo-bronchial lesions. Then, the patient was submitted to a spiral CT-scan of the chest with 3-dimensional reconstruction of the tracheobronchial tree that showed a rupture of the right main bronchus from the trachea. The lesion was successfully treated by surgery. Bronchoscopic findings in TBI may be unclear also for an experienced thoracic surgeon.
Objectives: Pain control after thoracotomies prevents complications and improves respiratory function. The gold standard is epidural catheter (EP). In 2013 we published early results comparing EP ...with a technique involving placement of a catheter in the paravertebral space. To improve the value of the study we now present an update of the study with a wider patient population in order to improve its value.
Methods: From November 2011 to July 2013, 71 patients were randomized into two groups depending on site of catheter placement: epidural for group A and paravertebral for Group B. The catheter (Contiplex® Tully Set, BBraun) was placed by the same surgeons tunnelling the parietal pleura and entering the paravertebral space before thoracotomy closure. At 6, 12, 24, 48 and 72 hours after surgery, the following parameters were recorded: (a) pain control; (b) respiratory function using forced expiratory volume in one second (FEV1) and ambient air saturation and (c) blood cortisol values as systemic reactions to pain. Records were analyzed with the Mann-Withney or Student's tests.
Results: Statistically significant differences (P < 0.05) have been found in favour of group B concerning both cough and rest pain control (P = 0.0021 and 0.002 respectively) and respiratory function in terms of FEV1 and ambient air saturation (P = 0.0231 and 0.001). No significant differences have been found in blood cortisol trends (P > 0.05). No complications after placement were recorded in both groups. Collateral effects such as vomit, nausea, low pressure or urinary retention have been observed in 28 of 34 patients belonging to group A.
Conclusions: Results of this update were consistent with our previous study. Extended data strengthen the evidence that drugs administered through a catheter in the paravertebral space are very effective. This technique does not present collateral effects. Moreover there are no contraindications to its positioning.
Disclosure: No significant relationships.
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