Study objectives: The management of patients diagnosed with non-small cell lung cancer is dependant on the stage of disease, which is also crucial for prognosis and selection of an appropriate treatment regimen. Historically a whole body bone scan has been used to identify skeletal metastases. The aim of this study was to investigate the usefulness of whole-body bone scanning (BS) in detecting bone metastases in newly diagnosed and apparently operable cases of lung cancer. Design and patients: Ninety two patients with a diagnosis made between 2008 and 2010 were recruited (squamous cell carcinoma, n =29; adenocarcinoma, n=36 ; non-small cell carcinoma, n= 22; others n=5). None of these patients had clinical factors suggesting bone metastasis (skeletal pain, elevated alkaline phosphatase, hypercalcemia). BS was performed in all patients, and additional imaging or biopsy was ordered in patients where there were doubtful lesions. Measurements and results: Bone metastases were detected in 14.13 % (n =13 ) of 92 clinical factor-negative patients. Of the eighteen abnormal bone scan results (eleven positive and seven probable), thirteen were true-positive and the five remaining were false-positive. In our study, PPV of the BS was 72.2%. Skeletal metastases was found more commonly in adenocarcinoma (46.15%, n=6 ) than other cell types. In 13 patients diagnosed with metastases, 53.8 % (n=7) were patients with non-small cell lung cancer and 38.4% (n=5) with small cell lung cancer. 4 of the 18 patients (22.2%) in T2N0M0 clinical stage had bone metastases. The routine bone scanning prevented thirteen futile thoracotomies (14%) in 92 patients with apparently operable lung cancer. Conclusions: Though clinical factors have a high NPV and the bone scans have less than desired specificity in diagnosing metastases, BS could be considered in those asymptomatic patients as a part of their work up and staging, in whom operative intervention is contemplated.
{"title":"Skeletal Metastases In Apparently Operable Lung Cancer Evaluated With Whole Body Bone Scan – A Pilot Study In South India.","authors":"A. Shinto, L. Pachen, K. SreekanthT, C. Joseph","doi":"10.5580/b96","DOIUrl":"https://doi.org/10.5580/b96","url":null,"abstract":"Study objectives: The management of patients diagnosed with non-small cell lung cancer is dependant on the stage of disease, which is also crucial for prognosis and selection of an appropriate treatment regimen. Historically a whole body bone scan has been used to identify skeletal metastases. The aim of this study was to investigate the usefulness of whole-body bone scanning (BS) in detecting bone metastases in newly diagnosed and apparently operable cases of lung cancer. Design and patients: Ninety two patients with a diagnosis made between 2008 and 2010 were recruited (squamous cell carcinoma, n =29; adenocarcinoma, n=36 ; non-small cell carcinoma, n= 22; others n=5). None of these patients had clinical factors suggesting bone metastasis (skeletal pain, elevated alkaline phosphatase, hypercalcemia). BS was performed in all patients, and additional imaging or biopsy was ordered in patients where there were doubtful lesions. Measurements and results: Bone metastases were detected in 14.13 % (n =13 ) of 92 clinical factor-negative patients. Of the eighteen abnormal bone scan results (eleven positive and seven probable), thirteen were true-positive and the five remaining were false-positive. In our study, PPV of the BS was 72.2%. Skeletal metastases was found more commonly in adenocarcinoma (46.15%, n=6 ) than other cell types. In 13 patients diagnosed with metastases, 53.8 % (n=7) were patients with non-small cell lung cancer and 38.4% (n=5) with small cell lung cancer. 4 of the 18 patients (22.2%) in T2N0M0 clinical stage had bone metastases. The routine bone scanning prevented thirteen futile thoracotomies (14%) in 92 patients with apparently operable lung cancer. Conclusions: Though clinical factors have a high NPV and the bone scans have less than desired specificity in diagnosing metastases, BS could be considered in those asymptomatic patients as a part of their work up and staging, in whom operative intervention is contemplated.","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115311772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Yunus, M. K. Saikia, Nari M. Lyndoh, Rajani Thabah, J. Bardoloi, S. Day, C. Selvam
Successful removal of a very large left atrial organized infected thrombus (weight 200 gram) and Mitral valve replacement: A case report. Abstract LA thrombus is common in mitral valve disease. They are even more commonly seen after an episode of AF. This thrombus may cause sudden circulatory arrest and systemic embolization. In this case we report a very large organized infected thrombus in the LA with severe MS. An emergency open heart surgery was conducted and successful removal of thrombus and mitral valve replacement with prosthetic valve was done.
{"title":"Successful removal of a very large left atrial organized infected thrombus (weight 200 gram) and Mitral valve replacement: A case report.","authors":"M. Yunus, M. K. Saikia, Nari M. Lyndoh, Rajani Thabah, J. Bardoloi, S. Day, C. Selvam","doi":"10.5580/99","DOIUrl":"https://doi.org/10.5580/99","url":null,"abstract":"Successful removal of a very large left atrial organized infected thrombus (weight 200 gram) and Mitral valve replacement: A case report. Abstract LA thrombus is common in mitral valve disease. They are even more commonly seen after an episode of AF. This thrombus may cause sudden circulatory arrest and systemic embolization. In this case we report a very large organized infected thrombus in the LA with severe MS. An emergency open heart surgery was conducted and successful removal of thrombus and mitral valve replacement with prosthetic valve was done.","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127584630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Rodriguez-Rivera, L. Sandberg, A. Ahmadinejad, C. Tzarnas, Steve Thuahnai
Patients with coexistent aortoiliac aneurysms and persistent sciatic artery (PSA) run the risk of postoperative complications. This can occur with open or endovascular procedures. EVAR with coiling of the internal iliac artery is one of the situations where ischemia may occur. We report a case where open aortic aneurysm repair with isolation and bypass of the PSA were performed with an excellent result. We recommend routine careful preoperative analysis of the CT angiogram and / or angiogram to rule out PSA.
{"title":"Management of the persistent sciatic artery with coexistent aortoiliac aneurysms; endovascular and open techniques.","authors":"A. Rodriguez-Rivera, L. Sandberg, A. Ahmadinejad, C. Tzarnas, Steve Thuahnai","doi":"10.5580/630","DOIUrl":"https://doi.org/10.5580/630","url":null,"abstract":"Patients with coexistent aortoiliac aneurysms and persistent sciatic artery (PSA) run the risk of postoperative complications. This can occur with open or endovascular procedures. EVAR with coiling of the internal iliac artery is one of the situations where ischemia may occur. We report a case where open aortic aneurysm repair with isolation and bypass of the PSA were performed with an excellent result. We recommend routine careful preoperative analysis of the CT angiogram and / or angiogram to rule out PSA.","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123546061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 76-year-old male presented with exertional dyspnea 5 months after motor vehicle accident. Preoperative echocardiography showed aortic insufficiency(AI) due to partial detachment of the non coronary cusp. He was successfully treated by valve replacement surgery. Postoperative examination of the excised aortic valve had no changes related to endocardiatis, but suggestive of traumatic AI. The issues attached to traumatic AI including lapse of time from blunt cheat trauma to onset of AI were discussed.
{"title":"Aortic Insufficiency By Blunt Chest Trauma.","authors":"S. Tatebe, Yoshiro Chiba","doi":"10.5580/139a","DOIUrl":"https://doi.org/10.5580/139a","url":null,"abstract":"A 76-year-old male presented with exertional dyspnea 5 months after motor vehicle accident. Preoperative echocardiography showed aortic insufficiency(AI) due to partial detachment of the non coronary cusp. He was successfully treated by valve replacement surgery. Postoperative examination of the excised aortic valve had no changes related to endocardiatis, but suggestive of traumatic AI. The issues attached to traumatic AI including lapse of time from blunt cheat trauma to onset of AI were discussed.","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128244760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Gegouskov, P. Petrov, D. Simov, V. Danov, J. Blagov, S. Petrov
Infective endocarditis associated with spleen infarcts is common and very complicated condition. Splenic lesions in infective endocarditis are presented of infarcts and abscesses. Operative mortality in such patients is high. The septic status, heart failure, hemodynamic instability, renal dysfunction make the success much difficult. Use of abdominal Computed Tomography to locate infectious sources is of paramount importance for the treatment plan. We present one case of infective endocarditis, complicated by infected splenic infarcts and heart failure. On urgent conditions we performed one-stage mitral valve replacement and splenectomy.
{"title":"One-Stage Mitral Valve Replacement And Splenectomy In Splenic Infarcts And Infective Endocarditis","authors":"V. Gegouskov, P. Petrov, D. Simov, V. Danov, J. Blagov, S. Petrov","doi":"10.5580/228f","DOIUrl":"https://doi.org/10.5580/228f","url":null,"abstract":"Infective endocarditis associated with spleen infarcts is common and very complicated condition. Splenic lesions in infective endocarditis are presented of infarcts and abscesses. Operative mortality in such patients is high. The septic status, heart failure, hemodynamic instability, renal dysfunction make the success much difficult. Use of abdominal Computed Tomography to locate infectious sources is of paramount importance for the treatment plan. We present one case of infective endocarditis, complicated by infected splenic infarcts and heart failure. On urgent conditions we performed one-stage mitral valve replacement and splenectomy.","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133805617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 40 year old female presented with the clinical features suggestive of acute arterial occlusion of the right leg for one day . Compression Ultrasonography revealed a linear membrane like defect in the right popliteal artery suggestive of an embolus . Patient was subjected to emergency catheter embolectomy revealing a laminated hydatid membrane within the artery . The patient was evaluated postoperatively and CECT chest documented a primary mediastinal hydatid cyst eroding into descending thoracic aorta . The mediastinal lesion was later treated with total cyst excision . In endemic areas, it is important to consider hydatid cysts in the differential diagnosis of an acute arterial occlusion .
{"title":"Acute Popliteal Artery Embolism Due To Ruptured Mediastinal Hydatid Cyst Into Thoracic Aorta – A Case Report .","authors":"M. Mushtaque, P. Khan, M. F. Mir, S. Khanday","doi":"10.5580/2370","DOIUrl":"https://doi.org/10.5580/2370","url":null,"abstract":"A 40 year old female presented with the clinical features suggestive of acute arterial occlusion of the right leg for one day . Compression Ultrasonography revealed a linear membrane like defect in the right popliteal artery suggestive of an embolus . Patient was subjected to emergency catheter embolectomy revealing a laminated hydatid membrane within the artery . The patient was evaluated postoperatively and CECT chest documented a primary mediastinal hydatid cyst eroding into descending thoracic aorta . The mediastinal lesion was later treated with total cyst excision . In endemic areas, it is important to consider hydatid cysts in the differential diagnosis of an acute arterial occlusion .","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126522996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. DeepakA, V. Rathee, Nityasha, V. Malik, R. Dahiya
In surgical practice, diaphragmatic injuries are present in 1-7 % of people with significant blunt trauma and an average of 3% abdominal injuries. Diaphragmatic rupture resulting from blunt trauma is still not suspected by many surgeons. We encountered an interesting case, where a traumatic diaphragmatic hernia could only be diagnosed after 20 days of the initial chest trauma and that too because of intercostal thoracostomy tube drain showed food particles. CT scan revealed abdominal contents in the chest and thoracostomy tube was placed inside the stomach. He was successfully managed by exploratory laparotomy, closure of perforation and diaphragm repair with a prolene sutures.
{"title":"A Delayed Diaphragmatic Hernia","authors":"N. DeepakA, V. Rathee, Nityasha, V. Malik, R. Dahiya","doi":"10.5580/2612","DOIUrl":"https://doi.org/10.5580/2612","url":null,"abstract":"In surgical practice, diaphragmatic injuries are present in 1-7 % of people with significant blunt trauma and an average of 3% abdominal injuries. Diaphragmatic rupture resulting from blunt trauma is still not suspected by many surgeons. We encountered an interesting case, where a traumatic diaphragmatic hernia could only be diagnosed after 20 days of the initial chest trauma and that too because of intercostal thoracostomy tube drain showed food particles. CT scan revealed abdominal contents in the chest and thoracostomy tube was placed inside the stomach. He was successfully managed by exploratory laparotomy, closure of perforation and diaphragm repair with a prolene sutures.","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114477244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Technical improvements in coronary revascularization over the past decade have led to a revival of interest in off-pump coronary artery bypass surgery. Cost containment in coronary artery bypass surgery is becoming increasingly important in modern hospital management. Therefore, further savings could be obtained by using a surgical technique able to decrease the fixed direct cost while maintaining clinical quality of care. Economic considerations are an extremely important issue in evaluating the role of off-pump coronary artery bypass grafting in the future of cardiac surgery, as off-pump coronary artery bypass grafting is expected to lower costs by reducing perioperative morbidity and recovery time. However, the acceptance of this procedure as a routine alternative for the treatment of coronary artery disease will depend on both long-term graft patency rates as well as a competitive market cost. This review examines these effects.
{"title":"Does Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass Reduce Costs in Cardiac Surgery","authors":"E. Hijazi","doi":"10.5580/1de6","DOIUrl":"https://doi.org/10.5580/1de6","url":null,"abstract":"Technical improvements in coronary revascularization over the past decade have led to a revival of interest in off-pump coronary artery bypass surgery. Cost containment in coronary artery bypass surgery is becoming increasingly important in modern hospital management. Therefore, further savings could be obtained by using a surgical technique able to decrease the fixed direct cost while maintaining clinical quality of care. Economic considerations are an extremely important issue in evaluating the role of off-pump coronary artery bypass grafting in the future of cardiac surgery, as off-pump coronary artery bypass grafting is expected to lower costs by reducing perioperative morbidity and recovery time. However, the acceptance of this procedure as a routine alternative for the treatment of coronary artery disease will depend on both long-term graft patency rates as well as a competitive market cost. This review examines these effects.","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116922377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Nagashima, F. Shikata, T. Okamura, K. Kawachi, T. Higaki, F. Suetsugu
In the conventional extracardiac total cavopulmonary connection (TCPC), a graft is placed lateral to the atrium. To prevent pulmonary venous obstruction, a thorough dissection around the pulmonary veins is required. The cause of sinus node dysfunction after extracardiac TCPC is still unknown. One possibility may be a compression of the sinus node from the outside by the graft. In this report, we proposed to modify TCPC by implanting a graft antero-medially rather than laterally to prevent the aforementioned complications. Six patients underwent this modified technique of TCPC. There was no death. The average pulmonary arterial pressure was 11 mmHg. The average follow-up was 24 months. No pulmonary venous stenosis or sinus node dysfunction was observed. In the conventional TCPC, the flow from the superior vena cava directly collides with the flow from the inferior vena cava at the central pulmonary artery (PA) resulting in energy loss. The central PA slightly curves anteriorly to posteriorly. In this modified technique, the flow from the graft enters the central PA from the front and may smoothly advance backwards into the distal PA along its naturally curved line. Thus, this modified technique may produce less energy loss compared to the conventional extracardiac TCPC.
{"title":"Modification Of The Extracardiac Total Cavopulmonary Connection - Placement Of A Graft Antero-Medially Rather Than Laterally","authors":"M. Nagashima, F. Shikata, T. Okamura, K. Kawachi, T. Higaki, F. Suetsugu","doi":"10.5580/1b5e","DOIUrl":"https://doi.org/10.5580/1b5e","url":null,"abstract":"In the conventional extracardiac total cavopulmonary connection (TCPC), a graft is placed lateral to the atrium. To prevent pulmonary venous obstruction, a thorough dissection around the pulmonary veins is required. The cause of sinus node dysfunction after extracardiac TCPC is still unknown. One possibility may be a compression of the sinus node from the outside by the graft. In this report, we proposed to modify TCPC by implanting a graft antero-medially rather than laterally to prevent the aforementioned complications. Six patients underwent this modified technique of TCPC. There was no death. The average pulmonary arterial pressure was 11 mmHg. The average follow-up was 24 months. No pulmonary venous stenosis or sinus node dysfunction was observed. In the conventional TCPC, the flow from the superior vena cava directly collides with the flow from the inferior vena cava at the central pulmonary artery (PA) resulting in energy loss. The central PA slightly curves anteriorly to posteriorly. In this modified technique, the flow from the graft enters the central PA from the front and may smoothly advance backwards into the distal PA along its naturally curved line. Thus, this modified technique may produce less energy loss compared to the conventional extracardiac TCPC.","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123711244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manubriosternal joint dislocation is extremely rare and yet there is no definite standard for treating such injury. The reported results of conservative or surgical approach vary between patients. We report a case where different methods of treatment were tried. However, controlling symptoms could only be established by stabilizing the joint using a plate fixation.
{"title":"Manubriosternal Joint Dislocation- A Treatment Dilemma","authors":"W. Salloum, N. Nikolaidis, D. Weeden","doi":"10.5580/1c3c","DOIUrl":"https://doi.org/10.5580/1c3c","url":null,"abstract":"Manubriosternal joint dislocation is extremely rare and yet there is no definite standard for treating such injury. The reported results of conservative or surgical approach vary between patients. We report a case where different methods of treatment were tried. However, controlling symptoms could only be established by stabilizing the joint using a plate fixation.","PeriodicalId":330833,"journal":{"name":"The Internet Journal of Thoracic and Cardiovascular Surgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127671652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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