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Journal and News Scan
The authors deal with a dramatic complication of acute Type A aortic
dissection - mesenteric malperfusion. They reviewed 309 papers on acute
aortic dissection and concluded that initial interventional management of
mesenteric malperfusion followed by delayed proximal aortic repair is a
reasonable strategy, since the prognosis of those immediately operated on
the ascending aorta was extremely poor.
The authors queried whether PET has utility in clinically staging Tis or T1 esophageal cancers; this was a single institution retrospective study involving 79 pts. The incidence of FDG uptake increased with increasing T status, as did the SUV. Nodal staging was false positive in 3 pts and false negative all 13 pts with nodal involvement. Metastatic staging was false positive in 5 pts. PET is not recommended for pts with Tis or T1 disease on EUS.
The efficacy of induction therapy for clinical T2 esophageal cancer was evaluated using the National Cancer Database. Pretreatment staging was accurate in only 27% of pts. 42% of pts were upstaged and 32% were downstaged. Induction therapy had no survival benefit.
Participants in the Lung Cancer Screening Trial were evaluated for success in smoking cessation linked to findings in their screening CTs. The odds ratios for continued smoking decreased with increasingly worrisome abnormalities on CTs: 0.81 for a major abnormality not suspicious for cancer, 0.79 for an abnormality suspicious for cancer but stable, and 0.66 for a finding suspicious for cancer that was new or changed from prior. CT screening is an opportunity to aid patients with smoking cessation.
This study tracked changes in management for and outcomes of T1a and T1b esophageal cancer using data from the National Cancer Data Base. Endoscopic resection increased nearly 3-fold to 53% for T1a lesions during the interval, and increased nearly 3-fold to 21% for T1b cancers. Nodal involvement was predicted by T status, tumor size >2cm, and tumor grade. The rate of nodal involvement in resected pts was 5% for T1a and 17% for T1b. Endoscopic therapy had a lower risk of procedure-related mortality (HR 0.33). 5-year survival was better after surgical resection (88% vs 77%).
Outcomes of lung adenocarcinoma classified according to the new IASLC/ATS/ERS system were evaluated in this retrospective single-institution study involving 573 pts who underwent surgical treatment. Histologic patterns were associated with sex and tumor TNM factors. Recurrence was higher in micropapillary and solid-predominant cancers. These subtypes were also associated with poorer overall and disease-specific survival compared to other types.
This article presents guidelines on the diagnosis and management of advanced stage lung cancer developed by the ESMO in 2013.
This article summarizes consensus guidelines for the diagnosis and management of early stage lung cancer developed by ESMO in 2013.
– The aim of this study was to evaluate the effect of vein graft preservation solutions on vein graft failure (VGF) and clinical outcomes in patients undergoing coronary artery bypass graft (CABG) surgery. These researchers concluded that patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and showed trends toward better long–term clinical outcomes compared with patients whose grafts were preserved in saline– or blood–based solutions.
- Researchers used data from the Project of Ex–Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double–blind, placebo–controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003.
- Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts.
- Interventions included preservation of vein grafts in saline, blood, or buffered saline solutions.
- Main outcomes measures included 1–year angiographic VGF and 5–year rates of death, myocardial infarction, and subsequent revascularization.
- Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]).
- Baseline characteristics were similar among groups.
- Researchers found that 1–year VGF rates were much lower in the buffered saline group than in the saline group (patient–level odds ratio [OR], 0.59 [95% CI, 0.45–0.78; P<0.001]; graft–level OR, 0.63 [95% CI, 0.49–0.79; P<0.001]) or the blood group (patient–level OR, 0.62 [95% CI, 0.46–0.83; P=0.001]; graft–level OR, 0.63 [95% CI, 0.48–0.81; P<0.001]).
- Use of buffered saline solution also tended to be associated with a lower 5–year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64–1.02; P=0.08]) and blood (0.81 [0.63–1.03; P=0.09]) solutions.
The timing of surgery in patients with asymptomatic severe aortic stenosis (AS) remains a matter of debate. In this study, the authors evaluate the prognostic value of plasma levels of B-type natriuretic peptide (BNP) during exercise in 211 patients with asymptomatic AS. In multivariate analysis, second and third tertiles of peak-exercise BNP were strong predictors of death or aortic valve replacement motivated by development of symptoms or LV dysfunction, compared with the first tertile. Patients with asymptomatic severe AS and a high peak BNP values may require closer follow up and may benefit from earlier surgery.