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Journal and News Scan
Optimal therapy (surgery vs multimodality therapy) for clinical T2N0 esophageal cancer is controversial. This STS Database review assessed accuracy of clinical staging compared to pathologic staging in nearly 500 patients who underwent initial resection. T2N0 was confirmed in 27%, 26% were downstaged, and 47% were upstaged. The most common cause for upstaging was nodal involvement without change in T status. In another group of clinical T2N0 patients who underwent induction therapy, upstaging was evident in the resection specimen in 38%.
In this multi-institutional prospective trial, 400 pts at increased risk for pulmonary complications after major abdominal surgery were randomized to standard intraoperative ventilator management and lung-protective management with low tidal volumes and PEEP. A composite of pulmonary and extrapulmonary complications occurred in 27.5% of the control group compared to 10.5% of the treatment group at 7 days. The incidence of respiratory failure was 17% in the control group and 5% in the treatment group. The treatment group length of stay was 2.5 days shorter.
This study sought to investigate the immediate safety and feasibility of complete percutaneous access/closure of arteriotomy for device deployment compared to the surgical approach for transfemoral transcatheter aortic valve replacement (TAVR). The percutaneous approach is a feasible access/closure method with a potential of lowering access site infection and bleeding, and shortening hospital stay, while maintaining similar rates of major vascular complications compared to the surgical approach.
The intent of this American Heart Association Scientific Statement is to synthesize and summarize data relevant to sexual activity and heart disease in order to provide recommendations and foster physician and other healthcare professional communication with patients about sexual activity. Recommendations in this document are based on published studies, the Princeton Consensus Panel,4,5 the 36th Bethesda Conference,6–10 European Society of Cardiology recommendations on physical activity and sports participation for patients with CVD,11–13 practice guidelines from the American College of Cardiology/American Heart Association14–16 and other organizations,17 and the multidisciplinary expertise of the writing group. The classification of recommendations in this document are based on established ACCF/AHA criteria (Table).
3D printers are slowly entering everyday life and they are increasingly being used in medicine. Doctors at Washington's Children's National Medical Center say the life-size tri-dimensional prints of their patients' hearts helps them in planning and executing surgeries. Magnetic resonance imaging, computer tomography and ultrasound already give pretty good images of patients' internal organs, but doctors at the Children's National Medical Center say nothing beats holding a life-size model of a heart in your hand prior to the surgery. They can study it, plan the procedure and even practice the access to the damaged area. Pediatric cardiologist Laura Olivieri says many of their young patients were born with hearts that did not form as they should have, but surgeons can correct that. "Seeing the heart defect in three dimensions can really help the interventionist or the surgeon plan the best procedure," she said. The hospital acquired the $250,000 printer about 18 months ago and the team is still expanding and finding new areas to print. The procedure always starts with taking a set of three-dimensional images with magnetic resonance imager, computer tomography scanner and ultrasound machine. Highly trained pediatric cardiologists manipulate those images and separate the organ from the noise in the picture. In order to save time in printing they sometimes also cut away parts of the image irrelevant to the planned procedure.
This is a great video of an operation to replace endocarditis of the tricuspid valve due to an infected pacing lead.
The USPST updated its review on lung cancer screening utilizing RTCs and cohort studies. One trial reported that screening resulted in important reductions in cancer and all-cause mortality. Three trials reported no benefit but were underpowered. They conclude that screening offers benefit but is associated with potential harm that must be taken into consideration.
Cancer Research UK announced a large investment into TRACERx, a project aimed at identifying genetic abnormalities in lung cancers and following their evolution over the lifetime of the patient. Similar efforts are underway in France and the US.
In this manuscript the authors investigate the effect of the intracoronary injection of autologus cardiac stem cells (CSCs) in chronic ischemic cardiomyopathy in pigs. CSCs were obtained from the pigs’ right atrium. Three groups were created. Groups II and III underwent a 90 minute occlusion of the left anterior descending artery in order to cause an anterior myocardial infarction (MI). Group I served as control. At 3 to 4 months after MI, pigs received intracoronary infusion of vehicle (group II), or autologous CSCs into the infarct-related artery by the use of a balloon catheter (group III). Echocardiographic and hemodynamic assessment of cardiac function was performed before treatment and at the time of euthanasia at 31 days after vehicle/CSC therapy. Morphometric and histological studies were also carried out. CSC-treated pigs exhibited significantly greater LV ejection fraction, systolic thickening fraction in the infarcted left ventricular wall, and maximum LV dP/dt, as well as lower LV end-diastolic pressure. Microscopic findings were consistent with cardiac regeneration. These findings were in keeping with those recently published on humans in the SCIPIO trial.
Nine patients from a single institution underwent ECMO support as a bridge to transplantation with 100% post-transplant one year survival. Five patients underwent a rehabilitation program and had minimal sedation. Four patients underwent standard sedation and were immobilized in bed during the ECMO bridge. Rehabilitation could be conducted only in those patients who were cannulated with a two stage single cannula either in the internal jugular or subclavian vein as those with femoral vein cannula could not be mobilized. Rehabilitation started with active and passive exercises in bed, progressed to sitting, then standing and finally ambulation. This required a multi-person team including one strictly responsible for the ECMO cannula and lines. Those who underwent rehabilitation had shorter: post-transplant mechanical ventilation (4 d vs. 34 d), ICU stay (11 d vs. 45 d) and hospital stay (26 d vs. 80 d). This paper underscores two points: ECMO can be successfully used as a bridge to lung transplantation and pre-transplant deconditioning has a negative impact on the post-transplant outcome.