Purpose: Follow-up practices for patients who have undergone surgical resection of esophagogastric malignancies are variable and poorly documented. To better understand practice, a questionnaire was used to survey surgeons and medical oncologists to determine whether any consensus exists.
Methods: An opt-in online questionnaire was sent to esophagogastric surgeons and medical oncologists via the membership lists for the Australian and New Zealand Gastric and Oesophageal Surgery Association (ANZGOSA), the Australian Gastro-Intestinal Trials Groups (AGITG), and the Medical Oncology Group of Australia (MOGA). The questionnaire proposed five clinical scenarios and provided a range of follow-up options for each scenario. Clinicians were asked to indicate which best matched their clinical practice.
Results: Most clinicians follow patients for at least 3–5 years following resection of gastric or esophageal cancer. In total, 52% perform routine surveillance imaging, with individual scenarios not altering this. Tumor markers are infrequently used. Endoscopy and routine blood tests are used by around half the respondents.
Conclusion: There was little consensus about the use of investigations to monitor patients following esophagogastric cancer surgery. Choices do not follow guidelines or evidence. The identified patterns of postoperative surveillance practice appear not to be evidence based, and generally do not match recently published Australian guidelines.
Purpose: We investigated the outcomes of surgery for pneumothorax following outpatient drainage therapy.
Methods: We reviewed the records of 34 patients who underwent operations following outpatient drainage therapy with the Thoracic Vent at our hospital between December 2012 and September 2016. Indications for outpatient drainage therapy were pneumothorax without circulatory or respiratory failure and pleural effusion. Indications for surgical treatment were persistent air leakage and patient preference for surgery to prevent or reduce the incidence of recurrent pneumothorax.
Results: Intraoperatively, 9 of 34 cases showed loose adhesions around the Thoracic Vent, all of which were dissected bluntly. The preoperative drainage duration ranged from 5 to 13 days in patients with adhesions and from 3 to 19 days in those without adhesions, indicating no significant difference. The duration of preoperative drainage did not affect the incidence of adhesions. The operative duration ranged from 30 to 96 minutes in patients with adhesions and from 31 to 139 minutes in those without adhesions, also indicating no significant difference.
Conclusion: Outpatient drainage therapy with the Thoracic Vent was useful for spontaneous pneumothorax patients who underwent surgery, and drainage for less than 3 weeks did not affect intraoperative or postoperative outcomes.
This study aimed to report the clinical features and early and long-term outcomes of patients treated with carotid endarterectomy (CEA) combined with a routine shunt for carotid stenosis with the occlusion of the contralateral carotid artery (CCO), and to compare them with patients without contralateral occlusion (NO-CCO). A retrospective analysis included 301 patients who had carotid artery stenosis treated with CEA using a routine shunt. Of these patients, 35 patients and 266 patients were categorized into a CCO group and NO-CCO group, respectively. Demographics and short-term and long-term outcomes were documented and compared. The demographic characteristics were not significantly different between the two groups. The periprocedural mortality, stroke rate, and rate of periprocedural myocardial infarction were not significantly different between both groups. The mean follow-up period for long-term outcomes was 34.45 ± 22.99 months, and the Kaplan–Meier analysis showed no statistical difference between both groups regarding stroke, myocardial infarction, and mortality. CEA combined with the routine shunt is an effective and durable procedure for carotid artery stenosis patients with CCO.
Purpose: The aim was to examine the predictors of improvement of quality of life after 2 years of coronary artery bypass grafting (CABG).
Methods: In all, 208 patients who underwent the elective CABG at the Institute for Cardiovascular Diseases Dedinje in Belgrade were contacted and examined 2 years after the surgery. All patients completed Nottingham Health Profile Questionnaire part one.
Results: Two years after CABG, quality of life (QOL) in patients was significantly improved in all sections compared to preoperative period. Independent predictors of QOL improvement after 2 years of CABG were found to be serious angina under sections of physical mobility [p = 0.003, odds ratio (OR) = 1.76, 95% confidence interval (CI) 1.21–2.55], energy (p = 0.01, OR = 1.63, 95% CI: 1.11–2.38), sleep (p = 0.005, OR = 1.65, 95% CI: 1.16–2.35), pain (p <0.001, OR = 2.43, 95% CI: 1.57–3.77), absence of hereditary load in energy section (p = 0.002, OR = 0.35, 95% CI: 0.18–0.68), male sex in the sleep section (p = 0.03, OR = 0.43, 95% CI: 0.20–0.93), and absence of diabetes in pain section (p = 0.006, OR = 0.27, 95% CI: 0.10–0.68).
Conclusion: Predictors of improvement of QOL after 2 years of CABG are serious angina, absence of hereditary load, male sex, and absence of diabetes.
Purpose: This purpose of this prospective study was to use a continuous glucose monitoring (CGM) system to evaluate the suitability of our institution’s glucose management protocol after cardiovascular surgery and to clarify the impact of glycemic variability on postoperative complications.
Methods: In all, 76 patients who underwent elective cardiovascular surgery and were monitored perioperatively using a CGM system were evaluated. Postoperative glucose management consisted of continuous intravenous insulin infusion (CIII) in the intensive care unit, and subcutaneous insulin injections (SQII) after oral food intake started. CIII and subcutaneous injections were initiated when blood glucose level exceeded 150 mg/dL. CGM data were used to analyze perioperative glycemic variability and association with postoperative complications.
Results: Target glucose levels (71–180 mg/dL) were achieved during 97.1 ± 5.5% and 86.4 ± 19.0% of the continuous insulin infusion and subcutaneous injection periods, respectively. Major postoperative complications were surgical site infections, found in 6.6% of total patients, and atrial fibrillation, found in 44% of patients with off-pump coronary artery bypass grafting. High glycemic variability during SQII was associated with increased risk for both complications.
Conclusion: Data analysis revealed that our glucose management protocol during CIII was adequate. However, the management protocol during SQII required improvement.
Background: The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV.
Methods: In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value.
Results: The study population had a mean age of 59 ± 16 years, mean aortic gradient of 47.1 ± 6.4 mmHg, and mean aortic valve area (AVA) index of 0.45 ± 0.11 cm² /m² . Baseline PWV values correlated positively with the mean aortic gradient (r = 0.350, p = 0.031) and negatively with the AVA index (r = −0.512, p = 0.001). The mean PWV improved in 20 patients (53%) and worsened in 18 patients (47%). The baseline New York Heart Association (NYHA) class (odds ratio [OR] = 1.023, 95% confidence interval [CI] = 1.005–1.041, p = 0.041) and AVA index (OR = 1.040, 96% CI = 1.023–1.057, p = 0.028) emerged as the independent predictors of improvement in PWV following AVR.
Conclusion: The severity of AS was significantly associated with baseline PWV. In general, the mean PWV did not change with AVR. Baseline NYHA class and the AVA index independently predicted PWV improvement following AVR. Since the change in PWV after AVR was polarized based on the patients’ characteristics, such as preoperative NYHA functional class or AVA index, further studies are needed to confirm clinical significance of PWV change following AVR in severe AS patients.
Thymomas with ring calcifications are very rare and quaint style. Herein, we presented our three cases of thymomas with ring calcifications and reviewed totally 10 cases including 7 cases of previous English literatures. The median age was 53 years. Myasthenia gravis was a complication in 40%. The median maximal diameter was 50 mm. They were diagnosed as pathological type B or had type B component. Based on World Health Organization (WHO) classification, 20%, 60%, and 20% cases were stage I, stage II, and stage III, respectively. Seven ring calcifications were within tumors (inner type) and two cases were outside tumors (outer type). The other had a thymoma arising in the calcic wall of a calcified thymic cyst (miscellaneous type). Four other anterior mediastinal tumors with ring calcification had been reported. We need pathological examinations for a definitive diagnosis. Surgeons should plan surgery because of the possibility of invasive thymomas, or other malignant tumors.
Purpose: Benign tumors are known to grow or develop sometimes during pregnancy. We present a case report about a young woman with a growing sternal tumor.
Methods: After her second pregnancy, a 32-year-old female presented with a rapid growing sternal tumor. Computed tomography (CT) scan revealed a tumor measuring 10 × 8 × 7 cm with an intrathoracic bulk, compressing the heart and the upper margin of the liver.
Results: Resection of the tumor was performed uneventfully. Histologic examination of the resected mass revealed a chondroma.
Conclusion: To the best of our knowledge, this is the first report of a huge sternal chondroma growing in a pregnant patient. There is not often a need to treat these patients before delivery, however, thereafter surgical treatment of growing tumors is recommended.
We present a case of a 10-month-old girl baby with pulmonary artery sling and bridging bronchus demonstrated using multidetector computed tomography with a three-dimensional volume-rendering display and minimum intensity projections. To the best of our knowledge, this method has been helpful not only in the diagnosis and surgical planning for this rare abnormality but also in the evaluation of prognosis. After pulmonary artery reimplantation, the patient was well and discharged.