To examine baseline characteristics associated with survival in patients with malignant pleural mesothelioma.122 patients with histologically proven malignant pleural mesothelioma during the period 2000-2010 were studied. Survival was evaluated by the Kaplan-Meier method with the logrank test. Cox regression analysis was used to estimate the hazard ratios for possible prognostic factors.105 (86%) patients had complete survival follow-up; 91 died and 14 (13.3%) were alive at the end of the observation period starting from the day of diagnosis. The median survival was 286 days (95% confidence interval: 212-359). Talc pleurodesis was performed in 59 patients, and 17 had surgical interventions (2 chest wall resections, 2 extrapleural pneumonectomies, and 13 decortications). Chemotherapy was used in 41 patients, port-site radiation in 68, and combined therapy in 26. Cox regression analysis identified talc pleurodesis (p=0.04), chemotherapy (p<0.001), port-site radiation (p<0.001), and combined chemotherapy and port-site radiation (p<0.006) as favorable prognostic factors after adjusting for age, sex, histologic subtype, smoking, and performance status.Surgical intervention including decortications and extrapleural pneumonectomy had no effect on survival in this series. Chemotherapy and radiation to port sites independently and in combination were associated with improved overall survival in malignant pleural mesothelioma patients. Talc pleurodesis was an independent determinant of survival, but further studies are warranted.
Oesophageal cancer is more commonly described in male patients, and there are far fewer women affected. Gender differences have not been fully investigated.
Aims/Background
This report explores such differences in clinico-pathologic features, long-term outcome and disease recurrence in women in comparison to those in men.
Method
A total of 169 patients with oesophageal cancer were surgically treated between 2005 and 2010 (43 [25.4%] females and 126 males). Gender differences in these patients were retrospectively investigated.
Results
Ninety-six patients (57%) survived at end of follow up. Median survival rate was 52 months and a 5-years survival rate was 50%. Median follow up for the whole cohort was 25 months (0–79). Fifty patients (30%) developed recurrence at end of follow up. Median disease free progression (DFP) rate was 33 months and 5-years DFP rate was 20%. Data on co-morbidities were only available in 120 patients. Females were more likely to be non smokers (58% vs. 27%; p<0.007) and non drinkers (55% vs. 36%; p<0.05). Recurrence was less likely in women (19% vs. 35%; p<0.03), and Clinico-pathologic features significantly associated with female gender were: squamous cell type (42% vs. 17%; p<0.001), complete resection (82% vs. 62%; p<0.01), clear circumferential margins (80% vs. 62%; p<0.02), smaller tumor size (32 vs. 39 mm, p<0.02) and higher FDG uptake of tumor on pre-operative PET scan (SUVmax 14.4 vs. 10.5;p<0.02). Female gender did not seem to influence overall outcome or disease recurrence and did not independently predict survival or disease recurrence.
Conclusion
Our data support the fact that common known risk factors for oesophageal cancers are less encountered in females, however certain tumour characteristics were significantly associated with female gender. Esophageal cancer causes the same symptoms and progresses in the same way in both men and women.
Benign metastasizing leiomyoma is a rare disorder involving distant metastases secondary to a smooth muscle tumour of the myometrium. This case report describes a 48-year-old woman with multiple pulmonary nodules noted on post-operative chest x-ray. Further investigation revealed a history of total abdominal hysterectomy for benign fibroids of the uterus, 6 years prior to the scan. CT-guided fine needle aspirate of the pulmonary nodules showed smooth muscle proliferation within lung parenchyma, suggesting smooth muscle tumour confirmed with immunohistochemistry. Management is still controversial in view of low case numbers; however, treatment with hormone therapy and castration has been attempted.
Abstract Background Left ventricular diastolic dysfunction (DD) is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both during exercise as well as at rest, while left atrial pressure does not exceed 12 mm Hg. We examined the concept of left ventricular diastolic dysfunction in a cardiac surgery setting. Materials and methods Literature review was carried out in order to identify the overall experience of an important and highly underestimated issue: the unexpected adverse outcome due to ventricular stiffness, following cardiac surgery. Results Although diverse group of patients for cardiac surgery could potentially affected from diastolic dysfunction, there are only few studies looking in to the impact of DD on the postoperative outcome; Trans-thoracic echo-cardiography (TTE) is the main stay for the diagnosis of DD. Intraoperative trans-oesophageal (TOE) adds to the management. Subgroups of DD can be defined with prognostic significance. Conclusion DD with elevated left ventricular end-diastolic pressure can predispose to increased perioperative mortality and morbidity. Furthermore, DD is often associated with systolic dysfunction, left ventricular hypertrophy or indeed pulmonary hypertension. When the diagnosis of DD is made, peri-operative attention to this group of patients becomes mandatory.
Pulmonary artery haemorrhage is thankfully a very rare complication following pulmonary artery catheter insertion. It carries a significant mortality of 50%, and most cases are managed conservatively or with embolization therapy. We present an occult case, in which a patient presented with haemodynamic compromise without haemoptysis or significant haemothorax, who required surgical intervention. We discuss surgical treatment management options and the need for a high index of clinical suspicion to prevent mortality from this condition.
A 54-year-old man with typical ischaemic chest pain underwent emergency percutaneous coronary intervention for anterolateral ST elevation myocardial infarction. At this time, acute occlusion of an end artery, the intermediate branch of the left coronary artery, was identified (figure 1). A ventriculogram, right oblique view, also demonstrated dilation of the myocardium within the territory of the intermediate vessel (figure 2). At first, this was thought to be a cardiac diverticulum. The patient underwent coronary artery bypass grafting, and the diverticulum was, in fact, found …
Cardiac myxomas are rare primary tumors with varied clinical presentations that may pose a diagnostic challenge. Here, we describe the case of a 21-year-old man with multiple cavitating lung lesions with aspergillosis and underlying right atrial myxoma, who presented with hemoptysis and weight loss. He was successfully treated with right atrial myxoma resection and antifungal agents, with no recurrence or complications after one year of follow-up.
Up to 150 words summarising the case presentation and outcome (this will be freely available online). A Marfan case with dilated aortic root and prolapsed leaflets underwent aortic repair. The non-coronary leaflet-measured effective height was 7 mm (prolapsing) and was lifted up to 10 mm with a centrally placed plicating sutures. The right coronary leaflet had a geometric height of 17 mm (restricted) and was enlarged up to 21 mm with an autologous pericardial patch. The enlarged root was repaired with an inclusion technique. The final result showed a competent valve. This report outlines the feasibility of aortic repair provided one adheres to the principles of aortic valve repair.
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