David Sanchez

Cryopreserved Arterial Allograft Reconstruction After Excision of Thoracic Malignancies

BACKGROUND The purpose of this study was to evaluate the long-term clinical and immunologic outcome of cryopreserved arterial allograft (CAA) revascularization of intrathoracic vessels invaded by malignancies. METHODS Since January 2002, consecutive patients whose intrathoracic vessels were invaded by malignancies were operated on and revascularizion made using human lymphocyte antigen (HLA)- and ABO-mismatched CAAs. Immunologic studies were performed preoperatively, and 1, 3, 6, 12, and 24 months postoperatively. Postoperative oral anticoagulation therapy was not given. RESULTS Twenty-six patients aged 53.1 +/- 15 years with a nonsmall-cell lung cancer (n = 10), invasive mediastinal tumors (n = 7), pulmonary artery sarcoma (n = 3), laryngeal (n = 2), or other rare lung neoplasms (n = 4) underwent operation. Cardiopulmonary bypass was used in 10 cases (38%), and all resections were pathologically complete. Revascularization was either for venous (n = 12) or arterial (n = 14) vessels, and a total of 30 allografts revascularized the superior vena cava (n = 6), pulmonary artery (n = 7), innominate vein (n = 3) or artery (n = 2), ascendent (n = 4) or descending (n = 1) aorta, and subclavian vein (n = 3) or artery (n = 4). Hospital morbidity and mortality were 50% (n = 13) and 3.8% (n = 1), respectively, all CAA unrelated. With a median follow-up of 18 months (range, 3 to 60+), 5-year survival and allograft patency were 84% and 95%, respectively. Preoperative anti-HLA antibodies were detected in 2 patients (7.7%) and a postoperative anti-HLA antibody response, clinically irrelevant, in 1 of 24 patients (4%). CONCLUSIONS Revascularization of intrathoracic venous and arterial vessels in patients with malignancies using HLA- and ABO-mismatched CAA is technically feasible and clinically attractive because of no infection risk and postoperative anticoagulation, and excellent long-term survival, patency, and nonimmunogeneicity.

Mediastinal staging by videomediastinoscopy in clinical N1 non-small cell lung cancer: a prospective multicentre study

A quarter of patients with clinical N1 (cN1) non-small cell lung cancer (NSCLC) based on positron emission tomography–computed tomography (PET-CT) imaging have occult mediastinal nodal involvement (N2 disease). In a prospective study, endosonography alone had an unsatisfactory sensitivity (38%) in detecting N2 disease. The current prospective multicentre trial investigated the sensitivity of preoperative mediastinal staging by video-assisted mediastinoscopy (VAM) or VAM-lymphadenectomy (VAMLA). Consecutive patients with operable and resectable (suspected) NSCLC and cN1 after PET-CT imaging underwent VAM(LA). The primary study outcome was sensitivity to detect N2 disease. Secondary endpoints were the prevalence of N2 disease, negative predictive value (NPV) and accuracy of VAM(LA). Out of 105 patients with cN1 on imaging, 26% eventually developed N2 disease. Invasive mediastinal staging with VAM(LA) had a sensitivity of 73% to detect N2 disease. The NPV was 92% and accuracy 93%. Median number of assessed lymph node stations during VAM(LA) was 4 (IQR 3–5), and in 96%, at least three stations were assessed. VAM(LA) has a satisfactory sensitivity of 73% to detect mediastinal nodal disease in cN1 lung cancer, and could be the technique of choice for pre-resection mediastinal lymph node assessment in this patient group with a one in four chance of occult-positive mediastinal nodes after negative PET-CT. Videomediastinoscopy reaches a sensitivity of 73% detecting N2 disease in cN1 NSCLC patients; N2 prevalence is 26% http://ow.ly/VrzL30gIOWm

MUSIC: An 8 channel readout ASIC for SiPM arrays

This paper presents an 8 channel ASIC for SiPM anode readout based on a novel low input impedance current conveyor (under patent1). This Multiple Use SiPM Integrated Circuit (MUSIC) has been designed to serve several purposes, including, for instance, the readout of SiPM arrays for some of the Cherenkov Telescope Array (CTA) cameras. The current division scheme at the very front end part of the circuit splits the input current into differently scaled copies which are connected to independent current mirrors. The circuit contains a tunable pole zero cancellation of the SiPM recovery time constant to deal with sensors from different manufacturers. Decay times up to 100 ns are supported covering most of the available SiPM devices in the market. MUSIC offers three main features: (1) differential output of the sum of the individual input channels; (2) 8 individual single ended analog outputs and; (3) 8 individual binary outputs. The digital outputs encode the amount of collected charge in the duration of the digital signal using a time over threshold technique. For each individual channel, the user must select the analog or digital output. Each functionality, the signal sum and the 8 A/D outputs, include a selectable dual-gain configuration. Moreover, the signal sum implements dual-gain output providing a 15 bit dynamic range. Full die simulation results of the MUSIC designed using AMS 0.35 µm SiGe technology are presented: total die size of 9 mm2, 500 MHz bandwidth for channel sum and 150 MHz bandwidth for A/D channels, low input impedance (≈32 Ω), single photon output pulse width at half maximum (FWHM) between 5 and 10 ns and with a power consumption of ≈ 30 mW/ch plus ≈ 200 mW for the 8 ch sum. Encapsulated prototype samples of the MUSIC are expected by March 2016.

Performance of the FlexToT v2 ASIC on the readout of different detector designs for PET

A new version of the FlexToT application-specific integrated circuit (ASIC) has been designed and fabricated with an extended dynamic range and improved channel uniformity suitable for readout of different detector block designs in time of flight (TOF) positron emission tomography (PET) applications. The performance of the FlexToT v2 ASIC has been evaluated using segmented, monolithic and phoswich scintillator elements and matrices coupled to silicon photmultiplier (SiPM) arrays. The enhanced dynamic range of FlexToT v2 compared to its previous version allows the correct identification of individual crystals in scintillator matrices, both single layer and phoswich. Operation with monolithic scintillators was also demonstrated, with energy resolutions of 18% (FWHM) at 511 keV and reconstructed PET images of point sources yielding spatial resolutions on the order of 2 mm (FWHM). The results show that the FlexToT v2 ASIC is a flexible solution for the front-end readout of different designs of SiPM-based scintillator detectors in TOF-PET applications.

Performance of FlexToT Time Based PET Readout ASIC for Depth of Interaction Measurements

J. Trenadoa∗, J. M. Celab, A. Comermaa†, D. Gascona, R. Graciania, L. Freixasb, J. Marinb, G. Martínezb, R. Masachsa, J.M. Perezb, P. Ratob, D. Sancheza, A. Sanuya, I. Sarasolab a University of Barcelona, Spain b CIEMAT, Spain E-mail: jtrenado@ecm.ub.edu, josemanuel.cela@ciemat.es, comerma@physi.uni-heidelberg.de, dgascon@ecm.ub.edu, graciani@ecm.ub.edu, lluis.freixas@ciemat.es, jesus.marin@ciemat.es, gustavo.martinez@ciemat.es, rmasachs@ecm.ub.edu, jm.perez@ciemat.es, pedro.rato@ciemat.es, dsanchez@ecm.ub.edu, asanuy@ecm.ub.edu, iciar.sarasola@ciemat.es

Diagnosis and Treatment of Malignant Pleural Effusion

Malignant pleural effusion (MPE) is a common clinical problem in patients with neoplastic disease. The optimal palliative management for patients with symptomatic MPE is not well understood. There is a variety of possible treatments: thoracentesis or repeat thoracentesis; instillation of irritating agents into the pleural cavity by the thoracostomy tube or under thoracoscopic vision; alternatives to the pleurodesis such as chronic indwelling pleural catheter and pleuroperitoneal shunt for those cases with trapped lung. The treatment choice depends on the clinician’s specialty and expertise, the patient’s performance status and the hospitalization status. This chapter presents a comprehensive review of the current methods for diagnosing and managing patients with MPE.

Blunt traumatic bronchial transection.

17-year-old man underwent a high-speed motorbike collision and was admitted into our intensive are unit. A chest computed tomographic scan showed a omplete bronchial disruption at the level of the interediate bronchus contained by mediastinal structures Fig 1A, arrows), pneumothorax, and pneumomediastium, and a right-sided upper and lower lobe parenchyal contusion, but no rib fractures. The transection ollowed an oblique path starting in front of the right pper lobe takeoff on its membranous face and reaching he middle lobe bronchus on its cartilaginous aspects Fig 1B, arrows). The pneumothorax was treated with the lacement of a chest tube, and a rigid bronchoscopy