Sheen Peeceeyen

Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients.

OBJECTIVES This meta-analysis aimed to compare the perioperative outcomes of video-assisted thoracic surgery (VATS) with open thoracotomy for propensity score-matched patients with early-stage non-small cell lung cancer (NSCLC). METHODS Four relevant studies with propensity score-matched patients were identified from six electronic databases. Endpoints included perioperative mortality and morbidity, individual postoperative complications and duration of hospitalization. RESULTS Results indicate that all-cause perioperative mortality was similar between VATS and open thoracotomy. However, patients who underwent VATS were found to have significantly fewer overall complications, and significantly lower rates of prolonged air leak, pneumonia, atrial arrhythmias and renal failure. In addition, patients who underwent VATS had a significantly shorter length of hospitalization compared with those who underwent open thoracotomy. CONCLUSIONS In view of a paucity of high-level clinical evidence in the form of large, well-designed randomized controlled trials, propensity score matching may provide the highest level of evidence to compare VATS with open thoracotomy for patients with NSCLC. The present meta-analysis demonstrated superior perioperative outcomes for patients who underwent VATS, including overall complication rates and duration of hospitalization.

Right ventricular loop indicating malposition of J-wire introducer for double lumen bicaval Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) cannula

The key to safe placement of a bicaval double lumen cannula for Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) is to visualise correct guide wire placement in the inferior vena cava (IVC), thus aiding subsequent correct advancement of the cannula. Transoesophageal (TOE) and transthoracic (TTE) echocardiography, as well as fluoroscopy, have been described as aiding imaging techniques. We report a case of guide wire malposition into the right ventricle, despite echocardiographic confirmation of guide wire position deep into the IVC. This malposition, if undetected, may have resulted in potential life threatening complications.

Treatment of Intravenous Leiomyomatosis with Cardiac Extension following Incomplete Resection.

Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign uterine leiomyoma. Incomplete resection has a recurrence rate of over 30%. Different hormonal treatments have been described following incomplete resection; however no standard therapy currently exists. We review the literature for medical treatments options following incomplete resection of IVL with CE. Methods. Electronic databases were searched for all studies reporting IVL with CE. These studies were then searched for reports of patients with inoperable or incomplete resection and any further medical treatments. Our database was searched for patients with medical therapy following incomplete resection of IVL with CE and their results were included. Results. All studies were either case reports or case series. Five literature reviews confirm that surgery is the only treatment to achieve cure. The uses of progesterone, estrogen modulation, gonadotropin-releasing hormone antagonism, and aromatase inhibition have been described following incomplete resection. Currently no studies have reviewed the outcomes of these treatments. Conclusions. Complete surgical resection is the only means of cure for IVL with CE, while multiple hormonal therapies have been used with varying results following incomplete resection. Aromatase inhibitors are the only reported treatment to prevent tumor progression or recurrence in patients with incompletely resected IVL with CE.

Early stenosis of Medtronic Mosaic bioprosthesis in the aortic position

The Medtronic Mosaic valve (Medtronic, Inc, Minneapolis, Minn) is a third-generation stented porcine bioprosthesis combining physiologic fixation and a-amino-oleic acid antimineralization treatment to improve hemodynamic performance and durability. Despite encouraging short-term and midterm clinical results, however, there has been a heightened interest in the safety and efficacy of this device after a recent case series study of early valve failure resulting from an unknown cause. We present here 2 case reports of early structural valve dysfunction after implantation of the Mosaic valve in the aortic position.

Safety and efficacy of aerobic exercise commenced early after cardiac surgery: A systematic review and meta-analysis

Background Aerobic exercise is a critical component of cardiac rehabilitation following cardiac surgery. Aerobic exercise is traditionally commenced 2–6 weeks following hospital discharge and most commonly includes stationary cycling or treadmill walking. The initiation of aerobic exercise within this early postoperative period not only introduces the benefits associated with aerobic activity sooner, but also ameliorates the negative effects of immobilization associated with the early postoperative period. Methods A systematic review identified all studies reporting safety and efficacy outcomes of aerobic exercise commenced within two weeks of cardiac surgery. A meta-analysis was performed comparing functional, aerobic and safety outcomes in patients receiving early postoperative aerobic exercise compared with usual postoperative care. Results Six-minute walk test distance at hospital discharge was 419 ± 88 m in early aerobic exercise patients versus 341 ± 81 m in those receiving usual care (mean difference 69.5 m, 95% confidence interval (CI) 39.2–99.7 m, p < 0.00001). Peak aerobic power was 18.6 ± 3.8 ml·kg–1·min–1 in those receiving early exercise versus 15.0 ± 2.1 ml·kg–1·min–1 in usual care (mean difference 3.20 ml·kg–1·min–1, 95% CI 1.45–4.95, p = 0.0003). There was no significant difference in adverse events rates between the two groups (odds ratio 0.41, 95% CI 0.12–1.42, p = 0.16). Conclusion Aerobic exercise commenced early after cardiac surgery significantly improves functional and aerobic capacity following cardiac surgery. While adverse event rates did not differ significantly, patients included were very low risk. Further studies are required to adequately assess safety outcomes of aerobic exercise commenced early after cardiac surgery.

Tension pneumomediastinum after blunt chest trauma

presence of a tubular structure extending into the stomach. Jejunogastric intussusception can be classified into three subtypes depending on the involved loop: type 1, afferent loop; type 2, efferent loop; and type 3, both afferent and efferent loop invagination. Most cases, including the one presented in this paper, are type 2 jejunogastric intussusceptions. These originate in the efferent limb and extend in a retrograde fashion against peristalsis. Because of the high risk of incarceration and strangulation jejunogastric intussusception generally warrants surgical intervention. This can range from simple reduction of the intussusception to resection and re-fashioning the gastroenterostomy. In the majority of cases resection is undertaken because of either the risk of an associated lead point caused by a small bowel lesion or ischaemic changes in the involved segment. Delay in surgical intervention is associated with a significant increase in mortality especially after 48 h. Our case highlights how this unusual presentation needs to be considered even years after gastrojejunostomies.