The Annals of thoracic surgery
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Patients with clinical stage I lung cancer can be considered as arising from three treatment groups: (1) good-risk patients, who are usually treated with lobectomy; (2) high-risk patients, who are usually treated with sublobar (segmental or wedge) resection; and (3) medically inoperable patients, who have traditionally been treated with external beam radiation. Stereotactic body radiation therapy and radiofrequency ablation are two approaches that are gaining increasing popularity for medically inoperable patients. Some have even argued that stereotactic body radiation therapy may be equivalent to lobectomy because of equivalent local control. ⋯ Lymph node dissection and sampling can also be undertaken at the time of sublobar resection, potentially improving outcomes and allowing identification of unsuspected nodal disease. Despite this, stereotactic body radiation therapy and radiofrequency ablation may be clinically equivalent to sublobar resection for the high-risk patient because of lower procedural morbidity and more rapid return to normal function; however, this has not yet been determined in prospective studies. We review current data on oncologic and secondary outcomes such as morbidity and effect on pulmonary function to help define which therapy is best.
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Horace Smithy, a native Virginian, received his surgical education in Charleston, then joined the Medical College of South Carolina faculty. He developed a valvulotome, which was used to perform a successful mitral valvulotomy on a 21-year-old woman on January 30, 1948. ⋯ Tragically, he died of progressive congestive heart failure at the age of 34 (on October 28, 1948), 270 days after his first operation. Horace Smithy was unquestionably an innovative pioneering cardiac surgeon who performed the first successful mitral valve operation of the "modern" era.
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Little is known about the molecular mechanisms of neurologic complications after hypothermic circulatory arrest (HCA) with cardiopulmonary bypass (CPB). Canine genome sequencing allows profiling of genomic changes after HCA and CPB alone. We hypothesize that gene regulation will increase with increased severity of injury. ⋯ Our genomic profile of canine brains after HCA and CPB revealed 1-hour and 2-hour HCA induced markedly increased gene regulation, in contrast to the minimal effect of CPB alone. This adds to the body of neurologic literature supporting the safety of CPB alone and the minimal effect of CPB on a normal brain, while illuminating genomic results of both.
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Meta Analysis
Off-pump coronary artery bypass may increase late mortality: a meta-analysis of randomized trials.
Although a lot of randomized trials of off-pump coronary artery bypass grafting (CABG) versus on-pump CABG were conducted, the majority of them reported only early outcomes. Previous meta-analyses of a few randomized trials found no differences for 1-year to 2-year mortality. ⋯ The results of our analysis suggest that off-pump CABG may increase late all-cause mortality by a factor of 1.37 over on-pump CABG. Longer term mortality from randomized trials of off-pump versus on-pump CABG is needed.
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Pulmonary segmentectomy has become a good option for small peripheral non-small cell lung cancers and is currently being evaluated in a large North American randomized study, CALGB-140503 (Cancer and Leukemia Group B-140503). Using a video-assisted thoracic surgical approach to segmentectomy decreases the morbidity and hastens the recovery of patients having this operation relative to a thoracotomy. This technique can be easily learned by surgeons who use video-assisted thoracic surgery to perform other operations.