The Annals of thoracic surgery
-
Patients receiving chemotherapy for lung cancer usually modify their lung function during treatment with increases in forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC) and decreases in lung diffusion for carbon monoxide (DLCO). This prospective study was designed to evaluate functional changes in forced expiratory volume in 1 second, forced vital capacity, and DLCO after three courses of induction chemotherapy with cisplatinum and gemcitabine in stage IIIa lung cancer patients and to assess their impact on respiratory complications after lung resection. ⋯ In lung cancer patients, forced expiratory volume in 1 second and forced vital capacity assessed after neoadjuvant chemotherapy are not reliable indicators of the likelihood of respiratory complications after surgery. The risk of respiratory complication may be directly linked to loss of DLCO/Va. Lung diffusion for carbon monoxide assessed after neoadjuvant chemotherapy is probably the most sensitive risk indicator of respiratory complications after surgery. We recommend that DLCO studies be performed before and after chemotherapy in lung cancer patients undergoing induction therapy.
-
Case Reports
Iatrogenic iliac artery rupture and type a dissection after endovascular repair of type B aortic dissection.
We report a case of two iatrogenic complications after endovascular repair of a type B aortic dissection treated for abdominal aortic branch ischemia. A rupture of the common iliac artery occurred first during the procedure. ⋯ The proximal part of the aortic endovascular graft had created a tear in the aortic wall resulting in a retrograde type A dissection. Although aortic endovascular grafting is apparently associated with less morbidity and mortality, potentially lethal complications, both acute and delayed, may arise.
-
Methods to assess the six competency categories outlined by the Accreditation Council on Graduate Medical Education are essential to allow residency programs to develop reproducible evaluations of their educational curriculum. Current tools to evaluate competencies are insufficient to perform these tasks, particularly in subspecialty disciplines. The key objective of this initiative was to develop and implement an evaluative tool that would provide data to residents and program leadership regarding their performance and to provide the training program with a reliable way to assess this component of the program. ⋯ The 360-degree feedback results provided valuable information for the residents. It also provided our program with a reproducible, quantifiable tool to assess these competencies. Combined with other instruments, the 360-degree feedback was found to be a particularly valuable instrument.
-
Video-assisted thoracic surgery (VATS) is conventionally performed under single-lung ventilation. A small proportion of patients are often excluded from undergoing VATS because of their inability to tolerate single-lung ventilation. We describe a simple technique of selective lobar lung collapse that may help to recruit additional, selected patients for VATS. ⋯ This technique is simple and safe and requires no expensive disposable devices. Although not essential for most patients undergoing VATS, it deserves to be in the armamentarium of the thoracic surgeon. Further studies will be required to better define its application in clinical practice.
-
Use of arterial grafts in coronary surgery is based on the excellent patency of the left internal thoracic artery (LITA) and an expectation that other arterial grafts-right internal thoracic artery (RITA) and radial artery (RA)-will give similar patencies, superior to saphenous vein. We examined patencies of arterial grafts in a practice with extensive use for more than 15 years. ⋯ Excellent long-term patencies of arterial grafts are noted, superior to those of vein grafts. Patencies were influenced by conduit, by distribution, and by coronary artery stenosis.