Journal of thoracic disease
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Review
Completely thoracoscopic surgical stabilization of rib fractures: can it be done and is it worth it?
Surgical stabilization of rib fractures (SSRF) is now a common operation at most high-volume trauma centers. Increased experience with the procedure has spawned a variety of technical modifications to minimize incision length, muscle division, scapular retraction, and general tissue trauma. The ultimate example of such a minimally invasive approach is completely thoracoscopic SSRF, which refers to using a video-assisted thoracoscopic surgery (VATS) technique to both reduce and fixate rib fractures in an intra-thoracic fashion. ⋯ A VATS may also aid in trainee education. Despite these theoretical benefits, early attempts at thoracoscopic SSRF have been limited by both user inexperience and inadequate instrumentation. Furthermore, there are currently no data comparing the efficacy of completely thoracoscopic SSRF to either contemporary, minimally-invasive, extra-thoracic SSRF or non-operative management.
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The aim of the study was to assess the predictive ability of risk calculators of the EuroSCORE II and the Society of Thoracic Surgeons (STS) score in patients undergoing aortic valve replacement (AVR) due to severe aortic valve stenosis (AS) during a 30-day and 1-year follow-up. ⋯ The EuroSCORE II and STS score showed satisfactory discrimination and calibration for predicting 30-day and 1-year mortality in patients undergoing AVR.
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Although oxygen supplementation during bronchoscopy in patients with pre-existing hypoxemia is provided, adequacy of oxygenation may not be achieved, resulting in the occurrence of respiratory failure that requires endotracheal tube intubation. The purpose of this study was to compare high-flow nasal cannula (HFNC) with non-invasive ventilation (NIV) in patients with pre-existing hypoxemia undergoing flexible bronchoscopy (FB) on the ability to maintain oxygen saturation during bronchoscopy. ⋯ In overall, NIV and HFNC provided the similar effectiveness in prevention of hypoxemia in hypoxemic patients undergoing FB. However, in subgroup analysis, NIV provided greater adequacy and stability of oxygenation than HFNC in patients with baseline PaO2 <60 mmHg on ambient air.
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To compare the outcome of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in low and intermediate risk patients with severe aortic stenosis (AS). Randomized controlled trials (RCT) and propensity score matching (PSM) studies compare TAVR with SAVR in patients at low and intermediate surgical risk. ⋯ PROSPERO CRD 42018112626.
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Leptomeningeal spread in non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations who experience disease progression on TKIs portends a poor prognosis. Mutation profiling of tumour DNA in cerebrospinal fluid (CSF) samples can be used to determine the presence of the EGFR T790M resistance mutation, indicating that osimertinib, a CNS-penetrating 3rd generation TKI may be efficacious. ⋯ Standard-dose osimertinib resulted in a clinically meaningful response in a patient with EGFR T790M-negative 1st generation EGFR TKI refractory leptomeningeal disease. Next generation sequencing and ddPCR has a role at identifying the C797S mutation and its allelic conformation with the T790M mutation with clinical implications.