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The optimal timing for post traumatic Chest Wall Reconstruction (CWR) in severely injured / polytraumatized patients with severe chest wall instability remains a subject of debate. While early surgery within 72 h is associated with improved outcomes, the efficacy and safety of an even earlier "rapid sequence" approach on the day of admission are unclear. This study aims to compare outcomes of severely injured patients undergoing rapid sequence surgery (Day 0) versus early surgery (Days 1-3). A retrospective analysis was conducted using data from the TraumaRegister DGU® (2015-2023). Patients with serious chest wall injuries (AISThorax ≥3), an Injury Severity Score (ISS) ≥ 9, who survived the first 48 h and underwent CWR were included. Patients were stratified into a "Rapid Sequence" group (surgery on Day 0) and an "Early" group (surgery on Days 1-3). Propensity score matching (PSM) was performed to balance baseline characteristics, including injury patterns, demographics, and initial physiological status. Primary outcome was in-hospital mortality. Secondary outcomes included sepsis, multi-organ failure (MOF), and length of stay. From an initial cohort of 34,659 patients with severe chest wall injuries, 2,498 operatively treated patients with a known date of surgery were analyzed. 1,168 (46.8%) underwent rapid sequence surgery (Day 0) and 567 (22.7%) underwent early surgery (Days 1-3). Before matching, the Rapid Sequence group had a higher ISS (27.7 vs. 26.0), a higher incidence of severe head trauma (14.4% vs. 9.2%), and significantly higher mortality (8.4% vs. 4.1%). PSM yielded 500 matched pairs. Despite matching, the Rapid Sequence group retained a higher baseline injury burden (mean ISS: 28.1 vs. 26.2; mortality prognosis (Revised Injury Severity Classification, Version III (RISC III) Score): 16.2% vs. 10.7%). The primary outcome showed a nearly threefold higher mortality rate in the Rapid Sequence group (10.6% vs. 3.6%; p < .001). Rates of sepsis (14.6% vs. 12.0%) and MOF (33.6% vs. 28.3%) were also higher in the rapid group, though not statistically significant. In this large registry analysis, rapid sequence CWR on the day of admission identified a distinct subgroup of patients with more severe concomitant injuries and higher baseline risk. The higher mortality in this group likely reflects residual confounding by indication and survivorship bias, rather than a detrimental effect of rapid surgery per se. This suggests that the decision for immediate surgery is likely driven by life-threatening concomitant injuries not fully captured in the matching model, identifying a patient population with an intrinsically higher risk of death. Our findings therefore do not justify a blanket Day-0-for-all strategy, but are consistent with the broader literature suggesting that CWR performed within 72 h is beneficial when timing is individualized to overall injury severity and physiological stability.
Masculinising chest surgery, also known as top surgery, is the most requested gender-affirming procedure among transgender and gender-diverse (TGD) adolescents, yet research on patient experiences remains limited. This study explored the experiences of TGD adolescents who were seeking or had undergone masculinising chest surgery. Qualitative secondary analysis using existing themes framework and data from the GENDER-Q (GQ) and GENDER-Q Youth (GQY) research programmes, which aim to develop comprehensive patient-reported outcome measures for gender-affirming care. Participants were sampled from five high-volume gender-affirming care clinics, three in Canada and two in the United States. Interviews were conducted online. 35 GQ and GQY participants aged 13-18 years who were assigned female at birth, identified as trans men or non-binary, and were pursuing (n=19) or had undergone (n=16) masculinising chest surgery. Three major themes emerged: chest appearance, health-related quality of life (HRQL) and gender practices. Most participants expected a flatter chest that aesthetically aligned with their gender identity. Presurgery participants anticipated that surgery would allow them to engage in previously avoided physical activities and would enhance their relationships. Postoperative participants reported increased physical activity, mental resilience, bodily connection and social comfort. Most reported binder use and related reliance or discomfort as motivators for pursuing surgery. This study highlights the multidimensional experiences surrounding masculinising chest surgery on TGD adolescents with impacts on chest appearance, HRQL and gender practices. Centering adolescents' perspectives, these findings underscore the importance of accessible, affirming surgical care and provide valuable insights for clinicians, policymakers and future research.
Breast-conserving surgery (BCS), mastectomy alone (MA), and mastectomy with immediate breast reconstruction (IBR) offer similar oncologic outcomes in early-stage breast cancer, leading patients to base decisions on nononcologic factors such as chest wall discomfort, tightness, and functional limitations. The authors' primary objective was to evaluate the effects of these operations on quality of life using the BREAST-Q Physical Well-Being: Chest subscale. The secondary objective was to assess the impact of different radiation regimens on chest physical well-being. A retrospective review of stage 0 to III breast cancer patients who underwent BCS, MA, or IBR from 2015 to 2019 was conducted. The primary outcome was change in Physical Well-Being: Chest BREAST-Q scores from the preoperative period to 1-year postoperatively. A minimal important difference greater than or equal to 4 points indicated clinical significance. Of 517 patients, 202 underwent BCS, 125 underwent MA, and 190 underwent IBR. BCS patients demonstrated the highest decline of 15.3 points (89.1 to 73.8; P < 0.001) followed by MA with 12.7 points (76.6 to 63.9; P < 0.001). IBR had the smallest decline of 3.7 points (78.0 to 74.3; P = 0.022). A total of 262 radiation patients experienced a mean decline of 15.2 points (84.6 to 69.4; P < 0.001), with the regional node irradiation with boost group exhibiting the greatest decline of 21.5 points (88.5 to 67.0; P < 0.001). BCS patients, despite higher baseline scores, experienced the greatest decline, whereas IBR patients had the smallest. In addition, greater radiation intensity and extent correlated with larger declines. Integrating minimal important difference into clinical practice ensures that patient-reported outcomes capture changes that are meaningful to patients, guiding treatment decisions.
Background Cardiac MRI plays a key role in the assessment of pulmonary regurgitation (PR) after surgical repair of tetralogy of Fallot (TOF). However, its use may be limited by low availability, claustrophobia, or incompatible pacemakers or defibrillators. Purpose To evaluate the utility of dynamic chest radiography (DCR) for estimating PR after surgical TOF repair. Materials and Methods In this retrospective observational study, patients with repaired TOF who underwent DCR and phase-contrast cardiac MRI within 1 week between February 2018 and June 2024, and age- and sex-matched healthy volunteers, were enrolled. Temporal changes in pixel values of pulmonary arteries on DCR images were analyzed using specialized software. The maximum pixel value change (Max PV), maximum slope of pixel value change (Max PV Slope), and minimum slope of pixel value change (Min PV Slope) during a single cardiac cycle were calculated. Correlation between these indexes and PR fraction (PRF) at phase-contrast MRI and the ability of each index to differentiate severe PR (>30%) from nonsevere PR (≤30%) were assessed. Pearson correlation and receiver operating characteristic analyses were performed. Results The final study sample included 58 patients with repaired TOF (mean age, 30.6 years ± 10.3 [SD]; 29 [50%] male patients) and 14 healthy volunteers (mean age, 31.1 years ± 5.5; eight [57%] male individuals). Compared with patients with nonsevere PR and volunteers, patients with severe PR had the highest mean Max PV (severe PR: 26.2% ± 8.1; nonsevere PR: 14.1% ± 4.2; volunteers: 9.4% ± 3.0; P < .001), highest mean Max PV Slope (percentage change per frame) (severe PR: 6.6 ± 2.2; nonsevere PR: 2.9 ± 0.9; volunteers: 1.8 ± 0.6; P < .001), and lowest mean Min PV Slope (percentage change per frame) (severe PR: -7.2 ± 2.0; nonsevere PR: -4.6 ± 1.6; volunteers: -3.5 ± 1.4; P < .001). For patients with repaired TOF, all indexes were correlated with PRF; of these indexes, Max PV Slope had the highest correlation (R = 0.87; P < .001) and area under the receiver operating characteristic curve (0.98 [95% CI: 0.94, 1.0]; cutoff, 4.13%), yielding a sensitivity of 93% and specificity of 94%. Conclusion Max PV Slope from DCR showed high diagnostic value for PR severity in patients with repaired TOF. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Gerstner Saucedo in this issue.
Surgical treatments of the thorax are one of the most painful surgeries known. Postoperative pain is an important factor affecting treatment success, hospital stay, complications, duration of chest tube placement, and respiratory dynamics. The aim of this study was to compare the effects of analgesic treatments on postoperative pain in patients who underwent surgery with uniportal or biportal VATS (video-assisted thoracoscopic surgery), minithoracotomy, and thoracotomy. This retrospective, single-center observational analytical study was conducted from October 7, 2023, to June 25, 2024, in Department of Thoracic Surgery at Gaziantep City Hospital. Patients who were over 18 years of age, had undergone thoracic surgery were included in the study. Demographic data, comorbidities, surgical techniques, postoperative pain severity according to VAS (visual analogue scale) score, analgesic treatments and interventions, duration of chest tube placement, complications, hospital length of stay were reviewed. A total of 319 patients were examined in the study retrospectively. The gender distribution of the patients were 70.22% male, 29.78% female. Postoperative pain VAS values were 0 to 2 very mild 36.2%, 3 to 4 mild 26.3%, 5 to 6 moderate 27.8%, 7 to 8 severe 11.1%, 9 to 10 very severe 6.2% in uniportal VATS. Pain VAS values for biportal VATS were found as 0 to 2 36.2%, 3 to 4 26.3%, 5 to 6 21.1%, 7 to 8 15.5%, and 9 to 10 18.8%. The VAS values of pain in minithoracotomy were 0 to 2 24.7%, 3 to 4 37.3%, 5 to 6 33.4%, 7 to 8 26.7%, and 9 to 10 18.8%. Postoperative pain VAS values were 0 to 2 very mild 2.9%, 3 to 4 mild 10.1%, 5 to 6 moderate 17.7%, 7 to 8 severe 46.7%, 9 to 10 very severe 56.2% in thoracotomy. Very mild pain value on visual analog scale was related with uniportal VATS, biportal VATS, and minithoracotomy. Very severe pain was only associated with thoracotomy. There was no significant difference in pain between uniportal VATS and biportal. Thoracoscopic surgical techniques (uniportal and biportal VATS) were related with less pain than minithoracotomy and thoracotomy. Intercostal block with uniportal VATS was also associated with less pain than other interventions. Intercostal crush and intercostal ligation were related with lower pain than other interventions in all surgical techniques. No statistically significant difference was found between intercostal crush and ligation on low pain values of visual analog scale.
Minimally invasive mitral valve (MIMV) surgery has increased in prevalence due to reduced postoperative pain, length of stay, and improved cosmesis. However, there is a lack of data describing the risk and impact of postoperative diaphragm dysfunction (DD) after MIMV. Consecutive patients at a single institution undergoing isolated mitral valve surgery either via full sternotomy (FS) or MIMV (right thoracotomy) between 2015 and 2024 were included. The diagnosis of DD was based on postoperative diaphragm elevation on chest X-ray and confirmation via ultrasound Sniff test. Factors associated with postoperative DD were identified, and postoperative outcomes were compared between groups. The incidence of postoperative DD was 3.0% (n = 35) among the 1,155 patients undergoing MV surgery. The incidence of DD was 1.8% after FS and 9.3% after MIMV (P < 0.001). Among MIMV patients, all suffered from right DD. After controlling for age, body mass index, and pulmonary comorbidities, MIMV was independently associated with postoperative DD compared with FS (odds ratio = 5.1, 95% CI: 2.4 to 11.0, P < 0.001). Although patients with and without DD had similar postoperative outcomes, those patients older than 70 years with DD had longer postoperative ventilation times (P = 0.03) and hospital length of stay (P = 0.02). MIMV via right thoracotomy is associated with increased risk of postoperative DD and increased ventilation times and hospital length of stay for elderly patients. Further studies are needed to elucidate the causes for diaphragm injury to minimize this complication.
For the repair of chest wall defects, three-dimensional-printed PEEK implants show great potential due to their excellent anatomical matching and mechanical properties. However, Quality-Of-Life assessments after using these implants in chest wall reconstruction remain underexplored. A retrospective cohort study included 20 patients who underwent chest wall defect reconstruction with 3D-printed PEEK implants at our center between April 2017 and June 2024 and were followed up long-term. Clinical data collected at various time points included safety indicators (long-term adverse reactions, blood routine, hepatic and renal function), respiratory function assessments (pulmonary function tests, arterial blood gas analysis), Quality-Of-Life indicators (SF-36 health survey). Through a median follow-up of 35.3 months, we found that personalized PEEK thoracic rib implants achieved precise anatomical reconstruction and effective respiratory dynamics maintenance. Complete recovery of preoperative hematological parameters (p > 0.05) and liver/kidney function confirmed their biochemical safety. ≥ 1 year after surgery, the restrictive ventilation function of the patients was still lower than that before the operation, and the CO2 excretion increased (p < 0.05), but the alveolar ventilation function wasn't impaired. Oxygenation was normal (p > 0.05). The patient's physical health scores (SF-36 PCS) remained unchanged from preoperative levels (p > 0.05), while psychosocial functioning (SF-36 MCS) showed significant improvement (p < 0.05). 3D-printed PEEK implants used in chest wall reconstruction exhibited favorable safety and were associated with improved long-term Quality Of Life. These findings support that PEEK reconstruction may contribute to a combined benefit of disease control, functional preservation, and psychological recovery.
The management of chest tubes after pulmonary resection remains non- standardized, and suction levels are often determined by the surgeon's preference. This retrospective study aimed to compare the clinical outcomes of low suction -2cmH2O-2cmH2​O versus the conventional suction level used in our institution -15cmH2O-15cmH2​O using digital drainage devices after videoassisted thoracic surgery (VATS) lobectomy for suspected or confirmed lung cancer in a thoracic surgery centre. We analysed 120 patients who underwent pleural drainage after VATS lobectomy between January 2023 and September 2024. The primary outcome was drainage duration. Secondary outcomes included hospital stay, prolonged air leak, complications, and readmissions. No significant differences were observed in drainage duration (2.0 vs. 4.0 days; p=0.125p=0.125) or hospital stay (3.0 vs. 4.0 days; p=0.104p=0.104 ). The incidence of prolonged air leak was similar between groups (20.3% vs. 24.6%; p=0.578p=0.578 ). However, subcutaneous emphysema occurred more frequently in the low suction group (22% vs. 8.2%; p=0.04p=0.04 ), with a higher need for intervention, despite comparable baseline forced expiratory volume in the first second (FEV1) values between suction level groups. Importantly, patients who developed subcutaneous emphysema had significantly lower baseline FEV1 values, regardless of suction level. COPD was identified as a significant predictor of longer drainage duration, longer hospital stay, and higher complication rates. Although suction level did not significantly influence postoperative recovery, the higher incidence of subcutaneous emphysema in the low suction group warrants further investigation. The presence of COPD and impaired baseline lung function should be considered when selecting suction levels after VATS lobectomy.
Pectus excavatum (PE) is the most common congenital chest wall deformity, characterized by a depression of the anterior chest wall which may compromise cardiac function and cause symptoms like exercise intolerance, chest pain, and shortness of breath. While diagnosis is often based on appearance, imaging-based metrics provide objective severity assessment. This study evaluated associations between PE severity indices and cardiac rotation angle in 37 adolescents generated two sex-specific anatomical models of severe cases for future diagnostic and treatment planning. Chest computed tomography (CT) scans of 30 male and seven female PE patients aged 12-16 years were analyzed to measure the Haller index, Correction index, and cardiac rotation angle. Severity by Haller index was classified as mild (2.0-3.2 cm,n= 15), moderate (3.2-3.5 cm,n= 7), or severe (>3.5 cm,n= 15). Cardiac rotation angle increased with severity (p= 0.001): mild (37.6 ± 13.1°), moderate (44.8 ± 13.6°), and severe (51 ± 13.2°). Cardiac rotation angle was positively associated with the Haller index (R2= 0.24,p= 0.002), but not the Correction index (R2= 0.01,p= 0.55). CT scans of a representative male and female were segmented to generate 3D models of thoracic and abdominal structures. These measurements and models may inform diagnostic criteria, treatment planning, and personalized device development for adolescents with PE.
Postmastectomy pain syndrome (PMPS) is a prevalent chronic pain condition that occurs after breast cancer surgery, often impairing quality of life in survivors of breast cancer. Despite its prevalence, no standardized treatment has been established. Acupuncture has been reported to be an efficacious intervention for the management of chronic pain and may be an effective treatment for PMPS. This study aims to explore the effectiveness and safety of integrative treatment of acupuncture-based intervention for PMPS. This is a single-center, single-arm, prospective interventional study. Eligible participants are patients with breast cancer who experience chronic postoperative pain in the chest, neck, or shoulder with a numerical rating scale (NRS) score ≥4, are at least 6 months postcurative treatment, have no evidence of disease recurrence, and are not receiving anticancer treatment at enrollment. Participants will receive the intervention once weekly for 12 sessions, followed by a 4-week observation period. The primary end point is the change in the average pain NRS score from baseline to week 16. The study commenced in October 2023 and is scheduled to continue through March 31, 2027. The first participant was enrolled on October 24, 2023. As of the manuscript submission, 24 patients have been enrolled. This study will explore the potential role of an integrative treatment of acupuncture-based intervention in the management of PMPS. The results will contribute to the evidence base for acupuncture in PMPS and inform the design of future clinical studies.
Comparative data on postoperative outcomes between da Vinci robotic surgery and video-assisted thoracoscopic surgery (VATS) remain limited. This study compared pain, recovery, quality of life, and cost-effectiveness between these approaches. This propensity score-matched retrospective study included 60 patients (30 per group) undergoing thoracic surgery (January 2022-December 2024). Outcomes included VAS pain scores, morphine equivalents, SF-36 quality of life, 3-month chronic pain assessment, and cost-utility analysis. The da Vinci group had lower VAS scores at 4 h, 12 h, 24 h and 48 h (p < 0.001), with 33.6% less morphine consumption. Chest tube duration (4.55 ± 2.06 vs. 6.23 ± 2.41 days, p = 0.005) and hospital stay (5.69 ± 2.46 vs. 7.87 ± 2.83 days, p = 0.002) were shorter. SF-36 physical scores favoured robotic surgery at discharge (p = 0.006). Chronic pain at 3 months trended lower (10.7% vs. 25.0%, p = 0.168). The incremental cost-effectiveness ratio was 570,000 CNY/QALY. Da Vinci robotic surgery is associated with reduced postoperative pain and faster recovery compared with VATS, though cost-effectiveness and long-term benefits require further investigation.
BACKGROUND: Recurrent tracheoesophageal fistula (RTEF) is one of the most challenging long-term complications following primary repair of esophageal atresia/tracheoesophageal fistula (EA/TEF). Thoracoscopic revision has been increasingly used in patients. Anastomotic leakage (AL) remains an important postoperative complication after RTEF repair. Objective predictors for surgical timing and AL risk are limited. METHODS: We retrospectively analyzed patients undergoing thoracoscopic RTEF repair at Beijing Children’s Hospital between January 2019 and January 2025. Preoperative, intraoperative, and postoperative variables were evaluated to identify predictors of AL. Based on preoperative features, a transfer learning (TL) model was developed to predict AL risk. RESULTS: A total of 92 thoracoscopic repairs were performed in 84 patients, with AL occurring in 23/92 cases (25.0%). Univariate analysis identified significant associations between AL and preoperative CT-determined pulmonary inflammation adjacent to the anastomosis (P < 0.001), persistent upper esophageal negative-pressure suction (P = 0.008), oral feeding (P = 0.037), approach used for primary EA/TEF repair (P = 0.021), and esophageal gap > 2 cm (P < 0.001). Multivariate analysis confirmed that preoperative inflammation severity (moderate: OR = 17.07, P = 0.014; severe: OR = 50.62, P = 0.001) independently increased AL risk, whereas an esophageal gap ≤ 2 cm was protective (OR = 0.18, P = 0.014). The TL model integrating preoperative features achieved excellent discrimination (training AUROC 0.929 [95%CI: 0.850–0.986]; validation AUROC 0.863 [95%CI: 0.688–1.000]) with high accuracy (0.919). CONCLUSIONS: Thoracoscopic RTEF repair is safe and effective when guided by preoperative assessment. CT-quantified pulmonary inflammation at the T4 vertebral level is a powerful independent predictor of AL. The proposed TL-based model enables individualized, data-driven optimization of surgical timing for improved outcomes.
The relative incidence of postoperative air leak between lobectomy and segmentectomy remains unclear. This study aimed to examine how the presence and severity of emphysema-an established risk factor for air leak-affect the incidence of this complication in each surgical procedure. This retrospective study included patients who underwent lobectomy or segmentectomy for non-small cell lung cancer between April 2009 and March 2024. Patients were stratified into 2 groups based on the Goddard score (GS), a visual evaluation method for quantifying radiologic findings of emphysema on computed tomography (CT)with a maximum of 24 points: GS 0-5 and GS ≥6. The incidences of postoperative air leak-related complications (prolonged air leak, pleurodesis, reinsertion of the chest tube, or reoperation for air leak) were compared between the lobectomy and segmentectomy groups. Overall, 747 patients were included in the study. Among 564 patients with GS 0-5, there were no significant differences in the incidence of postoperative air leak-related complications between lobectomy (5.7%) and segmentectomy (8.2%) groups (P = .275). Conversely, in 183 patients with GS ≥6, the incidence of such complications was significantly lower in the segmentectomy group (7.0%) compared to the lobectomy group (18.3%) (P = .036). In patients with moderate to severe emphysema (GS ≥6), segmentectomy was associated with a lower incidence of postoperative air leak-related complications than lobectomy. This may reflect the advantage of greater parenchymal preservation; however, these findings should be interpreted cautiously given the observational study design.
<sec><title>BACKGROUND</title>Data on the benefits of thoracic surgery for the treatment of pulmonary TB (PTB) are scarce. The majority of studies pertain to patients with multi- or extensively drug-resistant TB. We conducted this Europe-wide survey to evaluate attitudes towards thoracic surgery in TB care.</sec><sec><title>METHODS</title>We compiled a questionnaire of 17 questions on the respondents and their patients and on the modalities, indications, and outcomes of adjunctive surgery for PTB. The questions were distributed via the Tuberculosis Network European Trials Group (TBnet), ESCMID Study Group for Mycobacterial Infections (ESGMYC), and the European Society of Thoracic Surgeons (ESTS).</sec><sec><title>RESULTS</title>We received answers from 63 participants in 23 countries of the WHO European region. Surgery was mainly perceived to be reserved for specific clinical situations such as a differential diagnosis of cancer, a cavity with fungi/sequester, or a scarred stenosis of the draining bronchus. We observed substantial variations of attitudes towards surgical treatment between different specialties.</sec><sec><title>CONCLUSION</title>This study underscores a case-specific approach to adjunctive thoracic surgery in PTB. Differences in surgical availability and treatment attitudes suggest a need for specific, standardised guidelines. Future studies should aim to clarify the role of certain procedures and measure long-term outcomes of surgical treatment.</sec>.
Off-pump coronary artery bypass grafting (OPCAB) minimizes systemic inflammation associated with cardiopulmonary bypass, yet postoperative atrial fibrillation (POAF) incidence remains substantial. This suggests that local pericardial factors may contribute significantly to POAF in this setting. We evaluated the impact of left posterior pericardiotomy (LPP) on POAF and drainage patterns in isolated OPCAB to determine if enhancing local drainage effectively mitigates POAF. We retrospectively analyzed 283 patients (mean age 65.1 ± 10.2 years; female, 18.7%) undergoing elective isolated multivessel OPCAB by a single surgeon (2021-2025). Patients were categorized into LPP (n = 122, routinely performed since April 2024) and no-LPP (n = 161) groups. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. The primary endpoint was in-hospital POAF. Postoperative chest tube drainage distribution and incidence of postoperative pericardial effusion were analyzed to assess the mechanistic efficacy of LPP. After IPTW adjustment, the LPP group showed a significantly lower incidence of POAF (15.1% vs. 30.7%; p = 0.003) and shorter hospital length of stay (p = 0.032). Operative time was significantly shorter in the LPP group (334 ± 44 vs. 349 ± 48 min; p = 0.006), suggesting that LPP did not prolong the procedure. Operative mortality and LPP-related complications were absent. Postoperative pericardial effusion was also less frequent in the LPP group (3.2% vs. 8.4%; p = 0.084). Mechanistically, the LPP group demonstrated a significantly higher left-to-total drainage ratio in the early postoperative period, indicating effective diversion of pericardial fluid to the left pleural space during the critical early postoperative period. In elective isolated OPCAB, concomitant LPP was associated with a lower incidence of POAF and shorter hospital length of stay without increasing operative time or complications. The observed shift in drainage distribution supports the mechanism that LPP reduces POAF by effectively mitigating local pericardial fluid retention.
Managing small Lung-RADS 4 pulmonary nodules is clinically challenging. While CT-guided TTFNAB is standard, its efficacy and safety for lesions ≤2 cm require further evaluation to optimize outcomes and reduce unnecessary surgeries. This study aimed to evaluate the diagnostic accuracy, safety, and factors influencing the outcomes of CT-guided TTFNAB in Lung-RADS category 4 pulmonary nodules measuring ≤2 cm. Retrospective study. Single-center, a tertiary referral center. A retrospective analysis was performed on 95 patients who underwent CT-guided TTFNAB between January 2021 and April 2024. Data included demographics, lesion characteristics (size, location, density, and pleural proximity), histopathological findings, and procedural outcomes. The primary endpoints were diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and factors influencing TTFNAB results, alongside procedural complications-specifically pneumothorax and chest tube requirement. 95 patients. Of the 95 nodules, 26 (27%) were benign and 69 (73%) were malignant according to TTFNAB. Final pathology confirmed 18 (19%) benign and 77 (81%) malignant lesions. All biopsies yielded sufficient material. Sensitivity, specificity, and overall diagnostic accuracy were 83%, 94%, and 89%, respectively. The PPV was 98%, while the NPV was 65%. Pleural thickening was significantly more frequent in both the TTFNAB benign group (38% vs. 13%, P=.006) and final benign diagnosis group (44% vs. 14%, P=.008). Pneumothorax occurred in 30% of cases, with 24% of these requiring chest tube drainage. No significant associations were found between diagnostic accuracy or complications and variables such as age, emphysema, Lung-RADS category, or nodule size. CT-guided TTFNAB is an effective diagnostic method for confirming malignancy in pulmonary nodules ≤2 cm classified as Lung-RADS 4, providing an overall accuracy of 89% and a PPV of 98%. However, a benign TTFNAB result cannot be considered diagnostically safe: the NPV of 65% and false-negative rate of 35% indicate that a negative biopsy does not reliably exclude malignancy. Clinicians must not rely on a negative result alone; close radiological follow-up or surgical biopsy is essential for these high-risk lesions. The retrospective single-center design, small sample size, and limited generalizability. 2024/010.99/6/23 (Date: 26.07.2024).
Water-soluble esophagram and endoscopy are commonly used to detect anastomotic leak after esophagectomy. However, the comparative performance of these two modalities in detecting leaks has not been well established. We retrospectively reviewed all patients who underwent esophagectomy for cancer between January 2021 and December 2022 from a prospectively maintained database. Occurrence, management and consequences of leaks were examined. The primary outcome was to compare the diagnostic performance of esophagram and endoscopy in detecting anastomotic leak. Therefore, a total of 846 patients were identified. The overall incidence of anastomotic leak was 10.4%. Patients with leaks had older age and more retrosternal routes for reconstruction. Of them, 466 patients underwent endoscopy and 217 underwent esophagram. After matching, 434 patients, 217 per group were analyzed. The sensitivity and negative predictive value of endoscopy were 79.2% and 97.5%, whereas those of esophagram were only 37.9% and 91.3%, respectively (P = 0.003; P = 0.007). In the subset of patients with cervical anastomosis, endoscopy also demonstrated superior sensitivity (78.3% vs 36.0%, P = 0.004) and negative predictive value (97.4% vs 90.8%, P = 0.007). Esophagram showed false-negative results in 18 patients, while only 5 leaks were missed by initial endoscopy. Regarding the management of false negatives, esophagram group showed non-significant trends toward longer hospital stay and more interventions, including stenting (11.1% vs 0%) and clipping (5.6% vs 0%) (both P > 0.05). In conclusion, endoscopy showed higher sensitivity and negative predictive value than esophagram in detecting anastomotic leak after esophagectomy in this study. However, a large-scale, randomized study is warranted to validate these results.
Interstitial lung disease (ILD) is the most common pulmonary affection of rheumatoid arthritis (RA). Patients with a severe RA-ILD extent i.e. >20% according to chest Computed Tomography (CT) semiquantitative (SQCT) scores, have poor prognosis. Quantitative CT (QCT) assessment with operator independent methods based on free software represents a reliable solution already tested in other ILD related to rheumatic diseases. The main objective of this monocentric study is to verify if in RA-ILD there is a correlation between QCT and SQCT performed by experienced radiologists. Secondary aims are: (a) to explore if there is a difference of QTC indexes (QCTi) in RA-ILD patients with severe vs mild ILD extent; (b) to evaluate the discriminative ability of QCT in identifying severe RA-ILD patients. The chest CTs of consecutive RA-ILD underwent to a SQCT assessment by two experienced chest radiologists. All CTs were also blindly post-processed by a rheumatologist in order to obtain the QCTi. QCTi correlations, distribution and discriminative ability were, respectively, verified using Spearman rank test, Mann-Whitney test and ROC curves. The majority of QCTi showed a moderate degree (0.40<r<0.59) with SQCT assessment (p-value<0.01). Patients with severe and mild ILD had dissimilar QCTi values (p=0.001). Almost all of QCTi had a good discriminative ability (AUC from 0.73 to 0.81, p-value=0.0001). These preliminary findings suggest that RA-ILD extent is related to QCTi. Moreover, QCTi can discriminate very well patients with a severe ILD. So, QCTi may become simple tools quickly estimate RA-ILD prognosis.
BACKGROUND: Primary cardiac tumors are extremely uncommon, and malignant variants are even rarer. Among them, pericardial liposarcoma is exceptionally infrequent, with very few cases reported worldwide. Because of its nonspecific clinical presentation and the complexity of cardiac anatomy, diagnosis is often delayed. This case is notable due to the tumor’s unusual pericardial origin and demonstrates the critical role of multimodal cardiac imaging in identifying rare primary cardiac malignancies. CASE PRESENTATION: A 56-year-old woman with a history of arterial hypertension and prior SARS-CoV-2 infection presented with progressive dyspnea and chest pain of several weeks’ duration. Physical examination and initial laboratory tests were nonspecific. Transthoracic echocardiography revealed a large heterogeneous pericardial mass. Further evaluation with computed tomography and cardiac magnetic resonance imaging demonstrated a lesion with mixed solid and fatty components, closely associated with the pericardium. Surgical biopsy with histopathological and immunohistochemical analysis confirmed the diagnosis of undifferentiated liposarcoma of probable pericardial origin. The patient was referred for specialized oncologic management; however, her clinical course was unfavorable, and she ultimately experienced disease progression. CONCLUSIONS: This case illustrates the diagnostic challenges associated with rare primary cardiac malignancies and emphasizes the importance of integrated multimodal imaging in characterizing pericardial tumors. Increased clinical awareness and further research are needed to optimize therapeutic strategies and improve outcomes in patients with pericardial liposarcoma.
Numerous algorithms predict the origin of idiopathic premature ventricular contractions (PVCs) with an inferior axis using the electrocardiogram (ECG), especially trying to differentiate between PVCs from the left and right ventricular outflow tract (LVOT and RVOT). Although evaluating the PVC origin goes along with evaluating risks and benefits of catheter ablation, this approach is complex for non-electrophysiology (EP) experts and shows limited reliability. As an additional strategy to guide decision-making, we sought to find simple ECG criteria that predict outcome of catheter ablation directly rather than origin. Patients undergoing catheter ablation of idiopathic PVCs with an inferior axis at our center between 2012 and 2020 were included. Procedural data assessed included complete suppression of the PVC at the end of the procedure, ECG analysis included assessment of Q-, R-, and S-amplitudes, -durations and derived parameters. 104 patients (54% male, 54 ± 17 years) were included. Overall ablation success was 81%. Two ECG features - a more leftward PVC axis in the limb leads and an earlier precordial transition in the chest leads - independently predicted ablation failure. Using ROC statistics, we suggest combining the following two criteria to predict ablation success with a positive predictive value of 95% with no major complications: (1) PVC axis ≥ 75° (lead III ≥ (neg) aVR) and (2) TZ-score > 2 (V2 net negative, p < 0.001). If either parameter was not met, success rate was only 60% and major complication rate was 7%. Considering the PVC origin underlying these findings, the two criteria were inversely associated with a parahisian and LV summit origin, while no differences in ablation success or procedural data were observed between RVOT and LVOT origins. While catheter ablation of LVOT and RVOT PVCs show similarly high success rates, two simple ECG criteria based on PVC axis and precordial transition independently predict ablation outcome due to complex PVC foci. These should be considered when evaluating patients with idiopathic PVCs with an inferior axis for catheter ablation.