Background. This study was designed to investigate the effects of the potassium channel opener KR... more Background. This study was designed to investigate the effects of the potassium channel opener KRN4884 in mimicking hypoxic preconditioning on coronary arteries and to explore the possible mechanisms.
European Journal of Cardio Thoracic Surgery, Aug 1, 2000
Objectives: We sought to determine the long-term survival of patients treated for bronchial carci... more Objectives: We sought to determine the long-term survival of patients treated for bronchial carcinoid tumors and whether lesser resections have had an effect on outcomes. Methods: We conducted a retrospective, multi-institutional review of patients treated surgically for primary bronchial carcinoid tumors since 1980. Operative approach, pathologic stage, histology, surgical complications, tumor recurrence, and longterm survival were assessed. Results: There were 50 men and 89 women with a mean age of 52.2^17.4 and 58.9^13.3 years, respectively (P 0:021). Men were more likely to be current or former smokers than were women. Operations included lobectomy or bilobectomy in 110, pneumonectomy in four, wedge resection in 22, and bronchial sleeve resection only in three patients; resection was performed thoracoscopically in six patients. One patient died postoperatively. Stages were I, 121; II, nine; III, six; and IV, three. Typical carcinoid tumors were stage I in 100 and more advanced (stages II±IV) in nine, whereas atypical carcinoid tumors were stage I in 18 and more advanced in eight (P 0:002). Median follow-up was 43 months (range 1±149) during which 21 (15%) patients died (four from recurrent cancer) and 19 patients (14%) were lost to follow-up. Recurrent cancer developed in 2/98 patients with typical and 5/25 patients with atypical subtypes (P , 0:001; log-rank test). The likelihood of recurrence was related to histological subtype (relative risk 7.9 for atypical carcinoid; 95% con®dence interval 1.4±43.5). Five-year survival was 88% for stage I patients and was 70% for patients with more advanced stages. When strati®ed by stage, survival was related to age (relative risk 1.9 for a 10 year increase in age; 95% con®dence interval 1.2±2.9) and possibly to the histological subtype, but not to patient gender, year of operation, or type of operation performed. Conclusions: Either major lung resection or wedge resection is appropriate treatment for patients with early stage typical bronchial carcinoid tumors. Survival is favorable for early stage tumors regardless of histological subtype. Local recurrence is more common among patients with atypical subtypes, suggesting that a formal resection may improve long-term outcome. q
A previous operation is generally considered to be a relative contraindication to the minimal acc... more A previous operation is generally considered to be a relative contraindication to the minimal access approach. We reviewed our combined experience from three centers with video-assisted thoracic surgery on reoperated chests.
To evaluate the efficacy of a continuous thoracic paravertebral infusion of bupivacaine for pain ... more To evaluate the efficacy of a continuous thoracic paravertebral infusion of bupivacaine for pain management in patients with unilateral multiple fractured ribs (MFR). Prospective nonrandomized case series. Multidisciplinary tertiary hospital. Fifteen patients with unilateral MFR. Insertion of a catheter into the thoracic paravertebral space. We administered an initial injection of 0.3 mL/kg (1.5 mg/kg) bupivacaine 0.5% with 1:200,000 epinephrine followed 30 min later by an infusion of bupivacaine 0.25% at 0.1 to 0.2 mL/kg/h for 4 days. The following parameters were measured during the initial assessment before thoracic paravertebral block (TPVB), 30 min after the initial injection, and during follow-up on day 1 and day 4 after commencing the infusion of bupivacaine: visual analog pain score at rest and during coughing; respiratory rate; arterial oxygen saturation (SaO(2)); bedside spirometry (ie, FVC, FEV(1), FEV(1)/FVC ratio, and peak expiratory flow rate [PEFR]); arterial blood gas measurements; and O(2) index (ie, PaO(2)/fraction of inspired oxygen ratio). There were significant improvements in pain scores (at rest, p = 0.002; during coughing, p = 0.001), respiratory rate (p < 0.0001), FVC (p = 0.007), PEFR (p = 0.01), SaO(2) (p = 0.04), and O(2) index (p = 0.01) 30 min after the initial injection, which were sustained for the 4 days that the thoracic paravertebral infusion was in use (p < 0.05). PaCO(2) did not change significantly after the initial injection, but on day 4 it was significantly lower than the post-TPVB value (p = 0.04). One patient had an inadvertent epidural injection, and another developed transient ipsilateral Horner syndrome with sensory changes in the arm. No patient exhibited clinical signs of inadvertent intravascular injection or local anesthetic toxicity. Our results confirmed that continuous thoracic paravertebral infusion of bupivacaine is a simple and effective method of providing continuous pain relief in patients with unilateral MFR. It also produced a sustained improvement in respiratory parameters and oxygenation.
Objective: Neointimal and medial thickening play a critical role in late vein graft failure follo... more Objective: Neointimal and medial thickening play a critical role in late vein graft failure following CABG. Previous ex vivo experiment suggested that perivenous application of fibrin glue may reduce the damage in the circular smooth muscle cell layer of the media of the vein graft shortly after exposing to arterial pressure. However, the in vivo as well as the longer term impact of this intervention remain unknown. Methods: Bilateral saphenous vein-carotid artery interposition grafting was performed in eight large white pigs (35-45 kg). In each pig, one of the grafts was randomly selected to receive perivenous fibrin glue support while the contralateral graft served as control. At 1 and 4 months following surgery (n = 4 pigs in each group), all 16 patent vein grafts were removed and pressure-fixed. Multiple histological sections from each graft were prepared. Proliferating cell nuclear antigen (PCNA) was detected by immunocytochemistry. Vein graft morphology was assessed using computeraided planimetry. Results: Although perivenous application of fibrin glue had little effects either on medial thickness 1 month after implantation or on PCNA index, it significantly increased medial thickness (control: 0.37 AE 0.02 mm; treated: 0.55 AE 0.02 mm, p < 0.001) and total wall thickness (control: 0.75 AE 0.04 mm; treated: 0.92 AE 0.04 mm, p = 0.008) at 4 months (mean AE SEM; n = 4 in each group). Conclusions: Our data indicated that perivenous application of fibrin glue enhances graft thickening and as such does not constitute a strategy for preventing late vein graft failure after CABG. #
time factor-mediated function in coronary microarteries: influence of temperature and and univers... more time factor-mediated function in coronary microarteries: influence of temperature and and university of wisconsin solutions on endothelium-derived hyperpolarizing Effect of 11,12-epoxyeicosatrienoic acid as an additive to st. thomas' cardioplegia http://ats.ctsnetjournals.org/cgi/content/full/76/5/1623 located on the World Wide Web at: The online version of this article, along with updated information and services, is Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. Background. We examined the effect of 11,12epoxyeicosatrienoic acid (EET 11,12 ) added to St. Thomas' Hospital (ST) solution or University of Wisconsin (UW) solution on endothelium-derived hyperpolarizing factor (EDHF)-mediated relaxation under clinically relevant temperature and exposure time.
The insertion of intraluminal stents is an effective method of relieving the distressing symptom ... more The insertion of intraluminal stents is an effective method of relieving the distressing symptom of asphyxia in patients with obstructive lesions in the trachea and main-stem bronchi. We report our experience in the use of the studded Dumon silicone stent (Endoxane prosthesis; Axion, Aubagne, France). Between February 1994 and August 1996, 42 stents were placed in 30 patients. Of the 27 patients with a malignant stricture, 10 had carcinoma of the bronchus, 13 carcinoma of the esophagus, and 4 metastatic carcinoma involving the tracheobronchial tree. The benign lesions were made up of two tuberculous strictures and one suprastomal stenosis after tracheostomy. Stents were placed through a rigid bronchoscope with patients under general anesthesia. Postplacement assessment was performed with a 10-point, symptom-based visual analog scale. In eight less urgent cases, forced expiratory volume in I second and forced vital capacity were determined before and after surgery. The mean symptomatic improvement on the 10-point scale was 6. I points, whereas the forced expiratory volume in I second (in the eight patients tested) improved by 75%, and the forced vital capacity improved by 54%. The median survival was 2 months for patients with carcinoma of the bronchus and 3 months for patients with carcinoma of the esophagus. Two patients with metastatic carcinoma and all of the patients with the benign lesions were alive and well after 12 months of follow-up. Insertion of the Dumon stent is a simple, safe, and effective method of countering the distressing symptoms arising from obstructive tracheobronchial lesions. (Otolaryngol Head Neck Surg 1998; 118:256-60.) The symptom of asphyxiation resulting from obstructive lesions of the tracheobronchial tree is distressing. Malignant lesions obstructing the major airway promise a most unpleasant terminal course for the patient and his or her family. Symptomatic control through laser cytoreducfion of intraluminal lesions with the neodymium:YAG laser has been popular over the years 1,2 but is unsuitable for circumferential collapse caused by tracheobronchomalacia or extrinsic lesions. In Hong Kong, where carcinoma of the esophagus is prevalent, extrinsic tracheobronchial compression by this tumor is not uncommon. Intraluminal stenting is a suitable treatment for both intrinsic and extrinsic lesions if they are bypassable. Early attempts at intraluminal stenting were made with the Montgomery T tube, 3 which required a tracheostomy, and were fraught with problems of crusting and granuloma formation.
The primary tumors showed jigsaw puzzlelike lobulation resembling thymic epithelial tumor and co... more The primary tumors showed jigsaw puzzlelike lobulation resembling thymic epithelial tumor and consisted of spindly cells arranged in fascicles, whorls, and a storiform pattern. The spindly cells had indistinct cell borders, vesicular nuclei, and distinct nucleoli. Perivascular ...
Objective: Whether video-assisted thoracic surgery (VATS) is associated with less shoulder dysfun... more Objective: Whether video-assisted thoracic surgery (VATS) is associated with less shoulder dysfunction when compared with poster- olateral thoracotomy (PLT) remains unclear. We therefore conducted this prospective study to assess the shoulder function in patients following major lung resection using either the VATS or PLT approach. Methods: Twenty-nine consecutive patients were prospectively recruited into the study. Eighteen patients underwent major lung
Objective: Video-assisted thoracic surgery (VATS) is an established treatment for recurrent or co... more Objective: Video-assisted thoracic surgery (VATS) is an established treatment for recurrent or complicated primary spontaneous pneumothorax (PSP). However, a proportion of patients still complains of chronic pain or discomfort after VATS pleurodesis. We aimed to investigate if paresthesia is a distinct component of the post-operative discomfort in patients receiving VATS for PSP. Methods: Telephone interviews were conducted with 52 patients
Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The... more Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The management of patients with spontaneous pneumothorax remains controversial. With the advances in thoracoscopic techniques and instrumentation, video-assisted thoracic surgery (VATS) is now accepted by many as the procedure of choice for surgical treatment of spontaneous pneumothorax. We report our combined experience with 757 patients who suffered from recurrent or persistent spontaneous pneumothorax treated by VATS over a 5-year period. Surgical indications included persistent air leak (n ؍ 165), recurrence (n ؍ 325), radiologically demonstrated huge bulla (n ؍ 12), spontaneous hemopneumothorax (n ؍ 13), incomplete expansion of the lung (n ؍ 212), and bilateral involvement (n ؍ 30). Several surgical procedures were undertaken, based on the thoracoscopic findings: endoscopic stapled bullectomy (n ؍ 312), argon beam coagulation (n ؍ 6), endoscopic suturing (n ؍ 52), and endoloop ligation (n ؍ 352). In 49 cases, mechanical or chemical pleurodesis was the only procedure performed. There were no mortalities or intraoperative hazards. Complications consisted of wound infections (n ؍ 16), localized empyema (n ؍ 2), chest wall bleeding (n ؍ 1), and persistent air leaks (bulla type III) (n ؍ 31). The median duration of the operation was 55 minutes (15-160 minutes), and the average postoperative hospital stay was 4.5 days (range 0 -27 days). There were 16 recurrences (2.1%), after a mean follow-up of 30 months (range 1-60 months). Seven patients had recurrence from 9 to 17 months after stapled bullectomy. All the remaining patients had recurrence after failed pleurodesis. On the basis of our results, we conclude that video-assisted thoracoscopic management allows effective, safe performance of standard surgical procedures, avoiding a formal thoracotomy incision. We consider thoracoscopy the treatment of choice for patients with pneumothorax requiring surgical therapy.
The lack of depth perception and spatial orientation in video vision are the drawbacks of laparos... more The lack of depth perception and spatial orientation in video vision are the drawbacks of laparoscopic surgery. The advent of a three-dimensional camera system enables surgeons to regain binocular vision and may be advantageous in complex laparoscopic procedures. We prospectively studied two groups of surgeons (with and without experiences in laparoscopic surgery) who performed a designated standardized laparoscopic task using a two-dimensional camera system (Olympus OTV-S4) vs a three-dimensional camera system (Baxter-V. Mueller VS7700) and compared their time performances. The results suggested that only experience in laparoscopic surgery had significant effect on individual&#39;s performance. We could not demonstrate any superiority of the 3D system over the 2D system. However, two-thirds of the surgeons commented that the depth perception did improve. With further refinement of the technology, the 3D system may improve its potential in laparoscopic surgery.
behind the complex pathophysiology of IR lung injury remains incomplete. Unlike any organ in the ... more behind the complex pathophysiology of IR lung injury remains incomplete. Unlike any organ in the human body, the lung possesses two blood supply networks with extensive anastamotic connections and a total of three potential sources for lung tissue oxygenation, thus making lung IR injury all the more complex and intriguing to study. Over the past two decades, the role of neutrophils, free radicals, and other inflammatory mediators in IR injury have been extensively investigated. However, these responses and mediators appear to contribute only in part to lung IR injury. We herein review and discuss the current knowledge on the physiology and inflammatory responses that are associated with lung IR injury.
Background. Appropriateness of video-assisted thoracic surgery (VATS) pulmonary metastasectomy fo... more Background. Appropriateness of video-assisted thoracic surgery (VATS) pulmonary metastasectomy for curative intent has been a controversial topic. We reviewed our experience with VATS wedge resection for peripheral lung metastases to determine the efficacy and potential adverse consequences of this approach for pulmonary metastasectomy. , renal , sarcoma , breast (4), melanoma , head/neck , lymphoma (2), uterine (1), and "other" (5). The average number of lesions resected was .
become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic a... more become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic and therapeutic procedures, and over the past one and a half decades, the scope of MITS has undergone rapid evolution. The role of MITS is well established in the management of pleural and mediastinal conditions, and it is beginning to move beyond diagnostic procedures for lung parenchyma conditions, to gain acceptance as a viable option for primary lung cancer treatment. However MITS poses technical challenges that are quite different from the conventional open surgical procedures. After a brief review of the history of MITS, an overview of the scope of MITS is given. Important examples of diagnostic and therapeutic indications are then discussed, with special emphasis on the potential complications specific to MITS, and their prevention and management.
The insertion of intraluminal stents is an effective method of relieving the distressing symptom ... more The insertion of intraluminal stents is an effective method of relieving the distressing symptom of asphyxia in patients with obstructive lesions in the trachea and main-stem bronchi. We report our experience in the use of the studded Dumon silicone stent (Endoxane prosthesis; Axion, Aubagne, France). Between February 1994 and August 1996, 42 stents were placed in 30 patients. Of the 27 patients with a malignant stricture, 10 had carcinoma of the bronchus, 13 carcinoma of the esophagus, and 4 metastatic carcinoma involving the tracheobronchial tree. The benign lesions were made up of two tuberculous strictures and one suprastomal stenosis after tracheostomy. Stents were placed through a rigid bronchoscope with patients under general anesthesia. Postplacement assessment was performed with a 10-point, symptom-based visual analog scale. In eight less urgent cases, forced expiratory volume in I second and forced vital capacity were determined before and after surgery. The mean symptomatic improvement on the 10-point scale was 6. I points, whereas the forced expiratory volume in I second (in the eight patients tested) improved by 75%, and the forced vital capacity improved by 54%. The median survival was 2 months for patients with carcinoma of the bronchus and 3 months for patients with carcinoma of the esophagus. Two patients with metastatic carcinoma and all of the patients with the benign lesions were alive and well after 12 months of follow-up. Insertion of the Dumon stent is a simple, safe, and effective method of countering the distressing symptoms arising from obstructive tracheobronchial lesions. (Otolaryngol Head Neck Surg 1998; 118:256-60.) The symptom of asphyxiation resulting from obstructive lesions of the tracheobronchial tree is distressing. Malignant lesions obstructing the major airway promise a most unpleasant terminal course for the patient and his or her family. Symptomatic control through laser cytoreducfion of intraluminal lesions with the neodymium:YAG laser has been popular over the years 1,2 but is unsuitable for circumferential collapse caused by tracheobronchomalacia or extrinsic lesions. In Hong Kong, where carcinoma of the esophagus is prevalent, extrinsic tracheobronchial compression by this tumor is not uncommon. Intraluminal stenting is a suitable treatment for both intrinsic and extrinsic lesions if they are bypassable. Early attempts at intraluminal stenting were made with the Montgomery T tube, 3 which required a tracheostomy, and were fraught with problems of crusting and granuloma formation.
This is a randomized phase II study designed to compare the toxicity profile of a non-platinum-ba... more This is a randomized phase II study designed to compare the toxicity profile of a non-platinum-based with a platinum-based regimen in the treatment of advanced non-small cell lung cancer. Eighty-nine chemotherapy-naïve patients were randomized either to gemcitabine (1,000 mg/m2, 30-min infusion on days 1, 8 and 15) and oral etoposide (50 mg, days 1-14; GE group) or gemcitabine at the same schedule and cisplatin (75 mg/m2 on day 15; GP group). The primary endpoint is toxicity, and secondary endpoints include response rate, survival outcome and quality of life (QOL). The incidence of WHO grade 3 or 4 anemia, neutropenia and thrombocytopenia was 29, 44 and 22% (GE group), and 28, 49 and 23% (GP group), respectively (p = 0.75, 0.95 and 0.87, respectively). The rate of grade 2 or above nausea was numerically higher in the GP arm, but the difference was not statistically significant (GE 15.5%, GP 27.7%, p = 0.20). The rate of vomiting in the GE and GP arms was 20.0 and 20.5%, respectively (p = 0.96). However, subjective changes in QOL scores on nausea and vomiting were significantly higher in the GP arm (p = 0.001). Other symptoms including sore mouth and hair loss were significantly higher in the GE arm (p = 0.003 and 0.007, respectively). There were also significant differences observed in emotional (p = 0.014), cognitive (p = 0.028) and social functioning (p = 0.034) in favor of GP. The differences in tumor response (35.5 and 46.5% for GE and GP, respectively) were not significantly different. Median time to disease progression (33.8 and 40.7 weeks, respectively) and overall survival (41.4 and 57.3 weeks, respectively) were of borderline significance in favor of the GP arm (p = 0.055). This toxicity profile of GE is similar to GP, but the apparent inferior efficacy may discourage further investigation.
Background. This study was designed to investigate the effects of the potassium channel opener KR... more Background. This study was designed to investigate the effects of the potassium channel opener KRN4884 in mimicking hypoxic preconditioning on coronary arteries and to explore the possible mechanisms.
European Journal of Cardio Thoracic Surgery, Aug 1, 2000
Objectives: We sought to determine the long-term survival of patients treated for bronchial carci... more Objectives: We sought to determine the long-term survival of patients treated for bronchial carcinoid tumors and whether lesser resections have had an effect on outcomes. Methods: We conducted a retrospective, multi-institutional review of patients treated surgically for primary bronchial carcinoid tumors since 1980. Operative approach, pathologic stage, histology, surgical complications, tumor recurrence, and longterm survival were assessed. Results: There were 50 men and 89 women with a mean age of 52.2^17.4 and 58.9^13.3 years, respectively (P 0:021). Men were more likely to be current or former smokers than were women. Operations included lobectomy or bilobectomy in 110, pneumonectomy in four, wedge resection in 22, and bronchial sleeve resection only in three patients; resection was performed thoracoscopically in six patients. One patient died postoperatively. Stages were I, 121; II, nine; III, six; and IV, three. Typical carcinoid tumors were stage I in 100 and more advanced (stages II±IV) in nine, whereas atypical carcinoid tumors were stage I in 18 and more advanced in eight (P 0:002). Median follow-up was 43 months (range 1±149) during which 21 (15%) patients died (four from recurrent cancer) and 19 patients (14%) were lost to follow-up. Recurrent cancer developed in 2/98 patients with typical and 5/25 patients with atypical subtypes (P , 0:001; log-rank test). The likelihood of recurrence was related to histological subtype (relative risk 7.9 for atypical carcinoid; 95% con®dence interval 1.4±43.5). Five-year survival was 88% for stage I patients and was 70% for patients with more advanced stages. When strati®ed by stage, survival was related to age (relative risk 1.9 for a 10 year increase in age; 95% con®dence interval 1.2±2.9) and possibly to the histological subtype, but not to patient gender, year of operation, or type of operation performed. Conclusions: Either major lung resection or wedge resection is appropriate treatment for patients with early stage typical bronchial carcinoid tumors. Survival is favorable for early stage tumors regardless of histological subtype. Local recurrence is more common among patients with atypical subtypes, suggesting that a formal resection may improve long-term outcome. q
A previous operation is generally considered to be a relative contraindication to the minimal acc... more A previous operation is generally considered to be a relative contraindication to the minimal access approach. We reviewed our combined experience from three centers with video-assisted thoracic surgery on reoperated chests.
To evaluate the efficacy of a continuous thoracic paravertebral infusion of bupivacaine for pain ... more To evaluate the efficacy of a continuous thoracic paravertebral infusion of bupivacaine for pain management in patients with unilateral multiple fractured ribs (MFR). Prospective nonrandomized case series. Multidisciplinary tertiary hospital. Fifteen patients with unilateral MFR. Insertion of a catheter into the thoracic paravertebral space. We administered an initial injection of 0.3 mL/kg (1.5 mg/kg) bupivacaine 0.5% with 1:200,000 epinephrine followed 30 min later by an infusion of bupivacaine 0.25% at 0.1 to 0.2 mL/kg/h for 4 days. The following parameters were measured during the initial assessment before thoracic paravertebral block (TPVB), 30 min after the initial injection, and during follow-up on day 1 and day 4 after commencing the infusion of bupivacaine: visual analog pain score at rest and during coughing; respiratory rate; arterial oxygen saturation (SaO(2)); bedside spirometry (ie, FVC, FEV(1), FEV(1)/FVC ratio, and peak expiratory flow rate [PEFR]); arterial blood gas measurements; and O(2) index (ie, PaO(2)/fraction of inspired oxygen ratio). There were significant improvements in pain scores (at rest, p = 0.002; during coughing, p = 0.001), respiratory rate (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), FVC (p = 0.007), PEFR (p = 0.01), SaO(2) (p = 0.04), and O(2) index (p = 0.01) 30 min after the initial injection, which were sustained for the 4 days that the thoracic paravertebral infusion was in use (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). PaCO(2) did not change significantly after the initial injection, but on day 4 it was significantly lower than the post-TPVB value (p = 0.04). One patient had an inadvertent epidural injection, and another developed transient ipsilateral Horner syndrome with sensory changes in the arm. No patient exhibited clinical signs of inadvertent intravascular injection or local anesthetic toxicity. Our results confirmed that continuous thoracic paravertebral infusion of bupivacaine is a simple and effective method of providing continuous pain relief in patients with unilateral MFR. It also produced a sustained improvement in respiratory parameters and oxygenation.
Objective: Neointimal and medial thickening play a critical role in late vein graft failure follo... more Objective: Neointimal and medial thickening play a critical role in late vein graft failure following CABG. Previous ex vivo experiment suggested that perivenous application of fibrin glue may reduce the damage in the circular smooth muscle cell layer of the media of the vein graft shortly after exposing to arterial pressure. However, the in vivo as well as the longer term impact of this intervention remain unknown. Methods: Bilateral saphenous vein-carotid artery interposition grafting was performed in eight large white pigs (35-45 kg). In each pig, one of the grafts was randomly selected to receive perivenous fibrin glue support while the contralateral graft served as control. At 1 and 4 months following surgery (n = 4 pigs in each group), all 16 patent vein grafts were removed and pressure-fixed. Multiple histological sections from each graft were prepared. Proliferating cell nuclear antigen (PCNA) was detected by immunocytochemistry. Vein graft morphology was assessed using computeraided planimetry. Results: Although perivenous application of fibrin glue had little effects either on medial thickness 1 month after implantation or on PCNA index, it significantly increased medial thickness (control: 0.37 AE 0.02 mm; treated: 0.55 AE 0.02 mm, p < 0.001) and total wall thickness (control: 0.75 AE 0.04 mm; treated: 0.92 AE 0.04 mm, p = 0.008) at 4 months (mean AE SEM; n = 4 in each group). Conclusions: Our data indicated that perivenous application of fibrin glue enhances graft thickening and as such does not constitute a strategy for preventing late vein graft failure after CABG. #
time factor-mediated function in coronary microarteries: influence of temperature and and univers... more time factor-mediated function in coronary microarteries: influence of temperature and and university of wisconsin solutions on endothelium-derived hyperpolarizing Effect of 11,12-epoxyeicosatrienoic acid as an additive to st. thomas' cardioplegia http://ats.ctsnetjournals.org/cgi/content/full/76/5/1623 located on the World Wide Web at: The online version of this article, along with updated information and services, is Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. Background. We examined the effect of 11,12epoxyeicosatrienoic acid (EET 11,12 ) added to St. Thomas' Hospital (ST) solution or University of Wisconsin (UW) solution on endothelium-derived hyperpolarizing factor (EDHF)-mediated relaxation under clinically relevant temperature and exposure time.
The insertion of intraluminal stents is an effective method of relieving the distressing symptom ... more The insertion of intraluminal stents is an effective method of relieving the distressing symptom of asphyxia in patients with obstructive lesions in the trachea and main-stem bronchi. We report our experience in the use of the studded Dumon silicone stent (Endoxane prosthesis; Axion, Aubagne, France). Between February 1994 and August 1996, 42 stents were placed in 30 patients. Of the 27 patients with a malignant stricture, 10 had carcinoma of the bronchus, 13 carcinoma of the esophagus, and 4 metastatic carcinoma involving the tracheobronchial tree. The benign lesions were made up of two tuberculous strictures and one suprastomal stenosis after tracheostomy. Stents were placed through a rigid bronchoscope with patients under general anesthesia. Postplacement assessment was performed with a 10-point, symptom-based visual analog scale. In eight less urgent cases, forced expiratory volume in I second and forced vital capacity were determined before and after surgery. The mean symptomatic improvement on the 10-point scale was 6. I points, whereas the forced expiratory volume in I second (in the eight patients tested) improved by 75%, and the forced vital capacity improved by 54%. The median survival was 2 months for patients with carcinoma of the bronchus and 3 months for patients with carcinoma of the esophagus. Two patients with metastatic carcinoma and all of the patients with the benign lesions were alive and well after 12 months of follow-up. Insertion of the Dumon stent is a simple, safe, and effective method of countering the distressing symptoms arising from obstructive tracheobronchial lesions. (Otolaryngol Head Neck Surg 1998; 118:256-60.) The symptom of asphyxiation resulting from obstructive lesions of the tracheobronchial tree is distressing. Malignant lesions obstructing the major airway promise a most unpleasant terminal course for the patient and his or her family. Symptomatic control through laser cytoreducfion of intraluminal lesions with the neodymium:YAG laser has been popular over the years 1,2 but is unsuitable for circumferential collapse caused by tracheobronchomalacia or extrinsic lesions. In Hong Kong, where carcinoma of the esophagus is prevalent, extrinsic tracheobronchial compression by this tumor is not uncommon. Intraluminal stenting is a suitable treatment for both intrinsic and extrinsic lesions if they are bypassable. Early attempts at intraluminal stenting were made with the Montgomery T tube, 3 which required a tracheostomy, and were fraught with problems of crusting and granuloma formation.
The primary tumors showed jigsaw puzzlelike lobulation resembling thymic epithelial tumor and co... more The primary tumors showed jigsaw puzzlelike lobulation resembling thymic epithelial tumor and consisted of spindly cells arranged in fascicles, whorls, and a storiform pattern. The spindly cells had indistinct cell borders, vesicular nuclei, and distinct nucleoli. Perivascular ...
Objective: Whether video-assisted thoracic surgery (VATS) is associated with less shoulder dysfun... more Objective: Whether video-assisted thoracic surgery (VATS) is associated with less shoulder dysfunction when compared with poster- olateral thoracotomy (PLT) remains unclear. We therefore conducted this prospective study to assess the shoulder function in patients following major lung resection using either the VATS or PLT approach. Methods: Twenty-nine consecutive patients were prospectively recruited into the study. Eighteen patients underwent major lung
Objective: Video-assisted thoracic surgery (VATS) is an established treatment for recurrent or co... more Objective: Video-assisted thoracic surgery (VATS) is an established treatment for recurrent or complicated primary spontaneous pneumothorax (PSP). However, a proportion of patients still complains of chronic pain or discomfort after VATS pleurodesis. We aimed to investigate if paresthesia is a distinct component of the post-operative discomfort in patients receiving VATS for PSP. Methods: Telephone interviews were conducted with 52 patients
Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The... more Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The management of patients with spontaneous pneumothorax remains controversial. With the advances in thoracoscopic techniques and instrumentation, video-assisted thoracic surgery (VATS) is now accepted by many as the procedure of choice for surgical treatment of spontaneous pneumothorax. We report our combined experience with 757 patients who suffered from recurrent or persistent spontaneous pneumothorax treated by VATS over a 5-year period. Surgical indications included persistent air leak (n ؍ 165), recurrence (n ؍ 325), radiologically demonstrated huge bulla (n ؍ 12), spontaneous hemopneumothorax (n ؍ 13), incomplete expansion of the lung (n ؍ 212), and bilateral involvement (n ؍ 30). Several surgical procedures were undertaken, based on the thoracoscopic findings: endoscopic stapled bullectomy (n ؍ 312), argon beam coagulation (n ؍ 6), endoscopic suturing (n ؍ 52), and endoloop ligation (n ؍ 352). In 49 cases, mechanical or chemical pleurodesis was the only procedure performed. There were no mortalities or intraoperative hazards. Complications consisted of wound infections (n ؍ 16), localized empyema (n ؍ 2), chest wall bleeding (n ؍ 1), and persistent air leaks (bulla type III) (n ؍ 31). The median duration of the operation was 55 minutes (15-160 minutes), and the average postoperative hospital stay was 4.5 days (range 0 -27 days). There were 16 recurrences (2.1%), after a mean follow-up of 30 months (range 1-60 months). Seven patients had recurrence from 9 to 17 months after stapled bullectomy. All the remaining patients had recurrence after failed pleurodesis. On the basis of our results, we conclude that video-assisted thoracoscopic management allows effective, safe performance of standard surgical procedures, avoiding a formal thoracotomy incision. We consider thoracoscopy the treatment of choice for patients with pneumothorax requiring surgical therapy.
The lack of depth perception and spatial orientation in video vision are the drawbacks of laparos... more The lack of depth perception and spatial orientation in video vision are the drawbacks of laparoscopic surgery. The advent of a three-dimensional camera system enables surgeons to regain binocular vision and may be advantageous in complex laparoscopic procedures. We prospectively studied two groups of surgeons (with and without experiences in laparoscopic surgery) who performed a designated standardized laparoscopic task using a two-dimensional camera system (Olympus OTV-S4) vs a three-dimensional camera system (Baxter-V. Mueller VS7700) and compared their time performances. The results suggested that only experience in laparoscopic surgery had significant effect on individual&#39;s performance. We could not demonstrate any superiority of the 3D system over the 2D system. However, two-thirds of the surgeons commented that the depth perception did improve. With further refinement of the technology, the 3D system may improve its potential in laparoscopic surgery.
behind the complex pathophysiology of IR lung injury remains incomplete. Unlike any organ in the ... more behind the complex pathophysiology of IR lung injury remains incomplete. Unlike any organ in the human body, the lung possesses two blood supply networks with extensive anastamotic connections and a total of three potential sources for lung tissue oxygenation, thus making lung IR injury all the more complex and intriguing to study. Over the past two decades, the role of neutrophils, free radicals, and other inflammatory mediators in IR injury have been extensively investigated. However, these responses and mediators appear to contribute only in part to lung IR injury. We herein review and discuss the current knowledge on the physiology and inflammatory responses that are associated with lung IR injury.
Background. Appropriateness of video-assisted thoracic surgery (VATS) pulmonary metastasectomy fo... more Background. Appropriateness of video-assisted thoracic surgery (VATS) pulmonary metastasectomy for curative intent has been a controversial topic. We reviewed our experience with VATS wedge resection for peripheral lung metastases to determine the efficacy and potential adverse consequences of this approach for pulmonary metastasectomy. , renal , sarcoma , breast (4), melanoma , head/neck , lymphoma (2), uterine (1), and "other" (5). The average number of lesions resected was .
become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic a... more become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic and therapeutic procedures, and over the past one and a half decades, the scope of MITS has undergone rapid evolution. The role of MITS is well established in the management of pleural and mediastinal conditions, and it is beginning to move beyond diagnostic procedures for lung parenchyma conditions, to gain acceptance as a viable option for primary lung cancer treatment. However MITS poses technical challenges that are quite different from the conventional open surgical procedures. After a brief review of the history of MITS, an overview of the scope of MITS is given. Important examples of diagnostic and therapeutic indications are then discussed, with special emphasis on the potential complications specific to MITS, and their prevention and management.
The insertion of intraluminal stents is an effective method of relieving the distressing symptom ... more The insertion of intraluminal stents is an effective method of relieving the distressing symptom of asphyxia in patients with obstructive lesions in the trachea and main-stem bronchi. We report our experience in the use of the studded Dumon silicone stent (Endoxane prosthesis; Axion, Aubagne, France). Between February 1994 and August 1996, 42 stents were placed in 30 patients. Of the 27 patients with a malignant stricture, 10 had carcinoma of the bronchus, 13 carcinoma of the esophagus, and 4 metastatic carcinoma involving the tracheobronchial tree. The benign lesions were made up of two tuberculous strictures and one suprastomal stenosis after tracheostomy. Stents were placed through a rigid bronchoscope with patients under general anesthesia. Postplacement assessment was performed with a 10-point, symptom-based visual analog scale. In eight less urgent cases, forced expiratory volume in I second and forced vital capacity were determined before and after surgery. The mean symptomatic improvement on the 10-point scale was 6. I points, whereas the forced expiratory volume in I second (in the eight patients tested) improved by 75%, and the forced vital capacity improved by 54%. The median survival was 2 months for patients with carcinoma of the bronchus and 3 months for patients with carcinoma of the esophagus. Two patients with metastatic carcinoma and all of the patients with the benign lesions were alive and well after 12 months of follow-up. Insertion of the Dumon stent is a simple, safe, and effective method of countering the distressing symptoms arising from obstructive tracheobronchial lesions. (Otolaryngol Head Neck Surg 1998; 118:256-60.) The symptom of asphyxiation resulting from obstructive lesions of the tracheobronchial tree is distressing. Malignant lesions obstructing the major airway promise a most unpleasant terminal course for the patient and his or her family. Symptomatic control through laser cytoreducfion of intraluminal lesions with the neodymium:YAG laser has been popular over the years 1,2 but is unsuitable for circumferential collapse caused by tracheobronchomalacia or extrinsic lesions. In Hong Kong, where carcinoma of the esophagus is prevalent, extrinsic tracheobronchial compression by this tumor is not uncommon. Intraluminal stenting is a suitable treatment for both intrinsic and extrinsic lesions if they are bypassable. Early attempts at intraluminal stenting were made with the Montgomery T tube, 3 which required a tracheostomy, and were fraught with problems of crusting and granuloma formation.
This is a randomized phase II study designed to compare the toxicity profile of a non-platinum-ba... more This is a randomized phase II study designed to compare the toxicity profile of a non-platinum-based with a platinum-based regimen in the treatment of advanced non-small cell lung cancer. Eighty-nine chemotherapy-naïve patients were randomized either to gemcitabine (1,000 mg/m2, 30-min infusion on days 1, 8 and 15) and oral etoposide (50 mg, days 1-14; GE group) or gemcitabine at the same schedule and cisplatin (75 mg/m2 on day 15; GP group). The primary endpoint is toxicity, and secondary endpoints include response rate, survival outcome and quality of life (QOL). The incidence of WHO grade 3 or 4 anemia, neutropenia and thrombocytopenia was 29, 44 and 22% (GE group), and 28, 49 and 23% (GP group), respectively (p = 0.75, 0.95 and 0.87, respectively). The rate of grade 2 or above nausea was numerically higher in the GP arm, but the difference was not statistically significant (GE 15.5%, GP 27.7%, p = 0.20). The rate of vomiting in the GE and GP arms was 20.0 and 20.5%, respectively (p = 0.96). However, subjective changes in QOL scores on nausea and vomiting were significantly higher in the GP arm (p = 0.001). Other symptoms including sore mouth and hair loss were significantly higher in the GE arm (p = 0.003 and 0.007, respectively). There were also significant differences observed in emotional (p = 0.014), cognitive (p = 0.028) and social functioning (p = 0.034) in favor of GP. The differences in tumor response (35.5 and 46.5% for GE and GP, respectively) were not significantly different. Median time to disease progression (33.8 and 40.7 weeks, respectively) and overall survival (41.4 and 57.3 weeks, respectively) were of borderline significance in favor of the GP arm (p = 0.055). This toxicity profile of GE is similar to GP, but the apparent inferior efficacy may discourage further investigation.
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Papers by Anthony Yim