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INTRODUCTION:Isolated pulmonary metastases from soft tissue sarcomas occur in 20-50% of these (the issue is about metastases, not lung cancer) patients, and 70% of these patients will present disease limited only to the lungs. Surgical resection is well accepted as a standard approach to treat metastases from soft tissue sarcomas isolated in the lungs, and many studies investigating this technique have reported an overall 5-year survival ranging from 30-40%. The most consistent predictor of survival in these patients is complete resection. The aim of the present study was to determine the demographics and clinical treatment-related variables associated with long-term (90-month) overall survival in patients with lung metastases undergoing pulmonary metastasectomy from soft tissue sarcomas.METHODS:We performed a retrospective review of patients admitted in the Thoracic Surgery Department with lung metastases who underwent thoracotomy for resection following treatment of the primary tumor. Data regarding primary tumor features, demographics, treatment, and outcome were collected.RESULTS:One hundred twenty-two thoracotomies and 273 nodules were resected from 77 patients with previously treated soft tissue sarcomas. The median follow-up time of all patients was 36.7 months (range: 10-138 months). The postoperative complication rate was 9.1%, and the 30-day mortality rate was 0%. The 90-month overall survival rate for all patients was 34.7%. Multivariate analysis identified the following independent prognostic factors for overall survival: the number of metastases resected, the disease-free interval, and the number of complete resections.CONCLUSION:These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after lung resection.

Introduction: Although the necessity of small bowel (SB) vs gastric placement of FTs remains controversial, many prefer to use SB feeds. However, challenges in getting FTs into the SB may limit delivery of early enteral nutrition. We compared placement of FTs using the "corkscrew" technique described by Zaloga (CHEST, 1991) and the new Gabriel® magnetized FT with those placed by the patient's bedside nurse. Hypothesis: FTs inserted by individuals trained and coached in specific methods would be more successfully placed into the SB than those placed by healthcare providers with little formal instruction using a variety of methods. Methods: After obtaining consent, 30 ICU patients were randomized into 3 groups (G) of 10. G1 FTs were placed by bedside nurses per hospital policy but without specification of a particular technique, G2 by 2 critical care fellows previously inexperienced in FT placement who were trained by one of the investigators (PRR) in the "corkscrew" technique, and G3 by the same 2 fellows using a magnetized FT plus an external magnet and similar techniques as the "corkscrew" method. Successful placement in the SB after 1, 2, and up to 3 efforts was determined by XRay. Data are presented as percentages and were analyzed by Cramer's V test; p<0.05 significant. Results: 1st effort success was G1: 20%; G2 and G3: 80% (p<0.05). 2nd efforts increased success to G1: 40%; G2 and G3: 90% (p<0.05). A 3rd effort in some pts improved success in G1 to 50%; 3rd efforts were not made for G2 and G3. Conclusions: This small study suggests that placement of FTs into the SB is more likely to be accomplished if distinct individuals are trained and they adhere to specific protocols. Success was high in both specific technique groups. The "corkscrew" method has been hard to learn without direct instruction. It seemed to our fellows that the magnetic FT may be easier to learn and master as it has a light detector which facilitates recognition of the direction the tube is moving during insertion. This tube offers an alternative for ICUs that have difficulty placing SB tubes at the bedside. Introduction: Managing fecal incontinence and diarrhea challenges intensive care unit (ICU) staff to control the fecal output and protect the skin. This diverts resources from other vital patient needs. A new medical device system (FMS) was developed in which an inflated balloon retains a tube within the rectum while an external pouch collects fecal material offering an option for temporary continence in subjects with uncontrolled diarrhea. Hypothesis: Safety and performance of an innovative system (FMS) for managing fecal incontinence was evaluated in a prospective non-comparative study in two ICUs. Methods: Ten subjects with diarrhea and incontinence in two ICUs had the FMS inserted. Endoscopic proctoscopies of the rectal vault assessed condition of the anorectal mucosa pre-insertion and post-removal. Investigators assessed ease of FMS insertion and removal, device retention and leakage, patient comfort, perineal skin condition and ...

BackgroundChamydophila pneumoniae (CP) and/or Mycoplasma pneumoniae (MP) are two bacteria detected in vulnerable atheromas. In this study we aimed to analyze whether CP and/or MP aggravates atherosclerosis induced by cholesterol-enriched diet in C57BL/6 apoE KO male mice. Thirty male apoE KO mice aged eight weeks fed by a diet containing 1% cholesterol until 32 weeks of age were divided into four groups: the first was inoculated with CP (n = 7), the second with MP (n = 12), the third with both CP + MP (n = 5), and the fourth with saline (sham n = 6). The animals were re-inoculated at 36 weeks of age, and sacrificed at 40 weeks of age. Two ascending aorta and one aortic arch segments were sampled. In the most severely obstructed segment, vessel diameter, plaque height, percentage of luminal obstruction and the degree of adventitial inflammation were analyzed. The plaque area/intimal surface ratio was obtained by measuring all three segments. The adventitial inflammation was semiquantified (0 absent, 1 mild, 2 moderate, and 3 diffuse).ResultsThe mean and standard deviation of plaque height, % luminal obstruction, external diameter, the plaque area/intimal surface ratio and the adventitial inflammation values are the following for each group: MP (0.20 +/- 0.12 mm, 69 +/- 26%, 0.38 +/- 0.11 mm, 0.04 +/- 0.04 and 0.22 +/- 0.67), CP (0.23 +/- 0.08 mm, 90 +/- 26%, 0.37 +/- 0.08 mm, 0.04 +/- 0.03, and 0.44 +/- 0.53), MP + CP (18 +/- 0.08 mm, 84 +/- 4.0%, 0.35 +/- 0.25 mm, 0.03 +/- 0.03 and 1.33 +/- 0.82) and sham (0.08 +/- 0.09 mm, 42 +/- 46%, 0.30 +/- 0.10 mm, 0.02 +/- 0.03 and 0.71 ± 0.76). A wider area of plaque/intimal surface was observed in MP + CP inoculated groups (p = 0.07 and 0.06) as well as an increased plaque height in CP (p = 0.01) in comparison with sham group. There was also an increased luminal obstruction (p = 0.047) in CP inoculated group in comparison to sham group. Adventitial inflammation in MP + CP inoculated group was higher than MP, CP and the sham groups (p = 0.02).ConclusionInoculation of CP, MP or both agents in C57BL/6 apoE KO male mice caused aggravation of experimental atherosclerosis induced by cholesterol-enriched diet, with distinct characteristics. CP inoculation increased the plaque height with positive vessel remodeling and co-inoculation of MP + CP caused the highest adventitial inflammation measures.