The 7th lung cancer TNM classification and staging system: Review of the changes and implications.

Lung cancer is the most common cause of death from cancer in males, accounting for more than 1.4 million deaths in 2008. It is a growing concern in China, Asia and Africa as well. Accurate staging of the disease is an important part of the management as it provides estimation of patient's prognosis and identifies treatment sterategies. It also helps to build a database for future staging projects. A major revision of lung cancer staging has been announced with effect from January 2010. The new classification is based on a larger surgical and non-surgical cohort of patients, and thus more accurate in terms of outcome prediction compared to the previous classification. There are several original papers regarding this new classification which give comprehensive description of the methodology, the changes in the staging and the statistical analysis. This overview is a simplified description of the changes in the new classification and their potential impact on patients' treatment and prognosis.

Massive aneurysmal dilatation of a depopulated ureteric hemodialysis xenograft.

Use of depopulated bovine ureteric xenografts for hemodialysis vascular access has recently been described. Cellular components have been removed, giving a connective tissue matrix which can be neocellularized, retaining native biomechanics. A 24-year-old male with end-stage renal disease from focal segmental glomerulosclerosis presented with particularly difficult vascular access. A depopulated bovine ureteric xenograft was implanted from the left subclavian artery to innominate vein. It became massively aneurysmal, requiring emergency embolization. Biopsy of the graft stained positive for alpha-gal. We believe this is the first reported case of massive aneurysmal dilatation of a depopulated bovine ureteric xenograft.

Biomechanical characterization of decellularized and cross-linked bovine pericardium.

BACKGROUND AND AIM OF THE STUDY: Although bovine pericardium has been used extensively in cardiothoracic surgery, its degeneration and calcification are important limiting factors in the continued use of this material. The study aims were to decellularize bovine pericardium and to compare the biomechanical properties of fresh and decellularized bovine pericardia to those treated with different concentrations of glutaraldehyde (GA). METHODS: An established protocol for decellularization using sodium dodecyl sulfate was used, and histological analysis performed to validate the adequacy of decellularization. Contact cytotoxicity was used to study the in-vitro biocompatibility of variously treated pericardia. Mechanical testing involved uniaxial testing to failure. Mechanical properties of the fresh and decellularized pericardia (untreated and treated with 0.5% and 0.05% GA) were compared. RESULTS: Histological analysis of decellularized bovine pericardium did not show any remaining cells or cell fragments. The histoarchitecture of the collagen-elastin matrix appeared well preserved. Untreated decellularized pericardium was biocompatible in contact cytotoxicity tests with smooth muscle and fibroblast cells. The GA-treated tissue was cytotoxic. There were no significant differences in the mechanical properties of fresh and decellularized pericardia, but there was an overall tendency for GA-treated pericardia to be stiffer than their untreated counterparts. CONCLUSION: An acellular matrix, cross-linked with a reduced concentration of GA, can be produced using bovine pericardium. This biomaterial has excellent biomechanical properties and, potentially, may be used in the manufacture of heart valves and pericardial patches for clinical application.

Single stage sternal reconstruction using titanium mesh for dehiscence following open-heart surgery.

Wound complications are a well-recognised entity following median sternotomy. Soft tissue reconstruction in the form of muscle flaps generally provides adequate wound stability; nevertheless, skeletal reconstruction of the anterior chest wall is sometimes necessary. We describe a novel technique applied in three patients for reconstructing fragments of the sternum using a titanium mesh that provides a scaffold for the bony union.

Use of a Fogarty Embolectomy Catheter to Retrieve a Foreign Body during Redo Coronary Artery Bypass Surgery: Case Report.

Abstract We report the successful use of an embolectomy catheter to retrieve a metal bullet tip of a cardiotomy suction device that was lost during redo coronary artery surgery. The metal tip was lost somewhere in the vicinity of a tear created in the ascending aorta during repeat sternotomy. Initial attempts at retrieval using a Foley catheter were made but were unsuccessful. The foreign body was successfully retrieved by withdrawing an inflated Fogarty balloon embolectomy catheter. The patient went on to have coronary artery bypass grafting and made a sound recovery from the operation.