ABSTRACT
Gestational trophoblastic neoplasia (GTN) is a rare collection of malignancies which are usually curable with modern chemotherapy. Lung metastasis is a relatively common feature of these malignancies and is not considered an adverse prognostic feature. Occasionally, however, the management of these patients necessitates adjuvant thoracic surgery, either to establish the diagnosis or to potentially provide a curative resection of drug-resistant foci of disease. This case series highlights 5 such cases in which thoracic surgery has significantly contributed to the management and outcome of complicated GTN patients, and suggests when thoracic surgery should be considered in this rare group of patients.
Subject(s)
Choriocarcinoma/therapy , Lung Neoplasms/therapy , Lymph Node Excision , Thoracotomy , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Choriocarcinoma/genetics , Choriocarcinoma/pathology , Choriocarcinoma/secondary , Chorionic Gonadotropin/blood , Female , Genotype , Humans , Hysterectomy , Lung Neoplasms/diagnosis , Lung Neoplasms/genetics , Lung Neoplasms/secondary , Microsatellite Repeats , Pregnancy , Radiosurgery , Remission Induction , Stem Cell Transplantation , Uterine Neoplasms/genetics , Uterine Neoplasms/pathology , Uterine Neoplasms/therapyABSTRACT
OBJECTIVE: Postoperative pain is associated with delayed discharged and recovery, reduced patient satisfaction, and increased costs. The aim of this study was to investigate the short-term association between preoperative psychological variables (pain catastrophizing, anxiety, and depression) and postoperative pain in a sample of cardiac surgery patients. DESIGN: This is a prospective epidemiological study. SETTING: This study was carried out at two Imperial College Healthcare National Health Service Trust Hospitals (St. Mary's Hospital and Hammersmith Hospital, London, UK). SUBJECTS: Sixty-four cardiac surgery patients completed the "pain catastrophizing scale (PCS)," the "hospital anxiety and depression scale," and the "verbal rating scale" (VRS) for pain intensity preoperatively and at 48 hours postoperatively. Analgesia consumption was recorded. Data on demographic, operative, and clinical characteristics were obtained from medical records. OUTCOME MEASURES: Pain intensity at 48 hours postoperatively. RESULTS: Scores on the anxiety, depression, and PCSs were not significantly different between the pre- and postoperative period. In contrast, patients reported a higher level of pain intensity postoperatively (P < 0.001). In the fully adjusted multiple regression analysis, postoperative pain intensity was predicted by a higher level of preoperative pain intensity (dichotomized above median; ß = 2.00, 95% confidence interval [CI]: 0.28-3.72) and a higher score on the preoperative PCS (dichotomized above median; ß = 1.87, 95% CI: 0.53-3.21). CONCLUSIONS: Pain catastrophizing can predict postoperative pain intensity in cardiac surgery patients, independently of the presence of anxiety, depression, or preoperative level of pain. Future studies should aim to establish the role of pain catastrophizing in longer-term outcomes in cardiac surgery.
Subject(s)
Cardiac Surgical Procedures/psychology , Catastrophization/psychology , Pain, Postoperative/psychology , Aged , Anxiety/epidemiology , Cardiac Surgical Procedures/adverse effects , Depression/epidemiology , Female , Humans , Male , Preoperative PeriodABSTRACT
Purulent pericarditis involves the whole pericardium and usually presents as an acute illness with high mortality without prompt diagnosis and treatment. Presentation as a mediastinal mass causing compression of the right ventricle (RV) and symptoms of heart failure in patients without previous cardiac surgery is very rare and only three cases have been reported up to now (English language medical literature). Clinicians should be aware of this unusual condition for prompt diagnosis and treatment to be instituted.
Subject(s)
Abscess/complications , Abscess/diagnostic imaging , Heart Failure/etiology , Pericarditis/complications , Pericarditis/diagnostic imaging , Acute Disease , Aged , Diagnosis, Differential , Echocardiography, Transesophageal , Female , Heart Failure/diagnostic imaging , Heart Neoplasms/diagnostic imaging , HumansABSTRACT
BACKGROUND: Cardiopulmonary bypass is associated with an inflammatory response with potential deleterious effects. The white cell subpopulation mostly investigated so far is the neutrophil. To date very little has been investigated regarding the role of the monocyte/macrophage. This study focuses on the expression of Fc gamma receptors I, II, and III by monocytes in patients undergoing cardiopulmonary bypass. METHODS: We studied the surface expression of Fc gamma receptors I, II, and III by flow cytometry on gated monocyte subpopulations in the whole blood of adult patients undergoing elective coronary artery bypass grafting. Blood samples were drawn preoperatively and at 15 minutes, 1, 2, 4, 24, 48, and 72 hours, and 6 days postoperatively. A second group of patients undergoing lung resection surgery were studied in a similar fashion. RESULTS: Neither Fc receptor I nor receptor II expression were significantly changed throughout the time points studied. Fc receptor III expression was reduced at 2 and 4 hours (p = 0.016 and 0.002) and increased at 24, 48, and 72 hours after commencement of CPB on a selected subpopulation (15%-35%) of monocytes (p = 0.004, < 0.001, and < 0.001, respectively). This expression returned to preoperative levels by the sixth postoperative day. There were no statistically significant changes in the lung resection group. CONCLUSIONS: Our study demonstrated that cardiopulmonary bypass is associated with a biphasic Fc gamma receptor III expression on a subpopulation of peripheral blood monocytes up to 3 days postoperatively.
