Role of Pre-Operative Brain Imaging in Patients with NSCLC Stage I: A Retrospective, Multicenter Analysis.

Background: Lung cancer is the worldwide leading oncological cause of death in both genders combined and accounts for around 40-50% of brain metastases in general. In early-stage lung cancer, the incidence of brain metastases is around 3%. Since the early detection of asymptomatic cerebral metastases is of prognostic value, the aim of this study was to analyze the incidence of brain metastases in early-stage lung cancer and identify possible risk factors. Methods: We conducted a retrospective multicentric analysis of patients with Stage I (based on T and N stage only) Non-Small Cell Lung Cancer (NSCLC) who had received preoperative cerebral imaging in the form of contrast-enhanced CT or MRI. Patients with a history of NSCLC, synchronous malignancy, or neurological symptoms were excluded from the study. Analyzed variables were gender, age, tumor histology, cerebral imaging findings, smoking history, and tumor size. Results were expressed as mean with standard deviation or median with range. Results: In total, 577 patients were included in our study. Eight (1.4%) patients were found to have brain metastases in preoperative brain imaging. Tumor histology was adenocarcinoma in all eight cases. Patients were treated with radiotherapy (five), surgical resection (two), or both (one) prior to thoracic surgical treatment. Other than tumor histology, no statistically significant characteristics were found to be predictive of brain metastases. Conclusion: Given the low incidence of brain metastases in patients with clinical Stage I NSCLC, brain imaging in this cohort could be avoided.

Organ Procurement From Poisoned Patients: A 14-Year Survey in 2 Academic Centers.

OBJECTIVES: Organ transplant from poisoned donors is an issue that has received much attention, especially over the past decade. Unfortunately, there are still opponents to this issue who emphasize that toxins and drugs affect the body's organs and do not consider organs from poisoned donors appropriate for transplantation. MATERIALS AND METHODS: Cases of brain death due to poisoning were collected from 2 academic centers in Tehran, Iran during a period from 2006 to 2020. Donor information and recipient condition at 1 month and 12 months after transplant and the subsequent transplant success rates were investigated. RESULTS: From 102 poisoned donors, most were 30 to 40 years old (33.4%) and most were men (55.9%). The most common causes of poisoning among donors were opioids (28.4%). Six candidate donors had been referred with cardiorespiratory arrest; these patients had organs that were in suitable condition, and transplant was successful. Acute kidney injury was seen in 30 donors, with emergency dialysis performed in 23 cases. For 51% of donors, cardiopulmonary resuscitation was performed. The most donated organs were the liver (81.4%), left kidney (81.4%), and right kidney (80.4%). Survival rate of recipients at 1 month and 12 months was 92.5% and 91.4%, respectively. Graft rejection rate at 1 month and 12 months after transplant was 0.7% and 2.21%, respectively. CONCLUSIONS: Organ donation from poisoning-related brain deaths is one of the best sources of organ supply for people in need. If the organ is in optimal condition before transplant, there are no exclusions for use of the graft.

Indications and Results of Sternal Allograft Transplantation: Learning From a Worldwide Experience.

BACKGROUND: Reconstruction of the anterior chest wall defect after sternectomy is a challenge for cardiothoracic surgeons. In 2010, the Padua group published the first case of cadaveric sternum transplantation after sternectomy. This multicenter study reports the clinical indications and early and long-term results of sternal chondral allograft transplantation. METHODS: This is a retrospective multicenter study from 7 academic centers. We collected demographic data, surgical indications, technical details, and early postoperative results. The complications, long-term stability, and tolerance of the allografts were also analyzed. RESULTS: Between January 2008 and December 2019, 58 patients underwent sternectomy followed by reconstruction using cadaveric-cryopreserved sternochondral allografts. Thirty-two patients were male, median age 63.5 years (interquartile range, 50-72 years). Indications for sternectomy were secondary sternal tumors (n = 13), primary sternal tumors (n = 15), and nonneoplastic disease (n = 30). Thirty patients underwent total sternectomy, 16 lower-body sternectomy, and 12 upper-body manubrium resection. The 30-day mortality was 5%; overall morbidity was 31%. Six early reoperations were necessary because of bleeding (n = 1), titanium plate dislocation (n = 1), and resuture of the skin in the lower part of the incision (n = 4). Overall, 5-year survival was 74%. In all the survived patients, the reconstructions were stable and free from mechanical or infective complications. CONCLUSIONS: The main indications for sternal allograft implantation were complex poststernotomy dehiscence followed by primary or secondary tumor involvement of the sternum. The collected results demonstrate that sternochondral allograft transplantation is a safe and effective method in reconstructing the anterior chest wall after sternectomy. Further studies to demonstrate the integration of the bone grafts into the patients' sternal wall will be made.