A systematic review of restaging after induction therapy for stage IIIa lung cancer: prediction of pathologic stage.

BACKGROUND: Many clinicians use restaging after induction therapy as a way to select patients for surgery. METHODS: A systematic review was conducted to define the reliability of restaging tests after induction therapy for stage III(N2) lung cancer, when compared with pathologic findings at surgery. RESULTS: A complete response at all sites carries a false-negative (FN) rate of 50% for computed tomography and 30% for positron emission tomography. Mediastinal node involvement has FN and false-positive rates of 33% and 33% by computed tomography, and 25% and 33% by positron emission tomography. The FN rate of invasive restaging is 22% by repeat mediastinoscopy, 14% by esophageal ultrasound and needle aspiration in expert hands (reliable results are not yet available for endobronchial ultrasound), and 9% by primary mediastinoscopy done with optimal thoroughness. These results are not significantly affected by the type of induction therapy or the timing of restaging. CONCLUSION: The ability to identify patients who have achieved mediastinal downstaging other than by a careful primary mediastinoscopy is poor.

[Utility of omentoplasty for poststernotomy mediastinitis secondary to myocardial revascularization surgery]. / Utilidad de la omentoplastia en el tratamiento de la esternomediastinitis secundaria a cirugía de revascularización miocárdica.

Acute poststernotomy mediastinitis is a serious complication of cardiac surgery and is associated with high mortality. Conservative treatment with local debridement, irrigating-suction systems, and specific antibiotic therapy is sometimes inadequate. Omentoplasty is occasionally used for reconstruction and the treatment of various chest diseases. This useful procedure is most often indicated for suppurative processes and radionecrosis, to complement myoplasty, or to cover a chest wall prosthesis. When used to treat poststernotomy mediastinitis secondary to cardiac surgery, omentoplasty improves control of infection and prognosis. We describe 2 cases of poststernotomy mediastinitis secondary to cardiac revascularization surgery in which omentoplasty was an effective treatment. Excellent control of infection was achieved.

Utilidad de la omentoplastia en el tratamiento de la esternomediastinitis secundaria a cirugía de revascularización miocárdica / Utility of omentoplasty for poststernotomy mediastinitis secondary to myocardial revascularization surgery

La esternomediastinitis aguda es una complicación grave que puede aparecer tras intervenciones de cirugía cardíaca y que presenta una elevada mortalidad. El tratamiento conservador mediante curas locales, sistemas de drenaje-lavado y uso de antibióticos específicos es a veces insuficiente. La omentoplastia, ocasionalmente utilizada en la reconstrucción y tratamiento de diferentes enfermedades torácicas, es un procedimiento útil, que tiene su mayor indicación en procesos supurativos, radionecrosis, complemento a mioplastias y protección de prótesis de pared torácica. Su utilización en el tratamiento de la esternomediastinitis secundaria a cirugía cardíaca ayuda al control de la infección y mejora la evolución de los pacientes. Presentamos 2 casos de esternomediastinitis secundaria a cirugía de revascularización miocárdica en los que la omentoplastia ha sido un tratamiento efectivo, consiguiendo excelentes resultados en el control de la infección

Acute poststernotomy mediastinitis is a serious complication of cardiac surgery and is associated with high mortality. Conservative treatment with local debridement, irrigating-suction systems, and specific antibiotic therapy is sometimes inadequate. Omentoplasty is occasionally used for reconstruction and the treatment of various chest diseases. This useful procedure is most often indicated for suppurative processes and radionecrosis, to complement myoplasty, or to cover a chest wall prosthesis. When used to treat poststernotomy mediastinitis secondary to cardiac surgery, omentoplasty improves control of infection and prognosis. We describe 2 cases of poststernotomy mediastinitis secondary to cardiac revascularization surgery in which omentoplasty was an effective treatment. Excellent control of infection was achieved