Ratio between maximum standardized uptake value of N1 lymph nodes and tumor predicts N2 disease in patients with non-small cell lung cancer in 18F-FDG PET-CT scan.

OBJECTIVE: F-18 fluorodeoxyglucose integrated PET-CT scan is commonly used in the work-up of lung cancer to improve preoperative disease stage. The aim of the study was to analyze the ratio between SUVmax of N1 lymph nodes and primary lung cancer to establish prediction of mediastinal disease (N2) in patients operated on non-small cell lung cancer. MATERIAL AND METHOD: This is a retrospective study of a prospective database. Patients operated on non-small cell lung cancer (NSCLC) with N1 disease by PET-CT scan were included. None of them had previous induction treatment, but they underwent standard surgical resection plus systematic lymphadenectomy. RESULTS: There were 51 patients with FDG-PET-CT scan N1 disease. 44 (86.3%) patients were male with a mean age of 64.1±10.8 years. Type of resection: pneumonectomy=4 (7.9%), lobectomy/bilobectomy=44 (86.2%), segmentectomy=3 (5.9%). HISTOLOGY: adenocarcinoma=26 (51.0%), squamous=23 (45.1%), adenosquamous=2 (3.9%). Lymph nodes after surgical resection: N0=21 (41.2%), N1=12 (23.5%), N2=18 (35.3%). Mean ratio of the SUVmax of N1 lymph node to the SUVmax of the primary lung tumor (SUVmax N1/T ratio) was 0.60 (range 0.08-2.80). ROC curve analysis to obtain the optimal cut-off value of SUVmax N1/T ratio to predict N2 disease was performed. At multivariate analysis, we found that a ratio of 0.46 or greater was an independent predictor factor of N2 mediastinal lymph node metastases with a sensitivity and specificity of 77.8% and 69.7%, respectively. CONCLUSIONS: SUVmax N1/T ratio in NSCLC patients correlates with mediastinal lymph node metastasis (N2 disease) after surgical resection. When SUVmax N1/T ratio on integrated PET-CT scan is equal or superior to 0.46, special attention should be paid on higher probability of N2 disease.

Laparoscopic versus open inguinal hernia repair in octogenarians.

PURPOSE: This retrospective chart review was designed to compare outcomes for open and laparoscopic repair of inguinal hernias in the population over the age of 80. METHODS: A retrospective chart review was conducted for 104 patients over 80 years old who underwent inguinal hernia repair (2005-2008) at The Mount Sinai Medical Center. Patients were grouped into laparoscopic or open repair cohorts and compared accordingly. RESULTS: The open group (n = 73) and the laparoscopic group (n = 31) had mean ages of 84 and 83 years, respectively. The mean American Society of Anesthesiologists score was 2.6 for the open cohort and 2.3 for the laparoscopic group (P < 0.05). Peri-operative complications in the open and laparoscopic groups were not found to be statistically significant. There was no mortality in either group. CONCLUSIONS: With octogenarians, laparoscopic inguinal hernia repair can be performed as a safe alternative to open repair with comparable rates of morbidity and mortality.

Cardiac surgery at the San Pablo Heart Institute: an update of statistics on surgical mortality and morbidity.

We performed 1,739 cardiac surgery procedures between August 1988 and July 1991 at the San Pablo Heart Institute. The statistics for mortality and morbidity are among the best in the nation and they showed an overall mortality for the entire period of 1.8%, a mortality for coronary artery bypass graft of 1.5% no patient has died as a result of mitral valve replacement, and a mortality of 1.1% for aortic valve replacement. We have demonstrated that our cardiac surgery team is capable of performing a high volume of these procedures with good results.

Surgery for acquired valvular heart disease: the San Pablo Heart Institute experience.

Ninety-nine patients underwent surgery for acquired diseases of the mitral and aortic valves between August 22, 1988 and August 21, 1990, of these, 64 procedures were done on the aortic valve and 35 procedures on the mitral valve. The early mortality for mitral valve surgery was 5.8% and late death occurred at a rate of 8.8%. As for the aortic valve surgery the operative mortality was zero and late death occurred at a rate of 3.4%. Thromboembolism occurred at a rate of 3.3% per patient year for patient undergoing mitral valve surgery and 6.3% per patient year for those undergoing aortic valve surgery. Valve thrombosis occurred at a rate of 6.6% per patient year for patients undergoing mitral valve surgery and zero for patients undergoing aortic valve surgery. Anticoagulation related bleeding occurred at a rate of 49% per patient year for patients undergoing mitral valve surgery and fatal bleeding at a rate of 3.3% per patient year. For those patients undergoing aortic valve surgery bleeding occurred at a rate of 25% per patient year and fatal bleeding occurred at a rate of 3.1%. This rate of bleeding appears high; and is due to poorly monitored anticoagulation.

Cardiac surgery at San Pablo Heart Institute: a preliminary report of the first year experience.

A series of 341 patients undergoing cardiac surgery, of which 276 underwent coronary artery bypass grafting (CABG) and 37 underwent valve replacement, is presented herein. Results of mortality and morbidity are shown, discussed and compared to that of other institutions, and found favorable. These patients represent our first year of experience at the San Pablo Heart Institute.