Morbidity and mortality after major pulmonary resections in patients with locally advanced stage IIIA non-small cell lung carcinoma who underwent induction therapy.

BACKGROUND: The optimal treatment for patients with locally advanced stage IIIA non-small cell lung carcinoma (NSCLC) remains controversial, but induction therapy is increasingly used. The aim of this study was to evaluate mortality, morbidity, hospital stay and frequency of postoperative complications in stage IIIA NSCLC patients that underwent major pulmonary resections after neoadjuvant chemotherapy or chemoradiation. METHODS: We conducted a retrospective analysis of all patients who underwent major pulmonary resections after induction therapy for locally advanced NSCLC from October 2009 to February 2014. Forty-one patients were included in the study. RESULTS: Complete resection was achieved in 40 patients (97.5%). A complete pathologic response was seen in 10 patients (24.4%). Mean hospital stay was 17.7 days (ranged 5-129 days). Early (in-hospital) mortality occurred in 2.4% (one patient after bilobectomy), late (six months) mortality in 4.9% (two patients after right pneumonectomy and bilobectomy), and overall morbidity in 58.5% (24 patients). Postoperative complications included: bronchopleural fistula (BPF) with empyema - three patients, empyema without BPF - five patients, air leak - eight patients, atrial fibrillation - eight patients, pneumonia - eight patients, and lobar atelectasis - four patients. CONCLUSION: Following neoadjuvant therapy for stage IIIA NSCLC, pneumonectomy can be performed with low early and late mortality (0% and 5.8%, respectively), bilobectomy is a high risk operation (16.7% early and 16.7% late mortality); and lobectomy a low risk operation (0% early and late mortality). The need for major pulmonary resections should not be a reason to exclude patients from a potentially curative procedure if it can be performed with acceptable morbidity and mortality rates at an experienced medical centre.

Stercoral colitis: a lethal disease-computed tomographic findings and clinical characteristic.

OBJECTIVE: The aim of this study was to describe the radiographic findings in stercoral colitis. METHODS: The computed tomographic scans and abdominal radiographs of 13 patients with surgically and pathologically confirmed stercoral colitis from 4 affiliated hospitals were reviewed by a board-certified abdominal radiologist blinded to the official imaging, surgical, and pathologic findings. RESULTS: The median age was 66 years. The patients presented mainly with constipation (100%) and an acute inflammatory process (85%); 5 patients (38%) had frank septic shock. Mortality was 46%. Imaging scans showed that the colon dilated proximally to the impaction site in 6 patients (50%). Other findings included fat stranding (100%), mucosal sloughing (58%), mesenteric hyperemia (58%), and extraluminal gas (17%). CONCLUSIONS: Computed tomography is an important diagnostic modality for stercoral colitis. The presence of a large fecaloma with distention of the affected colon and wall thickening and pericolonic fat stranding should alert radiologists and surgeons to the presence of this potentially fatal condition.

[Combination of imaging studies and autopsy in death investigations].

The progress in quality and availability of imaging studies has made them an invaluable part of the clinical diagnostic process, so much so that the forensic medical community had to acknowledge their importance and to implement them in death investigations. Since 2011 roughly 200 post-mortem radiographic examinations were conducted, mostly followed by full autopsies. Four of those cases are given as an example of the benefits and limitations of these methods. A review of the literature and our experience so far, show that computed tomography provides better visualization and 3D reconstruction of traumatic bone injuries, as well as good assessment of air in the tissues and vascular system, gunshot wound tracts, and anthropological characteristics for identification. Imaging methods are relatively limited in definite diagnostic findings in cases of sudden death from natural causes, such as pneumonia, pulmonary embolism, acute myocardial infarction or meningitis, problems which can be partially solved with the aid of angiographic studies. These methods also do not allow for sampling of tissues for microscopic examination, nor fluid samples for cultures and toxicology. In the current cultural and social reality in Israel, imaging studies enable minimization of the autopsy and, in certain cases, its relinquishment serves as a compromise between the necessity of death investigation and beliefs in the wholeness of the body. In light of the advantages of imaging, no autopsy of a trauma-related death can be complete without it.

A 37-year-old man with recurrent fainting: a short communication.

The possible influence of the oesophageal diseases on the heart is well known. Deglutition syncope and pre-syncope have been described in relation to arrhythmias or mechanical problems. We report here a case of recurrent pre-syncope in a patient after gastric banding.

Bilateral pelvic urinomas following ureteral injury from surgery: lymphocele look-alikes on computed tomography.

Postoperative fluid collections are a not-infrequent finding on computed tomography (CT), and their causes are numerous. One of the more rare etiologies is a urinoma resulting from a ureteral injury. Such an injury is one of the most serious complications of abdominal, mainly gynecological, surgery. This complication is often clinically unsuspected, as symptoms are nonspecific and the patient may present weeks and even months after the injury. We present a patient in whom clinically unsuspected bilateral pelvic urinomas were diagnosed on a baseline CT 8 weeks after radical hysterectomy. We want to emphasize the crucial role of CT, especially with delayed scanning, in reaching this diagnosis.