Citations

Objectives although video-assisted thoracoscopic surgery for pulmonary resection appears to be associated with more favorable postoperative outcomes than thoracotomy, no reports have discussed its benefit at subsequent reoperative pulmonary resection. Methods between January 2000 and December 2009, 144 patients underwent reoperative pulmonary resections for benign and malignant nodules at the Mayo Clinic, Rochester. Their data were evaluated retrospectively. Twenty-three (16%) patients had prior video-assisted thoracoscopic surgery, and 121 (84%) had undergone a prior open thoracotomy. Intraoperative and short-term postoperative outcomes were analyzed and compared between the two groups, using the chi-square test or Mann-Whitney test. Results overall reoperative mortality was 1.38% and morbidity was 49.3%. Intraoperative factor analysis showed that the prior video-assisted thoracoscopic surgery group more often underwent anatomical resection ( p = 0.0011) and showed a tendency towards a lower conversion rate from video-assisted thoracoscopic surgery to thoracotomy at reoperative pulmonary resection ( p = 0.051). Short-term postoperative outcomes showed that the prior video-assisted thoracoscopic surgery group had a significantly lower morbidity rate ( p = 0.013), significantly shorter hospital stay ( p = 0.002), and a tendency for a shorter duration of chest tube drainage ( p = 0.09). Conclusion our results suggest that prior video-assisted thoracoscopic surgery may lead to improved postoperative outcomes at subsequent reoperative pulmonary resection. Video-assisted thoracoscopic surgery may be favored for future potential reoperative pulmonary resections.

Key Points Eosinophils recruited to the airways in response to A fumigatus sensitization and challenge degranulate in response to virus infection. Activated eosinophils are antiviral and promote survival from an otherwise lethal respiratory virus infection.

Background We describe a patient with tardy ulnar neuropathy and cubitus valgus deformity found to have an intracapsular ulnar nerve. Methods An 89-year-old woman presented with severe neuropathic pain in the ulnar digits of the hand, advanced degenerative arthritis of the elbow, and tardy ulnar nerve palsy. Her pain was exacerbated with elbow movement, particularly flexion. She had paralysis of ulnar nerve innervated muscles, hypersensitivity with absence of two-point discrimination in her ulnar 1–1/2 digits, and a fixed ulnar claw deformity. She also had a grossly unstable elbow. Results Plain films revealed a cubitus valgus deformity (38°), an absent radial head, a dislocated proximal radioulnar joint and advanced arthritic changes. Ultrasonography revealed an indistinct ulnar nerve within the cubital tunnel which penetrated the joint. Electrophysiological studies revealed evidence of a severe ulnar neuropathy at the level of the elbow. Intraoperatively, an attenuated 2 cm length of the retrocondylar ulnar nerve was observed to be incorporated into the joint capsule tethered by a fibrous/synovial band which was released. A large effusion was drained. The ulnar nerve was transposed subcutaneously. The capsular rent was repaired in layers. She noted immediate and sustained (2 year follow-up) pain relief and regained moderate function in her interossei. Conclusions We believe that the chronic cubitus valgus deformity and secondary degenerative elbow joint changes led to an altered course of the nerve and attenuation of the medial joint capsule such that the ulnar nerve spontaneously buttonholed itself intra-articularly.

Objective: We investigated ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type 1 motif, member 13) messenger RNA levels as a biomarker of disease features in systemic lupus erythematosus. Methods: We measured and compared messenger RNA (mRNA) levels of ADAMTS13 in peripheral blood cells in patients with systemic lupus erythematosus and healthy control subjects by whole-genome microarray. We retrospectively analyzed the correlations of ADAMTS13 mRNA expression with clinical features, laboratory parameters, therapeutic features, and disease activity (according to the Systemic Lupus Erythematosus Disease Activity Index). We also examined the association of three single nucleotide polymorphisms (rs4962145, rs2285467, and rs685523) of the ADAMTS13 gene with patient characteristics. Results: In 309 patients, the median ADAMTS13 mRNA expression levels were significantly higher in blood cells of systemic lupus erythematosus patients than in 23 healthy controls ( p = .03). Notably, ADAMTS13 mRNA expression levels were significantly higher in systemic lupus erythematosus patients with a history of stroke ( p = .02) or transient ischemic attack ( p = .02). Among the three single nucleotide polymorphisms analyzed, rs2285467 was significantly associated with stroke ( p = .03) and anticardiolipin antibodies ( p = .04). Conclusions: Increased expression of ADAMTS13 mRNA in blood cells is associated with the presence of ischemic cerebrovascular disease in systemic lupus erythematosus patients and suggests a potential role for ADAMTS13 in the pathogenesis of ischemic cerebrovascular disease in these patients.