Objectives: To assess whether preoperative levels of physical activity predict the incidence of post-operative complications following anatomical lung resection. Methods: Levels of physical activity (daily steps) were measured for 15 consecutive days using pedometers in 90 consecutive patients (prior to admission). Outcomes measured were cardiac and respiratory complications, length of stay, and 30-day re-admission rate. Results: A total of 78 patients’ datasets were analysed (12 patients were excluded due to non-compliance). Based on steps performed they were divided into quartiles; 1 (low physical activity) to 4 (high physical activity). There were no significant differences in age, smoking history, COPD, BMI, percentage predicted FEV1 and KCO and cardiovascular risk factors between the groups. There were significantly fewer total complications in quartiles 3 and 4 (high physical activity) compared to quartiles 1 and 2 (low physical activity) (8 vs 22; P = .01). There was a trend ( P > .05) towards shorter hospital length of stay in quartiles 3 and 4 (median values of 4 and 5 days, respectively) compared to quartiles 1 and 2 (6 days for both groups). Conclusions: Preoperative physical activity can help to predict postoperative outcome and can be used to stratify risk of postoperative complications and to monitor impact of preoperative interventions, ultimately improving short term outcomes.
BackgroundHistiocystic sarcoma is a rare, but aggressive tumour that often involves extranodal sites. Histiocystic sarcoma is recognised by the World Health Organization as one of six subtypes of dendritic cell neoplasms. Diagnosis is difficult due to overlapping immunohistochemistry with other dendritic cell neoplasms. The optimal roles for chemotherapy, radiotherapy and surgery in the treatment of histiocytic sarcoma remain unknown.MethodsWe report a case of a patient with histiocytic sarcoma diagnosed after excisional biopsy and immunohistochemistry testing.ResultsThe patient underwent external beam radiation therapy (EBRT). After 18 Gray (Gy), the 8 cm lesion had regressed to ~5 cm in diameter. The treatments were continued to a total dose of 45 Gy with the lesion regressing to less than a centimeter by the end of treatment. Local control was maintained but the patient died of acute myelogenous leukemia 5 months after her treatment.ConclusionsThis case suggests that histicytic sarcomas can be controlled locally with EBRT.
1. The effect of cooling on the properties of the crop and gizzard of the earthworm has been investigated. Evidence is advanced that the rhythmic movements of the ‘warm’ preparation are neurogenic in origin and peristaltic in nature. They are abolished by nicotine and by cooling, but not by atropine. 2. Acetylcholine contracts the muscle in the crop and gizzard. This effect is abolished by atropine. The excitability of the muscle to acetylcholine is not lost after cooling. 3. Peristalsis is accompanied in the ‘warm’ preparation by a continual liberation of acetylcholine. This is absent in cold preparations. The disappearance of rhythmic activity in these is associated with the loss of acetylcholine synthesis. 4. In the ‘warm’ crop and gizzard, potassium produces contraction which is enhanced by eserine, but not abolished by nicotine or by atropine. With higher doses of potassium, stimulation is followed by inhibition. After short periods of cooling, the motor response to potassium is lost, but the inhibitory effect is still present. Prolonged cooling abolishes both actions. It is suggested that the augmentor action of potassium is due to an intermediate release of acetylcholine from the cholinergic nerve endings, and the inhibitory action to a liberation of adrenaline from the adrenergic nerves in the crop and gizzard. 5. Calcium inhibits the rhythmic activity of ‘warm’ preparations, and the effect of potassium. It has no action on cooled preparations, and in these it does not affect the contractions produced by acetylcholine. It is suggested that calcium acts on ‘warm’ preparations by preventing the release of acetylcholine from cholinergic nerve endings. 6. The action of adrenaline on ‘warm’ preparations is twofold: small doses have an augmentor effect; larger doses are inhibitory. After cooling, adrenaline has no action by itself. It is suggested that the augmentor effect of adrenaline is due to an improvement in acetylcholine-transmission at the cholinergic nerve endings. 7. Small doses of barium contract the ‘warm’ preparation. This action is inhibited by calcium, abolished by nicotine, and is lost after cooling. It is suggested that the action of such doses of barium is due to a stimulation of parasympathetic ganglion cells. 8. The presence of multipolar nerve cells in the enteric plexus was demonstrated in histological sections of the crop and gizzard. These were found lying between the circular and longitudinal muscle layers, in a position analogous to that of Auerbach's plexus.
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