Thoracoscopic diaphragm plication with a running suture is safe and achieves excellent early and long-term improvements. This addresses technical challenges of tying multiple interrupted sutures by video-assisted thoracoscopic surgery without any apparent compromise to efficacy or durability.
The compliant Thoracic Artificial Lung (cTAL) has been studied in acute in vivo and in vitro experiments. The cTAL’s long term function and potential use as a bridge to lung transplantation are assessed presently. The cTAL without anti-coagulant coatings was attached to sheep (n=5) via the pulmonary artery and left atrium for 14 days. Systemic heparin anticoagulation was utilized. cTAL resistance, cTAL gas exchange, hematologic parameters, and organ function were recorded. Two sheep were euthanized for non-device related issues. The cTAL’s resistance averaged 1.04±0.05 mmHg/(L/min) with no statistically significant increases. The cTAL transferred 180±8 mL/min of oxygen with 3.18±0.05 L/min of blood flow. Except for transient surgical effects, organ function markers were largely unchanged. Necropsies revealed pulmonary edema and atelectasis, but no other derangements. Hemoglobin levels dropped with device attachment but remained steady at 9.0±0.1 g/dL thereafter. In a fourteen day experiment, the cTAL without anti-coagulant coatings exhibited minimal clot formation. Sheep physiology was largely unchanged, except for device attachment related hemodilution. This suggests that patients treated with the cTAL shouldn’t require multiple blood transfusions. Once tested with anti-coagulant coatings and plasma resistant gas exchange fiber, the cTAL could serve as a bridge to transplantation.
Background Centrifugal pumps are increasingly used for temporary mechanical support for the treatment of cardiogenic shock. However, centrifugal pumps can generate excessive negative pressure and are afterload-sensitive. A previously developed modified roller pump mitigates these limitations both in vitro and in preliminary animal experiments. We report the results of intermediate-term testing of our evolving pump technology, known as BioVAD. Methods The BioVAD was implanted in 6 adult male sheep (62.5 ± 3.9 kg), with drainage from the left atrium and reinfusion into the descending aorta. The sheep were monitored for 5 days. Heparin was given during the initial implantation, but no additional anti-coagulation was given. Data collected included hemodynamic status, pump flow and pressures, laboratory values to monitor end-organ function and hemolysis, pathologic specimens to evaluate for thromboembolic events and organ ischemia, and explanted pump evaluation. Results All animals survived the planned experimental duration and there were no pump malfunctions. Mean BioVAD flow was 3.57 ± 0.30 L/min (57.1 cc/kg/min) and mean inlet pressure was -30.51 ± 4.25 mmHg. Laboratory values, including plasma free hemoglobin, creatinine, lactate, and bilirubin levels, remained normal. Three animals had small renal cortical infarcts, but there were no additional thromboembolic events or other abnormalities seen on pathologic examination. No thrombus was identified in the BioVAD blood flow path. Conclusions The BioVAD performed well for five days in this animal model of temporary left ventricular assistance. Its potential advantages over centrifugal pumps may make it applicable for short-term mechanical circulatory support.
BackgroundDermatomyositis, an inflammatory myopathy with cutaneous involvement, is associated with malignancy and often manifests paraneoplastically. While co-occurrence with small cell carcinoma is well attested, primary lung adenocarcinoma, which may present as focal ground-glass opacification on computed tomography of the thorax, is less frequently coincident.Case presentationWe report the case of a 72-year-old female patient with dermatomyositis — treated with a combination of prednisone, methotrexate, and intravenous immunoglobulin — and an indolent, subsolid, non-hypermetabolic pulmonary lesion, which was determined to be invasive primary lung adenocarcinoma. Supporting a paraneoplastic basis, immunosuppressive therapy was discontinued following tumor excision without relapse of signs or symptoms of dermatomyositis.ConclusionsWhile dermatomyositis prodromal to lung adenocarcinoma is not without precedent, association with an indolent, subsolid lesion has, to the best of our knowledge, not been reported. The case described herein illustrates the importance of maintaining a high index of suspicion for malignancy in the setting of dermatomyositis.
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