With the growing number of patients with degenerative aortic valve pathology, mainly an older population, sometimes with calcified and fragile aortic wall, the issue of dealing with an SAR poses the dilemma of whether to implant a smaller prosthesis and admit some degree of PPM, or to enlarge the aortic root. This study demonstrates that the latter can be done in a safe and reproducible manner.

The chest wall chondrosarcoma (CWC) is a rare slowly growing primary tumor of the chest wall with an incidence of <0.5 per million person-years. We present the case of a giant CWC that caused a mass effect on the mediastinum, heart, and lung. Large tumors with thoracic structures compression may be life threatening, and its resection and subsequent chest wall reconstruction represent a significant multidisciplinary surgical challenge. In this case, despite the large tumor dimensions, the preoperative planning-sparing key reconstructive options without compromising the tumor resection-allowed a complete en bloc tumor excision of a grade III chondrosarcoma with negative histologic margins. Successful reconstruction of the large full-thickness chest wall defect, with a latissimus dorsi muscle flap and methyl methacrylate incorporated into a polypropylene mesh in a sandwich fashion, was accomplished. Patient recovery was uneventful with good functional and aesthetic outcomes, and no evidence of recurrence at 1.5 years follow-up. This case report illustrates the main clinical, radiological, and histologic features of a CWC while discussing the surgical goals and highlighting the principles for chest wall reconstruction following extensive resection of a large and rare entity.

Redo AVS performed in patients submitted to CABG previously results in mortality and morbidity rates that are much lower than what is expected, bringing clear benefits to the patients.

relationship, and patients with higher body mass index (BMI), obese or overweight, have improved survival. BMI is the ratio between the weight in kilograms and the height in meters squared and is commonly used as surrogate for body composition. Using the BMI, obesity is defined as a BMI 30 Kg/m 2 , of overweight as a BMI between 25 and 29,9 Kg/m 2 , normal weight as a BMI from 18,5 to 24,9 Kg/m 2 and underweight below 18,5 Kg/m 2 . The objective of this study was to analyze the BMI of the patients with Non-Small Cell Lung Cancer (NSCLC) and to investigate its impact on overall survival. Methods: We conducted a retrospective analysis of patients diagnosed with metastatic non-small cell lung cancer diagnosed between 2000 and 2019, at AC Camargo Cancer Center, Brazil. Demographics, clinical-pathological characteristics, treatment patterns and outcomes data were obtained from electronic medical records. We collected weight and height information to calculate the BMI. Other variables such as ECOG, Charlson's comorbidity score, histological subtype, smoking load and number of metastasis were also analyzed. Overall survival was defined as the time between diagnosis and death by any cause. We used descriptive statistics to characterize the study population. Association between BMI and other variables was tested with Pearson's Chi-Squared or Fisher's exact tests. The Kaplan-Meyer method was used to estimate survival. Impact of BMI on survival was calculated with Cox regression method. P-values <0.05 were considered statistically significant. Results: We analyzed data from 456 patients with metastatic NSCLC. About 52,9% were men, 73,9% were white, 21,9% were smokers, 42,1% were former smokers and 32,2% non-smokers. Most of the patients had adenocarcinoma (78,5%). 63,2% of patients had 2 sites of metastasis. Median Charlson's score was 8 and 46,7% had ECOG 1. Median BMI was 24,3 kg/m2 (13,0-50,8). Patients were dichotomized into two groups based on the median BMI: <24,3 (89,7%) and 24,3 (10,3%). At a median follow up of 41,5 months, the median overall survival of the group who had lower BMI was 15,8 months versus 24,3 months in the group with higher BMI (HR¼1,56; 95% IC 1,0-2,3; P-value¼0,034). Conclusion: According to our data, there is an inverse relation between BMI and risk of death in patients with metastatic NSCLC. Patients who had lower BMI had a worse overall survival. BMI is associated with survival and should be considered as a prognostic factor in patients with lung cancer.

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The hospital-stay duration after first surgery was 30 (12-99) days. There were no postoperative mortalities. Conclusion: Diabetes mellitus, preoperative chemotherapy, and COPD could be significant risk factors for postoperative empyema. Infecting organisms associated with postoperative empyema were related to preceding postoperative complications. Therefore, emphasis on controlling factors that contribute to pulmonary and surgical-site infection and pulmonary air leak is important to prevent postoperative empyema.

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