AimsThe aim of this systematic review is to gain insight into the published experience on percutaneous closure of a post-infarction ventricular septal rupture (VSR).MethodRelevant literature was obtained by MeSH-term searches in the online search-engine PubMed. Articles published in the last 10 years were included. Further filtering was done by using search limits and individual article selection based on the aims of this systematic review.ConclusionPercutaneous closure is a potential technique in a select group of patients. The presence of cardiogenic shock and closure in the acute phase after VSR diagnosis are important risk factors of mortality. Device implantation is in general successful with few procedure-related complications. Reduction of the shunt fraction has been reported frequently. This technique is a less invasive alternative to surgical treatment and should be applied on a case-by-case basis.
We present the case of a 58-year-old man who underwent urgent blowhole colostomy for toxic megacolon (TM) secondary to Clostridium difficile infection (CDI). This infection occurred under antibiotic coverage with amoxicillin-clavulanic acid, four days after laparoscopic sigmoidectomy in our hospital. Although prospective clinical research regarding the surgical management of TM is lacking, decompressive procedures like blowhole colostomy are reported to carry a high risk of postoperative morbidity and mortality and are widely regarded as obsolete. Subtotal or total colectomy with end ileostomy is currently considered the procedure of choice. After presenting our case, we discuss the literature available on the subject to argue that the scarce evidence on the optimal surgical treatment for TM is primarily based on TM associated with inflammatory bowel diseases (IBD) and that there might be a rationale for considering minimally invasive procedures like blowhole colostomy for CDI-associated TM.
In this editorial we will discuss several interesting and timely topics which are relevant for current thoracic oncological practice. First, we will address epidermal growth factor receptor (EGFR) mutations and resistance, followed by ground glass opacities (GGO), current diagnostic assessment tools including patient derived organoids (PDO), assessment of circulating tumour DNA (ctDNA) and circulation tumour cells (CTC). Finally, we will also address a complex case of delayed extensive chest wall infection following a lobectomy via thoracotomy.The treatment of advanced non-small cell lung cancer (NSCLC) has traditionally been via the systemic administration of platinum-based chemotherapy. Overall survival (OS) is poor with only 33% at 1 year and 11% at 2 years (1). With the discovery of EGFR mutations, new treatment pathways emerged. These mutations are primarily found in lung cancer with an adenocarcinoma component, non-squamous NSCLC, young Asian women (<50 years) and non or light smokers (2). In these patients, if systemic treatment is considered, molecular testing including EGFR mutations need to be assessed. Selective tyrosine kinase inhibitors (TKI) of EGFR (EGFR-TKI) were developed to target EGFR mutation harbouring NCSLC. Via EGFR stimulation, the tyrosine kinase (TK) pathway has a role in cell proliferation and migration, apoptosis evasion, and angiogenesis pathways. In case of EGFR mutated NSCLC activation, this will lead to overstimulation of the EGFR and cause tumour growth.Initial first generation inhibitors of the EGFR-TK pathway, in the form of gefitinib, erlotinib and icotinib were promising. Monotherapy with gefitinib showed an overall response rate (ORR) of 71.2% vs. 47.3% when compared to platinum-based chemotherapy as demonstrated in the IPASS trial (3). Yet the ORR in the population lacking an EGFR mutation was a mere 1.1% (gefinitib group) vs. 23.5% (carboplatin-paclitaxel group). In the WJTOG345 trial, gefitinib was compared to docetaxel and cisplatin in patients with EGFR mutated NSCLC, demonstrating an ORR of 62.1% vs. 32.2% (4). Erlotinib, another first generation EGFR-TKI has been used in the first-line treatment for EGFR mutated NSCLC patients. It showed a progressionfree survival (PFS) of 8.0-13.1 months compared to 4.6-6.9 months in the platinum-based chemotherapy (5).
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