Conclusions -Sclerosing mediastinitis is a slowly progressive condition associated with previous tuberculosis, mediastinal malignancy, and autoimmune disease. The outlook is excellent for those cases without underlying malignancy. (Thorax 1995;50:280-283)

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Induction CTx ± RT for cN1 or cN2 NSCLC patients did not affect EBL, operative times, or in-house mortality after RAVTS lobectomy. Patients undergoing RAVTS lobectomy after ICTx+ RT may be at greater risk for RLN injury, tracheal/bronchial injury, and pulmonary embolism. Fewer N2 LN stations, but not numbers of LNs, are assessed after ICTx ± RT. Induction therapy does not lead to increased downstaging.

We present the case of a 65-year-old male with severe coronary artery disease and a single colorectal liver metastasis. An elective intra-aortic balloon pump (IABP) was inserted following induction of anaesthesia to reduce left ventricular workload during his liver resection. After an uneventful recovery he was discharged on day 5. We review the literature on the elective use of these devices in cardiac surgery in which it is becoming routine practice in high risk patients. However in non-cardiac surgery there have been only 15 published cases all in very high risk patients, with favourable outcomes. To our knowledge this is the first published case of the use of elective IABP during liver surgery. The intra-aortic balloon pump (IABP) is an invasive device first described in the 1960s, used to stabilise and improve the haemodynamic function associated with cardiovascular disease. It improves mean arterial blood pressure, increases myocardial perfusion, reduces afterload and decreases myocardial oxygen demand by reducing cardiac work [1]. The indications for its use are expanding, although because of the need for full anticoagulation, its use in liver surgery has not been previously described. Case reportA 65-year-old male ex-smoker was referred to a specialist hepatobiliary unit with a solitary synchronous metastasis in segment 3 of the liver from a T3 N1 rectal adenocarcinoma. His primary surgery was performed 6 months previously following an emergency presentation with large bowel obstruction. A prolonged ileus and extensive wound abscess complicated his postoperative course. He had a past history of a myocardial infarction 6 years previously with ongoing angina. At presentation, his daily medications included aspirin 75 mg, atenolol 25 mg, simvastatin 20 mg and ramipril 5 mg.On pre-operative assessment he suffered occasional non-limiting chest pain. He had undergone some cardiac investigations at his local hospital but had been poorly compliant with follow-up.His pre-operative ECG showed sinus rhythm and q waves in leads III and V1. An exercise stress test previously performed at the patient's local hospital was terminated due to fatigue and chest discomfort after 4 min 20 s of SRH Bruce protocol and showed ST segment depression of up to 2 mm, which fully reverted after 7 min rest. An echocardiogram showed a moderate reduction in left ventricular function with the basal to apical septum thinned and akinetic.A coronary angiogram performed in the specialist unit showed an apical infarct with an ejection fraction of 55%. The left main stem coronary artery was normal, but the left anterior descending artery (LAD) and the right coronary artery (RCA) were both occluded at the ostium. The circumflex artery was a non-dominant vessel that collateralised both the LAD and RCA.With the discovery of severe coronary vessel disease we were left with a difficult decision; whether to proceed with the liver resection as planned or to arrange for coronary artery bypass grafting (CABG) prior to hepatic surgery. A multidisciplina...

Background: Female gender has been associated with worse outcomes after cardiovascular surgery and critical illness. We investigated the effect of gender on perioperative outcomes following robotic-assisted pulmonary lobectomy. 44.5%; P=0.004), the most common of which, in both women and men, were prolonged air leak for ≥7 days (13.0% vs. 22.7%, P=0.03), atrial fibrillation (7.1% vs. 14.8%, P=0.04), and pneumonia (7.8% vs. 10.2%, P=0.49). Hospital length of stay (LOS) (4±0.3 vs. 5±0.5 days) was also shorter for women (P=0.02). Despite the higher postoperative complication rate in men, in-hospital mortality did not differ between genders (P=0.23). Multivariable analyses did not identify female gender as an independent predictor of post-operative complications. Conclusions: Female gender was associated with rates of intraoperative complications and of conversion to open lobectomy as low as those for men, but with better perioperative outcomes, lower risk of intraoperative bleeding, and fewer postoperative complications. Thus, robotic-assisted pulmonary lobectomy is feasible and safe for women.