A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed whether pyloroplasty following elective esophagectomy improves clinical outcomes. Altogether 170 relevant papers were identified using the below-mentioned search. One meta-analysis and six randomised controlled trials from the nine that were summarised in the meta-analysis represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that pyloroplasty seems to reduce the incidence of gastric outlet obstruction and speed up gastric emptying. In addition, the incidence of complications from this procedure seems low. However, other significant improvements to outcomes such as mortality, nutrition, anastomotic leakage, gastric symptoms and aspiration are yet to be established.
Study Type – Therapy (case series)
Level of Evidence 4
What’s known on the subject ? and What does the study add?
The treatment of younger men with testicular germ cell cancers is well documented with established intensive chemotherapy regimens for those with advanced disease. Although the majority of patients present in the third or fourth decade, men also present in later life. These patients are typically excluded from clinical trials and there are no contemporary published series describing their management.
This series describes the management of older patients with testicular germ cell tumours at both early and advanced stages of disease. Patients with stage I seminoma can be safely managed with all recognised treatment strategies and state I non‐seminomas were managed with surveillance. Cure can still be achieved in older patients with advance germ cell tumours however chemotherapy regimens developed in younger patients must be tailored to the presence of co‐morbidity.
OBJECTIVES
• To review the practice of a large referral centre for the management of older patients with testicular germ cell cancer (GCC).
• There are few published data available on the management of testicular GCC in elderly patients, who often have medical comorbidities and have been excluded from clinical trials.
PATIENTS AND METHODS
• We reviewed our prospectively collected database for patients presenting with GCC who were aged ≥60 years.
• Details of presentation, management and outcome were recorded.
RESULTS
• In total, 60 patients aged ≥60 years were identified from 1461 patients treated with GCC from 1979–2005, representing 4% of the total population.
• Median age was 67 years, 44 had seminoma (73%) and 16 had non‐seminoma histology (27%).
• Stage I seminoma patients were managed with surveillance, adjuvant radiotherapy and adjuvant carboplatin. All stage I non‐seminomas underwent surveillance.
• In total, 15 patients received systemic chemotherapy for metastatic disease with modified bleomycin, etoposide and cisplatin; etoposide and cisplatin; carboplatin‐based regimens; or other combinations. Toxicity was manageable, with no toxic deaths.
• In total, four patients (6.7%) died of GCC.
CONCLUSIONS
• In elderly patients, GCC should be managed with curative intent.
• Conventional therapies are tolerable for most men with stage I seminoma. In metastatic disease, comorbidity may necessitate treatment modifications.
• Most patients are cured with manageable toxicity.
The reported frequency of detection of air embolism during neurosurgical operations carried out in the sitting position has varied widely, from 1.6%' to as high as 93%,2 but the mortality associated with this complication has ranged from 73X3 to The method of detection is relevant to the apparent incidence of embolism since the more sensitive methods have been shown to increase the frequency of diagnosis.Numerous clinical and instrumental methods of diagnosing the presence of air in these circumstances have been described. These include the observations of hypotension, cardiovascular collapse4 and rise in venous p r e~s u r e ,~ dysrhythmias6 and
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.