[Show abstract][Hide abstract] ABSTRACT: Pneumonectomy remains a high-risk procedure. Comprehensive patient selection should be based on analysis of proven risk factors.
The records of 323 pneumonectomy patients were retrospectively reviewed. Multiple demographic data were collected. End points were operative mortality at 30 and at 90 days, major procedurally related complications, and cardiovascular events. Univariate and multivariate statistical analyses were performed.
Smoking habits, chronic obstructive pulmonary disease (COPD) status, induction chemotherapy status, diabetes, and obesity had no statistical influence on short-term outcomes. After right pneumonectomy, 30-day mortality (p = 0.045) and the incidence of bronchopleural fistulas (p = 0.009) were increased. Multivariate analysis for postoperative bronchopleural fistulas discovered that right pneumonectomies are the sole risk factor (p = 0.015). Univariate analysis for postoperative atrial fibrillation showed that male gender, age 70 and older, hypertension, and dyslipidemia are risk factors. Multivariate analysis found no definite risk factor. Patients with coronary artery disease had more postoperative cardiovascular events (p = 0.003). Among patients free of coronary artery disease, COPD led to an increased 90-day mortality rate (p = 0.028).
Patients with right pneumonectomies are at increased risk. Postoperative cardiovascular events are more frequent in coronary artery disease patients. COPD is a risk factor in patients free of coronary disease.
The Annals of thoracic surgery 12/2009; 88(6):1737-43. DOI:10.1016/j.athoracsur.2009.07.016 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examined the prognostic value of histologic indices in non-small cell lung cancer with particular interest in major blood vessel invasion.
We studied 593 patients who had curative resection between November 1983 and December 1988. We determined the histology, T and N status, peritumoral lung tissue invasion, tumor stroma, necrosis, mitotic rate, and blood vessel invasion.
The median patient survival of the whole series was 3.2 years, with a 5-year survival of 38.9%. In univariate analysis, a high T stage, a high percentage of necrosis, blood vessel invasion, and N stage significantly worsened the survival. In multivariate analysis, only blood vessel invasion and, less significantly, T stage and lymph node metastasis remained independent prognostic factors.
These results highlight the negative prognostic value of blood vessel invasion in non-small cell lung cancer and suggest that blood vessel invasion, T stage, and node metastasis are three unrelated and distinctive characteristics of resected non-small cell lung cancer.
The Annals of Thoracic Surgery 12/1996; 62(5):1489-93. DOI:10.1016/0003-4975(96)00540-1 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Summary : Hospital Information Systems must adopt tools to give security. Our system propose a way to manage users and their authorisation to insure computer security and confidentiality. The health care professionals holder still improve this by user responsabilization. Cryptography and electronique signature or message authentification will allow us to develop data processing in health care system with Hospital Information Systems opening.