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Journal of Surgery and Science

ISSN 2333-4703 (Print)

ISSN 2333-4711 (Online)

Website: http://www.researchpub.org/journal/jss/jss.html

Volume 02, Number 01  (December 2014)
Prone Position Improved Pneumonia in a Patient with Total Artificial Heart
Author(s) Sami S. Tannouri, Harrison T. Pitcher, Jaime Byrne RN, Joseph Miessau, Nicholas C. Cavarocchi and Hitoshi Hirose
Abstract

Introduction: In the setting of acute lung injury or acute respiratory distress syndrome (ARDS), prone positioning has shown survival and outcome benefits. Our aim is to demonstrate the technical feasibility and benefit of this therapy in a patient with a total artificial heart (TAH). Case Report: A 29-year-old man was admitted to hospital with symptoms of NYHA class 4 heart failure. His hemodynamics acutely deteriorated despite inotropic support and echocardiography showed bilateral ventricular dysfunction. Subsequently, he was placed on venoarterial extracorporeal membrane oxygenation bridged to a total artificial heart (TAH). The patient had remained intubated, ventilator dependent, and was found to have bilateral multifocal pneumonias. Despite broad-spectrum antibiotic therapy and intermittent bronchoscopy for bronchial toileting, his pneumonia did not improve; thus, he was placed in prone position using the Rotoprone Therapy System (KCI, San Antonio, TX). There were no technical complications in regards to the patient's driveline or sternal incision. Hemodynamically, the patient had variations in flow and chamber filling at the extremes of rotation (left side or right side down), likely from the TAH compressing mediastinal structures. His pneumonia was improved after this therapy. Conclusion: Prone positioning is feasible and manageable in the patient with a total artificial heart.

The role of HER-2 in Breast Cancer
Author(s) Takashi Ishikawa, Yasushi Ichikawa, Daisuke Shimizu, Takeshi Sasaki, Mikiko Tanabe, Takashi Chishima, Kazuaki Takabe and Itaru Endo
Abstract

The Pathological Response to Anthracycline is Associated with Topoisomerase IIα Gene Amplification in the HER2 Breast Cancer Subset
Author(s) Takashi Ishikawa, Takeshi Sasaki, Mikiko Tanabe, Kazutaka Narui, Kumiko Kida, Kazuhiro Shimada, Daisuke Shimizu, Akimitsu Yamada, Satoshi Morita, Mari S. Oba, Kae Kawachi, Akinori Nozawa, Yasushi Ichikawa, Kazuaki Takabe, and Itaru Endo
Abstract

Background: HER2-positive breast cancer sensitivity to anthracyclines is enhanced when topoisomerase IIa (TOP2A) is co-amplified under both adjuvant and metastatic settings. However, the relationship between anthracycline sensitivity and TOP2A amplification in HER2-positive breast cancers in neoadjuvant settings is not known. Methods: The TOP2A gene status was examined by FISH in biopsies from 18 patients who received anthracycline and cyclophosphamide before surgery. Results: The TOP2A gene was amplified in 6/17 patients and was significantly associated with pathological response to the chemotherapy regimen. Conclusions: TOP2A amplification could predict anthracycline-sensitivity. Thus, the HER2/TOP2A co-amplified subtype may be effectively treated by anthracycline-containing regimens alone.

Procalcitonin Guided Antibiotic Management in Postoperative Cardiac Surgery Patients
Author(s) Daizo Tanaka, Shinya Unai, Harrison T. Pitcher, Nicholas Cavarocchi, James T. Diehl and Hitoshi Hirose
Abstract

Procalcitonin (PCT) is a biomarker for infection and its value can be obtained on the day of sampling. Prompt diagnosis of infection from other cause of physiological inflammatory responses and initiation of treatment is crucial in post cardiac surgery patients. Thus, an algorithm for PCT guided antibiotic management was developed. PCT evaluations and antibiotic usages were retrospectively studied among the patients who underwent cardiac surgery in 2012. PCT was sent when patients were clinically suspected of systemic infection. Antibiotic therapy was considered when PCT was more than 2 ng/ml. 31 patients with 33 episodes of suspected infection were evaluated by PCT. Among them, 16 patients (48%) had infections confirmed by cultures. PCT levels of patients with and without proven infection were 16.4 ± 26.5 ng/mL and 4.1±10.2 ng/mL, respectively. PCT was able to predict infection with sensitivity of 81% and specificity of 82%. All patient with PCT ≥ 2 ng/ml in the true positive group were treated with antibiotics; 86% of true negative group (PCT < 2 ng/ml) avoided unnecessary antibiotic therapy. PCT guided antibiotics management can be useful for prompt initiation of antibiotics and avoidance of unnecessary treatment. This PCT guided algorithm potentially reduces hospital cost and length of stay.

Outcomes of Hybrid Video Assisted Thoracoscopic Surgery for Pulmonary Metastasectomy
Author(s) Ali Raza, Kazuaki Takabe, Luke G. Wolfe, C. Gregory Lockhart and Roger H. Kim
Abstract

BACKGROUND: Pulmonary metastasectomy is an acceptable treatment option in various metastatic lesions. The role of minimally invasive surgery for metastasectomy remains controversial. We report on a recently described hybrid video-assisted thoracoscopic surgery (hVATS) technique in the community hospital setting. METHODS: Using a retrospective study design, data on 61 patients undergoing 67 resections between April 2000 and January 2008 was collected at a single institution. Patient demographics, pathology, and clinical outcome data were recorded. Kaplan Meier estimates and multivariate Cox regression were used to assess survival and prognostic factors, respectively. RESULTS: Mean patient age was 61.7 years. The majority of lesions were solitary, unilateral, and genitourinary or gastrointestinal in origin (69%). R0 resection was achieved in 97% of cases with the most common operation being lobectomy. Mean length of stay was 4.4 days. Mean follow-up was 39.7 months and 5- year overall survival was 63.2% for the cohort; median survival was not reached. The number of lesions (univariate only) and tumor size over 4 cm influenced overall survival. CONCLUSIONS: Hybrid VATS is a safe and feasible technique in the community medical center setting and warrants additional investigation as an alternative strategy in the management of pulmonary metastases.