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A differential ventilation-perfusion scan demonstrated that the left lung only received 19% of total perfusion. (b) Solid white tumour is evident occluding the left pulmonary artery at the hilium of the lung. gl Macroscopic evaluation of the resected specimen demonstrated a tumour spanning 80 mm which invaded adjacent lung parenchyma and hilar lymph nodes (Fig. [Extracted from the article]

Abstract: Background: Indigenous Australians have higher rates of cardiovascular disease and comorbidities compared to their non‐indigenous counterparts. Aims: We sought to evaluate whether indigenous status per se portends a worse prognosis following isolated coronary artery bypass grafting (CABG). Methods: The outcomes of 778 Indigenous Australians (55 ± 10 years; 32% female) enrolled in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry were compared to 36 124 non‐Indigenous Australians (66 ± 10 years; 21% female) following isolated CABG. In a secondary analysis, patients were propensity‐matched by age, sex, renal function, diabetes and ejection fraction (778 individuals in each group). Results: Indigenous Australians were younger and more likely to be female and current smokers and to have diabetes, hypertension, renal impairment, heart failure and previous CABG (all P < 0.04). Indigenous patients had fewer bypasses with arterial conduits (including less internal mammary artery use) and a higher number of distal vein anastomoses (P < 0.001). Postoperative bleeding rates were higher in indigenous patients (P = 0.001). However, in‐hospital and 30‐day all‐cause mortality and rates of 30‐day readmission were similar between both groups, although cardiac mortality was higher in the indigenous cohort (1.5% vs 0.8%, P = 0.02). With propensity‐matching, rates of postoperative complications were similar among the two groups, with the exception of bleeding, which remained higher in Indigenous Australians (P = 0.03). Conclusions: Despite procedural differences and higher rates of baseline comorbidities, Indigenous Australians do not have worse short‐term outcomes following isolated CABG. Given the higher rates of baseline comorbidities and lower rates of arterial conduit use, it will be essential to determine long‐term outcomes. [ABSTRACT FROM AUTHOR]

Aims BRCA1 has a role in maintaining normal nuclear DNA content during cell division and its inactivation may result in DNA aneuploidy and cancer progression. BRCA 1-linked breast cancers are more aneuploid and have a worse prognosis, but this has not been elucidated in ovarian cancers. This study explores the potential difference in ploidy status between BRCA 1-mutated and sporadic ovarian carcinomas. It also explores the potential association between BRCA 1 mutation site and DNA ploidy status. Methods This study compared DNA ploidy status of tumor blocks from 23 BRCA 1-mutated ovarian carcinomas with that of 23 sporadic ovarian carcinomas matched for histologic subtype, patient age, stage and grade. DNA content of the nuclei was measured by Feulgen- Schiff staining followed by image cytometry and compared. Results BRCA 1-linked tumors with a stop codon closer to the N-terminal (between 1 and 500 aa; 6/6, 100%) had a significantly higher frequency of nondiploidy compared with those with stop codon above 500 aa (7/12, 58%) ( P = 0.033). A diploid peak was detected in 28% of BRCA 1-mutated ovarian cancers and in 33% of sporadic ovarian cancers. Conclusions The present study concluded that ovarian tumors with mutations closer to the N-terminal of BRCA 1 may have a higher risk of DNA aneuploidy. There is no significant difference between BRCA 1-mutated and sporadic ovarian carcinomas with respect to the DNA content. [ABSTRACT FROM AUTHOR]

Background & Aims Liver transplantation is the only curative intervention for terminal liver disease. Accurate long-term quality of life (QOL) data are required in the context of improved surgical outcomes and increasing post-transplant survival. This study reviews the long-term QOL after primary liver transplantation in adult patients surviving 5 or more years after surgery. Methods A literature search was conducted on PubMed for all studies matching the eligibility criteria between January 2000 and October 2013. Bibliographies of included studies were also reviewed. Two authors independently performed screening of titles and abstracts. Consensus for studies included for review was achieved by discussion between authors based on predetermined eligibility criteria. Quality appraisal and data tabulation were performed using predetermined forms. Results were synthesized by narrative review. Results Twenty-three studies (5402 patients) were included. QOL following liver transplantation remains superior to preoperative status up to 20 years post-operatively. More post-operative complications predicted worse QOL scores especially in physical domains. Benefits in functional domains persist long-term with independence in self-care and mobility. Employment rates recover in the short-term but decline after 5 years, and differ significantly between various aetiologies of liver disease. Overall QOL improves to a similar level as the general population, but physical function remains worse. Participation in post-operative physical activity is associated with superior QOL outcomes in liver transplant recipients compared to the general population. QOL improvements are similar compared to lung, kidney and heart transplantation. Heterogeneity between studies precluded quantitative analysis. Conclusions Liver transplantation confers specific long-term QOL and functional benefits when compared to preoperative status. This information can assist in providing a more complete estimate of the overall health of liver transplant recipients and the effectiveness of surgery. Guidelines for future studies are provided. [ABSTRACT FROM AUTHOR]

Background We assessed the accuracy of three different methods measuring the angle between two fixed Kirschner wires for the potential purpose of determining correction during rotational osteotomy of long bones. Methods Thirty-one orthopaedic consultants and registrars were prospectively asked to measure the angle between two fixed Kirschner wires in four saw bones models using three different techniques: visual estimation ( VE), osteotomy templates ( OT), and a contemporary smartphone (i Phone4; SP) with its gyroscopic function. These three methods were compared with the value obtained by computed tomography ( CTV), which we considered the preferred value. Results For the pooled data for all four bone models, the mean difference of the VE compared with the CTV was 5.4° ± 5.3°; the mean difference of the OT compared with the CTV was 2.9 ± 3.8°; and the mean difference of the SP compared with the CTV was 0.8 ± 0.9°. Using the pooled data, the difference between using each of these methods was highly significant, as demonstrated by the one-way analysis of variance across groups ( P ≤ 0.001). In addition, for the pooled data the independent t-test between each pair of the three methods ( VE and OT, VE and SP, and OT and SP) also demonstrated these differences were highly significant ( P ≤ 0.001) for all three comparisons. In this study, the number of years of orthopaedic experience did not significantly influence the ability of individual test subjects. Conclusion Measurement of a rotational deformity using a SP app was significantly more accurate and consistent than both VE and OT. We believe the currently available SP technology provides orthopaedic surgeons with a significantly better alternative method of determining the magnitude of rotational deformity when performing corrective osteotomies. [ABSTRACT FROM AUTHOR]

Purpose To compare the outcomes (survival and adverse events) of the authors' use of 90 Y microsphere radioembolisation in patients with chemotherapy-refractory liver metastases with published data from other groups using radioembolisation. To retrospectively evaluate the efficiency, in particular survival benefits, of radioembolisation in the treatment of liver metastases. Methods and Materials Over 5 years, 339 patients underwent 90 Y microsphere radioembolisation for unresectable liver metastases and were evaluated for adverse events at the time of treatment and 1 and 3 months after treatment. Overall survival ( OS) was calculated by the Kaplan- Meier method. The results from the present retrospective study were compared with a number of prospective and retrospective clinical trials which have addressed the use of 90 Y microspheres as a salvage treatment for liver metastases. Results The OS time of the present study (12.0 months) compares favourably with survival times reported by other groups. The incidence of late grade 2 adverse events (e.g. duodenal or gastric ulceration, radiation-induced liver disease, gall bladder complications) is comparable to previous studies, with a lower prevalence of grade 2/3 ulcerations (3.7%) at our centre. Conclusions The survival results, together with the low acute and late toxicity observed in our data and previous studies, support the use of radioembolisation to aid in the local control of unresectable liver metastases in the salvage setting. The present study contributes to the growing evidence for efficiency, in particular survival gains, of radioembolisation in the treatment of liver metastases. [ABSTRACT FROM AUTHOR]

The article presents a study on the prognostic factors for long-term survival after treatment with a focus on the use of systemic chemotherapy and radiofrequency ablation (RFA). The study involves evaluating 100 patients with unresectable colorectal pulmonary metastases who underwent percutaneous RFA, using univariate and multivariate analyses. Furthermore, RFA for colorectal pulmonary metastases is shown as a nonsurgical option of combining systemic and local treatment for metastatic disease.

Resection of hepatocellular carcinoma (HCC) offers the only hope for cure. However, in patients undergoing resection, recurrences, in particular, intrahepatic recurrence are common. The effectiveness of transarterial chemoembolization (TACE) as a neoadjuvant therapy for unresectable HCC was exploited by numerous liver units and employed preoperatively in the setting of resectable HCC with an aim to prevent recurrence and prolong survival. A systematic literature search of databases (Medline and PubMed) to identify published studies of TACE administered preoperatively as a neoadjuvant treatment for resectable HCC was undertaken. A systematic review by tabulation of the results was performed with disease-free survival (DFS) as the primary endpoint. Overall survival (OS), rate of pathological response, impact on surgical morbidity and mortality and pattern of recurrences were secondary endpoints of this review. Eighteen studies; three randomized trials and 15 observational studies were evaluated. This comprised of 3927 patients, of which, 1293 underwent neoadjuvant TACE. The median DFS in the TACE and non-TACE group ranged from 10 to 46 and 8 to 52 months, respectively, with 67% of studies reporting similar DFS between groups despite higher extent of tumour necrosis from the resected specimens indicating a higher rate of pathological response (partial TACE 27–72% vs. non-TACE 23–52%; complete TACE 0–28% vs. non-TACE zero), with no difference in surgical morbidity and mortality outcome. No conclusion could be drawn with respect to OS. Both randomized and non-randomized trials suggest the use of TACE preoperatively as a neoadjuvant treatment in resectable HCC is a safe and efficacious procedure with high rates of pathological responses. However, it does not appear to improve DFS. [ABSTRACT FROM AUTHOR]

Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with colorectal peritoneal carcinomatosis (CRPC). This treatment modality is associated with relatively high rates of perioperative morbidity and mortality. This study evaluated the clinical and treatment-related risk factors for perioperative morbidity and mortality in patients with CRPC who underwent CRS and PIC. Sixty-three consecutive patients who underwent CRS and PIC for CRPC were evaluated. Adverse events were rated from grades I to V with increasing severity. Clinical and treatment-related risk factors for grades III and IV/V morbidity were determined. There were no perioperative deaths (0%). The grades III and IV morbidity rates were 14 and 17%, respectively. A peritoneal cancer index >12 ( p = 0.019), transfusion >4 units ( p = 0.028), number of peritonectomy procedures >3 ( p = 0.013), left upper quadrant peritonectomy procedure ( p < 0.001), and number of primary colonic anastomosis >1 ( p = 0.004) were associated with grade IV morbidity on univariate analysis. Only left upper quadrant procedure was associated with grade IV morbidity on multivariate analysis ( p = 0.002). Only number of primary colonic anastomosis >1 ( p = 0.037) was associated with grade III morbidity on univariate analysis. This also was associated with grade III morbidity on multivariate analysis ( p = 0.028). CRS and PIC has an acceptable risk of perioperative morbidity in carefully selected patients with CRPC. Patients who require extensive surgery have the highest risk for a severe adverse event. Preoperative evaluation of patients is essential to improve perioperative outcome. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with early and late outcomes after concomitant aortic valve replacement and coronary artery bypass graft surgery in octogenarians.

The article discusses the need for Australian medical schools to provide anatomy teaching in an undergraduate level for surgical training. It notes that the practice of basic surgical skills in a dissecting laboratory can be provided in anatomy education by dissection. It mentions that comprehension of pathophysiology underlying surgical conditions can be improved by a sound anatomical knowledge.

Background: Frailty is associated with poorer outcomes in cardiac surgery, but the heterogeneity in frailty assessment tools makes it difficult to ascertain its true impact in cardiac surgery. Slow gait speed is a simple, validated, and reliable marker of frailty. We performed a systematic review and meta-analysis to examine the effect of slow gait speed on postoperative cardiac surgical patients., Methods: PubMED, MEDLINE, and EMBASE databases were searched from January 2000 to August 2021 for studies comparing slow gait speed and "normal" gait speed. Primary outcome was in-hospital mortality. Secondary outcomes were composite mortality and major morbidity, AKI, stroke, deep sternal wound infection, prolonged ventilation, discharge to a healthcare facility, and ICU length of stay., Results: There were seven eligible studies with 36,697 patients. Slow gait speed was associated with increased likelihood of in-hospital mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]: 1.87-2.87). Additionally, they were more likely to suffer from composite mortality and major morbidity (RR: 1.52; 95% CI: 1.38-1.66), AKI (RR: 2.81; 95% CI: 1.44-5.49), deep sternal wound infection (RR: 1.77; 95% CI: 1.59-1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48-2.63), reoperation (RR: 1.38; 95% CI: 1.05-1.82), institutional discharge (RR: 2.08; 95% CI: 1.61-2.69), and longer ICU length of stay (MD: 21.69; 95% CI: 17.32-26.05)., Conclusion: Slow gait speed is associated with poorer outcomes in cardiac surgery. Frail patients are twofold more likely to die during hospital admission than nonfrail counterparts and are at an increased risk of developing various perioperative complications., (© 2021 Wiley Periodicals LLC.)