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Lung volume reduction surgery (LVRS) has been shown to be beneficial in patients with chronic obstructive pulmonary disease, but there is low uptake, partly due to perceived concerns of high operative mortality. We aimed to develop an individualised risk score following LVRS.This was a cohort study of patients undergoing LVRS. Factors independently predicting 90-day mortality and a risk prediction score were identified. Reliability of the score was tested using area under the receiver operating characteristic curve (AUROC).237 LVRS procedures were performed. The multivariate analysis factors associated independently with death were: body mass index (BMI)<18.5 kg·m -2 (OR 2.83, p=0.059), forced expiratory volume in 1 s (FEV 1 )<0.71 L (OR 5.47, p=0.011) and transfer factor of the lung for carbon monoxide ( T LCO ) <20% (OR 5.56, p=0.031). A risk score was calculated and total score assigned. AUROC for the risk score was 0.80 and a better predictor than individual components (p<0.01). The score was stratified into three risk groups. Of the total patients, 46% were classified as low risk. Similar improvements in lung function and health status were seen in all groups. The score was introduced and tested in a further 71 patients. AUROC for 90-day mortality in this cohort was 0.84.It is possible to provide an individualised predictive risk score for LVRS, which may aid decision making for both clinicians and patients., Competing Interests: Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com, (Copyright ©ERS 2017.)

The nursing profession prides itself on its ability to reflect on practice to improve patient care. Yet we have seen a number of high-profile cases in recent years where care has not been provided at the level you would expect.

Pulmonary carcinoid and pulmonary lymphoma are both rare cancers and are seldom seen together. Cases have been reported of their coexistence in the gastrointestinal tract, but our literature searches only found a single case of their coexistence in the lung. We discuss our case as well as the literature to try to find a connection and explanation for this occurrence., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

The eponymous Carney triad reported the association of gastric leiomyosarcoma, also known as a gastrointestinal stromal tumor, extra-adrenal paraganglioma and pulmonary chondromata. Subsequently, Carney and Stratakis distinguished the inherited gastrointestinal stromal tumor with paraganglioma syndrome from the classical Carney Triad as an autosomal dominant condition in adult patients. This combination of gastrointestinal stromal tumor and cardiac paragangliomata in a child is almost unique., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Endobronchial valves are increasingly used as a treatment modality as a less invasive alternative to lung volume reduction surgery in patients with severe emphysema. Endobronchial valves have also been used to treat patients with persistent pulmonary air leaks and those with bronchopleural fistulae. We report a case of a 61-year-old male with severe bullous emphysema. Following video-assisted thoracoscopic surgery and giant bullectomy, he had a persistent air leak. We inserted two endobronchial valves (in the lingular lobe and the anterior segment of the upper lobe) and the air leak ceased immediately. However, over the subsequent 5 months following the insertion of the endobronchial valves, the patient suffered recurrent chest infections and the endobronchial valves were found to have migrated to the orifice of the basal segment of the left lower lobe and the orifice of the basal segments of the right lower lobe., (Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

Background: Although an atrial myxoma is the commonest cardiac tumor, it is still relatively rare, with an annual incidence of approximately 0.5 per million. In our unit, which performs 1000 major cardiac procedures per year, this equates to approximately 3 patients annually. We therefore sought to evaluate our experience of managing this type of tumor over the last 5 years., Methods: A retrospective review was performed of prospectively collected data from the departmental database. We analyzed consecutive patients who were operated upon between 2002 and 2007. Three patients with a papillary fibroelastoma on histological examination were excluded from this study., Results: We have performed excision of atrial myxoma in 18 patients. Twelve patients (66%) were female; the median age was 64 years (range, 35-80 years), and the median logistic euroSCORE was 5.22% (range, 1.51-27.82%). Fifteen patients (83%) were deemed urgent, 2 elective, and 1 emergency. Sixteen tumors (89%) were left sided. Symptoms attributable to the tumor were found in 16 of the 18 patients (embolic, n = 9; chest pain, n = 3; palpitations, n = 2; incidental finding, n = 2, others n = 4), and the mean time from diagnosis to operation was 3 days (range, 0-22 months). The median cardiopulmonary bypass time was 87 minutes (range, 28-228 minutes), with the median aortic cross clamp time being 61 minutes (16-175 minutes).The approaches used were transeptal via right atriotomy (n = 8), biatrial/Dubost (n = 4), left atrial (n = 4), and right atrial (n = 2); the interatrial septum was involved in 14 patients. The resultant defect was closed using a pericardial (n = 8) or prosthetic patch (n = 5) or directly sutured (n = 5). Concomitant procedures were performed in 8 patients (coronary artery bypass graft [CABG], n = 4; mitral valve replacement [MVR], n = 2; valve + grafts, n = 2). All tumors were completely excised.Postoperatively there were no deaths within 30 days of the procedure. Indeed, only 2 patients have died at 4 and 25 months postoperatively, respectively, both of unrelated causes. Median intensive therapy unit (ITU) stay was 2 days (range, 1-9 days), and median hospital stay was 10 days (range, 5-20 days). A permanent pacemaker was required in only 1 patient, and median blood loss was 340 mL (range, 140-1760 mL). Atrial fibrillation was the commonest complication affecting 6/18 patients (33%)., Conclusions: Excision of atrial myxoma can be performed using a variety of intraoperative approaches and closure techniques, all with acceptable postoperative morbidity and low mortality rates. To date, no recurrences have been found at median 2-year follow-up.

Penetrating aortic ulcers are frequently observed in the descending thoracic and abdominal aorta. They are uncommon in the aortic arch, and they are extremely rare in the major branches of the aorta. We present the case of a 71-year-old woman who presented with multiple penetrating aortic ulcers affecting both the aortic arch and the brachiocephalic artery, and its successful treatment., (2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Around this time last year, there were said to be about 40,000 managers in the NHS, and questions were asked in the media about what they all did. More recently, managers at several NHS trusts have been blamed for losing patient records.

One of the earliest indications for Gamma Knife treatment, radiosurgery for cerebral arteriovenous malformations, has stood the test of time. While initially only the ideal cases (small, compact nidus in a non-eloquent site) were chosen, increasingly larger, more complex AVMs were treated. Combination treatment with embolisation and surgery enables most lesions to be treated with success and remarkably low complication rate. This paper is a brief overview of the experience gained in Sheffield.

Background and Aim of the Study: In 1998, the American College of Cardiology and The American Heart Association (ACC/AHA) published guidelines for the postoperative anticoagulation of patients who have undergone heart valve replacement. The American College of Chest Physicians made similar recommendations in 2001. The present survey was conducted to review anticoagulation practice among UK consultant cardiac surgeons, and to assess compliance with these guidelines., Methods: An anonymous postal questionnaire was distributed to 185 adult cardiac surgeons identified from the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS)., Results: The analysis was based upon 97 replies. All consultants use lifelong warfarin after mechanical valve replacement. In general, target INR ranges were lower for aortic valves compared with mitral valves. Some 53% (51/97) of consultants never use warfarin after bioprosthetic aortic valve replacement (AVR), compared with 33% (28/86) after bioprosthetic mitral valve replacement (MVR). Temporary (< or = 3 months) warfarin is used by 47% (46/97) of consultants after bioprosthetic AVR and by 63% (54/86) after bioprosthetic MVR. Some 64% (52/81) of consultants use warfarin after mitral valve repair, when an annuloplasty ring is inserted. This was always temporary (< or = 6 months). Aspirin is used long term by 54% (44/82) of consultants after mitral valve repair., Conclusion: All consultant cardiac surgeons adequately anticoagulate their patients after mechanical valve replacement. Only 16% (16/97) of cardiac surgeons follow current guidelines for the postoperative anticoagulation of bioprosthetic AVR. Only 28% (24/86) of consultant cardiac surgeons comply with guidelines for bioprosthetic MVR. No guidelines exist for the anticoagulation of patients after mitral valve repair. Guidelines need to be reviewed for the anticoagulation of patients undergoing bioprosthetic valve replacement and formulated for patients undergoing mitral valve repair.