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Background: The influence of nutritional status on outcome after major lung resection remains controversial. Nutritional assessment is not included as a major recommendation in lung cancer guidelines. The purpose of this study was to assess the nutritional status of patients referred for pneumonectomy and to assess the predictive value of malnutrition in determining the surgical outcome., Methods: This study was a multicenter observational trial. The eligibility criterion for participants was pneumonectomy for lung cancer. Criteria for group classification according to nutritional status were albumin and transthyretin levels. Predicted outcomes were major infectious and noninfectious complications and 90-day mortality. Univariate analysis identified independent variables for the predictive model of age, sex, induction chemotherapy, extended resections, treatment side, smoking, and malnutrition. Predictive variables were then included in a logistic regression model., Results: Between January 2010 and December 2011, 86 (mean age, 61.5 years) consecutive patients referred for pneumonectomy (left side, n = 58; right side, n = 28) at 4 thoracic surgery centers were included. The malnutrition group included 33 patients (39%) and the normal nutritional status group included 53 patients. Univariate analysis elected malnutrition, recent active smoking, and extended resection to be included in a multivariate analysis. Multivariate analysis identified malnutrition, recent smoking, and extended resection as predictive variables for major complications and mortality., Conclusions: The frequency of malnutrition detected by biological markers was dramatically high. Malnutrition, as well as recent active smoking and extended resection, is a predictive factor for infectious complications and mortality after pneumonectomy. Nutritional assessment with appropriate markers should be considered before pneumonectomy., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Aortic stenosis is of concern in the elderly. Although aortic valve replacement provides good long-term survival with functional improvement, many elderly patients are still not referred for surgery because of their age. Percutaneous aortic valve implantation offers an alternative to open-heart surgery. Concerns about the management of aortic valve stenosis in the elderly will be reviewed., Methods: We retrospectively analyzed 1,193 consecutive aortic valve replacements, performed in octogenarians since January 2000. A total of 657 patients (55%) had at least one associated comorbidity (eg, respiratory failure) and 381 (32%) associated coronary lesions. Valve replacement was the only procedure in 883 patients (74%), and was associated with coronary revascularization in 262 cases, or with another cardiac procedure in 48 patients., Results: Overall operative mortality was 6.9% (83 of 1,193 patients); 5.5% for single replacement and 11.5% if associated with coronary artery bypass surgery. Univariate and multivariate analyses identified 11 operative risk factors related to general status, cardiologic condition, and the procedure itself: older age (p<0.015); respiratory failure (p<0.03); aortic regurgitation (p<0.001); emergency surgery (p<0.0029); New York Heart Association class IV (p<0.0007); right heart failure (p<0.03); atrial fibrillation (p<0.04); impaired ejection fraction (p<0.001); coronary disease (p<0.01); redo surgery (p<0.02); associated coronary revascularization (p<0.008)., Conclusions: Today, valve replacement has acceptable low hospital mortality, even in the elderly. Thus, older patients should not be denied surgery due to their advanced age alone. Conventional surgery remains the gold standard treatment for aortic stenosis; the decision should be made on an individual basis. If several risk factors suggest very high-risk surgery, then percutaneous valve implantation should be considered instead., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background and Aim of the Study: The increasing incidence of cardiovascular disease with age, coupled to a constant extension of life expectancy in industrialized countries, is leading to an ever-increasing number of elderly patients being referred for aortic valve replacement (AVR). In light of advances in surgical technology and cardiac protection, the operative mortality and risk factors have been updated in order to specify surgical indications., Methods: Between January 2000 and December 2004, a total of 442 patients (203 males, 239 females) aged > or =80 years (mean age 82.7 +/- 2.3 years) underwent AVR at the authors' institution. Surgery was either isolated (n = 344) or associated with coronary revascularization (n = 86), mitral valvuloplasty (n = 5) or aortic surgery (n = 7). Seventeen patients had undergone previous cardiac surgery. The EuroScore was calculated for each patient., Results: Overall operative mortality was 7.5% (n = 33). Independent predictive factors of mortality were: aortic insufficiency (30%, p <0.004), NYHA class IV (20.5%, p < 0.001), left and right heart failure (11.5% and 19.4%, p <0.02), chronic renal insufficiency (18.5%, p <0.04), emergency (37.5%, p <0.001, OR = 4.7), left ventricular ejection fraction (21.1%, p <0.004, OR = 0.9), and redo surgery (35.3%, p <0.001, OR = 6). Mortality was also increased in case of associated coronary revascularization (11.6%), mitral or tricuspid surgery (20%) and ascending aorta procedure (25%)., Conclusion: Patient functional improvement achieved after valve replacement at the cost of a rather low operative mortality justifies considering octogenarians for surgery. However, decisions should be taken on an individual basis. An earlier referral to surgery before the onset of altered cardiac function could lead to further reductions in hospital mortality.

A 45 year old man, 10 weeks after angioplasty and endoprosthesis insertion for myocardial infarction, developed tamponade in an infectious context. RNA 16S investigation, using the universal amplification method with ribotyping, detected Porphyromonas gingivalis (a strict anaerobic bacillus associated with peridontitis) in the pericardial fluid. This appears to be the first description of such a clinical scenario, and suggests 5 aetio-pathological mechanisms: fissure syndrome, malignant tamponade, post-infarction pericardial syndrome, endoprosthesis infection and infectious tamponade. We also describe the ribotyping method, which by amplifying DNA coding for RNA 16S allows identification of an increasing number of micro-organisms implicated in infectious pathology.

Background: The aim of the study was to evaluate the long-term results of aortic valve replacement with the Carpentier-Edwards supraannular porcine bioprosthesis., Methods: A total of 278 patients who underwent aortic valve replacement between January 1983 and December 1986 were reviewed. Mean age was 69.4+/-11.0 years (range 24 to 90 years)., Results: The operative mortality was 8.6% (24 patients). The total follow-up was 2367.1 years (mean 9.3+/-4.3 years, maximum 15.5). The late mortality rate was 6.8%/patient-year (162 patients) and the overall survival at 15 years was 26.5%+/-3.6%. Structural valve deterioration (SVD) occurred in 19 patients (linearized rate 0.8%/ patient-year). The mean time to onset of deterioration was 10.9+/-2.9 years. This time was independent of the age at the time of implantation. The freedom from SVD at 10, 12, and 15 years for patients aged less than 60 was respectively 87.6%+/-6.8%, 77.8%+/-8.9%, and 44.2%+/-12.9% (linearized rate 3.3%/patient-year). For patients aged 61 to 70 years, freedom from SVD was, respectively, 100%, 97.3%+/-2.1%, and 80.8%+/-8.3% (linearized rate 0.63% patient-year). For patients older than 70 years, it was respectively 99.1%+/-0.9%, 95.6%+/-2.6%, and 93.3%+/-3.3% (linearized rate 0.31%/patient-year). No significant difference was observed below the age of 60 years (< or =50 vs 51 to 60 years) or in the older subgroups (61 to 70 years, vs >70 years)., Conclusions: The Carpentier-Edwards supraannular bioprosthesis in aortic position provides low rate of structural valve deterioration at 15 years in patients aged more than 60 years at the time of implantation. The mean time to onset of SVD is independent of the subject's age at the time of implantation. After 60 years, the risk of deterioration is low and does not present any significant variation. The Carpentier-Edwards supraannular bioprosthesis can reliably be used for aortic valve replacement in patients over the age of 60 years because, beyond this age, SVD is observed much more rarely.

The Carbomedics valve prosthesis is a second generation mechanical prosthesis with a double hemi-disc. This study analysed long-term morbidity and mortality associated with this prosthesis. Between 1987 and 1996, 397 prostheses were implanted, 306 aortic, 42 mitral and 26 double replacements (3 combining a Carbomedics aortic prothesis with a mitral valve from another type) in 370 patients with a mean age of 62 (range 4 to 88 years). The global operative mortality was 7.4%. A questionnaire sent to treating cardiologists, general practitioners and patients updated the prospective data base of the cardiac surgical department. The follow-up was 99%, representing a total of 1244 patient-years with an average of 41 months (range 1.1 month to 9.9 years). The 1, 3, 5 and 7 year survival (operative mortality included) was 88%, 80%, 76% and 69.6% respectively. Haemorrhagic complications were the most common (17 cases, 1.36% per patient-year) and 11 thromboembolic episodes were observed (0.88% per patient-year) with a higher incidence (p < 10-4) in mitral valve replacement (3.8% in patient-year). The other complications observed were: 5 aseptic paravalvular leaks (0.4% per patient-year) and 5 prosthetic valve infections; no structural alterations were observed. In all, ten reoperations (0.8% per patient-year) were required for prosthetic valve complications. This study shows the reliability of Carbomedics valve prostheses with a low complication rate comparable to that of other modern mechanical valve prostheses.

A decreased production of interferon-gamma (IFN-gamma) and interleukin-2 (IL-2) upon in vitro stimulation by phytohemagglutinin (PHA) peripheral blood leucocyte in active rheumatoid arthritis (RA) patients has been described as an important immunological abnormality in this disease. However, the molecular level at which this defect might occur has not been fully documented. We have investigated the kinetics of IFN-gamma, interleukin-2 receptor (IL-2 R), and interleukin-1 beta (IL-1 beta) messenger RNA (mRNA) expression in RA patients (n = 9) and normal controls (n = 5) after PHA leucocyte activation. We demonstrate here a significantly decreased expression of IFN-gamma mRNA in RA patients without modification of its kinetics associated with a similar IL-1 beta mRNA expression.

This study concerns the immunoreactive somatomedin C secretion by prepubertal rabbit epiphyseal chondrocytes cultured in a defined serum-free medium. In such culture conditions, chondrocytes mainly synthesized Type II collagen (80% of total collagen) during 10 days. A small amount of Type I collagen was also found with a significant (p less than 0.05) higher level during the period of cell multiplication (6.4 +/- 1.5%) than when cells reached confluency (0.9 +/- 0.2%). During the 10 days of culture without serum and without hormone added, a Sm-C/IGF1 activity was measured by RIA at a mean level of 30 +/- 5 mU/ml/10 micrograms DNA. This value was significantly higher (p less than 0.001) than in the medium not incubated with the cells (1.7 +/- 0.9 mU/ml). When hGH was added to the culture medium during the period of cell division, the level of Sm-C/IGF1 activity was significantly elevated at 39 +/- 4 mU/ml/10 micrograms DNA (p less than 0.05) and at 55 +/- 3 mU/ml/10 micrograms DNA (p less than 0.001) with 50 ng/ml and 100 ng/ml hGH concentrations respectively. On the contrary, no difference was observed at confluency in treated and non treated cells.

Low serum complement is often observed in cirrhosis of the liver. This is the result of two mechanisms: a failure to synthesise a certain number of components and regulatory proteins of complement, and an increased consumption due to activation of the complement system. This acquired deficit in complement contributes to the increased risk of infection in patients with cirrhosis.