Level Of Inferior Pulmonary Vein Research Articles

Anatomical insights into posterior wall isolation in patients with atrial fibrillation: A hypothesis to protect the esophagus.

Left atrial posterior wall (LAPW) isolation may be performed as an additional atrial fibrillation (AF) ablation strategy based on pulmonary vein isolation. A modified posterior-inferior line (MPL) was proposed for reducing esophageal injury. The aim of this study was to evaluate the anatomical characteristics of the MPL, compared with the conventional posterior line (CPL). Multidetector computed tomography was performed in 102 consecutive AF patients (male/female = 60/42) preoperative, and the parameters were evaluated as follows: the distance from MPL and CPL to the esophagus, fat pad presence and thickness in the course of MPL and CPL, and the esophageal route below CPL. The average distance from the MPL to the esophagus was longer than from CPL to the esophagus (3.7 ± 1.5 vs. 1.7 ± 0.4 mm, p < .001). Proportion of fat pad was higher in the course of MPL than CPL. The myocardium tissue and fat pad under MPL was thicker than under CPL (2.9 ± 1.1 vs. 1.6 ± 0.3 mm, p < .001; 1.4 ± 0.6 vs. 0.9 ± 0.2 mm, p < .001), respectively. In patients whose esophagus was unconfined in a triangular space at the left inferior pulmonary vein level, the average distance from MPL to esophagus was longer than the confined patients (4.0 ± 1.7 vs. 3.2 ± 1.0 mm, p = .001). The MPL was far away from the esophagus with thicker myocardium tissue and more fat pad than the CPL; thus, MPL could serve as a favorable alternative in linear ablation for LAPW isolation.

Predictive value of chest CT scoring in COVID-19 patients in Wuhan, China: A retrospective cohort study

BackgroundComputed tomography (CT) findings of COVID-19 patients were demonstrated by cases series and descriptive studies, but quantitative analysis performed by clinical doctors and studies on its predictive value were rarely seen. The aim of the study is to analyze CT score in COVID-19 patients and explore its predictive value. Materials and methodsWe conducted a retrospective cohort study among confirmed COVID -19 patients with available CT images between February 8, 2020 and March 7, 2020. The lung was divided into six zones by the level of tracheal carina and the level of inferior pulmonary vein bilaterally on CT. Ground-glass opacity (GGO), consolidation, crazy-paving pattern and overall lung involvement were rated by Likert scale of 0–4 or binary as 0 or 1. Global severity score for each targeted pattern was calculated as total score of six zones. ResultsThere were 53 patients and 137 CT scans included in the study. There were 18(34%) of the patients classified as moderate cases while 35(66%) patients were severe/critical cases. Severe/critical patients had higher CT scores in several types of abnormalities than moderate patients from the second week to the fourth week post symptom onset. Overall lung involvement score in the second week demonstrated predictive value for severity with a sensitivity of 81.0% and specificity of 69.2%. ConclusionsOur modified semi-quantitative CT scoring system for COVID-19 patients demonstrated feasibility. Overall lung involvement score on the second week had predictive value for clinical severity and could be indicator for further treatment.

Mapping patterns of metastatic lymph nodes for postoperative radiotherapy in thoracic esophageal squamous cell carcinoma: a recommendation for clinical target volume definition

BackgroundThe clinical target volume (CTV) for postoperative radiotherapy for thoracic esophageal squamous cell carcinoma (TESCC) needs to be defined. The study aim was to map metastatic lymph nodes (LNMs) in a computed tomography (CT)-based atlas and delineate the postoperative radiotherapy target area.MethodsSixty-nine TESCC patients with first recurrent regional LNMs after esophagectomy were included. The LNM epicenters were registered onto corresponding anatomic axial CT images of a standard patient in the treatment position, with reference to the surrounding vascular and bony structures. The LNM sites were based on lymph node map of esophageal cancer, AJCC 8th. The lymph metastasis risk for different segments of thoracic esophagus was assessed.ResultsOne hundred and seventy-nine LNMs were mapped onto standard axial CT images. The upper-middle mediastinum region (station 1 to 8 M) contained 97% of metastases in the upper segment of thoracic esophagus, 90% in the middle segment, and 66% in the lower one. Advanced pathological stage (≥IIIB) might be a predictive factor for upper abdominal region (UAR) relapse in lower TESCC. Lower cervical para-tracheal LNMs were within a 4.3-cm bilaterally expanded area from the midline of the body and a 2.2-cm expanded area from the anterior of vertebral body, from the superior border of the C7, to the inferior border of the first thoracic vertebra.ConclusionA modified target from the upper border of C7 to the lower border of caudal margin of the inferior pulmonary vein level could cover the high-risk area of TESCC underwent postoperative radiotherapy. UAR seems to be an elective irradiation target for lower TESCC at pathological IIIB stage and higher.

Correlation of quantitative and qualitative parameters of high-resolution computed tomography with pulmonary function test for diagnosing and assessing the severity of obstructive pulmonary disease.

PurposeThe aim of the study was to evaluate the role of high-resolution computed tomography (HRCT) in the prediction of presence and severity of chronic obstructive pulmonary disease (COPD), based on the pulmonary function test (PFT), to correlate the various quantitative and qualitative indices of COPD in HRCT with PFT values, and to derive at the threshold values for various quantitative HRCT indices of COPD.Material and methodsA one-year retrospective and prospective evaluation of the HRCTs of 90 cases and 38 controls was performed. Quantitative and qualitative parameters of COPD were assessed in HRCT and were correlated with PFT.ResultsAmong the qualitative parameters, significant correlation with spirometry was found with the qualitative scoring for emphysema and presence and inhomogeneous attenuation. Among the quantitative indices, anterior junction line length, thoracic cage ratio at both aortic arch and inferior pulmonary vein level, thoracic cross-sectional area/[height]² at the aortic arch were found to have good correlation with spirometry. There was significant strong correlation of anterior junction line length and tracheal index with residual volume/total lung capacity (RV/TLC). The threshold values of chest X-ray and HRCT quantitative parameters were calculated and were found to be lower than those of the western population.ConclusionHRCT has a definite role in the diagnosis of COPD and can be used to predict the severity of emphysema.

Su1805 Survival Following Neoadjuvant Chemotherapy in Esophagogastric Cancer: Evolving Improvements and Survival

BACKGROUND: Gastric decompression(GD) with nasogastric(NG) tube is considered to be necessary after esophagectomy and esophagogastrostomy because it can prevent the dilation of intra-thoracic stomach(ITS) and the postoperational Gastroesophageal reflux(GER). Thus it might be useful to prevent the anastomostic leakage. But the use of NG tube will bring about numerous complications and worsen the gross experience of patients. If we can limite the dilation of intra-thoracic stomach and alleviate GER with tubular gastroplasty and ITS emdedding with a medical sealant glue, is gastric decompression with NG tubes still Necessary?. METHODS: 150 patients with esophageal cancer were randomly divided into groups with gastric decompression (GD group) and without gastric decompression (NGD group) after surgery. According to the incision chosen, patients in each group were subdivided into Sweet group and Ivor Lewis group. In the operation, all patients received tubular gastroplasty, and a medical sealant glue was used to fix the stomach into mediastinum. The variables recorded for each patient included the gross feeling(with a 1-10 score system), the minimun diameter of ITS on the level of inferior pulmonary vein(with CT), the severity of GER(with Reflux Symptom Questionnaire), the need for placing/replacing the NG tube, the need for gastrointestinal prokinetic drugs, as well as the duration of postoperative hospitalization, pulmonary complications, anastomosis leak. RESULTS: After stratified analysis of operation mode, we found the gross feeling of patients is significantly worse in GD group(p<0.05). No difference was found in severity of GER, dilation of ITS, occurrence of complications, as well as the need for gastrointestinal prokinetic drugs and placing/replacing the NG tube between two groups. CONCLUSIONS: With the use of tubular gastroplasty and ITS emdedding, Gastric decompression with nasogastric(NG) tube is not necessary to be considered as a routine treatment after esophagectomy and esophagogastrostomy.

Su1803 Is Gastric Decompression Necessary After Esophagectomy and Esophagogastrostomy

BACKGROUND: Gastric decompression(GD) with nasogastric(NG) tube is considered to be necessary after esophagectomy and esophagogastrostomy because it can prevent the dilation of intra-thoracic stomach(ITS) and the postoperational Gastroesophageal reflux(GER). Thus it might be useful to prevent the anastomostic leakage. But the use of NG tube will bring about numerous complications and worsen the gross experience of patients. If we can limite the dilation of intra-thoracic stomach and alleviate GER with tubular gastroplasty and ITS emdedding with a medical sealant glue, is gastric decompression with NG tubes still Necessary?. METHODS: 150 patients with esophageal cancer were randomly divided into groups with gastric decompression (GD group) and without gastric decompression (NGD group) after surgery. According to the incision chosen, patients in each group were subdivided into Sweet group and Ivor Lewis group. In the operation, all patients received tubular gastroplasty, and a medical sealant glue was used to fix the stomach into mediastinum. The variables recorded for each patient included the gross feeling(with a 1-10 score system), the minimun diameter of ITS on the level of inferior pulmonary vein(with CT), the severity of GER(with Reflux Symptom Questionnaire), the need for placing/replacing the NG tube, the need for gastrointestinal prokinetic drugs, as well as the duration of postoperative hospitalization, pulmonary complications, anastomosis leak. RESULTS: After stratified analysis of operation mode, we found the gross feeling of patients is significantly worse in GD group(p<0.05). No difference was found in severity of GER, dilation of ITS, occurrence of complications, as well as the need for gastrointestinal prokinetic drugs and placing/replacing the NG tube between two groups. CONCLUSIONS: With the use of tubular gastroplasty and ITS emdedding, Gastric decompression with nasogastric(NG) tube is not necessary to be considered as a routine treatment after esophagectomy and esophagogastrostomy.

Evaluation of Airway Wall Thickness Via High-Resolution Computed Tomography in Mild Intermittent Asthma

This study aims to evaluate bronchial thickness via thorax high-resolution computed tomography (HRCT) in subjects with mild intermittent asthma in comparison with healthy control subjects. A total of 37 out-patients (mean ± SD age = 36.7 years (9.7 years); 54.8% males) with mild intermittent asthma and 13 healthy control subjects (mean ± SD age = 25.0 years (2.9 years); 61.5% males) were included in this case control study. Data on demographics, pulmonary function test results, and segmental and subsegmental thorax HRCT results were recorded. The ratio of bronchial wall thickness to bronchial lumen diameter (T/D) and bronchial wall area percentage (WA%) were calculated for all cases. Subject and control groups were similar in terms of pulmonary function test results, and total and subsegmental T/D values. Mean ± SD subsegmental WA% values at the level of inferior pulmonary vein (55.6% [16.8%] vs. 41.7% [7.4%], P = .047) and 2 cm above the diaphragm (49.8% [15.8%] vs. 38.6% [10.4%], P = .046) were significantly higher in subjects than control subjects. No significant correlation of overall and subsegmental T/D and WA% values to age in both groups, and to asthma duration in subjects. Our findings revealed an increase in bronchial wall thickness in peripheral airways in subjects with mild intermittent asthma regardless of the duration of asthma. This may indicate a need to also administer anti-inflammatory or bronchodilator therapy, which is effective in peripheral airways during the early period of the disease.

Surgical therapy for adenocarcinoma of the cardia: modalities of recurrence and extension of resection.

In order to define the optimal extent of resection for cancer of the cardia, we considered 116 patients operated upon with five different surgical techniques. The procedures were: transabdominal total gastrectomy associated with distal esophagectomy in 38 patients; transabdominal total gastrectomy and left thoracotomic esophageal resection at the inferior pulmonary vein level in 26 patients; transabdominal total gastrectomy and right thoracotomic esophageal resection at the azygos vein level in 27 patients; transabdominal total gastrectomy and transhiatal lower third esophagectomy in 18 patients; transhiatal total esophagectomy and upper third gastrectomy with cervical esophago-gastroplasty in seven patients. Grading, staging, neoplastic lymphangitis, satellite intramural metastases, infiltration of the resection margin, site of recurrence, and survival were analyzed. N+ was the single independent prognostic factor for survival. A poorly differentiated grading was related to T (P = 0.0009), N (P = 0.001), satellite growth (P = 0.05), and infiltration of the resection margin (P = 0.0001). Recurrence was local in 26% and distant in 74% of patients. The modalities of recurrence were not related to the aggressiveness parameters and the surgical technique. Infiltration of the esophageal resection margin was related to the type of operation (P = 0.005) and survival (P = 0.02), but it was not related to the site of recurrence. Transabdominal total gastrectomy and the right thoracotomic esophageal resection procedure achieved free margins and control of the lymph nodal metastatic spread. Transabdominal total gastrectomy and right thoracotomic esophageal resection at the azygos vein level provides a radical oncologic resection, particularly in poorly differentiated tumors. However, surgery alone cannot cure the majority of adenocarcinomas of the cardia.

Incorporation of a flap-valve at cardia, with esophagocardiomyotomy, for achalasia of the esophagus.

A lateral esophagocardiomyotomy extending from the level of inferior pulmonary vein to 3 cm on to the fundus of stomach for achalasia of esophagus was combined with a flap-valve constructed at the gastroesophageal junction. A total of 69 consecutive patients of achalasia cardia were subjected to this procedure between 1980 and 1994. There was no mortality. In a follow-up of up to 14 years, 73.9% patients had excellent results and 26.1% had good results. Recurrence of dysphagia and hiatus hernia were not detected and clinical, radiological and endoscopic studies did not show evidence of any significant gastroesophageal reflux.