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A Rare Case of Thymic Carcinoma

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Surgical Science 2011年第3期2卷 144-146页

作者： Farshad Anvari Arnold M. Schwartz gregory trachiotis 不详

Thymic carcinomas are unusual tumors of the thymus gland. Basaloid carcinoma, an unusal epithelioid varient of a thymic carcinoma, is a rare histopathological subtype, and is not well charecterized in the literature. We present the anatomical and histogical features of a basoloid thymic carcinoma, and discuss current diagnosis and imaging strategies, as well as the operative and oncologic care of this type of thymmic carcinoma. Basaloid carcinomas of the thymus after complete surgical resection and adjuvant therapy genarally have a favorable long-term prognosis.

关键词： Thymus Thymic Carcinoma

Pneumonectomy in a Patient with Swyer-James-MacLeod Syndrome

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Surgical Science 2015年第2期6卷 55-58页

作者： Mariana Vigiola Cruz gregory D. trachiotis The Division of Cardiothoracic Surgery Veterans Affairs Medical Center Portland USA The George Washington University Washington DC USA

Swyer-James-MacLeod syndrome is a rare disease that results in parenchymal damage believed to be caused by recurrent lung infections in childhood. We report a case of a previously healthy young woman that presented with insidious progression of exertional dyspnea with restrictive lung physiology. Axial imaging demonstrated a hyperinflated emphysematous right lung with lower lobe fibrosis, nodules and air-fluid filled cysts, with a small right pulmonary artery and contralateral shifting of the mediastinum. She underwent right pneumonectomy ultimately resulting in improvement of her symptoms, with surgical pathology indicating extensive emphysema, bronchiec- tasis, fibrosis with osseous metaplasia, and placental transmogrification of alveolar septa, being consistent with a diagnosis of SJMS.

关键词： Swyer-James Hyperlucent Lung Pneumonectomy

Global weirding at mass extinction horizons

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National Science Review 2024年第1期11卷 10-12页

作者： gregory J.Retallack Department of Earth Sciences University of Oregon

A strong motivation for studying mass extinctions is understanding how current climatic and biodiversity crises will affect creatures living on land such as ourselves. Perhaps the question is: how bad can it get? In that case, terrestrial Permian-Triassic mass extinctions are an irresistible worst-case scenario [1].

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Brain Natriuretic Peptide as an Additional Metric for Determining Operative Candidates among Veterans with Aortic Stenosis

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World Journal of Cardiovascular Surgery 2017年第9期7卷 111-118页

作者： Matthew Skancke Jacob Lambdin Richard Amdur Jason Morrisette Michael Greenberg gregory trachiotis Division of Cardiothoracic Surgery Veterans Affairs Medical Center Washington DC USA Division of Cardiology Veterans Affairs Medical Center Washington DC USA Division of Cardiothoracic Surgery the George Washington University Washington DC USA

Objective: As the veteran population ages, the incidence of clinically significant aortic stenosis (AS) is increasing and aortic stenosis has become a veterans’ health issue. This analysis focused on using serum Brain Natriuretic Peptide (BNP) levels as an adjunct to aid decision making for early aortic valve replacement (AVR) in veterans with severe AS to reduce hospital admission rates. Methods: We retrospectively reviewed the charts of patients referred to the heart valve clinic at the Washington DC, Veterans Affairs Medical Center (VAMC) Heart Center between 2004 and 2015 who were diagnosed with severe AS. We identified veterans who had a BNP drawn in addition to traditional echocardiography during their diagnostic workup. This cohort was then stratified based on their serum BNP levels and whether they received medical therapy or aortic valve replacement. The primary endpoint of interest was admission to a VAMC for valvular heart failure. Results: Univariate analysis of BNP quartile and operative status showed a reduction in number of admissions for veterans who underwent AVR with BNP between 101 and 300 (0.64 vs. 3.71, p = 0.054) and 301 and 1000 (1.36 vs. 4.0, p = 0.003) compared to veterans treated medically. There was no difference in number of admissions for veterans with BNP lower than 100 (p = 0.455) or higher than 1000 (p = 0.659). Conclusion: BNP may be a useful adjunct for selecting patients with AS for earlier AVR leading to lower rates of hospital admissions in the veteran population. Continued analysis in a larger cohort will be needed to further validate the utility of BNP stratification as a diagnostic tool to risk stratify patients with AS in a heart valve clinic.

关键词： BNP Aortic Stenosis Valve Replacement

Experience with Miniaturized Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Comparison of the NovoSCI Ready System to Off-Pump and Conventional Coronary Artery Bypass Grafting

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World Journal of Cardiovascular Surgery 2014年第12期4卷 232-238页

作者： Dominic Emerson Debbie Baldwin Miguel Pinales Michael Greenberg Melissa Mattes gregory trachiotis Veterans Affairs Medical Center Washington DC USA Georgetown University Hospital Washington DC USA The George Washington University Hospital Washington DC USA

The major source of morbidity following cardiopulmonary bypass (CPB) is the systemic inflammatory response (SIRS response) which leads to multiple derangements in different organ systems. To combat this, miniaturized cardiopulmonary bypass circuits (MCPBC) have been created to lessen the inflammatory response to CPB. Here we examine early outcomes following coronary artery bypass grafting (CABG) using a MCPBC system compared to conventional bypass techniques at a single institution. Methods: 60 consecutive patients undergoing elective CABG were prospectively enrolled. Nine patients underwent coronary artery bypass grafting (CABG) with conventional CPB (cCABG), 33 underwent off-pump CABG (OPCAB), and the remaining 18 patients underwent CABG with a MCPBC system. Demographics and outcomes were compared between groups and statistical analyses applied. Results: No significant difference was observed in mortality between groups, with only one death reported in total. Morbidity was also low, totaling only 6.7%, with none occurring in the MCPBC group. The MCPBC group required less PRBC and total blood product transfusion than the cCABG and OPCABG groups (p = 0.05), but changes in PLT and Hct over time were not different between groups. Conclusions: The MCPBC system was shown to be comparable to conventional bypass and OPCABG in terms of postoperative complications and mortality. Furthermore, the MCPBC system had the advantage of a decreased transfusion requirement. Based on our preliminary observations, this mini-cardiopulmonary bypass circuit provides a safe alternative to conventional bypass techniques.

关键词： Miniaturized Circuits Coronary Artery Bypass Graft Outcomes

Long-Term Survival after CABG in Diabetics with Aggressive Risk Factor Management

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World Journal of Cardiovascular Surgery 2014年第12期4卷 217-222页

作者： Kendal Endicott Conor Hynes Dominic Emerson Peter Kokkinos Michael Greenberg gregory trachiotis Division of Cardiothoracic Surgery Veterans Affairs Medical Center Washington DC USA Division of Cardiology Veterans Affairs Medical Center Washington DC USA Division of Cardiothoracic Surgery The George Washington University Washington DC USA

Objectives: Diabetes is a well-established risk factor for cardiovascular disease, and diabetics have a threefold increase in risk of death from cardiovascular disease compared to non-diabetics. Following coronary artery bypass grafting, tight glycemic control improves short-term outcomes, however limited data exist for long-term outcomes. Here we examine these outcomes in diabetics using aggressive risk factor management. Methods: A retrospective review of all patients under-going coronary artery bypass between 1991 and 2000 at a single Veterans Affairs Medical Center was undertaken. 973 patients were included, 313 with diabetes and 660 without. Strict glucose control was maintained for all patients. Additional risk factor modification, including anti-platelets medications, statins, and beta blockers were also used. Survival analysis was performed. Results: The diabetic group was at higher risk, with age, BSA, and NYHA class all being greater (p < 0.05). The mean follow-up time was 6.7 ± 3 years. There were 28 deaths/1000 person-years for non-diabetics, and 48 deaths/1000 person-years for diabetics. Survival rates were significantly higher for non-diabetics (72% versus 58% in the diabetic group, p < 0.001). Cox proportional hazard analysis demonstrated mortality risk was 57% higher for diabetic patients (hazard ratio = 1.57;CI: 1.19 - 2.09;p = 0.002). The mortality risk in diabetics with and without prior MI was similar (HR = 0.83;CI: 0.54 - 1.28;p = 0.40). Conclusions: Diabetics undergoing coronary bypass have poorer long-term survival than non-diabetics despite perioperative glycemic control and risk factor modification. The long-term survival decrease in diabetics with history of MI is attenuated with surgical revascularization.

关键词： Coronary Artery Bypass Graft Diabetes Mortality Myocardial Infarction

A numerical model to simulate the transient frictional viscoelastic sliding contact

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Friction 2024年第2期12卷 319-339页

作者： Dongze WANG gregory de BOER Anne NEVILLE Ali GHANBARZADEH School of Mechanical Engineering University of LeedsLeeds LS29JTUK

Sliding motion has always been one of the major concerns when it comes to the analysis of viscoelastic contact problems.A new model simulating the transient sliding contact of smooth viscoelastic surfaces is developed in this *** taking the dry contact friction and the coupling between shear tractions and normal pressure into account,the effect of the early partial slip period,which is often neglected in the study of viscoelastic sliding contact problems,is investigated *** with solutions based on the frictionless assumption,the steady-state pressure profile is found to be slightly different under the effect of the partial slip regime,including a lower peak pressure and the shift of the contacting region in the direction opposite to the sliding ***,the time required for the viscoelastic contact to reach its steady state is delayed owing to the partial slip period preceding the global sliding motion.

关键词： contact mechanics frictional sliding viscoelasticity viscoelastic friction

Heart Valve Clinic: A Model for Treatment of Structural Heart Disease

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World Journal of Cardiovascular Surgery 2017年第1期7卷 1-9页

作者： Kendal Endicott Jacob Lambdin Jason Morrisette Amy Kirkpatrick Christian Nagy Frederick Mordini Michael Greenberg gregory trachiotis Division of Cardiology and Cardiothoracic Surgery The Heart Center Washington DC Veterans Affairs Medical Center Washington DC USA The George Washington University Washington DC USA

Background and Aim of the Study: Valvular heart disease (VHD) should be managed by a Heart Valve Team (HVT) for optimal treatment. Although the prevalence of VHD is increasing, an overall lack of universal implementation of the HVT continues to exist. Here we present our model of care within a Veteran’s Affairs Medical Center (VAMC). Materials and Methods: All patients referred to our VAMC with structural valvular disease have been managed within our multidisciplinary heart valve clinic since 2006. The heart valve clinic consists of a dedicated valve surgeon as well as both a dedicated noninvasive imaging cardiologist and cardiac MRI/CT cardiologist. Cases are reviewed on a weekly basis with multidisciplinary input to guide treatment strategy. Therapy includes medical management, facilitation of further diagnostic workup, and referral for operative intervention. Results: Between 2006 and 2015, 560 patients have been evaluated in HVC. Overall, new patient yearly volume has nearly tripled with now over 90 new consults seen yearly. Of the patients evaluated, 313 were referred for operative intervention with follow up post-operatively to affirm adequate post-procedural function. Following HVC referral trends, operative yearly volume has increased 33% over the last year years compared to the first three years of the program. The heart valve clinic has also matured to support a dedicated TAVR program. Conclusions: As the options for heart valve therapy and indications for surgery continue to evolve, a multidisciplinary team to guide decision making is imperative. We present the success and growth of our heart valve clinic within a VAMC as a structural model that can be translated into both the community and academic setting.

关键词： Acquired Disease Valve Replacement

Leptomeningeal Carcinomatosis Presenting Early in Non-Small Cell Lung Cancer

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Surgical Science 2011年第8期2卷 427-429页

作者： Ezra N. Teitelbaum Susan M. Hasselquist Imad A. Tabbara gregory D. trachiotis 不详

Purpose: We present the case of a patient presenting with altered mental status on post-operative day seven after a diagnostic lung biopsy. The diagnosis of carcinomatous letomeningeal metastasis was confirmed. Methods: We discuss meningeal carcinomatosis in lung cancer, and describe challenges to diagnosis, therapy, and prognosis. Results: A review of the literature describing the clinical and oncologic principles of letomeningeal carcinomatosis in lung cancer is performed. Discussion: Leptomeningeal carcinomatosis (LC) occurs in approximately 5% of patients with non-small cell lung cancer and incurs a bleak prognosis. Presenting neurologic symptoms can be varied and diagnosis is confirmed via lumbar puncture and cerebrospinal fluid cytology. Few data exist regarding optimal treatment, although intrathecal chemotherapy has been shown to provide a modest improvement in median survival.

关键词： Leptomeningeal Carcinomatosis Lung Cancer