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PubMed2003

Effect of standard vs extended Roux limb length on weight loss outcomes after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Increasing the length of the Roux limb in open Roux-en-Y gastric bypass (RYGB) effectively increases excess weight loss in superobese patients with a body mass index (BMI) >50 kg/m2. Extending the RYGB limb length for obese patients with a BMI < 50 could produce similar results. The purpose of this study was to compare the outcomes of superobese patients undergoing laparoscopic RYGB with standard (< or =100-cm) with those undergoing the procedure with an extended (150-cm) Roux limb length over 1-year period of follow-up. METHODS: Retrospective data over 2.5 years were reviewed to identify patients with a BMI < 50 who underwent primary laparoscopic RYGB with 1-year follow-up ( n = 58). Forty-five patients (sRYGB group) received limb lengths < or = 100 cm, including 45 cm ( n = 1), 50 cm ( n = 2), 60 cm ( n = 6), 65 cm ( n = 1), 70 cm ( n = 1), 75 cm ( n = 3), and 100 cm ( n = 31). Thirteen patients (eRYGB group) received 150-cm limbs. Postoperative weight loss was compared at 3 weeks, 3 months, 6 months, and 1 year. RESULTS: Comparing the sRYGB vs the eRYGB group (average +/- SD), respectively: There were no significant differences in age (41.5 +/- 11.0 vs 38.0 +/- 11.9 years), preoperative weight (119.2 +/- 11.9 vs 127.8 +/- 12.5 kg), BMI (43.7 +/- 3.0 vs 45.2 +/- 3.5 kg/m2), operative time (167.1 +/- 72.7 vs 156.5 +/- 62.4 min), estimated blood loss (129.9 +/- 101.1 vs 166.8 +/- 127.3 cc), or length of stay (median, 3 vs 3 days; range, 2-18 vs 3-19). Body weight decreased over time in both groups, except in the sRYGB group between 3 and 6 months and 6 and 12 months after surgery and in the eRYGB group between 6 and 12 months. BMI also decreased over time, except in the eRYGB group between 6 and 12 months. Absolute weight loss leveled out between 6 and 12 months in both groups, with no increase after 6 months. Percent of excess weight loss did not increase in the eRYGB group after 6 months. An extended Roux limb did not significantly affect body weight, BMI, absolute weight loss, or precent of excess weight loss at any time point when the two groups were compared. A trend toward an increased proportion of patients with >50% excess weight loss ( p = 0.07) was observed in the extended Roux limb group. CONCLUSIONS: In this series, no difference in weight loss outcome variables were observed up to 1 year after laparoscopic RYGB. Thus, extending Roux limb length from < or =100 cm to 150 cm did not significantly improve weight loss outcome in patients with a BMI < 50 kg/m2.

Adult↗

PubMed2006

Tumor thrombectomy without bypass for low-grade malignant tumors extending into the inferior vena cava: report of two cases.

Endometrial stromal sarcoma (ESS) rarely extends into the inferior vena cava (IVC). Two cases of ESS extending into the IVC were encountered. In the first case a low-grade sarcoma and cavography revealed the tumor thrombus to extend to just below the left renal vein from the right internal iliac vein, and the IVC was patent. A tumor thrombectomy was accomplished to prevent pulmonary embolism (PE) and to achieve a good prognosis. The second case was also a low-grade sarcoma. Abdominal computed tomography scanning revealed a large thrombus extending into the IVC just below the hepatic vein. A tumor thrombectomy with an IVC resection was performed. The postoperative course was uneventful for both cases. Aggressive surgical treatment is thus recommended to excise a tumor thrombus with or without an IVC resection in patients with ESS of low-grade malignancy extending into the IVC to prevent sudden death due to PE.

Adult↗

PubMed1999

The extended transbasal approach: a quantitative anatomical and histological study.

Since its introduction in 1972 the transbasal approach to the anterior fossa and sphenoethmoidal region has undergone a number of modifications. The extended transbasal approach with preservation of olfaction not only improves exposure of the anterior fossa, but also provides access to the clivus as far inferiorly as the foramen magnum. An anatomical study has been undertaken to photographically demonstrate and quantify the varying degrees of exposure that this technique provides. The pituitary stalk was used as an intracranial target. The amount of exposure was compared using a standard subfrontal approach, a transbasal approach and an extended transbasal with preservation of olfaction. In addition, a histological study was carried out to investigate the level to which identifiable olfactory nerves extended into the nasal mucosa. The anatomical study demonstrates the area of the "external window of exposure" can be doubled using a transbasal approach and more than quadrupled using the extended transbasal approach, when gaining access to the pituitary stalk. In addition, the study highlights the exposure of other anatomical areas, such as the medial orbit, the cavernous sinus, the clivus and the vertebrobasilar complex. The histological study establishes that the olfactory nerves extend only 10 mms below the cribriform plate.

Brain↗

PubMed2006

An extended RNA code and its relationship to the standard genetic code: an algebraic and geometrical approach.

An algebraic and geometrical approach is used to describe the primaeval RNA code and a proposed Extended RNA code. The former consists of all codons of the type RNY, where R means purines, Y pyrimidines, and N any of them. The latter comprises the 16 codons of the type RNY plus codons obtained by considering the RNA code but in the second (NYR type), and the third, (YRN type) reading frames. In each of these reading frames, there are 16 triplets that altogether complete a set of 48 triplets, which specify 17 out of the 20 amino acids, including AUG, the start codon, and the three known stop codons. The other 16 codons, do not pertain to the Extended RNA code and, constitute the union of the triplets YYY and RRR that we define as the RNA-less code. The codons in each of the three subsets of the Extended RNA code are represented by a four-dimensional hypercube and the set of codons of the RNA-less code is portrayed as a four-dimensional hyperprism. Remarkably, the union of these four symmetrical pairwise disjoint sets comprises precisely the already known six-dimensional hypercube of the Standard Genetic Code (SGC) of 64 triplets. These results suggest a plausible evolutionary path from which the primaeval RNA code could have originated the SGC, via the Extended RNA code plus the RNA-less code. We argue that the life forms that probably obeyed the Extended RNA code were intermediate between the ribo-organisms of the RNA World and the last common ancestor (LCA) of the Prokaryotes, Archaea, and Eucarya, that is, the cenancestor. A general encoding function, E, which maps each codon to its corresponding amino acid or the stop signal is also derived. In 45 out of the 64 cases, this function takes the form of a linear transformation F, which projects the whole six-dimensional hypercube onto a four-dimensional hyperface conformed by all triplets that end in cytosine. In the remaining 19 cases the function E adopts the form of an affine transformation, i.e., the composition of F with a particular translation. Graphical representations of the four local encoding functions and E, are illustrated and discussed. For every amino acid and for the stop signal, a single triplet, among those that specify it, is selected as a canonical representative. From this mapping a graphical representation of the 20 amino acids and the stop signal is also derived. We conclude that the general encoding function E represents the SGC itself.

Amino Acids↗

PubMed1991

Extended vertical transatrial septal approach to the mitral valve.

Optimal mitral valve operation requires adequate exposure without impairment of atrial physiology, namely sinus node and atrioventricular node function. We used an extended vertical transseptal atrial approach in 34 consecutive patients. The extended vertical transseptal approach combines two semicircular atrial incisions circumscribing the tricuspid and mitral annuli anteriorly and superiorly, allowing exposure of the mitral valve by deflecting the ventricular side using stay sutures. The right atrium is opened anteriorly along the atrioventricular sulcus. The atrial septum is incised vertically through the fossa ovalis. The right atriotomy is extended superiorly in the right coronary fossa between the right atrial appendage and the atrioventricular sulcus to meet the septal incision. The two joint incisions are extended onto the left atrial roof transversely. At this point, the two semicircular incisions are performed and joined, and mitral valve operation is performed. There were 18 women and 16 men. Five patients had ischemic mitral valve regurgitation, 18 had mitral valve prolapse, and 11 had rheumatic heart disease. The mitral valve was replaced in 17 patients and repaired in 17. There were no perioperative complications associated with the atriotomies, ie, no bleeding, no atrioventricular nodal dysfunction, and no sinus node dysfunction. The extended vertical transatrial septal approach provides good mitral valve exposure without inherent complications.

Adult↗

PubMed1993

Extended resection of pulmonary metastases: is the risk justified?

Extended resection of pulmonary metastases by pneumonectomy or by pulmonary resection en bloc with chest wall or other thoracic structures (diaphragm, pericardium, superior vena cava) is infrequently performed as survival benefit is presumed low. Between 1981 and 1992, 38 patients underwent extended resection for pulmonary metastases (24 men, 14 women; average age, 48 years) from various primary neoplasms. Thirty-three patients (33/38, 87%) had complete resection. Five-year actuarial survival was 25.4%. Mortality was 5.3% (2/38) and occurred in patients undergoing pneumonectomy (2/19, 10.5%). Nineteen patients underwent pneumonectomy, and 19 patients had other assorted resections: pulmonary resection en bloc with chest wall in 11 and pulmonary resection en bloc with other thoracic structures in 8. Actuarial median survival (median, 27 months) did not differ between patients having pneumonectomy and those having pulmonary resection en bloc with chest wall or other thoracic structures. Initial disease-free interval (median) was no different between those patients undergoing pneumonectomy (32 months) or other type resection (35 months; p = 0.16). Median survival for extended resection as the initial operation for pulmonary metastases was 28 months compared with 14 months for all others (p = 0.095). Pneumonectomy for pulmonary metastases may be performed with operative risk equivalent to pneumonectomy for primary bronchogenic carcinoma. Patients may safely undergo extended resection of pulmonary metastases by pneumonectomy or in continuity with chest wall or other thoracic structures. Despite advanced localized metastatic disease, some patients achieve long-term survival after pneumonectomy and extended resection for pulmonary metastases.

Actuarial Analysis↗

PubMed1991

Glycine-extended processing intermediate of proVIP: a new form of VIP in the rat.

The biosynthesis of many peptides including vasoactive intestinal polypeptide (VIP) requires enzymatic alpha-carboxyamidation via a glycine-extended intermediate form. In an effort to identify and quantify glycine-extended VIP in rat tissue extracts a radio-immunoassay specific for this peptide was developed. The concentrations of glycine-extended VIP ranged from 1.3 pmol/g in the brain to 83.9 pmol/g in the small intestine. The identity of the peptide was substantiated by cation-exchange HPLC. The ratio of glycine-extended VIP to amidated VIP varied considerably being highest (63%) in the small intestine. The natural occurrence of glycine-extended VIP in connection with our recent demonstration of its biological activity suggest a physiological role for this biosynthetic intermediate VIP form.

Amino Acid Sequence↗

PubMed1988

Neither glycine-extended gastrin nor the 1-13 fragment of gastrin 17 influences gastric acid secretion in humans.

The effect on gastric acid secretion of two gastrin 17-related peptides without the carboxyamide, i.e., the glycine-extended 5-17 fragment and the 1-13 fragment of human gastrin 17, was examined in normal subjects. Acid secretion was stimulated by an intravenous infusion of 21 pmol/kg.h of gastrin 17 or by intragastric instillation of peptone; gastric acid output during simultaneous infusion of 325 pmol/kg.h of the glycine-extended 5-17 fragment or 319 pmol/kg.h of the 1-13 fragment was then compared with acid output during infusion of saline. Neither the glycine-extended 5-17 fragment nor the 1-13 fragment of gastrin 17 influenced gastric acid secretion. By gel and ion-exchange chromatography of serum drawn during infusion, the infused peptide was recovered at the position of the intact synthetic peptide. The disappearance curve of circulating glycine-extended gastrin could be described by two components with half-lives of 3.6 and 48 min. As the glycine-extended fragment was stable in serum or plasma in vitro for 1 h at 37 degrees C, the rapid elimination observed in vivo cannot be ascribed to circulating plasma enzymes.

Adult↗

PubMed1977

Histone neighbors in nuclei and extended chromatin.

Histone neighbors in compact and extended chromatin have been investigated by cross-linking histones in nuclei and in nucleohistone extended with 6 M urea, using the bifunctional reversible reagent methyl-4-mercaptobutyrimidate (MMB). Similar histone dimers are found in both conformational states of chromatin. The dimers most frequently found are H2b-H2a, H2b-H3 and H3-H2a; dimers found less frequently are H3-H4, H3-H3 and H2b-H4. More H3-H3 is found in nuclei than in extended chromatin. H1 is found predominantly as poly-H1, although it can be cross-linked to H2b or H3. After reaction with MMB, native compact chromatin is no longer extendable in 6 M urea, which shows that the reagent is capable of linking together histones holding the chromatin in a compact conformation. Thus the histone propinquity in extended chromatin mimics and intimate histone associations in compact chromatin.

Cell Nucleus↗

PubMed1994

Glycine-extended post-translational processing intermediates of gastrin and cholecystokinin in the gut.

Cholecystokinin (CCK) and gastrin are two polypeptide hormones of the gut that share complete structural homology in their carboxyl-terminal pentapeptide. Both peptides are biologically activated from their glycine-extended precursor forms by a carboxyl-terminal alpha-amidation reaction. In the present studies we used region specific antisera to characterize the carboxyl-terminally amidated and glycine-extended forms of gastrin and CCK in mammalian intestine. Multiple amidated molecular forms of gastrin and CCK and their corresponding glycine-extended forms were detected throughout the most of the small bowel. Although, we detected substantial amounts of glycine-extended CCK in the proximal rat duodenum, we detected none of the corresponding amidated molecular forms. In contrast, the proximal duodenum of dog and hog contained both glycine-extended and amidated CCK. These findings suggest that there may be peptide, tissue and species specific differences in expression and activity of the peptide alpha-amidating enzyme.

Amino Acid Sequence↗

PubMed1996

Tumor necrosis factor (TNF) microsatellite haplotypes in relation to extended haplotypes, susceptibility to diseases associated with the major histocompatibility complex and TNF secretion.

TNFabc microsatellite haplotypes were determined on normal, type I diabetes and multiple sclerosis Caucasian MHC haplotypes in family studies. Although independent examples of conserved extended haplotypes usually had the same TNFabc haplotypes, there were a number of exceptions, suggesting that these loci are more mutable than most loci in the human MHC. Some TNFabc haplotypes were characteristic of only one extended haplotype, whereas others were shared by several different extended haplotypes. From the analysis of TNFabc on extended haplotype fragments, and assuming that the fragments arose by ancient homologous crossing over, it was possible to "map" TNF and how that it was somewhat closer to HLA-B than the complement region, corresponding to the physical map of this region. TNF haplotype associations with type I diabetes and multiple sclerosis were attributable to the known extended haplotype associations of these diseases. There was also a trend for higher TNF-alpha secretion by peripheral blood mononuclear cells from individuals homozygous for [HLA-B8, SC01, DR3] than from individuals homozygous for [HLA-B7, SC31, DR2].

Alleles↗

PubMed1985

Extended training of ambulance staff in England.

It has been widely demonstrated that it is possible to teach ambulance staffs to carry out the extended trained skills of endotracheal intubation, intravenous infusion and ventricular defilbrillation. So far in England only a few health authorities have been able to develop courses i advanced ambulance aid. Data on the costs of this training in six authorities presently operating such courses were collected, together with the costs of operating vehicles crewed by extended trained staff. Training and operating costs vary according to the different organisation of the training schemes and the way in which the extended trained staff are deployed on operational duties. Total costs vary between 235 pounds and 878 pounds per trained person per year. The experience of different health authorities in the U.K. and in the U.S.A. operating ambulance services with extended trained staff is then examined to try to identify the benefits of reduced mortality and morbidity which accrued from the introduction of the improved service. Most of this experience is concerned with reduced mortality from the treatment of out-of-hospital cardio-pulmonary arrest, and the estimates of the life-saving potential of the service varied from one area to another. The most conservative estimate was that one fully equipped, permanently available vehicle staffed by extended trained personnel would save 3-4 lives per year. Although there is very little evidence available of reduced mortality and morbidity from trauma and other sudden serious illness, some experience indicated a further 1 or 2 lives could be saved per vehicle per year.(ABSTRACT TRUNCATED AT 250 WORDS)

Allied Health Personnel↗

PubMed2005

The impact of Ontario's extended drinking hours on cross-border cities of Windsor and Detroit.

PURPOSE: This study evaluated the cross-border safety impact of extended drinking hours from 1:00 to 2:00 a.m., in licensed establishments in Ontario, Canada. METHODS: This study examined patterns in total and alcohol-related casualties in: (1) Windsor, Ontario, Canada compared to Detroit, Michigan, US with a 2:00 a.m. closing time, and (2) Ontario compared to Michigan for overall trends. The criterion outcome indicators were: (1) monthly motor vehicle casualties (major injuries and fatalities) for the city-regions of Windsor and Detroit and (2) Ontario and Michigan monthly motor vehicle fatalities occurring between 11:00 p.m. and 3:00 a.m. for 4 years pre- and 3 years post-policy change. In order to examine cross-border drinking consequences, data were disaggregated to assess trends of motor vehicle injury collisions involving vehicles with US licence plates and with US drivers aged 16-20 in the Windsor region; similarly trends were assessed for motor vehicle injury collisions involving vehicles with Ontario licence plates in the Detroit region. RESULTS: The Windsor region total motor vehicle casualty data showed a non-significant pre-post increase, while the Detroit region showed a statistically significant decrease for total motor vehicle casualties. In the Windsor region, a significant increase was found for alcohol-related motor vehicle casualties after the drinking hours were extended. However, the Detroit region showed a statistically significant decrease in alcohol-related motor vehicle casualties concomitant with Ontario's drinking hour extension. No similar trends were found for the province of Ontario and the state of Michigan as a whole. Moreover, a significant decrease was found for injury collisions involving vehicles with Ontario licence plates in the Detroit region but no similar pattern was found for injury collisions involving vehicles with US licence plates and with 16-20-year-old US drivers in the Windsor region. DISCUSSION: These data seem to support a cross-border impact of the Ontario extended drinking policy. A significant increase in alcohol-related motor vehicle casualties was found in the Windsor region and concomitantly, significant decreases in total and alcohol-related motor vehicle casualties were found in the Detroit region after the extended drinking hours amendment. The Ontario government's belief that the extended drinking hour policy would "reduce the number of patrons who cross the border when Ontario's bars and restaurants close" may have been realized.

Accidents, Traffic↗

PubMed2005

Extended-release formulations of oxybutynin and tolterodine exhibit similar central nervous system tolerability profiles: a subanalysis of data from the OPERA trial.

OBJECTIVE: This study was undertaken to compare the central nervous system (CNS) tolerability profiles of the extended-release formulations of oxybutynin chloride and tolterodine tartrate in the treatment of women with overactive bladder (OAB), as observed in the OPERA (Overactive bladder: Performance of Extended Release Agents) trial. STUDY DESIGN: The OPERA trial was a randomized, double-blind, active-control comparison of the efficacy and safety of extended-release oxybutynin (10 mg/d) and extended-release tolterodine (4 mg/d) given to 790 women with OAB for 12 weeks. The incidence of reported CNS events was compared between the treatment groups by using the Fisher exact test. RESULTS: The incidence of CNS adverse events was 9% and 8% for the oxybutynin and tolterodine treatment groups, respectively. The difference between groups was not statistically significant. All reported CNS adverse events were rated as mild or moderate in severity. There were no serious treatment-related adverse events in either group, and discontinuation because of a CNS adverse event was infrequent. CONCLUSION: The extended-release formulations of oxybutynin and tolterodine were observed to be associated with a similar low incidence of CNS adverse events, which were mostly mild or moderate in severity.

Benzhydryl Compounds↗

PubMed2006

Effect of different procedures of ejaculate collection, extenders and packages on DNA integrity of boar spermatozoa following freezing-thawing.

Whole ejaculate or sperm-rich fraction, collected from four sexually mature boars, was frozen in an extender containing lactose-hen egg yolk with glycerol (lactose-HEY-G) or extender containing lactose, lyophilized lipoprotein fractions isolated from ostrich egg yolk and glycerol (lactose-LPFo-G), and Orvus Es Paste, respectively. The sperm samples were also frozen in a standard boar semen extender (Kortowo-3), without the addition of cryoprotective substances. Sperm DNA integrity was assessed using a modified neutral comet assay. Sperm characteristics such as motility, plasma membrane integrity (SYBR-14/PI), mitochondrial function (rhodamine 123) and acrosome integrity were monitored. Freezing-thawing caused a significant increase (P<0.05) in sperm DNA fragmentation, irrespective of the procedures of ejaculate collection and extender type. Sperm DNA fragmentation was significantly lower (P<0.05) in the whole ejaculate compared with the sperm-rich fraction, indicating that spermatozoa maintained in the whole seminal plasma prior to its removal for freezing-thawing procedure were less vulnerable to cryo-induced DNA fragmentation. Furthermore, spermatozoa frozen in lactose-HEY-G or lactose-LPFo-G extender exhibited lower (P<0.05) DNA fragmentation than those frozen in the absence of cryoprotective substances. The levels of sperm DNA damage, as expressed by comet tail length and tail moment values, were significantly higher (P<0.05) in sperm samples frozen in the absence of cryoprotective substances. The deterioration in post-thaw sperm DNA integrity was concurrent with reduced sperm characteristics. It can be suggested that evaluation of DNA integrity, coupled with different sperm characteristics such as motility, plasma membrane integrity and mitochondrial function, may aid in determining the quality of frozen-thawed boar semen.

Animals↗

PubMedDate not supplied

Depression in primary care: effectiveness of venlafaxine extended-release in elderly patients; Observational study.

Depression in the elderly is frequent but is often not recognized or treated as such. Few studies have assessed the effectiveness and tolerability of venlafaxine extended-release in patients over 60 years in primary care. This study aims to demonstrate the effectiveness and safety of venlafaxine extended-release in depressive disorders in this kind of population. Observational, multicenter and prospective study in an outpatient population over 60 years with depressive symptoms that needs pharmacological treatment and with a minimum score of 14 on the 17-items Hamilton rating scale for depression (HAM-D17). Effectiveness was assessed by HAM-D17. Physician's assessment of the patient's global status was also used and all the possible adverse effects were recorded. Venlafaxine extended-release was administered for 6 months at 75 mg per day dose, with the possibility of going up to 150 mg per day according to clinical criterion. Data of 1214 patients were obtained, with remission rates (HAM-D17 </= 7) in 70.2% of the patients and response rates (50% decrease in HAM-D17) of 83.2%. Global assessment of the patient's status significantly improved in each visit. After 6 months of treatment, 87.6% of the patients continued taking 75 mg per day of venlafaxine extended release. A total of 4.6% of the patients reported adverse events during the study. Venlafaxine extended-release is effective and safe for the treatment of depression in elderly patients managed by primary care physicians.

Aged↗

PubMed2004

Comparison of late results of basic transsternal and extended transsternal thymectomies in the treatment of myasthenia gravis.

BACKGROUND: The influence of the technique of thymectomy on late results in the treatment of myasthenia gravis remains controversial. METHODS: Results of 60 basic transsternal thymectomies and 58 extended transsternal thymectomies were compared. Both positive results (complete remissions or improvement) and negative results (no improvement, deterioration, or death from myasthenia) were analyzed. RESULTS: There were no differences between both groups according to patient's characteristics and postoperative complications rate. Ectopic foci of the thymic tissue were discovered in the fat of the neck and the mediastinum in 56.9% of patients from the extended thymectomy group. The foci occurred in all areas of dissection of the neck and the mediastinum. Complete remission rates in the basic thymectomy group were 8.3%, 11.7%, 15.0%, 16.7%, 20.0%, and 21.7% after 1, 2, 3, 4, 5, and 6 years of follow-up, respectively, and 29.3%, 37.9%, 41.4%. and 46.6% after 1, 2, 3, and 4 years, respectively, in the extended thymectomy group. The differences between both groups after 1, 2, 3, and 4 years were statistically significant (p = 0.0093, p = 0.0013, p = 0.0018, and p = 0.0007, respectively). Negative results were noted in 23.3% of patients in the basic thymectomy group and in 6.9% of patients in the extended thymectomy group (p = 0.0613). No other factors had any influence on the results. CONCLUSIONS: Late results, both positive and negative, were considerably better in the extended thymectomy group. The difference can be explained by the removal of ectopic foci of the thymic tissue from the neck and the mediastinum in these patients.

Adipose Tissue↗

PubMed2005

Extended surgical staging for potentially resectable malignant pleural mesothelioma.

BACKGROUND: Extrapleural pneumonectomy for malignant pleural mesothelioma (MPM) is a high-risk procedure, and patients require careful preoperative staging to exclude advanced disease. Computed tomography, magnetic resonance imaging, and positron emission tomography are useful staging modalities, but do not reliably identify contralateral mediastinal involvement or transdiaphragmatic invasion. We evaluated the role of extended surgical staging procedures, which generally includes a combination of laparoscopy, peritoneal lavage, and mediastinoscopy, to more precisely stage patients with MPM. METHODS: One hundred eighteen patients with MPM, deemed clinically and radiologically resectable, underwent extended surgical staging. Mediastinoscopy was performed in 111 patients, laparoscopy in 109 patients, and peritoneal lavage in 78 patients. RESULTS: Ten (9.2%) patients had gross evidence of transdiaphragmatic or peritoneal involvement. Peritoneal lavage was positive for metastatic MPM in 2 (2.6%) patients, neither of whom had obvious transdiaphragmatic invasion. Ipsilateral mediastinal nodes contained metastatic tumor in 10 of 62 (16.1%) patients. Contralateral nodes were positive in 4 of 111 (3.6%) patients. Of the patients who underwent biopsy of both ipsilateral and contralateral mediastinal nodes, and who had complete pathologic staging after extrapleural pneumonectomy (n = 46), 14 (30.4%) had N2-positive nodes. Only 5 of these patients were correctly identified by mediastinoscopy (sensitivity 36%, accuracy 80%). Extended surgical staging identified 16 (13.6%) patients who had contralateral nodal involvement, transdiaphragmatic invasion, or positive peritoneal cytology. CONCLUSIONS: Extended surgical staging defines an important subset of patients with unresectable MPM not identified by imaging. Because of the potential morbidity associated with extrapleural pneumonectomy, we advocate that extended surgical staging be performed in all patients with MPM before resection.

Adult↗