Colin Clelland | Search PubMed

PubMed2006

Recurrent localized fibrous tumor of the pleura.

Localized fibrous tumors of the pleura are rare. They are often asymptomatic and may have symptoms based on size, bronchial invasion, or hormone production, or a combination of these. Complete resection offers the best chance of cure. However, recurrence is reported in a significant number of patients and can often be treated by repeated resection, albeit with increasing difficulty. We present a case in which delayed recurrence occurred after excision of such a tumor. This required a chest-wall resection and reconstruction after which a second recurrence occurred. Further thoracotomy including a latissimus dorsi free flap procedure was needed for a third-time recurrence.

Diaphragm↗

PubMed2005

Seeding of stage I thymoma into the chest wall 12 years after needle biopsy.

It is known that benign encapsulated thymoma can pursue an aggressive clinical course on rare occasions. It may recur locally, it may be invasive, or it may metastasize. We present a case of local seeding into the chest wall, presenting 12 years after core needle biopsy and complete excision of the mediastinal tumor. We draw attention to the malignant clinical behavior of some benign stage I thymomas.

Aged↗

PubMed2002

End-organ function during chronic nonpulsatile circulation.

BACKGROUND: Evolving blood pump technology has produced user-friendly continuous flow left ventricular assist devices, but uncertainty exists about the safety of chronic nonpulsatile circulation. We established consistently nonpulsatile blood flow in a sheep model using the Terumo magnetically suspended centrifugal pump. We then compared end-organ function between pulseless and control animals. METHODS: Fifteen healthy sheep (65 to 85 kg) were allocated to either left ventricular assist device (n = 9) or control (n = 6) groups. We implanted the device through a left thoracotomy and determined the flow rate at which pulse pressure was absent. The flow rate was then adjusted to exceed that rate (4.2 +/- 1.5 L/min), and all variables of pump function were continuously monitored by computer. Blood tests were taken serially for hepatic and renal function and plasma renin levels. The sheep were sacrificed electively at 30 (n = 3), 90 (n = 4), 180 (n = 1), and 340 (n = 1) days. Detailed histologic examination was made of the brain, liver, kidney, myocardium, and major arteries. RESULTS: All animals remained in good condition until sacrifice. All measures of end-organ function remained within normal limits for both groups. There were no histologic differences between the organs of pulsatile and nonpulsatile animals. Although there was no significant difference in mean blood pressure, plasma renin levels were substantially elevated in pulseless animals (1.4 +/- 0.3 pg/mL versus 2.9 +/- 0.3 pg/mL; p < 0.05). We also identified thinning of the medial layer of the ascending aorta in nonpulsatile sheep (1.8 +/- 0.4 mm in left ventricular assist device animals versus 2.6 +/- 0.6 mm in control sheep; p < 0.05). CONCLUSIONS: Chronic nonpulsatile circulation was well tolerated, and we found neither functional nor histologic changes in major end organs. The renin-angiotensin system was upregulated, but this did not provide a significant rise in blood pressure. The changes in the aortic wall merit further investigation. As a result of these findings, we consider that nonpulsatile devices can be used safely for long-term circulatory support.

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