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author:("sonorae, A S")
1.  Effect of training on patient outcomes following lobectomy 
Thorax  2006;61(4):327-330.
Little is known about the effect of surgical training on outcomes in thoracic surgery. The impact of surgeon training on outcomes following lung resection was examined, focusing on lobectomy as a marker operation.
328 consecutive patients who underwent lobectomy at our institution between 1 October 2001 and 30 June 2003 were studied. Data were collected prospectively during the patient's admission as part of routine clinical practice and validated by a designated audit officer. Patient characteristics and postoperative outcomes were compared between trainee led and consultant led operations.
In 115 cases (35.1%) the operation was performed by a trainee thoracic surgeon as the first operator. There were no significant differences in patient characteristics between the two groups. In‐hospital mortality was similar for operations led by trainees and consultants (3.5% and 2.8%, respectively; p>0.99). Outcomes in the two groups did not differ significantly with respect to respiratory, cardiovascular, renal, neurological, chest infection, bleeding, and gastrointestinal complications. Survival rates at 1 year were 82.6% for procedures led by trainees compared with 81.7% for procedures led by consultants (p = 0.83).
With appropriate supervision, trainee thoracic surgeons can perform lobectomies safely without compromising short or intermediate term patient outcome.
PMCID: PMC2104602  PMID: 16449272
training; lobectomy; mortality; morbidity; thoracic surgery
2.  Pneumothorax and malignant mesothelioma in patients over the age of 40. 
Thorax  1991;46(8):584-585.
Five patients over the age of 40 with malignant mesothelioma of the pleura presented with a spontaneous pneumothorax in the course of five years. The diagnosis of malignant mesothelioma was not suspected at surgery but was made by histological examination of the pleurectomy specimens. During this time 91 pleurectomies for recurrent pneumothorax were performed, 45 in patients over the age of 40; malignant mesothelioma therefore accounted for 11% of spontaneous pneumothorax requiring pleurectomy in this age group. The association of spontaneous pneumothorax and malignant mesothelioma is not emphasised in current publications. These five cases highlight the need for all pleurectomy specimens in cases of spontaneous pneumothorax to be sent for histological examination and for a full occupational history to be taken, especially in older patients.
PMCID: PMC463282  PMID: 1926028
3.  Haemangioleiomyomatous tumour of the lung. 
Journal of Clinical Pathology  1980;33(1):81-85.
A case of haemangioleiomyomatous tumour of the lung, occurring as a peripheral, solitary nodule in an asymptomatic 54-year-old man is presented. The tumour was well-demarcated and microscopically it was characterised by the presence of vascular spaces with endothelial, pericytic, and, predominantly, smooth muscle proliferation. Islands of cartilage and slit-like spaces lined by bronchial epithelium make this a hamartomatous lesion of a quite distinctive and unusual variety, which does not fit any of the well-recognised patterns of hamartomas previously described. The long-term prognosis after limited excision is considered to be favourable.
PMCID: PMC1145986  PMID: 7358861
4.  Aortic valve replacement for severe aortic regurgitation caused by idiopathic giant cell aortitis. 
Thorax  1980;35(1):60-63.
Giant cell aoritis occurred in a 25-year-old woman, with absent pulses in the left arm and severe aortic regurgitation from dilatation of the valvar annulus. The aortic valve was replaced by a Starr-Edwards prosthesis, and the patient was treated with steroids. Five years later, she continues asymptomatic and haemodynamically stable. The left brachial and radial pulses have returned.
PMCID: PMC471222  PMID: 7361287
6.  Primary oat cell carcinoma of the trachea. 
Thorax  1979;34(1):130-131.
PMCID: PMC471024  PMID: 220746
7.  Staged bilateral lobectomy for synchronous bilateral squamous cell carcinoma of lung. 
Thorax  1978;33(4):511-513.
The history, diagnosis, and treatment by staged bilateral lobectomy of synchronous bilateral squamous cell carcinoma of the lung occurring in a 61-year-old man is presented. Histological diagnosis of pulmonary lesions suspected of being carcinomas should always be obtained, and extrathoracic metastasis should be excluded by all available means before planning treatment. The side showing evidence of greater malignancy on histology, or the one with the larger carcinoma, should be operated on first. Conservative, staged, bilateral resection is recommended.
PMCID: PMC470923  PMID: 694806
8.  Delayed non-mycotic false aneurysm of ascending aortic cannulation site. 
Thorax  1977;32(6):743-748.
Two cases of delayed non-mycotic false aneurysm arising from ascending aortic cannulation site, presenting one-and-a-hald years and seven years after cardiopulmonary bypass, are described. These two cases represent an incidence of 0.12% of this complication. Repair using profound hypothermia and circulatory arrest with femoral artery and femoral vein cannulation for cardiopulmonary bypass is recommended. The advantages and complications of aortic cannulation are discussed and recommendations to minimise the complications of cannulation are made. The clinical presentation and diagnosis of non-mycotic false aneurysms arising from the aortic cannulation site are described. In addition one delayed and two early cases of non-mycotic cannulation site false aneurysms previously published are analysed. Surgeons should be alert to the possibility of this complication in all patients who have had aortic cannulation for cardiopulmonary bypass even in the distant past. Unexpected symptoms such as constant anterior chest pain, dysphagia, hoarseness, and increasing widening of the superior mediastinum on the chest radiograph warrant prompt investigation.
PMCID: PMC470825  PMID: 601739
9.  Tumour size as a prognostic factor after resection of lung carcinoma. 
Thorax  1977;32(1):19-25.
Two hundred and ninety-five patients who underwent resection for carcinoma of the lung are reviewed, with a particular view to size of tumour and survival rate. The carcinomas were divided into four groups by size. It was found that the larger the tumour the worse was the prognosis. The prognosis in large carcinomas could not be directly attributed to a preponderance of an unfavourable cell type, lymph node metastasis or mediastinal extension. Vascular dissemination at the time of operation is believed to be a major factor for the poor prognosis in this group of carcinomas. Radiotherapy before operation and early ligation of the pulmonary veins might improve the results of resection of large carcinomas.
PMCID: PMC470519  PMID: 841529

Results 1-9 (9)