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Background: This study evaluated the safety and efficacy of endoscopy in diagnosing anastomotic leaks after esophagectomy., Methods: One hundred consecutive postesophagectomy patients, all having reconstruction using the stomach, underwent endoscopy in the first week after operation. The anastomosis and gastric mucosa were examined for evidence of ischemia, necrosis, and leak., Results: There was no evidence that the procedure caused damage to the anastomosis or gastric conduit. The results of 79 examinations were normal, 15 showed gastric ischemia, 2 showed a leak, and 4 showed ischemia plus leakage. The 15 patients with ischemia alone were monitored with a repeat endoscopy after a further week: a late leak developed in 1 patient that was diagnosed at the second examination. No further leaks developed subsequently, making endoscopy 100% accurate in the diagnosis of leaks after esophagectomy., Conclusions: Esophagoscopy within 1 week of esophagectomy is a safe and highly accurate method of diagnosing leaks and provides unique information on the condition of the stomach. We believe it allows a more targeted approach to patient care in the context of anastomotic healing and in the treatment of leaks., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Numerous historical screening programs to detect lung cancer have been undertaken. With technologic advances, complimentary diagnostic tests have been developed; however, only the National Lung Cancer Trial has demonstrated increased survival. Following the success of this study, screening programs are being trialled in several countries. Screening should, in theory, reduce lung cancer deaths by identifying asymptomatic patients with earlier tumors. This study asked whether lung cancer patients who are asymptomatic at presentation have a better survival than those who present with symptoms., Methods: This was a retrospective analysis of a validated prospective thoracic surgery database from a tertiary center in the Northwest of England. Included were 1,546 consecutive patients (826 men, 720 women) who received operative intervention for non-small cell lung cancer. The main outcome measures included 5-year survival and univariate and multivariate Cox regression analysis., Results: Cancer stage, age, and operation type were confirmed as being of prognostic importance, validating previous studies. Survival between asymptomatic or symptomatic patients did not differ significantly (p = 0.489), regardless of stage. The hazard ratios (with 95% confidence intervals) for variables associated with poorer outcome identified by Cox's regression analysis were male sex, 1.34 (1.15 to 1.56); advancing age, 1.03 (1.02 to 1.04); advancing stage, 3.30 (2.69 to 4.04); and pneumonectomy, 1.24 (1.01 to 1.52). Symptoms were not a significant variable affecting survival on multivariate analysis., Conclusions: This retrospective study from the Northwest of England showed that in our subset of lung cancer patients undergoing resection, asymptomatic patients with non-small cell lung cancer do not have improved survival, implying it is a systemic disease in many at diagnosis. Care should be taken when generalizing the results of the National Lung Screening Trial to all populations until further validation has been performed., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Little data exist as to the long-term outcome of non-small cell lung cancer that extends across the fissure into the adjacent lobe that requires either a bilobectomy or a lobectomy and wedge resection., Methods: Lobectomy survival data was benchmarked with the International Association for the Study of Lung Cancer (IALSC) dataset. Matched analysis of a prospective thoracic surgery database of 1,020 patients who had undergone lobectomy during a 6-year period was analyzed to elucidate the effect on long-term survival of tumors that extend across the interlobar fissure., Results: Benchmarking revealed our data are not significantly different from the IALSC dataset, allowing survival recommendations to be drawn. Histopathologic staging of matched patients was IA, 11.7%; IB, 51.1%; IIA, 1.7%; IIB, 21.1%; IIIA, 10.0%; IIIB, 2.8%; and IV, 1.7%. Stage I tumors crossing the interlobar fissure had a reduction in survival that is significant (10% to 15%) after 5 years (p = 0.037). The 5-year survival for stage I tumors extending across a lung fissure was 50%. This places the 5-year survival between stage I and II (60% and 40%, respectively). There was no difference in survival for tumors stage IIA and above with regard to importance of interlobar extension. The number of patients was too small to detect a significant difference between bilobectomy versus lobectomy and wedge., Conclusions: Non-small cell lung cancer that extends across the fissure into an adjacent lobe requiring a bilobectomy or a lobectomy and wedge resection has a 5-year survival between stages I and II., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

For the most part, the competitive athlete is a well-adjusted individual who demonstrates considerable vigor and well-being, as well as less depression, anxiety, and fatigue than nonathletic counterparts. The well-trained athlete, however, may also have a personality that is somewhat rigid, strongly goal oriented, and perfectionist. It is not unrealistic to expect that when confronted with diminished performance or success, such an athlete may be compelled to drive himself or herself harder to succeed. Such behavior typically leads to the phenomenon of overtraining, which can express itself in the form of chronic fatigue and depression. There are a number of other organic causes of chronic fatigue and depression, however, which must be excluded by careful evaluation and appropriate diagnostic testing. Although the evaluation of the athlete who presents with chronic fatigue and depression can be somewhat complex, a diagnostic framework has been outlined here to assist the clinician in the assessment of an athlete who presents with such complaints.