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Sample records for surgical vats lobectomy

  1. Crossing the bridge to VATS lobectomy.

    Science.gov (United States)

    Tcherveniakov, P; Bogdan, C; Chaudhuri, N

    2017-11-01

    Introduction The impact of the introduction of video assisted thoracoscopic surgery (VATS) on the management of lung cancer 20 years ago has been well documented. However, the uptake of VATS lobectomy in surgical practice worldwide has been slower than expected. We believe that this is partly due to a lack of consensus on how this procedure should be integrated into training programmes. We present our initial experience with a newly developed training model, which could help bridge the divide between open and VATS lobectomy. Methods Two surgical registrars were initiated into this model, supervised by a single consultant. All cases were performed using a standardised three-port anterior approach with systematic lymph node dissection. Both registrars were scrubbed for each case, alternating as first surgeon and assistant, with the supervising consultant operating the camera. Results Over a 6-month period, 22 lung resections for non-small cell lung carcinoma were performed as VATS lobectomies. Thirteen of them were upper lobectomies. There were no emergency conversions to open surgery. The mean operative time for the registrars was 155 minutes compared with 140 minutes for consultant-led operations (p=0.22). There was no perioperative mortality. The most common postoperative complications were atrial fibrillation (4 cases) and prolonged air leak (3 cases). Conclusions VATS lobectomy involves a team approach. Especially in upper lobectomies, the assistant surgeon plays a significant role in the operation, often helping with the dissection as well as stapling of the bronchial and vascular structures. With a team consisting of two trainees and a supervising surgeon, the teaching process becomes more intuitive and is accelerated. This should reduce the learning curve considerably and improve safety during training.

  2. VATS Lobectomy: Surgical Evolution from Conventional VATS to Uniportal Approach

    Directory of Open Access Journals (Sweden)

    Diego Gonzalez-Rivas

    2012-01-01

    Full Text Available There is no standardized technique for the VATS lobectomy, though most centres use 2 ports and add a utility incision. However, the procedure can be performed by eliminating the two small ports and using only the utility incision with similar outcomes. Since 2010, when the uniportal approach was introduced for major pulmonary resection, the technique has been spreading worldwide. The single-port technique provides a direct view to the target tissue. The conventional triple port triangulation creates a new optical plane with genesis of dihedral or torsional angle that is not favorable with standard two-dimension monitors. The parallel instrumentation achieved during single-port approach mimics inside the maneuvers performed during open surgery. Furthermore, it represents the less invasive approach possible, and avoiding the use of trocar, we minimize the compression of the intercostal nerve. Further development of new technologies like sealing devices for all vessels and fissure, robotic arms that open inside the thorax, and wireless cameras will facilitate the uniportal approach to become the standard surgical procedure for pulmonary resection in most thoracic departments.

  3. Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: are there outcomes advantages?

    Science.gov (United States)

    Lee, Benjamin E; Korst, Robert J; Kletsman, Elaine; Rutledge, John R

    2014-02-01

    To determine if there are advantages to transitioning to robotics by a surgeon who is already proficient in performing video-assisted thoracic surgical (VATS) lobectomy. A single surgeon proficient in VATS lobectomy initiated a robotic lobectomy program, and a retrospective review was conducted of his patients undergoing minimally invasive lobectomy (robotics or VATS) for lung cancer between 2011 and 2012. Data collected included patient/tumor characteristics, morbidity, mortality, operative times, and length of hospital stay. Over a 24-month period, a total of 69 patients underwent minimally invasive lobectomy (35 robotic, 34 VATS). Patients in each group were similar in age and clinical stage. Robotic upper lobectomy operative times were longer than VATS (172 vs 134 minutes; P = .001), with no significant difference in lower lobectomies noted (140 vs 123 minutes; P = .1). Median length of stay was 3 days in both groups, and the median number of lymph nodes harvested was 18 (robotic) versus 16 (VATS; P = .42). Morbidity and mortality for robotic versus VATS were 11% versus 18% (P = .46) and 0% versus 3% (P = .49), respectively. There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes. The learning curve for robotic upper lobectomies seems to be more significant than that for lower lobectomies. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  4. Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy.

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    Jensen, Katrine; Bjerrum, Flemming; Hansen, Henrik Jessen; Petersen, René Horsleben; Pedersen, Jesper Holst; Konge, Lars

    2017-06-01

    The societies of thoracic surgery are working to incorporate simulation and competency-based assessment into specialty training. One challenge is the development of a simulation-based test, which can be used as an assessment tool. The study objective was to establish validity evidence for a virtual reality simulator test of a video-assisted thoracoscopic surgery (VATS) lobectomy of a right upper lobe. Participants with varying experience in VATS lobectomy were included. They were familiarized with a virtual reality simulator (LapSim ® ) and introduced to the steps of the procedure for a VATS right upper lobe lobectomy. The participants performed two VATS lobectomies on the simulator with a 5-min break between attempts. Nineteen pre-defined simulator metrics were recorded. Fifty-three participants from nine different countries were included. High internal consistency was found for the metrics with Cronbach's alpha coefficient for standardized items of 0.91. Significant test-retest reliability was found for 15 of the metrics (p-values 50 VATS lobectomies performed). A pass/fail level defined as approximately one standard deviation from the mean metric scores for experienced surgeons passed none of the novices (0 % false positives) and failed four of the experienced surgeons (29 % false negatives). This study is the first to establish validity evidence for a VATS right upper lobe lobectomy virtual reality simulator test. Several simulator metrics demonstrated significant differences between novices and experienced surgeons and pass/fail criteria for the test were set with acceptable consequences. This test can be used as a first step in assessing thoracic surgery trainees' VATS lobectomy competency.

  5. Video-assisted Thoracoscopic surgery (VATS) lobectomy for lung cancer does not induce a procoagulant state

    DEFF Research Database (Denmark)

    Christensen, Thomas Decker; Vad, Henrik; Pedersen, Søren

    2017-01-01

    Background: Changes in the coagulation system in patients undergoing surgery for lung cancer have been sparsely investigated and the impact of the surgical trauma on the coagulation system is largely unknown in these patients. An increased knowledge could potentially improve the thromboprophylaxis...... regimes. The aim of this study was to assess the coagulation profile evoked in patients undergoing curative surgery by Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer. Methods: Thirty-one patients diagnosed with primary lung cancer undergoing VATS lobectomy were prospectively...... thrombography. Patients did not receive thromboprophylactic treatment. Data was analyzed using repeated measures one-way ANOVA. Results: The standard coagulation parameters displayed only subtle changes after surgery and the ROTEM® and thrombin generation results remained largely unchanged. Conclusions...

  6. Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy

    DEFF Research Database (Denmark)

    Jensen, Katrine; Bjerrum, Flemming; Hansen, Henrik Jessen

    2017-01-01

    for a virtual reality simulator test of a video-assisted thoracoscopic surgery (VATS) lobectomy of a right upper lobe. METHODS: Participants with varying experience in VATS lobectomy were included. They were familiarized with a virtual reality simulator (LapSim(®)) and introduced to the steps of the procedure...... % false positives) and failed four of the experienced surgeons (29 % false negatives). CONCLUSION: This study is the first to establish validity evidence for a VATS right upper lobe lobectomy virtual reality simulator test. Several simulator metrics demonstrated significant differences between novices...

  7. Lung salvage by pulmonary arterioplasty after vascular injury during video-assisted thoracoscopic surgical right upper lobectomy.

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    Petel, M R; Mahieu, J; Baste, J M

    2015-01-01

    Video Assisted Thoracoscopic Surgical (VATS) lobectomy is now considered feasible and safe. Nevertheless, thoracic surgeons need to be aware of dramatic complications that may occur during this procedure and how best to manage them. We report the case of a severe tear of the right pulmonary artery (PA) during elective VATS upper lobectomy, leading to emergency conversion to control the bleeding. Initial arterial repair was performed by end-to-end anastomosis. Early CT angiography showed thrombosis of the right PA due to anastomotic stenosis. We performed emergency pulmonary arterioplasty with a prosthetic patch to save the right lung. A CT scan days after surgical lung salvage confirmed the permeability of the PA and normal vascularization of the two remaining right lobes. We discuss herein this dramatic complication of VATS lobectomy, the viability of the lung after pulmonary arterial thrombosis, and advocate for early postoperative imaging after pulmonary arterioplasty. Copyright© Acta Chirurgica Belgica.

  8. Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach

    DEFF Research Database (Denmark)

    Hansen, Henrik Jessen; Petersen, René Horsleben; Christensen, Merete

    2011-01-01

    Lobectomy using video-assisted thoracoscopic surgery (VATS) still is a controversial operation despite its many observed benefits. The controversy may be due to difficulties performing the procedure. This study addresses a standardized anterior approach facilitating the operation....

  9. Uniportal video assisted thoracoscopic lobectomy: primary experience from an Eastern center.

    Science.gov (United States)

    Feng, Mingxiang; Shen, Yaxing; Wang, Hao; Tan, Lijie; Mao, Xuping; Liu, Yi; Wang, Qun

    2014-12-01

    Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy is an emerging technique for the surgical resection of non-small cell lung cancer (NSCLC). Besides its wide debates on safety and efficacy throughout the world, there were few report on uniportal VATS from the Eastern countries. In this article, we summarized our primary experience on uniportal VATS lobectomy in an Eastern center. From October 2013 till February 2014, 54 consecutive uniportal VATS lobectomy were performed in the Department of Thoracic Surgery, Zhongshan Hospital of Fudan University. Patients' clinical features and operative details were recorded. Post-operatively, the morbidity and mortality were recorded to analyze the safety and efficacy of uniportal VATS lobectomy for NSCLCs. Among the 54 planned uniportal VATS lobectomy, there was one conversion to mini-thoracotomy due to lymph node sticking. Extra ports were required in two patients. The uniportal VATS lobectomy was achieved in 51 out of 54 patients (94.4%). The average operation duration was 122.2±37.5 min (90-160 min). The average volume of estimated blood loss during the operation was 88.8±47.1 mL (50-200 mL). The mean chest tube duration and hospital stay were 3.2±1.9 days and 4.6±2.0 days, respectively. There was no postoperative mortality in this study. Two patients suffered from prolonged air leakage (5 and 7 days), and one atrial fibrillation was observed in this cohort. Based on our primary experience, uniportal VATS lobectomy is a safe and effective procedure for the surgical resection of NSCLCs. The surgical refinements and instrumental improvements would facilitate the technique. Further studies based on larger population are required to determine its benefits towards patients with NSCLCs.

  10. Video-assisted thoracoscopic surgery lobectomy at 20 years

    DEFF Research Database (Denmark)

    Yan, Tristan D; Cao, Christopher; D'Amico, Thomas A

    2014-01-01

    OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) lobectomy has been gradually accepted as an alternative surgical approach to open thoracotomy for selected patients with non-small-cell lung cancer (NSCLC) over the past 20 years. The aim of this project was to standardize the perioperative....... No statistically significant differences in the responses between the two rounds of questioning were identified. Consensus was reached on 21 controversial points, outlining the current accepted definition of VATS lobectomy, its indications and contraindications, perioperative clinical management...... and recommendations for training and future research directions. CONCLUSION: The present Consensus Statement represents a collective agreement among 50 international experts to establish a standardized practice of VATS lobectomy for the thoracic surgical community after 20 years of clinical experience....

  11. Learning thoracoscopic lobectomy

    DEFF Research Database (Denmark)

    Petersen, René Horsleben; Hansen, Henrik Jessen

    2010-01-01

    Thoracoscopic (video-assisted thoracoscopic surgery (VATS)) lobectomy is a safe and effective method for treating early-stage lung cancer. Despite this, it is still not widely practised, which could be due to a shallow learning curve. We have evaluated the surgical outcome in a training programme...

  12. Concomitant Mediastinoscopy Increases the Risk of Postoperative Pneumonia After Pulmonary Lobectomy.

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    Yendamuri, Sai; Battoo, Athar; Attwood, Kris; Dhillon, Samjot Singh; Dy, Grace K; Hennon, Mark; Picone, Anthony; Nwogu, Chukwumere; Demmy, Todd; Dexter, Elisabeth

    2018-05-01

    Mediastinoscopy is considered the gold standard for preresectional staging of lung cancer. We sought to examine the effect of concomitant mediastinoscopy on postoperative pneumonia (POP) in patients undergoing lobectomy. All patients in our institutional database (2008-2015) undergoing lobectomy who did not receive neoadjuvant therapy were included in our study. The relationship between mediastinoscopy and POP was examined using univariate (Chi square) and multivariate analyses (binary logistic regression). In order to validate our institutional findings, lobectomy data in the National Surgical Quality Improvement Program (NSQIP) from 2005 to 2014 were analyzed for these associations. Of 810 patients who underwent a lobectomy at our institution, 741 (91.5%) surgeries were performed by video-assisted thoracic surgery (VATS) and 487 (60.1%) patients underwent concomitant mediastinoscopy. Univariate analysis demonstrated an association between mediastinoscopy and POP in patients undergoing VATS [odds ratio (OR) 1.80; p = 0.003], but not open lobectomy. Multivariate analysis retained mediastinoscopy as a variable, although the relationship showed only a trend (OR 1.64; p = 0.1). In the NSQIP cohort (N = 12,562), concomitant mediastinoscopy was performed in 9.0% of patients, with 44.5% of all the lobectomies performed by VATS. Mediastinoscopy was associated with POP in patients having both open (OR1.69; p < 0.001) and VATS lobectomy (OR 1.72; p = 0.002). This effect remained in multivariate analysis in both the open and VATS lobectomy groups (OR 1.46, p = 0.003; and 1.53, p = 0.02, respectively). Mediastinoscopy may be associated with an increased risk of POP after pulmonary lobectomy. This observation should be examined in other datasets as it potentially impacts preresectional staging algorithms for patients with lung cancer.

  13. Development and validation of a theoretical test of proficiency for video-assisted thoracoscopic surgery (VATS) lobectomy

    DEFF Research Database (Denmark)

    Savran, Mona M; Hansen, Henrik Jessen; Horsleben Petersen, René

    2015-01-01

    BACKGROUND: Testing stimulates learning, improves long-term retention, and promotes technical performance. No purpose-orientated test of competence in the theoretical aspects of VATS lobectomy has previously been presented. The purpose of this study was, therefore, to develop and gather validity...... performed significantly better than the novices (p better than the novices (p

  14. Video-assisted lobectomy for endobronchial leiomyoma.

    LENUS (Irish Health Repository)

    Bartosik, Waldemar

    2011-02-01

    Endobronchial leiomyomas are rare tumours arising from the smooth muscle on the bronchial tree. We describe a patient with a six-month history of chest infections, who was treated surgically with a video-assisted thoracic surgery (VATS) lobectomy. The pathology revealed an endobronchial leiomyoma that coexisted with postobstructive pulmonary non-necrotising granulomas.

  15. A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme.

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    Brunelli, Alessandro; Tentzeris, Vasileios; Sandri, Alberto; McKenna, Alexandra; Liew, Shan Liung; Milton, Richard; Chaudhuri, Nilanjan; Kefaloyannis, Emmanuel; Papagiannopoulos, Kostas

    2016-05-01

    To develop a clinically risk-adjusted financial model to estimate the cost associated with a video-assisted thoracoscopic surgery (VATS) lobectomy programme. Prospectively collected data of 236 VATS lobectomy patients (August 2012-December 2013) were analysed retrospectively. Fixed and variable intraoperative and postoperative costs were retrieved from the Hospital Accounting Department. Baseline and surgical variables were tested for a possible association with total cost using a multivariable linear regression and bootstrap analyses. Costs were calculated in GBP and expressed in Euros (EUR:GBP exchange rate 1.4). The average total cost of a VATS lobectomy was €11 368 (range €6992-€62 535). Average intraoperative (including surgical and anaesthetic time, overhead, disposable materials) and postoperative costs [including ward stay, high dependency unit (HDU) or intensive care unit (ICU) and variable costs associated with management of complications] were €8226 (range €5656-€13 296) and €3029 (range €529-€51 970), respectively. The following variables remained reliably associated with total costs after linear regression analysis and bootstrap: carbon monoxide lung diffusion capacity (DLCO) 0.05) in 86% of the samples. A hypothetical patient with COPD and DLCO less than 60% would cost €4270 more than a patient without COPD and with higher DLCO values (€14 793 vs €10 523). Risk-adjusting financial data can help estimate the total cost associated with VATS lobectomy based on clinical factors. This model can be used to audit the internal financial performance of a VATS lobectomy programme for budgeting, planning and for appropriate bundled payment reimbursements. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  16. Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy

    DEFF Research Database (Denmark)

    Gjeraa, Kirsten; Mundt, Anna S.; Spanager, Lene

    2017-01-01

    Background Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived...... with complementary and overlapping scopes of practice between surgical and anesthesia subteams. Conclusions This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important...... by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. Methods This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data...

  17. To Explore Clinical Value of Single-port Video-assisted Thoracoscopic Surgery 
in Elderly Patients with Non-small Cell Lung Cancer: Lobectomy, Segmentectomy 
and Lobectomy vs Segmentectomy

    Directory of Open Access Journals (Sweden)

    Lin HUANG

    2018-04-01

    Full Text Available Background and objective The morbidity of lung cancer has long been the highest in cancer. Stage I, stage II and partly of stage III non-small cell lung cancer (NSCLC are mainly treated by surgery. Lobectomy and segmentectomy both are common lung resection methods. Video-assisted thoracoscopic surgery (VATS has been widely used in clinical, and the application of single-portvideo-assisted thoracoscopic surgery (SP VATS has gradually been recognized and accepted by professors. With increasing degree of eldly in society, eldly patients already have become inceasingly difficulties in the diagnosis and treatment of NSCLC. The aim of this study is to explore and analyze clinical value of SP VATS lobectomy and segmentectomy in elderly patients with NSCLC. Methods In this retrospective observational study, the outcomes of 417 consecutive patients who had undergone SP VATS anatomic segmentectomy or lobectomy for NSCLC from May 2014 to December 2016 on department of thoracic surgery in Fujian Medical University Affiliated Union Hospital were examined, including 139 elderly-case (lobectomy vs segmentectomy: 124 vs 15 and 278 nonelderly-case (lobectomy vs segmentectomy: 248 vs 30. The condition of perioperative period and postoperative short-time recovery could be compared with lobectomy and segmentectomy between elderly and nonelderly cases and lobectomy and segmentectomy in elderly cases. Results The morbidty of preoperative complications was significant difference (P0.05. Numbers of dissected lymph nodes and mediastinal nodal stations of SP VATS lobectomy in elderly patients with NSCLC were more than segmentectomy (P0.05. Postoperative drainage volume [(1,150.15±140.02 mL vs (853.53±177.04 mL] and duration [(7.00±1.31 d vs (5.00±0.74 d], duration of postoperative hospital stay [(3.18±1.32 d vs (5.04±1.30 d], costs [(70.06±5.23 thousands yuan vs (61.20±5.22 thousands yuan ] or postoperative complications (5.97% vs 20.00%(P>0.05. Notwithstanding

  18. Three-dimensional image reconstruction with free open-source OsiriX software in video-assisted thoracoscopic lobectomy and segmentectomy.

    Science.gov (United States)

    Yao, Fei; Wang, Jian; Yao, Ju; Hang, Fangrong; Lei, Xu; Cao, Yongke

    2017-03-01

    The aim of this retrospective study was to evaluate the practice and the feasibility of Osirix, a free and open-source medical imaging software, in performing accurate video-assisted thoracoscopic lobectomy and segmentectomy. From July 2014 to April 2016, 63 patients received anatomical video-assisted thoracoscopic surgery (VATS), either lobectomy or segmentectomy, in our department. Three-dimensional (3D) reconstruction images of 61 (96.8%) patients were preoperatively obtained with contrast-enhanced computed tomography (CT). Preoperative resection simulations were accomplished with patient-individual reconstructed 3D images. For lobectomy, pulmonary lobar veins, arteries and bronchi were identified meticulously by carefully reviewing the 3D images on the display. For segmentectomy, the intrasegmental veins in the affected segment for division and the intersegmental veins to be preserved were identified on the 3D images. Patient preoperative characteristics, surgical outcomes and postoperative data were reviewed from a prospective database. The study cohort of 63 patients included 33 (52.4%) men and 30 (47.6%) women, of whom 46 (73.0%) underwent VATS lobectomy and 17 (27.0%) underwent VATS segmentectomy. There was 1 conversion from VATS lobectomy to open thoracotomy because of fibrocalcified lymph nodes. A VATS lobectomy was performed in 1 case after completing the segmentectomy because invasive adenocarcinoma was detected by intraoperative frozen-section analysis. There were no 30-day or 90-day operative mortalities CONCLUSIONS: The free, simple, and user-friendly software program Osirix can provide a 3D anatomic structure of pulmonary vessels and a clear vision into the space between the lesion and adjacent tissues, which allows surgeons to make preoperative simulations and improve the accuracy and safety of actual surgery. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: a systematic review and meta-analysis.

    Science.gov (United States)

    Wei, Shiyou; Chen, Minghao; Chen, Nan; Liu, Lunxu

    2017-05-08

    The aim of this study is to evaluate the feasibility and safety of robot-assisted thoracic surgery (RATS) lobectomy versus video-assisted thoracic surgery (VATS) for lobectomy in patients with non-small cell lung cancer (NSCLC). An electronic search of six electronic databases was performed to identify relevant comparative studies. Meta-analysis was performed by pooling the results of reported incidence of overall morbidity, mortality, prolonged air leak, arrhythmia, and pneumonia between RATS and VATS lobectomy. Subgroup analysis was also conducted based on matched and unmatched cohort studies, if possible. Relative risks (RR) with their 95% confidence intervals (CI) were calculated by means of Revman version 5.3. Twelve retrospective cohort studies were included, with a total of 60,959 patients. RATS lobectomy significantly reduced the mortality rate when compared with VATS lobectomy (RR = 0.54, 95% CI 0.38-0.77; P = 0.0006), but this was not consistent with the pooled result of six matched studies (RR = 0.12, 95% CI 0.01-1.07; P = 0.06). There was no significant difference in morbidity between the two approaches (RR = 0.97, 95% CI 0.85-1.12; P = 0.70). RATS lobectomy is a feasible and safe technique and can achieve an equivalent short-term surgical efficacy when compared with VATS, but its cost effectiveness also should be taken into consideration.

  20. Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy: Team Perspectives.

    Science.gov (United States)

    Gjeraa, Kirsten; Mundt, Anna S; Spanager, Lene; Hansen, Henrik J; Konge, Lars; Petersen, René H; Østergaard, Doris

    2017-07-01

    Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data analysis was deductive, and directed content analysis was used to code the text into the Oxford Non-Technical Skills system for evaluating operating teams' non-technical skills. The most important non-technical skills described by the VATS teams were planning and preparation, situation awareness, problem solving, leadership, risk assessment, and teamwork. These non-technical skills enabled the team to achieve shared mental models, which in turn facilitated their efforts to anticipate next steps. This was viewed as important by the participants as they saw VATS lobectomy as a high-risk procedure with complementary and overlapping scopes of practice between surgical and anesthesia subteams. This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important additions to the shared mental model construct: planning and preparation, risk assessment, and leadership. Shared mental models are crucial for patient safety because they enable VATS teams to anticipate problems through adaptive patterns of both implicit and explicit coordination. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. VATS anatomic lung resections-the European experience

    DEFF Research Database (Denmark)

    Begum, Sofina; Hansen, Henrik Jessen; Papagiannopoulos, Kostas

    2014-01-01

    Video-assisted thoracoscopic surgery (VATS) has undergone significant evolution over several decades. Although endoscopic instruments continued to improve, it was not until 1992 that the first VATS lobectomy for lung cancer was performed. Despite significant seeding of such procedure in several...

  2. Medicoeconomic analysis of lobectomy using thoracoscopy versus thoracotomy for lung cancer: a study protocol for a multicentre randomised controlled trial (Lungsco01).

    Science.gov (United States)

    Pagès, Pierre-Benoit; Abou Hanna, Halim; Bertaux, Anne-Claire; Serge Aho, Ludwig Serge; Magdaleinat, Pierre; Baste, Jean-Marc; Filaire, Marc; de Latour, Richard; Assouad, Jalal; Tronc, François; Jayle, Christophe; Mouroux, Jérome; Thomas, Pascal-Alexandre; Falcoz, Pierre-Emmanuel; Marty-Ané, Charles-Henri; Bernard, Alain

    2017-06-15

    In the last decade, video-assisted thoracoscopic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC) has had a major effect on thoracic surgery. Retrospective series have reported benefits of VATS when compared with open thoracotomy in terms of postoperative pain, postoperative complications and length of hospital stay. However, no large randomised control trial has been conducted to assess the reality of the potential benefits of VATS lobectomy or its medicoeconomic impact. The French National Institute of Health funded Lungsco01 to determine whether VATS for lobectomy is superior to open thoracotomy for the treatment of NSCLC in terms of economic cost to society. This trial will also include an analysis of postoperative outcomes, the length of hospital stay, the quality of life, long-term survival and locoregional recurrence. The study design is a two-arm parallel randomised controlled trial comparing VATS lobectomy with lobectomy using thoracotomy for the treatment of NSCLC. Patients will be eligible if they have proven or suspected lung cancer which could be treated by lobectomy. Patients will be randomised via an independent service. All patients will be monitored according to standard thoracic surgical practices. All patients will be evaluated at day 1, day 30, month 3, month 6, month 12 and then every year for 2 years thereafter. The recruitment target is 600 patients. The protocol has been approved by the French National Research Ethics Committee (CPP Est I: 09/06/2015) and the French Medicines Agency (09/06/2015). Results will be presented at national and international meetings and conferences and published in peer-reviewed journals. NCT02502318. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Video-Assisted versus Open Lobectomy in Patients with Compromised Lung Function: A Literature Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Ruoyu Zhang

    Full Text Available It has been suggested that video-assisted (VATS lobectomy is safer than open lobectomy in patients with compromised lung function, but data regarding this are limited. We assessed acute outcomes of VATS compared to open lobectomy in these high-risk patients using a systematic literature review and meta-analysis of data.The databases PubMed and Scopus were searched for studies published between 2000 and 2013 that reported mortality and morbidity of VATS in high-risk lung cancer patients defined as having compromised pulmonary or cardiopulmonary function. Study selection, data collection and critical assessment of the included studies were performed according to the recommendations of the Cochrane Collaboration.Three case-control studies and three case series that included 330 VATS and 257 open patients were identified for inclusion. Operative mortality, overall morbidity and pulmonary morbidity were 2.5%, 39.3%, 26.2% in VATS patients and 7.8%, 57.5%, 45.5% in open lobectomy group, respectively. VATS lobectomy patients experienced significantly lower pulmonary morbidity (RR = 0.45; 95% CI, 0.30 to 0.67; p = 0.0001, somewhat reduced operative mortality (RR = 0.51; 95% CI, 0.24 to 1.06; p = 0.07, but no significant difference in overall morbidity (RR = 0.68; 95% CI, 0.41 to 1.14; p = 0.14.The existing data suggest that VATS lobectomy is associated with lower risk for pulmonary morbidity compared with open lobectomy in lung cancer patients with compromised lung function.

  4. Coagulation profile in open and video-assisted thoracoscopic lobectomies

    DEFF Research Database (Denmark)

    Christensen, Thomas Decker; Vad, Henrik; Pedersen, Søren

    2018-01-01

    OBJECTIVES: Lung cancer patients are perceived to have a relatively high risk of venous thromboembolic events due to an activation of the coagulation system. In terms of activation of the coagulation system, the difference between video-assisted thoracoscopic surgery (VATS) and open lobectomies...... for primary lung cancer has not been investigated. The aim of this study was to compare the impact on the coagulation system in patients undergoing curative surgery for primary lung cancer by either VATS or open lobectomies. METHODS: In total, 62 patients diagnosed with primary lung cancer were allocated...... to either VATS (n = 32) or open lobectomies (n = 30). All patients received subcutaneous injections with dalteparin (Fragmin®) 5000 IE once daily. The coagulation was assessed pre- and intraoperatively, and the first 2 days postoperatively by standard coagulation blood tests, thromboelastometry (ROTEM...

  5. [A Paired Case Controlled Study Comparing the Short-term Outcomes of Da Vinci RATS and VATS Approach for Non-small Cell Lung Cancer].

    Science.gov (United States)

    Dai, Feng; Xu, Shiguang; Xu, Wei; Ding, Renquan; Liu, Bo; Meng, Hao; Kang, Yunteng; Meng, Xiangrui; Lin, Jie; Wang, Shumin

    2018-03-20

    Da Vinci Surgical System is one of the greatest inventions of the 20th century, which represents the development direction of the precise minimally invasive surgical techniques, the aim of this study was to comparing the short-term outcomes between da Vinci robot-assisted lobectomy and video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer. 45 pairs of non-small cell lung cancer patients underwent pulmonary lobectomy with da Vinci Robotic assisted thoracoscopic (RATS) and VATS approach during the same period from January 2014 to January 2017. The operative time, estimated blood loss (EBL), total number and total groups of dissected lymph nodes, postoperative duration of drainage, the first day volume of drainage, total volume of drainage were compared. No perioperative death and convertion to thoracotomy occured in both groups. There were significant difference between RATS group and VATS group in EBL [(50.30±32.33) mL vs (208.60±132.63) mL], the first day volume of drainage [(275.00±145.42) mL vs (347.60±125.80) mL], the dissected total number [(22.67±9.67) vs (15.51±5.41)] and total team [(6.31±1.43) vs (4.91±1.04)] of lymph node. There were no significant difference in other outcomes. RATS is safe and effective and took better short-outcomes than VATS in non-small cell lung cancer.

  6. The influence of prior multiport experience on the learning curve for single-port thoracoscopic lobectomy: a multicentre comparative study†.

    Science.gov (United States)

    Martin-Ucar, Antonio E; Aragon, Javier; Bolufer Nadal, Sergio; Galvez Munoz, Carlos; Luo, Qigang; Perez Mendez, Itzel; Sihoe, Alan D L; Socci, Laura

    2017-06-01

    Competency in video-assisted thoracoscopic (VATS) lobectomy is estimated to be reached after the surgeon completes 50 cases. We wanted to explore the impact of competency in performing multiport VATS lobectomies on completing the needed number of single-port VATS. In a retrospective multicentre study, 6 individual surgeons (3 with previous competency in multiport VATS lobectomy and 3 without) submitted their first 50 cases of single-port VATS lobectomies. Extended and sublobar resections were excluded. Pre-, peri- and postoperative data were compared between the groups of surgeons. Chi-square and Wilcoxon's rank tests were used. The less experienced surgeons had previously attended dedicated training courses and visited with experts. A total of 300 cases were included [150 in Group A (surgeons with previous experience performing multiport VATS) and 150 in Group B (surgeons without extensive experience performing multiport VATS)]. Surgeons in Group B performed significantly more elective open lobectomies during their learning curve period than surgeons of Group A (58 vs 1). Patients in Group B were older and had more risk factors. There were 3 in-hospital deaths (respiratory failure, sepsis and fatal stroke). There were no differences between the groups in operative time, intensive care unit admissions, hospital stay, total complications, tumour size or number of N2 stations explored. Only the duration of intercostal drainage (2 vs 3 days, 0.012), incidence of respiratory tract infections (1% vs 7%, P  = 0.002) and conversion rates (4% vs 12%, P  = 0.018) were better in Group A. Patients characteristics played a role in the development of respiratory infections and longer drainage times but not in the need for conversion. Overall, postoperative outcomes during the learning curve period for single-port VATS lobectomies are not noticeably affected by previous multiport VATS experience. Less experienced surgeons were more selective in order to achieve

  7. A new possibility in thoracoscopic virtual reality simulation training: development and testing of a novel virtual reality simulator for video-assisted thoracoscopic surgery lobectomy.

    Science.gov (United States)

    Jensen, Katrine; Bjerrum, Flemming; Hansen, Henrik Jessen; Petersen, René Horsleben; Pedersen, Jesper Holst; Konge, Lars

    2015-10-01

    The aims of this study were to develop virtual reality simulation software for video-assisted thoracic surgery (VATS) lobectomy, to explore the opinions of thoracic surgeons concerning the VATS lobectomy simulator and to test the validity of the simulator metrics. Experienced VATS surgeons worked with computer specialists to develop a VATS lobectomy software for a virtual reality simulator. Thoracic surgeons with different degrees of experience in VATS were enrolled at the 22nd meeting of the European Society of Thoracic Surgeons (ESTS) held in Copenhagen in June 2014. The surgeons were divided according to the number of performed VATS lobectomies: novices (0 VATS lobectomies), intermediates (1-49 VATS lobectomies) and experienced (>50 VATS lobectomies). The participants all performed a lobectomy of a right upper lobe on the simulator and answered a questionnaire regarding content validity. Metrics were compared between the three groups. We succeeded in developing the first version of a virtual reality VATS lobectomy simulator. A total of 103 thoracic surgeons completed the simulated lobectomy and were distributed as follows: novices n = 32, intermediates n = 45 and experienced n = 26. All groups rated the overall user realism of the VATS lobectomy scenario to a median of 5 on a scale 1-7, with 7 being the best score. The experienced surgeons found the graphics and movements realistic and rated the scenario high in terms of usefulness as a training tool for novice and intermediate experienced thoracic surgeons, but not very useful as a training tool for experienced surgeons. The metric scores were not statistically significant between groups. This is the first study to describe a commercially available virtual reality simulator for a VATS lobectomy. More than 100 thoracic surgeons found the simulator realistic, and hence it showed good content validity. However, none of the built-in simulator metrics could significantly distinguish between novice, intermediate

  8. Coronary artery disease is associated with an increased mortality rate following video-assisted thoracoscopic lobectomy

    DEFF Research Database (Denmark)

    Sandri, Alberto; Petersen, Rene Horsleben; Decaluwé, Herbert

    2017-01-01

    OBJECTIVE: To compare the incidence of major adverse cardiac events (MACE) and mortality following video-assisted thoracoscopic surgery (VATS) lobectomy in patients with and without coronary artery disease (CAD). METHODS: Multicentre retrospective analysis of 1699 patients undergoing VATS lobectomy...

  9. Left lower lobe sleeve lobectomy for lung cancer using the Da Vinci surgical system.

    Science.gov (United States)

    Zhao, Yandong; Jiao, Wenjie; Ren, Xiaoyang; Zhang, Liangdong; Qiu, Tong; Fu, Bo; Wang, Lei

    2016-04-12

    Despite the robotic surgery is widely applied, sleeve lobectomy for lung cancer using the Da Vinci surgical system is still less performed. We described a sleeve lobectomy for adenocarcinoma located at the left lower lobe using the Da Vinci surgical system. A case of 57-year old female referred to our hospital. Computed tomography scan showed an occupation located at the left lower lobe and adenocarcinoma project from the lobe bronchus was diagnosed by bronchoscope examination. A sleeve lobectomy was performed using the Da Vinci surgical system and the postoperative recovery was uneventful. Robotic thoracic surgery is feasible to perform sleeve lobectomy inspite of inadequate experience.

  10. Propensity Score Analysis Comparing Videothoracoscopic Lobectomy With Thoracotomy: A French Nationwide Study.

    Science.gov (United States)

    Pagès, Pierre-Benoit; Delpy, Jean-Philippe; Orsini, Bastien; Gossot, Dominique; Baste, Jean-Marc; Thomas, Pascal; Dahan, Marcel; Bernard, Alain

    2016-04-01

    Video-assisted thoracoscopic surgery (VATS) lobectomy has recently become the recommended approach for stage I non-small cell lung cancer. However, these guidelines are not based on any large randomized control trial. Our study used propensity scores and a sensitivity analysis to compare VATS lobectomy with open thoracotomy. From 2005 to 2012, 24,811 patients (95.1%) were operated on by open thoracotomy and 1,278 (4.9%) by VATS. The end points were 30-day postoperative death, postoperative complications, hospital stay, overall survival, and disease-free survival. Two propensity scores analyses were performed: matching and inverse probability of treatment weighting, and one sensitivity analysis to unmask potential hidden bias. A subgroup analysis was performed to compare "high-risk" with "low-risk" patients. Results are reported by odds ratios or hazard ratios and their 95% confidence intervals. Postoperative death was not significantly reduced by VATS whatever the analysis. Concerning postoperative complications, VATS significantly decreased the occurrence of atelectasis and pneumopathy with both analysis methods, but there were no differences in the occurrence of other postoperative complications. VATS did not provide a benefit for high-risk patients. The VATS approach decreased the hospital length of stay from 2.4 days (95% confidence interval, -1.7 to -3 days) to -4.68 days (95% confidence interval, -8.5 to 0.9 days). Overall survival and disease-free survival were not influenced by the surgical approach. The sensitivity analysis showed potential biases. The results must be interpreted carefully because of the differences observed according to the propensity scores method used. A multicenter randomized controlled trial is necessary to limit the biases. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Video-assisted thoracoscopic surgery lobectomy via confronting upside-down monitor setting

    OpenAIRE

    Mun, Mingyon; Ichinose, Junji; Matsuura, Yosuke; Nakao, Masayuki; Okumura, Sakae

    2017-01-01

    Video-assisted thoracoscopic surgery (VATS) has been widely accepted as a minimally invasive surgery for treatment of early-stage lung cancer. However, various VATS approaches are available. In patients with lung cancer, VATS should achieve not only minimal invasiveness but also safety and oncological clearance. In this article, we introduce our method of VATS lobectomy.

  12. Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer.

    Science.gov (United States)

    Mafé, Juan J; Planelles, Beatriz; Asensio, Santos; Cerezal, Jorge; Inda, María-Del-Mar; Lacueva, Javier; Esteban, Maria-Dolores; Hernández, Luis; Martín, Concepción; Baschwitz, Benno; Peiró, Ana M

    2017-08-01

    Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use. A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed. One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% vs. 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05). The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.

  13. How to deal with benign hilar or interlobar lymphadenopathy during video-assisted thoracoscopic surgery lobectomy.

    Science.gov (United States)

    Yan, Shi; Lv, Chao; Wang, Xing; Wu, Nan

    2016-01-01

    Video-assisted thoracoscopic surgery (VATS) surgery has changed the way lobectomy procedure was performed over the past few decades. However, some difficulties impede the accomplishment of VATS lobectomy, which of them, benign lymphadenopathy may pose a threat to safety of surgery. We reported a case with enlarged hilar and interlobar lymph nodes. The video showed the instrumentation and techniques that we had adopted to deal with the complicated dilemma during the operation. Critical experience was also suggested in some hypothetical scenarios. AS techniques were further refined, successful VATS segmentectomy or lobectomy with challenging hilar or interlobar lymphadenopathy could be performed without uncontrolled bleeding or unexpected conversion. A VATS approach is acceptable in the management of benign hilar or interlobar lymphadenopathy. However, facile technique is necessary to deal with intraoperative dilemma. To those who are not sure about the practicability of the VATS procedure, planned conversion is still an effective method to ensure safety of the operation.

  14. Surgeons’ Volume-Outcome Relationship for Lobectomies and Wedge Resections for Cancer Using Video-Assisted Thoracoscopic Techniques

    Directory of Open Access Journals (Sweden)

    Guy David

    2012-01-01

    Full Text Available This study examined the effect of surgeons’ volume on outcomes in lung surgery: lobectomies and wedge resections. Additionally, the effect of video-assisted thoracoscopic surgery (VATS on cost, utilization, and adverse events was analyzed. The Premier Hospital Database was the data source for this analysis. Eligible patients were those of any age undergoing lobectomy or wedge resection using VATS for cancer treatment. Volume was represented by the aggregate experience level of the surgeon in a six-month window before each surgery. A positive volume-outcome relationship was found with some notable features. The relationship is stronger for cost and utilization outcomes than for adverse events; for thoracic surgeons as opposed to other surgeons; for VATS lobectomies rather than VATS wedge resections. While there was a reduction in cost and resource utilization with greater experience in VATS, these outcomes were not associated with greater experience in open procedures.

  15. A multi-center retrospective study of single-port versus multi-port video-assisted thoracoscopic lobectomy and anatomic segmentectomy.

    Science.gov (United States)

    Ji, Chunyu; Xiang, Yangwei; Pagliarulo, Vincenzo; Lee, Jangming; Sihoe, Alan D L; Kim, HyunKoo; Zhang, Xuefei; Wang, Zhexin; Zhao, Weigang; Feng, Jian; Fang, Wentao

    2017-10-01

    To assess the feasibility and perioperative outcomes of single-port (SP) and multi-port (MP) approaches for video-assisted thoracoscopic surgery (VATS) lobectomy and anatomical segmentectomy. Retrospective data from 458 patients who received VATS lobectomy or anatomical segmentectomy at Shanghai Chest Hospital, Korea University Guro Hospital, Affiliated Hospital of National Taiwan University, University of Hong Kong Queen Mary Hospital and Shenzhen Hospital were collected. Patients were divided into SP group and MP group according to the surgical approach. Perioperative factors such as operation time, blood loss during surgery, conversion rate, the number and stations of lymph nodes harvested, postoperative chest tube drainage time, postoperative hospitalization time, perioperative morbidity and mortality, and pain scores during the first 3 days after surgery were compared between the two groups. There were no differences in the number (P=0.278) and stations (P=0.564) of lymph nodes harvested, postoperative morbidity (P=0.414) or mortality(P=0.246), and pain score on the third day (P=0.630) after surgery between the two groups. The SP group had a longer operation time (P=0.042) and greater intraoperative blood loss (P<0.001), but the conversion rate was even higher in the MP group (P=0.018). Patients in the SP group had shorter chest tube removal time (P=0.012) and postoperative hospitalization time (P=0.005). Pain scores were lower on the first (P=0.014) and second (P=0.006) day after surgery in the SP group. SP VATS lobectomy and anatomical segmentectomy is technologically more demanding than MP VATS. It can be safe and feasible in the hands of experienced surgeons, with comparable preoperative outcomes to MP VATS, but less pain in the early postoperative period.

  16. Video-assisted thoracic surgery for left upper lobectomy for complex lesions: how to extend the indication with optimal safety?

    Science.gov (United States)

    Bayard, Nathanaël Frank; Barnett, Stephen Arthur; Rinieri, Philippe; Melki, Jean; Peillon, Christophe; Baste, Jean Marc

    2016-08-01

    The feasibility of extending the VATS approach to locally advanced NSCLC has been described with good clinical outcome. These complex resections are still technically challenging and patient safety must remain the highest priority. In this article, we describe our routine VATS approach for left upper lobectomy in proximal, locally advanced lesions. Both surgical and anaesthesiology teams are trained during simulation sessions to respond rapidly in case of urgent thoracotomy. Encircling arterial and venous vessels allow control of inadvertent bleeding during difficult dissection. Also, whenever needed the double vessel control technique is a time saver waiting for conversion to thoracotomy.

  17. Enhanced recovery after surgery and video-assisted thoracic surgery lobectomy: the Italian VATS Group**List of collaborators of the Italian ERAS Group: Jacopo Vannucci, MD (University of Perugia); Antonio D’Andrilli, MD (S. Andrea Hospital, Roma); Majed Refai, MD (Ospedali Riuniti, Ancona); Guendalina Graffigna, MD (Università Cattolica del Sacro Cuore, Milano); Stefano Lovadina, MD (Ospedali Riuniti, Trieste); Marzia Umari (Ospedali Riuniti, Trieste), Paolo Ferrari, MD (IRCCS ISMETT-UPMC, University of Pittsburgh, Palermo); Michele Zuliani, MD (Ospedali Riuniti, Trieste); Marco Taurchini, MD (Casa Sollievo della Sofferenza, San Giovanni Rotondo); Carlo Del Naja, MD (Casa Sollievo della Sofferenza, San Giovanni Rotondo); Domenico Massullo, MD (S. Andrea Hospital, Roma), Olha Putina, MD (ASST Mantova), Nicoletta Pia Ardò (University of Foggia). surgical protocol

    Science.gov (United States)

    Viggiano, Domenico; Voltolini, Luca; Bertani, Alessandro; Bertolaccini, Luca; Crisci, Roberto; Droghetti, Andrea

    2018-01-01

    Enhanced recovery after surgery (ERAS®) is a strategy that seeks to reduce patients’ perioperative stress response, thereby reducing potential complications, decreasing hospital length of stay and enabling patients to return more quickly to their baseline functional status. The concept was introduced in the late 1990s and was first adopted in patients undergoing open colorectal surgery. Since then, the concept of ERAS has been adopted by multiple surgical specialties. The diffusion of video-assisted thoracic surgery lobectomy (VATS-L) sets also the surgical treatment of lung cancer as a new area for ERAS development. In this paper, we present the Italian VATS Group (www.vatsgroup.org) surgical protocol as part of the ERAS clinical pathway belonging to the VATS-L national database. PMID:29629203

  18. Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative intercostal catheter

    DEFF Research Database (Denmark)

    Wildgaard, Kim; Petersen, Rene H; Hansen, Henrik J

    2012-01-01

    OBJECTIVES: No golden standard for analgesia in video-assisted thoracic surgery (VATS) lobectomy exists. A simple multimodal approach using an intercostal catheter (ICC) may be of benefit since acute post-operative pain following VATS lobectomy primarily originates from the chest drain area......) and inserted an ICC at the drain site level for continuous delivery of 6 ml of 0.25% bupivacaine h(-1). Pain scores at rest, mobilization and with the extended arms were followed until discharge or for 4 days. RESULTS: Forty-eight patients, mean age 64 years (CI: 61-68), were included. The mean time...... for the PVB and ICC placement was 5 min (CI: 4.7-5.9). The mean pain score at rest using a numerical rating scale (NRS, 0-10) was 85% of patients reporting satisfactory or very satisfactory pain treatment all days. CONCLUSIONS: Acute pain after VATS lobectomy may be adequately controlled using a multimodal...

  19. Coagulation profile in patients undergoing video-assisted thoracoscopic lobectomy

    DEFF Research Database (Denmark)

    Christensen, Thomas Decker; Vad, Henrik; Pedersen, Søren

    2017-01-01

    -, and the first two days postoperatively by standard coagulation blood test, thromboelastometry (ROTEM®) and thrombin generation. Results: Patients undergoing potential curative surgery for lung cancer were not hypercoagulable preoperatively. There was no statistically significant difference in the majority......Background: Knowledge about the impact of Low-Molecular-Weight Heparin (LMWH) on the coagulation system in patients undergoing minimal invasive lung cancer surgery is sparse. The aim of this study was to assess the effect of LMWH on the coagulation system in patients undergoing Video......-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer. Methods: Sixty-three patients diagnosed with primary lung cancer undergoing VATS lobectomy were randomized to either subcutaneous injection with dalteparin (Fragmin®) 5000 IE once daily or no intervention. Coagulation was assessed pre-, peri...

  20. Lung segmentectomy: does it offer a real functional benefit over lobectomy?

    Science.gov (United States)

    Charloux, Anne; Quoix, Elisabeth

    2017-12-31

    Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy, in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies, a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series, it emerges that the mean decrease in forced expiratory volume in 1 s (FEV 1 ) is low, ranging from -9% to -24% of the initial value within 2 months and -3 to -13% 12 months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy, but saves only a few per cent of pre-operative FEV 1 Moreover, the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed, including whether video-assisted thoracic surgery (VATS) segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function, especially within the early days after surgery, and whether this may translate to lowering the functional limit for surgery. Eventually, trials comparing stereotactic ablative body radiotherapy, radiofrequency ablation and segmentectomy functional consequences are warranted. Copyright ©ERS 2017.

  1. Lung segmentectomy: does it offer a real functional benefit over lobectomy?

    Directory of Open Access Journals (Sweden)

    Anne Charloux

    2017-10-01

    Full Text Available Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy, in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies, a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series, it emerges that the mean decrease in forced expiratory volume in 1 s (FEV1 is low, ranging from −9% to −24% of the initial value within 2 months and −3 to −13% 12 months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy, but saves only a few per cent of pre-operative FEV1. Moreover, the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed, including whether video-assisted thoracic surgery (VATS segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function, especially within the early days after surgery, and whether this may translate to lowering the functional limit for surgery. Eventually, trials comparing stereotactic ablative body radiotherapy, radiofrequency ablation and segmentectomy functional consequences are warranted.

  2. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer

    DEFF Research Database (Denmark)

    Bendixen, Morten; Jørgensen, Ole Dan; Kronborg, Christian

    2016-01-01

    (1:1) to lobectomy via four-port VATS or anterolateral thoracotomy. After surgery, we applied identical surgical dressings to ensure masking of patients and staff. Postoperative pain was measured with a numeric rating scale (NRS) six times per day during hospital stay and once at 2, 4, 8, 12, 26......, and 52 weeks, and self-reported quality of life was assessed with the EuroQol 5 Dimensions (EQ5D) and the European Organisation for Research and Treatment of Cancer (EORTC) 30 item Quality of Life Questionnaire (QLQ-C30) during hospital stay and 2, 4, 8, 12, 26, and 52 weeks after discharge. The primary...... died during the follow-up period (three in the VATS group and six in the thoracotomy group). INTERPRETATION: VATS is associated with less postoperative pain and better quality of life than is anterolateral thoracotomy for the first year after surgery, suggesting that VATS should be the preferred...

  3. Single port VATS: recent developments in Asia.

    Science.gov (United States)

    Yu, Peter S Y; Capili, Freddie; Ng, Calvin S H

    2016-03-01

    Single port video-assisted thoracic surgery (VATS) is the most recent evolution in minimally invasive thoracic surgery. With increasing global popularity, the single port VATS approach has been adopted by experienced thoracic surgeons in many Asian countries. From initial experience of single port VATS lobectomy to the more complex sleeve resection procedures now forming part of daily practice in some Asia institutes, the region has been the proving ground for single port VATS approaches' feasibility and safety. In addition, certain technical refinements in single port VATS lung resection and lymph node dissection have also sprung from Asia. Novel equipment designed to facilitate single port VATS allowing further reduce access trauma are being realized by the partnership between surgeons and the industries. Advanced thoracoscopes and staplers that are narrower and more maneuverable are particularly important in the smaller habitus of patients from Asia. These and similar new generation equipment are being applied to single port VATS in novel ways. As dedicated thoracic surgeons in the region continue to striving for excellence, innovative ideas in single incision access including subxiphoid and embryonic natural-orifice transluminal endoscopic surgery (e-NOTES) have been explored. Adjunct techniques and technology used in association with single port VATS such as non-intubated surgery, hybrid operating room image guidance and electromagnetic navigational bronchoscopy are all in rapid development in Asia.

  4. Video-assisted thoracic surgery lobectomy cost variability: implications for a bundled payment era.

    Science.gov (United States)

    Medbery, Rachel L; Perez, Sebastian D; Force, Seth D; Gillespie, Theresa W; Pickens, Allan; Miller, Daniel L; Fernandez, Felix G

    2014-05-01

    In 2013, the Centers for Medicare and Medicaid Services began its Bundled Payments for Care Improvement Initiative. If payments are to be bundled, surgeons must be able to predict which patients are at risk for more costly care. We aim to identify factors driving variability in hospital costs after video-assisted thoracic surgery (VATS) lobectomy for lung cancer. Our institutional Society of Thoracic Surgeons data were queried for patients undergoing VATS lobectomy for lung cancer during fiscal years 2010 to 2011. Clinical outcomes data were linked with hospital financial data to determine operative and postoperative costs. Linear regression models were created to identify the impact of preoperative risk factors and perioperative outcomes on cost. One hundred forty-nine VATS lobectomies for lung cancer were reviewed. The majority of patients had clinical stage IA lung cancer (67.8%). Median length of stay was 4 days, with 30-day mortality and morbidity rates of 0.7% and 37.6%, respectively. Mean operative and postoperative costs per case were $8,492.31 (±$2,238.76) and $10,145.50 (±$7,004.71), respectively, resulting in an average overall hospital cost of $18,637.81 (±$8,244.12) per patient. Patients with chronic obstructive pulmonary disease and coronary artery disease, as well as postoperative urinary tract infections and blood transfusions, were associated with statistically significant variability in cost. Variability in cost associated with VATS lobectomy is driven by assorted patient and clinical variables. Awareness of such factors can help surgeons implement quality improvement initiatives and focus resource utilization. Understanding risk-adjusted clinical-financial data is critical to designing payment arrangements that include financial and performance accountability, and thus ultimately increasing the value of health care. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Nonintubated uniportal VATS pulmonary anatomical resections.

    Science.gov (United States)

    Galvez, Carlos; Navarro-Martinez, Jose; Bolufer, Sergio; Lirio, Francisco; Sesma, Julio; Corcoles, Juan Manuel

    2017-01-01

    Nonintubated procedures have widely developed during the last years, thus nowadays major anatomical resections are performed in spontaneously breathing patients in some centers. In an attempt for combining less invasive surgical approaches with less aggressive anesthesia, nonintubated uniportal video-assisted thoracic surgery (VATS) lobectomies and segmentectomies have been proved feasible and safe, but there are no comparative trials and the evidence is still poor. A program in nonintubated uniportal major surgery should be started in highly experienced units, overcoming first a learning period performing minor procedures and a training program for the management of potential crisis situations when operating on these patients. A multidisciplinary approach including all the professionals in the operating room (OR), emergency protocols and a comprehensive knowledge of the special physiology of nonintubated surgery are mandatory. Some concerns about regional analgesia, vagal block for cough reflex control and oxygenation techniques, combined with some specific surgical tips can make safer these procedures. Specialists must remember an essential global concept: all the efforts are aimed at decreasing the invasiveness of the whole procedure in order to benefit patients' intraoperative status and postoperative recovery.

  6. Lung abscess combined with chronic osteomyelitis of the mandible successfully treated with video-assisted thoracoscopic surgery.

    Science.gov (United States)

    Arai, Hiromasa; Inui, Kenji; Watanabe, Keisuke; Watanuki, Kei; Okudela, Koji; Tsuboi, Masahiro; Masuda, Munetaka

    2015-04-01

    With the progress of antibiotic therapy, the mortality of lung abscess has been improved, and surgical intervention has declined. However, surgery is still required in selected cases that are intractable to antibiotic treatment. Video-assisted thoracoscopic surgery (VATS) is beneficial for treatment and/or diagnosis of pulmonary disease as it provides a less invasive surgical technique and reduces prolongation of post-operative recovery. However, the indication of VATS lobectomy for lung abscess is controversial as a result of particular complications, i.e. wet lung, intrapleural adhesion and ease of bleeding. We herein report a rare combination of lung abscess and osteomyelitis of mandible resulting from the same pathogen successfully treated with VATS lobectomy. We propose VATS lobectomy for lung abscess. This procedure might be the best treatment candidate for selected cases of lung abscess. © 2014 John Wiley & Sons Ltd.

  7. Comparison of VATS and Robotic Approaches For Clinical Stage I and II NSCLC Using the STS Database

    Science.gov (United States)

    Louie, Brian E.; Wilson, Jennifer L.; Kim, Sunghee; Cerfolio, Robert J.; Park, Bernard J.; Farivar, Alexander S.; Vallières, Eric; Aye, Ralph W.; Burfeind, William R.; Block, Mark I.

    2016-01-01

    Background Data from selected centers show that robotic lobectomy (RL) is safe, effective and has comparable 30-day mortality to video assisted lobectomy (VATS). However, widespread adoption of RL is controversial. We used the STS-GTS-Database to evaluate quality metrics for these two minimally invasive lobectomy techniques. Methods A database query for primary clinical stage I or II NSCLC at high volume centers from 2009 to 2013 identified 1,220 RLs and 12,378 VATS. Quality metrics evaluated included operative morbidity, 30-day mortality and nodal upstaging (NU), defined as cN0 to pN1. Multivariable logistic regression was used to evaluate NU. Results RL patients were older, less active, less likely to be an ever smoker, and had higher BMI (all p<0.05). They were also more likely to have coronary heart disease or hypertension (all p<0.001) and to have had preoperative mediastinal staging (p<0.0001). RL operative times were longer (median 186 vs 173 min, p<0.001); all other operative parameters were similar. All postoperative outcomes were similar including complications and 30-day mortality (RL 0.6% vs VATS 0.8%, p=0.4). Median length of stay was 4 days for both, but a higher proportion of RLs stayed < 4 days: 48% vs 39%, p<0.001. NU overall was similar (p=0.6), but with trends favoring VATS in the cT1b group, and RL in the cT2a group. Conclusions RL patients had more co-morbidities and RL operative times were longer, but quality outcome measures including complications, hospital stay, 30-day mortality, and NU suggest RL and VATS are equivalent. PMID:27209613

  8. The variability of practice in minimally invasive thoracic surgery for pulmonary resections.

    Science.gov (United States)

    Rocco, Gaetano; Internullo, Eveline; Cassivi, Stephen D; Van Raemdonck, Dirk; Ferguson, Mark K

    2008-08-01

    Thoracic surgeons participating in this survey seemed to have clearly indicated their perception of VATS major lung resections, in particular VATS lobectomy. 1. The acronym VATS as a short form of "video-assisted thoracic surgery" was the preferred terminology. 2. According to the respondents, the need or use of rib spreading served as the defining characteristic of "open" thoracic surgery. 3. It was most commonly suggested that VATS lobectomy is performed by means of two or three port incisions with the addition of a minithoracotomy or access incision. 4. Rib spreading (shearing) was not deemed acceptable as part of a strictly defined VATS procedure. 5. Although there was no general consensus, respondents suggested that the preferred approach for visualization in a VATS procedure was only through the video monitor. 6. Although minimally invasive procedures for lung resection are still mainly being used for diagnostic and minor therapeutic purposes, young surgeons seemed to be more likely to recommend VATS lung surgery for major pulmonary resections than their more senior colleagues. 7. The survey confirmed that the use of the standard posterolateral thoracotomy is still widespread. Almost 40% of the surgeons claimed to use the standard posterolateral thoracotomy for more than 50% of their cases and less than 30% use it for less than 5% of cases. 8. The major reasons to perform VATS lobectomy were perceived to be reduced pain and decreased hospitalization. 9. Approximately 60% of the surgeons claimed to perform VATS lobectomy in less than 5% of their lobectomy cases. Younger consultants reported using VATS lobectomy in up to 50% of their lobectomy cases. There was the suggestion that lack of resources could justify the minor impact of VATS lobectomy in the thoracic surgical practice in middle- to low-income countries. 10. The currently available scientific evidence on safety and effectiveness, and technologic advancements were emphasized as the two factors having a

  9. Use of sugammadex in lung cancer patients undergoing video-assisted thoracoscopic lobectomy.

    Science.gov (United States)

    Cho, Hyun Chul; Lee, Jong Hwan; Lee, Seung Cheol; Park, Sang Yoong; Rim, Jong Cheol; Choi, So Ron

    2017-08-01

    This study aimed to retrospectively evaluate the use of sugammadex in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. Data were obtained from medical record review of patients who underwent VATS lobectomy from January 2013 to November 2014. Fifty patients were divided into two groups: the sugammadex group (group S, n = 19) was administered sugammadex 2 mg/kg, while the pyridostigmine group (group P, n = 31) received pyridostigmine 20 mg with glycopyrrolate 0.2 mg or atropine 0.5 mg. The primary endpoint measure was the overall incidence of postoperative pulmonary complications including prolonged air leak, pneumonia, and atelectasis. The secondary endpoint measures were the length of postoperative hospital stay and duration of chest tube insertion. The overall incidence of postoperative pulmonary complications in patients in group S was significantly lower compared with that of group P (5 [26.3%] vs. 17 [54.8%]; P = 0.049). Also, the durations of chest tube insertion (5.0 [4.0-7.0] vs. 7.0 [6.0-8.0] days; P = 0.014) and postoperative hospital stay (8.0 [8.0-10.0] vs. 10.0 [9.0-11.0] days; P = 0.019) were shorter in group S compared with group P. Administration of sugammadex was associated reduced with postoperative pulmonary complications (OR: 0.22; 95% CI: 0.05-0.87; P = 0.031). The use of sugammadex, compared with pyridostigmine, showed a significantly reduced overall incidence of postoperative pulmonary complications and decreased duration of chest tube use and postoperative hospital stay in patients undergoing VATS lobectomy, suggesting that sugammadex might be helpful in improving clinical outcomes in such patients.

  10. Surgical Treatment for Pulmonary Hamartomas

    Directory of Open Access Journals (Sweden)

    Funda Ižncekara

    2015-11-01

    Full Text Available Aim: In this study, we evaluated the patients operated for hamartoma and treated endobronchially and the diagnostic value of this approach has been examined. Material and Method: 59 patients (24 females, 35 males; mean age 53 years, range 28-78 years which were operated and endobronchial treated for hamartoma in our clinic between January 2003 - January 2013 were analyzed retrospectively. Patient age, sex, symptoms, histopathological, surgical procedures and treatment outcomes were evaluated. Results: The most common complaint was shortness of breath, while 25 patients were asymptomatic. Thoracotomy and mass enucleation in 29 patients (%49,15, thoracotomy and wedge resection in 18 patients (%30.5, VATS and wedge resection in 4 patients (%6.77, thoracotomy and upper lobectomy in 4 patients (%6.77, thoracotomy and lower lobectomy in 2 patients (%3.38 and left upper lobe segmentectomy in 1 patient (%1.69 and right upper bronchial sleeve resection in 1 patient were performed. The postoperative pathology of lesions examined and diagnosis were chondroid hamartoma in 28 , pulmonary hamartoma in 20 , hamartoma chondrolypomatous in 11 and the bronchial hamartoma in 2 . No mortality was observed intraoperatively. Discussion: Although hamartomas are benign , diagnosis should be made because it can be confused with lung cancer. Definitive diagnosis and treatment can be performed successfully through VATS in primarily appropriate cases with minimal morbidity or thoracotomy or endobronchial treatment.

  11. Global development and current evidence of uniportal thoracoscopic surgery

    Science.gov (United States)

    Tu, Cheng-Che

    2016-01-01

    In the era of video-assisted thoracoscopic surgery (VATS), uniportal and single incision thoracoscopic surgeries are gaining popularity. The spectrum of uniportal VATS indications is now almost equal to that of conventional VATS. For example, successful uniportal sleeve lobectomy, rib segmental resection, and management of intraoperative bleeding have all been reported. According to published data in the English-language literature, more than 9,545 uniportal VATS have been performed to date, including 1,293 lobectomies, 1,024 procedures for pneumothorax, and 6,845 sympathectomies. Of the 192 articles discussing this topic, 35 were conducted in Spain, and there were an increasing number of publications from China, Korea, and other Asian countries. There were 41 technical and review articles, all of which provided an excellent foundation of surgical concept and skill learning. The benefits of uniportal VATS include better surgical geometry and cosmetics. Regarding postoperative outcomes, thirteen out of the 15 articles reviewed showed that uniportal VATS has similar or superior outcomes to conventional VATS. Most studies demonstrated that uniportal VATS produced less postoperative pain and paresthesia. In conclusion, uniportal VATS can produce excellent operative outcome, which is becoming a mature surgical approach in thoracic disease, supported by fast-accumulating and abundant experience. PMID:27014479

  12. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jensen, Katrine; Petersen, Rene Horsleben

    2014-01-01

    In fast-track pulmonary resections, we removed chest tubes after video-assisted thoracic surgery (VATS) lobectomy with serous fluid production up to 500 ml/day. Subsequently, we evaluated the frequency of recurrent pleural effusions requiring reintervention....

  13. Thoracoscopic surgery for pulmonary metastases after chemotherapy using a tailor-made virtual lung

    International Nuclear Information System (INIS)

    Akiba, Tadashi; Marushima, Hideki; Kinoshita, Satoki; Kamiya, Noriteru; Odaka, Makoto; Takeyama, Hiroshi; Morikawa, Toshiaki

    2011-01-01

    Details with regard to the standard criteria for a therapeutic metastasectomy and the use of video-assisted thoracic surgery (VATS) remain elusive. To evaluate the feasibility of VATS using a tailor-made virtual lung for patients with pulmonary metastases after chemotherapy, we reviewed the following cases. Clinical data from October 2006 to April 2010 were obtained from patients who received chemotherapy before a pulmonary metastasectomy (lobectomy or segmentectomy). VATS was the primarily selected surgical approach except for treating hilar lesions. A lobectomy was performed when the metastasis was greater than 3.0 cm in diameter or located deeply in the lobe. Tailor-made virtual lungs were created using three-dimensional multidetector computed tomography before lobectomy on a routine basis. The virtual lung consisted of three-dimensional pulmonary vessels, a tracheobronchial tree, pulmonary parenchyma, and tumors. Twelve operations, consisting of 1 segmentectomy, 10 lobectomies, and 1 wedge bronchoplasty upper lobectomy, were performed on 11 patients during the study period. VATS was completed in 10 of these 12 operations. The mean operative time for the lobectomies was 257 min, and the mean operative bleeding volume was 215 ml. Two cases experienced postoperative transient atrial fibrillation, and no mortalities associated with these operations were reported. VATS was performed safely in instances of metastasectomy after chemotherapy, and the tailor-made virtual lung assisted in lung orientation during the operation. (author)

  14. Video-assisted thoracic surgery lobectomy does not offer any functional recovery advantage in comparison to the open approach 3 months after the operation: a case matched analysis†.

    Science.gov (United States)

    Salati, Michele; Brunelli, Alessandro; Xiumè, Francesco; Monteverde, Marco; Sabbatini, Armando; Tiberi, Michela; Pompili, Cecilia; Palloni, Roberto; Refai, Majed

    2017-06-01

    The objective of the present study was to compare functional loss [forced expiratory volume in one second to forced vital capacity ratio (FEV1), DLCO and VO2max reduction] after VATS versus open lobectomies. We performed a prospective observational study on 195 patients who had a pulmonary lobectomy from June 2010 to November 2014 and who were able to complete a 3-months functional evaluation follow-up program. Since the VATS technique was our first choice for performing lobectomies from January 2012, we divided the patients into two groups: the OPEN group (112 patients) and the VATS group (83 patients). The open approach was intended as a muscle sparing/nerve sparing lateral thoracotomy. Fourteen baseline factors were used to construct a propensity score to match the VATS-group patients with their OPEN-group counterparts. These two matched groups were then compared in terms of reduction of FEV1, DLCO and VO2max (Mann-Whitney test). The propensity score analysis yielded 83 well-matched pairs of OPEN and VATS patients. In both groups, 3 months postoperatively, we found a reduction in FEV1, DLCO and VO2max values (OPEN patients: FEV1-10%, DLCO -11.9%, VO2max - 5.5%; VATS patients: FEV1-7.2%, DLCO-10.6%, VO2max-6.9%). The reductions in FEV1, DLCO and VO2max were similar to those in the two matched groups, with a Cohen effect size offer any advantages in terms of FEV1, DLCO and exercise capacity recovery in comparison to the muscle-sparing thoracotomy approach. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  15. Prospective Clinical Study to Evaluate Clinical Performance of a Powered Surgical Stapler in Video-assisted Thoracoscopic Lung Resections

    DEFF Research Database (Denmark)

    Licht, Peter B; Ribaric, Goran; Crabtree, Traves

    2015-01-01

    Video-assisted thoracic surgery (VATS) research often focuses on postoperative air leak, with special consideration for prolonged air leak. There is limited clinical data regarding how stapling devices might affect performance and postoperative outcomes, including air leak. This prospective...... of postoperative air leaks, including prolonged air leak. Additional data collected included intraoperative details and postoperative outcomes. Prolonged air leak occurred in 22 subjects (10.3%) across procedures (152 lobectomies, 63 wedge resections, and 11 occurrences of wedge resection plus lobectomy......). There were no significant differences in occurrence or duration of PAL between the U.S. and Europe. Regional differences were observed for intraoperative leak testing and cartridge selection relative to tissue type. Despite differences in surgical technique between continents, no major or significant...

  16. Surgical Treatment of Small Pulmonary Nodules Under Video-assisted Thoracoscopy 
(A Report of 129 Cases

    Directory of Open Access Journals (Sweden)

    Tong WANG

    2017-01-01

    Full Text Available Background and objective The development of image technology has led to increasing detection of pulmonary small nodules year by year, but the determination of their nature before operation is difficult. This clinical study aimed to investigate the necessity and feasibility of surgical resection of pulmonary small nodules through a minimally invasive approach and the operational manner of non-small cell lung cancer (NSCLC. Methods The clinical data of 129 cases with pulmonary small nodule of 10 mm or less in diameter were retrospectively analyzed in our hospital from December 2013 to November 2016. Thin-section computed tomography (CT was performed on all cases with 129 pulmonary small nodules. CT-guided hook-wire precise localization was performed on 21 cases. Lobectomy, wedge resection, and segmentectomy with lymph node dissection might be performed in patients according to physical condition. Results Results of the pathological examination of 37 solid pulmonary nodules (SPNs revealed 3 primary squamous cell lung cancers, 3 invasive adenocarcinomas (IAs, 2 metastatic cancers, 2 small cell lung cancers (SCLCs, 16 hamartomas, and 12 nonspecific chronic inflammations. The results of pathological examination of 49 mixed ground glass opacities revealed 19 IAs, 6 micro invasive adenocarcinomas (MIAs, 4 adenocarcinomas in situ (AIS, 1 atypical adenomatous hyperplasia (AAH, 1 SCLC, and 18 nonspecific chronic inflammations. The results of pathological examination of 43 pure ground glass opacities revealed 19 AIS, 6 MIAs, 6 IA, 6 AAHs, and 6 nonspecific chronic inflammations. Wedge resection under video-assisted thoracoscopic surgery (VATS was performed in patients with 52 benign pulmonary small nodules. Lobectomy and systematic lymph node dissection under VATS were performed in 33 patients with NSCLC. Segmentectomy with selective lymph node dissection, wedge resection, and selective lymph node dissection under VATS were performed in six patients with

  17. Chest pain control with kinesiology taping after lobectomy for lung cancer: initial results of a randomized placebo-controlled study.

    Science.gov (United States)

    Imperatori, Andrea; Grande, Annamaria; Castiglioni, Massimo; Gasperini, Laura; Faini, Agnese; Spampatti, Sebastiano; Nardecchia, Elisa; Terzaghi, Lorena; Dominioni, Lorenzo; Rotolo, Nicola

    2016-08-01

    Kinesiology taping (KT) is a rehabilitative technique performed by the cutaneous application of a special elastic tape. We tested the safety and efficacy of KT in reducing postoperative chest pain after lung lobectomy. One-hundred and seventeen consecutive patients, both genders, age 18-85, undergoing lobectomy for lung cancer between January 2013 and July 2015 were initially considered. Lobectomies were performed by the same surgical team, with thoracotomy or video-assisted thoracoscopic surgery (VATS) access. Exclusion criteria (n = 25 patients) were: previous KT exposure, recent trauma, pre-existing chest pain, lack of informed consent, >24-h postoperative intensive care unit treatment. After surgery, the 92 eligible patients were randomized to KT experimental group (n = 46) or placebo control group (n = 46). Standard postoperative analgesia was administered in both groups (paracetamol/non-steroidal anti-inflammatory drugs, epidural analgesia including opioids), with supplemental analgesia boluses at patient request. On postoperative day 1 in addition, in experimental group patients a specialized physiotherapist applied KT, with standardized tape length, tension and shape, over three defined skin areas: at the chest access site pain trigger point; over the ipsilateral deltoid/trapezius; lower anterior chest. In control group, usual dressing tape mimicking KT was applied over the same areas, as placebo. Thoracic pain severity score [visual analogue scale (VAS) ranging 0-10] was self-assessed by all patients on postoperative days 1, 2, 5, 8, 9 and 30. The KT group and the control group had similar demographics, lung cancer clinico-pathological features and thoracotomy/VATS ratio. Postoperatively, the two groups also resulted similar in supplemental analgesia, complication rate, mean duration of chest drainage and length of stay. There were no adverse events with KT application. After tape application, KT patients reported overall less thoracic pain than the

  18. Simulation-based training for thoracoscopic lobectomy

    DEFF Research Database (Denmark)

    Jensen, Katrine; Ringsted, Charlotte; Hansen, Henrik Jessen

    2014-01-01

    overcome the first part of the learning curve, but no virtual-reality simulators for thoracoscopy are commercially available. This study aimed to investigate whether training on a laparoscopic simulator enables trainees to perform a thoracoscopic lobectomy. METHODS: Twenty-eight surgical residents were...... randomized to either virtual-reality training on a nephrectomy module or traditional black-box simulator training. After a retention period they performed a thoracoscopic lobectomy on a porcine model and their performance was scored using a previously validated assessment tool. RESULTS: The groups did...... not differ in age or gender. All participants were able to complete the lobectomy. The performance of the black-box group was significantly faster during the test scenario than the virtual-reality group: 26.6 min (SD 6.7 min) versus 32.7 min (SD 7.5 min). No difference existed between the two groups when...

  19. Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols.

    Science.gov (United States)

    Piccioni, Federico; Segat, Matteo; Falini, Stefano; Umari, Marzia; Putina, Olga; Cavaliere, Lucio; Ragazzi, Riccardo; Massullo, Domenico; Taurchini, Marco; Del Naja, Carlo; Droghetti, Andrea

    2018-03-01

    Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

  20. Coagulation profile in patients undergoing video-assisted thoracoscopic lobectomy: A randomized, controlled trial.

    Directory of Open Access Journals (Sweden)

    Thomas Decker Christensen

    Full Text Available Knowledge about the impact of Low-Molecular-Weight Heparin (LMWH on the coagulation system in patients undergoing minimal invasive lung cancer surgery is sparse. The aim of this study was to assess the effect of LMWH on the coagulation system in patients undergoing Video-Assisted Thoracoscopic Surgery (VATS lobectomy for primary lung cancer.Sixty-three patients diagnosed with primary lung cancer undergoing VATS lobectomy were randomized to either subcutaneous injection with dalteparin (Fragmin® 5000 IE once daily or no intervention. Coagulation was assessed pre-, peri-, and the first two days postoperatively by standard coagulation blood test, thromboelastometry (ROTEM® and thrombin generation.Patients undergoing potential curative surgery for lung cancer were not hypercoagulable preoperatively. There was no statistically significant difference in the majority of the assessed coagulation parameters after LMWH, except that the no intervention group had a higher peak thrombin and a shorter INTEM clotting time on the first postoperative day and a lower fibrinogen level on the second postoperative day. A lower level of fibrin d-dimer in the LMWH group was found on the 1. and 2.postoperative day, although not statistical significant. No differences were found between the two groups in the amount of bleeding or number of thromboembolic events.Use of LMWH administered once daily as thromboprophylaxis did not alter the coagulation profile per se. As the present study primarily evaluated biochemical endpoints, further studies using clinical endpoints are needed in regards of an optimized thromboprophylaxis approach.

  1. A new possibility in thoracoscopic virtual reality simulation training

    DEFF Research Database (Denmark)

    Jensen, Katrine; Bjerrum, Flemming; Hansen, Henrik Jessen

    2015-01-01

    OBJECTIVES: The aims of this study were to develop virtual reality simulation software for video-assisted thoracic surgery (VATS) lobectomy, to explore the opinions of thoracic surgeons concerning the VATS lobectomy simulator and to test the validity of the simulator metrics. METHODS: Experienced...... VATS surgeons worked with computer specialists to develop a VATS lobectomy software for a virtual reality simulator. Thoracic surgeons with different degrees of experience in VATS were enrolled at the 22nd meeting of the European Society of Thoracic Surgeons (ESTS) held in Copenhagen in June 2014...... content validity. Metrics were compared between the three groups. RESULTS: We succeeded in developing the first version of a virtual reality VATS lobectomy simulator. A total of 103 thoracic surgeons completed the simulated lobectomy and were distributed as follows: novices n = 32, intermediates n = 45...

  2. VAT on Arbitration

    DEFF Research Database (Denmark)

    Thygesen, Jette

    2016-01-01

    The VAT classification of services provided in connection with arbitration proceedings will be illustrated on the basis of the law and practice in Denmark, Germany and Sweden. Since VAT is a tax that has been harmonised in the EU, the VAT position ought to be the same for similar services in all...... they are not regarded as subject to VAT. For the background to why VAT is not levied on services connected with arbitration proceedings in Denmark, it is necessary to look at some past rulings of the Danish VAT Tribunal (Momsnævn). These decisions were made prior to the amendment of the Danish VAT Act in 1994 and so...

  3. Preoperative computed tomography of the chest in lung cancer patients: the predictive value of calcified lymph nodes for the perioperative outcomes of video-assisted thoracoscopic surgery lobectomy

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Kwang Nam; Lee, Youkyung; Wi, Jae Yeon [Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Department of Radiology, Seoul (Korea, Republic of); Moon, Hyeon-Jong; Sung, Yong Won [Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Department of Cardiothoracic Surgery, Seoul (Korea, Republic of)

    2013-12-15

    To determine the predictive value of identifying calcified lymph nodes (LNs) for the perioperative outcomes of video-assisted thoracoscopic surgery (VATS). Fifty-six consecutive patients who underwent VATS lobectomy for lung cancer were included. We evaluated the number and location of calcified LNs on computed tomography (CT). We investigated clinical parameters, including percentage forced expiratory volume in 1 s (FEV{sub 1}%), surgery duration, chest tube indwelling duration, and length of hospital stay. We performed linear regression analysis and multiple comparisons of perioperative outcomes. Mean number of calcified LNs per patient was 0.9 (range, 0-6), mostly located in the hilar-interlobar zone (43.8 %). For surgery duration (mean, 5.0 h), FEV{sub 1}% and emphysema severity were independent predictors (P = 0.010 and 0.003, respectively). The number of calcified LNs was an independent predictor for chest tube indwelling duration (P = 0.030) and length of hospital stay (P = 0.046). Mean duration of chest tube indwelling and hospital stay was 8.8 days and 12.7 days in no calcified LN group; 9.2 and 13.2 in 1 calcified LN group; 12.8 and 19.7 in {>=}2 calcified LNs group, respectively. The presence of calcified LNs on CT can help predict more complicated perioperative course following VATS lobectomy. (orig.)

  4. Liver parenchyma transection-first approach in hemihepatectomy with en bloc caudate lobectomy for hilar cholangiocarcinoma: A safe technique to secure favorable surgical outcomes.

    Science.gov (United States)

    Kawabata, Yasunari; Hayashi, Hikota; Yano, Seiji; Tajima, Yoshitsugu

    2017-06-01

    Although hemihepatectomy with total caudate lobectomy (hemiHx-tc) is essential for the surgical treatment of hilar cholangiocarcinoma, the advantage of an anterior approach for hemiHx-tc has not been fully discussed technically; the significance of an anterior approach without liver mobilization for preventing infectious complications also remains unknown. The liver parenchyma transection-first approach (Hp-first) technique is an early transection of the hepatic parenchyma without mobilization of the liver that utilizes a modified liver-hanging maneuver to avoid damaging the future remnant liver. Between May 2010 and August 2016, a total of 40 consecutive patients underwent surgery for hilar cholangiocarcinoma. Of these, 19 patients underwent a conventional hemihepatectomy with total caudate lobectomy (cHx), while 21 patients received a Hp-first. The patients in the Hp-first group had significantly less intraoperative blood loss (P hilar cholangiocarcinoma because it resulted in improved surgical outcomes as compared with the conventional approach. © 2017 Wiley Periodicals, Inc.

  5. Electronic versus traditional chest tube drainage following lobectomy

    DEFF Research Database (Denmark)

    Lijkendijk, Marike; Licht, Peter B; Neckelmann, Kirsten

    2015-01-01

    thoracic surgery, we conducted a randomized controlled trial (RCT) investigating chest tube duration and length of hospitalization. METHODS: Patients undergoing lobectomy were included in a prospective open label RCT. A strict algorithm was designed for early chest tube removal, and this decision...... was delegated to staff nurses. Data were analysed by Cox proportional hazard regression model adjusting for lung function, gender, age, BMI, video-assisted thoracic surgery (VATS) or open surgery and presence of incomplete fissure or pleural adhesions. Time was distinguished as possible (optimal) and actual.......014). CONCLUSIONS: Electronic drainage systems did not reduce chest tube duration or length of hospitalization significantly compared with traditional water seal drainage when a strict algorithm for chest tube removal was used. This algorithm allowed delegation of chest tube removal to staff nurses, and in some...

  6. EU COMPARISON OF VAT

    Directory of Open Access Journals (Sweden)

    MARIA ZENOVIA GRIGORE

    2012-05-01

    Full Text Available VAT is one of the newest tools of the global economy and is widely adopted in most of the countries. For EU Member States is required not only the existence of VAT, but also that its main characteristics to be uniformly implemented. This should facilitate intra-Community transactions, but in practice does not as there are many local variations which can lead to costly errors and penalties. The objective of this paper is to collate data about the main characteristics of VAT in EU Member States and to highlight the key differences between them. This survey shows that there continue to be opportunities and risks for businesses trading cross border, as a result of differences in application of Community legislation on VAT. This led to the necessity of VAT reform. On this basis, the Commission adopted on the end of the last year a Communication on the future of VAT. This sets out the fundamental characteristics that must underlie the new VAT regime, and priority actions needed to create a simpler, more efficient and more robust VAT system in the EU.

  7. Classifying VAT Legislation for Automation

    DEFF Research Database (Denmark)

    Sudzina, Frantisek; Nielsen, Morten Ib; Simonsen, Jakob Grue

    The paper offers a framework for partitioning articles in legal documents pertaining to value added tax (VAT) into categories suitable for subsequent integration in computerized systems for automatically deriving VAT rates. The importance of an enterprise resource planning (ERP) system supporting...... 2006 on the common system of value added tax is presented. The classification of VAT articles is important in order to allow for easier VAT modeling for ERP systems. Better VAT modeling should eventually lead to lower cost of implementing changes in VAT legislature....

  8. Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: results of a nationwide study based on the French national thoracic database, EPITHOR.

    Science.gov (United States)

    Orsini, Bastien; Baste, Jean Marc; Gossot, Dominique; Berthet, Jean Philippe; Assouad, Jalal; Dahan, Marcel; Bernard, Alain; Thomas, Pascal Alexandre

    2015-10-01

    The incidence rate of prolonged air leak (PAL) after lobectomy, defined as any air leak prolonged beyond 7 days, can be estimated to be in between 6 and 15%. In 2011, the Epithor group elaborated an accurate predictive score for PAL after open lung resections, so-called IPAL (index of prolonged air leak), from a nation-based surgical cohort constituted between 2004 and 2008. Since 2008, video-assisted thoracic surgery (VATS) has become popular in France among the thoracic surgical community, reaching almost 14% of lobectomies performed with this method in 2012. This minimally invasive approach was reported as a means to reduce the duration of chest tube drainage. The aim of our study was thus to validate the IPAL scoring system in patients having received VATS anatomical lung resections. We collected all anatomical VATS lung resections (lobectomy and segmentectomy) registered in the French national general thoracic surgery database (EPITHOR) between 2009 and 2012. The area under the receiver operating characteristic (ROC) curve estimated the discriminating value of the IPAL score. The slope value described the relation between the predicted and observed incidences of PALs. The Hosmer-Lemeshow test was also used to estimate the quality of adequacy between predicted and observed values. A total of 1233 patients were included: 1037 (84%) lobectomies and 196 (16%) segmentectomies. In 1099 cases (89.1%), the resection was performed for a malignant disease. Ninety-six patients (7.7%) presented with a PAL. The IPAL score provided a satisfactory predictive value with an area under the ROC curve of 0.72 (0.67-0.77). The value of the slope, 1.25 (0.9-1.58), and the Hosmer-Lemeshow test (χ(2) = 11, P = 0.35) showed that predicted and observed values were adequate. The IPAL score is valid for the estimation of the predictive risk of PAL after VATS lung resections. It may thus a priori be used to characterize any surgical population submitted to potential preventive measures

  9. Influencing Factor of Postoperation Fast-track Recovery and in Hospital Cost after Lobctomy for Lung Cancer

    Directory of Open Access Journals (Sweden)

    Jianhua SU

    2014-07-01

    Full Text Available Background and objective It is unknown that the postoperation fast-track recovery and in hospital cost of the lobectomy in lung cancer, we explored the influencing factor of postoperative fast-track recovery and in hospital cost after undergoing lobectomy for lung cancer. Methods We retrospectively reviewed the medical records of all patients (n=176 who underwent lobectomy for lung cancer between January 2010 and November 2011 by a thoracic surgeon. Results The hospital costs of video-assisted thoracic surgery (VATS lobectomy (47,308.21 ¥ is significantly higher than open lobectomy (45,664.31 ¥(P=0.007. The hospital costs of body mass index (BMI ≥ 24 kg/m2 (51,186.99 ¥ is significantly higher than BMI < 24 kg/m2 (41,701.64 ¥(P=0.032. The hospital stay of VATS lobectomy (5.70 d is significantly less than open lobectomy (7.10 d(P<0.001. Conclusion These findings indicate that preoperative pulmonary rehabilitation and VATS lobectomy is contributed to fast-track recovery for patients who undergo lobectomy, but increase the hospital costs.

  10. What are the Advantages? A Prospective Analysis of 16 versus 28 French Chest Tube Sizes in Video-assisted Thoracoscopic Surgery Lobectomy of Lung Cancer

    Directory of Open Access Journals (Sweden)

    Mei YANG

    2015-08-01

    Full Text Available Background and objective Post-operation management of minimally invasive thoracic surgery is similar to that of open surgery, especially on the drainage tube of the chest. The aim of this study is to compare the advantages of using 16 F versus 28 F chest tubes in video-assisted thoracoscopic surgery (VATS lobectomy of lung cancer. Methods Data from 163 patients (February-May 2014 who underwent VATS lobectomy of lung cancer with insertion of one chest drain (16 F or 28 F were analyzed. The following post-operative data were evaluated: primary healing of tube incision, CXR abnormalities (pneumothorax, fluid, atelectasis, subcutaneous emphysema, and hematoma, drainage time, new drain insertion, and wound healing at the site of insertion. Results A total of 75 patients received 28 F chest tubes, and 88 patients received 16 F chest tubes. Both groups were similar in age, gender, comorbidities, and pathological evaluation of resection specimens. After adjustment, no statistically significant difference was found between the two groups in relation to tube-related complications including residual pneumothoraces (4.00% vs 4.44%; P=0.999, subcutaneous emphysema (8.00% vs 6.67%; P=0.789, retained hemothorax (0 vs 41%, P=0.253, and drainage time [(28.4±16.12 h vs (22.1±11.8 h; P=0.120] The average total drainage volume and rrhythmia rates of the 16 F group [(365±106 mL, 14.67%] was less than that of the 28 F group [(665±217 mL, 4.5%; P=0.030, P=0.047]. The rates of primary healing at the site of insertion in the 16 F group (95.45% was higher than that in the 28 F group (77.73%, P=0.039. A significant difference was found on the post-operative length of stay of the two groups [(4.23±0.05 d vs (4.57±0.16 d, P=0.078]. Conclusion The use of 16 F chest tube for VATS lobectomy of patients with lung cancer did not affect the clinically relevant outcomes tested. However, 16 F chest tube facilitated faster wound healing at the site of insertion.

  11. The Right for Deducting VAT

    Directory of Open Access Journals (Sweden)

    Constantin Sergiu-Bogdan Constantin

    2017-01-01

    Full Text Available Romania must comply with the VAT Directive, the judgments of the Court of Justice of theEuropean Union and the European Court of Human Rights on VAT matter, that includes the matterof VAT deduction. The right to deduct VAT, in principle, cannot be limited for a taxable person andit is an abuse of law made by tax authorities when refusing this right. There are exceptions though,when the substantive and/or formal requirements are not met, the taxable person was involved in aVAT fraud or its supplier incorrectly drawn-up the invoice. The substantive requirements are: thepurchases must be from a taxable person and must be used for taxable activities. The formalrequirements are the obligations relating to accounting, invoicing and tax declarations. If taxauthorities discover a VAT fraud or/and that a VAT liability has not been declared they must takeimmediate measures, impose compliance and collect the corresponding sums from the responsibleperson.

  12. Off-the-job training for VATS employing anatomically correct lung models.

    Science.gov (United States)

    Obuchi, Toshiro; Imakiire, Takayuki; Miyahara, Sou; Nakashima, Hiroyasu; Hamanaka, Wakako; Yanagisawa, Jun; Hamatake, Daisuke; Shiraishi, Takeshi; Moriyama, Shigeharu; Iwasaki, Akinori

    2012-02-01

    We evaluated our simulated major lung resection employing anatomically correct lung models as "off-the-job training" for video-assisted thoracic surgery trainees. A total of 76 surgeons voluntarily participated in our study. They performed video-assisted thoracic surgical lobectomy employing anatomically correct lung models, which are made of sponges so that vessels and bronchi can be cut using usual surgical techniques with typical forceps. After the simulation surgery, participants answered questionnaires on a visual analogue scale, in terms of their level of interest and the reality of our training method as off-the-job training for trainees. We considered that the closer a score was to 10, the more useful our method would be for training new surgeons. Regarding the appeal or level of interest in this simulation surgery, the mean score was 8.3 of 10, and regarding reality, it was 7.0. The participants could feel some of the real sensations of the surgery and seemed to be satisfied to perform the simulation lobectomy. Our training method is considered to be suitable as an appropriate type of surgical off-the-job training.

  13. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules.

    Science.gov (United States)

    Altorki, Nasser K; Yip, Rowena; Hanaoka, Takaomi; Bauer, Thomas; Aye, Ralph; Kohman, Leslie; Sheppard, Barry; Thurer, Richard; Andaz, Shahriyour; Smith, Michael; Mayfield, William; Grannis, Fred; Korst, Robert; Pass, Harvey; Straznicka, Michaela; Flores, Raja; Henschke, Claudia I

    2014-02-01

    A single randomized trial established lobectomy as the standard of care for the surgical treatment of early-stage non-small cell lung cancer. Recent advances in imaging/staging modalities and detection of smaller tumors have once again rekindled interest in sublobar resection for early-stage disease. The objective of this study was to compare lung cancer survival in patients with non-small cell lung cancer with a diameter of 30 mm or less with clinical stage 1 disease who underwent lobectomy or sublobar resection. We identified 347 patients diagnosed with lung cancer who underwent lobectomy (n = 294) or sublobar resection (n = 53) for non-small cell lung cancer manifesting as a solid nodule in the International Early Lung Cancer Action Program from 1993 to 2011. Differences in the distribution of the presurgical covariates between sublobar resection and lobectomy were assessed using unadjusted P values determined by logistic regression analysis. Propensity scoring was performed using the same covariates. Differences in the distribution of the same covariates between sublobar resection and lobectomy were assessed using adjusted P values determined by logistic regression analysis with adjustment for the propensity scores. Lung cancer-specific survival was determined by the Kaplan-Meier method. Cox survival regression analysis was used to compare sublobar resection with lobectomy, adjusted for the propensity scores, surgical, and pathology findings, when adjusted and stratified by propensity quintiles. Among 347 patients, 10-year Kaplan-Meier for 53 patients treated by sublobar resection compared with 294 patients treated by lobectomy was 85% (95% confidence interval, 80-91) versus 86% (confidence interval, 75-96) (P = .86). Cox survival analysis showed no significant difference between sublobar resection and lobectomy when adjusted for propensity scores or when using propensity quintiles (P = .62 and P = .79, respectively). For those with cancers 20 mm or less in

  14. VAT EVASION INLEBANON: CASES AND MAIN CAUSES

    Directory of Open Access Journals (Sweden)

    Rana Ismail

    2012-07-01

    Full Text Available The Value Added Tax (VAT is a very important source oftreasuryrevenuesinLebanon. It was initially introduced inLebanon in order to reduce the budgetdeficit and help contain the debt. However, VAT evasion growth inLebanon isleading to significant VAT revenue losses because of its size and frequency.In this paper, we will highlight the contribution of VAT to the treasury revenue. Inaddition, our research has led to figure out the most significant VAT evasion casesand the way tax payers evade paying their required VAT or try to have an illegalrefund. From these tax evasion cases, we will pinpoint the main causes of suchevasions and propose solutions to limit as much as possible VAT evasion inLebanon.

  15. Benefits of awake uniportal pulmonary resection in a patient with a previous contralateral lobectomy.

    Science.gov (United States)

    Galvez, Carlos; Navarro-Martinez, Jose; Bolufer, Sergio; Lirio, Francisco; Mafe, Juan Jose; Rivera, Maria Jesus; Roca, Joaquin; Baschwitz, Benno

    2014-09-01

    Surgical resection of a contralateral recurrence of non-small cell lung cancer (NSCLC) is indicated in patients without evidence of disseminated disease and considered functionally operable. General anesthesia and double-lumen intubation involves one lobe ventilation in a patient treated with a previous lobectomy, thus increasing the risks of ventilator-induced injuries and the morbidity. Awake procedures facilitate the surgery decreasing the anesthetic and surgical times, keeping the diaphragm motion and diminishing the ventilator-induced injuries into the remaining contralateral lobe. We present a 43-year-old woman with a previous left-lower lobectomy for a 3.1-cm mucinous adenocarcinoma 15 months before without nodal involvement, who presents a right-lower lobe 8-mm cavitated nodule, with evident radiological growth and fine-needle aspiration concordant with mucinous adenocarcinoma. We suggest an awake procedure with locoregional epidural anesthesia.

  16. The Diagnosis and Surgical Treatment for Solitary Pulmonary Metastases: A Report of 156 Cases

    Directory of Open Access Journals (Sweden)

    Hui ZHANG

    2012-04-01

    Full Text Available Background and objective In recent years, it has been proven that surgical treatment for solitary pulmonary metastases has achieved satisfactory results. Consequently, the study aims to investigate the diagnosis, indications for surgery, operative techniques, and prognostic factors of the surgical resection for solitary pulmonary metastases, and to improve the survival rate of patients with pulmonary metastases. Methods The medical records of 156 patients with surgical procedures at our institution were retrospectively reviewed. Results The primary tumors were verified as cancer in 134 cases, sarcoma in 21, and 1 contained unknown tissue. There was no perioperative mortality. A total of 153 patients returned for follow up. Follow-up time was 1 yr to 10 yr. The 5-year survival rates were 31.2%. The median survival time was 35.8 months. Systematic lymph node dissection was performed in 113 patients. The 5-year survival rates were 12.5% for lymph node-positive patients and 37.3% for lymph node–negative patients. The patients who underwent lobectomies had better survival rates, with a 5-year survival rate of 38.5%. Conclusion Surgery is recommended for patients with solitary pulmonary metastasis if they fulfill the surgical indications and favorable outcomes can be achieved. VATS can be chosen for the patients. Hilar and mediastinal lymph node involvement and the surgical approach are potentially important prognostic factors.

  17. Choice of Surgical Procedure for Patients With Non-Small-Cell Lung Cancer ≤ 1 cm or > 1 to 2 cm Among Lobectomy, Segmentectomy, and Wedge Resection

    DEFF Research Database (Denmark)

    Dai, Chenyang; Shen, Jianfei; Ren, Yijiu

    2016-01-01

    PURPOSE: According to the lung cancer staging project, T1a (≤ 2 cm) non-small-cell lung cancer (NSCLC) should be additionally classified into ≤ 1 cm and > 1 to 2 cm groups. This study aimed to investigate the surgical procedure for NSCLC ≤ 1 cm and > 1 to 2 cm. METHODS: We identified 15...... multiple prognostic factors. RESULTS: OS and LCSS favored lobectomy compared with segmentectomy or wedge resection in patients with NSCLC ≤ 1 cm and > 1 to 2 cm. Multivariable analysis showed that segmentectomy and wedge resection were independently associated with poorer OS and LCSS than lobectomy...... for NSCLC ≤ 1 cm and > 1 to 2 cm. With sublobar resection, lower OS and LCSS emerged for NSCLC > 1 to 2 cm after wedge resection, whereas similar survivals were observed for NSCLC ≤ 1 cm. Multivariable analyses showed that wedge resection is an independent risk factor of survival for NSCLC > 1 to 2 cm...

  18. VAT on domestic energy

    International Nuclear Information System (INIS)

    Crawford, Ian; Smith, Stephen; Webb, Steven.

    1993-01-01

    This publication traces the background to the imposition of VAT on domestic energy, and considers the current patterns of spending. Results of a simulation of the effects of imposition of 17.5% VAT on domestic fuels are presented, and policy measures to offset the impact on poorer households are considered. (UK)

  19. Uniportal video assisted thoracic surgery: summary of experience, mini-review and perspectives.

    Science.gov (United States)

    Migliore, Marcello; Calvo, Damiano; Criscione, Alessandra; Borrata, Francesco

    2015-09-01

    The uniportal-video assisted thoracic surgery (VATS) technique comprises operations which can be performed with skin incisions ranging from 2 to 8 cm and the manifest result of the introduction of the uniportal lobectomy had made possible to increase rapidly the number of published papers on this subject. Many of the large ensuing literature report incomplete historical information on uniportal VATS, and doubts exist about the indication of uniportal VATS for some thoracic oncologic pathologies. Known limitations have been overcome. On the other hand, the modern thoracic surgical team includes one surgeon, one assistant and a scrub nurse, and it is clear that the new generation of thoracic surgeons need to use the "less" used hand. The new technology which permitted the introduction of the uniportal VATS could influence the future need of thoracic surgeons worldwide.

  20. The role of diagnostic VATS in penetrating thoracic injuries

    Directory of Open Access Journals (Sweden)

    Guasti Guido

    2006-10-01

    Full Text Available Abstract Background Penetrating chest injuries account for 1–13% of thoracic trauma hospital admissions and most of these are managed with a conservative approach. Nevertheless, 18–30% of cases managed only with tube thoracostomy have residual clotted blood, considered the major risk factor for the development of fibrothorax and empyema. In addition, 4–23% of chest injury patients present persistent pneumothorax and 15–59% present an injury to the diaphragm, which is missed in 30% of cases. In order to make a correct diagnosis, reduce the number of missed injuries, chronic sequelae and late mortality we propose performing surgical exploration of all patients with a penetrating injury of the pleural cavity. Methods 1270 patients who sustained thoracic trauma were admitted to our hospital between 1994 and 2004. Of these, 16 patients had penetrating injuries: thirteen were surgically explored by means of Video Assisted Thoracic Surgery (VATS, and 3 with thoracotomy due to hemodynamic instability or suspected lesion of the heart or great vessels. Results In the 13 patients who underwent VATS, 5 injuries to the diaphragm, 3 lesions to an intercostal artery, and 1 lesion to the diaphragmatic artery were detected. In 12 of these patients a laceration of the pulmonary parenchyma was also present. A conversion to thoracotomy was necessary due to a broad laceration of the diaphragm and due to hemostasis of an intercostal artery. In all but one case, which was later converted, diagnostic imaging missed the diagnosis of laceration of the diaphragm. There was no intra- or postoperative mortality, and average hospital stay was five days. Conclusion VATS is a safe and effective way to diagnose and manage penetrating thoracic injuries, and its extensive use leads to a reduction in the number of missed, potentially fatal lesions as well as in chronic sequelae.

  1. Electrocautery device does not provide adequate pulmonary vessel sealing in transumbilical anatomic pulmonary lobectomy.

    Science.gov (United States)

    Liu, Hung-Ping; Chu, Yen; Wu, Yi-Cheng; Hsieh, Ming-Ju; Liu, Chieng-Ying; Chen, Tzu-Ping; Chao, Yin-Kai; Wu, Ching-Yang; Yeh, Chi-Ju; Ko, Po-Jen; Liu, Yun-Hen

    2016-05-01

    Safe pulmonary vessel sealing device plays a crucial role in anatomic lung resection. In 2014, we reported high rates of massive bleeding complications during transumbilical lobectomy in a canine model due to difficulty in managing the pulmonary vessel with an endostapler. In this animal survival series, we aimed to evaluate the outcome of pulmonary vessel sealing with an electrocautery device to simplify the transumbilical thoracic surgery. Under general anesthesia, a 3-cm longitudinal incision was made over the umbilicus. Under video guidance, a bronchoscope was inserted through the incision for exploration. The diaphragmatic wound was created with an electrocautery knife and used as the entrance into the thoracic cavity. Using the transumbilical technique, anatomic lobectomy was performed with electrosurgical devices and endoscopic vascular staplers in 15 canines. Transumbilical endoscopic anatomic lobectomy was successfully completed in 12 of the 15 animals. Intraoperative bleeding developed in three animals during pulmonary hilum dissection, where one animal was killed due to hemodynamic instability and the other two animals required thoracotomy to complete the operation. There were five delayed bleeding and surgical mortality cases caused by inadequate vessel sealing by electrosurgical devices. Postmortem examination confirmed correct transumbilical lobectomy in the twelve animals that survived the operations. Transumbilical anatomic lobectomy is technically feasible in a canine model; however, the electrosurgical devices were not effective in sealing the pulmonary vessel in the current canine model.

  2. uniportal vats for surgical repair

    African Journals Online (AJOL)

    2017-03-23

    Mar 23, 2017 ... aDepartamet of Pediatric Surgery, Hospital Teresa Herrera, Complejo Hospitalario. Universitario de A ... Advances in anesthesia, neonatal intensive, surgical, and cardiac care have ... First, these patients are at risk of airway ...

  3. REFORM OF RULES ON EU VAT

    Directory of Open Access Journals (Sweden)

    Maria Zenovia GRIGORE

    2018-05-01

    Full Text Available In January 2018 the EU has released two proposal designed to simplify the VAT system, specifically around reduced rates, and to reduce compliance costs of smaller businesses in respect of VAT. The EU's common rules on VAT rates do not treat Member States equally. More than 250 exemptions allow several Member States much more flexibility in setting VAT rates than others. While these derogations are due to expire once the reformed VAT system comes into place, the rates proposal will ensure that all Member States have the same flexibility and a uniform structure in which to set their own VAT rates. The second proposal is designed to make trading in other EU member states easier for smaller businesses. Currently, small businesses may benefit from generous thresholds in their state of establishment, but zero thresholds exist for nonestablished businesses, meaning higher compliance costs. The intended proposals will provide simplification measures (around invoicing, record keeping etc. for businesses with a turnover not exceeding €2 million and will allow member states to apply thresholds to non-established businesses with a turnover not exceeding €100,000.

  4. New European approach to combat VAT fraud?

    NARCIS (Netherlands)

    Griffioen, M.; Hel - van Dijk, van der E.C.J.M. (Lisette)

    2014-01-01

    The Member States of the European Union (EU) are missing billions of Euros each year as a result of cross-border VAT fraud. After its introduction, the current VAT system appeared to contain flaws and proved to be vulnerable to fraud. Tackling VAT fraud since then has become serious business within

  5. The experiment of interventional pulmonary lobectomy

    International Nuclear Information System (INIS)

    You Yufeng; Gan Wanchong; Ke Wei; Ying Wenhua

    2006-01-01

    Objective: To study the feasibility of interventional pulmonary lobectomy by animal experiment. Methods: Twelve healthy dogs were divided into three groups randomly, with 4 in each. Group A: the target bronchus and alveoli were filled with emulsion of lipiodol and alveolar cells damage liquors and then the target bronchus was occluded with Polymethylmethacrylate (PMMA) . Group B: The target bronchus was only occluded with PMMA. Group C: Pulmonary lobe was resected surgically. Arterial blood gases were measured at the time of pre-procedure and post-procedure and then 1st, 2nd, 3rd and 4th week after the procedure respectively. Chest radiography histology and bacterial culture of tissue of target lung lobe were made after 4 weeks. Results: There was a significant difference in arterial blood-gas among 3 groups pre-procedure in comparison with those of post-procedure immediately (P 0.05) in comparing with 1st, 2nd, 3rd and 4th week after the procedure. Atelectasis was shown radiologically with histological formation of fibrosis of target lung lobe but no bacteria grew in target tissue 4th week after the procedure. There were two cases of lung atelectasis but no pulmonary fibrosis occluded in group B. Conclusions: Interventional pulmonary lobectomy might be obtained after the target bronchus and pulmonary alveoli were filled with emulsion of lipiodol and alveolar cells damage liquors and then the target bronchus was occluded with PMMA. (authors)

  6. Comparative Short-Term Clinical Outcomes of Mediastinum Tumor Excision Performed by Conventional VATS and Single-Port VATS: Is It Worthwhile?

    Science.gov (United States)

    Wu, Ching-Feng; Gonzalez-Rivas, Diego; Wen, Chih-Tsung; Liu, Yun-Hen; Wu, Yi-Cheng; Chao, Yin-Kai; Hsieh, Ming-Ju; Wu, Ching-Yang; Chen, Wei-Hsun

    2015-11-01

    Single-port video-assisted thoracoscopic surgery (VATS) has been widely applied recently. However, there are still only few reports describing its use in mediastinum tumor resection. We present the technique of single-port video-assisted thoracoscopic mediastinum tumor resection and compare it with conventional VATS with regard to short-term outcome.We retrospectively enrolled 105 patients who received mediastinum surgery in Chang Gung Memorial Hospital. Sixteen patients received sternotomy or thoracotomy, 29 patients received single-port VATS, and 60 patients received conventional VATS (3 ports). The operative time, blood loss, postoperation day 1 pain score, discharge day pain score, and postoperative hospital stay were compared. In order to establish a well balanced cohort study, we also use propensity scores match (1:1) to compare the short-term clinical outcome in 2 groups.No operative deaths occurred in this study. Single-port VATS was associated with shorter operative time, lower postoperation day 1 pain score, and shorter postoperation hospital stay in our cohort study (P = 0.001, short-term outcome not inferior to conventional VATS in our cohort study. The long-term oncology outcome may require time and more enrolled patients to be further evaluated.

  7. Incidence of blood transfusion requirement and factors associated with transfusion following liver lobectomy in dogs and cats: 72 cases (2007-2015).

    Science.gov (United States)

    Hanson, Kayla R; Pigott, Armi M; J Linklater, Andrew K

    2017-10-15

    OBJECTIVE To determine the incidence of blood transfusion, mortality rate, and factors associated with transfusion in dogs and cats undergoing liver lobectomy. DESIGN Retrospective case series. ANIMALS 63 client-owned dogs and 9-client owned cats that underwent liver lobectomy at a specialty veterinary practice from August 2007 through June 2015. PROCEDURES Medical records were reviewed and data extracted regarding dog and cat signalment, hematologic test results before and after surgery, surgical method, number and identity of lobes removed, concurrent surgical procedures, hemoabdomen detected during surgery, incidence of blood transfusion, and survival to hospital discharge (for calculation of mortality rate). Variables were compared between patients that did and did not require transfusion. RESULTS 11 of 63 (17%) dogs and 4 of 9 cats required a blood transfusion. Mortality rate was 8% for dogs and 22% for cats. Pre- and postoperative PCV and plasma total solids concentration were significantly lower and mortality rate significantly higher in dogs requiring transfusion than in dogs not requiring transfusion. Postoperative PCV was significantly lower in cats requiring transfusion than in cats not requiring transfusion. No significant differences in any other variable were identified between dogs and cats requiring versus not requiring transfusion. CONCLUSIONS AND CLINICAL RELEVANCE Dogs and cats undergoing liver lobectomy had a high requirement for blood transfusion, and a higher requirement for transfusion should be anticipated in dogs with perioperative anemia and cats with postoperative anemia. Veterinarians performing liver lobectomies in dogs and cats should have blood products readily available.

  8. VAT Cashing System: between Myth and Reality

    Directory of Open Access Journals (Sweden)

    Roxana ISPAS

    2014-11-01

    Full Text Available The value added tax (VAT collection system, which is applied to any company with a turnover of up to 500,000 Euros, has become optional from 1 January 2014. Since January 1, 2014, taxpayers may choose the optional introduction of new system of VAT collection anytime during the year 2014 by filing a notice from the IRS, SELF removal from the register of taxable persons applying this system. By making changes and deregistration itself, taxpayers will continue to apply the system of VAT collection.For operations whose VAT chargeable event occurred until 31 December 2013 for the invoices issued before that date, in the event that the 90th calendar day from the date of invoice or the date set imitates the chargeability of tax occurs on full or partial consideration receipt of goods delivered or services rendered. Changing the Tax Code is provided in GEO no. 111/2013, published in Official Gazette no. 809 of 19 December. New tax rules allow taxpayers to decide if they want apply VAT at collection system, this decision targeting about half a million taxpayers from Romania.

  9. „WELL TEMPERED " VAT - BETWEEN THEORY AND PRACTICE

    Directory of Open Access Journals (Sweden)

    SĂLCEANU ALEXANDRU

    2014-05-01

    Full Text Available VAT represents an indirect tax due to the state budget that includes all phases of the economic circuit, namely manufacturing, services and distribution, up to sales to final consumers. VAT collection is done fractionally, according to the value added at each stage of the economic circuit. Introduced in our country in 1993, VAT has been continuously improved and since Romania has been a member of the European Union (EU since 2007, WATT has been harmonized with the European Community directives. Today, Romania encounters serious difficulties in collecting the VAT, being atop of the countries with tax arrears. This is why it is required a more effective collaboration between the parliament, which adopts laws, the government, that implements and business environment, where the added value is obtained, in order to achieve a more efficient and robust VAT system against fraud that can contribute to fiscal consolidation by increasing public budget revenues.

  10. Impact of standard rate of VAT on tax mix in EU 27

    Directory of Open Access Journals (Sweden)

    Tereza Šinkyříková

    2012-01-01

    Full Text Available The Value Added Tax (VAT is one of the key resources within tax collection and therefore VAT effectiveness and VAT complexity represent one of the current world topics. Standard rates of VAT may and may not be the simple key to define whether VAT is important in the tax mix or not. This paper focuses on the question whether the amount of the VAT rate has an impact on the share of VAT in the tax mix. The VAT share on total taxes is studied in connection of average and median standard rates applied so as to answer the question: “Do the countries with higher share of VAT in the tax mix set its standard rates of VAT beyond the average of EU 27?” The paper examines this issue using data EU member countries, especially EU 27, in years 1995–2010.

  11. Kalevipoeg ja Mumm-Summ VAT Teatri moodi

    Index Scriptorium Estoniae

    2003-01-01

    VAT Teatris esietendub 5. dets. M. Kampuse lavastatud jõuluetendus "Lihtsalt ... Mesilane" C. Vogli lugude "Väike mesilane Mumm-Summ" ainetel. VAT Teatri ja Markus Zohneri koostööprojektina esietendus 30. nov. Tallinna Linnateatris rahvuseepose "Kalevipoeg" motiividel loodud M. Zohneri lavaversioon

  12. The VAT in the bank system

    Directory of Open Access Journals (Sweden)

    Krzysztof Biernacki

    2013-07-01

    Full Text Available The bank system in the European Union plays an important role as a significant sector of the economy. Implementing in the last century -VAT exemption also for services performed by banks generates extra tax inflows, but decreases international competitiveness of this sector. However, VAT is a perfect consumption tax, alternatives were created for banks’ services taxation. As the paper shows, many of them are used in other then EU countries and provide smaller distortions in taxation. The aim of this article is to shortly present the dominant model of VAT taxation in the EU with a particular reference to banks’ services and describe an alternative method of taxating them. The analysis will also refer to introducing a new Financial Transaction Tax since 2014.

  13. Pre-operative ultrasound identification of thyroiditis helps predict the need for thyroid hormone replacement after thyroid lobectomy.

    Science.gov (United States)

    Morris, Lilah F; Iupe, Isabella M; Edeiken-Monroe, Beth S; Warneke, Carla L; Hansen, Mandy O; Evans, Douglas B; Lee, Jeffrey E; Grubbs, Elizabeth G; Perrier, Nancy D

    2013-01-01

    To evaluate whether pre-operative thyroiditis identified by ultrasound (US) could help predict the need for thyroid hormone replacement (THR) following thyroid lobectomy. Data from patients who underwent thyroid lobectomy in 2006-2011, were not taking THR pre-operatively, and had ≥1 month of follow-up were reviewed retrospectively. THR was prescribed for relatively elevated thyroid-stimulating hormone (TSH) and hypothyroid symptoms. The Kaplan-Meier method was used to estimate the percentage of patients who required THR at 6, 12, 18, and 24 months postoperatively, and Cox proportional hazards regression models were used to evaluate prognostic factors for requiring post-thyroid lobectomy THR. During follow-up, 45 of 98 patients required THR. Median follow-up among patients not requiring THR was 11.6 months (range, 1.2 to 51.3 months). Six months after thyroid lobectomy, 22% of patients were taking THR (95% confidence interval [CI], 15-32%); the proportion increased to 46% at 12 months (95% CI, 36-57%) and 55% at 18 months (95% CI, 43-67%). On univariate analysis, significant prognostic factors for postoperative THR included a pre-operative TSH level >2.5 μ international units [IU]/mL (hazard ratio [HR], 2.8; 95% CI, 1.4-5.5; P = .004) and pathology-identified thyroiditis (HR, 2.4; 95% CI, 1.3-4.3; P = .005). Patients with both pre-operative TSH >2.5 μIU/mL and US-identified thyroiditis had a 5.8-fold increased risk of requiring postoperative THR (95% CI, 2.4-13.9; P2.5 μIU/mL significantly increases the risk of requiring THR after thyroid lobectomy. Thyroiditis can add to that prediction and guide pre-operative patient counseling and surgical decision making. US-identified thyroiditis should be reported and post-thyroid lobectomy patients followed long-term (≥18 months).

  14. Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches.

    Science.gov (United States)

    Deen, Shaun A; Wilson, Jennifer L; Wilshire, Candice L; Vallières, Eric; Farivar, Alexander S; Aye, Ralph W; Ely, Robson E; Louie, Brian E

    2014-03-01

    Knowledge about the cost of open, video-assisted thoracoscopic (VATS), or robotic lung resection and drivers of cost is crucial as the cost of care comes under scrutiny. This study aims to define the cost of anatomic lung resection and evaluate potential cost-saving measures. A retrospective review of patients who had anatomic resection for early stage lung cancer, carcinoid, or metastatic foci between 2008 and 2012 was performed. Direct hospital cost data were collected from 10 categories. Capital depreciation was separated for the robotic and VATS cases. Key costs were varied in a sensitivity analysis. In all, 184 consecutive patients were included: 69 open, 57 robotic, and 58 VATS. Comorbidities and complication rates were similar. Operative time was statistically different among the three modalities, but length of stay was not. There was no statistically significant difference in overall cost between VATS and open cases (Δ = $1,207) or open and robotic cases (Δ = $1,975). Robotic cases cost $3,182 more than VATS (p depreciation. The main opportunities to reduce cost in open cases were the intensive care unit, respiratory therapy, and laboratories. Lowering operating time and supply costs were targets for VATS and robotic cases. VATS is the least expensive surgical approach. Robotic cases must be shorter in operative time or reduce supply costs, or both, to be competitive. Lessening operating time, eradicating unnecessary laboratory work, and minimizing intensive care unit stays will help decrease direct hospital costs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. 21 CFR 73.3112 - C.I. Vat Orange 1.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false C.I. Vat Orange 1. 73.3112 Section 73.3112 Food... COLOR ADDITIVES EXEMPT FROM CERTIFICATION Medical Devices § 73.3112 C.I. Vat Orange 1. (a) Identity. The color additive is C.I. Vat Orange 1, Colour Index No. 59105. (b) Uses and restrictions. (1) The...

  16. Regional analgesia for video-assisted thoracic surgery – a systematic review

    DEFF Research Database (Denmark)

    Julia Steinthorsdottir, Kristin; Wildgaard, Lorna; Jessen Hansen, Henrik

    2013-01-01

    there is no gold standard for regional analgesia for VATS. This systematic review aimed to assess different regional techniques in regards to effect on acute post-operative pain following VATS, with emphasis on VATS lobectomy. The systematic review of the PubMed, Cochrane Library and Embase databases yielded...... be demonstrated, but a guide of factors to include in future studies on regional analgesia for VATS is presented....

  17. Video-assisted thoracoscopic double lobectomy for bronchiectasis ...

    African Journals Online (AJOL)

    Although thoracoscopic lobectomy for severe bronchiectasis has been reported in children, this is the fi rst report of double lobectomy of the right middle and lower lobes performed using the video-assisted thoracoscopy in a 9-year-old girl. The post-operative course was uneventful and she is currently well after 18 months' ...

  18. The revenue raising capabilities of a VAT system in developing countries

    Directory of Open Access Journals (Sweden)

    NT Azaria

    2015-01-01

    Full Text Available The paper attempts to elaborate on the revenue-raising capabilities (economic efficiency and viability of a value-added tax (VAT system, particularly in developing countries.  The analysis concentrates on the effect of a VAT on tax revenues raised, and the main objective is to determine whether a VAT system generates greater benefits than previously utilised sales taxes, i.e. pre-existing sales taxes (PEST. Using a panel data regression analysis, our results indicate that while all countries gain revenue from the presence of VAT, it is significantly more in developed countries, although the dummy VAT variable interacted with trace openness enters positively for the lower- and upper middle-income groups.  This proves the importance of trade for VAT revenues, but also that VAT combined with interaction variables is conducive to higher tax revenues.

  19. Comparative Short-Term Clinical Outcomes of Mediastinum Tumor Excision Performed by Conventional VATS and Single-Port VATS

    OpenAIRE

    Wu, Ching-Feng; Gonzalez-Rivas, Diego; Wen, Chih-Tsung; Liu, Yun-Hen; Wu, Yi-Cheng; Chao, Yin-Kai; Hsieh, Ming-Ju; Wu, Ching-Yang; Chen, Wei-Hsun

    2015-01-01

    Abstract Single-port video-assisted thoracoscopic surgery (VATS) has been widely applied recently. However, there are still only few reports describing its use in mediastinum tumor resection. We present the technique of single-port video-assisted thoracoscopic mediastinum tumor resection and compare it with conventional VATS with regard to short-term outcome. We retrospectively enrolled 105 patients who received mediastinum surgery in Chang Gung Memorial Hospital. Sixteen patients received st...

  20. VAT ON E-SERVICES: HOW NEW RULES AFFECT BUSINESSES

    Directory of Open Access Journals (Sweden)

    Adina TRANDAFIR

    2014-06-01

    Full Text Available From 1st January 2015, in the European Unionwill enter into force a new VAT regime for business-to-consumer suppliers of telecoms, broadcasting and electronic services. This regime will have an impact on businesses engaged in the supply of certain products and services over the Internet. This article is a literature review. It is aimed to provide an analysis of the European VAT regime applicable to electronic services and clarify some key issues like: what are e-services, what are the changes and how the businesses are affected by these new rules. The paper also approaches issues such as: the change of the rules regarding VAT place of supplying and the introduction of the VAT Mini One Stop Shop (MOSS. The main conclusion is that the change in the place of supplying rules will serve to negate the VAT advantages associated with Internet companies which locate their invoicing functions in a Member State that is different from where they locate their substantial activities.

  1. High-volume intensive training course: a new paradigm for video-assisted thoracoscopic surgery education.

    Science.gov (United States)

    Sihoe, Alan D L; Gonzalez-Rivas, Diego; Yang, Timothy Y; Zhu, Yuming; Jiang, Gening

    2018-03-27

    The emergence of ultra-high-volume centres promises new opportunities for thoracic surgical training. The goal of this study was to investigate the effectiveness of a novel observership course in teaching video-assisted thoracoscopic surgery (VATS) at an ultra-high-volume centre. Two-week courses in VATS at a specialist unit now performing >10 000 major lung resections annually (>50 daily on average) were attended by 230 surgeons from around the world from 2013 to 2016. An online survey preserving responder anonymity was completed by 156 attendees (67.8%). Attendees included 37% from Western Europe, 18% from Eastern Europe and 17% from Latin America. Experience with open thoracic surgery for more than 5 years was reported by 67%, but 79% had less than 5 years of VATS lobectomy experience. During the course, 70% observed over 30 uniportal VATS operations (including 38% observing over 50), and 69% attended an animal wet lab. Although 72% of the responders attended the course less than 12 months ago, the number of ports used (P < 0.001), operation times (P < 0.001) and conversion rates (P < 0.001) reported by the responders were reduced significantly after the course. Improvements in the problem areas of tissue retraction, instrumentation, stapler application and coordination with the assistant during VATS were reported by 56%, 57%, 58% and 53%, respectively. Of those who had attended other VATS courses previously, 87% preferred the training from this high-volume course. High-volume intensive observership training at an ultra-high-volume centre may improve VATS proficiency in a short period of time, and may provide a time-efficient modality for future thoracic surgical training.

  2. Robotic thoracic surgery: The state of the art

    Science.gov (United States)

    Kumar, Arvind; Asaf, Belal Bin

    2015-01-01

    Minimally invasive thoracic surgery has come a long way. It has rapidly progressed to complex procedures such as lobectomy, pneumonectomy, esophagectomy, and resection of mediastinal tumors. Video-assisted thoracic surgery (VATS) offered perceptible benefits over thoracotomy in terms of less postoperative pain and narcotic utilization, shorter ICU and hospital stay, decreased incidence of postoperative complications combined with quicker return to work, and better cosmesis. However, despite its obvious advantages, the General Thoracic Surgical Community has been relatively slow in adapting VATS more widely. The introduction of da Vinci surgical system has helped overcome certain inherent limitations of VATS such as two-dimensional (2D) vision and counter intuitive movement using long rigid instruments allowing thoracic surgeons to perform a plethora of minimally invasive thoracic procedures more efficiently. Although the cumulative experience worldwide is still limited and evolving, Robotic Thoracic Surgery is an evolution over VATS. There is however a lot of concern among established high-volume VATS centers regarding the superiority of the robotic technique. We have over 7 years experience and believe that any new technology designed to make minimal invasive surgery easier and more comfortable for the surgeon is most likely to have better and safer outcomes in the long run. Our only concern is its cost effectiveness and we believe that if the cost factor is removed more and more surgeons will use the technology and it will increase the spectrum and the reach of minimally invasive thoracic surgery. This article reviews worldwide experience with robotic thoracic surgery and addresses the potential benefits and limitations of using the robotic platform for the performance of thoracic surgical procedures. PMID:25598601

  3. Institutional paradoxes of vat under developing economy of transition period

    Directory of Open Access Journals (Sweden)

    Dmitriy G. Bachurin

    2016-01-01

    Full Text Available Objective to determine the characteristics of the destructive impact of VAT taxation on the socioeconomic situation of the Russian Federation. Methods the research is based on the complex economic and legal methodology including the institutional approach with the account of the national socioeconomic and legal realities determining the conditions of functioning of branches and particular enterprises in the Russian economy. Results the conditions and characteristics of the introduction of VAT in the Russian Federation are viewed the reasons are revealed for the formation and development of the problemcausing VAT in the domestic tax system the socioeconomic implications of VAT are analyzed the viability of replacing VAT for a turnover tax is demonstrated. Scientific novelty for the first time the conceptual position is articulated that under the realities of the reformed Russian economy the normativelegal outline of the VAT complements the accumulated destructive potential blocking the way to the industrial growth in the national economy enhances the asymmetry of conditions of different forms of ownership while the actual conditions of the transition period in Russia do not correspond to the main idea and purpose of VAT as an institution aimed at the efficient relocation of a significant part of the newly created value added to the social sectors and at the modernizing effect on the productive forces for technological improvement in industry. Practical significance the provisions and conclusions of the article can be used when discussing issues on the need for the VAT reform in the Russian Federation including switching to the turnover tax. nbsp

  4. Surgical versus non-surgical management for pleural empyema.

    Science.gov (United States)

    Redden, Mark D; Chin, Tze Yang; van Driel, Mieke L

    2017-03-17

    Empyema refers to pus in the pleural space, commonly due to adjacent pneumonia, chest wall injury, or a complication of thoracic surgery. A range of therapeutic options are available for its management, ranging from percutaneous aspiration and intercostal drainage to video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage. Intrapleural fibrinolytics may also be administered following intercostal drain insertion to facilitate pleural drainage. There is currently a lack of consensus regarding optimal treatment. To assess the effectiveness and safety of surgical versus non-surgical treatments for complicated parapneumonic effusion or pleural empyema. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015 to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015), Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS (1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for ongoing studies (December 2016). Randomised controlled trials that compared a surgical with a non-surgical method of management for all age groups with pleural empyema. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. We included eight randomised controlled trials with a total of 391 participants. Six trials focused on children and two on adults. Trials compared tube thoracostomy drainage (non-surgical), with or without intrapleural fibrinolytics, to either VATS or thoracotomy (surgical) for the management of pleural empyema. Assessment of risk of bias for the included studies was generally unclear for selection and blinding but low for attrition and reporting bias. Data analyses compared

  5. Different dissecting orders of the pulmonary bronchus and vessels during right upper lobectomy are associated with surgical feasibility and postoperative recovery for lung cancer patients.

    Science.gov (United States)

    Zhai, Hao-Ran; Yang, Xue-Ning; Nie, Qiang; Liao, Ri-Qiang; Dong, Song; Li, Wei; Jiang, Ben-Yuan; Yang, Jin-Ji; Zhou, Qing; Tu, Hai-Yan; Zhang, Xu-Chao; Wu, Yi-Long; Zhong, Wen-Zhao

    2017-06-27

    Right upper lobectomy (RUL) for lung cancer with different dissecting orders involves the most variable anatomical structures, but no studies have analyzed its effects on postoperative recovery. This study compared the conventional surgical approach, VAB (dissecting pulmonary vessels first, followed by the bronchus), and the alternative surgical approach, aBVA (dissecting the posterior ascending arterial branch first, followed by the bronchus and vessels) on improving surgical feasibility and postoperative recovery for lung cancer patients. According to the surgical approach, consecutive lung cancer patients undergoing RUL were grouped into aBVA and VAB cohorts. Their clinical, pathologic, and perioperative characteristics were collected to compare perioperative outcomes. Three hundred one patients were selected (109 in the aBVA cohort and 192 in the VAB cohort). The mean operation time was shorter in the aBVA cohort than in the VAB cohort (164 vs. 221 min, P  0.05). The median disease-free survival was comparable for all patients in the two cohorts (not arrived vs. 41.97 months) and for patients with disease recurrences (13.25 vs. 9.44 months) (both P > 0.05). The recurrence models in two cohorts were also comparable for patients with local recurrences (6.4% vs. 7.8%), distant metastases (10.1% vs. 8.3%), and both (1.8% vs. 1.6%) (all P > 0.05). Dissecting the right upper bronchus before turning over the lobe repeatedly and dissecting veins via the aBVA approach during RUL would promote surgical feasibility and achieve comparable postoperative recovery for lung cancer patients.

  6. Features of VAT Accounting and Fiscality – History, Practices and Prospects

    Directory of Open Access Journals (Sweden)

    Violeta ISAI

    2013-12-01

    Full Text Available The value-added tax (VAT is an indirect tax, supported by the final consumer of the good/service that it is applied. During the productive and commercial cycle, the companies pay VAT according to the value added on the good/service. Quite recently appeared in the fiscal system of different states, VAT has a big spreading area. The taxation rates are different from a country to another, according to the economic conditions and the fiscal law (in EU, from 15% for Cyprus and Luxembourg to 27% for Hungary, and outside EU, from 3% for Iran, to 25% for Norway. In Romania, the rates are: the standard rate of 24% and the reduced rates of 9% and 5%, the payment term being monthly or quarterly, according to the company turnover. In the accounting and fiscality area, VAT presents special features, conditioned by the type of activity and the company size. In order to support the small companies, starting with 01.01.2013 the “VAT Encashment System” was introduced, that relates the VAT payability to the encashment moment of the invoice. The VAT impact on the profitability is an aspect that must be considered when we discuss about: costs, cash-flow, results, liquidity, solvency or efficiency rates.

  7. The reduced VAT rate for small business in Croatia

    Directory of Open Access Journals (Sweden)

    Mira Dimitrić

    2009-06-01

    Full Text Available This paper assesses the potential effects of introduction of the reduced VAT rate for small business, based on the EU VAT legislation development. The analysis includes effects on prices, sales, shadow economy and employment. It starts with the assumption of no substantial effect. Survey for Croatia is done by small business owners’ interviews and encompasses descriptive and inferential statistics based on parametric tests. The EU expected existence of a link between VAT reduction, price reduction, sales increase and positive effects on employment (as well as decline in the shadow economy is proved even in this research. However, the pass-through to prices is very moderate as well as other effects. The reduced VAT rate could have some positive results for the restaurants and bars only. There exists also some possibility for construction of housing and construction services related to housing as well as some other labour intensive services.

  8. The value-added tax (VAT) rate of international natural gas trade

    International Nuclear Information System (INIS)

    Botter, E.

    2008-01-01

    Since January 1, 2005, international gas trades are controlled by common right derogatory VAT rules. Transfrontier exchanges do not obey to the classical territory rules of exchange of goods but to a particular VAT regime. Moreover, the access to networks and the transportation of natural gas are subjected to particular VAT regulations. This article explains these particularities. (J.S.)

  9. Transfer pricing principles in VAT Law

    DEFF Research Database (Denmark)

    Jensen, Dennis Ramsdahl

    2011-01-01

    The main part of the article is devoted to a critical analysis of the optional transfer pricing provisions in the EC VAT Directive in the light of the principle of fiscal neutrality. As an integrated part of this analysis, the VAT transfer pricing regime is considered in the light of the well......-known principles for transfer pricing in the area of income tax law, as set out in Art. 9 of the OECD Model Tax Convention. The last part of the article contains a brief discussion of to which extent it is desirable to harmonize the two tax systems´ transfer pricing rules....

  10. The use of a water seal to manage air leaks after a pulmonary lobectomy: a retrospective study.

    Science.gov (United States)

    Okamoto, Junichi; Okamoto, Tatsuro; Fukuyama, Yasuro; Ushijima, Chie; Yamaguchi, Masafumi; Ichinose, Yukito

    2006-08-01

    The methods for managing chest drainage tubes during the postoperative period differ among thoracic surgeons and, as a result, the optimal method remains controversial. We reviewed 170 consecutive patients undergoing a pulmonary lobectomy for either primary lung cancer or metastatic lung cancer from January 1998 to December 2002. After the operation, the chest drainage tube was placed on a suction pump with a negative pressure of -10 cmH(2)O in 120 patients before 2001, while such drainage tubes were kept on water seal in 47 cases mainly since 2001. Regarding the preoperative and postoperative variables, postoperative air leak as well as the video-assisted thoracic surgery (VATS) procedure were more frequently observed in the water seal group than in the suction group (p=0.01580, pleak seemed to be similar between the two methods. These observations suggest that applying chest tubes on water seal seems to be an effective method for preventing postoperative air leak in clinical practice. However, a prospective randomized trial using a larger series of patients is warranted for this subject.

  11. VAT-teater vaatab 30 aastat tulevikku / Tiiu Laks

    Index Scriptorium Estoniae

    Laks, Tiiu, 1984-

    2010-01-01

    VAT Teater toob S. Becketti "Krappi viimase lindi" lavale ebatavalisel moel. Festivalil "Draama 2010" Tartus toimub 8. septembril esimene avalik lindistus "...viimane lint / Saare esimene lint". Kontseptsioon: Tanel Saar ja Co. Esitus: Tanel Saar ja Hanna Allsaar. Näitejuhid-konsultandid: Rait Avestik ja Aare Toikka. "Krappi viimane lint" esietendub VAT Teatri ja Tanel Saare esituses 2040. a. sügisel. Festivali "Draama 2010" kavast

  12. Tax Reforms in Nigeria: Case for Value Added Tax (VAT)

    African Journals Online (AJOL)

    Nneka Umera-Okeke

    amended based on destination principle to impose VAT on imported services rendered ... It was the view of Popoola (2009) that Nigeria tax administration and practice be structured ..... have low VAT rates, e.g. Nigeria, India and Malaysia.

  13. Assessment of competence in video-assisted thoracoscopic surgery lobectomy: A Danish nationwide study.

    Science.gov (United States)

    Petersen, René Horsleben; Gjeraa, Kirsten; Jensen, Katrine; Møller, Lars Borgbjerg; Hansen, Henrik Jessen; Konge, Lars

    2018-04-18

    Competence in video-assisted thoracoscopic surgery lobectomy has previously been established on the basis of numbers of procedures performed, but this approach does not ensure competence. Specific assessment tools, such as the newly developed video-assisted thoracoscopic surgery lobectomy assessment tool, allow for structured and objective assessment of competence. Our aim was to provide validity evidence for the video-assisted thoracoscopic surgery lobectomy assessment tool. Video recordings of 60 video-assisted thoracoscopic surgery lobectomies performed by 18 thoracic surgeons were rated using the video-assisted thoracoscopic surgery lobectomy assessment tool. All 4 centers of thoracic surgery in Denmark participated in the study. Two video-assisted thoracoscopic surgery experts rated the videos. They were blinded to surgeon and center. The total internal consistency reliability Cronbach's alpha was 0.93. Inter-rater reliability between the 2 raters was Pearson's r = 0.71 (P video-assisted thoracoscopic surgery lobectomy assessment tool scores for the 10 procedures performed by beginners were 22.1 (standard deviation [SD], 8.6) for the 28 procedures performed by the intermediate surgeons, 31.2 (SD, 4.4), and for the 20 procedures performed by experts 35.9 (SD, 2.9) (P better than intermediates (P better than beginners (P video-assisted thoracoscopic surgery lobectomy (video-assisted thoracoscopic surgery lobectomy assessment tool) in a clinical setting. The discriminatory ability among expert surgeons, intermediate surgeons, and beginners proved highly significant. The video-assisted thoracoscopic surgery lobectomy assessment tool could be an important aid in the future training and certification of thoracic surgeons. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  14. The Problem of VAT Credit on Expired Goods: An Opinion

    Directory of Open Access Journals (Sweden)

    Fatma TAŞ

    2017-12-01

    Full Text Available VAT paid on certain goods acquired does not allow the deducting of the Turkish tax system. One of them is the loss of goods VAT. There is no clear definition in the law is wasted. Therefore, there are certain problems in practice. The problems, in particular, focused on the VAT on expired or valueless goods. Current opinion on the subject of the tax administration is inconvenient regarding tax justice. Both states of the solution to the problem should be developed as well as an objective approach to protecting taxpayers.

  15. THE VAT SPLIT-PAYMENT MECHANISM, MEASURE FOR COMBATING TAX EVASION IN ROMANIA

    Directory of Open Access Journals (Sweden)

    IONUT - GHEORGHE CARAUS

    2017-12-01

    Full Text Available The need to improve the methods of collecting and detecting value-added tax amounts is an increasingly difficult process for tax authorities. In this respect, a rigorous analysis of the ways in which the state manages to prevent or combat VAT evasion, in the context in which VAT fraud accounts for about 60% of Romania's total tax evasion, is required. Therefore, the new provisions concerning the VAT split payments, applicable from January 1, 2018 for all categories of taxpayers, can contribute significantly to the efficiency of collection, of the amounts derived from the VAT, as well as to reduce tax evasion in the field of value added tax and providing a fair competitive environment, by eliminating benefits for economic operators with incorrect tax behavior who do not pay VAT to the State budget. Also, through these measures taken by the state, the main motivation for the introduction of the value added tax splitpayments mechanism, contributes to the increase of the voluntary compliance degree by providing the financial resources for the payment of VAT due to the State budget.

  16. VAT COLLECTION TO COLLECTION: ADVANTAGES AND DISADVANTAGES

    Directory of Open Access Journals (Sweden)

    ROXANA ISPAS

    2012-10-01

    Full Text Available This paper presents the major changes in the payment system of value added tax (VAT. Through the Government Ordinance no. 15/2012 amending and supplementing Law no. 571/2003 regarding the Fiscal Code, there was introduced, with effect from 01.01.2013, the payment of the value added tax (VAT on cashing the whole or partial counter value of the supply of goods or provision of services. There are detailed the most important data on the topic, but also information about the risks and benefits resulting from the new legal provisions.

  17. Reimbursement of VAT on written-off Receivables

    DEFF Research Database (Denmark)

    Florentsen, Bjarne; Møller, Michael; Nielsen, Niels Chr.

    2003-01-01

    In many OECD countries, a seller has a right to reimbursement of VAT (RVAT) she has paid on goods sold, but for which she has not yet received payment. Such reimbursement of VAT on receivables is economically inefficient. It leads to:@* Distortion of credit markets, by subsidizing direct credit...... at the cost of financial intermediaries.@* Price discrimination, by subsidizing buyers with low creditworthiness.@* A less efficient collection of bad debts, as trade with bad debts is made extremely expensive.The finance literature presents several `good' arguments in favor of trade credits, e.g. transaction...

  18. [Treatment-refractory-dental-extraction-associated pyothorax involving infection by 2 species of oral originated bacteria requires surgical debridement by video assisted thoracoscopic surgery (VATS)].

    Science.gov (United States)

    Rai, Kammei; Matsuo, Kiyoshi; Yonei, Toshiro; Sato, Toshio

    2008-09-01

    Cases of septic pulmonary embolism (SPE) diagnosed clinically by CT after dental extraction rarely include verification of bacteria from the local infection site. We report the case of a 70-year-old man without background disease suffering severe pyothrax after dental extraction. We detected two species of oral bacteria from his pleural effusion. Treatment was so difficult that it required surgical debridement by video assisted thoracoscopic surgery (VATS), even after the appropriate administration of antibiotics. According to the American Heart Association (AHA) prophylaxis guidelines for preventing infective endocarditis indicate that it is uncommon to prescribe antibiotics to patients without background disease after dental extraction. No appropriate Japanese guidelines exist considering the prevention of SPE causing severe pyothorax as in our case. The hematogenous spread of bacteria such as SPE caused by sepsis after tooth extraction thus requires more attended careful consideration in clinical practice if patients are to be properly protected against potentially serious complications.

  19. Stoppage - Vat Return and Accounting Practice in Re-Delivery of a Delivery Subject to Stoppage

    Directory of Open Access Journals (Sweden)

    Ahmet Yanık

    2016-12-01

    Full Text Available Value Added Tax (VAT is calculated based on the goods and service delivery costs realized by the corporations. Unless this VAT is subject to stoppage, seller takes the VAT from the purchaser in delivery of goods or services and then the corporate pays this amount to the tax office or sets off through the VAT he paid for his service or goods procurement. However, in some cases, Ministry of Finance holds not those providing the delivery or service but those purchasing or procuring the goods or services responsible partly or fully for the tax calculated based on the delivery or service fee. The purpose of this paper is to reveal VAT stoppage, accounting entries with regards to the corporation accepting the delivery and re-delivering it, VAT set off and VAT return in the re-delivery of a delivery subject to stoppage pursuant to General Communiqué of VAT Serial No 117

  20. Efficiency of a single-rate and broad-based VAT system: the case of Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Dinka Antić

    2014-09-01

    Full Text Available The aim of this paper is to analyze the performance and efficiency of the VAT system in B&H and explore the effects of internal and external factors influencing VAT collection. The VAT system in B&H is a consumption-type, single-rate and broad-based system. Ever since its implementation, VAT collection in B&H has been subject to strong oscillations, from an extremely high performance in the first two years after the introduction, to a sharp drop at the beginning of the crisis. After a temporary recovery, VAT collection declined in the last quarter of 2012 and has been negative ever since, although a weak recovery of the B&H economy was observed in 2013. The key hypothesis is that the high efficiency of the broadbased and single-rate structured VAT system may be neutralized by the country’s specific circumstances and VAT policy design. Applying a set of indicators for VAT efficiency analysis, developed by IMF, OECD and EU, we find a deterioration of the components of the policy gap caused by derogations of the VAT Law, and an increasing compliance gap, due to an increase of the VAT debt and tax evasion, in consequence of poor policy design in the field of excises. As a result of the influence of the country’s specific circumstances and its VAT policy design the identifiable current net losses on VAT in 2013 amount to 4% of net VAT collection or 0.4% of GDP. The analysis presented in the paper proves the main hypothesis that a VAT design, even when it is close to theoretically ideal concept, cannot on its own produce a high level of VAT efficiency and performance.

  1. STUDY ON THE APPLICATION OF CASH ACCOUNTING SYSTEM FOR VAT IN ROMANIA

    Directory of Open Access Journals (Sweden)

    ECOBICI NICOLAE

    2014-02-01

    Full Text Available The cash accounting system for VAT has been implemented in Romania as of 1 January 2013 and now turns one year of application in Romania. Since its implementation the system has sparked controversy, being harshly criticised by professional accountants in Romania and elsewhere. Criticisms mainly concerned the following issues: no possibility to choose to apply the system, breach of the VAT neutrality principles, maximum period of 90 days to postpone the chargeability of VAT for unpaid deliveries, while VAT deduction was subject to payment of the value of goods and services invoiced without specifying any term. In this article we would like to examine the extent to which the legislative changes that came into effect as of 1 January 2014 improve the cash accounting system for VAT in Romania. We will also analyse to what extent the system applied in 2013 has brought advantages/disadvantages to the economic entities in Romania based on a survey carried out on a heterogeneous sample of companies in the county of Gorj, regarded as nationally representative. Finally, we intend to compare the cash accounting system for VAT in Romania with its UK counterpart.

  2. Biological features produced by additive manufacturing processes using vat photopolymerization method

    DEFF Research Database (Denmark)

    Davoudinejad, Ali; Mendez Ribo, Macarena; Pedersen, David Bue

    2017-01-01

    of micro biological features by Additive Manufacturing (AM) processes. The study characterizes the additive manufacturing processes for polymeric micro part productions using the vat photopolymerization method. A specifically designed vat photopolymerization AM machine suitable for precision printing...

  3. Transfer Pricing Principles VAT/GST v. Direct Taxation

    DEFF Research Database (Denmark)

    Jensen, Dennis Ramsdahl

    2009-01-01

    Convention, [2] including an examination of whether it is appropriate to base transfer pricing rules on the same principles in the two different areas of tax law. [1] Council Directive 2006/112/EC of 28 November 2006 on the common system of value added tax, OJ L 347 of 11 December 2006, pp. 1-118 (EC VAT......In this paper the optional transfer pricing provisions in the EC VAT Directive [1] are subject to a more detailed analysis, with a view to considering them in the light of the well-known principles for transfer pricing in the area of income tax law, as set out in Art. 9 of the OECD Model Tax...... Directives are to be construed as references to the EC VAT Directive and should be read in accordance with the correlation table in Annex XII. [2] OECD Model Tax Convention on Income and on Capital (OECD Model Tax Convention)....

  4. Estimated revenues of VAT and fuel tax on aviation

    Energy Technology Data Exchange (ETDEWEB)

    Korteland, M.; Faber, J.

    2013-07-15

    International aviation is exempt from VAT, both on their inputs (e.g. on fuel or aircraft) and on their revenues (e.g. on tickets). In the EU, aviation fuel is also exempt from the minimum fuel excise tariffs. This report calculates the potential revenues of VAT on tickets and fuel tax on jet fuel. If VAT were to be levied on tickets while other aviation taxes were simultaneously abolished, this would yield revenues in the order of EUR 7 billion. Excise duty on jet fuel would raise revenues in the order of EUR 20 billion. These figures do not take into account the impact of the cost increases on demand for aviation into account. Since higher costs will reduce demand, the estimates can be considered an upper bound.

  5. Radiation dosimetry of [(18)F]VAT in nonhuman primates.

    Science.gov (United States)

    Karimi, Morvarid; Tu, Zhude; Yue, Xuyi; Zhang, Xiang; Jin, Hongjun; Perlmutter, Joel S; Laforest, Richard

    2015-12-01

    The objective of this study is to determine the radiation dosimetry of a novel radiotracer for vesicular acetylcholine transporter (-)-(1-((2R,3R)-8-(2-[(18)F]fluoro-ethoxy)-3-hydroxy-1,2,3,4-tetrahydronaphthalen-2-yl)piperidin-4-yl)(4-fluorophenyl)-methanone ([(18)F]VAT) based on PET imaging in nonhuman primates. [(18)F]VAT has potential for investigation of neurological disorders including Alzheimer's disease, Parkinson's disease, and dystonia. Three macaque fascicularis (two males, one female) received 185.4-198.3 MBq [(18)F]VAT prior to whole-body imaging in a MicroPET-F220 scanner. Time activity curves (TACs) were created from regions of interest (ROIs) that encompassed the entire small organs or samples with the highest activity within large organs. Organ residence times were calculated based on the TACs. We then used OLINDA/EXM 1.1 to calculate human radiation dose estimates based on scaled organ residence times. Measurements from directly sampled arterial blood yielded a residence time of 0.30 h in agreement with the residence time of 0.39 h calculated from a PET-generated time activity curve measured in the left ventricle. Organ dosimetry revealed the liver as the critical organ (51.1 and 65.4 μGy/MBq) and an effective dose of 16 and 19 μSv/MBq for male and female, respectively. The macaque biodistribution data showed high retention of [(18)F]VAT in the liver consistent with hepatobiliary clearance. These dosimetry data support that relatively safe doses of [(18)F]VAT can be administered to obtain imaging in humans.

  6. Contracting out: Dutch municipalities reject the solution for the VAT-distortion

    NARCIS (Netherlands)

    Gradus, R.H.J.M.; Dijkgraaf, E.; Wassenaar, M.C.

    2010-01-01

    In 2003, the Dutch government introduced a VAT-compensation fund in order to create a level playing field for local governments with respect to Value Added Tax (VAT). This fund eliminates the effect of the tax difference between local governments that supply services themselves and local governments

  7. The Impact of the Charter of Fundamental Rights of the European Union on VAT Law

    DEFF Research Database (Denmark)

    Elgaard, Karina Kim Egholm

    2016-01-01

    The Charter of Fundamental Rights of the European Union became legally binding following its entry into force with the Lisbon Treaty on 1 December 2009, and it has the same legal value as the EU Treaties. Since then, the EU fundamental rights aspect of VAT law has not been subject to much academic...... discussion or particular attention from VAT practitioners. This article contributes to further development of research in the area of EU fundamental rights and VAT law by examining; when the Charter is relevant in VAT law and if so how the Charter manifests itself in EU VAT case law, and what special...

  8. Thyroid Lobectomy Is Associated with Excellent Clinical Outcomes in Properly Selected Differentiated Thyroid Cancer Patients with Primary Tumors Greater Than 1 cm

    Science.gov (United States)

    Vaisman, Fernanda; Momesso, Denise; Bulzico, Daniel A.; Pessoa, Cencita H. C. N.; da Cruz, Manuel Domingos Gonçalves; Dias, Fernando; Corbo, Rossana; Vaisman, Mario; Tuttle, R. Michael

    2013-01-01

    Background and Objective. An individualized risk-based approach to the treatment of thyroid cancer is being extensively discussed in the recent literature. However, controversies about the ideal surgical approach remain an important issue with regard to the impact on prognosis and follow-up strategies. This study was designed to describe clinical outcomes in a cohort of low and intermediate risk thyroid cancer patients treated with thyroid lobectomy. Methods. Retrospective review of 70 patients who underwent lobectomy. Results. After a median follow-up of 11 years, 5 patients (5/70, 7.1%) recurred and 5 had a completion for benign lesions, while 60 patients (86%) continued to be observed without evidence for disease recurrence. Suspicious ultrasound findings were significantly more common in patients that had structural disease recurrence (100% versus 4.3%, P < 0.001). Furthermore, a rising suppressed Tg value over time was also associated with structural disease recurrence (80% versus 21.5%, P = 0.01). After additional therapy, 99% of the patients had no evidence of disease. Conclusions. Properly selected thyroid cancer patients can be treated with lobectomy with excellent clinical outcomes. PMID:24455413

  9. Thyroid Lobectomy Is Associated with Excellent Clinical Outcomes in Properly Selected Differentiated Thyroid Cancer Patients with Primary Tumors Greater Than 1 cm

    Directory of Open Access Journals (Sweden)

    Fernanda Vaisman

    2013-01-01

    Full Text Available Background and Objective. An individualized risk-based approach to the treatment of thyroid cancer is being extensively discussed in the recent literature. However, controversies about the ideal surgical approach remain an important issue with regard to the impact on prognosis and follow-up strategies. This study was designed to describe clinical outcomes in a cohort of low and intermediate risk thyroid cancer patients treated with thyroid lobectomy. Methods. Retrospective review of 70 patients who underwent lobectomy. Results. After a median follow-up of 11 years, 5 patients (5/70, 7.1% recurred and 5 had a completion for benign lesions, while 60 patients (86% continued to be observed without evidence for disease recurrence. Suspicious ultrasound findings were significantly more common in patients that had structural disease recurrence (100% versus 4.3%, P<0.001. Furthermore, a rising suppressed Tg value over time was also associated with structural disease recurrence (80% versus 21.5%, P=0.01. After additional therapy, 99% of the patients had no evidence of disease. Conclusions. Properly selected thyroid cancer patients can be treated with lobectomy with excellent clinical outcomes.

  10. The direct and immediate link test regarding deduction of input VAT

    DEFF Research Database (Denmark)

    Jensen, Dennis Ramsdahl; Stensgaard, Henrik

    2014-01-01

    It follows explicitly from the EC VAT Directive that the deduction of input VAT depends on a positive link between on the one hand the incurred expenses and on the other hand the planned or actually completed taxed output transactions. In theory and in practice the deeper nature of this link...

  11. An Analysis on Combating Vat Fraud in The European Union Using New IT Technologies

    Directory of Open Access Journals (Sweden)

    Lixăndroiu R.

    2009-12-01

    Full Text Available European VAT fraud has been growing at an alarming rate [2]. The level of VAT losses for one year is between €60bn and €100bn for all member states. This level of fraud has created an urgent need for Europe to address the issue of the reform of the VAT system.

  12. Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience.

    Science.gov (United States)

    Terra, Ricardo Mingarini; Araujo, Pedro Henrique Xavier Nabuco de; Lauricella, Leticia Leone; Campos, José Ribas Milanez de; Costa, Herbert Felix; Pego-Fernandes, Paulo Manuel

    2016-01-01

    To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015). Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min). Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3), in two patients. Pathological examination revealed complete tumor resection in all cases. When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality. Descrever a implantação de um programa de cirurgia torácica robótica em um hospital terciário público universitário e analisar seus resultados iniciais. Este estudo é uma análise interina planejada de um ensaio clínico aleatorizado cujo objetivo

  13. Postoperative use of drain in thyroid lobectomy – a randomized clinical trial conducted at Civil Hospital, Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Memon Zahid

    2012-09-01

    Full Text Available Abstract Background Thyroidectomy is a common surgical procedure, after which drains are placed routinely. This study aims to assess the benefits of placing postoperative drains, its complications and affects on postoperative stay, in thyroid lobectomy. Methodology Randomized Clinical Trial of 60 goitre patients undergoing lobectomy was conducted at Civil Hospital Karachi, during July’11-December’11. Patients were randomly assigned into drain and non drain groups. Patient demographics, labs and complications were noted. Ultrasound of neck was performed on both groups. For drain group, the amount of fluid present in the surgical bed and redivac drain was added to calculate fluid collection while in non drain group it was calculated by ultrasound of neck on first and second post-op days. Data was entered and analyzed on SPSS v16 using Independent T tests. Result The mean total drain output for 2 days in non-drain group was significantly lower 10.67 (±9.072 ml while in drain group was 30.97 (±42.812 ml (p = 0.014. The mean postoperative stay of drain group (79.2 ±15.63 hours was significantly higher, as compared to mean postoperative stay of non drain group (50.4 ±7.32 hours. Mean Visual Analogue Score (VAS for pain day 1 (6.2 ±0.997 and day 2 (4.17 ±0.95 in drain group were significantly higher compared to day 1 (2.6 ±1.163 and day 2 (1.3 ±0.877 of non drain group. From drain group, 2 patients complained of stridor, dyspnea on Day 1 which subsided by Day 2 and 1 case of voice change, with no such complains in non drain group. No patients from both groups developed seroma, wound infection or hematoma. Conclusion In uncomplicated surgeries especially for lobectomy, use of drain can be omitted.

  14. Kivirähk VAT Teatris / Meelis Kapstas

    Index Scriptorium Estoniae

    Kapstas, Meelis, 1963-

    1999-01-01

    VAT Teatri hooaja repertuaar. A. Kivirähki näidend "Sibulad ja šokolaad". Järgmise aasta jaanuaris saab teater oma statsionaarse lava - amfiteatri põhimõttel tehtud kammersaali Rahvusraamatukogus

  15. A Self-Peeling Vat for Improved Release Capabilities During DLP Materials Processing

    DEFF Research Database (Denmark)

    Pedersen, David Bue; Zhang, Yang; Nielsen, Jakob Skov

    2016-01-01

    for an eased release of the manufactured part from the vat by means of a flexible membrane system. A membrane of fluorinated ethylene polymer will through elastic deformation automatically peel off the part as the part is lifted during layer changes. Peeling has been qualified by means of a truncated inverted...... cone as test geometry. As the cross-sectional diameter of the cone increase throughout the build-job, the geometry will release from the glass based build platform at the point where the peeling force exceed the adhesion force between platform and part. At failure point the lateral surface area...... of the top and bottom of the truncated cone is used as a measure of the performance of the vat with respect to release-capability. This has been tested at increasing manufacturing rates. The new self-peeling vat outperformed industrial state-of-the-art vats by 814% percent....

  16. INTRODUCTION OF VAT SPLIT PAYMENT MECHANISM IN ROMANIA – COMPULSORY VERSUS OPTIONALLY

    Directory of Open Access Journals (Sweden)

    ECOBICI NICOLAE

    2017-11-01

    Full Text Available The objective of this article is to analyze the implications of introducing the VAT split payment mechanism in Romania, as it is regulated, as a compulsory system, through GO 23/2017 respectively, as well as in the case of the modification of the regulation in the sense of replacing the compulsory by optionality. We will analyze the effects of Ordinance 23/2017 of the Romanian Government regarding the mandatory distinctly payment of VAT for Romanian legal persons, registered or not for VAT purposes, as well as the result which the Government hopes to obtain as a result of the application of this provision, on the one hand. On the other hand, we will discuss the effects of a change in regulation for the optionally application of the VAT split payment mechanism, as of January 1, 2018, as compared with the amendments already approved by the Romanian Senate on October 31st, 2017. The structure of the article includes the following main sections: a briefly presents of the VAT split payment mechanism, as it was originally regulated by GO 23/2017; the second part includes the analysis of the implications of introducing the VAT split payment mechanism on legal entities and the state, in the initial phase of the Ordinance; the third part is devoted to the presentation of the amendments approved at the end of October 2017, respectively to the recommendations on amendments needed to be taken into account by the Chamber of Deputies, and the last part will include the conclusions and recommendations.

  17. V. Monitoring the stability of coumaphos acaricide in field cattle dipping vats by using HPLC

    International Nuclear Information System (INIS)

    Espinosa Gonzalez, J.; Rodriguez, F.; Barrera, R.

    1997-01-01

    The concentration of coumaphos in four field cattle dipping vats and its distribution at different depths in the suspension and in the sediment was monitored over 12 to 48 weeks. The residual concentration of coumaphos and degradation products was determined by HPLC. Coumaphos was extracted from the suspension by shaking with equal volume of methanol and 90% of coumaphos was extracted by this method. A reverse phase C-18 column (25 cm x 0.4 cm) was used in the HPLC and the eluent was a mixture of methanol+ water (80+20,v/v). The initial concentration of coumaphos was 200 mg/L. However, it steadily decreased in all four vats with time. The final concentration was reduced to 39% of the concentration at zero time in vat number 1 after 12 week 17% after 18 weeks in vat number 2, 29% after 19 weeks in vat number 3 and 23% after 48 weeks in vat number 4. The concentration in the sediment increased from 165 mg/kg at zero time to 1960 mg/kg after 18 weeks in vat number 1 and 152 mg/kg to 2020 mg/kg after 48 weeks in vat number 4. The concentration of coumaphos in the suspension ranged between 28 to 81 mg/L at the surface, 46 to 115 mg/L at 20 cm and 86 to 147 mg/L at 100 cm depth. (author)

  18. [Surgical Treatment of Bronchial Stricture due to Endobronchial Tuberculosis: 
Results in 36 Consecutive Cases].

    Science.gov (United States)

    Ruan, Junzhong; Zhang, Tianhui; Li, Fugen; Duan, Yong; Han, Ming; Wang, Zitong

    2018-04-20

    Bronchial tuberculosis is a common complication of pulmonary tuberculosis. The present report is to investigate and analyze the indication and efficacy of surgical treatment of bronchial stricture due to severe endobronchial tuberculosis, when the drug and endoscopic treatment were no effect. Reviewed the clinical-pathological records documenting the surgical outcomes in 36 bronchial stricture due to severe endobronchial tuberculosis who underwent lobectomy or pneumonectomy enrolled in our hospital between January 2000 and February 2016. Pneumonectomy in 8 cases, lobectomy in 23 cases, sleeve resection in 5 cases. No intraoperative or early postoperative death occurred. Six patients developed complications. All 6 cases recovered well after treatment. Surgical treatment is still the recommended treatment modatity for bronchial stricture caused by endobronchial tuberculosis due to its good results. It should be performed in time when the drug and intraluninal treatment were no effect for avoiding of being progeressed.

  19. Construction of a 3-D anatomical model for teaching temporal lobectomy.

    Science.gov (United States)

    de Ribaupierre, Sandrine; Wilson, Timothy D

    2012-06-01

    Although we live and work in 3 dimensional space, most of the anatomical teaching during medical school is done on 2-D (books, TV and computer screens, etc). 3-D spatial abilities are essential for a surgeon but teaching spatial skills in a non-threatening and safe educational environment is a much more difficult pedagogical task. Currently, initial anatomical knowledge formation or specific surgical anatomy techniques, are taught either in the OR itself, or in cadaveric labs; which means that the trainee has only limited exposure. 3-D computer models incorporated into virtual learning environments may provide an intermediate and key step in a blended learning approach for spatially challenging anatomical knowledge formation. Specific anatomical structures and their spatial orientation can be further clinically contextualized through demonstrations of surgical procedures in the 3-D digital environments. Recordings of digital models enable learner reviews, taking as much time as they want, stopping the demonstration, and/or exploring the model to understand the anatomical relation of each structure. We present here how a temporal lobectomy virtual model has been developed to aid residents and fellows conceptualization of the anatomical relationships between different cerebral structures during that procedure. We suggest in comparison to cadaveric dissection, such virtual models represent a cost effective pedagogical methodology providing excellent support for anatomical learning and surgical technique training. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. DETERMINING VAT PRO RATE. CASE STUDY AT A PAWNSHOP IN ROMANIA

    Directory of Open Access Journals (Sweden)

    NICOLAE ECOBICI

    2017-02-01

    Full Text Available Determining VAT pro rate entails in terms of theory the calculation of the share of taxable transactions made by an entity in total transactions. Thus, the entities that use VAT mixed regimes will be able to deduct the VAT related to operations afferent to the transactions with deductibility right and without deduction right, just in the same proportion with calculated pro rata. Also, regulations and adjustments will be made using the final pro rate applied for the entire ending year in the last statement of every year. By the 25th of the first month of the financial year, any entity must declare the provisional pro rate for the coming year to the tax administration body, which is equal to that determined for the ended year. The method used for capturing the main practical tax and accounting problems inherent to determine the VAT pro rate is the case study made at a pawn shop in Romania over the year 2016. Thus, given the multiplicity of operations carried out by pawnshops (pawnshop with gold and silver goods, pawnshop with electronics, selling goods unclaimed at the expiration of the pawn contracts, melting gold and silver and sale in the form of ingots or bars etc., in this article there will be discussed the main problems which may occur in practice on the VAT pro rata, using the example of an entity of this kind in Romania for 2016.

  1. COMPARATIVE ANALYSIS OF VAT EVOLUTION IN THE EUROPEAN ECONOMIC SYSTEM

    Directory of Open Access Journals (Sweden)

    MIHAELA ANDREEA STROE

    2011-04-01

    Full Text Available In this paper we study a comparative analysis of VAT in different states of the world. I made some observation on this theme because I believe that VAT is very important in carrying out transactions and the increase or decrease of this tax has a major impact upon national economies and also on the quality of life in developing countries. The papers has to pourpose to make a comparison between the American and European system of taxation with its advantages and disadvantages and, in the end to render an economic model and its statistics components. VAT is a value added tax which appeared about 50 years, initially with two purposes: one to replace certain indirect taxes, and another to reduce the budget deficit according to the faith of that time. The first country that has adopted this model was France, calling it today as value-added tax.

  2. VAT: a computational framework to functionally annotate variants in personal genomes within a cloud-computing environment.

    Science.gov (United States)

    Habegger, Lukas; Balasubramanian, Suganthi; Chen, David Z; Khurana, Ekta; Sboner, Andrea; Harmanci, Arif; Rozowsky, Joel; Clarke, Declan; Snyder, Michael; Gerstein, Mark

    2012-09-01

    The functional annotation of variants obtained through sequencing projects is generally assumed to be a simple intersection of genomic coordinates with genomic features. However, complexities arise for several reasons, including the differential effects of a variant on alternatively spliced transcripts, as well as the difficulty in assessing the impact of small insertions/deletions and large structural variants. Taking these factors into consideration, we developed the Variant Annotation Tool (VAT) to functionally annotate variants from multiple personal genomes at the transcript level as well as obtain summary statistics across genes and individuals. VAT also allows visualization of the effects of different variants, integrates allele frequencies and genotype data from the underlying individuals and facilitates comparative analysis between different groups of individuals. VAT can either be run through a command-line interface or as a web application. Finally, in order to enable on-demand access and to minimize unnecessary transfers of large data files, VAT can be run as a virtual machine in a cloud-computing environment. VAT is implemented in C and PHP. The VAT web service, Amazon Machine Image, source code and detailed documentation are available at vat.gersteinlab.org.

  3. Surgical team turnover and operative time: An evaluation of operating room efficiency during pulmonary resection.

    Science.gov (United States)

    Azzi, Alain Joe; Shah, Karan; Seely, Andrew; Villeneuve, James Patrick; Sundaresan, Sudhir R; Shamji, Farid M; Maziak, Donna E; Gilbert, Sebastien

    2016-05-01

    Health care resources are costly and should be used judiciously and efficiently. Predicting the duration of surgical procedures is key to optimizing operating room resources. Our objective was to identify factors influencing operative time, particularly surgical team turnover. We performed a single-institution, retrospective review of lobectomy operations. Univariate and multivariate analyses were performed to evaluate the impact of different factors on surgical time (skin-to-skin) and total procedure time. Staff turnover within the nursing component of the surgical team was defined as the number of instances any nurse had to leave the operating room over the total number of nurses involved in the operation. A total of 235 lobectomies were performed by 5 surgeons, most commonly for lung cancer (95%). On multivariate analysis, percent forced expiratory volume in 1 second, surgical approach, and lesion size had a significant effect on surgical time. Nursing turnover was associated with a significant increase in surgical time (53.7 minutes; 95% confidence interval, 6.4-101; P = .026) and total procedure time (83.2 minutes; 95% confidence interval, 30.1-136.2; P = .002). Active management of surgical team turnover may be an opportunity to improve operating room efficiency when the surgical team is engaged in a major pulmonary resection. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  4. Impact of VAT on the Profitability and the Cash Flow of Romanian Small and Medium Enterprises

    Directory of Open Access Journals (Sweden)

    MARIA ZENOVIA GRIGORE

    2014-05-01

    Full Text Available The options available to taxpayers make tax systems attractive and give them an opportunity to choose one system or another after a careful analysis of the fiscal advantages and disadvantages of each choice. A small or medium company has to explore the options available, whether that is VAT registration or de-registration or choosing the best VAT special scheme. VAT optimisation is particularly interesting because of the high cash flow involved and because of the cash flow benefits that can be obtained. This paper presents an analysis of VAT costs and their impact on profitability and cash flow of small and medium enterprises. We also analysed specific mechanisms to improve profitability and cash flow through VAT optimisation.

  5. IMPACT OF VAT ON THE PROFITABILITY AND THE CASH FLOW OF ROMANIAN SMALL AND MEDIUM ENTREPRISES

    Directory of Open Access Journals (Sweden)

    Maria Zenovia GRIGORE

    2014-05-01

    Full Text Available The options available to taxpayers make tax systems attractive and give them an opportunity to choose one system or another after a careful analysis of the fiscal advantages and disadvantages of each choice. A small or medium company has to explore the options available, whether that is VAT registration or de-registration or choosing the best VAT special scheme. VAT optimisation is particularly interesting because of the high cash flow involved and because of the cash flow benefits that can be obtained. This paper presents an analysis of VAT costs and their impact on profitability and cash flow of small and medium enterprises. We also analysed specific mechanisms to improve profitability and cash flow through VAT optimisation.

  6. Video-assisted Thoracoscope versus Video-assisted Mini-thoracotomy for Non-small Cell Lung Cancer: A Meta-analysis

    Directory of Open Access Journals (Sweden)

    Bing WANG

    2017-05-01

    Full Text Available Background and objective The aim of this study is to assess the effect of video-assisted thoracoscopic surgery (VATS and video-assisted mini-thoracotomy (VAMT in the treatment of non-small cell lung cancer (NSCLC. Methods We searched PubMed, EMbase, CNKI, VIP and ISI Web of Science to collect randomized controlled trials (RCTs of VATS versus VAMT for NSCLC. Each database was searched from May 2006 to May 2016. Two reviewers independently assessed the quality of the included studies and extracted relevant data, using RevMan 5.3 meta-analysis software. Results We finally identified 13 RCTs involving 1,605 patients. There were 815 patients in the VATS group and 790 patients in the VAMT group. The results of meta-analysis were as follows: statistically significant difference was found in the harvested lymph nodes (SMD=-0.48, 95%CI: -0.80--0.17, operating time (SMD=13.56, 95%CI: 4.96-22.16, operation bleeding volume (SMD=-33.68, 95%CI: -45.70--21.66, chest tube placement time (SMD=-1.05, 95%CI: -1.48--0.62, chest tube drainage flow (SMD=-83.69, 95%CI: -143.33--24.05, postoperative pain scores (SMD=-1.68, 95%CI: -1.98--1.38 and postoperative hospital stay (SMD=-2.27, 95%CI: -3.23--1.31. No statistically significant difference was found in postoperative complications (SMD=0.83, 95%CI: 0.54-1.29 and postoperative mortality (SMD=0.95, 95%CI: 0.55-1.63 between videoassisted thoracoscopic surgery lobectomy and video-assisted mini-thoracotomy lobectomy in the treatment of NSCLC. Conclusion Compared with video-assisted mini-thoracotomy lobectomy in the treatment of non-small cell lung cancer, the amount of postoperative complications and postoperative mortality were almost the same in video-assisted thoracoscopic lobectomy, but the amount of harvested lymph nodes, operating time, blood loss, chest tube drainage flow, and postoperative hospital stay were different. VATS is safe and effective in the treatment of NSCLC.

  7. Feasibility of four-arm robotic lobectomy as solo surgery in patients with clinical stage I lung cancer.

    Science.gov (United States)

    Park, Seong Yong; Suh, Jee Won; Narm, Kyoung Sik; Lee, Chang Young; Lee, Jin Gu; Paik, Hyo Chae; Chung, Kyoung Young; Kim, Dae Joon

    2017-06-01

    This study was performed to investigate the feasibility of four-arm robotic lobectomy (FARL) as a solo surgical technique in patients with non-small cell lung cancer (NSCLC). Early outcome and long-term survival of FARL were compared with those of video-assisted thoracoscopic lobectomy (VATL). Prospective enrollment of patients with clinical stage I NSCLC undergoing FARL or VATL (20 patients in each group) was planned. Interim analysis for early postoperative outcome was performed after the initial 10 cases in each group. The study was terminated early because of safety issues in the FARL group after enrollment of 12 FARL and 17 VATL patients from 2011 to 2012. There were no differences in clinical characteristics between groups. Lobectomy time and total operation time were significantly longer in the FARL group (P=0.003). There were three life-threatening events in the FARL group (2 bleedings, 1 bronchus tear) that necessitated thoracotomy conversion in 1 patient. There were no differences in other operative outcomes including pain score, complications, or length of hospital stay. Pathologic stage and number of dissected lymph nodes (LNs) were also comparable. During a follow-up of 48.9±9.5 months, recurrence was identified in 2 (16.7%) patients in FARL group and 3 (23.5%) in VATL group. Five-year overall survival (100% vs . 87.5%, P=0.386) and disease-free survival (82.5% vs . 75.6%, P=0.589) were comparable. FARL as solo surgery could not be recommended because of safety issues. It required a longer operation time and had no benefits over VATL in terms of early postoperative outcome or long-term survival.

  8. Effect of Introducing Second Reduced Rate of VAT on Consumer Purchase Behaviour with Gluten‑free Food

    Directory of Open Access Journals (Sweden)

    Daniela Šálková

    2017-01-01

    Full Text Available The aim of the paper is to assess the effect of introducing the second reduced rate of VAT of 10 % since 1 January 2015 on consumer behaviour when purchasing gluten‑free food. Monitoring the effect of the VAT rate reduction on selected gluten‑free food and products was a part of a research focused on gluten‑free consumer preferences when eating in restaurants (960 respondents were interviewed. Further research which was focused on the effect of the VAT rate reduction and which surveyed the consumer criteria when purchasing gluten‑free products addressed a total of 160 respondents with a gluten‑free diet. According to the respondents’ experience, the introduction of the second reduced VAT rate of 10 % has not significantly affected the prices for the final consumers. The reason for that may be the fact that the second reduced VAT rate applies mostly to ingredients used in gluten‑free production and only a few final products. A large group of coeliacs is not even aware of or has not registered the VAT change.

  9. Resignation from the VAT exemption of sales of residential premises by the developer

    Directory of Open Access Journals (Sweden)

    Joanna Koziollek

    2016-09-01

    Full Text Available Tax institutions should be construed in a rational manner, in order so as to not restrict economic turnover excessively. The regulations concerning the possibility to resign from the VAT exemption of sales of residential premises by the developer characterizes by the high level of formalism which affects in a negative manner the sales process performed by the developer. This paper is devoted to the fragment of the polish Act on the goods and services tax governing the issue of resignation from the VAT exemption of sales of residential premises, which implies in a certain extent to appeal to the regulation of exemptions stipulated in this Act. The subject matter of this analysis is to examine the correctness of transposition of the Directive 112 into polish legal system in the field of real estate exemptions from VAT, the conditions for exercising the optional exemption, as well as the benefit of the resignation from the VAT exemption by the taxpayer.

  10. Dissipation of coumaphos acaricide in model cattle dipping vats and soil columns under sub-tropical climate of Delhi

    International Nuclear Information System (INIS)

    Jindal, T.; Singh, D.K.; Agarwal, H.C.

    1997-01-01

    The stability of coumaphos was studied in model dipping vats under field conditions using 14 C-labelled and unlabelled coumaphos, with or without additives. Four vats were used each containing 50 litre of water treated with 3.7 MBq 14 C and 10 g (AI) unlabelled coumaphos in 25 mL acetone. Vat 1 was control. Vat 2 and 3 were maintained at pH 5 by addition of superphosphate initially and at regular intervals as required. Vat 3 and 4 were treated with bacteriostat copper sulphate at 0.01 g per litre. The pH of vat 1 and 4 gradually increased with time from initial value of 7 to 8.47 and 7.57 respectively. In vat 1 and 4 the concentration of coumaphos declined from about initial concentration of 200 μg/mL to about 9 μg/mL in 255 days after initial treatment, whereas the persistence of coumaphos was more in vats 2 and 3. The stability of coumaphos in model vats increased significantly by maintaining a pH of 5 by addition of superphosphate. The pesticide residues consisted of 80 % or more of unchanged coumaphos. In addition potasan, chlorferon and 4 - methylumbelliferone were detected in small proportions. In another experiment the effect of pH was studied. Coumaphos was most stable at pH 5 as also observed in model vats under field conditions. Coumaphos did not leach below 10 cm in all the four cases. Dissipation, degradation and bound residue formation was more in case of alkali treated coumaphos than normal coumaphos. Aged residues of vat 3 were reasonably stable as copper sulphate inhibited the degradation of coumaphos in soil by microorganisms. Coumaphos along with the the above three metabolises were detected in the extractable insecticide residues from the soil, though the proportion of metabolises was much more than found in model vats. Again treatment of coumaphos with alkali further increased its metabolism and the soil bound residues were double as compared to untreated coumaphos

  11. Single-staged uniportal VATS in the supine position for simultaneous bilateral primary spontaneous pneumothorax.

    Science.gov (United States)

    Kim, Kyung Soo

    2017-05-15

    Simultaneous bilateral primary spontaneous pneumothorax (SBPSP) is rare, but requires surgery on both sides, in patients with definite bilateral bullae to prevent life-threatening conditions. Recently, uniportal video-assisted thoracoscopic surgery (VATS) has been widely accepted as a less invasive technique for the treatment of pneumothorax. Thus, we introduced single-staged uniportal VATS technique in the supine position, for the management of two cases of SBPSP. A 17-year-old boy presented with bilateral spontaneous pneumothorax and he underwent single-staged uniportal VATS in the supine position. Single wide draping in consecutive bilateral approaches removes the needs of changing patients' position. Whole thoracoscopic procedure for wedge resection of bullae lesions was conducted without difficulty. The total operation time took 65 min and the patient discharged 3 days after the operation. The patient was followed for 24 months without recurrence of both sides. Another 18-year-old boy was admitted with bilateral spontaneous pneumothorax and single-staged uniportal VATS was also performed in the supine position. The total operation time took 79 min and the patient discharged on postoperative day 4. He was followed for 19 months without recurrence of both sides. Single-staged uniportal VATS approach yielded satisfactory results from simplicity that not requires position change compared to conventional multi-ports VATS in the lateral position, and with better cosmetics. This technique is thought to be a feasible procedure in selective patients with SBPSP or with contralateral bullae for preventive role.

  12. VAT teatril kaks uut noortelavastust / Tiiu Talvist

    Index Scriptorium Estoniae

    Talvist, Tiiu

    2010-01-01

    VAT teater panustab sel hooajal uutesse laste- ja noortelavastustesse: lisaks itaallaste Nino d’Introna ja Giacomo Ravicchio teksti põhjal valminud seiklusloole „Robinson & Crusoe” (lavastaja Aare Toikka), esietendub aprillis Mare Sabolotny noorte probleemidest kõnelev lavalugu „Kirjaklambritest vöö”. Lavastaja Rein Agur

  13. Changes in the Strength of the Polymer Concrete Used in the Electroplating Vats Under Operational Load

    Directory of Open Access Journals (Sweden)

    Radna Lidia

    2017-12-01

    Full Text Available Due to the strong and aggressive electrolyte media and thermal load, design of the electroplating vats in the copper industry often relies on the resin concrete. The article presents the results of the strength tests of the polymer concrete based on the "Derakane" resin, used in the construction of electroplating vats. Samples were taken from the real vats - both new and 17-year old. Strength tests included compression and bending tensile strength test. To assess the effect of operational conditions the tests were performed on the same-age vats, some of which were never used while others were subjected to the operational load. During the operation, the vats sustained load of the anode and cathode weights, cyclic electrolyte loading with a temperatures up to 60°C. As a result, it was noted that the operational conditions led to the increased strength of the polymer concrete material.

  14. Changes in the Strength of the Polymer Concrete Used in the Electroplating Vats Under Operational Load

    Science.gov (United States)

    Radna, Lidia; Sakharov, Volodymyr

    2017-12-01

    Due to the strong and aggressive electrolyte media and thermal load, design of the electroplating vats in the copper industry often relies on the resin concrete. The article presents the results of the strength tests of the polymer concrete based on the "Derakane" resin, used in the construction of electroplating vats. Samples were taken from the real vats - both new and 17-year old. Strength tests included compression and bending tensile strength test. To assess the effect of operational conditions the tests were performed on the same-age vats, some of which were never used while others were subjected to the operational load. During the operation, the vats sustained load of the anode and cathode weights, cyclic electrolyte loading with a temperatures up to 60°C. As a result, it was noted that the operational conditions led to the increased strength of the polymer concrete material.

  15. The taxable events for the Value-Added Tax (VAT based on a Comparative Law approach

    Directory of Open Access Journals (Sweden)

    Walker Villanueva Gutiérrez

    2014-07-01

    Full Text Available This article analyzes the definitions of the main taxable events for the Value-Added Tax (VAT based on a comparative approach to thelegislation of different countries (Spain, Mexico, Chile, Colombia, Argentina and Peru. In this regard, it analyzes which legislations offer definitions according to the principles of generality, fiscal neutrality and legal certainty for VAT. Moreover, it points out that the VAT systems of those countries do not require as a condition for the configuration of the taxable events that the transactions involve a «value added» or a final consumption. In the specificcase of «supplies of goods», the VAT systems have a similar definition of the taxable event, although there are a few differences. However, in the case of«supplies of services», which is the most important taxable event for VAT, there are important differences at the time each country defines it. This is not a desirable effect for the international trade of services, since the lack of harmonization produces double taxation or double non taxation.

  16. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection

    Energy Technology Data Exchange (ETDEWEB)

    Su, Tian-Hao; Jin, Long; He, Wen [Capital Medical University, Department of Radiology, Beijing Friendship Hospital, Beijing (China); Fan, Yue-Feng [Xiamen University, Department of Interventional Therapy, The First Affiliated Hospital, Xiamen, Fujian (China); Hu, Li-Bao [Peking University People' s Hospital, Department of Radiology, Beijing (China)

    2015-09-15

    To describe and assess the localization of small peripheral pulmonary nodules prior to video-assisted thoracoscopic surgical (VATS) resection using the implantation of microcoils. Ninety-two patients with 101 pulmonary nodules underwent computed tomography (CT)-guided implantation of microcoils proximal to each nodule. Patients were randomly assigned to undergo entire microcoil or leaving-microcoil-end implantations. The complications and efficacy of the two implantation methods were evaluated. VATS resection of lung tissue containing each pulmonary lesion and microcoil were performed in the direction of the microcoil marker. Histopathological analysis was performed for the resected pulmonary lesions. CT-guided microcoil implantation was successful in 99/101 cases, and the placement of microcoils within 1 cm of the nodules was not disruptive. There was no difference in the complications and efficacy associated with the entire implantation method (performed for 51/99 nodules) versus the leaving-microcoil-end implantation method (performed for 48/99 nodules). All nodules were successfully removed using VATS resection. Asymptomatic pneumothorax occurred in 16 patients and mild pulmonary haemorrhage occurred in nine patients. However, none of these patients required further surgical treatment. Preoperative localization of small pulmonary nodules using a refined percutaneous microcoil implantation method was found to be safe and useful prior to VATS resection. (orig.)

  17. In pursuit of tax equity: lessons from VAT rate structure adjustment in Poland

    Directory of Open Access Journals (Sweden)

    Artur Świstak

    2015-06-01

    Full Text Available In 2011, in the aftermath of the economic crisis, Poland increased its value added tax rates. Despite an already large VAT policy gap, further rate differentiation was used to address distributional concerns and to protect the most vulnerable households. We find that the changes to the VAT rate structure hardly improved the overall progressivity of the VAT and the tax system as a whole. While providing only minimal relief to the poor, taxation of food products at a super reduced rate greatly subsidized the richer households. With a small change to the income tax structure, the government could have secured more progressivity at a lower cost in terms of revenue foregone.

  18. Geometrical shape assessment of additively manufactured features by direct light processing vat polymerization method

    DEFF Research Database (Denmark)

    Péreza, Lucia C. Díaz; Davoudinejad, Ali; Quagliotti, Danilo

    The importance of Additive Manufacturing (AM) in the field of micro manufacturing is increasing. Vat Polymerization Methods are one of the lead AM technologies to produce polymer micro parts. In the Technical University of Denmark (DTU), a vat photopolymerization AM machine able to print features...

  19. Preparation of iron-deposited graphite surface for application as cathode material during electrochemical vat-dyeing process

    International Nuclear Information System (INIS)

    Anbu Kulandainathan, M.; Kiruthika, K.; Christopher, G.; Babu, K. Firoz; Muthukumaran, A.; Noel, M.

    2008-01-01

    Iron-deposited graphite surfaces were prepared, characterized and employed as cathode materials for electrochemical vat-dyeing process containing very low concentration of sodium dithionite. The electrodeposition, in presence of ammonium thiocyanate and gelatin or animal glue as binding additives, were found to give finer iron deposits for improved electrochemical dyeing application. The electrodeposits were characterized using scanning electron microscopy, electron-dispersive X-ray spectroscopy and X-ray diffraction methods, before and after electrochemical dyeing process. The electrochemical activity of the iron-deposited graphite electrodes always stored in water seems to depend on the surface-bound Fe 3+ /Fe 2+ redox species. Vat dyes like C.I. Vat Violet 1, C.I. Vat Green 1 and C.I. Vat Blue 4 could be efficiently dyed employing these above electrode materials. The colour intensity and washing fastness of the dyed fabrics were found to be equal with conventionally dyed fabrics. The electrodes could also be reused for the dyeing process

  20. Changes in VAT rates during the economic crisis

    Directory of Open Access Journals (Sweden)

    Jan Široký

    2011-01-01

    Full Text Available To solve the current economical crisis, there are used various tools of economic policy. Some of them are changes in taxes, particularly changes in the value added tax due to its importance.Value added tax is the most harmonized tax in the single internal market of the European Communities. Although community law defines the basic legal constraints of VAT rules in individual countries, the Council Directive 2006/112/EC on the common system of value added tax, as amended, leaves some areas open for the Member States. One of the main characteristics of VAT is its tax rates which are – while maintaining specified minimal borders – in competency of Member States.Paper illustrates and evaluates the changes in tax rates of individual Member States during the economic crisis and points to their context and consequences.

  1. Material-Dependent Implant Artifact Reduction Using SEMAC-VAT and MAVRIC: A Prospective MRI Phantom Study.

    Science.gov (United States)

    Filli, Lukas; Jud, Lukas; Luechinger, Roger; Nanz, Daniel; Andreisek, Gustav; Runge, Val M; Kozerke, Sebastian; Farshad-Amacker, Nadja A

    2017-06-01

    The aim of this study was to compare the degree of artifact reduction in magnetic resonance imaging achieved with slice encoding for metal artifact correction (SEMAC) in combination with view angle tilting (VAT) and multiacquisition variable resonance image combination (MAVRIC) for standard contrast weightings and different metallic materials. Four identically shaped rods made of the most commonly used prosthetic materials (stainless steel, SS; titanium, Ti; cobalt-chromium-molybdenum, CoCr; and oxidized zirconium, oxZi) were scanned at 3 T. In addition to conventional fast spin-echo sequences, metal artifact reduction sequences (SEMAC-VAT and MAVRIC) with varying degrees of artifact suppression were applied at different contrast weightings (T1w, T2w, PDw). Two independent readers measured in-plane and through-plane artifacts in a standardized manner. In addition, theoretical frequency-offset and frequency-offset-gradient maps were calculated. Interobserver agreement was assessed using intraclass correlation coefficient. Interobserver agreement was almost perfect (intraclass correlation coefficient, 0.86-0.99). Stainless steel caused the greatest artifacts, followed by CoCr, Ti, and oxZi regardless of the imaging sequence. While for Ti and oxZi rods scanning with weak SEMAC-VAT showed some advantage, for SS and CoCr, higher modes of SEMAC-VAT or MAVRIC were necessary to achieve artifact reduction. MAVRIC achieved better artifact reduction than SEMAC-VAT at the cost of longer acquisition times. Simulations matched well with the apparent geometry of the frequency-offset maps. For Ti and oxZi implants, weak SEMAC-VAT may be preferred as it is faster and produces less artifact than conventional fast spin-echo. Medium or strong SEMAC-VAT or MAVRIC modes are necessary for significant artifact reduction for SS and CoCr implants.

  2. Absolute spike frequency as a predictor of surgical outcome in temporal lobe epilepsy.

    Science.gov (United States)

    Ngo, Ly; Sperling, Michael R; Skidmore, Christopher; Mintzer, Scott; Nei, Maromi

    2017-04-01

    Frequent interictal epileptiform abnormalities may correlate with poor prognosis after temporal lobe resection for refractory epilepsy. To date, studies have focused on limited resections such as selective amygdalohippocampectomy and apical temporal lobectomy without hippocampectomy. However, it is unclear whether the frequency of spikes predicts outcome after standard anterior temporal lobectomy. Preoperative scalp video-EEG monitoring data from patients who subsequently underwent anterior temporal lobectomy over a three year period and were followed for at least one year were reviewed for the frequency of interictal epileptiform abnormalities. Surgical outcome for those patients with frequent spikes (>60/h) was compared with those with less frequent spikes. Additionally, spike frequency was evaluated as a continuous variable and correlated with outcome to determine if increased spike frequency correlated with worse outcome, as assessed by modified Engel Class outcome. Forty-seven patients (18 men, 29 women; mean age 40 years at surgery) were included. Forty-six patients had standard anterior temporal lobectomy (24 right, 22 left) and one had a modified left temporal lobectomy. There was no significant difference in seizure outcome between those with frequent (57% Class I) vs. those with less frequent (58% Class I) spikes. Increased spike frequency did not correlate with worse outcome. Greater than 20 complex partial seizures/month and generalized tonic-clonic seizures within one year of surgery correlated with worse outcome. This study suggests that absolute spike frequency does not predict seizure outcome after anterior temporal lobectomy unlike in selective procedures, and should not be used as a prognostic factor in this population. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  3. Thoracoscopic-assisted pulmonary surgery for partial and complete lung lobectomy in dogs and cats: 11 cases (2008-2013).

    Science.gov (United States)

    Wormser, Chloe; Singhal, Sunil; Holt, David E; Runge, Jeffrey J

    2014-11-01

    To describe the use of thoracoscopic-assisted pulmonary surgery (TAPS) for partial and complete lung lobectomy in small animal patients and to evaluate short-term outcome. Retrospective case series. 11 client-owned dogs and cats. Procedures-Medical records of dogs and cats that underwent a partial or complete TAPS lung lobectomy were reviewed. All patients underwent general anesthesia and were positioned in lateral recumbency with the affected hemithorax uppermost. One-lung ventilation was not implemented in any patient. For initial exploration, a 5- to 10-mm incision was made for insertion of a 30° telescope approximately 5 to 7 rib spaces away from the site of the pulmonary lesion in the dorsal third of the thorax. All subsequent incision placements were case dependent and determined by the location of the lesion to be resected. Following lesion localization, a 2- to 7-cm minithoracotomy incision was made with direct thoracoscopic visualization without the use of rigid rib retractors. In 10 of 11 patients, a 360° wound retraction device was placed at the minithoracotomy site prior to exteriorization and resection of the affected lung. Lymph nodes were inspected intraoperatively, but biopsies were not performed; incisions were closed routinely, and a thoracostomy tube was placed in all patients. 3 cats and 8 dogs underwent successful partial (5) or complete (6) TAPS lung lobectomy over a 5-year period (2008 through 2013). Median surgery time was 92.7 minutes (range, 77 to 150 minutes). Thoracostomy tubes were removed a median of 22.3 hours after surgery (range, 18 to 36 hours). The median time to discharge was 3.1 days (range, 1 to 6 days). No intraoperative complications were encountered. All patients were discharged from the hospital, with 9 of 11 patients alive 6 months after surgery. Results of this study suggested that lung lobectomy by means of TAPS can be successfully performed in dogs and cats. When compared with total thoracoscopic surgery, TAPS may

  4. Three-dimensional (3D)- computed tomography bronchography and angiography combined with 3D-video-assisted thoracic surgery (VATS) versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of non-small cell lung cancer.

    Science.gov (United States)

    She, Xiao-Wei; Gu, Yun-Bin; Xu, Chun; Li, Chang; Ding, Cheng; Chen, Jun; Zhao, Jun

    2018-02-01

    Compared to the pulmonary lobe, the anatomical structure of the pulmonary segment is relatively complex and prone to variation, thus the risk and difficulty of segmentectomy is increased. We compared three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with 3D video-assisted thoracic surgery (3D-VATS) to perform segmentectomy to conventional two-dimensional (2D)-VATS for the treatment of non-small cell lung cancer (NSCLC). We retrospectively reviewed the data of randomly selected patients who underwent 3D-CTBA combined with 3D-VATS (3D-CTBA-VATS) or 2D-VATS at the Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University Hospital, from January 2014 to May 2017. The operative duration of 3D group was significantly shorter than the 2D group (P 0.05). The extent of intraoperative bleeding and postoperative drainage in the 3D group was significantly lower than in the 2D group (P 3D group was shorter than in the 2D group (P 0.05). However, hemoptysis and pulmonary air leakage (>3d) occurred significantly less frequently in the 3D than in the 2D group (P 3D-CTBA-VATS is a more accurate and smooth technique and leads to reduced intraoperative and postoperative complications. © 2018 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  5. Assessing Survival and Grading the Severity of Complications in Octogenarians Undergoing Pulmonary Lobectomy

    Directory of Open Access Journals (Sweden)

    Andrew Feczko

    2017-01-01

    Full Text Available Introduction. Octogenarians are at increased risk for complications after lung resection. With alternatives such as radiation, understanding the risks of surgery and associated survival are valuable. Data grading the severity of complications and long-term survival in this population is lacking. We reviewed our experience with lobectomy in octogenarians, grading complications using a validated thoracic morbidity and mortality schema. Methods. We retrospectively reviewed consecutive patients aged ≥80 undergoing lobectomy between 2004 and 2012. Demographics, clinical/pathologic stage, complications, recurrence, and mortality were collected. Complications were graded by the Seely thoracic morbidity and mortality model. Results. 45 patients (mean age 82.2 years were analyzed. The majority of patients (28/45, 62% were clinical stage IA/IB. 62% (28/45 of patients experienced a complication. Only 15.6% (7/45 were considered significantly morbid (≥ grade IIIB per the Seely model. Perioperative mortality was 2% and half of patients were living at a follow-up of 53 months. Overall five-year survival was 52%. Conclusions. In carefully selected octogenarians, lobectomy carries a 15.6% rate of significantly morbid complications with encouraging overall survival. These data provide the basis for a more complete discussion with patients regarding lobectomy for lung cancer.

  6. Surgical management of bronchiectasis. The indications and outcomes

    International Nuclear Information System (INIS)

    Gursoy, S.; Ozturk, A.A.; Ucvet, A.; Erbaycu, A.E.

    2010-01-01

    Social limitations in addition to treatment failure, despite preventive precautions and aggressive medical treatment, are the main indications for surgery in patients with bronchiectasis. The aim of this study was to evaluate all aspects of treatment outcomes in surgically treated patients with bronchiectasis. Ninety-two patients with bronchiectasis treated by a surgical resection between January 2002 and June 2007 were included in the study. Age, sex, symptoms, etiologic factors, radiological findings, surgical procedures, postoperative morbidity and mortality, and hospital stay were analyzed. Fifty-four patients were female and 38 were male, with an average age of 38.7 (range, 10-67) years, and 84.8% were symptomatic. The etiologic factors included frequent infections (37%), childhood infections (22%), tuberculosis (12%), foreign bodies (3%), and unknown causes (26%). Ten pneumonectomies, 36 lobectomies, 2 bilobectomies, 32 lobectomies and segmentectomies, and 12 segmentectomies were performed. The morbidity was 16%, the mortality was 1%, and the mean follow-up duration was 15.3 months. Follow-up data were obtained in 75 patients of whom 63 (84%) were asymptomatic, 8 (10.7%) were symptomatic with clinical improvement, and 4 (5.3%) had had no clinical improvement. Despite the advances in preventive precautions, medical treatment, and follow-up, surgery, with its low mortality and morbidity rates, remains a good alternative in selected patients in the treatment of bronchiectasis, and fulfills the clinical and social improvement expectations of patients. (author)

  7. How early should VATS be performed for retained haemothorax in blunt chest trauma?

    Science.gov (United States)

    Lin, Hsing-Lin; Huang, Wen-Yen; Yang, Chyan; Chou, Shih-Min; Chiang, Hsin-I; Kuo, Liang-Chi; Lin, Tsung-Ying; Chou, Yi-Pin

    2014-09-01

    Blunt chest injury is not uncommon in trauma patients. Haemothorax and pneumothorax may occur in these patients, and some of them will develop retained pleural collections. Video-assisted thoracoscopic surgery (VATS) has become an appropriate method for treating these complications, but the optimal timing for performing the surgery and its effects on outcome are not clearly understood. In this study, a total of 136 patients who received VATS for the management of retained haemothorax from January 2003 to December 2011 were retrospectively enrolled. All patients had blunt chest injuries and 90% had associated injuries in more than two sites. The time from trauma to operation was recorded and the patients were divided into three groups: 2-3 days (Group 1), 4-6 days (Group 2), and 7 or more days (Group 3). Clinical outcomes such as the length of stay (LOS) at the hospital and intensive care unit (ICU), and duration of ventilator and chest tube use were all recorded and compared between groups. The mean duration from trauma to operation was 5.9 days. All demographic characteristics showed no statistical differences between groups. Compared with other groups, Group 3 had higher rates of positive microbial cultures in pleural collections and sputum, longer duration of chest tube insertion and ventilator use. Lengths of hospital and ICU stay in Groups 1 and 2 showed no statistical difference, but were longer in Group 3. The frequency of repeated VATS was lower in Group 1 but without statistically significant difference. This study indicated that an early VATS intervention would decrease chest infection. It also reduced the duration of ventilator dependency. The clinical outcomes were significantly better for patients receiving VATS within 3 days under intensive care. In this study, we suggested that VATS might be delayed by associated injuries, but should not exceed 6 days after trauma. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Surgical treatment of bronchiectasis: A review of 20 years of experience

    Directory of Open Access Journals (Sweden)

    D. Coutinho

    2016-03-01

    Full Text Available Background: Bronchiectasis is defined as an abnormal and irreversible dilation and distortion of the bronchi, which has numerous causes. Surgical treatment of this disease is usually reserved for focal disease and when the medical treatment is no longer effective. We report our center experience and outcomes in bronchiectasis surgery during the last 20 years. Methods: Between 1994 and 2014, sixty-nine patients underwent surgical resection for bronchiectasis. Patient demographics, presenting symptoms, indications for surgical treatment, type of lung resection, morbidity and mortality, as well as clinical follow-up and outcomes were analyzed. Results: From the 69 patients included, 31 (44.9% were male and 38 (55.1% were female. Surgery was indicated because of unsuccessful medical therapy in 33 patients (47.8%, haemoptysis in 22 patients (31.9%, nondiagnostic lung mass in 9 patients (13.0% and lung abscess in 5 patients (7.3%. The surgical procedures were lobectomy in 45 (65.2% patients, pneumonectomy in 10 (14.5% patients, bilobectomy in 8 (11.6% patients, lobectomy plus segmentectomy in 3 (4.3% patients and only segmentectomy in 3 (4.3% patients. Morbidity rate was 14.5% and there was no perioperative mortality. The follow-up was possible in 60 patients, with an outcome reported as excellent in 44 (73.3% patients, as improved in 11 (18.3% and as unchanged in 5 (8.3%. Conclusion: Although the number of patients with bronchiectasis referred for surgical treatment has decreased, pulmonary resection still plays a significant role. Surgical resection of localized bronchiectasis is a safe procedure with proven improvement of quality of life for the majority of patients. Keywords: Bronchiectasis, Thoracic surgery

  9. The Impact of Taxation of the Domestic Economic Transactions on the Vat Collection Through Electronic Fiscal Devices

    Directory of Open Access Journals (Sweden)

    Ionel Bostan

    2017-05-01

    Full Text Available The issue of collecting tax resources to the consolidated budget has determined and still determines difficulties which cannot be neglected in all the former socialist countries of the Central and Eastern Europe. From the Members States of the European Union, Romania is the country with the highest VAT Gap between EU Member States: 41%, compared to a European average of 15.2%. One solution tried to solve this problem was the regulation of mandatory use of electronic cash registers with fiscal memory. In this way, it was considered that a better highlight and also a tighter control of economic transactions will be achieved, from a fiscal point of view. In our study, we analyze, for the Romanian context in the postEU accession, whether the mandatory introduction of these devices in recording commercial transactions has had a significant impact on VAT collection. The study includes two stages of the analysis: in the first stage we estimated the influence of VAT rate variation on the degree of the VAT collection. Then we used the residual component to test the influence of EFDs’ mandatory introduction on VAT collection or on fiscal efficiency. The results indicate an improvement in the collection of VAT but also a decrease in the efficiency of fiscal collection.

  10. A case of typical pulmonary carcinoid tumor treated with bronchoscopic therapy followed by lobectomy

    Directory of Open Access Journals (Sweden)

    Porpodis K

    2012-02-01

    Full Text Available Konstantinos Porpodis1, Michael Karanikas2, Paul Zarogoulidis1, Theodoros Kontakiotis1, Alexandros Mitrakas2, Agisilaos Esebidis2, Maria Konoglou3, Kalliopi Domvri1, Alkis Iordanidis4, Nikolaos Katsikogiannis5, Nikolaos Courcoutsakis4, Konstantinos Zarogoulidis11Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece; 21st University Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 31st Pulmonary Department, "G Papanikolaou" General Hospital, Thessaloniki, Greece; 4Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 5Surgery Department (NHS, University General Hospital of Alexandroupolis, GreeceAbstract: Carcinoid bronchopulmonary tumors represent approximately 25% of all carcinoid tumors and 1%–2% of all lung neoplasms. The most common symptoms are: persistent cough, asthma-like wheezing, chest pain, dyspnea, hemoptysis and obstructive pneumonitis. We present a case of a young adult diagnosed with a typical carcinoid tumor. The diagnosis was established on the basis of imaging examination and bronchoscopic biopsy. The patient was treated with bronchoscopic electrocautery therapy to relieve the obstructed airway, followed by surgical lobectomy in order to entirely remove the exophytic damage. This approach was not only a palliative management to bronchial obstruction but also avoided pneumonectomy. Recent studies support the use of such interventional resection methods, as they may result in a more conservative surgical resection.Keywords: carcinoid tumor, typical lung carcinoid, therapeutic bronchoscopy, surgical resection

  11. Treatment of Early Stage Non-Small Cell Lung Cancer: Surgery or Stereotactic Ablative Radiotherapy?

    Directory of Open Access Journals (Sweden)

    Esengül Koçak Uzel

    2015-03-01

    Full Text Available The management of early-stage Non-small Cell Lung Cancer (NSCLC has improved recently due to advances in surgical and radiation modalities. Minimally-invasive procedures like Video-assisted thoracoscopic surgery (VATS lobectomy decreases the morbidity of surgery, while the numerous methods of staging the mediastinum such as endobronchial and endoscopic ultrasound-guided biopsies are helping to achieve the objectives much more effectively. Stereotactic Ablative Radiotherapy (SABR has become the frontrunner as the standard of care in medically inoperable early stage NSCLC patients, and has also been branded as tolerable and highly effective. Ongoing researches using SABR are continuously validating the optimal dosing and fractionation schemes, while at the same time instituting its role for both inoperable and operable patients.

  12. Recent advances in surgical management of early lung cancer

    Directory of Open Access Journals (Sweden)

    Shun-Mao Yang

    2017-12-01

    Full Text Available The broad application of low-dose computed tomography screening has resulted in the detection of many more cases of early lung cancer than ever before in modern history. Recent advances in the management of early-stage non-small cell lung cancer have focused on making therapy less traumatic, enhancing recovery, and preserving lung function. In this review, we discuss several new modalities associated with minimally invasive surgery for lung cancer. Firstly, less lung parenchyma resection via sublobar resection has become an acceptable alternative to lobectomy in patients with tumors less than 2 cm in size or with poor cardiopulmonary reserve. Secondly, thoracoscopic surgery using a single-portal or needlescopic approach to decrease chest wall trauma is becoming common practice. Thirdly, less invasive anesthesia, using nonintubated techniques, is feasible and safe and is associated with fewer intubation- and ventilator-associated complications. Fourthly, preoperative or intraoperative image-guided localization is an effective modality for identifying small and deep nodules during thoracoscopic surgery. Keywords: Anesthesia, Lung cancer, Nonintubated, Surgery, Thoracoscopy, Video-assisted thoracoscopic surgery (VATS

  13. VAT-teatris mõtiskletakse allasurutud pingete üle / Mari Rebane

    Index Scriptorium Estoniae

    Rebane, Mari

    2006-01-01

    13. apr. esietendus VAT Teatris Amélie Nothombi "Vaenlase kosmeetika", tõlkija, lavastaja ja muusikaline kujundaja Peeter Raudsepp, kunstnik Hardi Volmer. Tükki mängitakse rahvusraamatukogu teatrisaalis

  14. Surgical Management of Complicated Necrotizing Pneumonia in Children.

    Science.gov (United States)

    Lai, Jin-Yao; Yang, Wendy; Ming, Yung-Ching

    2017-08-01

    There are no well-established indications for the surgical management of acute necrotizing pneumonitis in children. This study presents our experience regarding this challenging topic. Between 2002 and 2009, 56 necrotizing pneumonitis patients with empyema were treated surgically. The outcomes were analyzed retrospectively. Computed tomography findings of massive lung necrosis or large cavities involving more than 50% of the involved lobe were deemed to be complicated necrotizing pneumonitis. Patients without the above indications were considered uncomplicated. Thirty-one cases were uncomplicated and 25 were complicated. Operative procedures included 38 decortications (31 uncomplicated and seven complicated), 14 wedge resections, and four lobectomies (complicated only). Preoperatively, patients with complicated necrotizing pneumonia had a higher incidence of pneumothorax (32% vs. 14.3%; p = 0.001), endotracheal intubation (44% vs. 9.7%; p = 0.008), and hemolytic uremic syndrome (20% vs. 3.2%; p = 0.01). These patients also had higher incidences of intraoperative transfusion (68% vs. 9.7%; p = 0.03), major postoperative complications (16% vs. 0%; p = 0.02), reoperations (16% vs. 0%; p = 0.02), and longer postoperative stay (19.8 ± 24.2 days vs. 11.2 ± 5.8 days; p = 0.03). Four complicated patients, who initially had decortications and limited resections, underwent reoperations. Compared with uncomplicated patients, those who underwent decortications and wedge resection required longer postoperative stays (23.6 ± 9.9 days, p < 0.01 and 21.1 ± 30.7 days, p = 0.04, respectively), whereas patients who had lobectomy had a similar duration of recovery (9.0 ± 2.1 days, p = 0.23). All patients improved significantly at follow-up. Children with complicated necrotizing pneumonitis have more preoperative morbidities, more major postoperative complications, and require longer postoperative stays. Aggressive surgical treatment results in

  15. Complete remission of epileptic psychosis after temporal lobectomy: case report

    Directory of Open Access Journals (Sweden)

    Marchetti Renato Luiz

    2001-01-01

    Full Text Available We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS. After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.

  16. The Society for Translational Medicine: clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy.

    Science.gov (United States)

    Gao, Shugeng; Zhang, Zhongheng; Brunelli, Alessandro; Chen, Chang; Chen, Chun; Chen, Gang; Chen, Haiquan; Chen, Jin-Shing; Cassivi, Stephen; Chai, Ying; Downs, John B; Fang, Wentao; Fu, Xiangning; Garutti, Martínez I; He, Jianxing; He, Jie; Hu, Jian; Huang, Yunchao; Jiang, Gening; Jiang, Hongjing; Jiang, Zhongmin; Li, Danqing; Li, Gaofeng; Li, Hui; Li, Qiang; Li, Xiaofei; Li, Yin; Li, Zhijun; Liu, Chia-Chuan; Liu, Deruo; Liu, Lunxu; Liu, Yongyi; Ma, Haitao; Mao, Weimin; Mao, Yousheng; Mou, Juwei; Ng, Calvin Sze Hang; Petersen, René H; Qiao, Guibin; Rocco, Gaetano; Ruffini, Erico; Tan, Lijie; Tan, Qunyou; Tong, Tang; Wang, Haidong; Wang, Qun; Wang, Ruwen; Wang, Shumin; Xie, Deyao; Xue, Qi; Xue, Tao; Xu, Lin; Xu, Shidong; Xu, Songtao; Yan, Tiansheng; Yu, Fenglei; Yu, Zhentao; Zhang, Chunfang; Zhang, Lanjun; Zhang, Tao; Zhang, Xun; Zhao, Xiaojing; Zhao, Xuewei; Zhi, Xiuyi; Zhou, Qinghua

    2017-09-01

    Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH 2 O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs

  17. Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy

    DEFF Research Database (Denmark)

    Laursen, Lykke Østergaard; Petersen, René Horsleben; Hansen, Henrik Jessen

    2016-01-01

    OBJECTIVES: Lung cancer is the most common cause of cancer-related deaths worldwide. Survival is highly dependent on surgery. Video-assisted thoracoscopic surgery (VATS) is increasingly chosen over open thoracotomy (OT) because of the possible benefits of the minimally invasive approach. Conseque...

  18. The impact of VAT introduction on UK residential energy demand: an investigation using the cointegration approach

    International Nuclear Information System (INIS)

    Fouquet, Roger

    1995-01-01

    Over a two-year period, which started in April 1994, the real price of energy to UK households was expected to rise by 17.5% as a result of value-added tax (VAT) introduction. The regressive nature of the tax forced the government to limit VAT on residential fuel to 8%. Using a cointegration approach, to take account of the non-stationarity fuel consumption time series, this paper estimates real energy and fuel specific price and income elasticities for the period 1974:1-1994:1. They suggest that natural gas has a positive real energy price elasticity indicating that, as real price of energy rises, households scrap inefficient heaters and invest in more efficient ones, principally natural gas. These estimates enable projections to be made of the impact of the introduction of VAT and imply a rise in natural gas consumption as a result of the additional VAT, although at the expense of other less efficient fuels. (author)

  19. Anesthesia for Lobectomy in a Pediatric Patient` with Cystic Fibrosis: A Case Report

    Directory of Open Access Journals (Sweden)

    Seyedhejazi Mahin

    2014-07-01

    Full Text Available Cystic Fibrosis is the most common autosomal recessive disease which causes a lot of complications and there are some needed operations in lifelong of such patients. Anesthesia in these patients requires particular attention and a full cooperation of surgeon, anesthetist and pediatrician .We reported a case of lobectomy with lung separation in a 4.5 years old child with cystic fibrosis which was performed with minor complications in the hope that an awareness of such situations may turn up similar cases of study. Keywords: Cystic Fibrosis, Anesthesia, Pulmonic Lobectomy

  20. The role of wet lab in thoracic surgery.

    Science.gov (United States)

    Bedetti, Benedetta; Schnorr, Philipp; Schmidt, Joachim; Scarci, Marco

    2017-01-01

    During the last three decades, minimally invasive surgery has become common practice in all kinds of surgical disciplines and, in Thoracic Surgery, the minimally invasive approach is recommended as the treatment of choice for early-stage non-small cell lung cancer. Nevertheless, all over the world a large number of lobectomies is still performed by conventional open thoracotomy and not as video-assisted thoracic surgery (VATS), which shows the need of a proper training for this technique. Development and improvement of surgical skills are not only challenging and time-consuming components of the training curriculum for resident or fellow surgeons, but also for more experienced consultants learning new techniques. The rapid evolution of medical technologies like VATS or robotic surgery requires an evolution of the existing educational models to improve cognitive and procedural skills before reaching the operating room in order to increase patient safety. Nowadays, in the Thoracic Surgery field, there is a wide range of simulation-based training methods for surgeons starting or wanting to improve their learning curve in VATS. Aim is to overcome the learning curve required to successfully master this new technique in a brief time. In general, the basic difference between the various learning techniques is the distinction between "dry" and "wet" lab modules, which mainly reflects the use of synthetic or animal-model-based materials. Wet lab trainings can be further sub-divided into in vivo modules, where living anaesthetized animals are used, and ex vivo modules, where only animal tissues serve as basis of the simulation-based training method. In the literature, the role of wet lab in Thoracic Surgery is still debated.

  1. Adjuvant chemotherapy compliance is not superior after thoracoscopic lobectomy

    DEFF Research Database (Denmark)

    Licht, Peter B; Schytte, Tine; Jakobsen, Erik

    2014-01-01

    BACKGROUND: It is generally assumed that patient compliance with adjuvant chemotherapy is superior after video-assisted thoracoscopic surgery compared with open lobectomy for non-small cell lung cancer (NSCLC). The level of evidence for this assumption, however, is limited to single-institution, ......BACKGROUND: It is generally assumed that patient compliance with adjuvant chemotherapy is superior after video-assisted thoracoscopic surgery compared with open lobectomy for non-small cell lung cancer (NSCLC). The level of evidence for this assumption, however, is limited to single...... adjuvant chemotherapy and 121 (38.7%) completed all four cycles. Ordinal logistic regression revealed that chemotherapy compliance (none, partial, and full chemotherapy) was significantly reduced by the patient's age (p....02). No significant difference between video-assisted thoracoscopic surgery and thoracotomy was seen regarding chemotherapy compliance (p=0.17), number of chemotherapy cycles (p=0.60), or time from surgery to chemotherapy (p = 0.41). CONCLUSIONS: Complete national data do not support the widespread assumption...

  2. Comparison study between bacteriological aetiology and outcome of VAT & VAP

    Directory of Open Access Journals (Sweden)

    Nasr H. Kahlil

    2017-01-01

    Conclusion: From the study we concluded that VAT infection is as severe as VAP and it needs more attention to prevent its presence as, once present, it usually progress to VAP increasing mortality rate in ICU.

  3. Intercostal muscle flap to protect the bronchial stump in pediatric lobectomy for lung abscess.

    Science.gov (United States)

    Lisi, Gabriele; Lauriti, Giuseppe; Cascini, Valentina; Lococo, Achille; Chiesa, Pierluigi Lelli

    2013-01-01

    Lung suppurative diseases in children are usually responsive to medical treatment or percutaneous drainage. Rarely, pulmonary resection is required for lung abscess in childhood, particularly in presence of co-morbidities. In these cases, a lobectomy is usually performed through an open thoracotomy, with a reported incidence of bronco-pleural fistula up to 9.1% of pediatric series. This consequence is mainly due to the inflammatory condition; however the lack of knowledge of pediatric and thoracic surgeons with this rare condition in childhood can also play a role. In adults with lung cancer, the buttressing of bronchial stump with the additional support of an intercostal muscle (ICM) flap has proved to prevent this complication, as well as to reduce post-operative pain. We report the first pediatric experience of ICM flap used in 2 immunocompetent children requiring lobectomy for suppurative lung conditions. Our preliminary experience confirms the feasibility of protecting the bronchial stump after lobectomy in children, especially in conditions at risk for bronco-pleural fistula development.

  4. The correlation between E.M.I. scan appearances and the pathologic findings in a small group of patients submitted to anterior temporal lobectomy for intractable epilepsy

    International Nuclear Information System (INIS)

    Polkey, C.E.

    1978-01-01

    In a group of nine patients undergoing anterior temporal lobectomy for intractable epilepsy, EMI scans are available for direct comparison with other neuroradiological investigations and the pathology found in the resected temporal lobes. The atrophic lesion of mesial temporal sclerosis is difficult to demonstrated by CAT scanning. However, lesions such as tumours and angiomas containing areas of increased radiodensity are better indentified by this method. Because of this difference, CAT scanning is not a suitable single investigation for screening epileptic populations for surgical candidates. (orig.) [de

  5. The Vat Exemption for Health Care: Eu Law and its Impact on Swedish law

    Directory of Open Access Journals (Sweden)

    Påhlsson Robert

    2015-12-01

    Full Text Available The general rule in EU law is that value-added tax (VAT is to be levied on all goods and services. There are a number of exceptions, however, one of which applies to certain medical services. This paper examines the legal basis for tax exemptions in EU VAT law and in Swedish law, with particular attention to the extent to which the rapidly growing private health-care sector is covered by these tax exemptions.

  6. Diode-Pumped Laser for Lung-Sparing Surgical Treatment of Malignant Pleural Mesothelioma.

    Science.gov (United States)

    Bölükbas, Servet; Biancosino, Christian; Redwan, Bassam; Eberlein, Michael

    2017-06-01

    Surgical resection represents one of the essential cornerstones in multimodal treatment of malignant pleural mesothelioma. In cases of tumor infiltration of the lung, lung-scarifying procedures such as lobectomies or pneumonectomies might be necessary to achieve macroscopic complete resection. However, this increases the morbidity of the patients because it leads to possible delay of the planned chemotherapy or radiotherapy. Innovative surgical techniques are therefore required to enable salvage of the lung parenchyma and optimization of surgical treatment. Here we report our first experience with a diode-pumped neodymium-doped yttrium aluminium garnet laser for parenchyma-sparing lung resection during surgery for malignant pleural mesothelioma. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Flow Characteristics of a Thermoset Fiber Composite Photopolymer Resin in a Vat Polymerization Additive Manufacturing Process

    DEFF Research Database (Denmark)

    Hofstätter, Thomas; Spangenberg, Jon; Pedersen, David B.

    Additive manufacturing vat polymerization has become a leading technology and gained a massive amount of attention in industrial applications such as injection molding inserts. By the use of the thermoset polymerization process inserts have increased their market share. For most industrial...... understood. Research indicates an orientation within the manufacturing layer and efforts have been made to achieve a more uniform orientation within the part. A vat polymerization machine consisting of a resin vat and a moving build plate has been simulated using the fluid flow module of Comsol Multiphysics...... photopolymer resin. The prediction can be used to identify potential clusters or misalignment of fibers and in the future allow for optimization of the machine design and manufacturing process....

  8. The Society for Translational Medicine: clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy

    Science.gov (United States)

    Zhang, Zhongheng; Brunelli, Alessandro; Chen, Chang; Chen, Chun; Chen, Gang; Chen, Haiquan; Chen, Jin-Shing; Cassivi, Stephen; Chai, Ying; Downs, John B.; Fang, Wentao; Fu, Xiangning; Garutti, Martínez I.; He, Jianxing; Hu, Jian; Huang, Yunchao; Jiang, Gening; Jiang, Hongjing; Jiang, Zhongmin; Li, Danqing; Li, Gaofeng; Li, Hui; Li, Qiang; Li, Xiaofei; Li, Yin; Li, Zhijun; Liu, Chia-Chuan; Liu, Deruo; Liu, Lunxu; Liu, Yongyi; Ma, Haitao; Mao, Weimin; Mao, Yousheng; Mou, Juwei; Ng, Calvin Sze Hang; Petersen, René H.; Qiao, Guibin; Rocco, Gaetano; Ruffini, Erico; Tan, Lijie; Tan, Qunyou; Tong, Tang; Wang, Haidong; Wang, Qun; Wang, Ruwen; Wang, Shumin; Xie, Deyao; Xue, Qi; Xue, Tao; Xu, Lin; Xu, Shidong; Xu, Songtao; Yan, Tiansheng; Yu, Fenglei; Yu, Zhentao; Zhang, Chunfang; Zhang, Lanjun; Zhang, Tao; Zhang, Xun; Zhao, Xiaojing; Zhao, Xuewei; Zhi, Xiuyi; Zhou, Qinghua

    2017-01-01

    Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50–70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs

  9. The Intertemporal Substitution and Income Effects of a VAT Rate Increase: Evidence from Japan

    OpenAIRE

    David CASHIN; UNAYAMA Takashi

    2011-01-01

    One of the biggest political issues in Japan is an increase in the rate of value added tax (VAT). In this paper, we evaluate its impact on household expenditure, using Japan's April 1997 VAT rate increase from three to five percent as a case study. A rate increase induces price hikes, and provided this increase in price levels is anticipated, households should engage in intertemporal substitution of purchases. In addition, if households are not compensated for the rate increase, it has the po...

  10. METHODOLOGICAL AND PRACTICAL ASPECTS CONCERNING THE VAT COLLECTION SYSTEM Case study made in a company operating in the construction sector

    Directory of Open Access Journals (Sweden)

    BOGDAN OANA

    2015-03-01

    Full Text Available This paper presents the impact of the collected VAT on a company acting in the construction field in the current economic environmnet; the study is based on data provided by the company before and after applying the VAT collection system. The research reflects the VAT payable on State Budget three times: before its entry into the system, its activity during the application system and its situation in 2014 when the company can choose between staying in the system or getting out of it. The research method consisted in reviewing approaches made in the literature, articles and specialized studies in national and international journals. We followed a detailed approach of the effects generated by the VAT collection system among companies acting in the construction filed and we made a case study based on the activity of the construction companies before applying the system and their option to stay or exit the VAT collection system.

  11. VAT Teater toob külakosti Hiiumaa lastele ja noortele / Tiiu Talvist

    Index Scriptorium Estoniae

    Talvist, Tiiu

    2009-01-01

    VAT Teater esineb Hiiumaal lastelavastusega "Varblase Priidu" (autor Rudolf Herfurtner, lavastaja Mart Kampus) ja noortelavastusega "Kas sulle meeldib porno?" (autor Klas Abrahamsson, lavastaja Margo Teder)

  12. Intraoperative costs of video-assisted thoracoscopic lobectomy can be dramatically reduced without compromising outcomes.

    Science.gov (United States)

    Richardson, Michael T; Backhus, Leah M; Berry, Mark F; Vail, Daniel G; Ayers, Kelsey C; Benson, Jalen A; Bhandari, Prasha; Teymourtash, Mehran; Shrager, Joseph B

    2018-03-01

    To determine whether surgeon selection of instrumentation and other supplies during video-assisted thoracoscopic lobectomy (VATSL) can safely reduce intraoperative costs. In this retrospective, cost-focused review of all video-assisted thoracoscopic surgery anatomic lung resections performed by 2 surgeons at a single institution between 2010 and 2014, we compared VATSL hospital costs and perioperative outcomes between the surgeons, as well as costs of VATSL compared with thoracotomy lobectomy (THORL). A total of 100 VATSLs were performed by surgeon A, and 70 were performed by surgeon B. The preoperative risk factors did not differ significantly between the 2 groups of surgeries. Mean VATSL total hospital costs per case were 24% percent greater for surgeon A compared with surgeon B (P = .0026). Intraoperative supply costs accounted for most of this cost difference and were 85% greater for surgeon A compared with surgeon B (P costs, accounting for 55% of the difference in intraoperative supply costs between the surgeons. Operative time was 25% longer for surgeon A compared with surgeon B (P accounted for only 11% of the difference in total cost. Surgeon A's overall VATSL costs per case were similar to those of THORLs (n = 100) performed over the same time period, whereas surgeon B's VATSL costs per case were 24% less than those of THORLs. On adjusted analysis, there was no difference in VATSL perioperative outcomes between the 2 surgeons. The costs of VATSL differ substantially among surgeons and are heavily influenced by the use of disposable equipment/devices. Surgeons can substantially reduce the costs of VATSL to far lower than those of THORL without compromising surgical outcomes through prudent use of costly instruments and technologies. Copyright © 2017 The American Association for Thoracic Surgery. All rights reserved.

  13. A Technique for Resecting Occipital Pole Gliomas Using a Keyhole Lobectomy.

    Science.gov (United States)

    Conner, Andrew K; Baker, Cordell M; Briggs, Robert G; Burks, Joshua D; Glenn, Chad A; Smitherman, Adam D; Morgan, Jake P; Pittman, Nathan A; Sughrue, Michael E

    2017-10-01

    Our purpose is to describe a method of resecting occipital pole gliomas through a keyhole lobectomy and share the patient outcomes of this technique. We performed a retrospective review of data obtained on all patients who underwent resection of occipital pole gliomas by the senior author between 2012 and 2016. We describe our technique for resecting these tumors using a keyhole lobectomy and share the patient outcomes of this operation. Eight patients were included in this study. Four patients (50%) had not received previous surgery. One patient (13%) was diagnosed with a World Health Organization grade II tumor, and 7 patients (88%) were diagnosed with glioblastoma. Two tumors (25%) were left sided and 6 (75%) right sided. The median size of resection was 28 cm 3 . The median extent of resection was 96%, and at least 90% of the tumor was resected in all cases. None of the patients experienced permanent postoperative complications. Temporary neurologic complications included 3 patients (38%) with encephalopathy and 1 patient (13%) with aphasia. There were no neurosurgical complications. Our study provides details on the technical aspects of occipital keyhole lobectomies and gives the outcomes of patients who have received an operation for tumors in this uncommon location. Taking white matter tract anatomy into consideration, we show that the keyhole method can be applied to gliomas of the occipital lobe. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. [Flexible endoscope in thoracic surgery: CITES or cVATS?].

    Science.gov (United States)

    Assouad, J; Fénane, H; Masmoudi, H; Giol, M; Karsenti, A; Gounant, V; Grunenwald, D

    2013-10-01

    Early pain and persistent parietal disorders remains a major unresolved problem in thoracic surgery. Thoracotomy and the use of multiple ports in most Video Assisted Thoracic Surgery (VATS) procedures are the major cause of this persistent pain. For the last decade, a few publications describing the use of either single incision VATS and cervical thoracic approaches have been reported without significant results in comparison with current used techniques. Intercostals compression during surgery and early after by intercostals chest tube placement, are probably the major cause of postoperative pain. Flexible endoscope is currently used in several surgeries and will take more and more importance in our daily use in thoracic surgery. Instrument flexibility allows its use through minimally invasive approaches and offers a very interesting intra-thoracic navigation. We describe here the first use in France of a flexible endoscope in thoracic surgery through a single cervical incision to perform simultaneous exploration and biopsies of the mediastinum and right pleura using the original approach of Cervical Incision Thoracic Endoscopic Surgery (CITES). Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. Vat leaching of gold ores and utilization of the tailings; Kinkoseki no vat leaching to koshi no yuko riyo

    Energy Technology Data Exchange (ETDEWEB)

    Hosooka, T. [Nippon Clay Mining Co. Ltd., Tokyo (Japan); Miyagawa, H. [Mitsui Mining and Smelting Co. Ltd., Tokyo (Japan)

    1996-01-25

    Mitsui Kushikino Mine previously processed two gold ores from Kushikino and Iwato ore deposits by the all slime cyanidation method, where the ores were ground to fine size smaller than 75 {mu}m and leached with sodium, cyanide. A large amount of slimes were produced as waste and discarded in tailings ponds. To save the costs of grinding and waste treatment it is desirable to process coarse sized ores. The Iwato ore is gold and silver bearing silicified porous rock. As most gold and silver in the Iwato ore are concentrated in the pores, leaching of coarse sized ore is expected to be possible. Laboratory tests and pilot plant tests of vat leaching for the Iwato ore were carried out using 0.15-8.0 mm feed. These results showed that the gold dissolution rate was similar to that by the all slime cyanidation and the decrease in gold recovery was a few %. The properties of these tailings can be used in fine aggregate of concrete. Based on the results vat leaching of the Iwato ore was adopted in the plant. The tailings are sold and used as fine aggregate. Utilization of slime tailings from the other ores was also developed and they are used as flux in copper smelters. Now, there is no tailings pond at Mitsui Kushikino Mine. 9 refs., 10 figs., 5 tabs.

  16. Changes in the VAT Burden on Expenses of Selected Households in the Czech Republic (2007–2014

    Directory of Open Access Journals (Sweden)

    Střílková Regína

    2015-09-01

    Full Text Available The Czech Republic is a typical representative EU Member State which has several times changed VAT rates during the analyzed period 2007–2014 in an effort to consolidate the public budget. These changes are reflected in household spending, which were analyzed by means of the consumer basket, the composition of which is also undergoing changes. Another factor that has an impact on household expenditures is the transfer of commodities between the reduced and standard rate of VAT. The final factor used is the differentiation of households according to their income levels. The aim of this paper is to determine how these changes took effect in the Czech Republic in the share of consumption of commodities included in the standard and reduced VAT rates and in exempt transactions according to household income groups in the analyzed period 2007–2014 and to determine the impact of these changes on the tax burden on selected households by value added tax and confirmation of the assumption of VAT regressivity.

  17. THE VALUE ADDED TAX AND THE EVASION CHAIN OF INTRA-COMMUNITARIAN VAT

    Directory of Open Access Journals (Sweden)

    Deliman Eugen

    2011-12-01

    Full Text Available The relationship IRS taxpayer runs the risk of turning into a psychological war in which, however, given the positions held, the IRS is by far on a favorable footing. Between the apparently excessively formal position held by the IRS, which seems to conceal behind the laws, and the sometimes forced interpretation of the laws, by the taxpayer, there are the courts of law, also disturbed by the legislative changes which appear to have entered a perpetual motion. The objective of the fiscal administration regarding the value added tax is to combat tax evasion and fraud. It is very important to combat evasion in the VAT field because it represents the indirect tax of the largest share in the consolidated general budget. VAT evasion represents the intention of not paying the tax, withholding or not declaring it, or requesting its refund which would not be fit, due to the exaggeration of the deductible amount of the VAT. The essential aim of the IRS inspector is to verify the correctness of the declared amount of the value added tax. It should also be observed whether the incorrectness is deliberate or whether it was due to misunderstanding, carelessness or the ignorance of the payer. In all cases judgment is necessary, as for the cases of negligence the amount to be paid must be corrected and accompanied by applying fines and / or penalties, and in the cases of intended fraud legal actions are to be applied in order to obtain a conviction. Deceitful deductions represent other methods for tax evasion and are undertaken based on fake invoices, invoices often used several times for deduction, or invoices related to purchases that have never been made. Thus there are examples of economic agents who have practiced the right to deduct the VAT due to the acquisition of goods which consisted in the property of other economic agents. In other cases noticed was the deduction of VAT on goods or services that were not included in the activities of the economic

  18. Physiologic assessment before video thoracoscopic resection for lung cancer in patients with abnormal pulmonary function.

    Science.gov (United States)

    Benattia, Amira; Debeaumont, David; Guyader, Vincent; Tardif, Catherine; Peillon, Christophe; Cuvelier, Antoine; Baste, Jean-Marc

    2016-06-01

    Impaired respiratory function may prevent curative surgery for patients with non-small cell lung cancer (NSCLC). Video-assisted thoracoscopic surgery (VATS) reduces postoperative morbility-mortality and could change preoperative assessment practices and therapeutic decisions. We evaluated the relation between preoperative pulmonary function tests and the occurrence of postoperative complications after VATS pulmonary resection in patients with abnormal pulmonary function. We included 106 consecutive patients with ≤80% predicted value of presurgical expiratory volume in one second (FEV1) and/or diffusing capacity of carbon monoxide (DLCO) and who underwent VATS pulmonary resection for NSCLC from a prospective surgical database. Patients (64±9.5 years) had lobectomy (n=91), segmentectomy (n=7), bilobectomy (n=4), or pneumonectomy (n=4). FEV1 and DLCO preoperative averages were 68%±21% and 60%±18%. Operative mortality was 1.89%. Only FEV1 was predictive of postoperative complications [odds ratio (OR), 0.96; 95% confidence interval (CI), 0.926-0.991, P=0.016], but there was no determinable threshold. Twenty-five patients underwent incremental exercise testing. Desaturations during exercise (OR, 0.462; 95% CI, 0.191-0.878, P=0.039) and heart rate (HR) response (OR, 0.953; 95% CI, 0.895-0.993, P=0.05) were associated with postoperative complications. FEV1 but not DLCO was a significant predictor of pulmonary complications after VATS pulmonary resection despite a low rate of severe morbidity. Incremental exercise testing seems more discriminating. Further investigation is required in a larger patient population to change current pre-operative threshold in a new era of minimally invasive surgery.

  19. Tutorial on Modeling VAT Rules Using OWL-DL

    DEFF Research Database (Denmark)

    Nielsen, Morten Ib; Simonsen, Jakob Grue; Larsen, Ken Friis

    . In an ERP setting such a model could reduce the Total Cost of Ownership (TCO) and increase the quality of the system. We have selected OWL-DL because we believe that description logic is suited for modeling VAT rules due to the decidability of important inference problems that are key to the way we plan...... to use the model and because OWL-DL is relatively intuitive to use....

  20. Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

    Institute of Scientific and Technical Information of China (English)

    Tahsin COLAK; Tamer AKCA; Ozgur TURKMENOGLU; Hakan CANBAZ; Bora USTUNSOY; Arzu KANIK; Suha AYDI

    2008-01-01

    Objective: This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. Methods: A total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale (VAS), total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed. Results: The mean operating time was similar between two groups (the drained and non-drained groups). The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day (POD) 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases of seroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group. Conclusion: These findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.

  1. Cost-effectiveness of lobectomy versus genetic testing (Afirma®) for indeterminate thyroid nodules: Considering the costs of surveillance.

    Science.gov (United States)

    Balentine, Courtney J; Vanness, David J; Schneider, David F

    2018-01-01

    We evaluated whether diagnostic thyroidectomy for indeterminate thyroid nodules would be more cost-effective than genetic testing after including the costs of long-term surveillance. We used a Markov decision model to estimate the cost-effectiveness of thyroid lobectomy versus genetic testing (Afirma®) for evaluation of indeterminate (Bethesda 3-4) thyroid nodules. The base case was a 40-year-old woman with a 1-cm indeterminate nodule. Probabilities and estimates of utilities were obtained from the literature. Cost estimates were based on Medicare reimbursements with a 3% discount rate for costs and quality-adjusted life-years. During a 5-year period after the diagnosis of indeterminate thyroid nodules, lobectomy was less costly and more effective than Afirma® (lobectomy: $6,100; 4.50 quality-adjusted life- years vs Afirma®: $9,400; 4.47 quality-adjusted life-years). Only in 253 of 10,000 simulations (2.5%) did Afirma® show a net benefit at a cost-effectiveness threshold of $100,000 per quality- adjusted life-years. There was only a 0.3% probability of Afirma® being cost saving and a 14.9% probability of improving quality-adjusted life-years. Our base case estimate suggests that diagnostic lobectomy dominates genetic testing as a strategy for ruling out malignancy of indeterminate thyroid nodules. These results, however, were highly sensitive to estimates of utilities after lobectomy and living under surveillance after Afirma®. Published by Elsevier Inc.

  2. The diagnosis efficacy and safety of video-assisted thoracoscopy surgery (VATS) in undefined interstitial lung diseases: a retrospective study.

    Science.gov (United States)

    Luo, Qun; Han, Qian; Chen, Xiaobo; Xie, Jiaxing; Wu, Lulu; Chen, Rongchang

    2013-06-01

    To evaluate the efficacy and safety of lung biopsies by video-assisted thoracoscopy surgery (VATS) in the diagnosis of undefined interstitial lung disease (ILD). The retrospective analysis was performed in 32 who patients underwent VATS for the diagnosed with ILD from Jan 2007 to Dec 2011. The main reason for VATS for all the patients was due to no specific diagnosis could be obtained after non-invasive methods, transbronchial lung biopsy (TBLB) examination and the consultation with pulmonologist, radiologist and pathologist. The clinical profiles, chest high resolution computerized tomography (HRCT), laboratory profile, TBLB as well as the diagnosis of before and after the VATS were analyzed. The surgery site, biopsy number, duration of the thoracic drain, post-operative complications were also recorded. The 30- and 90-day post-operative mortality rates were calculated. The risk factors associated with the incidence of post-operative complications were assessed. The specific diagnosis could be established in all patients after VATS lung biopsies, with change from previous ones in 27 (84.4%). Among 20 cases (62.5%) diagnosed as unclassified ILD before the surgery, 14 (70.0%) were diagnosed as nonspecific interstitial pneumonia (NSIP), 3 (15.0%) as idiopathic pulmonary fibrosis (IPF) and 3 (15.0%) as connective tissue disease-related ILD (CTD-ILD). Among the 7 cases with complete change of diagnosis after VATS, 4 (57.1%) were cryptogenic organizing pneumonia (COP). The number of site of biopsy had no significant impact on the diagnostic efficacy. There were no significant change of vital sign and lung function after the VATS. 21 (65.6%) patients had post-operative complications, including pulmonary infection (56.3%), pulmonary atelectasis (28.1%) and pneumothorax (25.0%). The 30- and 90-day mortality rates were 0 and 5.2% respectively. Patients were divided into 2 groups based on the incidence of post-operative complications, and no significant difference was found

  3. Clinical Experience of the Treatment of Solitary Pulmonary Nodules with Da Vinci Surgical System

    Directory of Open Access Journals (Sweden)

    Xiangdong TONG

    2014-07-01

    Full Text Available Background and objective A solitary pulmonary nodule (SPN is defined as a round intraparenchimal lung lesion less than 3 cm in size, not associated with atelectasis or adenopathy. The aim of this study is to learn clinical experience of the treatment of SPN with Da Vinci Surgical System. Methods A total of 9 patients with solitary pulmonary nodules (SPN less than 3 cm in diameter was treated with Da Vinci Surgical System (Intuitive Surgical, California in thoracic surgery department from General Hospital of Shenyang Militrary Region from November 2011 to March 2014. This group of patients included 3 males and 6 females, and the mean age was 51±9.9 yr (range: 41-74 yr. Most of the patients were no obvious clinical symptoms (7 cases were found by physical examination, others were with cough and expectoration. Their median medical history was 12 mo (range: 4 d-3 yr. All the lesions of patients were peripheral pulmonary nodules and the mean diameter of those was (1.4±0.6 cm(range: 0.8-2.8 cm. Wedge-shaped resection or lobectomy was performed depending on the result of rapid pathology and systemic lymph node dissection was done for malignant leision. We used general anesthesis with double lumens trachea cannula. We set the patients in lateral decubitus position with jackknife. The patient cart enter from top of the patient. The position of trocars would be set according to the position of lesion. A 12 mm incision was positioned at the 8th intercostal space in the posterior axillary line as vision port, and two 8 mm incisions were positioned at the 5th intercostal space between the anterior axillary line and midclavicular line, and the 8th infrascapular line as robotic instrument ports about 10 cm apart from the vision port. One additional auxiliary small incision for instrument without retracting ribs was set at the 7th intercostal space in the middle axillary line. Results There were 4 benign leisions and 5 malignancies identified. Wedge

  4. Reduce chest pain using modified silicone fluted drain tube for chest drainage after video-assisted thoracic surgery (VATS) lung resection.

    Science.gov (United States)

    Li, Xin; Hu, Bin; Miao, Jinbai; Li, Hui

    2016-02-01

    The aim of this study was to assess the feasibility, efficacy and safety of a modified silicone fluted drain tube after video-assisted thoracic surgery (VATS) lung resection. The prospective randomized study included 50 patients who underwent VATS lung resection between March 2015 and June 2015. Eligible patients were randomized into two groups: experimental group (using the silicone fluted drain tubes for chest drainage) and control group (using standard drain tubes for chest drainage). The volume and characteristics of drainage, postoperative (PO) pain scores and hospital stay were recorded. All patients received standard care during hospital admission. In accordance with the exit criteria, three patients were excluded from study. The remaining 47 patients included in the final analysis were divided into two groups: experiment group (N=24) and control group (N=23). There was no significant difference between the two groups in terms of age, sex, height, weight, clinical diagnosis and type of surgical procedure. There was a trend toward less PO pain in experimental group on postoperative day (POD) 1, with a statistically significant difference. Patients in experimental group had a reduced occurrence of fever [temperature (T) >37.4 °C] compared to the control group. The silicone fluted drain tube is feasible and safe and may relieve patient PO pain and reduce occurrence of fever without the added risk of PO complications.

  5. VAP/VAT: video analytics platform and test bed for testing and deploying video analytics

    Science.gov (United States)

    Gorodnichy, Dmitry O.; Dubrofsky, Elan

    2010-04-01

    Deploying Video Analytics in operational environments is extremely challenging. This paper presents a methodological approach developed by the Video Surveillance and Biometrics Section (VSB) of the Science and Engineering Directorate (S&E) of the Canada Border Services Agency (CBSA) to resolve these problems. A three-phase approach to enable VA deployment within an operational agency is presented and the Video Analytics Platform and Testbed (VAP/VAT) developed by the VSB section is introduced. In addition to allowing the integration of third party and in-house built VA codes into an existing video surveillance infrastructure, VAP/VAT also allows the agency to conduct an unbiased performance evaluation of the cameras and VA software available on the market. VAP/VAT consists of two components: EventCapture, which serves to Automatically detect a "Visual Event", and EventBrowser, which serves to Display & Peruse of "Visual Details" captured at the "Visual Event". To deal with Open architecture as well as with Closed architecture cameras, two video-feed capture mechanisms have been developed within the EventCapture component: IPCamCapture and ScreenCapture.

  6. Reflection of the Change in VAT Rates on Selected Household Expenditures in the Czech Republic and the Slovak Republic (2007–2013

    Directory of Open Access Journals (Sweden)

    Jan Široký

    2014-01-01

    Full Text Available Member States of the European Union in the period of years 2007–2013 increased the rate of value added tax several times in an attempt to consolidate public budgets. While the Czech Republic is a typical representative of country changing VAT rates several times, Slovakia made practically only one change in the VAT rate. On the other hand, the Slovak Republic is a country where the reduced rate is applied only to the minimum of commodities. Changes in VAT are naturally reflected in household expenditures which are analyzed by the consumer basket, whose composition is also a subject of changes. Another factor that has an impact on household spending is swapping commodities between the rates of VAT.The aim of this paper is, based on the analytic-synthetic methods, to determine how are these changes differently manifested in the Czech Republic and the Slovak Republic in reference to the share of commodity consumption included in the standard and reduced VAT rates and to the exempt transactions, and, in particular, to determine how they affected the VAT burden of the hypothetical household in both countries.

  7. Surgical treatment for medically refractory focal epilepsy in a patient with fragile X syndrome.

    Science.gov (United States)

    Kenmuir, Cynthia; Richardson, Mark; Ghearing, Gena

    2015-10-01

    Medication resistant temporal lobe epilepsy occurs in a small population of patients with fragile X syndrome. We present the case of a 24-year-old man with medically refractory temporal lobe epilepsy and fragile X syndrome who underwent left anterior temporal lobectomy resulting in cessation of seizures. Our patient was diagnosed with fragile X syndrome with a fully mutated, fully methylated FMR1 gene resulting in 572 CGG repeats. He developed seizures initially controlled with Depakote monotherapy, but progressed to become medically refractive to combination treatment with Depakote, lamotrigine and zonisamide. Prolonged video EEG monitoring revealed interictal left temporal sharp waves and slowing as well as subclinical and clinical seizures, each with left temporal onset. 3T MRI was consistent with left mesial temporal sclerosis. After discussing the case in our multidisciplinary surgical epilepsy conference, he was referred for presurgical evaluation including neuropsychological testing and Wada testing. He underwent an asleep left anterior temporal lobectomy, sparing the superior temporal gyrus. Pathology showed neuronal loss and gliosis in the hippocampus and amygdala. Twelve months after surgery, the patient has not experienced a seizure. He is described by his parents as less perseverative and less restless. We have presented the case of a 24 year-old-man with fragile X syndrome who underwent successful left anterior temporal lobectomy for the treatment of medically refractory epilepsy who is now seizure free without further functional impairment. This case report demonstrates the feasibility of surgical treatment for a patient with comorbid fragile X syndrome and mesial temporal sclerosis. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  8. [Cardioversion for paroxysmal supraventricular tachycardia during lung surgery in a patient with concealed Wolff-Parkinson-White syndrome].

    Science.gov (United States)

    Sato, Yoshiharu; Nagata, Hirofumi; Inoda, Ayako; Miura, Hiroko; Watanabe, Yoko; Suzuki, Kenji

    2014-10-01

    We report a case of paroxysmal supraventricular tachycardia (PSVT) that occurred during video-assisted thoracoscopic (VATS) lobectomy in a patient with concealed Wolff-Parkinson-White (WPW) syndrome. A 59-year-old man with lung cancer was scheduled for VATS lobectomy under general anesthesia. After inserting a thoracic epidural catheter, general anesthesia was induced with intravenous administration of propofol. Anesthesia was maintained with inhalation of desfurane in an air/oxygen mixture and intravenous infusion of remifentanil. Recurrent PSVT occurred three times, and the last episode of PSVT continued for 50 minutes regardless of administration of antiarrhythmic drugs. Synchronized electric shock via adhesive electrode pads on the patient's chest successfully converted PSVT back to normal sinus rhythm. The remaining course and postoperative period were uneventful. An electrophysiological study performed after hospital discharge detected concealed WPW syndrome, which had contributed to the development of atrioventricular reciprocating tachycardia. Concealed WPW syndrome is a rare, but critical complication that could possibly cause lethal atrial tachyarrhythmias during the perioperative period. In the present case, cardioversion using adhesive electrode pads briefly terminated PSVT in a patient with concealed WPW syndrome.

  9. Fatal stroke after completion pneumonectomy for torsion of left upper lobe following left lower lobectomy

    Directory of Open Access Journals (Sweden)

    Apostolakis Efstratios

    2006-09-01

    Full Text Available Abstract Background The lobar torsion after lung surgery is a rare complication with an incidence of 0.09 to 0.4 %. It may occur after twisting of the bronchovascular pedicle of the remaining lobe after lobectomy, usually on the right side. The 180-degree rotation of the pedicle produces an acute obstruction of the lobar bronchus (atelectasis and of the lobar vessels as well. Without prompt treatment it progresses to lobar ischemia, pulmonary infarction and finally fatal gangrene. Case Presentation A 62 years old female patient was admitted for surgical treatment of lung cancer. She underwent elective left lower lobectomy for squamous cell carcinoma (pT2 N0. The operation was unremarkable, and the patient was extubated in the operating room. After eight hours the patient established decrease of pO2 and chest x-ray showed atelectasis of the lower lobe. To establish diagnosis, bronchoscopy was performed, demonstrating obstructed left lobar bronchus. The patient was re-intubated, and admitted to the operating room where reopening of the thoracotomy was performed. Lobar torsion was diagnosed, with the diaphragmatic surface of the upper lobe facing in an anterosuperior orientation. A completion pneumonectomy was performed. At the end of the procedure the patient developed a right pupil dilatation, presumably due to a cerebral embolism. A subsequent brain angio-CT scan established the diagnosis. She died at the intensive care unit 26 days later. Conclusion The thoracic surgeon should suspect this rare early postoperative complication after any thoracic operation in every patient with atelectasis of the neighboring lobe. High index of suspicion and prompt diagnosis may prevent catastrophic consequences, such as, infarction or gangrene of the pulmonary lobe. During thoracic operations, especially whenever the lung or lobe hilum is full mobilized, fixation of the remaining lobe may prevent this life threatening complication.

  10. Perioperative and long-term outcome of thymectomy for myasthenia gravis: comparison of surgical approaches and prognostic analysis.

    Science.gov (United States)

    Liu, Cheng-wu; Luo, Meng; Mei, Jian-dong; Zhu, Yun-ke; Pu, Qiang; Ma, Lin; Che, Guo-wei; Lin, Yi-dan; Wu, Zhu; Wang, Yun; Kou, Ying-li; Liu, Lun-xu

    2013-01-01

    Thymectomy is an established treatment for myasthenia gravis (MG), and video-assisted thoracoscopic surgery (VATS) thymectomy has become an acceptable surgical procedure. This study aimed to compare the results of VATS thymectomy and open thymectomy and to identify the prognostic factors after thymectomy. The clinical data of 187 consecutive thymectomies performed between July 2000 and December 2009 were retrospectively reviewed; 75 open thymectomies and 112 VATS thymectomies. Clinical efficacy and variables influencing outcome were assessed by Kaplan-Meier survival curves and Cox proportional hazards regression analysis. The operative blood loss in the VATS group was significantly less than that in the open group ((62.14 ± 55.43) ml vs. (137.87 ± 165.25) ml, P CSR) was the end point for evaluation of the treatment results. The overall five-year CSR rate was 57.5%. Two good prognostic factors were identified; preoperative prescription of anticholinesterase alone (P = 0.035) and non-thymomatous MG (P = 0.003). The five-year CSR rate of the ocular type of MG reached a high level of 67.4%. Thymectomy can achieve good long-term CSR in MG, and VATS is an ideal alternative method. High-dose prescription of anticholinesterase and the advanced stage by Myasthenia Gravis Foundation of America (MGFA) classification have higher risks of postoperative crisis. Preoperative prescription of anticholinesterase alone and non-thymomatous MG are good prognostic factors. Thymectomy should also be considered for the ocular type of MG.

  11. Robotic surgery, video-assisted thoracic surgery, and open surgery for early stage lung cancer: comparison of costs and outcomes at a single institute.

    Science.gov (United States)

    Novellis, Pierluigi; Bottoni, Edoardo; Voulaz, Emanuele; Cariboni, Umberto; Testori, Alberto; Bertolaccini, Luca; Giordano, Laura; Dieci, Elisa; Granato, Lorenzo; Vanni, Elena; Montorsi, Marco; Alloisio, Marco; Veronesi, Giulia

    2018-02-01

    Robotic surgery is increasingly used to resect lung cancer. However costs are high. We compared costs and outcomes for robotic surgery, video-assisted thoracic surgery (VATS), and open surgery, to treat non-small cell lung cancer (NSCLC). We retrospectively assessed 103 consecutive patients given lobectomy or segmentectomy for clinical stage I or II NSCLC. Three surgeons could choose VATS or open, the fourth could choose between all three techniques. Between-group differences were assessed by Fisher's exact, two-way analysis of variance (ANOVA), and Wilcoxon-Mann-Whitney test. P values open surgery. Age, physical status, pulmonary function, comorbidities, stage, and perioperative complications did not differ between the groups. Pathological tumor size was greater in the open than VATS and robotic groups (P=0.025). Duration of surgery was 150, 191 and 116 minutes, by robotic, VATS and open approaches, respectively (Popen groups. Estimated costs were 82%, 68% and 69%, respectively, of the regional health service reimbursement for robotic, VATS and open approaches. Robotic surgery for early lung cancer was associated with shorter stay and more extensive lymph node dissection than VATS and open surgery. Duration of surgery was shorter for robotic than VATS. Although the cost of robotic thoracic surgery is high, the hospital makes a profit.

  12. VATS intraoperative tattooing to facilitate solitary pulmonary nodule resection

    Directory of Open Access Journals (Sweden)

    Boutros Cherif

    2008-03-01

    Full Text Available Abstract Introduction Video-assisted thoracic surgery (VATS has become routine and widely accepted for the removal of solitary pulmonary nodules of unknown etiology. Thoracosopic techniques continue to evolve with better instruments, robotic applications, and increased patient acceptance and awareness. Several techniques have been described to localize peripheral pulmonary nodules, including pre-operative CT-guided tattooing with methylene blue, CT scan guided spiral/hook wire placement, and transthoracic ultrasound. As pulmonary surgeons well know, the lung and visceral pleura may appear featureless on top of a pulmonary nodule. Case description This paper presents a rapid, direct and inexpensive approach to peripheral lung lesion resection by marking the lung parenchyma on top of the nodule using direct methylene blue injection. Methods In two patients with peripherally located lung nodules (n = 3 scheduled for VATS, we used direct methylene blue injection for intraoperative localization of the pulmonary nodule. Our technique was the following: After finger palpation of the lung, a spinal 25 gauge needle was inserted through an existing port and 0.1 ml of methylene blue was used to tattoo the pleura perpendicular to the localized nodule. The methylene blue tattoo immediately marks the lung surface over the nodule. The surgeon avoids repeated finger palpation, while lining up stapler, graspers and camera, because of the visible tattoo. Our technique eliminates regrasping and repalpating the lung once again to identify a non marked lesion. Results Three lung nodules were resected in two patients. Once each lesion was palpated it was marked, and the area was resected with security of accurate localization. All lung nodules were resected in totality with normal lung parenchymal margins. Our technique added about one minute to the operative time. The two patients were discharged home on the second postoperative day, with no morbidity. Conclusion

  13. 7 CFR 58.416 - Cheese vats, tanks and drain tables.

    Science.gov (United States)

    2010-01-01

    ... uniform heating. The inner liner shall be minimum 16 gauge stainless steel or other equally corrosion... jacket. The outer jacket shall be constructed of stainless steel or other metal which can be kept clean... 7 Agriculture 3 2010-01-01 2010-01-01 false Cheese vats, tanks and drain tables. 58.416 Section 58...

  14. Measuring Error Identification and Recovery Skills in Surgical Residents.

    Science.gov (United States)

    Sternbach, Joel M; Wang, Kevin; El Khoury, Rym; Teitelbaum, Ezra N; Meyerson, Shari L

    2017-02-01

    Although error identification and recovery skills are essential for the safe practice of surgery, they have not traditionally been taught or evaluated in residency training. This study validates a method for assessing error identification and recovery skills in surgical residents using a thoracoscopic lobectomy simulator. We developed a 5-station, simulator-based examination containing the most commonly encountered cognitive and technical errors occurring during division of the superior pulmonary vein for left upper lobectomy. Successful completion of each station requires identification and correction of these errors. Examinations were video recorded and scored in a blinded fashion using an examination-specific rating instrument evaluating task performance as well as error identification and recovery skills. Evidence of validity was collected in the categories of content, response process, internal structure, and relationship to other variables. Fifteen general surgical residents (9 interns and 6 third-year residents) completed the examination. Interrater reliability was high, with an intraclass correlation coefficient of 0.78 between 4 trained raters. Station scores ranged from 64% to 84% correct. All stations adequately discriminated between high- and low-performing residents, with discrimination ranging from 0.35 to 0.65. The overall examination score was significantly higher for intermediate residents than for interns (mean, 74 versus 64 of 90 possible; p = 0.03). The described simulator-based examination with embedded errors and its accompanying assessment tool can be used to measure error identification and recovery skills in surgical residents. This examination provides a valid method for comparing teaching strategies designed to improve error recognition and recovery to enhance patient safety. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Flow Characteristics of a Thermoset Fiber Composite Photopolymer Resin in a Vat Polymerization Additive Manufacturing Process

    DEFF Research Database (Denmark)

    Hofstätter, Thomas; Spangenberg, Jon; Pedersen, David B.

    Additive manufacturing vat polymerization has become a leading technology and gained a massive amount of attention in industrial applications such as injection molding inserts. By the use of the thermoset polymerization process inserts have increased their market share. For most industrial...... applications, strength and stiffness are crucial factors to a successful implementation of cured photopolymer thermosets. Hence, fiber-reinforced polymers have recently been introduced. The behavior and especially orientation of fibers during the vat photopolymerization process has yet not been fully...

  16. Video-Assisted Minithoracotomy for Pulmonary Laceration with a Massive Hemothorax

    Directory of Open Access Journals (Sweden)

    Hideki Ota

    2014-01-01

    Full Text Available Severe intrathoracic hemorrhage from pulmonary parenchyma is the most serious complication of pulmonary laceration after blunt trauma requiring immediate surgical hemostasis through open thoracotomy. The safety and efficacy of video-assisted thoracoscopic surgery (VATS techniques for this life-threatening condition have not been fully evaluated yet. We report a case of pulmonary laceration with a massive hemothorax after blunt trauma successfully treated using a combination of muscle-sparing minithoracotomy with VATS techniques (video-assisted minithoracotomy. A 22-year-old man was transferred to our department after a falling accident. A diagnosis of right-sided pneumothorax was made on physical examination and urgent chest decompression was performed with a tube thoracostomy. Chest computed tomographic scan revealed pulmonary laceration with hematoma in the right lung. The pulmonary hematoma extending along segmental pulmonary artery in the helium of the middle lobe ruptured suddenly into the thoracic cavity, resulting in hemorrhagic shock on the fourth day after admission. Emergency right middle lobectomy was performed through video-assisted minithoracotomy. We used two cotton dissectors as a chopstick for achieving compression hemostasis during surgery. The patient recovered satisfactorily. Video-assisted minithoracotomy can be an alternative approach for the treatment of pulmonary lacerations with a massive hemothorax in hemodynamically unstable patients.

  17. Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome.

    Science.gov (United States)

    Jardim, Anaclara Prada; Neves, Rafael Scarpa da Costa; Caboclo, Luís Otávio Sales Ferreira; Lancellotti, Carmen Lucia Penteado; Marinho, Murilo Martinez; Centeno, Ricardo Silva; Cavalheiro, Esper Abrão; Scorza, Carla Alessandra; Yacubian, Elza Márcia Targas

    2012-05-01

    To analyze retrospectively a series of patients with temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS), and the association of patterns of hippocampal sclerosis with clinical data and surgical prognosis. Sixty-six patients with medically refractory TLE with unilateral MTS after anterior temporal lobectomy were included. Quantitative neuropathological evaluation was performed on NeuN-stained hippocampal sections. Patient's clinical data and surgical outcome were reviewed. Occurrence of initial precipitating insult (IPI), as well as better postoperative seizure control (i.e. Engel class 1), were associated with classical and severe patterns of hippocampal sclerosis (MTS type 1a and 1b, respectively). Quantitative evaluation of hippocampal neuronal loss patterns predicts surgical outcome in patients with TLE-MTS.

  18. Implicit and Explicit Memory for Affective Passages in Temporal Lobectomy Patients

    Science.gov (United States)

    Burton, Leslie A.; Rabin, Laura; Vardy, Susan Bernstein; Frohlich, Jonathan; Porter, Gwinne Wyatt; Dimitri, Diana; Cofer, Lucas; Labar, Douglas

    2008-01-01

    Eighteen temporal lobectomy patients (9 left, LTL; 9 right, RTL) were administered four verbal tasks, an Affective Implicit Task, a Neutral Implicit Task, an Affective Explicit Task, and a Neutral Explicit Task. For the Affective and Neutral Implicit Tasks, participants were timed while reading aloud passages with affective or neutral content,…

  19. Glutathione oxidation correlates with one-lung ventilation time and PO2/FiO2 ratio during pulmonary lobectomy.

    Science.gov (United States)

    García-de-la-Asunción, José; García-Del-Olmo, Eva; Galan, Genaro; Guijarro, Ricardo; Martí, Francisco; Badenes, Rafael; Perez-Griera, Jaume; Duca, Alejandro; Delgado, Carlos; Carbonell, Jose; Belda, Javier

    2016-09-01

    During lung lobectomy, the operated lung completely collapses with simultaneous hypoxic pulmonary vasoconstriction, followed by expansion and reperfusion. Here, we investigated glutathione oxidation and lipoperoxidation in patients undergoing lung lobectomy, during one-lung ventilation (OLV) and after resuming two-lung ventilation (TLV), and examined the relationship with OLV duration. We performed a single-centre, observational, prospective study in 32 patients undergoing lung lobectomy. Blood samples were collected at five time-points: T0, pre-operatively; T1, during OLV, 5 minutes before resuming TLV; and T2, T3, and T4, respectively, 5, 60, and 180 minutes after resuming TLV. Samples were tested for reduced glutathione (GSH), oxidized glutathione (GSSG), glutathione redox potential, and malondialdehyde (MDA). GSSG and MDA blood levels increased at T1, and increased further at T2. OLV duration directly correlated with marker levels at T1 and T2. Blood levels of GSH and glutathione redox potential decreased at T1-T3. GSSG, oxidized glutathione/total glutathione ratio, and MDA levels were inversely correlated with arterial blood PO2/FiO2 at T1 and T2. During lung lobectomy and OLV, glutathione oxidation, and lipoperoxidation marker blood levels increase, with further increases after resuming TLV. Oxidative stress degree was directly correlated with OLV duration, and inversely correlated with arterial blood PO2/FiO2.

  20. [Anesthetic Management of Right Lower Lobectomy in a Patient with Marfan Syndrome].

    Science.gov (United States)

    Deguchi, Shiho; Komasawa, Nobuyasu; Matsunami, Sayuri; Kusaka, Yusuke; Ohchi, Fumihiro; Minami, Toshiaki

    2015-05-01

    We report a case of partial lobectomy in a patient with Marfan syndrome. A 56-year-old woman with Marfan syndrome was scheduled for partial lobectomy for suspected lung cancer under general anesthesia. She underwent a Bentall operation and mitral valve replacement 10 months before and strict blood pressure management was required. After induction of general anesthesia with propofol and fentanyl, topical intratracheal lidocaine anesthesia was performed using the Pentax-AWS Airwayscope (AWS) for visualization, allowing for the Soft-tipped Tube Exchanger (TE-Soft) to be inserted into the trachea. Next, a double-lumen tracheal tube was uneventfully intubated via the TE-Soft with minimal change in vital signs. During the operation, pressure-controlled ventilation was performed to minimize the risk of pneumothorax. After the operation, under continuous administration of landiorol and dexmedetomidine, the double-lumen tracheal tube was extubated uneventfully. Strict airway and circulation management is needed for lung or vessel preservation in patients whose conditions are complicated by Marfan syndrome.

  1. Uniportal video-assisted thoracoscopic surgery: safety, efficacy and learning curve during the first 250 cases in Quebec, Canada.

    Science.gov (United States)

    Drevet, Gabrielle; Ugalde Figueroa, Paula

    2016-03-01

    Video-assisted thoracoscopic surgery (VATS) using a single incision (uniportal) may result in better pain control, earlier mobilization and shorter hospital stays. Here, we review the safety and efficiency of our initial experience with uniportal VATS and evaluate our learning curve. We conducted a retrospective review of uniportal VATS using a prospectively maintained departmental database and analyzed patients who had undergone a lung anatomic resection separately from patients who underwent other resections. To assess the learning curve, we compared the first 10 months of the study period with the second 10 months. From January 2014 to August 2015, 250 patients underwent intended uniportal VATS, including 180 lung anatomic resections (72%) and 70 other resections (28%). Lung anatomic resection was successfully completed using uniportal VATS in 153 patients (85%), which comprised all the anatomic segmentectomies (29 patients), 80% (4 of 5) of the pneumonectomies and 82% (120 of 146) of the lobectomies attempted. The majority of lung anatomic resections that required conversion to thoracotomy occurred in the first half of our study period. Seventy patients underwent other uniportal VATS resections. Wedge resections were the most common of these procedures (25 patients, 35.7%). Although 24 of the 70 patients (34%) required the placement of additional ports, none required conversion to thoracotomy. Uniportal VATS was safe and feasible for both standard and complex pulmonary resections. However, when used for pulmonary anatomic resections, uniportal VATS entails a steep learning curve.

  2. Impact of Electronic Tax Registers on VAT Compliance: A Study of ...

    African Journals Online (AJOL)

    The purpose of this study was to assess the impact of use of Electronic Tax Registers (ETRs ) on Value Added Tax (VAT) compliance among private business firms in Kisumu city, Kenya. A sample of 233 private firms was selected from a population of 590 private firms using stratified sampling technique. The data was ...

  3. Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion.

    Science.gov (United States)

    Safdie, Fernando M; Sanchez, Manuel Villa; Sarkaria, Inderpal S

    2017-01-01

    Video assisted thoracic surgery (VATS) has become a routinely utilized approach to complex procedures of the chest, such as pulmonary resection. It has been associated with decreased postoperative pain, shorter length of stay and lower incidence of complications such as pneumonia. Limitations to this modality may include limited exposure, lack of tactile feedback, and a two-dimensional view of the surgical field. Furthermore, the lack of an open incision may incur technical challenges in preventing and controlling operative misadventures leading to major hemorrhage or other intraoperative emergencies. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. Unplanned conversions for major intraoperative bleeding or airway injury during general thoracic surgical procedures are relatively rare and often can be avoided with careful preoperative planning, review of relevant imaging, and meticulous surgical technique. When these events occur, a pre-planned, methodical response with initial control of bleeding, assessment of injury, and appropriate repair and/or salvage procedures are necessary to maximize outcomes. The surgeon should be well versed in injury-specific incisions and approaches to maximize adequate exposure and when feasible, allow completion of the index operation. Decisions to continue with a minimally invasive approach should consider the comfort and experience level of the surgeon with these techniques, and the relative benefit gained against the risk incurred to the patient. These algorithms may be expected to shift in the future with increasing sophistication and capabilities of minimally invasive technologies and approaches.

  4. Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

    Directory of Open Access Journals (Sweden)

    Anaclara Prada Jardim

    2012-05-01

    Full Text Available OBJECTIVE: To analyze retrospectively a series of patients with temporal lobe epilepsy (TLE and mesial temporal sclerosis (MTS, and the association of patterns of hippocampal sclerosis with clinical data and surgical prognosis. METHOD: Sixty-six patients with medically refractory TLE with unilateral MTS after anterior temporal lobectomy were included. Quantitative neuropathological evaluation was performed on NeuN-stained hippocampal sections. Patient's clinical data and surgical outcome were reviewed. RESULTS: Occurrence of initial precipitating insult (IPI, as well as better postoperative seizure control (i.e. Engel class 1, were associated with classical and severe patterns of hippocampal sclerosis (MTS type 1a and 1b, respectively. CONCLUSION: Quantitative evaluation of hippocampal neuronal loss patterns predicts surgical outcome in patients with TLE-MTS.

  5. Thoracoscopic lung lobectomy for treatment of lung tumors in dogs.

    Science.gov (United States)

    Lansdowne, Jennifer L; Monnet, Eric; Twedt, David C; Dernell, William S

    2005-01-01

    To report use of thoracoscopic lung lobectomy (TLL) for treatment of lung tumors (LT) in dogs. Retrospective study. Nine dogs. Dogs that had TLL for tumor removal were included. Using general anesthesia and 1-lung ventilation, TLL was performed using a 30-60 mm endoscopic gastrointestinal anastomosis stapler. If the visual field was obscured, lobe resection was completed via thoracotomy. Metastatic and primary LT were resected by thoracoscopic lobectomy in 9 dogs (6 male, 3 female; mean (+/-SD) weight, 29+/-7 kg; mean age, 10.7+/-1.9 years). Six dogs had a solitary mass and 3 dogs had 2 masses within a single lobe. The left caudal lobe was removed in 3 dogs. In 5 dogs, TLL was used alone whereas conversion to thoracotomy was required in 4 dogs because of poor visibility. There were 7 metastatic LT and 2 primary LT. Mean duration of thoracoscopic surgery was 108.8+/-30.3 minutes compared with 150.75+/-55.4 minutes in dogs requiring conversion to thoracotomy. Mean hospitalization was 3.1+/-1.3 days. Provided the visual field is not obscured, TLL can be performed effectively in dogs. Dogs with metastatic or primary LTs should be considered for TLL, particularly for small masses positioned away from the hilus in the left caudal lung lobe.

  6. Video Assisted Thoracoscopic Surgical Enucleation of a Giant Esophageal Leiomyoma Presenting with Persistent Cough

    Directory of Open Access Journals (Sweden)

    Parvez Mujawar

    2016-01-01

    Full Text Available Esophageal leiomyoma is a relatively rare tumor of esophagus but it is the most common benign neoplasm of the esophagus. Small esophageal leiomyoma can be observed but larger ones and those producing symptoms should be excised. As observed for other esophageal tumors, dysphagia is its main symptom. Traditionally, open thoracotomy and enucleation are its main treatment but in the last few years video assisted thoracoscopic surgical (VATS enucleation is gaining recognition with proven advantages of minimally invasive surgery. Herein we present our experience with patient presenting with cough rather than dysphagia as a main symptom, who was diagnosed to be having giant esophageal leiomyoma. VATS guided enucleation was accomplished successfully. Size of lesion was 16×4×3 cm. Postoperative recovery was uneventful and patient is not having any signs of recurrence, after three years during follow-up period.

  7. [Surgical treatment of multinodular goiter at the Instituto Nacional de la Nutrición Salvador Zubirán].

    Science.gov (United States)

    López, L H; Herrera, M F; Gamino, R; González, O; Pérez-Enriquez, B; Rivera, R; Gamboa-Domínguez, A; Angeles-Angeles, A; Rull, J A

    1997-01-01

    Surgical treatment is the first option for patients with obstructive multinodular goiter. The extent of the resection and the use of postoperative hormonal therapy are, on the other hand, still under debate. To analyze the results of surgical treatment in 101 patient with multinodular goiter seen from 1980 to 1995. The clinical/pathologic charts of all patients were reviewed with emphasis to the clinical diagnosis, extent of resection, final histology, type and number of complications, and long-term follow-up. The mean follow-up was three years (range 0.5-12). Ten males and 91 females with a mean age of 46 years were included. Surgery was recommended for a nodule suspicious of malignancy in 60 patients, for airway compression in 33, and for cosmetic reasons in eight. Unilateral lobectomy was performed in 30, bilateral subtotal thyroidectomy in 55 and total thyroidectomy in 16. Postoperative hormone therapy was administrated to 83 patients. Surgical complications occurred in six patients. Four developed permanent hypoparathyroidism and two vocal cord paralysis. There was no operative mortality. A final diagnosis of multinodular goiter was established in 89 whereas 12 had cancer. There were three asymptomatic recurrences in the group with benign lesions (they had undergone unilateral lobectomy followed by hormonal therapy). Bilateral subtotal thyroidectomy was the best treatment for multinodular goiter in our series. This procedure had few complications and there was no recurrence of the disease.

  8. A Comparison of Some Properties of Vat-Heated and Dry Skim Milk ...

    African Journals Online (AJOL)

    Some properties, namely; viscosity, flavour, acidity, texture, aroma and palatability of cultured yoghurt made from milk previously heated to 90OC for 30 minutes in a Vat were studied and the results compared to those of yoghurt fortified by addition of dry skim milk powder. The results showed no significant difference (P ...

  9. The compliance costs of VAT in the hotel industry in Mauritius | Pillai ...

    African Journals Online (AJOL)

    The cost of complying with tax legislation has stimulated much controversy recently and the survey conducted by Sandford (1973) suggested that the essential characteristics of a successful VAT system are clarify and simplicity. This article lays down facts and figures that arise from a survey carried out in July 1999 in the ...

  10. A Review on Fabricating Tissue Scaffolds using Vat Photopolymerization.

    Science.gov (United States)

    Chartrain, Nicholas A; Williams, Christopher B; Whittington, Abby R

    2018-05-09

    Vat Photopolymerization (stereolithography, SLA), an Additive Manufacturing (AM) or 3D printing technology, holds particular promise for the fabrication of tissue scaffolds for use in regenerative medicine. Unlike traditional tissue scaffold fabrication techniques, SLA is capable of fabricating designed scaffolds through the selective photopolymerization of a photopolymer resin on the micron scale. SLA offers unprecedented control over scaffold porosity and permeability, as well as pore size, shape, and interconnectivity. Perhaps even more significantly, SLA can be used to fabricate vascular networks that may encourage angio and vasculogenesis. Fulfilling this potential requires the development of new photopolymers, the incorporation of biochemical factors into printed scaffolds, and an understanding of the effects scaffold geometry have on cell viability, proliferation, and differentiation. This review compares SLA to other scaffold fabrication techniques, highlights significant advances in the field, and offers a perspective on the field's challenges and future directions. Engineering de novo tissues continues to be challenging due, in part, to our inability to fabricate complex tissue scaffolds that can support cell proliferation and encourage the formation of developed tissue. The goal of this review is to first introduce the reader to traditional and Additive Manufacturing scaffold fabrication techniques. The bulk of this review will then focus on apprising the reader of current research and provide a perspective on the promising use of vat photopolymerization (stereolithography, SLA) for the fabrication of complex tissue scaffolds. Copyright © 2018. Published by Elsevier Ltd.

  11. Surgical treatment of catamenial pneumothorax: Report of three cases

    Directory of Open Access Journals (Sweden)

    Yoshinobu Ichiki

    2015-07-01

    Full Text Available Catamenial pneumothorax (CP is a rare entity of spontaneous, recurring pneumothorax in females. Although it has been known to be associated with thoracic endometriosis, varying clinical course and the lack of consistent intraoperative findings have led to conflicting etiological theories. We herein discuss the etiology, clinical course, and surgical treatment of three patients with CP. Three females (aged 40 years, 28 years, and 34 years had recurrent right-sided spontaneous pneumothoraces that coincided with their menses. They had undergone video-assisted thoracoscopic surgery (VATS previously. Blueberry spots in the right diaphragm were detected in all three cases. Two patients had recurrence, postoperatively. The other patient, who received luteinizing hormone-releasing hormone analog therapy for an abdominal endometriosis in the perioperative period and postoperative chemical pleurodesis to prevent recurrence, has been free of recurrence for 15 months, postoperatively. However, pelvic endometriosis was detected in this patient only. Therefore, CP should be suspected in ovulating females with spontaneous pneumothorax, even in the absence of any symptoms associated with pelvic endometriosis. In addition, while performing VATS, careful inspection of the diaphragmatic surface is important. In complicated cases, hormonal suppression therapy and chemical pleurodesis might also be helpful adjunct modalities.

  12. The Effect of VAT e-Service Quality on Taxpayers’ Satisfaction in Iran

    Directory of Open Access Journals (Sweden)

    Maryam Alipour

    2017-03-01

    Full Text Available The design of e-government websites with improper service quality is one of the common problems in the contemporary era. Users’ perceptions of e-service quality are affected by their perceived service content and delivery quality. In this study, based on the model of e-government service quality, first we identify the factors of service content and delivery related to Value Added Tax (VAT system in Iran. Then, we develop a conceptual model that depicts the influence of these factors on service quality and users’ satisfaction.  Data gathering is performed through electronic questionnaire and the case study of taxpayers using VAT services. The results show that transactional performance and accessibility respectively, have the greatest impact on quality of service content and delivery. In addition, the users’ positive perceptions of service content and delivery quality influence their positive perceptions of overall service quality. This study offers the design of a user-centric governmental website with effective service quality to improve users’ satisfaction and also to encourage the adoption and continuance use of these services.

  13. Disabling amnestic syndrome following stereotactic laser ablation of a hypothalamic hamartoma in a patient with a prior temporal lobectomy

    Directory of Open Access Journals (Sweden)

    Sarah Zubkov

    2015-01-01

    Full Text Available A 19-year-old man with cortical dysplasia and intractable focal seizures underwent a right temporal lobectomy. A hypothalamic hamartoma was subsequently recognized, and he then underwent MRI-guided stereotactic laser ablation. Unfortunately, he sustained damage to the bilateral medial mammillary bodies and suffered significant memory loss. We review laser ablation therapy for hypothalamic hamartomas and the anatomy of the memory network. We postulate that his persistent memory disorder resulted from a combination of the right temporal lobectomy and injury to the bilateral medial mammillary bodies.

  14. Evaluation of polymer micro parts produced by additive manufacturing processes using vat photopolymerization method

    DEFF Research Database (Denmark)

    Davoudinejad, Ali; Pedersen, David Bue; Tosello, Guido

    2017-01-01

    Micro manufacturing scale feature production by Additive Manufacturing (AM) processes for the direct production of miniaturized polymer components is analysed in this work. The study characterizes the AM processes for polymer micro parts productions using the vat photopolymerization method...

  15. Different types of working memory binding in epilepsy patients with unilateral anterior temporal lobectomy.

    Science.gov (United States)

    van Geldorp, Bonnie; Bouman, Zita; Hendriks, Marc P H; Kessels, Roy P C

    2014-03-01

    The medial temporal lobe is an important structure for long-term memory formation, but its role in working memory is less clear. Recent studies have shown hippocampal involvement during working memory tasks requiring binding of information. It is yet unclear whether this is limited to tasks containing spatial features. The present study contrasted three binding conditions and one single-item condition in patients with unilateral anterior temporal lobectomy. A group of 43 patients with temporal lobectomy (23 left; 20 right) and 20 matched controls were examined with a working memory task assessing spatial relational binding (object-location), non-spatial relational binding (object-object), conjunctive binding (object-colour) and working memory for single items. We varied the delay period (3 or 6s), as there is evidence showing that delay length may modulate working memory performance. The results indicate that performance was worse for patients than for controls in both relational binding conditions, whereas patients were unimpaired in conjunctive binding. Single-item memory was found to be marginally impaired, due to a deficit on long-delay trials only. In conclusion, working memory binding deficits are found in patients with unilateral anterior temporal lobectomy. The role of the medial temporal lobe in working memory is not limited to tasks containing spatial features. Rather, it seems to be involved in relational binding, but not in conjunctive binding. The medial temporal lobe gets involved when working memory capacity does not suffice, for example when relations have to be maintained or when the delay period is long. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage I non-small cell lung cancer.

    Science.gov (United States)

    Chan, Ernest G; Landreneau, James R; Schuchert, Matthew J; Odell, David D; Gu, Suicheng; Pu, Jiantao; Luketich, James D; Landreneau, Rodney J

    2015-09-01

    Accurate cancer localization and negative resection margins are necessary for successful segmentectomy. In this study, we evaluate a newly developed software package that permits automated segmentation of the pulmonary parenchyma, allowing 3-dimensional assessment of tumor size, location, and estimates of surgical margins. A pilot study using a newly developed 3-dimensional computed tomography analytic software package was performed to retrospectively evaluate preoperative computed tomography images of patients who underwent segmentectomy (n = 36) or lobectomy (n = 15) for stage 1 non-small cell lung cancer. The software accomplishes an automated reconstruction of anatomic pulmonary segments of the lung based on bronchial arborization. Estimates of anticipated surgical margins and pulmonary segmental volume were made on the basis of 3-dimensional reconstruction. Autosegmentation was achieved in 72.7% (32/44) of preoperative computed tomography images with slice thicknesses of 3 mm or less. Reasons for segmentation failure included local severe emphysema or pneumonitis, and lower computed tomography resolution. Tumor segmental localization was achieved in all autosegmented studies. The 3-dimensional computed tomography analysis provided a positive predictive value of 87% in predicting a marginal clearance greater than 1 cm and a 75% positive predictive value in predicting a margin to tumor diameter ratio greater than 1 in relation to the surgical pathology assessment. This preoperative 3-dimensional computed tomography analysis of segmental anatomy can confirm the tumor location within an anatomic segment and aid in predicting surgical margins. This 3-dimensional computed tomography information may assist in the preoperative assessment regarding the suitability of segmentectomy for peripheral lung cancers. Published by Elsevier Inc.

  17. Epilepsy with temporal encephalocele: Characteristics of electrocorticography and surgical outcome.

    Science.gov (United States)

    Panov, Fedor; Li, Yi; Chang, Edward F; Knowlton, Robert; Cornes, Susannah B

    2016-02-01

    Temporal lobe encephaloceles (TEs) are increasingly identified in patients with epilepsy due to advances in neuroimaging. Select patients become seizure-free with lesionectomy. In practice, however, many of these patients will undergo standard anterior temporal lobectomy. Herein we report on the first series of patients with refractory temporal lobe epilepsy (TLE) with encephalocele to undergo chronic or intraoperative electrocorticography (ECoG) in order to characterize the putative epileptogenic nature of these lesions and help guide surgical planning. This retrospective study includes nine adult patients with magnetic resonance imaging/computed tomography (MRI/CT)-defined temporal encephalocele treated between 2007 and 2014 at University of California San Francisco (UCSF). Clinical features, ECoG, imaging, and surgical outcomes are reviewed. Six patients underwent resective epilepsy surgery. Each case demonstrated abnormal epileptiform discharges around the cortical area of the encephalocele. Two underwent tailored lesionectomy and four underwent lesionectomy plus anterior medial temporal resection. Postoperatively, five patients, including both with lesionectomy only, had Engel class Ia surgical outcome, and one had a class IIb surgical outcome. The role of TE in the pathogenesis of epilepsy is uncertain. ECoG can confirm the presence of interictal epileptiform discharges and seizures arising from these lesions. Patients overall had a very good surgical prognosis, even with selective surgical approaches. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  18. Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis.

    Science.gov (United States)

    Zhou, Dong; Deng, Xu-Feng; Liu, Quan-Xing; Chen, Qian; Min, Jia-Xin; Dai, Ji-Gang

    2016-05-27

    In this meta-analysis, we conducted a pooled analysis of clinical studies comparing the efficacy of single chest tube versus double chest tube after a lobectomy. According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed, Embase, Cochrane Library and Web of Science databases to identify articles to include in our meta-analysis. A literature search was performed using relevant keywords. A meta-analysis was performed using RevMan© software. Five studies, published between 2003 and 2014, including 630 patients (314 patients with a single chest tube and 316 patients with a double chest tube), met the selection criteria. From the available data, the patients using a single tube demonstrated significantly decreased postoperative pain [weighted mean difference [WMD] -0.60; 95 % confidence intervals [CIs] -0.68-- 0.52; P tube after a pulmonary lobectomy. However, there were no significant differences in postoperative complications [OR 0.91; 95 % CIs 0.57-1.44; P = 0.67] and re-drainage rates [OR 0.81; 95 % CIs 0.42-1.58; P = 0.54]. Our results showed that a single-drain method is effective, reducing postoperative pain, hospitalization times and duration of drainage in patients who undergo a lobectomy. Moreover, the single-drain method does not increase the occurrence of postoperative complications and re-drainage rates.

  19. Evaluation of surgeon's muscle fatigue during thoracoscopic pulmonary lobectomy using interoperative surface electromyography.

    Science.gov (United States)

    Yoon, Seung-Hyun; Jung, Myung-Chul; Park, Seong Yong

    2016-06-01

    The aim of this study was to document the physical stress experienced by a surgeon during thoracoscopic pulmonary lobectomy and mediastinal lymph node dissection for lung cancer by measuring the intraoperative electromyography (EMG). Surface EMG was recorded during 12 cases of thoracoscopic lobectomy. During the operation, 16 channels of a wireless EMG were used to measure muscle activity and fatigue from the bilateral muscles of the splenius capitis (SC), upper trapezius (UT), middle deltoid (MD), flexor carpi radialis (FCR), extensor carpi radialis (ECR), lumbar erector spinae (LES), rectus femoralis (RF), and tibialis anterior (TA). The EMG signals were processed to collect the values of the root mean square for muscle activity and median frequency (MF) for muscle fatigue. All operations were completed without adverse events. The mean operating time was 99.16±35.15 minutes. During the operation, the mean muscle activity of all muscles was 21.91±12.85 mV. High muscle activity was observed in the bilateral FCR and ECR, whereas low muscle activity was observed in the bilateral SC and LES. The final MFs in the bilateral SC and LES were found to be decreased from the initial status, which implied increased muscle fatigue. The muscles of the right and left LES were significantly fatigued by up to 29% and 37% compared to their initial status (P=0.021 and P=0.007, respectively). The MFs of the bilateral LES decreased with time (an average decreases of 0.008/5 minutes, P=0.002 in right LES and 0.004/5 minutes, P=0.018 in left LES). During thoracoscopic lobectomy, muscle fatigue was observed in muscles related to a static posture, such as the bilateral SC, UT, and ES. Further studies are required to investigate the ergonomic adjustments needed to reduce muscle fatigue in these static muscles.

  20. A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy.

    Science.gov (United States)

    Xie, Hong-Ya; Xu, Kai; Tang, Jin-Xing; Bian, Wen; Ma, Hai-Tao; Zhao, Jun; Ni, Bin

    2015-08-01

    To study the feasible and safe volume threshold for chest tube removal following video-assisted thoracoscopic surgical lobectomy. One hundred and sixty-eight consecutive patients (18 were excluded) who underwent video-assisted thoracoscopic surgery lobectomy or bilobectomy with two incisions between August 2012 and February 2014 were included. Eligible patients were randomized into three groups: Group A (chest tube was removed at a drainage volume of 150 ml/day or less. n = 49); Group B (chest tube was removed when the drainage volume was less than 300 ml/day. n = 50); Group C (chest tube was removed when the drainage volume was less than 450 ml/day. n = 51). The postoperative care of all patients was consistent. The time of extracting the drainage tube, postoperative hospital stay, postoperative visual analogue scale grades, dosage of analgesic, and the incidence of complications and thoracocentesis were measured. Group B and C had a much shorter drainage time and postoperative hospital stay than Group A (P 0.05). The mean dosage of pethidine hydrochloride was 248.9 ± 33.3 mg in Group B and 226.1 ± 32.7 mg in Group C (P > 0.05). The dosage of pethidine hydrochloride of Group A was significantly higher than that of Group B and C (P 0.05), Group A had a significantly higher total VAS score than Group B and C (P drains among the three groups (P > 0.05). A 300-ml/day volume threshold for chest tube removal after video-assisted thoracoscopic surgery lobectomy is feasible and safe, demonstating more advantages than the 150-ml/day volume threshold. However, a 450-ml/day volume threshold for chest tube removal may increase the risk of thoracentesis compared with the 300- and the 150-ml/day volume threshold. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  1. Surgical treatment for pulmonary aspergilloma in seventeenth years old female: case report

    Science.gov (United States)

    Yanni, G. N.; Lubis, M.; Yoel, C.

    2018-03-01

    Aspergillosis is defined as a mycosis group caused by various pathogenic fungi of the Aspergillus genus. Aspergillus has more than 900 species that cause infection in human. The most common Aspergillus species that cause infection is Aspergillus fumigatus, about 90%. Other species, Aspergillus flavus, about 10% cause invasive disease. Have been reported a young girl 17-year-8-month-old woman was admitted to emergency with complaints of coughing up blood. The patient has diagnosed an aspergilloma and treated with thoracotomy bi-lobectomy right lower lung based on thorax scan. The patient took Fluconazole and surgical bilobectomyfor treated the aspergilloma and got improvement.

  2. Robotic Versus Video-assisted Lobectomy/Segmentectomy for Lung Cancer: A Meta-analysis.

    Science.gov (United States)

    Liang, Hengrui; Liang, Wenhua; Zhao, Lei; Chen, Difei; Zhang, Jianrong; Zhang, Yiyin; Tang, Shiyan; He, Jianxing

    2017-06-16

    : Objective: To compare the safety/efficacy of the robotic-assisted lobectomy/segmentectomy (RAL/S) with the video-assisted lobectomy/segmentectomy (VAL/S) for radical lung cancer resection. It remains uncertain whether the newly developed RAL/S is comparable with the VAL/S. A comprehensive search of online databases was performed. Perioperative outcomes were synthesized. Cumulative meta-analysis was performed to evaluate the temporal trend of pooled outcomes. Specific subgroups (propensity score matching studies, pure lobectomy studies) were examined. Analysis of 14 studies including a total of 7438 patients was performed. RAL/S was performed on 3239 patients, whereas the other 4199 patients underwent VAL/S. The 30-day mortality [0.7% vs 1.1%; odds ratio (OR) 0.53, P = 0.045] and conversion rate to open surgery (10.3% vs 11.9%; OR 0.57, P < 0.001) were significantly lower in patients who underwent RAL/S than VAL/S. Meanwhile, the postoperative complications (27.5% vs 28.2%; OR 0.95, P = 0.431), operation time [176.63 vs 162.74 min; standardized mean difference (SMD) 0.30, P = 0.086], duration of hospitalization (4.90 vs 5.23 days; SMD -0.08, P = 0.292), days to tube removal (4.10 vs 3.53 days; SMD 0.25, P = 0.120), retrieved lymph node (11.96 vs 10.67; SMD 0.46, P = 0.381), and retrieved lymph node station (4.98 vs 4.32; SMD 0.83, P = 0.261) were similar between the 2 groups. The cumulative meta-analyses suggested that the relative effects between 2 groups have already stabilized. All outcomes of subgroup and overall analyses were similar. This up-to-date meta-analysis confirms that RAL/S is a feasible and safe alternative to VAL/S for radical resection of lung cancer. Future studies should focus on the long-term benefits and cost effectiveness of RAL/S compared with VAL/S.

  3. WE-AB-BRA-06: 4DCT-Ventilation: A Novel Imaging Modality for Thoracic Surgical Evaluation

    International Nuclear Information System (INIS)

    Vinogradskiy, Y; Jackson, M; Schubert, L; Jones, B; Mitchell, J; Kavanagh, B; Miften, M; Castillo, R; Castillo, E; Guerrero, T

    2016-01-01

    Purpose: The current standard-of-care imaging used to evaluate lung cancer patients for surgical resection is nuclear-medicine ventilation. Surgeons use nuclear-medicine images along with pulmonary function tests (PFT) to calculate percent predicted postoperative (%PPO) PFT values by estimating the amount of functioning lung that would be lost with surgery. 4DCT-ventilation is an emerging imaging modality developed in radiation oncology that uses 4DCT data to calculate lung ventilation maps. We perform the first retrospective study to assess the use of 4DCT-ventilation for pre-operative surgical evaluation. The purpose of this work was to compare %PPO-PFT values calculated with 4DCT-ventilation and nuclear-medicine imaging. Methods: 16 lung cancer patients retrospectively reviewed had undergone 4DCTs, nuclear-medicine imaging, and had Forced Expiratory Volume in 1 second (FEV1) acquired as part of a standard PFT. For each patient, 4DCT data sets, spatial registration, and a density-change based model were used to compute 4DCT-ventilation maps. Both 4DCT and nuclear-medicine images were used to calculate %PPO-FEV1 using %PPO-FEV1=pre-operative FEV1*(1-fraction of total ventilation of resected lung). Fraction of ventilation resected was calculated assuming lobectomy and pneumonectomy. The %PPO-FEV1 values were compared between the 4DCT-ventilation-based calculations and the nuclear-medicine-based calculations using correlation coefficients and average differences. Results: The correlation between %PPO-FEV1 values calculated with 4DCT-ventilation and nuclear-medicine were 0.81 (p<0.01) and 0.99 (p<0.01) for pneumonectomy and lobectomy respectively. The average difference between the 4DCT-ventilation based and the nuclear-medicine-based %PPO-FEV1 values were small, 4.1±8.5% and 2.9±3.0% for pneumonectomy and lobectomy respectively. Conclusion: The high correlation results provide a strong rationale for a clinical trial translating 4DCT-ventilation to the surgical

  4. [Surgical treatment of pediatric pulmonary metastases].

    Science.gov (United States)

    Costa Borrás, E; Ferrís i Tortajada, J; Jovaní Casano, C; Segarra Llido, V; Bermúdez Cortés, M; Cañete Nieto, A; Velázquez Terrón, J

    1998-07-01

    We comment and update the surgical treatment for pulmonary metastases (PM) within a multidisciplinary approach for paediatric cancer. We analyse patients with PM who have been operated between 1976-1996. Scientific literature published in the last 25 years (Cancerlit and Medline) was reviewed. PM from 13 patients were removed. Seven were males and 6 females with a mean age 5 4/12 years (range: 11 months- 12 3/12 years). Diagnoses were Wilms' tumour (7), osteosarcoma (3), Ewing sarcoma (1), rabdomiosarcoma (1), Yolk sac tumour (1). PM were unilateral in 7 cases and bilateral in six cases. PM appeared synchronically in four patients and metacronically in nine cases (3 of these after chemotherapy). All patients received chemotherapy and four of them local radiotherapy. Surgery consisted on radical segmentectomy and only one patient needed lobectomy due to a local relapse. Nowadays five patients (38%) are in complete remission with a mean follow-up from surgery of 11 11/12 years (range: 6 3/12-20 years). Metastasectomy is an important surgical technique in global treatment of children with PM and for a selected group of patients it can offer the only opportunity for curation.

  5. CONTROVERSIES ON THE APPLICATION OF THE VAT SPLIT PAYMENT MECHANISM

    Directory of Open Access Journals (Sweden)

    PALIU – POPA LUCIA

    2017-11-01

    Full Text Available Taking into account the urgent need to attract additional amounts to the state budget to cover the increased budget expenditures involved in the implementation of the government program, by the end of August 2017, the Government of Romania adopted an ordinance obliging the entities to apply, starting on January 1st 2018, the VAT split payment mechanism, system which no longer allows them to use the value added tax cashed affently to the delivery of goods and provision of services, which is why these amounts are to be cashed in separate accounts opened by entities in the state treasury or credit institutions. Only that, later, through the draft of Law on the approval of that ordinance, the Senate made changes to the legislative act, so that the VAT split payment would only apply to companies in insolvency or that register delays in payment of the tax. Although this measure aims at combating the tax evasion and fraud by increasing the voluntary compliance and tax collection degree, the measure can prove to be unfounded, which violates the legislative technique and, in particular, the Community provisions by being inappropriate. In this context, the main objective of this scientific approach is to identify the special situations that arise at the level of entities as a result of the application of the breakdown mechanism of value added tax and to determine the possible advantages and disadvantages.

  6. Surgical treatment of catamenial pneumothorax: Report of three cases.

    Science.gov (United States)

    Ichiki, Yoshinobu; Nagashima, Akira; Yasuda, Manabu; Takenoyama, Mitsuhiro; Toyoshima, Satoshi

    2015-07-01

    Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in females. Although it has been known to be associated with thoracic endometriosis, varying clinical course and the lack of consistent intraoperative findings have led to conflicting etiological theories. We herein discuss the etiology, clinical course, and surgical treatment of three patients with CP. Three females (aged 40 years, 28 years, and 34 years) had recurrent right-sided spontaneous pneumothoraces that coincided with their menses. They had undergone video-assisted thoracoscopic surgery (VATS) previously. Blueberry spots in the right diaphragm were detected in all three cases. Two patients had recurrence, postoperatively. The other patient, who received luteinizing hormone-releasing hormone analog therapy for an abdominal endometriosis in the perioperative period and postoperative chemical pleurodesis to prevent recurrence, has been free of recurrence for 15 months, postoperatively. However, pelvic endometriosis was detected in this patient only. Therefore, CP should be suspected in ovulating females with spontaneous pneumothorax, even in the absence of any symptoms associated with pelvic endometriosis. In addition, while performing VATS, careful inspection of the diaphragmatic surface is important. In complicated cases, hormonal suppression therapy and chemical pleurodesis might also be helpful adjunct modalities. Copyright © 2013. Published by Elsevier Taiwan.

  7. Persistence of wild Streptococcus thermophilus strains on wooden vat and during the manufacture of a traditional Caciocavallo type cheese.

    Science.gov (United States)

    Settanni, L; Di Grigoli, A; Tornambé, G; Bellina, V; Francesca, N; Moschetti, G; Bonanno, A

    2012-04-02

    The present work was undertaken to evaluate the influence of the wooden dairy plant equipment on the microbiological characteristics of curd to be transformed into Caciocavallo Palermitano cheese. Traditional raw milk productions were performed concomitantly with standard cheese making trials carried out in stainless steel vat inoculated with a commercial starter. Milk from two different farms (A and B) was separately processed. The wooden vat was found to be a reservoir of lactic acid bacteria (LAB), while unwanted (spoilage and/or pathogenic) microorganisms were not hosted or were present at very low levels. All microbial groups were numerically different in bulk milks, showing higher levels for the farm B. LAB, especially thermophilic cocci, dominated the whole cheese making process of all productions. Undesired microorganisms decreased in number or disappeared during transformation, particularly after curd stretching. LAB were isolated from the wooden vat surface and from all dairy samples, subjected to phenotypic and genetic characterization and identification. Streptococcus thermophilus was the species found at the highest concentration in all samples analyzed and it also dominated the microbial community of the wooden vat. Fourteen other LAB species belonging to six genera (Enterococcus, Lactobacillus, Lactococcus, Leuconostoc, Streptococcus and Weissella) were also detected. All S. thermophilus isolates were genetically differentiated and a consortium of four strains persisted during the whole traditional production process. As confirmed by pH and the total acidity after the acidification step, indigenous S. thermophilus strains acted as a mixed starter culture. Copyright © 2012 Elsevier B.V. All rights reserved.

  8. IMPLICAÇÕES DA ANÁLISE V-A-T DA TEORIA DAS RESTRIÇÕES NA GESTÃO DA CADEIA DE SUPRIMENTOS

    Directory of Open Access Journals (Sweden)

    Diego Augusto de Jesus Pacheco

    2016-03-01

    Full Text Available O objetivo dessa pesquisa é identificar o impacto da análise V-A-T da Teoria das Restrições na gestão estratégica de materiais à luz da Matriz de Posicionamento Estratégico dos Materiais (MPEM. A partir de dois estudos de caso, buscou-se verificar: i em qual classificação cada empresa se enquadrava dentro da lógica V-A-T, e ii se a gestão estratégica de materiais a partir da abordagem da MPEM pode ser considerada semelhante ou não nos casos investigados. Os resultados da pesquisa apontaram que a classificação V-A-T no caso da empresa S é do tipo A e no caso da empresa K é do tipo V. Já a análise da gestão estratégica de materiais a partir da MPEM, evidenciou que no caso S pertence ao quadrante não crítico e no caso K pertence ao quadrante estratégico. Identificou-se que a classificação V-A-T tende a impactar na gestão de materiais e no controle de estoques.

  9. ‘Do You Want a Receipt?’ Combating VAT and RST Evasion with Lottery Tickets

    NARCIS (Netherlands)

    S.J.C. Hemels (Sigrid); M. Fabbri (Marco)

    2013-01-01

    textabstractGovernments both in developed and developing countries are facing the problem of value added tax (VAT) and retail sales tax (RST) evasion. This explains a growing interest in policies alternative to the traditional methods of deterrence. This paper describes the achievements resulting

  10. Triple pathological findings in a surgically amenable patient with mesial temporal lobe epilepsy

    Directory of Open Access Journals (Sweden)

    Fumin Tong

    2015-01-01

    Full Text Available Mesial temporal sclerosis (MTS is a well-recognized cause of intractable epilepsy; however, coexistence with focal cortical dysplasia (FCD is less common. Middle fossa epidermoid cysts are rare and may involve the temporal lobe. Most epidermoids are clinically silent, slow-growing, and seldom associated with overt symptomatology, including seizures. We describe a patient with multiple comorbidities including left MTS and a large epidermoid cyst involving the left quadrigeminal plate cistern compressing upon the cerebellar vermis and tail of the left hippocampus, resulting in refractory left temporal lobe epilepsy. The patient underwent left anterior temporal lobectomy. The surgical pathology demonstrated a third pathological finding of left temporal FCD type Ia. The patient has been seizure-free since the surgery. This case provides additional information with regard to the understanding of epileptogenicity and surgical planning in patients with MTS and epidermoid cysts.

  11. Performance Simulation and Verification of Vat Photopolymerization Based, Additively Manufactured Injection Molding Inserts with Micro-Features

    DEFF Research Database (Denmark)

    Mischkot, Michael; Hofstätter, Thomas; Michailidou, Ifigeneia

    2017-01-01

    Injection molding soft tooling inserts manufactured additively with vat photopolymerization represent a valid technology for prototyping and pilot production of polymer parts. However, a significant drawback is the low heat conductivity of photopolymers influencing cycletime and part quality...

  12. Major morbidity after video-assisted thoracic surgery lung resections: a comparison between the European Society of Thoracic Surgeons definition and the Thoracic Morbidity and Mortality system.

    Science.gov (United States)

    Sandri, Alberto; Papagiannopoulos, Kostas; Milton, Richard; Kefaloyannis, Emmanuel; Chaudhuri, Nilanjan; Poyser, Emily; Spencer, Nicholas; Brunelli, Alessandro

    2015-07-01

    The thoracic morbidity and mortality (TM&M) classification system univocally encodes the postoperative adverse events by their management complexity. This study aims to compare the distribution of the severity of complications according to the TM&M system versus the distribution according to the classification proposed by European Society of Thoracic Surgeons (ESTS) Database in a population of patients submitted to video assisted thoracoscopic surgery (VATS) lung resection. A total of 227 consecutive patients submitted to VATS lobectomy for lung cancer were analyzed. Any complication developed postoperatively was graded from I to V according to the TM&M system, reflecting the increasing severity of its management. We verified the distribution of the different grades of complications and analyzed their frequency among those defined as "major cardiopulmonary complications" by the ESTS Database. Following the ESTS definitions, 20 were the major cardiopulmonary complications [atrial fibrillation (AF): 10, 50%; adult respiratory distress syndrome (ARDS): 1, 5%; pulmonary embolism: 2, 10%; mechanical ventilation >24 h: 1, 5%; pneumonia: 3, 15%; myocardial infarct: 1, 5%; atelectasis requiring bronchoscopy: 2, 10%] of which 9 (45%) were reclassified as minor complications (grade II) by the TM&M classification system. According to the TM&M system, 10/34 (29.4%) of all complications were considered minor (grade I or II) while 21/34 (71.4%) as major (IIIa: 8, 23.5%; IIIb: 4, 11.7%; IVa: 8, 23.5%; IVb: 1, 2.9%; V: 3, 8.8%). Other 14 surgical complications occurred and were classified as major complications according to the TM&M system. The distribution of postoperative complications differs between the two classification systems. The TM&M grading system questions the traditional classification of major complications following VATS lung resection and may be used as an additional endpoint for outcome analyses.

  13. Implementation of a biotechnological process for vat dyeing with woad.

    Science.gov (United States)

    Osimani, Andrea; Aquilanti, Lucia; Baldini, Gessica; Silvestri, Gloria; Butta, Alessandro; Clementi, Francesca

    2012-09-01

    The traditional process for vat dyeing with woad (Isatis tinctoria L.) basically relies on microbial reduction of indigo to its soluble form, leucoindigo, through a complex fermentative process. In the 19th century, cultivation of woad went into decline and use of synthetic indigo dye and chemical reduction agents was established, with a consequent negative impact on the environment due to the release of polluting wastewaters by the synthetic dyeing industry. Recently, the ever-growing demand for environmentally friendly dyeing technologies has led to renewed interest in ecological textile traditions. In this context, this study aims at developing an environmentally friendly biotechnological process for vat dyeing with woad to replace use of polluting chemical reduction agents. Two simple broth media, containing yeast extract or corn steep liquor (CSL), were comparatively evaluated for their capacity to sustain the growth and reducing activity of the strain Clostridium isatidis DSM 15098(T). Subsequently, the dyeing capacity of the CSL medium added with 140 g L⁻¹ of woad powder, providing 2.4 g L⁻¹ of indigo dye, was evaluated after fermentation in laboratory bioreactors under anaerobic or microaerophilic conditions. In all fermentations, a sufficiently negative oxidation/reduction potential for reduction of indigo was reached as early as 24 h and maintained up to the end of the monitoring period. However, clearly faster indigo dye reduction was seen in the broth cultures fermented under strict anaerobiosis, thus suggesting the suitability of the N₂ flushing strategy for enhancement of bacterial-driven indigo reduction.

  14. Phrenic Nerve Reconstruction and Bilateral Diaphragm Plication After Lobectomy.

    Science.gov (United States)

    Shinohara, Shuichi; Yamada, Tetsu; Ueda, Mitsuhiro; Ishinagi, Hiroyoshi; Matsuoka, Takahisa; Nagai, Shinjiro; Matsuoka, Katsunari; Miyamoto, Yoshihiro

    2017-07-01

    A 49-year-old man with left phrenic nerve paralysis caused by mediastinal tumor resection 28 years earlier was found to have a nodule in the right upper lobe. The right phrenic nerve was severed during right upper lobectomy but was reconstructed along with bilateral plication of the diaphragm. The patient was weaned from the ventilator during the daytime on postoperative day 13 and was discharged home on postoperative day 48. Three months postoperatively, chest fluoroscopic imaging showed recovery of movement of the right diaphragm. Nerve conduction studies showed improvement of function of the reconstructed right phrenic nerve. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Early pleural fluid dynamics following video-assisted thoracoscopic lobectomy has limited clinical value

    DEFF Research Database (Denmark)

    Holbek, Bo Laksáfoss; Petersen, René Horsleben; Kehlet, Henrik

    2017-01-01

    The objective of this study was to evaluate the potential of predicting the pleural fluid output in patients after video-assisted thoracoscopic lobectomy of the lung. Detailed measurements of continuous fluid output were obtained prospectively using an electronic thoracic drainage device (Thopaz...... and 48 hours. Assessment of initial fluid production may predict high 24-hour fluid output (≥500 mL) but seems to lack clinical value in drain removal criteria....

  16. Financial validation of the European Society of Thoracic Surgeons risk score predicting prolonged air leak after video-assisted thoracic surgery lobectomy.

    Science.gov (United States)

    Brunelli, Alessandro; Pompili, Cecilia; Dinesh, Padma; Bassi, Vinod; Imperatori, Andrea

    2018-04-27

    The objective of this study was to verify whether the European Society of Thoracic Surgeons prolonged air leak risk score for video-assisted thoracoscopic lobectomy was associated with incremental postoperative costs. We retrospectively analyzed 353 patients subjected to video-assisted thoracoscopic lobectomy or segmentectomy (April 2014 to March 2016). Postoperative costs were obtained from the hospital Finance Department. Patients were grouped in different classes of risk according to their prolonged air leak risk score. To verify the independent association of the prolonged air leak risk score with postoperative costs, we performed a stepwise multivariable regression analysis in which the dependent variable was postoperative cost. Prolonged air leak developed in 56 patients (15.9%). Their length of stay was 3 days longer compared with those without prolonged air leak (8.3 vs 5.4, P validated the European Society of Thoracic Surgeons prolonged air leak risk score for video-assisted thoracoscopic lobectomies, which appears useful in selecting those patients in whom the application of additional intraoperative interventions to avoid prolonged air leak may be more cost-effective. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  17. Abscess of residual lobe after pulmonary resection for lung cancer.

    Science.gov (United States)

    Ligabue, Tommaso; Voltolini, Luca; Ghiribelli, Claudia; Luzzi, Luca; Rapicetta, Cristian; Gotti, Giuseppe

    2008-04-01

    Abscess of the residual lobe after lobectomy is a rare but potentially lethal complication. Between January 1975 and December 2006, 1,460 patients underwent elective pulmonary lobectomy for non-small-cell lung cancer at our institution. Abscess of the residual lung parenchyma occurred in 5 (0.3%) cases (4 bilobectomies and 1 lobectomy). Postoperative chest radiography showed incomplete expansion and consolidation of residual lung parenchyma. Flexible bronchoscopy revealed persistent bronchial occlusion from purulent secretions and/or bronchial collapse. Computed tomography in 3 patients demonstrated lung abscess foci. Surgical treatment included completion right pneumonectomy in 3 patients and a middle lobectomy in one. Complications after repeat thoracotomy comprised contralateral pneumonia and sepsis in 1 patient. Residual lobar abscess after lobectomy should be suspected in patients presenting with fever, leukocytosis, bronchial obstruction and lung consolidation despite antibiotic therapy, physiotherapy and bronchoscopy. Computed tomography is mandatory for early diagnosis. Surgical resection of the affected lobe is recommended.

  18. Oxidative lung injury correlates with one-lung ventilation time during pulmonary lobectomy: a study of exhaled breath condensate and blood.

    Science.gov (United States)

    García-de-la-Asunción, José; García-del-Olmo, Eva; Perez-Griera, Jaume; Martí, Francisco; Galan, Genaro; Morcillo, Alfonso; Wins, Richard; Guijarro, Ricardo; Arnau, Antonio; Sarriá, Benjamín; García-Raimundo, Miguel; Belda, Javier

    2015-09-01

    During lung lobectomy, the operated lung is collapsed and hypoperfused; oxygen deprivation is accompanied by reactive hypoxic pulmonary vasoconstriction. After lung lobectomy, ischaemia present in the collapsed state is followed by expansion-reperfusion and lung injury attributed to the production of reactive oxygen species. The primary objective of this study was to investigate the time course of several markers of oxidative stress simultaneously in exhaled breath condensate and blood and to determine the relationship between oxidative stress and one-lung ventilation time in patients undergoing lung lobectomy. This single-centre, observational, prospective study included 28 patients with non-small-cell lung cancer who underwent lung lobectomy. We measured the levels of hydrogen peroxide, 8-iso-PGF2α, nitrites plus nitrates and pH in exhaled breath condensate (n = 25). The levels of 8-iso-PGF2α and nitrites plus nitrates were also measured in blood (n = 28). Blood samples and exhaled breath condensate samples were collected from all patients at five time points: preoperatively; during one-lung ventilation, immediately before resuming two-lung ventilation; immediately after resuming two-lung ventilation; 60 min after resuming two-lung ventilation and 180 min after resuming two-lung ventilation. Both exhaled breath condensate and blood exhibited significant and simultaneous increases in oxidative-stress markers immediately before two-lung ventilation was resumed. However, all these values underwent larger increases immediately after resuming two-lung ventilation. In both exhaled breath condensate and blood, marker levels significantly and directly correlated with the duration of one-lung ventilation immediately before resuming two-lung ventilation and immediately after resuming two-lung ventilation. Although pH significantly decreased in exhaled breath condensate immediately after resuming two-lung ventilation, these pH values were inversely correlated with the

  19. Intraoperative air leak measured after lobectomy is associated with postoperative duration of air leak.

    Science.gov (United States)

    Brunelli, Alessandro; Salati, Michele; Pompili, Cecilia; Gentili, Paolo; Sabbatini, Armando

    2017-11-01

    To verify the association between the air leak objectively measured intraoperatively (IAL) using the ventilator and the air leak duration after pulmonary lobectomy. Prospective analysis on 111 patients submitted to pulmonary lobectomy (33 by video-assisted thoracic surgery). After resection, objective assessment of air leak (in milliliter per minute) was performed before closure of the chest by measuring the difference between a fixed inspired and expired volume, using a tidal volume of 8 ml/kg, a respiratory rate of 10 and a positive-end expiratory pressure of 5 cmH2O. A multivariable analysis was performed for identifying factors associated with duration of postoperative air leak. Average IAL was 158 ml/min (range 0-1500 ml/min). The best cut-off (receiver-operating characteristics analysis) associated with air leak longer than 5 days was 500 ml/min. Nine patients had IAL >500 ml/min (8%). They had a longer duration of postoperative air leak compared with those with a lower IAL (mean values, 10.1 days, SD 8.8 vs 1.5 days, SD 4.9 P leak duration after multivariable regression: left side resection (P = 0.018), upper site resection (P = 0.031) and IAL >500 ml/min (P leak duration was generated: 1.7 + 2.4 × left side + 2.2 × upper site + 8.8 × IAL >500. The air leak measurement using the ventilator parameters after lung resection may assist in estimating the risk of postoperative prolonged air leak. An IAL > 500 ml/min may warrant the use of intraoperative preventative measures, particularly after video-assisted thoracic surgery lobectomy where a submersion test is often unreliable. © 2017 European Society of Cardiology and European Atherosclerosis Association. All rights reserved. For permissions please email: journals.permissions@oup.com.

  20. THE IMPACT OF VAT ON THE ECONOMY IN RELATION TO OTHER TAXES IN SOUTH EAST EUROPE

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    Petre BREZEANU

    2018-06-01

    Full Text Available Through this article, we aim to create a multifactorial model of linear regression by which we discover the impact of the most important taxes in an economy in the economies of the countries of Southeastern Europe. We have selected South East Europe to include and Romania in the empirical analysis. So for building the model, we considered it opportune to choose the following independent variables: VAT, Excise, Income Tax. The economy as a whole was considered to be well defined by the Gross Domestic Product it produces, which is why GDP has been selected as a variable. The chosen period spans a sample of 20 years. In conclusion, this study will try to highlight how fiscal pillars, such as VAT, ACIs and income taxes, affect the GDP. In the light of the results obtained, we will try to interpret the coefficients obtained through a fiscal policy that is dominant or not at this level.

  1. Non-verbal auditory cognition in patients with temporal epilepsy before and after anterior temporal lobectomy

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    Aurélie Bidet-Caulet

    2009-11-01

    Full Text Available For patients with pharmaco-resistant temporal epilepsy, unilateral anterior temporal lobectomy (ATL - i.e. the surgical resection of the hippocampus, the amygdala, the temporal pole and the most anterior part of the temporal gyri - is an efficient treatment. There is growing evidence that anterior regions of the temporal lobe are involved in the integration and short-term memorization of object-related sound properties. However, non-verbal auditory processing in patients with temporal lobe epilepsy (TLE has raised little attention. To assess non-verbal auditory cognition in patients with temporal epilepsy both before and after unilateral ATL, we developed a set of non-verbal auditory tests, including environmental sounds. We could evaluate auditory semantic identification, acoustic and object-related short-term memory, and sound extraction from a sound mixture. The performances of 26 TLE patients before and/or after ATL were compared to those of 18 healthy subjects. Patients before and after ATL were found to present with similar deficits in pitch retention, and in identification and short-term memorisation of environmental sounds, whereas not being impaired in basic acoustic processing compared to healthy subjects. It is most likely that the deficits observed before and after ATL are related to epileptic neuropathological processes. Therefore, in patients with drug-resistant TLE, ATL seems to significantly improve seizure control without producing additional auditory deficits.

  2. Weighing the value of memory loss in the surgical evaluation of left temporal lobe epilepsy: a decision analysis.

    Science.gov (United States)

    Akama-Garren, Elliot H; Bianchi, Matt T; Leveroni, Catherine; Cole, Andrew J; Cash, Sydney S; Westover, M Brandon

    2014-11-01

    Anterior temporal lobectomy is curative for many patients with disabling medically refractory temporal lobe epilepsy, but carries an inherent risk of disabling verbal memory loss. Although accurate prediction of iatrogenic memory loss is becoming increasingly possible, it remains unclear how much weight such predictions should have in surgical decision making. Here we aim to create a framework that facilitates a systematic and integrated assessment of the relative risks and benefits of surgery versus medical management for patients with left temporal lobe epilepsy. We constructed a Markov decision model to evaluate the probabilistic outcomes and associated health utilities associated with choosing to undergo a left anterior temporal lobectomy versus continuing with medical management for patients with medically refractory left temporal lobe epilepsy. Three base-cases were considered, representing a spectrum of surgical candidates encountered in practice, with varying degrees of epilepsy-related disability and potential for decreased quality of life in response to post-surgical verbal memory deficits. For patients with moderately severe seizures and moderate risk of verbal memory loss, medical management was the preferred decision, with increased quality-adjusted life expectancy. However, the preferred choice was sensitive to clinically meaningful changes in several parameters, including quality of life impact of verbal memory decline, quality of life with seizures, mortality rate with medical management, probability of remission following surgery, and probability of remission with medical management. Our decision model suggests that for patients with left temporal lobe epilepsy, quantitative assessment of risk and benefit should guide recommendation of therapy. In particular, risk for and potential impact of verbal memory decline should be carefully weighed against the degree of disability conferred by continued seizures on a patient-by-patient basis. Wiley

  3. Three dimensional computed tomography lung modeling is useful in simulation and navigation of lung cancer surgery.

    Science.gov (United States)

    Ikeda, Norihiko; Yoshimura, Akinobu; Hagiwara, Masaru; Akata, Soichi; Saji, Hisashi

    2013-01-01

    The number of minimally invasive operations, such as video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy, has enormously increased in recent years. These operations require extreme knowledge of the anatomy of pulmonary vessels and bronchi in each patient, and surgeons must carefully dissect the branches of pulmonary vessels during operation. Thus, foreknowledge of the anatomy of each patient would greatly contribute to the safety and accuracy of the operation. The development of multi-detector computed tomography (MDCT) has promoted three dimensional (3D) images of lung structures. It is possible to see the vascular and bronchial structures from the view of the operator; therefore, it is employed for preoperative simulation as well as navigation during operation. Due to advances in software, even small vessels can be accurately imaged, which is useful in performing segmentectomy. Surgical simulation and navigation systems based on high quality 3D lung modeling, including vascular and bronchial structures, can be used routinely to enhance the safety operation, education of junior staff, as well as providing a greater sense of security to the operators.

  4. Video-assisted thoracoscopic left lower lobectomy in a patient with lung cancer and a right aortic arch

    Directory of Open Access Journals (Sweden)

    Wada Hideyuki

    2012-11-01

    Full Text Available Abstract A right aortic arch is a rare congenital anomaly, with a reported incidence of around 0.1%. A patient with a right aortic arch underwent video-assisted thoracic surgery left lower lobectomy and mediastinal lymph node dissection for squamous cell carcinoma. There was no aortic arch or descending aorta in the left thoracic cavity, but the esophagus. There was no anomaly in the location or branching of the pulmonary vessels, the bronchi, and the lobulation of the lungs. The vagus nerve was found at the level of the left pulmonary artery. The arterial ligament was found between the left subclavian artery and the left pulmonary artery. The recurrent laryngeal nerve was recurrent around the left subclavian artery. A Kommerell diverticulum was found at the origin of the left subclavian artery. The patient experienced no complications. We conclude that video-assisted thoracoscopic lobectomy with mediastinal dissection is feasible for treating lung cancer with a right aortic arch.

  5. Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

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    Yuetian Yu

    2017-01-01

    Full Text Available Objective. To investigate whether high-flow nasal cannula (HFNC oxygen therapy is superior to conventional oxygen therapy for reducing hypoxemia and postoperative pulmonary complications (PPC in patients with thoracoscopic lobectomy after extubation. Methods. Patients with intermediate to high risk for PPC were enrolled in this study. Subjects were randomly assigned to HFNC group (HFNCG or conventional oxygen group (COG following extubation. Arterial blood samples were collected after extubation at 1, 2, 6, 12, 24, 48, and 72 h. Patients with postoperative hypoxemia and PPC were recorded. Adverse events were also documented. Results. Totally 110 patients were randomly assigned to HFNCG (n=56 and COG (n=54. The occurrence rate of hypoxemia in COG was twice more than that in HFNCG (29.62% versus 12.51%, P0.05. Adverse effects as throat and nasal pain occurred more frequently in COG. Conclusions. HFNC application improves oxygenation and reduces the risk of reintubation following thoracoscopic lobectomy but cannot decrease the incidence of PPC.

  6. Prolonged air leak following lobectomy can be predicted in lung cancer patients.

    Science.gov (United States)

    Okada, Satoru; Shimada, Junichi; Kato, Daishiro; Tsunezuka, Hiroaki; Inoue, Masayoshi

    2017-08-01

    The purpose of this study was to identify the factors associated with prolonged air leak (PAL) following pulmonary lobectomy for lung cancer. The data of 146 patients who underwent pulmonary lobectomy for lung cancer between August 2010 and July 2015 were retrospectively reviewed. Air leaks were assessed daily by a visual evaluation and were categorized as follows: forced expiratory only (Grade 1), expiratory only (Grade 2), or continuous (Grade 3). Logistic regression analyses were performed to identify the predictors of PAL (>5 days). PAL occurred in 23 patients (16%). An air leak at rest (Grade ≥ 2) was detected on postoperative day (POD) 1 in 48% of the patients with PAL and 7% of the patients without PAL. A univariate analysis demonstrated that PAL was significantly associated with male sex, a smoking history of ≥ 40 pack years, a serum albumin level of ≤4.0 mg/dL, and an air leak on POD1 (Grade ≥ 2). A multivariate analysis demonstrated that a serum albumin level of ≤4.0 mg/dL (p = 0.027) and an air leak on POD1 (p = 0.006) were independent predictors of PAL. PAL occurred in 75% of the patients with these two risk factors. The preoperative serum albumin level and the presence of a visually evaluated air leak on POD1 may be useful indicators for the perioperative management of air leaks.

  7. Analysis of Potential Impacts of Inclusion of Locally Supplied Services into Reduced VAT Rate on the Suppliers of these Services

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    Kateřina Randová

    2010-09-01

    Full Text Available Member States of the European Union are in accordance with the Community law allowed to include locally supplied services into reduced value added tax rates (hereinafter referred to as “VAT rates” without time restriction. In the Czech Republic there has not yet been a sufficient political will to implement this possibility into the legislation. The purpose of this paper is to analyse the potential impact of the relevant Directive implementation into the Czech VAT Act on the tax liability of the suppliers of these services. The paper is based on the comparison of the national legislation and the Community law, and their analysis. Moreover, the deductive method is used in this paper.

  8. External Suction and Fluid Output in Chest Drains After Lobectomy

    DEFF Research Database (Denmark)

    Lijkendijk, Marike; Neckelmann, Kirsten; Licht, Peter B

    2018-01-01

    influences the amount of fluid. METHODS: We randomly assigned (1:1) 106 patients who underwent lobectomy to either low (-5 cm H2O) or high (-20 cm H2O) external suction using an electronic chest drainage system. Only one chest drain was allowed, and we used strict algorithms for chest drain removal, which...... was delegated to staff nurses: air leakage less than 20 mL/min for 6 hours regardless of fluid output, provided it was serous. The primary end point was fluid output after 24 and 48 hours. RESULTS: Mean fluid output was significantly higher with high suction after both 24 (338 ± 265 mL versus 523 ± 215 m...

  9. Effects of dual pathology on cognitive outcome following left anterior temporal lobectomy for treatment of epilepsy.

    Science.gov (United States)

    Prayson, B E; Prayson, R A; Kubu, C S; Bingaman, W; Najm, I M; Busch, R M

    2013-09-01

    The objective of this retrospective study was to determine if dual pathology [DUAL - focal cortical dysplasia (FCD) and mesial temporal sclerosis (MTS)] in patients with left temporal lobe epilepsy is associated with greater risk for cognitive decline following temporal lobectomy than single pathology (MTS only). Sixty-three adults (Mage=36.5years, female: 52.4%) who underwent left anterior temporal lobectomy for treatment of epilepsy (MTS=28; DUAL=35) completed preoperative and postoperative neuropsychological evaluations. The base rate of dual pathology was 55.5%. Repeated measures ANOVAs yielded significant 2-way interactions (group×time) on most measures of language and memory with generally moderate effect sizes. Specifically, patients with MTS only demonstrated postoperative declines, while those with dual pathology remained unchanged or improved. Results suggest that dual pathology may be associated with better cognitive outcome following epilepsy surgery than MTS alone, possibly reflecting limited functionality of the resected tissue or intrahemispheric reorganization of function in the context of a developmental lesion. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Major Lung Resections Using Manual Suturing Versus Staplers During Fiscal Crisis.

    Science.gov (United States)

    Potaris, Konstantinos; Kapetanakis, Emmanuil; Papamichail, Konstantinos; Midvighi, Elena; Verveniotis, Alexis; Parissis, Fotios; Apostolou, Demetrios; Tziortziotis, Vaios; Maimani, Spiridoula; Pouliara, Evangelia; Vogiatzis, Gregorios; Kakaris, Stamatis; Konstantinou, Marios

    2015-07-27

    AbstractObjective: During fiscal crisis there was a period of shortage of staplers in our hospital, which drove us to manual suturing of bronchi and pulmonary vessels during major lung resections. We present our experience during that period in comparison to a subsequent period when staplers became available again. A total of 256 lobectomies and 78 pneumonectomies were performed using manual suturing (group A), between September 2009 and September 2010, and compared regarding surgical outcome to 248 lobectomies and 60 pneumonectomies using staplers (group B), between September 2011 and September 2012. Although we did not observe statistically significant differences but only a trend towards less operative time, for both lobectomies (p=0.21) and pneumonectomies (p=0.31), we actually noted a 41 and 47 minutes saving of operative time using staplers (group B), in comparison to manual suturing (group A). We also observed a trend towards less morbidity rates in patients of group B, who underwent lobectomy (10.48%), and pneumonectomy (20%), versus patients of group A, who underwent lobectomy (15.62%), and pneumonectomy (30.76%); we did not observe any substantial differences in the other surgical outcome variables, and in patients' demographics comorbidities, and anatomic allocation of surgical procedures performed. The use of staplers offers safety with secure bronchial or vascular sealing, and saving of operative time. Their unavailability at an interval during fiscal crisis although it did not affect surgical outcome, revealed their usefulness and value.

  11. Long-term Survival of Personalized Surgical Treatment of Locally Advanced Non-small Cell Lung Cancer Based on Molecular Staging

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    Qinghua ZHOU

    2011-02-01

    Full Text Available Background and objective Approximately 35%-40% of patients with newly diagnosed non-small cell Lung cancer have locally advanced disease. The average survival time of these patients only have 6-8 months with chemotherapy. The aim of this study is to explore and summarize the probability of detection of micrometastasis in peripheral blood for molecular staging, and for selection of indication of surgical treatment, and beneficiary of neoadjuvant chemotherapy and postoperative adjuvant therapy in locally advanced lung cancer; to summarize the long-time survival result of personalized surgical treatment of 516 patients with locally advanced non-small cell lung cancer based on molecular staging methods. Methods CK19 mRNA expression of peripheral blood samples was detected in 516 lung cancer patients by RT-PCR before operation for molecular diagnosis of micrometastasis, personalized molecular staging, and for selection of indication of surgical treatment and the beneficiary of neoadjuvant chemotherapy and postoperative adjuvant therapy in patients with locally advanced nonsmall cell lung cancer invaded heart, great vessels or both. The long-term survival result of personalized surgical treatment was retrospectively analyzed in 516 patients with locally advanced non-small cell lung cancer based on molecular staging methods. Results There were 322 patients with squamous cell carcinoma and 194 cases with adenocarcinoma in the series of 516 patients with locally advanced lung cancer involved heart, great vessels or both. There were 112 patients with IIIA disease and 404 cases with IIIB disease according to P-TNM staging. There were 97 patients with M-IIIA disease, 278 cases with M-IIIB disease and 141 cases with III disease according to our personalized molecular staging. Of the 516 patients, bronchoplastic procedures and pulmonary artery reconstruction was carried out in 256 cases; lobectomy combined with resection and reconstruction of partial left

  12. Clinical Significance of Diffuse {sup 18F} FDG Uptake in Residual Thyroid Gland after Unilateral Thyroid Lobectomy

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    Song, Hee Sung; Lee, Su Jin; Yoon, Seok Ho; Lee, Jandee; Soh, Euy Young; An, Young Sil; Yoon, Joon Kee [Ajou Univ. School of Medicine, Suwon (Korea, Republic of)

    2011-09-15

    We investigated the clinical significance of diffuse uptake in remaining thyroid after unilateral lobectomy for thyroid cancer. A total of 144 thyroid cancer patients who underwent {sup 18F} FDG PET/CT after lobectomy were evaluated for the presence of diffuse {sup 18F} FDG uptake with maximum SUV (SUVmax)>2.0 in the residual thyroid and placed into one of two groups: with diffuse uptake and without diffuse uptake group. Clinical, laboratory, and PET/CT parameters in both groups were compared. Correlations between SUVmax of thyroid and available parameters were analyzed. Forty two of 144 patients (29.2%) had diffuse thyroid uptake (mean SUVmax: 3.2{+-}1.1). All patients with diffuse uptake and 96 (94.1%) without diffuse uptake were receiving thyroxine therapy (P=0.09). Thyroid function tests showed that most patients were euthyroid status (78.6 vs. 85.3%, P=0.36). TgAb levels were significantly higher in patients with diffuse uptake (338.0{+-}664.6 vs. 57.3{+-}46.4, P<0.0001). Mean attenuation values in the diffuse uptake group were significantly lower (72.2{+-}15. vs. 97.0{+-}16.0, P<0.0001). An inverse correlation was found between SUVmax and mean attenuation values of residual thyroid in all patients (r=-0.57, P<0.0001) and subgroup with diffuse uptake (r=-0.31, P<0.05). In this study, diffuse {sup 18F} FDG uptake in the residual thyroid after unilateral lobectomy was a relatively frequent finding and may be associated with chronic thyroiditis. This uptake is not influenced by thyroid status or thyroxine therapy. The {sup 18F} FDG uptake is inversely correlated with mean attenuation value of thyroid.

  13. VAT TAXATION OF INTRA-COMMUNITY SUPPLIES AND ACQUISITIONS OF SERVICES

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    Antonescu Ligia

    2010-12-01

    Full Text Available As of January 1st, 2010, as a result of the transposition in the national legislation of the Council Directive 2008/8/CE of 12.02.2008 for the amendment of the Directive 2006/112/CE regarding the place of the supply of services, new notions of tax law have arisen, namely intra-community acquisitions of services and intra-community supply of services. The transposition in the national legislation of the new CE directives in the field of the VAT aims not only at the way the place of the supply of services is determined, but also at the changes regarding the person subject to taxation, tax registration, declarative obligations, etc.

  14. Postoperative thoracic hemorrhage after right upper lobectomy with thoracic wall resection during rivaroxaban anticoagulant therapy for deep leg vein thrombosis: A case report

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    Taiji Kuwata

    Full Text Available Introduction: Postoperative pulmonary embolism (PE is the one of the most important complications after thoracic surgery. This complicatin after the surgery is often treated by new anticoaglant drug, such as rivaroxaban, which dose not need to the monitoring of blood coaglation system. We experienced postoperative bleeding case during anticoaglant therapy using rivaroxaban. Presentation of case: The patient underwent a right upper lobectomy with lung and chest wall resection for lung cancer. On postoperative day (POD 10, we started to use rivaroxaban to treat the deep vein thrombosis (DVT. Four days after starting the rivaroxaban treatment, severe surgical site hemorrhage occurred, which led to the need for the infusion of concentrated red cells (CRC. After stopping the rivaroxaban, the thoracic bleeding ceased. Because the event occurred so long after the surgery, and because the bleeding stopped after withdrawal of treatment, we believe that rivaroxaban induced the thoracic bleeding. Conclusion: Some reports in the field of orthopedics (Turpie et al., 2009 have noted that rivarxaban is effective to prevent postoperative DVT. However, there were few reports that invied the attention to postoperative bleeding be induced by rivarxaban. Thus, we describe this case in order to alert clinicians to the potential bleeding risks associated with the admistration of rivaroxaban postoperatively. Keywords: Revaroxaban, Anticoagulant, Surgical site bleeding

  15. Anatomic pulmonary resection by video-assisted thoracoscopy: the Brazilian experience (VATS Brazil study

    Directory of Open Access Journals (Sweden)

    Ricardo Mingarini Terra

    Full Text Available ABSTRACT Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6. However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5% were male. The majority-521 (89.8%-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2% were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%. Postoperative complications occurred in 124 patients (19.1%, the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries.

  16. The Distinction between Direct and General Costs with Regard to the Deduction of Input VAT - The Case of Acquisition, Holding and Sale of Shares

    DEFF Research Database (Denmark)

    Jensen, Dennis Ramsdahl; Stensgaard, Henrik

    2012-01-01

    of distinguishing between direct and general costs. On the other hand the aim is to describe and analyse the law as it stands regarding the treatment of shares in the EU VAT system, with a special focus on the right to deduct input VAT on costs re-lating to transactions in shares. As a part of this analysis the aim......In revealing the conditions for the deduction of input VAT, the essential questions concern the nature of the so-called ‘direct and immediate link’ test and thus also the criteria for the important distinction between direct costs and general costs. The ‘direct and immediate link’ test...... is of general importance to all types of costs, but judged from the case law of the ECJ it has especially materialised itself when it comes to costs related to the acquisition, holding or sales of shares. The purpose of this article is therefore twofold. On the one hand it deals with the difficult question...

  17. Surgical options in benign parotid tumors: a proposal for classification.

    Science.gov (United States)

    Quer, Miquel; Vander Poorten, Vincent; Takes, Robert P; Silver, Carl E; Boedeker, Carsten C; de Bree, Remco; Rinaldo, Alessandra; Sanabria, Alvaro; Shaha, Ashok R; Pujol, Albert; Zbären, Peter; Ferlito, Alfio

    2017-11-01

    Different surgical options are currently available for treating benign tumors of the parotid gland, and the discussion on optimal treatment continues despite several meta-analyses. These options include more limited resections (extracapsular dissection, partial lateral parotidectomy) versus more extensive and traditional options (lateral parotid lobectomy, total parotidectomy). Different schools favor one option or another based on their experience, skills and tradition. This review provides a critical analysis of the literature regarding these options. The main limitation of all the studies is the bias of selection for different surgical approaches. For this reason, we propose a staging system that could facilitate clinical decision making and the comparison of results. We propose four categories based on the size of the tumor and its location within the parotid gland. Category I includes tumors up to 3 cm, which are mobile, close to the outer surface and close to the parotid borders. Category II includes deeper tumors up to 3 cm. Category III comprises tumors greater than 3 cm involving two levels of the parotid gland, and category IV tumors are greater than 3 cm and involve more than 2 levels. For each category and for the various pathologic types, a guideline of surgical extent is proposed. The objective of this classification is to facilitate prospective multicentric studies on surgical techniques in the treatment of benign parotid tumors and to enable the comparison of results of different clinical studies.

  18. VAT regime affecting the acquisition of electronic information sources in Slovenia and in the European Union

    Directory of Open Access Journals (Sweden)

    Tilen Mandelj

    2010-01-01

    Full Text Available Tax legislation system in the Republic of Slovenia as well as that of the European Union does not keep pace with the rapid technological development. A lot of problems arise in the field of purchasing and providing access to electronic information sources, namely electronic journals which are very important to disseminate research results. Problems arising from the application of the EC Directive 2006/112 in the Slovenian legislation system are described. The goal that the Value Added Tax (VAT would not affect the international competitiveness of the EU Member states was not met. Different levels of general and reduced tax rates and even different levels of taxation of electronic information sources put Member States in unequal positions. Tax regimes in Member States and their responses to the problem of VAT are discussed. The article shows the complexity of electronic information sources which can partly be taxed as services and party as goods in electronic form. A simulation of expenditure on electronic information sources at different tax rates and possible changes of tax legislation are presented.

  19. High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jensen, Per F; Bigler, Dennis R

    2018-01-01

    equally to 125 mg MP or placebo before the start of their elective video-assisted thoracoscopic surgery lobectomy. Group allocation was blinded to patients, investigators and caregivers, and all patients received standardized multimodal, opioid-sparing analgesia. Our primary outcome was area under...... the curve on a numeric rating scale from 0 to 10, for pain scores on the day of surgery and on postoperative days 1 and 2. Clinical follow-up was 2-3 weeks, and telephone follow-up was 12 weeks after surgery. RESULTS: Ninety-six patients were included in the primary analysis. Methylprednisolone...... significantly reduced pain at rest and after mobilization to a sitting position on the day of surgery, without later analgesic effects. Nausea and fatigue were improved without side effects, except transient higher postoperative blood glucose levels. CLINICAL TRIAL REGISTRATION: Registered...

  20. The learning curve of the three-port two-instrument complete thoracoscopic lobectomy for lung cancer—A feasible technique worthy of popularization

    Directory of Open Access Journals (Sweden)

    Yu-Jen Cheng

    2015-07-01

    Conclusion: Three-port complete thoracoscopic lobectomy with the two-instrument technique is feasible for lung cancer treatment. The length of the learning curve consisted of 28 cases. This TPTI technique should be popularized.

  1. The effect of gender on health-related quality of life and related factors in post-lobectomy lung-cancer patients.

    Science.gov (United States)

    Chang, Nai-Wen; Lin, Kuan-Chia; Hsu, Wen-Hu; Lee, Shih-Chun; Chan, James Yi-Hsin; Wang, Kwua-Yun

    2015-06-01

    While studies have documented gender differences by histologic type among lung cancer patients, the effect of these differences on the health-related quality of life (HRQoL) of post-lobectomy lungcancer patients and related factors remain uncertain. This study examines gender-specific HRQoL and related factors in post-lobectomy lung-cancer patients. A cross-sectional study design was applied. A convenience sample of 231 post-lobectomy lungcancer patients was recruited from the thoracic surgery outpatient departments of two teaching hospitals in Taipei, Taiwan from March to December 2012. Patients performed a spirometry test and completed instruments that included a Beck Depression Inventory-II, an Interpersonal Support Evaluation List, and the symptom and function scales of the Quality of Life Questionnaire. Data analysis used descriptive statistics, including mean and standard deviations, frequency, and percentage values. Independent-sample Student's t-tests and multivariate analyses were used for comparative purposes. This study confirmed a significant gender effect on HRQoL and HRQoL-related factors such as marital status, religious affiliation, smoking status, histologic type, symptoms, pulmonary function, depression, and family support. Moreover, multivariate analysis found gender to be a significant determinant of the HRQoL aspects of physical functioning, emotional functioning, and cognitive functioning. Finally, results indicated that factors other than gender were also significant determinants of HRQoL. Gender impacts the HRQoL and related factors of postoperative lung-cancer patients. Therefore, gender should be considered in assessing and addressing the individual care needs of these patients in order to attain optimal treatment outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. A segmentectomy of the right upper lobe has an advantage over a right upper lobectomy regarding the preservation of the functional volume of the right middle lobe. Analysis by perfusion single-photon emission computed tomography/computed tomography

    International Nuclear Information System (INIS)

    Yoshimoto, Kentaro; Nomori, Hiroaki; Mori, Takeshi; Ohba, Yasuomi; Shibata, Hidekatsu; Tashiro, Kuniyuki; Shiraishi, Shinya; Kobayashi, Toshiaki

    2010-01-01

    To evaluate the advantages of a segmentectomy of the right upper lobe (RUL) over a right upper (RU) lobectomy regarding the preservation of the functional volume of the right middle lobe (RML), the postoperative forced expiratory volume in one second (FEV 1 ) of the RML was compared between an RU lobectomy and an RUL segmentectomy, by using a coregistered perfusion single-photon emission computed tomography and computed tomography (SPECT/CT). The pulmonary function tests and perfusion SPECT/CT were conducted before and after surgery (RU lobectomy: 7; RUL segmentectomy: 13). The FEV 1 of the RML before and after surgery was calculated from the data of the pulmonary function test and SPECT/CT. In the RU lobectomy group, the percentage change of FEV 1 was 71%±12%, which was significantly lower in comparison to 92%±9% in the RUL segmentectomy group (P=0.001). In the lobectomy group, the preoperative FEV 1 of the RML was 0.17±0.101 which decreased significantly to 0.06±0.061 after surgery (P=0.009). In the segmentectomy group, FEV 1 of the RML before and after the surgery were 0.23±0.101 and 0.20±0.111, of which the difference was not significant. An RUL segmentectomy has an advantage over an RU lobectomy regarding the preservation of pulmonary function, due to a greater preservation of not only the lung tissue, but also the FEV 1 of the RML. (author)

  3. Positive correlation between postoperative tumor recurrence and changes in circulating tumor cell counts in pulmonary venous blood (pvCTC) during surgical manipulation in non-small cell lung cancer.

    Science.gov (United States)

    Hashimoto, Masaki; Tanaka, Fumihiro; Yoneda, Kazue; Takuwa, Teruhisa; Matsumoto, Seiji; Okumura, Yoshitomo; Kondo, Nobuyuki; Tsujimura, Tohru; Nakano, Takashi; Hasegawa, Seiki

    2018-01-01

    In non-small cell lung cancer (NSCLC), circulating tumor cells (CTC) are shed and circulate to the peripheral blood through the pulmonary vein. Previously, CTC count in pulmonary venous blood (pvCTC) was shown to significantly increase after surgical manipulation. Therefore, we assessed the correlation between the changes in the pvCTC count (ΔpvCTC) and clinical outcomes. Consecutive patients with peripheral-type, NSCLC, who underwent lobectomy or bi-lobectomy through open thoracotomy, were enrolled prospectively. Before and after lobectomy, 2.5 mL of blood was drawn from the associated lobar pulmonary vein (PV), and was served for the quantitative evaluation of CTC using the CellSearch ® system. The cut-off point of ΔpvCTC was determined according to clinical outcomes and ΔpvCTC using receiver operation characteristic (ROC) curve. Then the correlation between ΔpvCTC and clinical outcomes was evaluated by Kaplan-Meier analyses and log-rank test. In addition, the correlation between ΔpvCTC and perioperative variables was assessed. A total of 30 patients were enrolled, tumor recurrence occurred in 11 patients over a median follow-up of 64.4 months. Of these, 7 patients had distant metastasis and 4 had local recurrence. The median ΔpvCTC was 49 cells/2.5 mL, and pvCTC-count was increased during surgical manipulation in 24 patients (80%). We divided patients into two groups based on ΔpvCTC with the cut-off value as 119 cells/2.5 mL according to ROC curve. Significant shorter time to distant metastasis (TDM) (P=0.0123) was observed in high ΔpvCTC group (ΔpvCTC ≥119 cells/2.5 mL) than low ΔpvCTC group (ΔpvCTC <119 cells/ 2.5mL). Neither disease-free survival (DFS) nor overall survival (OS) was significantly correlated with ΔpvCTC. Increasing pvCTC count during surgical manipulation was significantly correlated with postoperative distant metastasis in completely resected NSCLC patients. Significant shorter TDM was observed in patient with high ΔpvCTC group.

  4. Thorascopic resection of an apical paraspinal schwannoma using the da Vinci surgical system.

    Science.gov (United States)

    Finley, David; Sherman, Jonathan H; Avila, Edward; Bilsky, Mark

    2014-01-01

    Posterior mediastinal neurogenic tumors have traditionally been resected via an open posterolateral thoracotomy. Video-assisted thorascopic surgery has emerged as an alternative technique allowing for improved morbidity with decreased blood loss, less postoperative pain, and a shorter recovery period, among others. The da Vinci surgical system, as first described for urologic procedures, has recently been reported for lung lobectomy. This technique provides the advantages of instrumentation with 6 degrees of freedom, stable operating arms, and improved visualization with the three-dimensional high-definition camera. We describe the technique for thorascopic resection of an apical paraspinal schwannoma of the T1 nerve root with the da Vinci surgical system. This technique used a specialized intraoperative neuromonitoring probe for free-running electromyography (EMG) and triggered EMG. We demonstrate successful resection of a posterior paraspinal schwannoma with the da Vinci surgical system while preserving neurologic function. The patient displayed stable intraoperative monitoring of the T1 nerve root and full intrinsic hand strength postoperatively. The technique described in this article introduces robotic system accuracy and precludes the need for an open thoracotomy. In addition, this approach demonstrates the ability of the da Vinci surgical system to safely dissect tumors from their neural attachments and is applicable to other such lesions of similar size and location. Georg Thieme Verlag KG Stuttgart · New York.

  5. Nonfunctioning parathyromatosis after endoscopic thyroid lobectomy via an axillo-breast approach: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jong Chun; Jeong, Young Ju [School of Medicine, Catholic University of Daegu, Daegu (Korea, Republic of)

    2015-04-15

    Parathyromatosis is characterized by multiple lesions of benign hyperfunctioning parathyroid tissue in the neck or mediastinum. Parathyromatosis is caused by proliferation of embryonic remnant or seeding of parathyroid tissue after parathyroidectomy. Parathyromatosis is rare but is the common cause of recurrent hyperparathyroidism. We describe a unique case of non-functional parathyromatosis in a 16-year-old girl with a history of right thyroid lobectomy via an axillo-breast approach for a nonfunctioning parathyroid adenoma in the right side of the neck.

  6. Is a sleeve lobectomy significantly better than a pneumonectomy?

    Science.gov (United States)

    Stallard, Joseph; Loberg, Anna; Dunning, Joel; Dark, John

    2010-11-01

    A best evidence topic was written according to a structured protocol. The question addressed was 'whether a sleeve lobectomy results in a better survival rate than a pneumonectomy in suitable patients?' Altogether, more than 327 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude in the biggest meta-analysis of nearly 3000 patients, the five-year survival was 50% for sleeve lobectomy compared to 30% for pneumonectomy. Operative mortality was 3% vs. 6% for pneumonectomy, and locoregional recurrence was 17% vs. 30%. These results are broadly consistent across all the 13 cohort studies presented here many of which document a 20-year single centre experience or more. There are significant issues in all cohort studies on this subject as, due to their non-randomized nature, the reason for not performing a sleeve resection may well have been more advanced disease, which would necessarily mean that the pneumonectomy patients would have a lower expected survival and higher local recurrence. In addition, there have been many large cohort studies to date and thus no more are required, as future studies are unlikely to resolve this issue. Thus, the only study that would adequately correct for this issue would be a randomized trial, but to prove a 10% increase in five-year survival a 300 patient study would be needed. This is bigger than any study ever done in this area and as some centres took 30 years to collect these numbers of potential sleeve patients an RCT is not a realistic possibility. Therefore, we conclude that no more cohort studies should be performed, as the results will be consistent with the meta-analyses and an RCT to eliminate their bias is unattainable, and thus no more research should be done on this topic and surgeons should use

  7. Robotic right middle lobectomy with a subxiphoid utility port.

    Science.gov (United States)

    Jayakumar, Shruti; Nardini, Marco; Papoulidis, Pavlos; Dunning, Joel

    2018-06-01

    We present the case of a 74-year-old man with Stage IIa pulmonary adenocarcinoma, for which he underwent a robotic right middle lobectomy. A 4-armed, 5-port approach was used. Four intercostal ports were created above the ninth rib using the Cerfolio's technique. The subxiphoid port was created in the midline, 5 cm down from the xiphisternum. The robot offers higher image quality, depth perception and improved articulation of the instruments, allowing for more accurate dissection and stitching. The usage of a subxiphoid utility port reduces the clashing between instruments, offers a good angle for stapling and provides a direct view of the instruments entering into the chest. Specimen removal through the subxiphoid port may reduce postoperative pain and enhance patient recovery. The use of the subxiphoid approach as a utility port for robotic surgery is promising and may be a suitable replacement for the traditional utility port.

  8. Insight into the bacterial diversity of fermentation woad dye vats as revealed by PCR-DGGE and pyrosequencing.

    Science.gov (United States)

    Milanović, Vesna; Osimani, Andrea; Taccari, Manuela; Garofalo, Cristiana; Butta, Alessandro; Clementi, Francesca; Aquilanti, Lucia

    2017-07-01

    The bacterial diversity in fermenting dye vats with woad (Isatis tinctoria L.) prepared and maintained in a functional state for approximately 12 months was examined using a combination of culture-dependent and -independent PCR-DGGE analyses and next-generation sequencing of 16S rRNA amplicons. An extremely complex ecosystem including taxa potentially contributing to both indigo reduction and formation, as well as indigo degradation was found. PCR-DGGE analyses revealed the presence of Paenibacillus lactis, Sporosarcina koreensis, Bacillus licheniformis, and Bacillus thermoamylovorans, while Bacillus thermolactis, Bacillus pumilus and Bacillus megaterium were also identified but with sequence identities lower than 97%. Dominant operational taxonomic units (OTUs) identified by pyrosequencing included Clostridium ultunense, Tissierella spp., Alcaligenes faecalis, Erysipelothrix spp., Enterococcus spp., Virgibacillus spp. and Virgibacillus panthothenicus, while sub-dominant OTUs included clostridia, alkaliphiles, halophiles, bacilli, moderately thermophilic bacteria, lactic acid bacteria, Enterobacteriaceae, aerobes, and even photosynthetic bacteria. Based on the current knowledge of indigo-reducing bacteria, it is considered that indigo-reducing bacteria constituted only a small fraction in the unique microcosm detected in the natural indigo dye vats.

  9. Grading of Emphysema Is Indispensable for Predicting Prolonged Air Leak After Lung Lobectomy.

    Science.gov (United States)

    Murakami, Junichi; Ueda, Kazuhiro; Tanaka, Toshiki; Kobayashi, Taiga; Hamano, Kimikazu

    2018-04-01

    The aim of this study was to assess the utility of quantitative computed tomography-based grading of emphysema for predicting prolonged air leak after thoracoscopic lobectomy. A consecutive series of 284 patients undergoing thoracoscopic lobectomy for lung cancer was retrospectively reviewed. Prolonged air leak was defined as air leaks lasting 7 days or longer. The grade of emphysema (emphysema index) was defined by the proportion of the emphysematous lung volume (less than -910 HU) to the total lung volume (-600 to -1,024 HU) by a computer-assisted histogram analysis of whole-lung computed tomography scans. The mean length of chest tube drainage was 1.5 days. Fifteen patients (5.3%) presented with prolonged air leak. According to a receiver-operating characteristics curve analysis, the emphysema index was the best predictor of prolonged air leak, with an area under the curve of 0.85 (95% confidence interval: 0.73 to 0.98). An emphysema index of 35% or greater was the best cutoff value for predicting prolonged air leak, with a negative predictive value of 0.99. The emphysema index was the only significant predictor for the length of postoperative chest tube drainage among conventional variables, including the pulmonary function and resected lobe, in both univariate and multivariate analyses. Prolonged air leak resulted in an increased duration of hospitalization (p leak that adversely influences early postoperative outcomes. We must take new measures against prolonged air leak in quantitative computed tomography-based high-risk patients. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. EMPYEMA THORACIS IN CHILDREN- EARLY SURGICAL TREATMENT IS BETTER

    Directory of Open Access Journals (Sweden)

    Shyam Bihari Sharma

    2016-11-01

    Full Text Available BACKGROUND Prolonged intercostal drainage for empyema thoracis in children is difficult to manage by parents at home and at the same time prolonged stay at hospital increases the financial burden on them. Hence, aim of this study is to get rid of intercostal drainage earliest by performing surgery thereby decreasing the morbidity and mortality. This is a prospective study done in infant and children below age of 12 at Paediatric Surgery Department, National Institute of Medical Science, Jaipur-Delhi Highway, Jaipur, from May 2012 to April 2016. Total number of cases in which surgical intervention done were 13 out which 2 required lobectomy whereas in 11 cases decortication and removing of peel was done. MATERIALS AND METHODS Out of all thirteen patients, the age ranging from 6 months to 10 years, a proforma was made and kept in OPD and ward filling with investigation, symptomatology, treatment and follow up. RESULTS Out of all 13 cases, lung expansion was complete and all are symptom free, follow up 3 years to 1 month was there. CONCLUSION Early surgical intervention of empyema thoracis is beneficial in children as prolonged intercostal drainage increase the misery of the patients as well as their parents.

  11. The usefulness of two-port video-assisted thoracosopic surgery in low-risk patients with secondary spontaneous pneumothorax compared with open thoracotomy.

    Science.gov (United States)

    Park, Kyoung Taek

    2014-01-01

    Secondary spontaneous pneumothorax is difficult to treat and has been thought to have high morbidity and mortality rate due to the underlying diseases and presence of comorbidities in the patients. However, early surgical intervention will be beneficial if it is tolerable by the patient. In the surgical approach for treating pneumothorax, video-assisted thoracoscopic surgery (VATS) may reduce the postoperative drainage period and hospital stay compared with open thoracotomy. A retrospective review of the clinical data of 40 patients with secondary spontaneous pneumothorax who underwent open thoracotomy (n = 20) or two-port VATS (n = 20) between January 2008 and December 2012 was performed. Postoperative drainage period of open thoracotomy group and two-port VATS group was 9.85 ± 5.28 and 6.75 ± 2.45, respectively, with a significant inter-group difference. Postoperative hospital stay was 11.8 ± 5.12 in the open thoracotomy group and 8.25 ± 2.88 in the two-port VATS group, with a significant inter-group difference. Recurrence rate and postoperative complication rate were not significant between the two groups. In selected patients with secondary spontaneous pneumothorax treated with surgical approach, two-port VATS resulted in shorter postoperative drainage period and hospital stay compared with open thoracotomy.

  12. Recovery from emotion recognition impairment after temporal lobectomy

    Directory of Open Access Journals (Sweden)

    Francesca eBenuzzi

    2014-06-01

    Full Text Available Mesial temporal lobe epilepsy (MTLE can be associated with emotion recognition impairment that can be particularly severe in patients with early onset seizures (1-3. Whereas there is growing evidence that memory and language can improve in seizure-free patients after anterior temporal lobectomy (ATL (4, the effects of surgery on emotional processing are still unknown. We used functional magnetic resonance imaging (fMRI to investigate short-term reorganization of networks engaged in facial emotion recognition in MTLE patients. Behavioral and fMRI data were collected from six patients before and after ATL. During the fMRI scan, patients were asked to make a gender decision on fearful and neutral faces. Behavioral data demonstrated that two patients with early-onset right MTLE were impaired in fear recognition while fMRI results showed they lacked specific activations for fearful faces. Post-ATL behavioral data showed improved emotion recognition ability, while fMRI demonstrated the recruitment of a functional network for fearful face processing. Our results suggest that ATL elicited brain plasticity mechanisms allowing behavioral and fMRI improvement in emotion recognition.

  13. VAT application in travel services pursuant to the Czech and EU legislations and a proposal for amendments in the Czech value-added tax law

    Directory of Open Access Journals (Sweden)

    Milena Otavová

    2010-01-01

    Full Text Available The domain of value-added tax has been already fully harmonized. Its regulation dwells on the Council Directive 2006/112/EC on the common system of value-added tax, and all member countries of the European Union are obliged to provide for the implementation of this Directive into their national legislations similarly as the Czech Republic, which entered the European Union on 1 May 2004. The Act no. 235/2004 Coll. on the value-added tax as amended (hereinafter „value-added tax law“ should be therefore in line with the Directive. In reality however, some issues in the VAT law have not been fully harmonized yet. One of these issues is for example the application of a special routine for travel services according to §89 of the VAT law, which is in essential contradiction with the Directive in question, the controversial point being definition of the person of customer whom the Directive understands in a different way than the VAT law. Thus, the characterization of the problem based on the Czech and EU legislations with respect to jurisdiction of the Court of Justice of the European Community forms a framework of the paper. Based on a comparative analysis of the application of special and ordinary routines in providing travel services to the customer by the taxpayer, tax incidence in his assessment base is determined. At the same time, the paper also includes a proposal for the change of the definition of customer in the VAT law so that the application of the given routine is fully in line with the EU Directive.

  14. Comparative study for surgical management of thymectomy for non-thymomatous myasthenia gravis from the French national database EPITHOR.

    Science.gov (United States)

    Orsini, Bastien; Santelmo, Nicola; Pages, Pierre Benoit; Baste, Jean Marc; Dahan, Marcel; Bernard, Alain; Thomas, Pascal Alexandre

    2016-09-01

    Thymectomy may be part of the therapeutic strategy in patients with myasthenia gravis (MG) without thymoma. Median sternotomy is still considered as the gold standard, but during the last 15 years, several groups have demonstrated the non-inferiority of cervicotomy with upper sternotomy and minimally invasive techniques. To date, there is no consensus on surgical procedure choice. The aim of our study was to compare the morbidity and mortality of three techniques [cervicotomy with upper sternotomy versus sternotomy versus video-assisted thoracic surgery (VATS)/robotic-assisted thoracic surgery (RATS)] from the national database EPITHOR and to analyse French epidemiology. From the national thoracic surgery database EPITHOR, we have extracted all the details regarding thymectomies performed for non-thymomatous MG. We have divided thymectomy into three groups: A-sternotomy; B-cervicotomy with upper sternotomy; C-VATS/RATS. We investigated the postoperative morbidity and mortality without analysis of the long-term evolution of the disease not available on EPITHOR. From 2005 to 2013, 278 patients were included: 131 (47%) in Group A, 31 (11%) in Group B and 116 (42%) in Group C. The sex ratio F/M was 2.3. The mean age was, respectively, 42 ± 17, 42 ± 16, 35 ± 14 years old (P < 0.01). The number of patients without comorbidities was 63 (48%), 25 (81%) and 78 (65%), respectively (P < 0.01). The operative time was 94 ± 37, 79 ± 42 and 112 ± 59 min, respectively (P < 0.01). The number of patients who presented at least one postoperative complication was 12 (14%), 0 and 3 (9%) (P= 0.03), respectively. The postoperative lengths of stay were 7.7 ± 4.5, 5 ± 1.7 and 4.5 ± 2 days, respectively (P < 0.01). There was no death. In our study, we were unable to prove the superiority of minimally invasive techniques due to the important differences between the groups. However, this study shows us major changes in French surgical procedures during the last decade with an

  15. Non-intubated uniportal left-lower lobe upper segmentectomy (S6).

    Science.gov (United States)

    Galvez, Carlos; Navarro-Martinez, Jose; Bolufer, Sergio; Sesma, Julio; Lirio, Francisco; Galiana, Maria; Rivera, Maria Jesus

    2017-01-01

    Worldwide accepted indications of anatomical segmentectomies are mainly early stage primary adenocarcinomas, pulmonary metastasis and benign conditions. Their performance through uniportal VATS has become more and more popular due to the less invasiveness of the whole procedure under this approach. Recently, many efforts have focused on non-intubated spontaneously breathing management of lobectomies and anatomical segmentectomies, although specific selection criteria and main advantages are not completely standardized. In a 62-year-old thin man with two pulmonary residual metastasis from sigma adenocarcinoma, after chemotherapy plus antiangiogenic treatment, we indicated a single-incision video-assisted left-lower lobe (LLL) upper segmentectomy (S6) under spontaneous breathing and intercostal blockade. Total operation time was 240 minutes. Chest tube was removed at 24 hours and the patient was discharge on postoperative day 2 without any complication. Non-intubated uniportal VATS is a safe and reasonable approach for lung-sparing resections in selected patients, although more evidence is required for selecting which patients can benefit more over standard intubated procedures.

  16. Smoking-related interstitial fibrosis combined with pulmonary emphysema: computed tomography-pathologic correlative study using lobectomy specimens.

    Science.gov (United States)

    Otani, Hideji; Tanaka, Tomonori; Murata, Kiyoshi; Fukuoka, Junya; Nitta, Norihisa; Nagatani, Yukihiro; Sonoda, Akinaga; Takahashi, Masashi

    2016-01-01

    To evaluate the incidence and pathologic correlation of thin-section computed tomography (TSCT) findings in smoking-related interstitial fibrosis (SRIF) with pulmonary emphysema. Our study included 172 consecutive patients who underwent TSCT and subsequent lobectomy. TSCT findings including clustered cysts with visible walls (CCVW) and ground-glass attenuation with/without reticulation (GGAR) were evaluated and compared in nonsmokers and smokers and among lung locations. TSCT findings, especially CCVW, were also compared with histological findings using lobectomy specimens. The incidence of CCVW and GGAR was significantly higher in smokers than in nonsmokers (34.1% and 40.7%, respectively, vs 2.0% and 12.2%). CCVW and GGAR were frequently found in the lower and peripheral zones. Histologically, CCVW corresponded more often with SRIF with emphysema than usual interstitial pneumonia (UIP, 63.3% vs 30%). CCVW of irregular size and shape were seen in 19 of 20 SRIF with emphysema and in seven of nine UIP-manifested areas with similar round cysts. A less-involved subpleural parenchyma was observed more frequently in SRIF with emphysema. SRIF with emphysema is a more frequent pathological finding than UIP in patients with CCVW on TSCT. The irregular size and shape of CCVW and a less-involved subpleural parenchyma may be a clue suggesting the presence of SRIF with emphysema.

  17. Direct fabrication of bio-inspired gecko-like geometries with vat polymerization additive manufacturing method

    DEFF Research Database (Denmark)

    Davoudinejad, A.; M. Ribo, M.; Pedersen, D. B.

    2018-01-01

    on. The geometry and fabrication of these surfaces are still under research. In this study, the feasibility of using direct fabrication of microscale features by Additive Manufacturing (AM) processes was investigated. The investigation was carried out using a specifically designed vat...... photopolymerization AM machine-tool suitable for precision manufacturing at the micro dimensional scale which has previously been developed, built and validated at the Technical University of Denmark. It was shown that it was possible to replicate a simplified surface inspired by the Tokay gecko, the geometry...

  18. Selective amygdalohippocampectomy versus standard temporal lobectomy in patients with mesiotemporal lobe epilepsy and unilateral hippocampal sclerosis: post-operative facial emotion recognition abilities.

    Science.gov (United States)

    Wendling, Anne-Sophie; Steinhoff, Bernhard J; Bodin, Frédéric; Staack, Anke M; Zentner, Josef; Scholly, Julia; Valenti, Maria-Paula; Schulze-Bonhage, Andreas; Hirsch, Edouard

    2015-03-01

    Surgical treatment of mesial temporal lobe epilepsy (mTLE) patients involves the removal either of the left or the right hippocampus. Since the mesial temporal lobe is responsible for emotion recognition abilities, we aimed to assess facial emotion recognition (FER) in two homogeneous patient cohorts that differed only in the administered surgery design since anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH) were performed independently of the underlying electroclinical conditions. The patient selection for the two respective surgical procedures was carried out retrospectively between 2000 and 2009 by two independent epilepsy centres, the Kork Epilepsy Centre, Germany and the University Hospital of Strasbourg, France. All included patients had presented with unilateral hippocampus sclerosis (HS) without associated dysplasia or white matter blurring and had become seizure-free postoperatively. Psychometric evaluation was carried out with the Ekman 60 Faces Test and screened for depression and psychosomatic symptoms with the SCL-90 R and the BDI. Thirty healthy volunteers participated as control subjects. Sixty patients were included, 27 had undergone SAH and 33 ATL. Patients and controls obtained comparable scores in FER for surprise, happiness, anger and sadness. Concerning fear and disgust the patient group scored significantly worse. Left-sided operations led to the the most pronounced impairment. The ATL group scored significantly worse for recognition of fear compared with SAH patients. Inversely, after SAH scores for disgust were significantly lower than after ATL, independently of the side of resection. Unilateral temporal damage impairs FER. Different neurosurgical procedures may affect FER differently. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Long-term local control with radiofrequency ablation or radiotherapy for second, third, and fourth lung tumors after lobectomy for primary lung cancer

    International Nuclear Information System (INIS)

    Yokouchi, Hideoki; Murata, Kohei; Miyazaki, Masaki; Miyamoto, Takeaki; Minami, Takafumi; Tsuji, Fumio; Mikami, Koji

    2016-01-01

    A 78-year-old woman developed second, third, and fourth lung tumors at intervals of 1-3 years after left upper lobectomy for primary lung cancer. The tumors were controlled with radiofrequency ablation (RFA) or conventional conformal radiotherapy for 9 years postoperatively. For the treatment of second primary lung cancer or lung metastasis after surgical resection of the primary lung cancer, reoperation is not recommended because of the impaired respiratory reserve. Thus, local therapy such as radiotherapy or RFA is applied in some cases. Among these, stereotactic body radiotherapy (SBRT) is a feasible option because of its good local control and safety, which is comparable with surgery. On the other hand, for cases of multiple lesions that are not suitable for radiotherapy or combination therapy, RFA could be an option because of its short-term local control, easiness, safety, and repeatability. After surgery for primary lung cancer, a second lung tumor could be controlled with highly effective and minimally invasive local therapy if it is recognized as a local disease but is medically inoperable. Therefore, long-term postoperative follow-up for primary lung cancer is beneficial. (author)

  20. Thoracoscopic or open surgery for pulmonary metastasectomy

    DEFF Research Database (Denmark)

    Eckardt, Jens; Licht, Peter B

    2014-01-01

    are now performed routinely worldwide. This prompted us to conduct a prospective observer-blinded study on pulmonary metastasectomy. METHODS: Eligible patients with oligometastatic pulmonary disease on computed tomography (CT) underwent high-definition VATS, with digital palpation by 1 surgical team...... number of additional nodules were detected during thoracotomy despite advancements in CT imaging and VATS technology. Many of these nodules were malignant and would have been missed if VATS was used exclusively. Consequently, we considered VATS inadequate if the intention is to resect all pulmonary...

  1. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer : a pooled analysis of two randomised trials

    NARCIS (Netherlands)

    Chang, Joe Y.; Senan, Suresh; Paul, Marinus A.; Mehran, Reza J.; Louie, Alexander V.; Balter, Peter; Groen, Harry; McRae, Stephen E.; Widder, Joachim; Feng, Lei; van den Borne, Ben E. E. M.; Munsell, Mark F.; Hurkmans, Coen; Berry, Donald A.; van Werkhoven, Erik; Kresl, John J.; Dingemans, Anne-Marie; Dawood, Omar; Haasbeek, Cornelis J. A.; Carpenter, Larry S.; De Jaeger, Katrien; Komaki, Ritsuko; Slotman, Ben J.; Smit, Egbert F.; Roth, Jack A.

    Background The standard of care for operable, stage I, non-small-cell lung cancer (NSCLC) is lobectomy with mediastinal lymph node dissection or sampling. Stereotactic ablative radiotherapy (SABR) for inoperable stage I NSCLC has shown promising results, but two independent, randomised, phase 3

  2. Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR).

    Science.gov (United States)

    Hernández, J; Molins, L; Fibla, J J; Heras, F; Embún, R; Rivas, J J

    2016-05-01

    Patients with pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. The objective of this study was to determine the role of major anatomic resection for pulmonary metastasectomy to improve survival when compared with limited pulmonary resection. Data of 522 patients (64.2% men, mean age 64.5 years) who underwent pulmonary resections with curative intent for CRC metastases over a 2-year period were reviewed. All patients were followed for a minimum of 3 years. Disease-specific survival (DSS) and disease-free survival (DFS) were assessed with the Kaplan-Meier method. Factors associated with DSS and DFS were analyzed using a Cox proportional hazards regression model. A total of 394 (75.6%) patients underwent wedge resection, 19 (3.6%) anatomic segmentectomy, 5 (0.9%) lesser resections not described, 100 (19.3%) lobectomy, and 4 (0.8%) pneumonectomy. Accordingly, 104 (19.9%) patients were treated with major anatomic resection and 418 (80.1%) with lesser resection. Operations were carried out with video-assisted thoracoscopic surgery (VATS) in 93 patients. The overall DSS and DFS were 55 and 28.3 months, respectively. Significant differences in DSS and DFS in favor of major resection versus lesser resection (DSS median not reached versus 52.2 months, P = 0.03; DFS median not reached versus 23.9 months, P < 0.001) were found. In the multivariate analysis, major resection appeared to be a protective factor in DSS [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.41-0.96, P = 0.031] and DFS (HR 0.5, 95% CI 0.36-0.75, P < 0.001). The surgical approach (VATS versus open surgical resection) had no effect on outcome. Major anatomic resection with lymphadenectomy for pulmonary metastasectomy can be considered in selected CRC patient with sufficient functional reserve to improve the DSS and DFS. Further prospective randomized studies are needed to confirm the present results. © The Author 2016. Published by Oxford University Press

  3. "Dual pathology" and the significance of surgical outcome in "Dostoewsky's epilepsy".

    Science.gov (United States)

    Vera, C L; Patel, S J; Naso, W

    2000-03-01

    A patient with a right occipital arterio-venous malformation (AVM) and seizures heralded by "lights", and experiencing "ecstasy" underwent a right occipital lobectomy after the AVM was embolized. Thereafter, seizures began with motor arrest and lip smacking, but never again with "light and ecstasy". A right temporal lobectomy and electrocorticogram (E.Co.G) were performed under local anesthesia four years after occipital lobectomy. Abundant spiking activity was recorded from the right hippocampus which showed gliosis and neuronal loss in the pathology studies. Electrical stimulation of the lateral and basal temporal cortices failed to elicit the vision of "lights" or the experience of "ecstasy". The patient has had two seizures in the last two years as a result of a lapse in taking his anti-convulsant medication. He now lives alone, seizure-free. The possible abnormally induced functional network organization and structures involved in the production of the "ecstasy" phenomenon are discussed.

  4. Clinical Features and Antimicrobial Resistance of Bacterial Agents of Ventilator-Associated Tracheobronchitis in Hamedan, Iran

    Directory of Open Access Journals (Sweden)

    Seyyed Hamid Hashemi

    2017-09-01

    Full Text Available Objectives: Ventilator-associated tracheobronchitis (VAT is a common cause of mortality and morbidity in patients admitted to intensive care units (ICUs. This study was conducted to evaluate the clinical course, etiology, and antimicrobial resistance of bacterial agents of VAT in ICUs in Hamedan, Iran. Methods: During a 12-month period, all patients with VAT in a medical and a surgical ICU were included. The criteria for the diagnosis of VAT were fever, mucus production, a positive culture of tracheal secretions, and the absence of lung infiltration. Clinical course, including changes in temperature and tracheal secretions, and outcomes were followed. The endotracheal aspirates were cultured on blood agar and chocolate agar, and antimicrobial susceptibility testing of isolates were performed using the disk diffusion method. Results: Of the 1 070 ICU patients, 69 (6.4% were diagnosed with VAT. The mean interval between the patient’s intubation and the onset of symptoms was 4.7±8.5 days. The mean duration of response to treatment was 4.9±4.7 days. A total of 23 patients (33.3% progressed to ventilator-associated pneumonia (VAP, and 38 patients (55.0% died. The most prevalent bacterial isolates included Acinetobacter baumannii (24.6%, Pseudomonas aeruginosa (20.2%, and Enterobacter(13.0%. P. aeruginosa and Enterobacter were the most prevalent bacteria in surgical ICU, and A. baumannii and K. pneumoniae were the most common in the medical ICU. All A. baumannii and Citrobacter species were multidrug-resistant (MDR. MDR pathogens were more prevalent in medical ICU compared to surgical ICU (p < 0.001. Conclusions: VAT increases the rates of progression to VAP, the need for tracheostomy, and the incidence of mortality in ICUs. Most bacterial agents of VAT are MDR. Preventive policies for VAP, including the use of ventilator care bundle, and appropriate empirical antibiotic therapy for VAT may reduce the incidence of VAP.

  5. The detection and settlement of VAT fraud in four countries : Addendum to the report value-added tax fraud in the European Union

    NARCIS (Netherlands)

    Aronowitz, A.A.; Laagland, D.C.G.; Paulides, G.

    1996-01-01

    This addendum to the report 'Value-added tax fraud in the European Union' gives additional information on the detection and settlement of VAT fraud in Belgium, Germany, the United Kingdom and the Netherlands. See link to the report at: More information.

  6. Recent clinical innovations in thoracic surgery in Hong Kong.

    Science.gov (United States)

    Zhao, Ze-Rui; Li, Zheng; Situ, Dong-Rong; Ng, Calvin S H

    2016-08-01

    The concept of personalized medicine, which aims to provide patients with targeted therapies while greatly reducing surgical trauma, is gaining popularity among Asian clinicians. Single port video-assisted thoracic surgery (VATS) has rapidly gained popularity in Hong Kong for major lung resections, despite bringing new challenges such as interference between surgical instruments and insertion of the optical source through a single incision. Novel types of endocutters and thoracoscopes can help reduce the difficulties commonly encountered during single-port VATS. Our region has been the testing ground and has led the development of many of these innovations. Performing VATS, in particular single-port VATS in hybrid operating theatre helps to localise small pulmonary lesions with real-time images, thus increasing surgical accuracy and pushes the boundaries in treating subcentimeter diseases. Such approach may be assisted by use of electromagnetic navigational bronchoscopy in the same setting. In addition, sublobar resection can also be more individualised according to pathologic tumour subtype that require rapid intraoperative diagnostic test to guide appropriate surgical therapy. A focus on technology and innovation for large tumours that require chest wall resection and reconstructions have also been on going, with new materials and prostheses that may be tailored to each individual needs. The current paper reviews the literature pertaining to the above topics and discusses recent related innovations in Hong Kong, highlighting the study results and future perspectives.

  7. Variability of Bacterial Biofilms of the “Tina” Wood Vats Used in the Ragusano Cheese-Making Process▿

    OpenAIRE

    Licitra, G.; Ogier, J. C.; Parayre, S.; Pediliggieri, C.; Carnemolla, T. M.; Falentin, H.; Madec, M. N.; Carpino, S.; Lortal, S.

    2007-01-01

    Ragusano cheese is a “protected denomination of origin” cheese made in the Hyblean region of Sicily from raw milk using traditional wooden tools, without starter. To explore the Ragusano bacterial ecosystem, molecular fingerprinting was conducted at different times during the ripening and biofilms from the wooden vats called “tinas” were investigated. Raw milks collected at two farm sites, one on the mountain and one at sea level, were processed to produce Ragusano cheese. Raw milk, curd befo...

  8. Preceding bronchial cutting for exposure of the pulmonary artery buried in scar tissue after chemoradiotherapy.

    Science.gov (United States)

    Nomori, Hiroaki; Cong, Yue; Sugimura, Hiroshi

    2017-01-01

    It is often difficult to expose the pulmonary artery buried in a scar tissue, especially in lung cancer patients that responded well to neoadjuvant chemoradiotherapy. Difficulty to access pulmonary artery branches may lead to potentially unnecessary pneumonectomy. To complete lobectomy in such cases, a technique with preceding bronchial cutting for exposure of the pulmonary artery is presented. After dissecting the pulmonary vein, the lobar bronchus is cut from the opposite side of the pulmonary artery with scissors. The back wall of the lobar bronchus is cut using a surgical knife from the luminal face, which can expose the pulmonary artery behind the bronchial stump and then complete lobectomy. Fourteen patients have been treated using the present technique, enabling complete resection by lobectomy (including sleeve lobectomy in 3 patients) without major bleeding. The present procedure can expose pulmonary artery buried in scar tissue, resulting in making the lobectomy safer.

  9. Minimally invasive thoracoscopic closure versus thoracotomy in children with patent ductus arteriosus.

    Science.gov (United States)

    Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Marczak, Jakub; Szymanska, Anna; Augustyn, Cyprian; Cichon, Romuald

    2017-02-01

    Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Once diagnosed, an immediate pharmacologic or invasive treatment should be performed. The purpose of this work was to evaluate the safety and efficacy of surgical PDA ligation in children using video-assisted thoracoscopic surgery (VATS) in comparison with a conventional muscle-sparing posterolateral thoracotomy technique (MSPLT). In this single-center, retrospective study 173 children qualified for surgical PDA closure were enrolled. Patients were divided according to their weight and type of surgery performed. The groups consisted of patients operated through thoracotomy (54%) or VATS (46%). Operative characteristics, cosmetic effect, postoperative complications and long-term survival were evaluated. Regardless of weight, fewer complications were noted in children after thoracoscopic clipping. Fifteen VATS patients required intraoperative conversion to thoracotomy; however, adverse sequelae were not observed. Aesthetics seemed to be the major complaint after conventional surgery. We did not observe any statistically significant differences in the long-term survival between both groups. Both techniques were shown to be safe and effective. Unsuccessfully performed thoracoscopic surgeries were safely converted to conventional thoracotomy. VATS, being a less invasive approach, leads to a better aesthetic effect and lower surgical complication rate. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Lung abscess presenting as tension pyopneumothorax in a gastrointestinal cancer patient.

    Science.gov (United States)

    Okita, Riki; Miyata, Yoshihiro; Hamai, Yoichi; Hihara, Jun; Okada, Morihito

    2014-01-01

    We report a surgical case of tension pyopneumothorax in a patient who was receiving chemotherapy for esophageal cancer. A 68-year-old man who had undergone total gastrectomy with splenectomy for gastric cancer and was receiving chemotherapy for esophageal cancer was presented to our hospital with dyspnea. Left tension pyopneumothorax was diagnosed, and he received left lower lobectomy after pleural drainage. His postoperative course was uneventful, and he is alive without any cancer recurrences 5 years after the lobectomy. Once tension pyopneumothorax has developed from lung abscess, emergent lobectomy may be a useful option to prevent lethal aspiration pneumonia.

  11. Anestesthesiological approach to pediatric patient for lobectomy due to lung abscess: Lung separation and epidural analgesia (lung separation and epidural analgesia

    Directory of Open Access Journals (Sweden)

    Vranić Lana

    2017-01-01

    Full Text Available Introduction: Acute lymphoblastic leukemia is the most common malignancy in childhood. Main characteristics of the disease are fast proliferation of lymphoblastic cells in bone marrow, destruction of other cells, causing insufficiency in the bone marow and infiltration of the liver, spleen and the lymphatic nodes. Pulmonary abscess and necrotizing pneumonia are rarely found in pediatric population and usually represent a significant problem for treatment. These conditions often require some surgical treatment modalities. The main goal of anesthesiological approach is to provide good and safe perioperative conditions and adequate analgesia. Case report: During treatment of acute leukemia in a 15-year-old boy, complication inform absenting pneumonia left side lung was developed. After four months antibiotic and antifungal therapy wide broad,(nije jasno decision of consilium was to perform left inferior lobectomy. Antibiotic prophylaxis with Ceftazidime 50 mg/kg BM. We performed a combination of general anesthesia and thoracic epidural anesthesia. Intubation with Robertshaw double lume tube. Ultrasound guided central venous catheter in left jugular veine and arterial line in right radial arteria. Anesthesia depth was controlled with entropy method. Epidural catheter was intoduded on level Thl0-Th 11. Conclusion: One ventilation with double lumen tube prevents spillage of infection sputum into the healthy lung. Epidural analgesia in this clinical situation held numerous benefits especially as a way to reduce postoperative respiratory complications caused by acute pain.

  12. Readmission Following Surgical Resection for Intractable Epilepsy: Nationwide Rates, Causes, Predictors, and Outcomes.

    Science.gov (United States)

    Rumalla, Kavelin; Smith, Kyle A; Arnold, Paul M; Schwartz, Theodore H

    2018-06-04

    Hospital readmissions can be detrimental to patients and may interfere with the potential benefits of the therapeutic procedure. Government agencies have begun to focus on reducing readmissions; however, the etiology of readmissions is lacking. To report the national rates, risk factors, and outcomes associated with 30- and 90-d readmissions following surgery for intractable epilepsy. We queried the Nationwide Readmissions Database from January to September 2013 using International Classification of Diseases, Ninth Edition, Clinical Modification codes to identify all patients with intractable epilepsy, who underwent hemispherectomy (01.52), brain lobectomy (01.53), amydalohippocampectomy, or partial lobectomy (01.59). Predictor variables included epilepsy type, presurgical diagnostic testing, surgery type, medical complications, surgical complications, and discharge disposition. In 1587 patients, the 30- and 90-d readmission rates were 11.5% and 16.8%, respectively. The most common reasons for readmission were persistent epilepsy, video electroencephalography monitoring, postoperative infection, and postoperative central nervous system complication. In multivariable analysis, risk factors associated with both 30- and 90-d readmission were Medicare payer status, lowest quartile of median income, depression, hemispherectomy, and postoperative complications (P < .05). The only unique predictor of 30-d readmission was small bedsize hospital (P = .001). Readmissions within 30 d were associated with longer length of stay (6.8 vs 5.8 d), greater costs ($18 660 vs $15 515), and increased adverse discharges (26.4% vs 21.8%). Following epilepsy surgery, most readmissions that occurred within 30 d can be attributed to management of persistent epilepsy and predicted by Medicare payer status, depression, and complications. These data can assist the clinician in preventing readmissions and assist policy makers determine which admissions are potentially avoidable.

  13. Short-run Distributional Effects of VAT Rate Change: Evidence from a consumption tax rate increase in Japan

    OpenAIRE

    David CASHIN; UNAYAMA Takashi

    2012-01-01

    Households will purchase more items than usual prior to a value added tax (VAT) rate increase in order to avoid taxation. Since this type of arbitrage requires resources such as shopping time and storage space, the impacts of tax increases vary across households, which has brought distributional effects in the short-run. Using the case of a consumption tax rate increase in Japan in 1997, we show that households who are non-working, with non-working spouses and residing in larger houses, benef...

  14. Apex-to-Cupola Distance Following VATS Predicts Recurrence in Patients With Primary Spontaneous Pneumothorax

    Science.gov (United States)

    Chang, Jia-Ming; Lai, Wu-Wei; Yen, Yi-Ting; Tseng, Yau-Lin; Chen, Ying-Yuan; Wu, Ming-Ho; Chen, Wei; Light, Richard W.

    2015-01-01

    Abstract Our study sought to determine whether the size of the residual apical pleural space in young patients with primary spontaneous pneumothorax (PSP) following video-assisted thoracoscopic surgery is associated with the risk of recurrence. We retrospectively reviewed patients (≤30 years’ old) with primary spontaneous pneumothorax following thoracoscopic surgery (2002–2010) in a university-affiliated hospital. The size of residual apical pleural space was estimated by measuring the apex-to-cupola distance on a postoperative chest radiograph at 2 time windows: first between postoperative day (POD) 0 and 3, and second between POD 4 and 14. A total of 149 patients were enrolled with a median follow-up of 11.2 months (interquartile range, 0.95–29.5 months), of whom 141 (94.6%) were male with a mean age of 20 years. The postoperative recurrence rate was 11.4%. Comparing the characteristics between the patients with and without recurrent pneumothorax, the patients with recurrence were younger (18.2 + 2.4 vs 20.7 + 3.7 years, P = 0.008), with a lower rate of pleurodesis (35% vs1 69%, P = 0.037), longer apex-to-cupola distance at POD 0 to 3 (22.41 ± 19.56 vs 10.07 ± 10.83 mm, P pneumothorax, age 10 mm (P = 0.027, OR: 5.319), and no pleurodesis during VATS (P = 0.022, OR: 5.042) were independent risk factors for recurrent pneumothorax. The recurrence rate was not low (11.4%) in young patients with PSP following VATS. Residual apical pleural space with apex-to-cupola distance of 10 mm or greater at POD 0 to 3, younger age, and no pleurodesis would increase postoperative recurrence of primary spontaneous pneumothorax. PMID:26376396

  15. Decolorization of a textile vat dye by adsorption on waste ash

    Directory of Open Access Journals (Sweden)

    MIODRAG ŠMELCEROVIĆ

    2010-06-01

    Full Text Available An adsorption process using cheap adsorbents could be described as a simple, selective and low cost alternative for the treatment of colored waste water compared to conventional physical and chemical processes. In this study the use of a natural waste adsorbent–ash was investigated for the removal of a textile vat dye Ostanthren blue GCD remaining after the dyeing of cotton textile. The ash obtained as a waste material during the burning of brown coal in the heating station of Leskovac (Serbia was used for the treatment of waste waters from the textile industry, i.e., waste water after the dyeing process. The effect of ash quantity, initial dye concentration, pH and agitation time on adsorption was studied. The Langmuir model was used to describe the adsorption isotherm. Based on the analytical expression of the Langmuir model, the adsorption constants, such as adsorption capacity and adsorption energy, were found. Pseudo first and second order kinetic models were studied to evaluate the kinetic data.

  16. Coumaphos dissipation, degradation and binding to sediment in a model laboratory vat system using 14C-labelled acaricide

    International Nuclear Information System (INIS)

    Khan, S.U.; Behki, R.

    1997-01-01

    Dissipation and degradation of 14 C-labelled coumaphos in suspension and binding to sediment was studied in a model laboratory glass vat was studied. The water in the vat was treated with a mixture of 14 C-labelled and unlabelled coumaphos and initial concentration determined. Two weeks later 50 g soil was added to the suspension and 3 x 25 mL samples taken and analysis. The procedure was repeated every two weeks for 44 weeks. pH was also recorded at each sampling time. At the end of the experiment soil was extracted by using Soxhlet apparatus and by supercritical fluid extraction and concentrations of free and bound coumaphos and metabolites were determined. Very little dissipation of total 14 C occurred and 88% of the initial concentration was still present at the end of 44 weeks. The 14 C content in the filtrate declined to 20% but there was a corresponding increase in the 14 C content of the sediment mixed with emulsion. The pH of the suspension steadily decreased with time. HPLC analysis of the filtrate, soil wash and Soxhlet extract indicated the presence of coumaphos and three metabolites chlorferon, potasan and oxygen analogue of coumaphos. Analysis of supercritical fluid extract of the sediment-bound radioactivity showed the presence of coumaphos but no metabolites. In another study filtered and washed soil from the tank was incubated with an EPTC-degrading bacterial strain, Rhodococcus TE1 to study the effect on the metabolism of coumaphos. About 10.9% of 14 C was released in the incubation mixture and it contained mostly chlorferon with some oxygen analogue of coumaphos. Exposure of 14 C-labelled coumaphos to U.V. and sun lamp, to study photolysis, resulted in the formation of a brown precipitate. While the 14 C content in the filtrate decreased, its concentration in the precipitate increased. The filtrate contained primarily coumaphos, whereas, the precipitate contained coumaphos, chlorferon and potasan. These findings suggest that in the field vat the

  17. Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy.

    Science.gov (United States)

    Olgac, Guven; Cosgun, Tugba; Vayvada, Mustafa; Ozdemir, Atilla; Kutlu, Cemal Asim

    2014-10-01

    Owing to the great absorption capability of the pleura for transudates, the protein content of draining pleural fluid may be considered as a more adequate determinant than its daily draining amount in the decision-making for earlier chest tube removal. In an a priori pilot study, we observed that the initially draining protein-rich exudate converts to a transudate quickly in most patients after lobectomies. Thus, chest tubes draining high-volume but low-protein fluids can safely be removed earlier in the absence of an air leak. This randomized study aims to investigate the validity and clinical applicability of this hypothesis as well as its influence on the timing for chest tube removal and earlier discharge after lobectomy. Seventy-two consecutive patients undergoing straightforward lobectomy were randomized into two groups. Patients with conditions affecting postoperative drainage and with persisting air leaks beyond the third postoperative day were excluded. Drains were removed if the pleural fluid to blood protein ratio (PrRPl/B) was ≤0.5, regardless of its daily draining amount in the study arm (Group S; n = 38), and patients in the control arm (Group C; n = 34) had their tubes removed if daily drainage was ≤250 ml regardless of its protein content. Patients were discharged home immediately or the following morning after removal of the last drain. All cases were followed up regarding the development of symptomatic pleural effusions and hospital readmissions for a redrainage procedure. Demographic and clinical characteristics as well as the pattern of decrease in PrRPl/B were the same between groups. The mean PrRPl/B was 0.65 and 0.67 (95% CI = 0.60-0.69 and 0.62-0.72) on the first postoperative day, and it remarkably dropped down to 0.39 and 0.33 (95% CI = 0.33-0.45 and 0.27-0.39) on the second day in Groups S and C, respectively, and remained below 0.5 on the third day (repeated-measures of ANOVA design, post hoc 'within-group' comparison of the first

  18. Operation of Small Radio Telescope (SRT) recorded 21 cm spectral line of Hydrogen at VATLY Laboratory

    International Nuclear Information System (INIS)

    Pham Ngoc Dong; Pham Tuan Anh; Pham Ngoc Diep; Pham Thi Tuyet Nhung; Nguyen Van Hiep

    2013-01-01

    A small radio telescope (SRT) has been installed on the roof of the Hanoi astrophysics laboratory VATLY. It is equipped with a 2.6 m diameter mobile parabolic dish remotely controlled in elevation and azimuth and with super-heterodyne detection around the 21 cm hydrogen line. They demonstrate the high quality of the telescope performance and are used to evaluate lobe size, signal to noise ratios, anthropogenic interferences and measurement accuracies. Particular attention is given to the measurement of the pointing accuracy. First results of observations of the Sun and of the centre of the Milky Way are presented. (author)

  19. Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

    Science.gov (United States)

    Pawlak, Krystian; Gąsiorowski, Łukasz; Gabryel, Piotr; Dyszkiewicz, Wojciech

    2018-03-01

    Additional use of the video-assisted thoracoscopic surgery (VATS) technique in the Nuss procedure has been globally accepted for the improvement of safety of surgical treatment as well as for decreased frequency of serious intraoperative and postoperative complications. To evaluate VATS in surgical treatment of patients with pectus excavatum by the left-to-right Nuss procedure for prevention of serious intra- and postoperative complications. From 2002 to 2016, 1006 patients with pectus excavatum aged 7 to 62 years (mean: 18.6) underwent the Nuss procedure. There were 796 males and 210 females. The clinical records of all patients were analyzed retrospectively. The follow-up varied from 1 to 172 months (mean: 80.7 ±43). The early 30-day postoperative mortality was zero. Early thoracoscopy-dependent postoperative complications, the majority transient and non-life-threatening, occurred in 35.6% of patients. The most frequent complication was pneumothorax, diagnosed in 24.5% of patients. Two patients required repeat surgery. One patient required VATS pleurectomy due to persistent postoperative air leakage. In another patient left thoracotomy following bleeding from the pleural cavity was performed. The use of VATS in the left-to-right Nuss procedure for pectus excavatum ensures the safety of surgical treatment and minimizes the occurrence of serious intra- and postoperative complications concerning injury of the mediastinum, lung, diaphragm or abdominal cavity.

  20. VAT-69, a software system for gamma spectroscopy

    International Nuclear Information System (INIS)

    Furr, A.K.; Roscoe, B.A.; Parkinson, T.F.

    1979-01-01

    The software system was originally developed solely for neutron activation analysis. Its usefulness has been enhanced by adding modules that allow processing of gamma spectra from natural radioisotopes and from fission products. It allows: (1) separation of overlapping peaks, allowing retrieval of a peak of interest in the presence of an interfering peak, (2) calibration of each gamma spectrum for energy and peak width, using criteria based on gamma peak data internal to the individual spectrum, (3) correction for errors due to rapidly changing dead times during the counting interval, permitting accurate count data for samples containing mixed short-, medium-, and long-lived isotopes. One disadvantage of the original software was that it produced more output information than desired. The modifications that have been implemented to produce final concentration values include: (1) computation of a weighted-average concentration of the ith element where two or more gamma peaks are available, (2) rejection of gamma peaks when the difference in energies of the located peak and library peak exceeds a preset value, (3) rejection of concentration values based on gamma peaks which do not satisfy preselected criteria for irradiation time and wait time, (4) computation of the error in concentration of the ith element, and (5) correction of sample concentration for trace elements in the irradiation vials. Overall performance of the software system is checked periodically by analyzing standards. Several thousand spectra are processed each year with VAT-69, with typically 25 to 40 elements quantitatively determined

  1. The predictive value of FDG-PET with 3D-SSP for surgical outcomes in patients with temporal lobe epilepsy.

    Science.gov (United States)

    Higo, Takuma; Sugano, Hidenori; Nakajima, Madoka; Karagiozov, Kostadin; Iimura, Yasushi; Suzuki, Masaru; Sato, Kiyoshi; Arai, Hajime

    2016-10-01

    We retrospectively evaluated the diagnostic value of (18)F-2-fluorodeoxy-d-glucose positron emission tomography (FDG-PET) with statistical analysis for the foci detection and predictive utility for postsurgical seizure outcome of patients with mesial temporal lobe epilepsy (mTLE). We evaluated 40 patients who were diagnosed mTLE and underwent selective amygdalohippocampectomy (SAH) or anterior temporal lobectomy (ATL) in our institute. Preoperative interictal FDG-PET with statistical analysis using three-dimensional stereotactic surface projection (3D-SSP) was detected with several clinical data including seizure semiology, MRI, scalp electroencephalography, surgical procedure with SAH or ATL and postsurgical outcome. The region of interest (ROI) was defined on 'Hippocampus & Amygdala', 'Parahippocampal gyrus & Uncus', 'T1 & T2', and 'T3 & Fusiform gyrus'. We obtained the ratio of hypometabolism difference (RHD) by 3D-SSP, and evaluated the relation among hypometabolic extent, surgical outcome and surgical procedure. The RHD in each ROIs ipsilateral to operative side was significantly higher than that of contralateral side in good outcome group. Hypometabolism of 'Hippocampus & Amygdala' was most reliable prognostic factor. Patients of discordant with presurgical examinations hardly showed obvious lateralized hypometabolism. Nevertheless, when they have significantly high RHD in mesial temporal lobe, good surgical outcome was expected. There was not significant difference of RHD distribution between SAH and ATL in good outcome group. Significant hypometabolism in mesial temporal lobe on FDG-PET with 3D-SSP is useful to predict good surgical outcome for patients with mTLE, particularly in discordant patients with hypometabolism in mesial temporal structure. However, FDG-PET is not indicative of surgical procedure. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  2. Accelerated long-term forgetting in temporal lobe epilepsy: evidence of improvement after left temporal pole lobectomy.

    Science.gov (United States)

    Gallassi, Roberto; Sambati, Luisa; Poda, Roberto; Stanzani Maserati, Michelangelo; Oppi, Federico; Giulioni, Marco; Tinuper, Paolo

    2011-12-01

    Accelerated long term forgetting (ALF) is a characteristic cognitive aspect in patients affected by temporal lobe epilepsy that is probably due to an impairment of memory consolidation and retrieval caused by epileptic activity in hippocampal and parahippocampal regions. We describe a case of a patient with TLE who showed improvement in ALF and in remote memory impairment after an anterior left temporal pole lobectomy including the uncus and amygdala. Our findings confirm that impairment of hippocampal functioning leads to pathological ALF, whereas restoration of hippocampal functioning brings ALF to a level comparable to that of controls. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Expectativas y satisfacción en el tratamiento del neumotórax espontáneo primario recurrente tratado por toracotomía o cirugía torácica video-asistida Expectations and patient satisfaction related to the use of thoracotomy and video-assisted thoracoscopic surgery for treating recurrence of spontaneous primary pneumothorax

    Directory of Open Access Journals (Sweden)

    Jorge Ramón Lucena Olavarrieta

    2009-02-01

    Full Text Available OBJETIVO: Comparar los resultados de la toracotomía con la video-assisted thoracoscopic surgery (VATS, cirugía torácica video-asistida en el tratamiento de las recurrencias del neumotórax espontáneo primario. MÉTODOS: Se revisaron los expedientes clínicos de los pacientes con neumotórax primario recurrente dividiéndose en dos grupos: pacientes sometidos a toracotomía (n = 53, grupo toracotomía y pacientes sometidos a VATS (n = 47, grupo VATS. RESULTADOS: La morbilidad fue mayor en el grupo A. Sin mortalidad en ninguno de los dos grupos. La duración de la hospitalización fue similar. Los pacientes del grupo toracotomía necesitaron más dosis de narcóticos durante períodos más largos de tiempo que los del grupo VATS (p OBJECTIVE: To compare the outcomes of thoracotomy and video-assisted thoracoscopic surgery (VATS in the treatment of recurrence of primary spontaneous pneumothorax. METHODS: Medical records of patients presenting recurrence of primary spontaneous pneumothorax were retrospectively reviewed. Patients were divided into two groups: those who underwent conservative thoracotomy (n = 53, thoracotomy group; and those who underwent VATS (n = 47, VATS group. RESULTS: Although there were no deaths in either group and the length of hospital stays was similar between the two, there was greater morbidity in the thoracotomy group. Patients in the thoracotomy group required more pain medication for longer periods than did those in the VATS group (p < 0.05. In the thoracotomy group, the rate of recurrence was 3%. Pain was classified as insignificant at one month after the operation by 68% of patients in the VATS group and by only 21% of those in the thoracotomy group (p < 0.05. At three years after the surgical procedure, 97% of the VATS group patients considered themselves completely recovered from the operation, compared with only 79% in the thoracotomy group (p < 0.05. Chronic or intermittent pain, requiring the use of analgesics

  4. The acquisition of face and person identity information following anterior temporal lobectomy.

    Science.gov (United States)

    Moran, Maria; Seidenberg, Michael; Sabsevitz, Dave; Swanson, Sara; Hermann, Bruce

    2005-05-01

    Thirty unilateral anterior temporal lobectomy (ATL) subjects (15 right and 15 left) and 15 controls were presented a multitrial learning task in which unfamiliar faces were paired with biographical information (occupation, city location, and a person's name). Face recognition hits were similar between groups, but the right ATL group committed more false-positive errors to face foils. Both left and right ATL groups were impaired relative to controls in acquiring biographical information, but the deficit was more pronounced for the left ATL group. Recall levels also varied for the different types of biographical information; occupation was most commonly recalled followed by city name and person name. In addition, city and person name recall was more likely when occupation was also recalled. Overall, recall of biographical information was positively correlated with clinical measures of anterograde episodic memory. Findings are discussed in terms of the role of the temporal lobe and associative learning ability in the successful acquisition of new face semantic (biographical) representations.

  5. C-VAT – Clinical Video game Addiction Test: een diagnostisch instrument voor het herkennen van gameverslaving in de klinische praktijk.

    OpenAIRE

    Rooij, A.J. van; Duin, L. van; Frielink, N.; DeFuentes-Merillas, L.; Schoenmakers, T.M.

    2012-01-01

    In de Nederlandse verslavingszorg worden hulpverleners in toenemende mate geconfronteerd met een hulpvraag op het gebied van ‘gameverslaving’. Tot nu toe is er echter geen diagnostisch instrument dat gebruikt kan worden om het probleem goed in kaart te brengen. Dit artikel bespreekt de ontwikkeling van een dergelijk instrument, de Clinical Video game Addiction Test (C-VAT). De lijst bestaat uit drie introductievragen, negen kernvragen en aanbevelingen gericht op het ontdekken van comorbide pr...

  6. Identification of acetates in elasmopalpulus lignosellus pheromone glands using a newly created mass spectral database and kóvats retention indices

    OpenAIRE

    Jham, Gulab N.; Silva, Alexsandro A. da; Lima, Eraldo R.; Viana, Paulo A.

    2007-01-01

    Based on a specially created mass spectral database utilizing 23 tetradecenyl and 22 hexadecenyl acetate standards along with Kóvats retention indices obtained on a very polar stationary phase [poly (biscyanopropyl siloxane)] (SP 2340), (Z)-9-hexadecenyl acetate, (Z)-11-hexadecenyl acetate and (E)-8-hexadecenyl acetate were identified in active pheromone extracts of Elasmopalpus lignosellus. This identification was more efficient than our previous study using gas chromatography/mass spectrome...

  7. Dosimetric optimization of worksite involving the installation of VATS containing highly active effluent

    International Nuclear Information System (INIS)

    Legee, F.; Busani, J.; Madigand, Y.; Pailloux, J.

    1996-01-01

    Within the framework of safety improvements at the CEA, CEA-FAR, concerned to formalize the ALARA initiative, has carried out for information and training purpose and to create awareness a dosimetric assessment of the worksite where new storage vats for highly active effluents are to be installed. The approach used for this worksite is global. Techniques used were all complementary, ensuring constant elaboration, experiment follow-up and feedback of a worksite at a relatively low dosimetric cost (an estimated 36 men.mSv brought down to 30 men.mSv through implementation of the ALARA principle). This type of global conception of radioprotection involving all the employees (head of project, project managers, companies, radioprotection employees...) which today proves its worth on a modest worksite must now be extended to worksites of a broader scope (several hundreds of men.mSv) where fulfillment of the dosimetric objectives is a major stake. (author)

  8. Clinical outcomes of CO2-less single-port video-assisted thoracoscopic thymectomy versus open thymectomy: comparative study.

    Science.gov (United States)

    Aragón, Javier; Pérez Méndez, Itzell; Gutiérrez Pérez, Alexia

    2016-01-01

    Although video-assisted thoracoscopic surgery (VATS) for thymic disorders has been introduced, its oncological outcome and benefits over others open approaches remains unclear. Single-port VATS thymectomy using a flexible port and CO 2 has been described. However, VATS thymectomy is possible by a single incision of 3 cm without CO 2 insufflation or special port device avoiding objections related to CO 2 insufflation and allowing instruments to move more freely making procedure easier and cheaper. Our institutional experience in open and CO 2 -less VATS single-port thymectomy was retrospectively reviewed to evaluate compared to sternotomy, the clinical and oncological outcomes with this novel approach. A retrospective review consisting of 84 patients who underwent thymectomy because different thymic disorders especially thymoma was performed. Eighteen patients underwent CO 2 -less VATS single port thymectomy, while 66 underwent thymectomy through open sternotomy. Many clinical factors associated with the surgical and clinical outcomes, including tumor recurrence and clinical remission, were recorded. Non major postoperative complications were observed in any group. The median operative time and postoperative hospital stay of CO 2 -less VATS single port thymectomy were 95 min and 1 day, respectively and 120 min and 7 days for open sternotomy. The thymoma was the most common thymic disorder with 7 patients (38%) in VATS group and 28 patients (42.4%) for the open approach. The median lesion size was 2.6 cm in the VATS group and 3.2 cm in the open approach. No thymoma recurrence in patients undergoing VATS was observed during the follow-up time, while in the open surgery group 14.28% recurrence was observed, distributed as follows: loco-regional 75% and 25% at distance; free disease period of these patients was 8.3 months. Thymectomy associated with myasthenia gravis (MG) was observed in 6 (33%) patients in the VATS group and 32 (48%) patients for sternotomy; our

  9. Multicentric evaluation of the impact of central tumour location when comparing rates of N1 upstaging in patients undergoing video-assisted and open surgery for clinical Stage I non-small-cell lung cancer.

    Science.gov (United States)

    Decaluwé, Herbert; Petersen, René Horsleben; Brunelli, Alex; Pompili, Cecilia; Seguin-Givelet, Agathe; Gust, Lucile; Aigner, Clemens; Falcoz, Pierre-Emmanuel; Rinieri, Philippe; Augustin, Florian; Sokolow, Youri; Verhagen, Ad; Depypere, Lieven; Papagiannopoulos, Kostas; Gossot, Dominique; D'Journo, Xavier Benoit; Guerrera, Francesco; Baste, Jean-Marc; Schmid, Thomas; Stanzi, Alessia; Van Raemdonck, Dirk; Bardet, Jeremy; Thomas, Pascal-Alexandre; Massard, Gilbert; Fieuws, Steffen; Moons, Johnny; Dooms, Christophe; De Leyn, Paul; Hansen, Henrik Jessen

    2017-09-27

    Large retrospective series have indicated lower rates of cN0 to pN1 nodal upstaging after video-assisted thoracic surgery (VATS) compared with open resections for Stage I non-small-cell lung cancer (NSCLC). The objective of our multicentre study was to investigate whether the presumed lower rate of N1 upstaging after VATS disappears after correction for central tumour location in a multivariable analysis. Consecutive patients operated for PET-CT based clinical Stage I NSCLC were selected from prospectively managed surgical databases in 11 European centres. Central tumour location was defined as contact with bronchovascular structures on computer tomography and/or visibility on standard bronchoscopy. Eight hundred and ninety-five patients underwent pulmonary resection by VATS (n = 699, 9% conversions) or an open technique (n = 196) in 2014. Incidence of nodal pN1 and pN2 upstaging was 8% and 7% after VATS and 15% and 6% after open surgery, respectively. pN1 was found in 27% of patients with central tumours. Less central tumours were operated on by VATS compared with the open technique (12% vs 28%, P < 0.001). Logistic regression analysis showed that only tumour location had a significant impact on N1 upstaging (OR 6.2, confidence interval 3.6-10.8; P < 0.001) and that the effect of surgical technique (VATS versus open surgery) was no longer significant when accounting for tumour location. A quarter of patients with central clinical Stage I NSCLC was upstaged to pN1 at resection. Central tumour location was the only independent factor associated with N1 upstaging, undermining the evidence for lower N1 upstaging after VATS resections. Studies investigating N1 upstaging after VATS compared with open surgery should be interpreted with caution due to possible selection bias, i.e. relatively more central tumours in the open group with a higher chance of N1 upstaging. © The Author 2017. Published by Oxford University Press on behalf of the European

  10. Clinical validation of the C-VAT 2.0 assessment tool for gaming disorder: A sensitivity analysis of the proposed DSM-5 criteria and the clinical characteristics of young patients with 'video game addiction'.

    Science.gov (United States)

    van Rooij, Antonius J; Schoenmakers, Tim M; van de Mheen, Dike

    2017-01-01

    Clinicians struggle with the identification of video gaming problems. To address this issue, a clinical assessment tool (C-VAT 2.0) was developed and tested in a clinical setting. The instrument allows exploration of the validity of the DSM-5 proposal for 'internet gaming disorder'. Using C-VAT 2.0, the current study provides a sensitivity analysis of the proposed DSM-5 criteria in a clinical youth sample (13-23years old) in treatment for video gaming disorder (N=32). The study also explores the clinical characteristics of these patients. The patients were all male and reported spending extensive amounts of time on video games. At least half of the patients reported playing online games (n=15). Comorbid problems were common (n=22) and included (social) anxiety disorders, PDD NOS, ADHD/ADD, Parent-Child relationship problem, and various types of depressive mood problems. The sensitivity of the test was good: results further show that the C-VAT correctly identified 91% of the sample at the proposed cut-off score of at least 5 out of 9 of the criteria. As our study did not include healthy, extreme gamers, we could not assess the specificity of the tool: future research should make this a priority. Using the proposed DSM-5 cut-off score, the C-VAT 2.0 shows preliminary validity in a sample of gamers in treatment for gaming disorder, but the discriminating value of the instrument should be studied further. In the meantime, it is crucial that therapists try to avoid false positives by using expert judgment of functional impairment in each case. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Determining the appropriate sleeve lobectomy versus pneumonectomy ratio in central non-small cell lung cancer patients: an audit of an aggressive policy of pneumonectomy avoidance.

    Science.gov (United States)

    Gómez-Caro, Abel; Garcia, Samuel; Reguart, Noemí; Cladellas, Esther; Arguis, Pedro; Sanchez, Marcelo; Gimferrer, Josep Maria

    2011-03-01

    To study the outcomes of broncho ± angioplastic sleeve lobectomy (SL) versus pneumonectomy (PN), and the PN:SL ratio after an aggressive policy of parenchyma-sparing surgery to improve postoperative complications rate and long-term quality of life (QoL). A prospective study was conducted in 490 patients with non-small cell lung cancer between 2005 and 2009. All patients not suitable for standard lobectomy were scheduled for SL, if possible, or for PN; eight patients with functional impairment were directly scheduled for SL. Of 76 procedures, 21 (4%) were PN and 55 (11%) SL (29 bronchoplastic, seven bronchovascular, seven angioplastic; 11 extended to more than one lobe). There were no surgical, oncological or physiological preoperative differences between the groups. The 5-year PN:SL ratio was 1:2.6 (2005: 1:2.1; 2006: 1:2.6; 2007: 1:3.6; 2008: 1:3; 2009: 1:3.5). SL and PN mortality were 2 (3.6%) and 1 (5%), respectively. Postoperative complications occurred in 18 (32%) SL and 7 (33%) PN patients. pN1 (p = 0.04), vascular reconstruction and upper-left SL were risk factors for postoperative complications of SL (p = 0.03) but were not detected as a mortality risk. Overall 5-year survival was 61% for SL and 31% for PN. Survival at 5 years was significantly higher for SL (p = 0.03, Kaplan-Meier). Age modelling, both remained positive factors. Surviving PN patients experienced significantly greater loss of respiratory function and lower QoL than those who avoided this surgery (preoperative score, PN vs SL: 52 vs 51; 3 months, 41 vs 43; and 6 months, 42 vs 51, p = 0.04). The adjuvant treatment complement was higher in SL at 34 (62%) than at PN 10 (47%). The side effects of this treatment were more frequent in patients with more extirpated parenchyma (p = 0.04). Parenchyma-sparing procedures can reduce the PN rate to less than 10%. A PN:SL index lower than 1:1.5 as a quality standard in a specialised thoracic unit should encourage the use of broncho

  12. Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database

    Directory of Open Access Journals (Sweden)

    Yasunaga Hideo

    2012-05-01

    Full Text Available Abstract Background Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume. Methods We analyzed 131,394 patients undergoing lung lobectomy, esophagectomy, gastrectomy, colorectal surgery, hepatectomy or pancreatectomy for cancer between July and December, 2007–2008, using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institutions data. Physician-to-bed ratio (PBR and nurse-to-bed ratio (NBR were determined for each hospital. Hospital volume was categorized into low, medium and high for each of six cancer surgeries. Failure to rescue (FTR was defined as a proportion of inhospital deaths among those with postoperative complications. Multi-level logistic regression analysis was performed to examine the association between physician/nurse staffing and FTR, adjusting for patient characteristics and hospital volume. Results Overall inhospital mortality was 1.8%, postoperative complication rate was 15.2%, and FTR rate was 11.9%. After adjustment for hospital volume, FTR rate in the group with high PBR (≥19.7 physicians per 100 beds and high NBR (≥77.0 nurses per 100 beds was significantly lower than that in the group with low PBR ( Conclusions Well-staffed hospitals confer a benefit for cancer surgical patients regarding reduced FTR, irrespective of hospital volume. These results suggest that consolidation of surgical centers linked with migration of medical professionals may improve the quality of cancer surgical management.

  13. Correlation between subacute sensorimotor deficits and brain water content after surgical brain injury in rats.

    Science.gov (United States)

    McBride, Devin W; Wang, Yuechun; Sherchan, Prativa; Tang, Jiping; Zhang, John H

    2015-09-01

    Brain edema is a major contributor to poor outcome and reduced quality of life after surgical brain injury (SBI). Although SBI pathophysiology is well-known, the correlation between cerebral edema and neurological deficits has not been thoroughly examined in the rat model of SBI. Thus, the purpose of this study was to determine the correlation between brain edema and deficits in standard sensorimotor neurobehavior tests for rats subjected to SBI. Sixty male Sprague-Dawley rats were subjected to either sham surgery or surgical brain injury via partial frontal lobectomy. All animals were tested for neurological deficits 24 post-SBI and fourteen were also tested 72 h after surgery using seven common behavior tests: modified Garcia neuroscore (Neuroscore), beam walking, corner turn test, forelimb placement test, adhesive removal test, beam balance test, and foot fault test. After assessing the functional outcome, animals were euthanized for brain water content measurement. Surgical brain injury resulted in significantly elevated frontal lobe brain water content 24 and 72 h after surgery compared to that of sham animals. In all behavior tests, significance was observed between sham and SBI animals. However, a correlation between brain water content and functional outcome was observed for all tests except Neuroscore. The selection of behavior tests is critical to determine the effectiveness of therapeutics. Based on this study's results, we recommend using beam walking, the corner turn test, the beam balance test, and the foot fault test since correlations with brain water content were observed at both 24 and 72 h post-SBI. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Correlation between subacute sensorimotor deficits and brain water content after surgical brain injury in rats

    Science.gov (United States)

    McBride, Devin W.; Wang, Yuechun; Sherchan, Prativa; Tang, Jiping; Zhang, John H.

    2015-01-01

    Brain edema is a major contributor to poor outcome and reduced quality of life after surgical brain injury (SBI). Although SBI pathophysiology is well-known, the correlation between cerebral edema and neurological deficits has not been thoroughly examined in the rat model of SBI. Thus, the purpose of this study was to determine the correlation between brain edema and deficits in standard sensorimotor neurobehavior tests for rats subjected to SBI. Sixty male Sprague-Dawley rats were subjected to either sham surgery or surgical brain injury via partial frontal lobectomy. All animals were tested for neurological deficits 24 post-SBI and fourteen were also tested 72 hours after surgery using seven common behavior tests: modified Garcia neuroscore (Neuroscore), beam walking, corner turn test, forelimb placement test, adhesive removal test, beam balance test, and foot fault test. After assessing the functional outcome, animals were euthanized for brain water content measurement. Surgical brain injury resulted in a significantly elevated frontal lobe brain water content 24 and 72 hours after surgery compared to that of sham animals. In all behavior tests, significance was observed between sham and SBI animals. However, a correlation between brain water content and functional outcome was observed for all tests except Neuroscore. The selection of behavior tests is critical to determine the effectiveness of therapeutics. Based on this study’s results, we recommend using beam walking, the corner turn test, the beam balance test, and the foot fault test since correlations with brain water content were observed at both 24 and 72 hours post-SBI. PMID:25975171

  15. Thinking on the Training of Uniportal Video-assisted Thoracic Surgery

    OpenAIRE

    Yuming ZHU; Gening JIANG

    2018-01-01

    Recently, uniportal video-assisted thoracic surgery (VATS) has developed rapidly and has become the main theme of global surgical development. The specific, standardized and systematic training of this technology has become an important topic. Specific training in the uniportal VATS approach is crucial to ensure safety and radical treatment. Such training approach, including a direct interaction with experienced surgeons in high-volume centers, is crucial and represents an indispensable step....

  16. Technique of total thyroidectomy

    International Nuclear Information System (INIS)

    Rao, R.S.

    1999-01-01

    It is essential to define the various surgical procedures that are carried out for carcinoma of the thyroid gland. They are thyroid gland, subtotal lobectomy, total thyroidectomy and near total thyroidectomy

  17. Electrocautery versus Ultracision versus LigaSure in Surgical Management of Hyperhidrosis.

    Science.gov (United States)

    Divisi, Duilio; Di Leonardo, Gabriella; De Vico, Andrea; Crisci, Roberto

    2015-12-01

    The aim of the study was to evaluate the sympathectomy procedures for primary hyperhidrosis in terms of complications and effectiveness. From January 2010 to September 2012 we performed 130 sympathectomies in 65 patients, 27 males (42%) and 38 females (58%). Electrocoagulation was used in 20 procedures (15%), ultrasonic scalpel in 54 (42%), and radiofrequency dissector in 56 (43%). Seven patients (11%) underwent bilateral sympathectomy in the same surgical session, while in 58 (89%) the right surgical approach was delayed 30 days from the first procedure. We noticed 12 complications (9%): (a) chest pain in 6 patients (4 with electrocoagulation, 1 with ultrasonic scalpel, and 1 with radiofrequency dissector), which disappeared in 20 ± 1 day; (b) paresthesias in 3 electrocoagulation patients, was solved in 23 ± 5 days; (c) bradycardia in 1 ultrasonic patient, normalized in 4th postoperative hour; (d) unilateral relapse in 2 electrocoagulation patients after the second side approach, positively treated in 1 patient by resurgery in video-assisted thoracoscopy (VAT). The quality-adjusted life year and the quality of life evaluation revealed a statistically significant improvement (p = 0.02) in excessive sweating and general satisfaction after surgery, with Ultracision and LigaSure showing better findings than electrocoagulation. The latest generation devices offered greater efficacy in the treatment of hyperhidrosis, minimizing complications and facilitating the resumption of normal work and social activity of patients. Georg Thieme Verlag KG Stuttgart · New York.

  18. Long-term seizure, cognitive, and psychiatric outcome following trans-middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy.

    Science.gov (United States)

    Bujarski, Krzysztof A; Hirashima, Fuyuki; Roberts, David W; Jobst, Barbara C; Gilbert, Karen L; Roth, Robert M; Flashman, Laura A; McDonald, Brenna C; Saykin, Andrew J; Scott, Rod C; Dinnerstein, Eric; Preston, Julie; Williamson, Peter D; Thadani, Vijay M

    2013-07-01

    Previous comparisons of standard temporal lobectomy (STL) and selective amygdalohippocampectomy (SelAH) have been limited by inadequate long-term follow-up, variable definitions of favorable outcome, and inadequate consideration of psychiatric comorbidities. The authors performed a retrospective analysis of seizure, cognitive, and psychiatric outcomes in a noncontemporaneous cohort of 69 patients with unilateral refractory temporal lobe epilepsy and MRI evidence of mesial temporal sclerosis after either an STL or an SelAH and examined seizure, cognitive, and psychiatric outcomes. The mean duration of follow-up for STL was 9.7 years (range 1-18 years), and for trans-middle temporal gyrus SelAH (mtg-SelAH) it was 6.85 years (range 1-15 years). There was no significant difference in seizure outcome when "favorable" was defined as time to loss of Engel Class I or II status; better seizure outcome was seen in the STL group when "favorable" was defined as time to loss of Engel Class IA status (p=0.034). Further analysis revealed a higher occurrence of seizures solely during attempted medication withdrawal in the mtg-SelAH group than in the STL group (p=0.016). The authors found no significant difference in the effect of surgery type on any cognitive and most psychiatric variables. Standard temporal lobectomy was associated with significantly higher scores on assessment of postsurgical paranoia (p=0.048). Overall, few differences in seizure, cognitive, and psychiatric outcome were found between STL and mtg-SelAH on long-term follow-up. Longer exposure to medication side effects after mtg-SelAH may adversely affect quality of life but is unlikely to cause additional functional impairment. In patients with high levels of presurgical psychiatric disease, mtg-SelAH may be the preferred surgery type.

  19. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas.

    Science.gov (United States)

    Ruffini, Enrico; Filosso, Pier Luigi; Guerrera, Francesco; Lausi, Paolo; Lyberis, Paraskevas; Oliaro, Alberto

    2018-04-01

    Until recently, the surgical approach to thymic tumors has remained basically unchanged. The collaborative effort led by ITMIG with the collaboration of regional and society-based interest groups (ESTS, JART) produced an enthusiastic surge of interest in testing the new technological advances in thoracic surgery and many historical dogmas in thymic surgery have been questioned and challenged. The present review addresses the new trends in the optimal surgical management of thymic tumors based on the review of the current literature. 1. Minimally-invasive techniques (MIT) including video-assisted thoracic surgery (VATS) and robotic-assisted thoracic Surgery (RATS) are now to be considered the standard of care in early-stage thymic tumors. MIT are no inferior to open approaches in terms of postoperative complications, loco-regional recurrence rates and survival. MIT are associated with a shorter length of stay, reduced intraoperative blood loss and better cosmetic results. 2. The adoption of the ITMIG/IASLC TNM staging system for thymic tumors requires a paradigm shift among thoracic surgeons to include regional lymphadenectomy according to the IASLC/ITMIG nodal map in the surgical management of thymic tumors. 3. A limited thymectomy instead of total thymectomy along with the removal of the thymic tumor in nonmyasthenic Stage I-II tumors has been proposed by some authors, although the results are not uniform. Until more mature data is available, adherence to the current guidelines recommending total thymectomy in addition to thymomectomy is always indicated. 4. In locally-advanced Stage IVa patients with pleural involvement, major pleural resections, including pleurectomy/decortication or extrapleural pneumonectomy are indicated, provided a complete resection of the pleural deposits is anticipated, usually in a multidisciplinary setting, with excellent long-term results. The incorporation of these new concepts and techniques in the surgical armamentarium of the

  20. Handheld single photon emission computed tomography (handheld SPECT) navigated video-assisted thoracoscopic surgery of computer tomography-guided radioactively marked pulmonary lesions.

    Science.gov (United States)

    Müller, Joachim; Putora, Paul Martin; Schneider, Tino; Zeisel, Christoph; Brutsche, Martin; Baty, Florent; Markus, Alexander; Kick, Jochen

    2016-09-01

    Radioactive marking can be a valuable extension to minimally invasive surgery. The technique has been clinically applied in procedures involving sentinel lymph nodes, parathyroidectomy as well as interventions in thoracic surgery. Improvements in equipment and techniques allow one to improve the limits. Pulmonary nodules are frequently surgically removed for diagnostic or therapeutic reasons; here video-assisted thoracoscopic surgery (VATS) is the preferred technique. VATS might be impossible with nodules that are small or located deep in the lung. In this study, we examined the clinical application and safety of employing the newly developed handheld single photon emission tomography (handheld SPECT) device in combination with CT-guided radioactive marking of pulmonary nodules. In this pilot study, 10 subjects requiring surgical resection of a pulmonary nodule were included. The technique involved CT-guided marking of the target nodule with a 20-G needle, with subsequent injection of 25-30 MBq (effective: 7-14 MBq) Tc-99m MAA (Macro Albumin Aggregate). Quality control was made with conventional SPECT-CT to confirm the correct localization and exclude possible complications related to the puncture procedure. VATS was subsequently carried out using the handheld SPECT to localize the radioactivity intraoperatively and therefore the target nodule. A 3D virtual image was superimposed on the intraoperative visual image for surgical guidance. In 9 of the 10 subjects, the radioactive application was successfully placed directly in or in the immediate vicinity of the target nodule. The average size of the involved nodules was 9 mm (range 4-15). All successfully marked nodules were subsequently completely excised (R0) using VATS. The procedure was well tolerated. An asymptomatic clinically insignificant pneumothorax occurred in 5 subjects. Two subjects were found to have non-significant discrete haemorrhage in the infiltration canal of the needle. In a single subject, the

  1. [Pulmonary resection using video-assisted thoracoscopic surgery--20 years experience].

    Science.gov (United States)

    Baste, J-M; Orsini, B; Rinieri, P; Melki, J; Peillon, C

    2014-04-01

    Major lung resection using minimally invasive techniques - video-assisted thoracoscopic surgery (VATS) - was first described 20 years ago. However, its development has been slow in many countries because the value of this approach has been questioned. Different techniques and definitions of VATS are used and this can be confusing for physicians and surgeons. The benefit of minimally invasive thoracic surgery was not always apparent, while many surgeons pointed to suboptimal operative outcomes. Recently, technological advances (radiology, full HD monitor and new stapler devices) have improved VATS outcomes. The objectives of this review are to emphasize the accepted definition of VATS resection, outline the different techniques developed and their results including morbidity and mortality compared to conventional approaches. Minimally invasive thoracic surgery has not been proven to give superior survival (level one evidence) compared to thoracotomy. A slight advantage has been demonstrated for short-term outcomes. VATS is not a surgical revolution but rather an evolution of surgery. It should be considered together with the new medical environment including stereotactic radiotherapy and radiofrequency. VATS seems to be more accurate in the treatment of small lung lesions diagnosed with screening CT scan. In the academic field, VATS allows easier teaching and diffusion of techniques. Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  2. Monitoring of lobectomy in cystic fibrosis with electrical impedance tomography - a new diagnostic tool.

    Science.gov (United States)

    Lehmann, Sylvia; Tenbrock, Klaus; Schrading, Simone; Pikkemaat, Robert; Antink, Christoph Hoog; Santos, Susana; Spillner, Jan Wilhelm; Wagner, Norbert; Leonhardt, Steffen

    2014-12-01

    Electrical impedance tomography (EIT) is a radiation-free technique generating cross-sectional images of the lung. EIT visualizes global and regional ventilation by illustrating the distribution of electrical bioimpedance. With an electrode belt around the patient's thorax, rotating injection-couples of a harmless alternating current allow voltage measurement of the remaining electrodes. This enables the reconstruction of a tomogram with highly dynamic changes within ventilation. We report on a female six-year-old patient with cystic fibrosis and complete destruction of the upper and middle lobe of the right lung. Lobectomy, a rare therapeutic option in patients with cystic fibrosis that needs to be considered in cases of severe localized destruction, was performed. We show a pre- and postoperative documentation of static (radiology) and dynamic investigation tools (spirometry) in correlation with EIT as a new non-invasive and radiation-free diagnostic tool for this patient group.

  3. O n-butil cianoacrilato na lobectomia pulmonar parcial em felinos: estudo experimental The n-butyl cyanoacrilate in partial lung lobectomy in cats: experimental study

    Directory of Open Access Journals (Sweden)

    Marcos Makoto Ishizaki

    2005-02-01

    Full Text Available O presente estudo teve como objetivo verificar a viabilidade do n-butil cianoacrilato na pneumostasia e hemostasia em lobectomia pulmonar parcial. Foram utilizadas seis gatas hígidas, adultas, com peso médio de três quilogramas. O procedimento cirúrgico consistiu na realização de toracotomia intercostal com lobectomia pulmonar parcial em que se utilizou adesivo cirúrgico para fechamento do lobo pulmonar. Após 21 dias da cirurgia, os animais foram novamente submetidos à toracotomia para a coleta de fragmento da região onde o adesivo fora aplicado, para análise histopatológica. Foram realizadas radiografias de tórax das pacientes para o acompanhamento pré e pós lobectomia pulmonar parcial e, aos dois, sete, 14 e 21 dias subseqüentes. As alterações radiográficas e clínicas encontradas como pneumotórax residual, aumento na densidade pulmonar, enfisema subcutâneo e apatia foram corrigidas em tempo hábil, não comprometendo os resultados do estudo. A histopatologia evidenciou reação inflamatória com predomínio de células mononucleares, neovascularização, proliferação de tecido conjuntivo e pequenas áreas de enfisema e atelectasia, sem comprometimento clínico significativo. Concluiu-se que o cianoacrilato é capaz de produzir adequada pneumostasia e hemostasia, e poderá ser uma opção para a realização de lobectomia pulmonar parcial em felinos.The n-butyl cyanoacrilate tissue adhesive was used in this study aiming to verify the viability of its use for hemostasis and to avoid air leakage in partial lung lobectomy. Six healthy adult female domestic shorthair cats, weight range of three kg were submitted to an intercostal thoracotomy with partial lung lobectomy using n-butyl cyanoacrilate to close the lobe. After 21 days they were submitted to another thoracotomy to collect a fragment of the lung where the adhesive was applied to a histopathological study. Chest films were taken pre and post partial lung lobectomy

  4. One-and-a-half ventricular repair for isolated right ventricle metastatic tumor resection after lobectomy for lung cancer.

    Science.gov (United States)

    Shiose, Akira; Desai, Parag; Criner, Gerard J; Pai, Sheela; Steiner, Robert M; Kaiser, Larry R; Guy, T Sloane; Toyoda, Yoshiya

    2014-01-01

    A 77-year-old woman presented with shortness of breath 1 year after a right upper lobectomy for lung cancer. She showed a possible intracardiac metastasis on positron emission tomography scan. There was no other evidence of recurrence. The large right ventricular mass was associated with the right ventricle free wall, the apex, the papillary muscle, and the chordae to the tricuspid valve. After mass resection of the right ventricle, a one-and-a-half ventricular repair was performed with tricuspid valve replacement and defect closure. The patient was discharged on postoperative day 14 without complications and has been well for the first 3 months after the surgery.

  5. Bilateral perisylvian ulegyria: an under-recognized, surgically remediable epileptic syndrome.

    Science.gov (United States)

    Schilling, Lucas P; Kieling, Renata R; Pascoal, Tharick A; Kim, Hyoung-Ihl; Lee, Min Cheol; Kim, Yun Hee; Paglioli, Eliseu; Neto, Pedro R; Costa, Jaderson C; Palmini, Andre

    2013-08-01

    Interest in the association of epilepsy and pseudobulbar palsy was rekindled since the identification through magnetic resonance imaging (MRI) of bilateral perisylvian polymicrogyria (PMG). Seizures are often intractable, but resective epilepsy surgery has not been recommended. However, a similar clinical picture can be encountered in patients with bilateral perisylvian destructive lesions, which fit the description of ulegyria (ULG). We report a series of patients with epilepsy and pseudobulbar palsy due to bilateral perisylvian ULG (BP-ULG), show that hippocampal sclerosis (HS) is often associated and highlight the fact that in this entity, unlike in malformative bilateral perisylvian PMG, seizures may be surgically treated. The motor, cognitive, epileptologic, and imaging features of 12 patients with perisylvian ULG followed at three institutions are described. For patients with refractory seizures, we detail extracranial and intracranial electrographic recordings, surgical strategies, histopathologic analyses of the resected tissue, and outcome of surgical treatment. Descriptive statistics were used for quantitative and categorical variables. Student's t-test was used to compare means, and a p Dual pathology with associated unilateral HS was present in four. One patient with dual pathology had a temporolimbic electroclinical picture and had an anterior temporal lobectomy (ATL) based upon noninvasive evaluation. The other four had ictal semiology suggesting involvement of both temporolimbic and perisylvian cortex. Intracranial electroencephalography (EEG) showed concomitant seizure onset in the anterior temporal region and in the ipsilateral ULG in three of the four with dual pathology and in the ulegyric cortex in the one without HS. Resection guided by a combination of semiology, MRI, and extra and intracranial EEG led to complete seizure control in two and almost complete seizure control (Engel class II) in two other patients. The only surgical failure was an

  6. Subcarinal Lymph Nodes Should be Dissected in All Lobectomies for Non-Small Cell Lung Cancer

    DEFF Research Database (Denmark)

    Eckardt, Jens; Jakobsen, Erik; Licht, Peter B

    2017-01-01

    BACKGROUND: Mediastinal staging is of paramount importance for planning of treatment in non-small cell lung cancer (NSCLC). Single institution reports recently claimed that subcarinal lymph node dissection during resection of upper lobe NSCLC could be spared. We used a complete national lung cancer...... registry to investigate patterns of unsuspected mediastinal lymph node involvement after lobectomy. METHODS: During an 11-year period (2004 to 2014) 5,577 consecutive patients who underwent operations for NSCLC were investigated for unsuspected mediastinal lymph node involvement (N2 disease) discovered......: Mediastinal lymph node dissection was performed in 5,577 patients during the operation, and unsuspected N2 disease was discovered in 612 (11.0%), and 193 (3.5%) had subcarinal metastasis. Subcarinal N2 disease was significantly more common in patients with lower-lobe or middle-lobe cancers compared with upper...

  7. Characterization of a Staphylococcal Plasmid Related to pUB110 and Carrying Two Novel Genes, vatC and vgbB, Encoding Resistance to Streptogramins A and B and Similar Antibiotics

    Science.gov (United States)

    Allignet, Jeanine; Liassine, Nadia; El Solh, Névine

    1998-01-01

    We isolated and sequenced a plasmid, named pIP1714 (4,978 bp), which specifies resistance to streptogramins A and B and the mixture of these compounds. pIP1714 was isolated from a Staphylococcus cohnii subsp. cohnii strain found in the environment of a hospital where pristinamycin was extensively used. Resistance to both compounds and related antibiotics is encoded by two novel, probably cotranscribed genes, (i) vatC, encoding a 212-amino-acid (aa) acetyltransferase that inactivates streptogramin A and that exhibits 58.2 to 69.8% aa identity with the Vat, VatB, and SatA proteins, and (ii) vgbB, encoding a 295-aa lactonase that inactivates streptogramin B and that shows 67% aa identity with the Vgb lactonase. pIP1714 includes a 2,985-bp fragment also found in two rolling-circle replication and mobilizable plasmids, pUB110 and pBC16, from gram-positive bacteria. In all three plasmids, the common fragment was delimited by two direct repeats of four nucleotides (GGGC) and included (i) putative genes closely related to repB, which encodes a replication protein, and to pre(mob), which encodes a protein required for conjugative mobilization and site-specific recombination, and (ii) sequences very similar to the double- and single-strand origins (dso, ssoU) and the recombination site, RSA. The antibiotic resistance genes repB and pre(mob) carried by each of these plasmids were found in the same transcriptional orientation. PMID:9661023

  8. Characterization of a staphylococcal plasmid related to pUB110 and carrying two novel genes, vatC and vgbB, encoding resistance to streptogramins A and B and similar antibiotics.

    Science.gov (United States)

    Allignet, J; Liassine, N; el Solh, N

    1998-07-01

    We isolated and sequenced a plasmid, named pIP1714 (4,978 bp), which specifies resistance to streptogramins A and B and the mixture of these compounds. pIP1714 was isolated from a Staphylococcus cohnii subsp. cohnii strain found in the environment of a hospital where pristinamycin was extensively used. Resistance to both compounds and related antibiotics is encoded by two novel, probably cotranscribed genes, (i) vatC, encoding a 212-amino-acid (aa) acetyltransferase that inactivates streptogramin A and that exhibits 58.2 to 69.8% aa identity with the Vat, VatB, and SatA proteins, and (ii) vgbB, encoding a 295-aa lactonase that inactivates streptogramin B and that shows 67% aa identity with the Vgb lactonase. pIP1714 includes a 2,985-bp fragment also found in two rolling-circle replication and mobilizable plasmids, pUB110 and pBC16, from gram-positive bacteria. In all three plasmids, the common fragment was delimited by two direct repeats of four nucleotides (GGGC) and included (i) putative genes closely related to repB, which encodes a replication protein, and to pre(mob), which encodes a protein required for conjugative mobilization and site-specific recombination, and (ii) sequences very similar to the double- and single-strand origins (dso, ssoU) and the recombination site, RSA. The antibiotic resistance genes repB and pre(mob) carried by each of these plasmids were found in the same transcriptional orientation.

  9. Pulmonary function after segmentectomy for small peripheral carcinoma of the lung.

    Science.gov (United States)

    Takizawa, T; Haga, M; Yagi, N; Terashima, M; Uehara, H; Yokoyama, A; Kurita, Y

    1999-09-01

    The aim of this study is to compare the pulmonary function after a segmentectomy with that after a lobectomy for small peripheral carcinoma of the lung. Between 1993 and 1996, segmentectomy and lobectomy were performed on 48 and 133 good-risk patients, respectively. Lymph node metastases were detected after the operation in 6 and 24 patients of the segmentectomy and lobectomy groups, respectively. For bias reduction in comparison with a nonrandomized control group, we paired 40 segmentectomy patients with 40 lobectomy patients using nearest available matching method on the estimated propensity score. Twelve months after the operation, the segmentectomy and lobectomy groups had forced vital capacities of 2.67 +/- 0.73 L (mean +/- standard deviation) and 2.57 +/- 0.59 L, which were calculated to be 94.9% +/- 10.6% and 91.0% +/- 13.2% of the preoperative values (P =.14), respectively. The segmentectomy and lobectomy groups had postoperative 1-second forced expiratory volumes of 1.99 +/- 0.63 L and 1.95 +/- 0.49 L, which were calculated to be 93.3% +/- 10.3% and 87.3% +/- 14.0% of the preoperative values, respectively (P =.03). The multiple linear regression analysis showed that the alternative of segmentectomy or lobectomy was not a determinant for postoperative forced vital capacity but did affect postoperative 1-second forced expiratory volume. Pulmonary function after a segmentectomy for a good-risk patient is slightly better than that after a lobectomy. However, segmentectomy should be still the surgical procedure for only poor-risk patients because of the difficulty in excluding patients with metastatic lymph nodes from the candidates for the procedure.

  10. Hippocampal sclerosis: correlation of MR imaging findings with surgical outcome

    International Nuclear Information System (INIS)

    Kim, Yoon Hee; Chang, Kee Hyun; Kim, Kyung Won; Han, Moon Hee; Park, Sung Ho; Nam, Hyun Woo; Choi, Kyu Ho; Cho, Woo Ho

    2001-01-01

    Atrophy and a high T2 signal of the hippocampus are known to be the principal MR imaging findings of hippocampal sclerosis. The purpose of this study was to determine whether or not individual MRI findings correlate with surgical outcome in patients with this condition. Preoperative MR imaging findings in 57 consecutive patients with pathologically-proven hippocampal sclerosis who underwent anterior temporal lobectomy and were followed-up for 24 months or more were retrospectively reviewed, and the results were compared with the postsurgical outcome (Engel classification). The MR images included routine sagittal T1-weighted and axial T2-weighted spin-echo images, and oblique coronal T1-weighted 3D gradient-echo and T2-weighted 2D fast spin-echo images obtained on either a 1.5 T or 1.0 T unit. The images were visually evaluated by two neuroradiologists blinded to the outcome; their focus was the presence or absence of atrophy and a high T2 hippocampal signal. Hippocampal atrophy was seen in 96% of cases (55/57) [100% (53/53) of the good outcome group (Engel class I and II), and 50% (2/4) of the poor outcome group (class III and IV)]. A high T2 hippocampal signal was seen in 61% of cases (35/57) [62% (33/53) of the good outcome group and 50% (2/4) of the poor outcome group]. All 35 patients with a high T2 signal had hippocampal atrophy. 'Normal' hippocampus, as revealed by MR imaging, occurred in 4% of patients (2/57), both of whom showed a poor outcome (Engel class III). The presence or absence of hippocampal atrophy correlated well with surgical outcome (p 0.05). Compared with a high T2 hippocampal signal, hippocampal atrophy is more common and correlates better with surgical outcome. For the prediction of this, it thus appears to be the more useful indicator

  11. Quantification of a Secondary Task-Specific Tremor in a Violinist after a Temporal Lobectomy

    Directory of Open Access Journals (Sweden)

    André eLee

    2014-07-01

    Full Text Available Task-specific tremors occur mainly during certain tasks and may be highly disabling. In this case study, we report on a 66-year-old violinist who developed a task-specific tremor of the right arm only while playing the violin four weeks after a temporal lobectomy, which had been performed as a result of his temporal lobe epilepsy. Since a similar case, to our knowledge, has not been reported so far, our aim was to quantitatively assess and describe the tremor by measuring (a the electromyography (EMG activity of the wrist flexor and extensor as well as (b an accelerometer signal of the hand. We found a tremor-related frequency of about 7 Hz. Furthermore, at a similar frequency of about 7 Hz, there was coherence between the tremor acceleration and EMG-activity of the wrist flexor and extensor as well as between the tremor acceleration and coactivation. The tremorgenesis remains unclear, and possible explanations can only be speculative.

  12. Pryce type I sequestration: no mosquito shooting.

    Science.gov (United States)

    Barik, Ramachandra; Patnaik, Amar Narayan; Malempati, Amaresh Rao; Nemani, Lalita

    2015-06-01

    We report a case of a 40-year-old woman with congenital dual arterial supply to an otherwise normal left lower lobe, causing hyperperfusion lung injury. In addition to near normal pulmonary arterial supply, the lower lobe of the left lung received a systemic arterial supply from the descending thoracic aorta. The patient was successfully managed by surgical ligation of the systemic arterial supply without lobectomy. We discuss when to defer lobectomy in Pryce type I sequestration. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. The usefulness of two-port video-assisted thoracosopic surgery in low-risk patients with secondary spontaneous pneumothorax compared with open thoracotomy

    Directory of Open Access Journals (Sweden)

    Kyoung Taek Park

    2014-01-01

    Conclusion: In selected patients with secondary spontaneous pneumothorax treated with surgical approach, two-port VATS resulted in shorter postoperative drainage period and hospital stay compared with open thoracotomy.

  14. Lung Middle Lobe Laceration Needing Lobectomy as Complication of Nuss Bar Removal.

    Science.gov (United States)

    Henry, Brice; Lacroix, Valérie; Pirotte, Thierry; Docquier, Pierre-Louis

    2018-01-01

    Minimally invasive procedure for the treatment of pectus excavatum as described by Nuss has been used from 1987. The bar initially introduced blindly is now introduced under thoracoscopic control to increase safety of the procedure. It is usually removed two to three years after its insertion in a one-day procedure. Complications of the bar removal are rare but potentially serious. We report the case of a serious complication which occurred immediately after the Nuss bar removal. A 15-year-old boy underwent a Nuss procedure for a severe pectus excavatum without relevant complication. The bar has been removed two years after its insertion in a minimally invasive procedure. Unfortunately, he developed in the immediate postoperative period a hemopneumothorax due to a right middle lobe laceration which required a middle lobectomy by thoracotomy for hemostasis. Lesions of intrathoracic organs are a rare but potentially serious complication of the removal of the Nuss bar. We now propose to perform this procedure under thoracoscopic control to avoid it. In our experience, adhesions between the bar and the pleura are always present, and those with potential risk for bleeding or inducing intrathoracic organ lesions are suppressed prior to the bar removal.

  15. Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis?

    Science.gov (United States)

    Zahid, Imran; Sharif, Sumera; Routledge, Tom; Scarci, Marco

    2011-01-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was how video-assisted thoracoscopic surgery (VATS) compares to median sternotomy in the surgical management of patients with myasthenia gravis (MG)? Overall 74 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that VATS produces equivalent postoperative mortality and complete stable remission (CSR) rates, with superior results in terms of hospital stay, operative blood loss and patient satisfaction at the expense of a doubling of operative time. Six studies comparing VATS and transsternal sternotomy in non-thymomatous myasthenia gravis (NTMG) patients found VATS to have lower operative blood loss (73.8±70.7 vs. 155.3±91.7 ml; P0.05). One study comparing video-assisted thoracoscopic extended thymectomy to transsternal thymectomy in only thymoma-associated myasthenia gravis (T-MG) patients found equivalent CSR (11.3 vs. 8.7%, P=0.1090) at six-year follow-up. Thymoma recurrence rate (9.64%) was not significantly different (P=0.1523) between the two groups. Eight studies comparing VATS and transsternal approach in mixed T-MG and NTMG patients found a lower hospital stay (1.9±2.6 vs. 4.6±4.2 days, P<0.001), reduced need for postoperative medication (76.5 vs. 35.7%, P=0.022), lower intensive care unit stay (1.5 vs. 3.2 days, P=0.018), greater symptom improvement (100 vs. 77.9%, P=0.019) and better cosmetic satisfaction (100 vs. 83, P=0.042) with VATS. In concordance with NTMG and T-MG alone patient groups, VATS and transsternal methods had equivalent complication rates (23 vs. 19%, P=0.765) with no mortalities in either group. Even though VATS has a longer operative time (268±51 vs. 177±92 min, P<0.05), its improved cosmesis, reduced need

  16. Continuous infusion of recombinant activated factor VII for bleeding control after lobectomy in a patient with inherited factor VII deficiency.

    Science.gov (United States)

    Miyata, Naoko; Isaka, Mitsuhiro; Kojima, Hideaki; Maniwa, Tomohiro; Takahashi, Shoji; Takamiya, Osamu; Ohde, Yasuhisa

    2016-03-01

    Inherited factor VII (FVII) deficiency is a rare recessive inherited coagulation disorder with limited available information, especially in patients undergoing major thoracic surgery. In addition, an optimal management strategy for the disease has not been defined. We herein report a case involving a 61-year-old man with asymptomatic FVII deficiency who underwent a right middle and lower lobectomy to treat lung cancer. To the best of our knowledge, the present report is the first to describe the use of recombinant activated FVII continuous infusion for bleeding control after a major thoracic surgery in a patient with inherited FVII deficiency.

  17. Thymoma and minimally invasive surgical treatment

    International Nuclear Information System (INIS)

    Krajc, T.; Spalek, P.; Lucenic, M.; Benej, R.; Harustiak, S.

    2011-01-01

    The authors review the current thymoma classification schemes, diagnosis and surgical treatment options. Many minimally invasive techniques do not provide sufficient extensiveness when compared to complete sternotomy. The Zieliński technique combines transcervical, subxiphoidal and bilateral thoracoscopic approach in a hybrid procedure (MMIT, maximal minimally invasive thymectomy) based on double sternal traction, and allows for removal of the thymus gland, the thymoma and all the relevant mediastinal adipose tissue, thus adhering to principles of oncological radicality. Of the 28 patients undergoing MMIT there were 7 with myasthenia associated thymoma (MGAT) and 5 with a thymoma and no myasthenia, tumors staged Masaoka I-II. Apart from one temporary recurrent nerve palsy there were no postoperative complications. The largest thymoma measured 70 x 65 x 55 mm. Adjuvant radiotherapy was applied in 5 patients. Ectopic thymic tissue was identified in 100 % of patients with thymoma and no myasthenia and in 42.9 % of MGAT patients. Until now there were no recurrences, however, the follow-up median is very short, the longest follow-up period being 30 months. MMIT is a safe technique suitable also for Masaoka I-II thymoma patients and for some specific cases with Masaoka III stage (lung parenchyma invasion). The authors approach all the anterior mediastinal tumors with no mediastinal lymphadenopathy and no myasthenia as a potential thymoma and always attempt the MMIT procedure starting as VATS procedure on the side of tumor. (author)

  18. Thoracoscopic versus open pulmonary metastasectomy

    DEFF Research Database (Denmark)

    Eckardt, Jens; Licht, Peter B

    2012-01-01

    ABSTRACTBACKGROUND:Patients with limited metastatic disease in the lung may benefit from metastasectomy. Thoracotomy is considered gold standard and video-assisted thoracoscopic surgery (VATS) is controversial because non-imaged nodules may be missed when bimanual palpation is restricted. Against...... intent but several non-imaged and therefore unexpected nodules are frequent during subsequent observer blinded thoracotomy. A substantial proportion of these nodules are malignant and despite modern imaging and surgical technology they would have been missed if VATS was used exclusively...

  19. Prediction of post-operative pulmonary function after lobectomy for primary lung cancer: A comparison among counting method, effective lobar volume, and lobar collapsibility using inspiratory/expiratory CT

    Energy Technology Data Exchange (ETDEWEB)

    Yabuuchi, Hidetake, E-mail: h-yabu@med.kyushu-u.ac.jp [Department of Health Sciences, Kyushu University Graduate School of Medical Sciences, Fukuoka (Japan); Kawanami, Satoshi, E-mail: kawanami_01@mac.com [Department of Clinical Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka (Japan); Kamitani, Takeshi, E-mail: kamitani@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka (Japan); Yonezawa, Masato, E-mail: ymasato@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka (Japan); Yamasaki, Yuzo, E-mail: yyama@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka (Japan); Yamanouchi, Torahiko, E-mail: tora0228jp@yahoo.co.jp [Department of Clinical Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka (Japan); Nagao, Michinobu, E-mail: minagao@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka (Japan); Okamoto, Tatsuro, E-mail: tatsuro@surg2.med.kyushu-u.ac.jp [Department of Surgery and Science, Kyushu University Graduate School of Medical Sciences, Fukuoka (Japan); Honda, Hiroshi, E-mail: honda@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka (Japan)

    2016-11-15

    Highlights: • ΔFEV{sub 1.0} and ppoΔFEV{sub 1.0} using lobar collapsibility were strongly correlated. • ΔVC and ppoΔVC using effective lobar volume were strongly correlated. • Counting method was inferior to lobar collapsibility for prediction of ppoFEV{sub 1.0}. • Inspiratory/expiratory CT is useful to predict post-operative pulmonary function. - Abstract: Purpose: To compare the predictabilities of postoperative pulmonary function after lobectomy for primary lung cancer among counting method, effective lobar volume, and lobar collapsibility. Methods: Forty-nine patients who underwent lobectomy for primary lung cancer were enrolled. All patients underwent inspiratory/expiratory CT and pulmonary function tests 2 weeks before surgery and postoperative pulmonary function tests 6–7 months after surgery. Pulmonary function losses (ΔFEV{sub 1.0} and ΔVC) were calculated from the pulmonary function tests. Predictive postoperative pulmonary function losses (ppoΔFEV{sub 1.0} and ppoΔVC) were calculated using counting method, effective volume, and lobar collapsibility. Correlations and agreements between ΔFEV{sub 1.0} and ppoFEV{sub 1.0} and those between ΔVC and ppoΔVC were tested among three methods using Spearman’s correlation coefficient and Bland-Altman plots. Results: ΔFEV{sub 1.0} and ppoΔFEV{sub 1.0insp-exp} were strongly correlated (r = 0.72), whereas ΔFEV{sub 1.0} and ppoΔFEV{sub 1.0count} and ΔFEV{sub 1.0} and Pred. ΔFEV{sub 1.0eff.vol.} were moderately correlated (r = 0.50, 0.56). ΔVC and ppoΔVC{sub eff.vol.} (r = 0.71) were strongly correlated, whereas ΔVC and ppoΔVC{sub count}, and ΔVC and ppoΔVC {sub insp-exp} were moderately correlated (r = 0.55, 0.42). Conclusions: Volumetry from inspiratory/expiratory CT data could be useful to predict postoperative pulmonary function after lobectomy for primary lung cancer.

  20. Non-invasive examinations successfully select patients with medial temporal lobe epilepsy for anterior temporal lobectomy

    Energy Technology Data Exchange (ETDEWEB)

    Morioka, Takato; Nishio, Shunji; Kawamura, Tadao; Fukui, Kimiko; Sasaki, Masayuki; Fukui, Masashi [Kyushu Univ., Fukuoka (Japan). Graduate School of Medical Sciences

    2001-06-01

    We retrospectively analyzed 8 patients with intractable medial temporal lobe epilepsy (MTLE) who underwent the anterior temporal lobectomy with hippocampectomy (ATL) without invasive examinations such as chronic subdural electrode recording. Five patients had a history of febrile convulsion. While all 8 patients had oral automatism, automatism of ipsilateral limbs with dystonic posture of contralateral limbs was demonstrated in 2 patients. Bilateral temporal paroxysmal activities on interictal EEG was observed in 4 patients and all patients had clear ictal onset zone on unilateral anterior temporal region. MRI demonstrated unilateral hippocampal sclerosis in 5 cases. Interictal FDG-PET depicted hypometabolism of the unilateral temporal lobe in all cases, however, ECD-SPECT failed to reveal the hypoperfusion of the unilateral temporal lobe in a case. Postoperatively, 7 cases became seizure free, and one had rare seizure. Non-invasive examinations, especially ictal EEG and concordant FDG-PET findings, in patients with oral automatism in seizure semiology, successfully select patients with MTLE for ATL. (author)

  1. Non-invasive examinations successfully select patients with medial temporal lobe epilepsy for anterior temporal lobectomy

    International Nuclear Information System (INIS)

    Morioka, Takato; Nishio, Shunji; Kawamura, Tadao; Fukui, Kimiko; Sasaki, Masayuki; Fukui, Masashi

    2001-01-01

    We retrospectively analyzed 8 patients with intractable medial temporal lobe epilepsy (MTLE) who underwent the anterior temporal lobectomy with hippocampectomy (ATL) without invasive examinations such as chronic subdural electrode recording. Five patients had a history of febrile convulsion. While all 8 patients had oral automatism, automatism of ipsilateral limbs with dystonic posture of contralateral limbs was demonstrated in 2 patients. Bilateral temporal paroxysmal activities on interictal EEG was observed in 4 patients and all patients had clear ictal onset zone on unilateral anterior temporal region. MRI demonstrated unilateral hippocampal sclerosis in 5 cases. Interictal FDG-PET depicted hypometabolism of the unilateral temporal lobe in all cases, however, ECD-SPECT failed to reveal the hypoperfusion of the unilateral temporal lobe in a case. Postoperatively, 7 cases became seizure free, and one had rare seizure. Non-invasive examinations, especially ictal EEG and concordant FDG-PET findings, in patients with oral automatism in seizure semiology, successfully select patients with MTLE for ATL. (author)

  2. Metachronous Lung Cancer: Clinical Characteristics and Effects of Surgical Treatment.

    Science.gov (United States)

    Rzechonek, Adam; Błasiak, Piotr; Muszczyńska-Bernhard, Beata; Pawełczyk, Konrad; Pniewski, Grzegorz; Ornat, Maciej; Grzegrzółka, Jędrzej; Brzecka, Anna

    2018-01-01

    The occurrence of a second lung tumor after surgical removal of lung cancer usually indicates a lung cancer metastasis, but sometimes a new lesion proves to be a new primary lung cancer, i.e., metachronous lung cancer. The goal of the present study was to conduct a clinical evaluation of patients with metachronous lung cancer and lung cancer metastasis, and to compare the early and distant outcomes of surgical treatment in both cancer types. There were 26 age-matched patients with lung cancer metastases and 23 patients with metachronous lung cancers, who underwent a second lung cancer resection. We evaluated the histological type of a resected cancer, the extent of thoracosurgery, the frequency of early postoperative complications, and the probability of 5-year survival after the second operation. The findings were that metachronous lung cancer was adenocarcinoma in 52% of patients, with a different histopathological pattern from that of the primary lung cancer in 74% of patients. In both cancer groups, mechanical resections were the most common surgery type (76% of all cases), with anatomical resections such as segmentectomy, lobectomy, or pneumectomy being much rarer conducted. The incidence of early postoperative complications in metachronous lung cancer and lung cancer metastasis (30% vs. 31%, respectively) and the probability of 5-year survival after resection of either cancer tumor (60.7% vs. 50.9%, respectively) were comparable. In conclusion, patients undergoing primary lung cancer surgery require a long-term follow-up due to the risk of metastatic or metachronous lung cancer. The likelihood of metachronous lung cancer and pulmonary lung cancer metastases, the incidence of postoperative complications, and the probability of 5-year survival after resection of metachronous lung cancer or lung cancer metastasis are similar.

  3. The patient had a normal magnetic resonance imaging and temporal lobe epilepsy secondary to a porencephalic cyst but showed structural lesions (hippocampal sclerosis)☆

    Science.gov (United States)

    Matsubara, Teppei; Ayuzawa, Satoshi; Aoki, Tsukasa; Fujiomto, Ayataka; Osuka, Satoru; Matsumura, Akira

    2013-01-01

    Patients with a porencephalic cyst frequently develop intractable temporal lobe epilepsy (TLE). We report a surgically-treated male patient with intractable mesial TLE (mTLE) secondary to a porencephalic cyst. Although magnetic resonance imaging showed no hippocampal abnormalities, long-term video-electrocorticography revealed seizure onset discharges in the hippocampus. Temporal lobectomy brought an end to the patient's seizures. Hippocampal sclerosis was histopathologically confirmed (dual pathology). Careful evaluation of hippocampal epileptogenicity is required, and temporal lobectomy, which is less invasive than hemispherectomy, can be a treatment of choice for patients with mTLE secondary to a porencephalic cyst. PMID:25667851

  4. Simulation of the fissureless technique for thoracoscopic segmentectomy using rapid prototyping.

    Science.gov (United States)

    Akiba, Tadashi; Nakada, Takeo; Inagaki, Takuya

    2015-01-01

    The fissureless lobectomy or anterior fissureless technique is a novel surgical technique, which avoids dissection of the lung parenchyma over the pulmonary artery during lobectomy by open thoracotomy approach or direct vision thoracoscopic surgery. This technique is indicated for fused lobes. We present two cases where thoracoscopic pulmonary segmentectomy was performed using the fissureless technique simulated by three-dimensional (3D) pulmonary models. The 3D model and rapid prototyping provided an accurate anatomical understanding of the operative field in both cases. We believe that the construction of these models is useful for thoracoscopic and other complicated surgeries of the chest.

  5. Simulation of the Fissureless Technique for Thoracoscopic Segmentectomy Using Rapid Prototyping

    Science.gov (United States)

    Nakada, Takeo; Inagaki, Takuya

    2014-01-01

    The fissureless lobectomy or anterior fissureless technique is a novel surgical technique, which avoids dissection of the lung parenchyma over the pulmonary artery during lobectomy by open thoracotomy approach or direct vision thoracoscopic surgery. This technique is indicated for fused lobes. We present two cases where thoracoscopic pulmonary segmentectomy was performed using the fissureless technique simulated by three-dimensional (3D) pulmonary models. The 3D model and rapid prototyping provided an accurate anatomical understanding of the operative field in both cases. We believe that the construction of these models is useful for thoracoscopic and other complicated surgeries of the chest. PMID:24633132

  6. A modified method using a two-port approach for accessing the hilar vasculature without transferring an endostapler from camera port to utility port during thoracoscopic right upper lobectomy.

    Science.gov (United States)

    Jiao, W; Zhao, Y; Xuan, Y; Wang, M

    2015-02-01

    For thoracoscopic upper lobectomies, most cutting endostaplers must be inserted through the camera port when using a two-port approach. Access to the hilar vasculature through only the utility port remains a challenge. In this study, we describe a procedure to access the hilar vasculature without transferring the endostapler site during a thoracoscopic right upper lobectomy. A 2.5-cm utility anterior incision was made in the fourth intercostal space. The posterior mediastinal visceral pleura were dissected to expose the posterior portion of the right upper bronchus and the anterior trunk of the right pulmonary artery. The pleura over the right hilar vasculature were then peeled with an electrocoagulation hook. The anterior trunk of the right pulmonary artery was then transected with a cutting endostapler through the utility port firstly. This crucial maneuver allowed the endostapler access to the right upper lobe pulmonary vein. The hilar structures were then easily handled in turn. This novel technique was performed successfully in 32 patients, with no perioperative deaths. The average operation time was 120.6 min (range 75-180 min). This novel technique permits effective control of the hilar vessels through the utility port, enabling simple, safe, quick and effective resection.

  7. Sleeve lobectomy versus pneumonectomy for non-small cell lung cancer: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Shi Woda

    2012-12-01

    Full Text Available Abstract Aim It is controversial that whether sleeve lobectomy (SL should be promoted more worthy than pneumonectomy (PN in suitable patients. Methods We searched all studies that had been published in English from PUBMED and Embase which compared the short-term and long-term outcomes of SL and pneumonectomy (PN in patients with non-small cell lung cancer (NSCLC. Results Nineteen studies met our criteria with a combined total of 3878 subjects, of which 1316 (33.9% underwent SL and 2562 (66.1% underwent PN. The odds ratio was 0.50 (95% CI: 0.34-0.72 for postoperative mortality, 1.17 (95% CI: 0.82-1.67 for postoperative complications, 0.78 (95% CI: 0.47-1.29 for locoregional recurrences. The risk difference for 1-, 3-, 5- year was 0.11 (95% CI: 0.07-0.14, 0.15 (95% CI: 0.06-0.24, 0.15 (95% CI: 0.09-0.20,respectively. The pooled hazard ratio was 0.63 (95% CI: 0.56-0.71 in favor of SL group. Conclusion SL is more worthy to be done than PN in suitable patients with less mortality and better long-term survival.

  8. Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology.

    Science.gov (United States)

    Lévesque, M F; Nakasato, N; Vinters, H V; Babb, T L

    1991-09-01

    The authors present their review of 178 patients who underwent en bloc temporal lobectomies as surgical treatment for intractable epilepsy. Hippocampal cell density was quantitatively analyzed and the histology of the anterior temporal lobe was reviewed. Fifty-four patients (30.3%) had evidence of extrahippocampal lesions in addition to neuronal cell loss within the hippocampus (the dual pathology group). The pattern of cell loss was analyzed in the remaining 124 cases (69.7%) with no extrahippocampal pathology, and compared with that of the dual pathology group and a control group of four nonepileptic patients. Hippocampal cell loss was found in almost all epileptic patients compared to the control group. Severe cell loss greater than 30% of control values was found in 88.7% of patients without extrahippocampal lesions, but in only 51.8% of patients with dual pathology. The difference between these two groups was statistically significant (p less than 0.001). In the dual pathology group, lesions of different pathology had a significant relationship with the degree of hippocampal cell loss: all 12 patients with glioma had mild cell loss, whereas all 13 patients with heterotopia were associated with severe cell loss. Severity of hippocampal cell loss was also analyzed in relation to seizure history: a prior severe head injury was associated with severe cell loss. Other factors such as seizure duration, secondary generalization, or family history of seizures were not associated with hippocampal damage. Dual pathology may produce a combination of neocortical and temporolimbic epilepsies that warrants a precise definition of the true epileptogenic area prior to surgical treatment.

  9. Development of Cerebral Metastasis after Medical and Surgical Treatment of Anal Squamous Cell Carcinoma

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    Andrew Austin Gassman

    2012-01-01

    Full Text Available Squamous cell carcinoma of the anus is a relatively uncommon GI malignancy. When it does occur, it metastasizes in only a small minority of patients. Spread of anal squamous cell carcinoma to the brain is exceedingly rare, and has been previously reported only three times in the medical literature. We report the case of a 67 year old male who was diagnosed on presentation with a poorly differentiated anal squamous cell carcinoma that already had a solitary metastasis to the liver. While the tumors were initially responsive to chemoradiotherapy, the patient’s primary and liver lesions recurred. The patient then underwent synchronous abdominoperineal resection for the primary lesion and a liver lobectomy for the metastasis. Soon thereafter, the patient developed focal neurologic symptoms and was found to have an intracranial lesion that on biopsy demonstrated metastatic squamous cell carcinoma. This case highlights the fact that patients with a previous history of anal squamous cell carcinoma can occasionally develop cerebral metastasis. Furthermore, cerebral metastases from anal squamous cell carcinoma portend a dismal prognosis even in the face of aggressive medical and surgical therapy.

  10. [Heparin-induced thrombocytopenia developed during the acute phase after left upper lobectomy for lung cancer].

    Science.gov (United States)

    Mitomo, Hideki; Miyamoto, Akira; Tabata, Toshiharu; Sugawara, Takafumi; Yabuki, Hiroshi; Fujimura, Shigefumi

    2014-12-01

    Heparin-induced thrombocytopenia (HIT) is a serious adverse effect of heparin administration. This must not be rarely encountered but is not often reported in Japan compared to Western countries. A 68-year-old woman underwent left upper lobectomy for lung cancer. Low-dose unfractionated heparin was administrated to prevent thromboembolism after the operation. Two days later, sudden dyspnea appeared and ultracardiosonography showing an extensive thromboembolus from the main trunk to both main branches of pulmonary artery indicated pulmonary embolization. After the establishment of percutaneous cardiopulmonary support (PCPS) support, the embolus was removed by emergent open heart surgery. However, despite further unfractionated heparin administration following embolization surgery, other thrombus was identified in both the bi-lateral internal jagular veins and inferior vena cava by ultrasonography and contrast computed tomography( CT). Her platelet count was decreased gradually despite platelet transfusion. Plate factor 4( PF4) antibody against heparin in her blood examination was found, and HIT II was diagnosed. Discontinuation of unfractionated heparin and administration of antithrombin agent improved platelet count, and no additional embolization was identified.

  11. Can Preoperative Peak Expiratory Flow Predict Postoperative Pulmonary Complications in Lung Cancer Patients Undergoing Lobectomy?

    Directory of Open Access Journals (Sweden)

    Kun ZHOU

    2017-09-01

    Full Text Available Background and objective Postoperative pulmonary complications (PPCs, especially postoperative pneumonia (POP, directly affect the rapid recovery of lung cancer patients after surgery. Peak expiratory flow (PEF can reflect airway patency and cough efficiency. Moreover, cough impairment may lead to accumulation of pulmonary secretions which can increase the risk of PPCs. The aim of this study is to investigate the effect of preoperative PEF on PPCs in patients with lung cancer. Methods Retrospective research was conducted on 433 lung cancer patients who underwent lobectomy at the West China Hospital of Sichuan University from January 2014 to December 2015. The associations between preoperative PEF and PPCs were analyzed based on patients’ basic characteristics and clinical data in hospital. Results Preoperative PEF value in PPCs group (280.93±88.99 L/min was significantly lower than that in non-PPCs group (358.38±93.69 L/min (P320 L/min group (9.4%(P<0.001. Conclusion Preoperative PEF and PPCs are correlated, and PEF may be used as a predictor of PPCs.

  12. White matter tract recovery following medial temporal lobectomy and selective amygdalohippocampectomy for tumor resection via a ROVOT-m port-guided technique: A case report and review of literature

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    Srikant S. Chakravarthi

    2016-12-01

    Conclusions: To our knowledge, this is the first reported case of a temporal lobectomy and amygdalohippocampectomy using a port technique, in particular, one that demonstrates recovery of the critical (ILF and uncinate fasciculus subcortical white matter tracts. The combination of real-time, rapid, geometrically accurate 3D-planning of white matter tracts is imperative, especially in conjunction with minimally invasive approaches, thereby offering a new, safer perspective into the approach of temporal lobe lesions.

  13. Elektronik Ticaretin Vergilendirilmesine İlişkin Türk Vergi Sisteminde Katma Değer Vergisi Açısından Bir Değerlendirme(An Evaluation of Taxation of Electronic Commerce Under Turkish Tax System According to Value Added Tax (VAT

    Directory of Open Access Journals (Sweden)

    Yunus CERAN

    2007-01-01

    Full Text Available The development of internet has brought e-commerce to front as a new and contemporary instrument that enables to trade effectively and efficiently. However, because of extensive acceptance of internet in trade-life, the unusual ways of commerce and distribution channels have emerged and this has caused serious problems in taxation of e-commerce processes. Most of these problems are about the differences of taxation systems in different countries like how to evaluate the value added tax (VAT or how to tax the web-based incomes, etc. The solution of all these internet-related problems is about to be solved by OECD. In addition, EU mostly involves with taxation of VAT.

  14. Robot-Assisted Thoracoscopic Surgery versus Video-Assisted Thoracoscopic Surgery for Lung Lobectomy: Can a Robotic Approach Improve Short-Term Outcomes and Operative Safety?

    Science.gov (United States)

    Mahieu, Julien; Rinieri, Philippe; Bubenheim, Michael; Calenda, Emile; Melki, Jean; Peillon, Christophe; Baste, Jean-Marc

    2016-06-01

    Background Minimally invasive surgery has been recently recommended for treatment of early-stage non-small cell lung cancer. Despite the recent increase of robotic surgery, the place and potential advantages of the robot in thoracic surgery has not been well defined until now. Methods We reviewed our prospective database for retrospective comparison of our first 28 video-assisted thoracoscopic surgery lobectomies (V group) and our first 28 robotic lobectomies (R group). Results No significant difference was shown in median operative time between the two groups (185 vs. 190 minutes, p = 0.56). Median preincision time was significantly longer in the R group (80 vs. 60 minutes, P < 0.0001). The rate of emergency conversion for uncontrolled bleeding was lower in the R group (one vs. four). Median length of stay was comparable (6 days in the R group vs. 7 days in the V group, p = 0.4) with no significant difference in the rate of postoperative complications (eight Grade I in both groups, four Grade III or IV in the V group vs. six in the R group, according to the Clavien-Dindo classification, p = 0.93). No postoperative cardiac morbidity was observed in the R group. Median drainage time was similar (5 days, p = 0.78), with a rate of prolonged air leak slightly higher in the R group (25 vs. 17.8%, p = 0.74). Conclusion Perioperative outcomes are similar even in the learning period but robotic approach seems to offer more operative safety with fewer conversions for uncontrolled bleeding. Georg Thieme Verlag KG Stuttgart · New York.

  15. Identification of acetates in elasmopalpulus lignosellus pheromone glands using a newly created mass spectral database and kóvats retention indices

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    Gulab N. Jham

    2007-08-01

    Full Text Available Based on a specially created mass spectral database utilizing 23 tetradecenyl and 22 hexadecenyl acetate standards along with Kóvats retention indices obtained on a very polar stationary phase [poly (biscyanopropyl siloxane] (SP 2340, (Z-9-hexadecenyl acetate, (Z-11-hexadecenyl acetate and (E-8-hexadecenyl acetate were identified in active pheromone extracts of Elasmopalpus lignosellus. This identification was more efficient than our previous study using gas chromatography/mass spectrometry with a dimethyl disulfide derivative where we could only identify the first two acetates. The acetate composition of the pheromone gland differed from region to region in Brazil and from that from the Tifton (GA, USA population, suggesting polymorphism or a different sub-species.

  16. Clinical validation of the C-VAT 2.0 assessment tool for gaming disorder: a sensitivity analysis of the proposed DSM-5 criteria and the clinical characteristics of young patients with ‘video game addiction’.

    NARCIS (Netherlands)

    Rooij, A.J. van; Schoenmakers, T.M.; Mheen, D. van de

    2017-01-01

    Aims: Clinicians struggle with the identification of video gaming problems. To address this issue, a clinical assessment tool (C-VAT 2.0) was developed and tested in a clinical setting. The instrument allows exploration of the validity of the DSM-5 proposal for ‘internet gaming disorder’. Method:

  17. Correlation Between Subacute Sensorimotor Deficits and Brain Edema in Rats after Surgical Brain Injury.

    Science.gov (United States)

    McBride, Devin W; Wang, Yuechun; Adam, Loic; Oudin, Guillaume; Louis, Jean-Sébastien; Tang, Jiping; Zhang, John H

    2016-01-01

    No matter how carefully a neurosurgical procedure is performed, it is intrinsically linked to postoperative deficits resulting in delayed healing caused by direct trauma, hemorrhage, and brain edema, termed surgical brain injury (SBI). Cerebral edema occurs several hours after SBI and is a major contributor to patient morbidity, resulting in increased postoperative care. Currently, the correlation between functional recovery and brain edema after SBI remains unknown. Here we examine the correlation between neurological function and brain water content in rats 42 h after SBI. SBI was induced in male Sprague-Dawley rats via frontal lobectomy. Twenty-four hours post-ictus animals were subjected to four neurobehavior tests: composite Garcia neuroscore, beam walking test, corner turn test, and beam balance test. Animals were then sacrificed for right-frontal brain water content measurement via the wet-dry method. Right-frontal lobe brain water content was found to significantly correlate with neurobehavioral deficits in the corner turn and beam balance tests: the number of left turns (percentage of total turns) for the corner turn test and distance traveled for the beam balance test were both inversely proportional with brain water content. No correlation was observed for the composite Garcia neuroscore or the beam walking test.

  18. Memory Outcomes Following Selective versus Nonselective Temporal Lobe Removal: A Systematic Review

    Science.gov (United States)

    Girgis, Fady

    2012-01-01

    The surgical removal of brain tissue for the treatment of temporal lobe epilepsy can be either nonselective, as with an anterior temporal lobectomy (ATL), or selective, as with a selective amygdalohippocampectomy (SAH). Although seizure outcomes are similar with both procedures, cognitive and memory outcomes remain a matter of debate. This study…

  19. Robotic Surgery for Lung Cancer

    Science.gov (United States)

    Ambrogi, Marcello C; Fanucchi, Olivia; Melfi, Franco; Mussi, Alfredo

    2014-01-01

    During the last decade the role of minimally invasive surgery has been increased, especially with the introduction of the robotic system in the surgical field. The most important advantages of robotic system are represented by the wristed instrumentation and the depth perception, which can overcome the limitation of traditional thoracoscopy. However, some data still exist in literature with regard to robotic lobectomy. The majority of papers are focused on its safety and feasibility, but further studies with long follow-ups are necessary in order to assess the oncologic outcomes. We reviewed the literature on robotic lobectomy, with the main aim to better define the role of robotic system in the clinical practice. PMID:25207216

  20. AN INVESTIGATION OF IMPLICIT MEMORY THROUGH LEFT TEMPORAL LOBECTOMY FOR EPILEPSY

    Science.gov (United States)

    Tracy, Joseph I.; Osipowicz, Karol; Godofsky, Samuel; Shah, Atif; Khan, Waseem; Sharan, Ashwini; Sperling, Michael R.

    2012-01-01

    Temporal lobe epilepsy patients have demonstrated a relative preservation in the integrity of implicit memory procedures. We examined performance in a verbal implicit and explicit memory task in left anterior temporal lobectomy patients (LATL) and healthy normal controls (NC) while undergoing fMRI. We hypothesized that despite the relative integrity of implicit memory in both the LATL patients and normal controls, the two groups would show distinct functional neuroanatomic profiles during implicit memory. LATLs and NCs performed Jacoby’s Process Dissociation Process (PDP) procedure during fMRI, requiring completion of word stems based on the previously studied words or new/unseen words. Measures of automaticity and recollection provided uncontaminated indices of implicit and explicit memory, respectively. The behavioral data showed that in the face of temporal lobe pathology implicit memory can be carried out, suggesting implicit verbal memory retrieval is non-mesial temporal in nature. Compared to NCs, the LATL patients showed reliable activation, not deactivation, during implicit (automatic) responding. The regions mediating this response were cortical (left medial frontal and precuneus) and striatal. The active regions in LATL patients have the capacity to implement associative, conditioned responses that might otherwise be carried out by a healthy temporal lobe, suggesting this represented a compensatory activity. Because the precuneus has also been implicated in explicit memory, the data suggests this structure may have a highly flexible functionality, capable of supporting implementation of either explicit memory, or automatic processes such as implicit memory retrieval. Our data suggest that a healthy mesial/anterior temporal lobe may be needed for generating the posterior deactivation perceptual priming response seen in normals. PMID:22981890

  1. Canine intrahepatic vasculature: is a functional anatomic model relevant to the dog?

    Science.gov (United States)

    Hall, Jon L; Mannion, Paddy; Ladlow, Jane F

    2015-01-01

    To clarify canine intrahepatic portal and hepatic venous system anatomy using corrosion casting and advanced imaging and to devise a novel functional anatomic model of the canine liver to investigate whether this could help guide the planning and surgical procedure of partial hepatic lobectomy and interventional radiological procedures. Prospective experimental study. Adult Greyhound cadavers (n = 8). Portal and hepatic vein corrosion casts of healthy livers were assessed using computed tomography (CT). The hepatic lobes have a consistent hilar hepatic and portal vein supply with some variation in the number of intrahepatic branches. For all specimens, 3 surgically resectable areas were identified in the left lateral lobe and 2 surgically resectable areas were identified in the right medial lobe as defined by a functional anatomic model. CT of detailed acrylic casts allowed complex intrahepatic vascular relationships to be investigated and compared with previous studies. Improving understanding of the intrahepatic vascular supply facilitates interpretation of advanced images in clinical patients, the planning and performance of surgical procedures, and may facilitate interventional vascular procedures, such as intravenous embolization of portosystemic shunts. Functional division of the canine liver similar to human models is possible. The left lateral and right medial lobes can be consistently divided into surgically resectable functional areas and partial lobectomies can be performed following a functional model; further study in clinically affected animals would be required to investigate the relevance of this functional model in the dog. © Copyright 2014 by The American College of Veterinary Surgeons.

  2. Subcortical surgical anatomy of the lateral frontal region: human white matter dissection and correlations with functional insights provided by intraoperative direct brain stimulation: laboratory investigation.

    Science.gov (United States)

    De Benedictis, Alessandro; Sarubbo, Silvio; Duffau, Hugues

    2012-12-01

    Recent neuroimaging and surgical results support the crucial role of white matter in mediating motor and higher-level processing within the frontal lobe, while suggesting the limited compensatory capacity after damage to subcortical structures. Consequently, an accurate knowledge of the anatomofunctional organization of the pathways running within this region is mandatory for planning safe and effective surgical approaches to different diseases. The aim of this dissection study was to improve the neurosurgeon's awareness of the subcortical anatomofunctional architecture for a lateral approach to the frontal region, to optimize both resection and postoperative outcome. Ten human hemispheres (5 left, 5 right) were dissected according to the Klingler technique. Proceeding lateromedially, the main association and projection tracts as well as the deeper basal structures were identified. The authors describe the anatomy and the relationships among the exposed structures in both a systematic and topographical surgical perspective. Structural results were also correlated to the functional responses obtained during resections of infiltrative frontal tumors guided by direct cortico-subcortical electrostimulation with patients in the awake condition. The eloquent boundaries crucial for a safe frontal lobectomy or an extensive lesionectomy are as follows: 1) the motor cortex; 2) the pyramidal tract and premotor fibers in the posterior and posteromedial part of the surgical field; 3) the inferior frontooccipital fascicle and the superior longitudinal fascicle posterolaterally; and 4) underneath the inferior frontal gyrus, the head of the caudate nucleus, and the tip of the frontal horn of the lateral ventricle in the depth. Optimization of results following brain surgery, especially within the frontal lobe, requires a perfect knowledge of functional anatomy, not only at the cortical level but also with regard to subcortical white matter connectivity.

  3. Thymectomy for Nonthymomatous Myasthenia Gravis: Comparison of Video-Assisted Thoracoscopic and Transsternal Thymectomy.

    Science.gov (United States)

    Bagheri, Reza; Boonstani, Reza; Sadrizadeh, Ali; Salehi, Maryam; Afghani, Reza; Rahnama, Ali; Azmounfar, Vahab; Hakimian, Saeed; Baradaran Firoozabadi, Mohammad

    Thymectomy considered as a standard procedure in treatment of all the steps of myasthenia gravis. Video-assisted thoracoscopic surgery (VATS) thymectomy is one of the minimally invasive procedures that because of the short duration of hospitalization, less postoperative pain, and scar after surgery, nowadays it is replaced the traditional methods of surgery for patients with myasthenia gravis, but there are still differences and concerns. The aim of this study was to compare outcomes of two different techniques of surgery, VATS versus transsternal (TS) in the treatment of myasthenia gravis. In this pilot study, 42 patients with myasthenia gravis and without a thymus tumor were evaluated based on Myasthenia Gravis Foundation of America classification and drug consumption. Then, they randomly underwent two different techniques of surgery: VATS versus TS. Patients were evaluated based on preoperative and postoperative variables. Duration of intensive care unit stay and hospitalization has been reduced in patients who underwent VATS thymectomy operation technique. In addition, duration of surgical procedure has been reduced significantly in these patients. These patients have less blood loss during surgery compared with TS group. The Myasthenia Gravis Foundation of America postoperative status in VATS thymectomy revealed that the number of patients with complete stable remission was higher and number of persons remained unchanged was lower in this group. VATS thymectomy is a safe and appropriate approach comparing with traditional methods such as TS thymectomy for patients with myasthenia gravis. This method has better results after surgery and can be used as a minimally invasive alternative method instead of TS thymectomy.

  4. Minimally invasive surgical approaches for temporal lobe epilepsy

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    Chang, Edward F.; Englot, Dario J.; Vadera, Sumeet

    2016-01-01

    Surgery can be a highly effective treatment for medically refractory temporal lobe epilepsy (TLE). The emergence of minimally invasive resective and nonresective treatment options has led to interest in epilepsy surgery among patients and providers. Nevertheless, not all procedures are appropriate for all patients, and it is critical to consider seizure outcomes with each of these approaches, as seizure freedom is the greatest predictor of patient quality of life. Standard anterior temporal lobectomy (ATL) remains the gold standard in the treatment of TLE, with seizure freedom resulting in 60–80% of patients. It is currently the only resective epilepsy surgery supported by randomized controlled trials and offers the best protection against lateral temporal seizure onset. Selective amygdalohippocampectomy techniques preserve the lateral cortex and temporal stem to varying degrees and can result in favorable rates of seizure freedom but the risk of recurrent seizures appears slightly greater than with ATL, and it is not clear whether neuropsychological outcomes are improved with selective approaches. Stereotactic radiosurgery presents an opportunity to avoid surgery altogether, with seizure outcomes now under investigation. Stereotactic laser thermo-ablation allows destruction of the mesial temporal structures with low complication rates and minimal recovery time, and outcomes are also under study. Finally, while neuromodulatory devices such as responsive neurostimulation, vagus nerve stimulation, and deep brain stimulation have a role in the treatment of certain patients, these remain palliative procedures for those who are not candidates for resection or ablation, as complete seizure freedom rates are low. Further development and investigation of both established and novel strategies for the surgical treatment of TLE will be critical moving forward, given the significant burden of this disease. PMID:26017774

  5. Systematic lymphadenectomy versus sampling of ipsilateral mediastinal lymph-nodes during lobectomy for non-small-cell lung cancer: a systematic review of randomized trials and a meta-analysis.

    Science.gov (United States)

    Mokhles, Sahar; Macbeth, Fergus; Treasure, Tom; Younes, Riad N; Rintoul, Robert C; Fiorentino, Francesca; Bogers, Ad J J C; Takkenberg, Johanna J M

    2017-06-01

    To re-examine the evidence for recommendations for complete dissection versus sampling of ipsilateral mediastinal lymph nodes during lobectomy for cancer. We searched for randomized trials of systematic mediastinal lymphadenectomy versus mediastinal sampling. We performed a textual analysis of the authors' own starting assumptions and conclusion. We analysed the trial designs and risk of bias. We extracted data on early mortality, perioperative complications, overall survival, local recurrence and distant recurrence for meta-analysis. We found five randomized controlled trials recruiting 1980 patients spanning 1989-2007. The expressed starting position in 3/5 studies was a conviction that systematic dissection was effective. Long-term survival was better with lymphadenectomy compared with sampling (Hazard Ratio 0.78; 95% CI 0.69-0.89) as was perioperative survival (Odds Ratio 0.59; 95% CI 0.25-1.36, non-significant). But there was an overall high risk of bias and a lack of intention to treat analysis. There were higher rates (non-significant) of perioperative complications including bleeding, chylothorax and recurrent nerve palsy with lymphadenectomy. The high risk of bias in these trials makes the overall conclusion insecure. The finding of clinically important surgically related morbidities but lower perioperative mortality with lymphadenectomy seems inconsistent. The multiple variables in patients, cancers and available treatments suggest that large pragmatic multicentre trials, testing currently available strategies, are the best way to find out which are more effective. The number of patients affected with lung cancer makes trials feasible. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. Perioperative Outcomes and Long-term Survival in Clinically Early-stage Thymic 
Malignancies: Video-assisted Thoracoscopic Thymectomy versus Open Approaches

    Directory of Open Access Journals (Sweden)

    Hao WANG

    2016-07-01

    Full Text Available Background and objective Video-assisted thoracoscopic surgery (VATS theoretically offers advantages over open thymectomy for clinically early-stage (Masaoka-Koga stage I and II thymic malignancies. However, longterm outcomes have not been well studied. We compared the postoperative outcomes and survival from a cohort study based on the database of the Chinese Alliance for Research in Thymomas (ChART. Methods Between 1994 and 2012, data of 1,117 patients having surgery for clinically early-stage (Masaoka-Koga stage I and II tumors were enrolled for the study. Among them, 241 cases underwent VATS thymectomy (VATS group, while 876 cases underwent open thymectomy (Open group. Univariate analyses were used to compare the clinical character and perioperative outcomes between the two groups. And multivariate analysis was performed to determine the independent predictive factors for long-term survival. Results Compared with the Open group, the VATS group had higher percentage of total thymectomy (80.5% vs 73.9%, P=0.028, resection rate (98.8% vs 88.7%, P<0.001 and less recurrence (2.9% vs 16.0%, P<0.001. Five-year overall survival was 92% after VATS and 92% after open thymectomy, with no significant difference between the two groups (P=0.15. However, 5-year disease free survival were 92% in VATS group and 83% in Open group (P=0.011. Cox proportional hazards model revealed that WHO classification, Masaoka-Koga stage and adjuvant therapy were independent predictive factors for overall survival, while surgical approach had no significant impact on long-term outcome. Conclusion This study suggests that VATS thymectomy is an effective approach for clinically early-stage thymic malignancies. And it may offer better perioperative outcomes, as well as equal oncological survival.

  7. Surgery for lung adenocarcinoma with smokers’ polycythemia: a case report

    Science.gov (United States)

    2013-01-01

    Background Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers’ polycythemia has never been reported. We herein report a patient with lung cancer and smokers’ polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. Case presentation A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA). When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists’ diagnosis was secondary polycythemia due to heavy smoking (smokers’ polycythemia) because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia. PMID:23374961

  8. Surgery for lung adenocarcinoma with smokers' polycythemia: a case report.

    Science.gov (United States)

    Sugiura, Yasoo; Nemoto, Etsuo; Shinoda, Hiromi; Nakamura, Naoya; Kaseda, Shizuka

    2013-02-01

    Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers' polycythemia has never been reported. We herein report a patient with lung cancer and smokers' polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA). When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists' diagnosis was secondary polycythemia due to heavy smoking (smokers' polycythemia) because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.

  9. Surgery for lung adenocarcinoma with smokers’ polycythemia: a case report

    Directory of Open Access Journals (Sweden)

    Sugiura Yasoo

    2013-02-01

    Full Text Available Abstract Background Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers’ polycythemia has never been reported. We herein report a patient with lung cancer and smokers’ polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. Case presentation A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA. When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists’ diagnosis was secondary polycythemia due to heavy smoking (smokers’ polycythemia because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at Conclusion We experienced a patient with smokers’ polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.

  10. Extratemporal hypometabolism on FDG PET in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joon Young; Kim, Sun Jung; Kim, Byung-Tae; Kim, Sang Eun [Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, 135-710, Kangnam-ku, Seoul (Korea); Hong, Seung Bong; Seo, Dae Won [Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea); Hong, Seung Chyul [Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea)

    2003-04-01

    We investigated the relationship between the presence of extratemporal hypometabolism on fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) and seizure outcome after temporal lobectomy in patients with medically intractable temporal lobe epilepsy (TLE). In 47 patients with intractable unilateral mesial TLE, regional metabolic changes on FDG PET images obtained during the 2 months preceding anterior temporal lobectomy were compared with postoperative seizure outcome. Postoperative seizure outcome was evaluated with a mean follow-up period of 6.1{+-}0.6 years (range 5.2-7.2 years). Forty-two (89%) of the 47 patients achieved a good postoperative seizure outcome (Engel class I or II). All patients had hypometabolism in the temporal cortex ipsilateral to the epileptogenic region on FDG PET scans. Fourteen (78%) of the 18 patients with hypometabolism only in the ipsilateral temporal cortex were completely seizure free (Engel class Ia) after surgery. In contrast, five (45%) of the 11 patients with extratemporal cortical hypometabolism confined to the ipsilateral cerebral hemisphere and only four (22%) of the 18 patients with hypometabolism in the contralateral cerebral cortex were completely seizure free after surgery. The postoperative seizure-free rates were significantly different across the three groups of patients with different cortical metabolic patterns (P<0.005). Furthermore, all of the nine patients with a non-class I outcome (Engel class II-IV) had extratemporal (including contralateral temporal) cortical hypometabolism. Thalamic hypometabolism was noted in 20 (43%) of the 47 patients (ipsilateral in 12, bilateral in 8). Sixteen (59%) of the 27 patients with normal thalamic metabolism were completely seizure free after surgery, while only seven (35%) of the 20 patients with thalamic hypometabolism became completely seizure free (P<0.05). Multivariate analysis revealed that among variables including clinical, EEG, magnetic resonance imaging

  11. Extratemporal hypometabolism on FDG PET in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy

    International Nuclear Information System (INIS)

    Choi, Joon Young; Kim, Sun Jung; Kim, Byung-Tae; Kim, Sang Eun; Hong, Seung Bong; Seo, Dae Won; Hong, Seung Chyul

    2003-01-01

    We investigated the relationship between the presence of extratemporal hypometabolism on fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) and seizure outcome after temporal lobectomy in patients with medically intractable temporal lobe epilepsy (TLE). In 47 patients with intractable unilateral mesial TLE, regional metabolic changes on FDG PET images obtained during the 2 months preceding anterior temporal lobectomy were compared with postoperative seizure outcome. Postoperative seizure outcome was evaluated with a mean follow-up period of 6.1±0.6 years (range 5.2-7.2 years). Forty-two (89%) of the 47 patients achieved a good postoperative seizure outcome (Engel class I or II). All patients had hypometabolism in the temporal cortex ipsilateral to the epileptogenic region on FDG PET scans. Fourteen (78%) of the 18 patients with hypometabolism only in the ipsilateral temporal cortex were completely seizure free (Engel class Ia) after surgery. In contrast, five (45%) of the 11 patients with extratemporal cortical hypometabolism confined to the ipsilateral cerebral hemisphere and only four (22%) of the 18 patients with hypometabolism in the contralateral cerebral cortex were completely seizure free after surgery. The postoperative seizure-free rates were significantly different across the three groups of patients with different cortical metabolic patterns (P<0.005). Furthermore, all of the nine patients with a non-class I outcome (Engel class II-IV) had extratemporal (including contralateral temporal) cortical hypometabolism. Thalamic hypometabolism was noted in 20 (43%) of the 47 patients (ipsilateral in 12, bilateral in 8). Sixteen (59%) of the 27 patients with normal thalamic metabolism were completely seizure free after surgery, while only seven (35%) of the 20 patients with thalamic hypometabolism became completely seizure free (P<0.05). Multivariate analysis revealed that among variables including clinical, EEG, magnetic resonance imaging

  12. Inspection with non destructive assay techniques of the aluminium coating of the TRIGA Mark III reactor vat

    International Nuclear Information System (INIS)

    Reyes A, A.I.; Gonzalez M, A.; Castaneda J, G.; Rivera M, H.; Sandoval G, I.

    2001-01-01

    In June 2000, the Reactor Department assigned to the Scientific Research Direction of the National Institute of Nuclear Research requested to the Non-destructive Assays Laboratory (LEND), assigned to the Materials Science Management, the inspection and measurement of thickness of the aluminium coating (liner) of the TRIGA Mark III reactor vat with non-destructive assay techniques, due to that the aluminium coating is exposed mainly to undergo slimming on its back side due to corrosion phenomena. Activity that was able to be carried out from april until august 2001. It is worth pointing out that this type of inspection with these techniques was realized by first time. The non-destructive assays (NDA) are techniques which use indirect physical methods for inspecting the sanitation of components in process or in service, for detect lack of continuity or defects which affect their quality or usefulness. The application of those do not alter the physical, chemical, mechanical or dimensional properties of the part subject of inspection. The results of the application of the ultrasound inspection techniques, industrial radiography and penetrating liquids are presented. (Author)

  13. Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice.

    Science.gov (United States)

    Umari, Marzia; Falini, Stefano; Segat, Matteo; Zuliani, Michele; Crisman, Marco; Comuzzi, Lucia; Pagos, Francesco; Lovadina, Stefano; Lucangelo, Umberto

    2018-03-01

    In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation. Deep neuromuscular blockade should be pursued and carefully monitored, and an appropriate reversal administered before extubation. Management of one-lung ventilation (OLV) needs to be optimized to prevent not only intraoperative hypoxemia but also postoperative acute lung injury (ALI): protective ventilation strategies are therefore to be implemented. Locoregional techniques should be favored over intravenous analgesia: the thoracic epidural, the paravertebral block (PVB), the intercostal nerve block (ICNB), and the serratus anterior plane block (SAPB) are thoroughly reviewed and the most common dosages are reported. Fluid therapy needs to be administered critically, to avoid both overload and cardiovascular compromisation. All these practices are analyzed singularly with the aid of the most recent evidences aimed at the best patient care. Finally, a few notes on some of the latest trends in research are presented, such as non-intubated video-assisted thoracoscopic surgery (VATS) and intravenous lidocaine.

  14. The affective value of faces in patients achieving long-term seizure freedom after temporal lobectomy.

    Science.gov (United States)

    Meletti, Stefano; Picardi, Angelo; De Risi, Marco; Monti, Giulia; Esposito, Vincenzo; Grammaldo, Liliana G; Di Gennaro, Giancarlo

    2014-07-01

    We investigated different aspects of facial expression evaluation in a homogeneous cohort of 42 seizure-free patients with 5 or more years of follow-up after temporal lobectomy (TL), with the aim of further characterizing the impairment in emotion and social cognition among patients. A group of healthy subjects matched for sex, age, and education served as controls. Four tasks of facial expression evaluation were used: (a) facial expression recognition, (b) rating of the intensity of facial expression, and (c) rating of valence (pleasantness) and (d) rating of arousal induced by facial expressions. Patients had a worse performance in the recognition task for all negative emotions, while no differences in intensity ratings were found. They also reported lower arousal ratings than controls for faces showing fear, anger, disgust, and neutral expressions, as well as lower valence ratings for all facial expressions except those showing happiness. Longer epilepsy duration before TL was negatively associated with ratings of arousal and intensity and positively associated with valence ratings for fearful facial expressions. This study showed that patients who become seizure-free after TL present long-term deficits in several aspects of facial expression evaluation. Longitudinal, prospective studies are needed to evaluate if social cognition improves or declines after TL. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. The association between thyroid malignancy and chronic lymphocytic thyroiditis: should it alter the surgical approach?

    Science.gov (United States)

    Büyükaşık, Oktay; Hasdemir, Ahmet Oğuz; Yalçın, Erol; Celep, Bahadır; Sengül, Serkan; Yandakçı, Kemal; Tunç, Gündüz; Küçükpınar, Tevfik; Alkoy, Seval; Cöl, Cavit

    2011-01-01

    The relation between thyroid neoplasms and chronic lymphocytic thyroiditis (CLT) is controversial. While it is accepted that focal lymphocytic thyroiditis develops secondarily to malignancy, it is not clear whether diffuse lymphocytic thyroiditis has a tendency to develop into thyroid cancer. The aim of this study was to investigate the relation between CLT and malignant tumours of the thyroid and evaluate the surgical approach to CLT cases. In this study, 917 patients operated on for thyroid diseases were investigated retrospectively. Seventy-seven (8.4%) patients histopathologically diagnosed as having CLT (either non-specific or Hashimoto's thyroiditis) were investigated for any concurrent malignant neoplasm. Fifteen patients in whom CLT and thyroid malignancy were coexisting were included in the study. In the pathological evaluation of 917 cases, malignancy in the thyroid was found in 97 (10.6%) cases. Seventy-seven cases were categorised as CLT. Of these 77, 16 (20.8%) were Hashimoto's thyroiditis (specific CLT) and the other 61 (79.2%) were non-specific CLT. In 15 cases, thyroid malignancy was found to be concurrent with CLT. Of the malignities, nine (60%) were papillary carcinoma, three (20%) medullar carcinoma, one (6.6%) follicular carcinoma, one (6.6%) Hurthle cell carcinoma, and one (6.6%) lymphoma. In our series, the rate of the development of malignancy against the background of CLT was 19.48%, while the rate in the groups without CLT was 9.76%, with a statistically significant difference between the groups (p = 0.008). CLT cases should be evaluated more carefully in terms of malignancy. If a nodule is detected on thyroiditis, the minimal surgical intervention should be lobectomy. Total thyroidectomy should be considered as preferable to subtotal thyroidectomy because of its many advantages such as controlling thyroiditis, removing the probability of reoperation, and hormonal stability.

  16. Severe atrophy of right hepatic lobe simulating right hepatic lobectomy

    International Nuclear Information System (INIS)

    Yeh, C.W.; Strashun, A.; Goldsmith, S.J.

    1981-01-01

    Absence of the right hepatic lobe following blunt abdominal trauma without surgical resection is reported. The usual site of the right hepatic lobe is demonstrated to be occupied by bowel by hepatobiliary imaging

  17. Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park.

    Science.gov (United States)

    Sesma, Julio; Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

    2017-08-01

    Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3 rd postoperative day and patient was discharged on 14 th postoperative day. He has already recovered his normal activity 6 months after surgery.

  18. Characterization of a Staphylococcal Plasmid Related to pUB110 and Carrying Two Novel Genes, vatC and vgbB, Encoding Resistance to Streptogramins A and B and Similar Antibiotics

    OpenAIRE

    Allignet, Jeanine; Liassine, Nadia; El Solh, Névine

    1998-01-01

    We isolated and sequenced a plasmid, named pIP1714 (4,978 bp), which specifies resistance to streptogramins A and B and the mixture of these compounds. pIP1714 was isolated from a Staphylococcus cohnii subsp. cohnii strain found in the environment of a hospital where pristinamycin was extensively used. Resistance to both compounds and related antibiotics is encoded by two novel, probably cotranscribed genes, (i) vatC, encoding a 212-amino-acid (aa) acetyltransferase that inactivates streptogr...

  19. Quantitative pre-surgical lung function estimation with SPECT/CT

    International Nuclear Information System (INIS)

    Bailey, D. L.; Willowson, K. P.; Timmins, S.; Harris, B. E.; Bailey, E. A.; Roach, P. J.

    2009-01-01

    Full text:Objectives: To develop methodology to predict lobar lung function based on SPECT/CT ventilation and perfusion (V/Q) scanning in candidates for lobectomy for lung cancer. Methods: This combines two development areas from our group: quantitative SPECT based on CT-derived corrections for scattering and attenuation of photons, and SPECT V/Q scanning with lobar segmentation from CT. Eight patients underwent baseline pulmonary function testing (PFT) including spirometry, measure of DLCO and cario-pulmonary exercise testing. A SPECT/CT V/Q scan was acquired at baseline. Using in-house software each lobe was anatomically defined using CT to provide lobar ROIs which could be applied to the SPECT data. From these, individual lobar contribution to overall function was calculated from counts within the lobe and post-operative FEV1, DLCO and VO2 peak were predicted. This was compared with the quantitative planar scan method using 3 rectangular ROIs over each lung. Results: Post-operative FEV1 most closely matched that predicted by the planar quantification method, with SPECT V/Q over-estimating the loss of function by 8% (range - 7 - +23%). However, post-operative DLCO and VO2 peak were both accurately predicted by SPECT V/Q (average error of 0 and 2% respectively) compared with planar. Conclusions: More accurate anatomical definition of lobar anatomy provides better estimates of post-operative loss of function for DLCO and VO2 peak than traditional planar methods. SPECT/CT provides the tools for accurate anatomical defintions of the surgical target as well as being useful in producing quantitative 3D functional images for ventilation and perfusion.

  20. Future of uniportal video-assisted thoracoscopic surgery-emerging technology.

    Science.gov (United States)

    Li, Zheng; Ng, Calvin S H

    2016-03-01

    Uniportal VATS poses unique difficulties to the surgeon, mainly as a consequence of operating through a small single incision. The instruments in uniportal VATS have limited movement through the small incision. In addition, the approach to the surgical operating site is unidirectional, which may restrict vision and retraction, and unavoidably suffers from instrument fencing. Recent thoracoscopic technology in the form of a wide variable angled lens has to some extent improved these shortcomings. The development of an extendable flexible thoracoscope and wireless steerable endoscope (WSE) systems can further improve the visualization for surgery and reduce or even remove fencing between endoscope and instruments. New single incision access platforms both derived from Natural orifice transluminal endoscopic surgery (NOTES) and robotic surgery approaches are on the horizon. These may allow uniportal VATS to be performed through an even smaller ultra-minimally invasive incision, with improved vision, more freedom of movement of the instruments and greater precision. However, a number of problems remain to be resolved, including provision of a stable platform and payload, applied force limitations and equipment sterilization. Advances in uniportal VATS major lung resection techniques have not only challenged the surgeon to acquire new skills and knowledge, but at the same time have rekindled the collaborative spirit between industry and clinician in developing novel equipment and technology to push the boundaries of minimally invasive surgery. These technological improvements and innovations may improve operating efficiency and safety during uniportal VATS surgery.

  1. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  2. Post surgical complications from students' large animal surgical ...

    African Journals Online (AJOL)

    A retrospective study of post surgical complications was conducted on records of students' Large Animal Surgical Laboratories in the Faculty of Veterinary Medicine (F.V.M.), Ahmadu Bello University (A.B.U), Zaria from 1989 to 1993. Three hundred and eleven surgical complications were recorded from five surgical ...

  3. Visual paired-associate learning: in search of material-specific effects in adult patients who have undergone temporal lobectomy.

    Science.gov (United States)

    Smith, Mary Lou; Bigel, Marla; Miller, Laurie A

    2011-02-01

    The mesial temporal lobes are important for learning arbitrary associations. It has previously been demonstrated that left mesial temporal structures are involved in learning word pairs, but it is not yet known whether comparable lesions in the right temporal lobe impair visually mediated associative learning. Patients who had undergone left (n=16) or right (n=18) temporal lobectomy for relief of intractable epilepsy and healthy controls (n=13) were administered two paired-associate learning tasks assessing their learning and memory of pairs of abstract designs or pairs of symbols in unique locations. Both patient groups had deficits in learning the designs, but only the right temporal group was impaired in recognition. For the symbol location task, differences were not found in learning, but again a recognition deficit was found for the right temporal group. The findings implicate the mesial temporal structures in relational learning. They support a material-specific effect for recognition but not for learning and recall of arbitrary visual and visual-spatial associative information. Copyright © 2010 Elsevier Inc. All rights reserved.

  4. Surgical Outcomes of Pneumatic Compression Using Carbon Dioxide Gas in Thoracoscopic Diaphragmatic Plication.

    Science.gov (United States)

    Ahn, Hyo Yeong; Kim, Yeong Dae; Hoseok, I; Cho, Jeong Su; Lee, Jonggeun; Son, Joohyung

    2016-12-01

    Surgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide (CO 2 ) gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy. Eleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using CO 2 gas and group without using CO 2 gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence. The improvement of forced expiratory volume at 1 second in the group using CO 2 gas and the group not using CO 2 gas was 22.46±11.27 and 21.08±5.39 (p=0.84). The improvement of forced vital capacity 3 months after surgery was 16.74±10.18 (with CO 2 ) and 15.6±0.89 (without CO 2 ) (p=0.03). During follow-up (17±17 months), there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred. Thoracoscopic plication under single lung ventilation using CO 2 insufflation could be an effective, safe option to flatten the diaphragm.

  5. Classification and Risk-factor Analysis of Postoperative Cardio-pulmonary 
Complications after Lobectomy in Patients with Stage I Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Yutian LAI

    2016-05-01

    Full Text Available Background and objective There are incresing lung cancer patients detected and diagnosed at the intermediate stage when the pre-malignant or early lesions are amenable to resection and cure, owing to the progress of medical technology, the renewal of detection methods, the popularity of medical screening and the improvement of social health consciousness. The aim of this study is to investigate the risk factors of the occurrence of postoperative cardio-pulmonary complications in stage I non-small cell lung cancer (NSCLC patients, based on routine laboratory tests, basic characteristics, and intraoperative variables in hospital. Methods The 421 patients after lobectomy in patients with stage I NSCLC at the West China Hospital of Sichuan University from January 2012 to December 2013 were included into the study and stratified into complication group and non-complication group, according to whether to occur postoperative cardio-pulmonary complications after lobectomy in 30 days. Results Of them, 64 (15.2% patients were finally identified and selected into the complication group, compared with 357 (84.8% in non-complication group: pneumonia (8.8%, 37/421 was the primary complication, and other main complications included atelectasis (5.9%, 25/421, pleural effusion (≥middle (5.0%, 21/421, persistent air leak (3.6%, 15/421; The operation time (P=0.007, amount of blood loss (P=0.034, preoperative chronic obstructive pulmonary disease (COPD (P=0.027, white blood cell (WBC count (P<0.001, neutrophil-lymphocyte ratio (NLR (P<0.001 were significantly different between the two groups. According to the binary logistics regression analysis, preoperative COPD (OR=0.031, 95%CI: 0.012-0.078, P<0.001 and WBC count (OR=1.451, 95%CI: 1.212-1.736, P<0.001 were independent risk factors for postoperative cardio-pulmonary complications. Conclusion Among an array of clinical variables in hospital, operation time, preoperative white blood cell count, preoperative COPD

  6. Chylous pericardial effusion after pulmonary lobectomy.

    Science.gov (United States)

    Yang, Weixiong; Luo, Canqiao; Liu, Zhenguo; Cheng, Chao

    2017-07-01

    Chylous pericardial effusion is a rarely reported complication of lung cancer surgery. Here, we report a case of an elderly man who suffered chylous pericardial effusion after radical right upper lung resection for cancer. The massive chylous effusion first occurred in the pericardium, drained to the right chest after the drainage of the hydropericardium and subsequently moved back to the pericardium again. Lymphoscintigraphy examination indicated that a chylous fistula was present in the plane of the tracheal carina. After failure to control the chylous effusion with conservative medical treatment, the patient underwent video-assisted thoracic surgery through the left chest for thoracic duct ligation and pericardial fenestration. The patient was ultimately discharged without recurrence of the effusion after surgical treatment. This case report discusses the possible mechanism of chylopericardium after lung cancer surgery and suggests some strategies to prevent postoperative chylous pericardial effusion. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  7. Surgical lighting

    NARCIS (Netherlands)

    Knulst, A.J.

    2017-01-01

    The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago,

  8. Surgical smoke.

    Science.gov (United States)

    Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

    2009-10-01

    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.

  9. Adipose Tissue Redistribution and Ectopic Lipid Deposition in Active Acromegaly and Effects of Surgical Treatment

    Science.gov (United States)

    Reyes-Vidal, Carlos M.; Mojahed, Hamed; Shen, Wei; Jin, Zhezhen; Arias-Mendoza, Fernando; Fernandez, Jean Carlos; Gallagher, Dympna; Bruce, Jeffrey N.; Post, Kalmon D.

    2015-01-01

    Context: GH and IGF-I have important roles in the maintenance of substrate metabolism and body composition. However, when in excess in acromegaly, the lipolytic and insulin antagonistic effects of GH may alter adipose tissue (AT) deposition. Objectives: The purpose of this study was to examine the effect of surgery for acromegaly on AT distribution and ectopic lipid deposition in liver and muscle. Design: This was a prospective study before and up to 2 years after pituitary surgery. Setting: The setting was an academic pituitary center. Patients: Participants were 23 patients with newly diagnosed, untreated acromegaly. Main Outcome Measures: We determined visceral (VAT), subcutaneous (SAT), and intermuscular adipose tissue (IMAT), and skeletal muscle compartments by total-body magnetic resonance imaging, intrahepatic and intramyocellular lipid by proton magnetic resonance spectroscopy, and serum endocrine, metabolic, and cardiovascular risk markers. Results: VAT and SAT masses were lower than predicted in active acromegaly, but increased after surgery in male and female subjects along with lowering of GH, IGF-I, and insulin resistance. VAT and SAT increased to a greater extent in men than in women. Skeletal muscle mass decreased in men. IMAT was higher in active acromegaly and decreased in women after surgery. Intrahepatic lipid increased, but intramyocellular lipid did not change after surgery. Conclusions: Acromegaly may present a unique type of lipodystrophy characterized by reduced storage of AT in central depots and a shift of excess lipid to IMAT. After surgery, this pattern partially reverses, but differentially in men and women. These findings have implications for understanding the role of GH in body composition and metabolic risk in acromegaly and other clinical settings of GH use. PMID:26037515

  10. Selected Aspects of the Copenhagen Economics Study on Reduced VAT Rates in the Current Conditions of the Moravian-Silesian Region

    Directory of Open Access Journals (Sweden)

    Kateřina Randová

    2012-01-01

    Full Text Available This paper deals with a long-debated issue of the application of value added tax rates to labour-intensive services. The level of value added tax rates has a dominant influence on the tax liability of suppliers of these services and subsequently on the amount of available funds that they could use for development of their business. The aim of this paper is a presentation of results of the student grant Quantification of Impacts of Application of Reduced Value Added Tax Rate to Locally Supplied Services on the Suppliers of these Services”, which is focused on selected aspects of the “Study on reduced VAT applied to goods and services in the Member States of the European Union” in the conditions of the providers of these services from the Moravian-Silesian Region. For this paper the methods of regression analysis and analysis of variance – ANOVA were used. The deductive method and method of analysis have also been used.

  11. Surgical Assisting

    Science.gov (United States)

    ... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...

  12. Paediatric Abdominal Surgical Emergencies in a General Surgical ...

    African Journals Online (AJOL)

    ... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...

  13. Cost-Benefit Performance of Robotic Surgery Compared with Video-Assisted Thoracoscopic Surgery under the Japanese National Health Insurance System.

    Science.gov (United States)

    Kajiwara, Naohiro; Patrick Barron, James; Kato, Yasufumi; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

    2015-01-01

    Medical economics have significant impact on the entire country. The explosion in surgical techniques has been accompanied by questions regarding actual improvements in outcome and cost-effectiveness, such as the da Vinci(®) Surgical System (dVS) compared with conventional video-assisted thoracic surgery (VATS). To establish a medical fee system for robot-assisted thoracic surgery (RATS), which is a system not yet firmly established in Japan. This study examines the cost benefit performance (CBP) based on medical fees compared with VATS and RATS under the Japanese National Health Insurance System (JNHIS) introduced in 2012. The projected (but as yet undecided) price in the JNHIS would be insufficient if institutions have less than even 200 dVS cases per year. Only institutions which perform more than 300 dVS operations per year would obtain a positive CBP with the projected JNHIS reimbursement. Thus, under the present conditions, it is necessary to perform at least 300 dVS operations per year in each institution with a dVS system to avoid financial deficit with current robotic surgical management. This may hopefully encourage a downward price revision of the dVS equipment by the manufacture which would result in a decrease in the cost per procedure.

  14. The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia.

    Science.gov (United States)

    Dydykin, Sergey; Kapitonova, Marina

    2015-01-01

    Traditional department-based surgical interest groups in Russian medical schools are useful tools for student-based selection of specialty training. They also form a nucleus for initiating research activities among undergraduate students. In Russia, the Departments of Topographical Anatomy and Operative Surgery play an important role in initiating student-led research and providing learners with advanced, practical surgical skills. In tandem with department-led activities, student surgical interest groups prepare learners through surgical competitions, known as "Surgical Olympiads," which have been conducted in many Russian centers on a regular basis since 1988. Surgical Olympiads stimulate student interest in the development of surgical skills before graduation and encourage students to choose surgery as their postgraduate specialty. Many of the participants in these surgical Olympiads have become highly qualified specialists in general surgery, orthopedic surgery, neurosurgery, urology, gynecology, and emergency medicine. The present article emphasizes the role of student interest groups and surgical Olympiads in clinical anatomical and surgical undergraduate training in Russia. © 2015 American Association of Anatomists.

  15. Catamenial pneumothorax revealing diaphragmatic endometriosis: a case report and revue of literature.

    Science.gov (United States)

    Aissa, Sana; Benzarti, Wafa; Alimi, Faouzi; Gargouri, Imen; Salem, Halima Ben; Aissa, Amène; Fathallah, Khadija; Abdelkade, Atef Ben; Alouini, Rafika; Garrouche, Abdelhamid; Hayoun, Abdelaziz; Abdelghani, Ahmed; Benzarti, Mohamed

    2017-01-01

    Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in women. We aim to discuss the etiology, clinical course, and surgical treatment of a 42-year-old woman with CP. This patient had a right-sided spontaneous pneumothoraces occurred one week after menses. She had under-gone video-assisted thoracoscopic surgery (VATS) because of a persistent air leak under chest tube. VATS revealed multiple diaphragmatic fenestrations with an upper right nodule. Defects were removed and a large part of the diaphragm was resected. Pleural abrasion was then performed over the diaphragm. Diaphragmatic endometriosis was confirmed by microscopic examination. Medical treatment with GnRH agonists was prescribed, and after recovery, the patient has been symptoms free for 20 months.

  16. Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events.

    Science.gov (United States)

    Hempel, Susanne; Maggard-Gibbons, Melinda; Nguyen, David K; Dawes, Aaron J; Miake-Lye, Isomi; Beroes, Jessica M; Booth, Marika J; Miles, Jeremy N V; Shanman, Roberta; Shekelle, Paul G

    2015-08-01

    Serious, preventable surgical events, termed never events, continue to occur despite considerable patient safety efforts. To examine the incidence and root causes of and interventions to prevent wrong-site surgery, retained surgical items, and surgical fires in the era after the implementation of the Universal Protocol in 2004. We searched 9 electronic databases for entries from 2004 through June 30, 2014, screened references, and consulted experts. Two independent reviewers identified relevant publications in June 2014. One reviewer used a standardized form to extract data and a second reviewer checked the data. Strength of evidence was established by the review team. Data extraction was completed in January 2015. Incidence of wrong-site surgery, retained surgical items, and surgical fires. We found 138 empirical studies that met our inclusion criteria. Incidence estimates for wrong-site surgery in US settings varied by data source and procedure (median estimate, 0.09 events per 10,000 surgical procedures). The median estimate for retained surgical items was 1.32 events per 10,000 procedures, but estimates varied by item and procedure. The per-procedure surgical fire incidence is unknown. A frequently reported root cause was inadequate communication. Methodologic challenges associated with investigating changes in rare events limit the conclusions of 78 intervention evaluations. Limited evidence supported the Universal Protocol (5 studies), education (4 studies), and team training (4 studies) interventions to prevent wrong-site surgery. Limited evidence exists to prevent retained surgical items by using data-matrix-coded sponge-counting systems (5 pertinent studies). Evidence for preventing surgical fires was insufficient, and intervention effects were not estimable. Current estimates for wrong-site surgery and retained surgical items are 1 event per 100,000 and 1 event per 10,000 procedures, respectively, but the precision is uncertain, and the per

  17. Management of Pleural Space After Lung Resection by Cryoneuroablation of Phrenic Nerve: A Randomized Study.

    Science.gov (United States)

    Pan, Xiao-Jie; Ou, De-Bin; Lin, Xing; Ye, Ming-Fang

    2017-06-01

    Residual air space problems after pulmonary lobectomy are an important concern in thoracic surgical practice, and various procedures have been applied to manage them. This study describes a novel technique using controllable paralysis of the diaphragm by localized freezing of the phrenic nerve, and assesses the effectiveness of this procedure to reduce air space after pulmonary lobectomy. In this prospective randomized study, 207 patients who underwent lobectomy or bilobectomy and systematic mediastinal node dissection in our department between January 2009 and November 2013 were randomly allocated to a cryoneuroablation group or a conventional group. Patients in the cryoneuroablation group (n = 104) received phrenic nerve cryoneuroablation after lung procedures, and patients in the conventional group (n = 103) did not receive cryoneuroablation after the procedure. Data regarding preoperative clinical and surgical characteristics in both groups were collected. Both groups were compared with regard to postoperative parameters such as total amount of pleural drainage, duration of chest tube placement, length of hospital stay, requirement for repeat chest drain insertion, prolonged air leak, and residual space. Perioperative lung function was also compared in both groups. Recovery of diaphragmatic movement in the cryoneuroablation group was checked by fluoroscopy on the 15th, 30th, and 60th day after surgery. There was no statistically significant difference in patient characteristics between the 2 groups; nor was there a difference in terms of hospital stay, new drain requirement, and incidence of empyema. In comparison with the conventional group, the cryoneuroablation group had less total drainage (1024 ± 562 vs 1520 ± 631 mL, P phrenic nerve offers a reasonable option for prevention of residual air space following major pulmonary resection.

  18. Surgical Outcomes of Pneumatic Compression Using Carbon Dioxide Gas in Thoracoscopic Diaphragmatic Plication

    Directory of Open Access Journals (Sweden)

    Hyo Yeong Ahn

    2016-12-01

    Full Text Available Background: Surgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide (CO2 gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy. Methods: Eleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using CO2 gas and group without using CO2 gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence. Results: The improvement of forced expiratory volume at 1 second in the group using CO2 gas and the group not using CO2 gas was 22.46±11.27 and 21.08±5.39 (p=0.84. The improvement of forced vital capacity 3 months after surgery was 16.74±10.18 (with CO2 and 15.6±0.89 (without CO2 (p=0.03. During follow-up (17±17 months, there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred. Conclusion: Thoracoscopic plication under single lung ventilation using CO2 insufflation could be an effective, safe option to flatten the diaphragm.

  19. Surgical Instrument Sets for Special Operations Expeditionary Surgical Teams.

    Science.gov (United States)

    Hale, Diane F; Sexton, Justin C; Benavides, Linda C; Benavides, Jerry M; Lundy, Jonathan B

    The deployment of surgical assets has been driven by mission demands throughout years of military operations in Iraq and Afghanistan. The transition to the highly expeditious Golden Hour Offset Surgical Transport Team (GHOST- T) now offers highly mobile surgical assets in nontraditional operating rooms; the content of the surgical instrument sets has also transformed to accommodate this change. The 102nd Forward Surgical Team (FST) was attached to Special Operations assigned to southern Afghanistan from June 2015 to March 2016. The focus was to decrease overall size and weight of FST instrument sets without decreasing surgical capability of the GHOST-T. Each instrument set was evaluated and modified to include essential instruments to perform damage control surgery. The overall number of main instrument sets was decreased from eight to four; simplified augmentation sets have been added, which expand the capabilities of any main set. The overall size was decreased by 40% and overall weight decreased by 58%. The cardiothoracic, thoracotomy, and emergency thoracotomy trays were condensed to thoracic set. The orthopedic and amputation sets were replaced with an augmentation set of a prepackaged orthopedic external fixator set). An augmentation set to the major or minor basic sets, specifically for vascular injuries, was created. Through the reorganization of conventional FST surgical instrument sets to maintain damage control capabilities and mobility, the 102nd GHOST-T reduced surgical equipment volume and weight, providing a lesson learned for future surgical teams operating in austere environments. 2017.

  20. Surgical orthodontics.

    Science.gov (United States)

    Strohl, Alexis M; Vitkus, Lauren

    2017-08-01

    The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

  1. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study

    Directory of Open Access Journals (Sweden)

    Jian Zhang

    2013-07-01

    Full Text Available OBJECTIVES: This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies. METHODS: Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded. RESULTS: The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group. CONCLUSION: The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting in thoracic surgery patients requiring one-lung ventilation.

  2. Dissection of lung parenchyma using electrocautery is a safe and acceptable method for anatomical sublobar resection

    OpenAIRE

    Ohtsuka, Takashi; Goto, Taichiro; Anraku, Masaki; Kohno, Mitsutomo; Izumi, Yotaro; Horinouchi, Hirohisa; Nomori, Hiroaki

    2012-01-01

    Abstract Background Anatomic sublobar resection is being assessed as a substitute to lobectomy for primary lung cancers. However, persistent air leak after anatomic sublobar resection is prevalent and increasing surgical morbidity and costs. The use of electrocautery is being popularized recently in anatomic sublobar resection. We have retrospectively evaluated the safety and efficacy of intersegmental plane dissection using electrocautery. Methods Between April 2009 to September 2010, 47 pat...

  3. Memory outcome following left anterior temporal lobectomy in patients with a failed Wada test.

    Science.gov (United States)

    Rathore, Chaturbhuj; Alexander, Aley; Sarma, P Sankara; Radhakrishnan, Kurupath

    2015-03-01

    This study aimed to compare the memory outcome following left anterior temporal lobectomy (ATL) between patients with a failed Wada test and patients who passed the Wada test. From 1996 to 2002, we performed the Wada test on all patients with unilateral left mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and concordant electroclinical data before ATL. We used a 12-item recognition paradigm for memory testing and awarded a score of +1 for each correct response and -0.5 for each incorrect response. No patient was denied surgery on the basis of Wada scores. We assessed cognitive and memory functions using the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale preoperatively and at one year after ATL. We compared the number of patients who showed decline in memory scores, as per the published reliable change indices, between the patients with a failed Wada test and the patients who passed the Wada test. Out of the 116 eligible patients with left MTLE-HS, 88 underwent bilateral Wada test, while 28 underwent ipsilateral Wada test. None of them developed postoperative amnesia. Approximately, one-third of patients with a failed Wada memory test when the failure was defined as a contralateral score of 8, and as an asymmetry score of failed Wada memory test and the group who passed the Wada memory test. The results remained the same when analyses were repeated at various other cutoff points. The patients with left MTLE-HS with concordant electroclinical, MRI, and neuropsychological data should not be denied ATL solely on the basis of Wada memory test results. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Management and Surgical Outcomes of Concurrent Tuberculosis and Lung Cancer.

    Science.gov (United States)

    Evman, Serdar; Baysungur, Volkan; Alpay, Levent; Uskul, Bahadir; Misirlioglu, Aysun Kosif; Kanbur, Serda; Dogruyol, Talha

    2017-10-01

    Background  Concurrent pulmonary tuberculosis (TB) and lung cancer are rarely encountered in Western countries; however, it is more common in developing countries. We aim to share the diagnostic and treatment approaches in this study. Materials and Methods  Clinical files of all patients undergoing lung resection for non-small cell carcinoma with concurrent pulmonary TB between February 2006 and December 2012 were investigated retrospectively in terms of patient characteristics, operation methods, definite pathology and stage of tumor, postoperative treatment schemes, and associated complications. Results  TB was detected in 17 (1.3%) of 1,266 operated carcinoma patients. Eleven had squamous cell carcinoma and six had adenocarcinoma. Mean age was 54.9 years. Two patients received anti-TB treatment preoperatively. Fifteen patients were given anti-TB treatment postoperatively, as soon as definite microbiological confirmation was obtained, and concurrently given adjuvant therapy after 3 weeks of sole four-drug TB treatment. Pneumonectomy was performed in four (23.5%), sleeve lobectomy in three (17.6%), lobectomy in eight (47%), and bilobectomy in two (11.7%) patients. Postoperative complications occurred in four (23.5%) patients, with bronchopleural fistula being seen in only one pneumonectomy patient. No postoperative mortality or reactivation of TB was seen. Mean survival time was 32 ± 2 months. Conclusion  Resection following a 3-week anti-TB treatment or concurrent anti-TB and postoperative adjuvant chemotherapy does not constitute an additional postoperative risk for patients with concomitant lung malignancy and pulmonary TB. The determination of optimum treatment for these patients presents a challenge in developing countries, where TB is still a common disease. Georg Thieme Verlag KG Stuttgart · New York.

  5. Micro-surgical endodontics.

    Science.gov (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  6. Experience of 1166 Thyroidectomy without Use of Prophylactic Antibiotic

    Directory of Open Access Journals (Sweden)

    Qiang Lu

    2014-01-01

    Full Text Available Background. Although the procedure requires a small surgical incision and a short duration, incision infection rate is very low in thyroidectomy; however, doctors still have misgivings about infection events. Aim. We retrospectively analyzed the prevention of incision infection without perioperative use of antibacterial medications following thyroidectomy. Materials and Methods. 1166 patients of thyroidectomy were not administered perioperative antibiotics. Unilateral total lobectomy or partial thyroidectomy was performed in 68.0% patients with single-side nodular goiter or thyroid adenoma. Bilateral partial thyroidectomy was performed in 25.5% patients with nodular goiter or Graves’ disease. The mean time of operation was 80.6 ± 4.87 (range: 25–390 min. Results. Resuturing was performed in two patients of secondary hemorrhage from residual thyroid following bilateral partial thyroidectomy. Temporally recurrent nerve paralysis was reported following right-side total lobectomy and left-side subtotal lobectomy in a nodular goiter patient. One case had suppurative infection in neck incision 5 days after bilateral partial thyroidectomy. Conclusions. Thyroidectomy, which is a clean incision, involves a small incision, short duration, and minor hemorrhage. If the operation is performed under strict conditions of sterility and hemostasis, antibacterial medications may not be required to prevent incision infection, which reduces cost and discourages the excessive use of antibiotics.

  7. Remediation of uranium-contaminated soil using the Segmented Gate System and containerized vat leaching techniques: a cost effectiveness study

    International Nuclear Information System (INIS)

    Cummings, M.; Booth, S.R.

    1996-01-01

    Because it is difficult to characterize heterogeneously contaminated soils in detail and to excavate such soils precisely using heavy equipment, it is common for large quantities of uncontaminated soil to be removed during excavation of contaminated sites. Until now, volume reduction of radioactively contaminated soil depended upon manual screening and analysis of samples, a costly and impractical approach, particularly with large volumes of heterogeneously contaminated soil. The baseline approach for the remediation of soils containing radioactive waste is excavation, pretreatment, containerization, and disposal at a federally permitted landfill. However, disposal of low-level radioactive waste is expensive and storage capacity is limited. ThermoNuclean's Segmented Gate System (SGS) removes only the radioactively contaminated soil, in turn greatly reducing the volume of soils that requires disposal. After processing using the SGS, the fraction of contaminated soil is processed using the containerized vat leaching (CVL) system developed at LANL. Uranium is leached out of the soil in solution. The uranium is recovered with an ion exchange resin, leaving only a small volume of liquid low-level waste requiring disposal. The reclaimed soil can be returned to its original location after treatment with CVL

  8. Exploration of Postoperative Follow-up Strategies for Early Staged NSCLC Patients on the Basis of Follow-up Result of 416 Stage I NSCLC Patients after Lobectomy

    Directory of Open Access Journals (Sweden)

    Liang DAI

    2018-03-01

    Full Text Available Background and objective Currently, there is no consensus on the follow-up strategy (follow-up time interval and content of non-small cell lung cancer (NSCLC in the world, and the relevant clinical evidence is also very limited. In this study, we aimed to summarize the recurrence/metastasis sites and timings of stage I NSCLC patients based on their follow-up data, aiming to provide a basis of follow-up time interval and content for this group of patients. Methods We retrospectively analyzed the 416 stage I NSCLC patients that underwent continuous anatomic lobectomy between Jan. 2000 to Oct. 2013 in our prospective lung cancer database. According to the recurrence/metastasis sites and timings, the long term follow-up time interval and content were explored. Results The 5-yr disease free survival (DFS and overall survival (OS in the whole group were 82.4% and 85.4%, respectively. There were 76 cases (18.3% had recurrence/metastasis during follow-up, among which the most frequent site was pulmonary metastasis (21 cases, 5.0%, followed by brain metastasis (20 cases, 4.8%, bone metastasis (12 cases, 2.9%, and mediastinal lymph node metastasis (12 cases, 2.9%. Among the factors that could influence recurrence/metastasis, patients with pT2a suffered from a higher recurrence/metastasis rate compared to patients with pT1 (P=0.006, with 5-yr DFS being 73.8% and 87.3%, respectively (P=0.002, and the 5-yr OS being 77.7% and 90.3%, respectively (P=0.011. Conclusion The commonest recurrence/metastasis sites of stage I NSCLC after anatomic lobectomy are lung, brain and mediastinal lymph nodes, the risk of recurrence/metastasis within 2 years were equal to that between 3 years and 5 years. The follow-up frequencies and content within 2 years could be adjusted according to T stages.

  9. The Statistical point of view of Quality: the Lean Six Sigma methodology.

    Science.gov (United States)

    Bertolaccini, Luca; Viti, Andrea; Terzi, Alberto

    2015-04-01

    Six Sigma and Lean are two quality improvement methodologies. The Lean Six Sigma methodology is applicable to repetitive procedures. Therefore, the use of this methodology in the health-care arena has focused mainly on areas of business operations, throughput, and case management and has focused on efficiency outcomes. After the revision of methodology, the paper presents a brief clinical example of the use of Lean Six Sigma as a quality improvement method in the reduction of the complications during and after lobectomies. Using Lean Six Sigma methodology, the multidisciplinary teams could identify multiple modifiable points across the surgical process. These process improvements could be applied to different surgical specialties and could result in a measurement, from statistical point of view, of the surgical quality.

  10. Is thoracoscopic patent ductus arteriosus closure superior to conventional surgery?

    Science.gov (United States)

    Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Marczak, Jakub; Cichon, Romuald

    2015-10-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether thoracoscopic patent ductus arteriosus (PDA) closure is superior to conventional surgery. Altogether 821 papers were found using the reported search, 11 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Eleven studies included in the analysis consisted of two prospective and three retrospective, non-randomized studies and six case series. Four included studies focused only on preterm infants, three studies enrolled neonates and the other four analysed all age groups from neonates to older children or young adults. There were no differences in mortality between video-assisted thoracoscopic surgery (VATS) and conventional surgery. Two studies suggested that VATS offers shorter operative times. Two papers observed shorter hospital stay, although the other two noted no significant difference. A large prospective trial found VATS to be associated with a lower number of postoperative complications in neonates and infants, whereas other studies suggested no significant differences in short-term postoperative complications. There is little evidence to suggest better musculoskeletal status and cosmesis in neonates following VATS. Conversion from thoracoscopy to thoracotomy described in six papers was seldom and it did not lead to any additional complications. All observational studies confirmed that both techniques are free from major adverse cardiovascular complications and these two techniques can be safely used in all patients qualified for surgical PDA closure. Two studies compared cost-effectiveness between the two techniques; one of them described VATS as significantly more cost-efficient, whereas the other study observed no difference. However, it should be noted that data

  11. Morbidity and mortality in a large series of surgical patients with pulmonary metastases of colorectal carcinoma: a prospective multicentre Spanish study (GECMP-CCR-SEPAR).

    Science.gov (United States)

    Rodríguez-Fuster, Alberto; Belda-Sanchis, José; Aguiló, Rafael; Embun, Raul; Mojal, Sergio; Call, Sergi; Molins, Laureano; Rivas de Andrés, Juan José

    2014-04-01

    Little information is available on postoperative morbidity and mortality after pulmonary metastasectomy. We describe the postoperative morbidity and mortality in a large multicentre series of patients after a first surgical procedure for pulmonary metastases of colorectal carcinoma (CRC) and identify the pre- and intraoperative variables influencing the clinical outcome. A prospective, observational and multicentre study was conducted. Data were collected from March 2008 to February 2010. Patients were grouped into Groups A and B according to the presence or absence of postoperative complications. Variables in both groups were compared by univariate and multivariate analyses. P-values of <0.05 were considered statistically significant. A total of 532 patients (64.5% males) from 32 hospitals were included. The mean (SD) ages of both study groups were similar [68 (10) vs 67 (10) years, P = NS). A total of 1050 lung resections were performed (90% segmentectomies or wedge, n = 946 and 10% lobectomies or greater, n = 104). Group A included 83 (15.6%) patients who developed a total of 100 complications. These included persistent air leaks in 18, atelectasis in 13, pneumonia in 13, paralytic ileum in 12, arrhythmia in 9, acute respiratory distress syndrome in 4 and miscellanea in 31. Reoperation was performed in 5 (0.9%) patients due to persistent air leaks in 4 and lung ischaemia in 1. The mortality rate was 0.4% (n = 2). Causes of death were sepsis in 1 patient and ventricular fibrillation in 1. In the multivariate analysis, lobectomy or greater lung resection [odds ration (OR) 1.9, 95% confidence interval (95% CI) 1.04-3.3, P = 0.03], respiratory co-morbidity (OR 2.3, 95% CI 1.1-4.6, P = 0.01) and cardiovascular co-morbidity (OR 2, 95% CI 1-3.8, P = 0.02) were independent risk factors for postoperative morbidity. Video-assisted surgery vs thoracotomy showed a protective effect (OR 0.3, 95% CI 0.1-0.8, P = 0.01). The first episode of lung surgery for pulmonary

  12. One-stoma carinoplasty: right upper sleeve lobectomy with hemicarinectomy for resection of right-tracheobronchial-angle tumors.

    Science.gov (United States)

    Kaya, Seyda Ors; Sevinc, Serpil; Ceylan, Kenan Can; Usluer, Ozan; Unsal, Saban

    2013-01-01

    Tracheobronchial-angle tumors involve the right main bronchus, the right upper lobar bronchus, and the lateral wall of the lower trachea. Resecting these tumors is one of the most complex procedures in thoracic surgery. In cases of high-caliber mismatch, the selection of a suitable anastomotic technique can be challenging. We found that our use of a one-stoma carinoplasty technique overcame high-caliber mismatch after the resection of these tumors. From 2009 through 2012, 8 men (mean age, 59 ± 6.2 yr; range, 46-66 yr) underwent complete resection of non-small-cell right-tracheobronchial-angle tumors at our institution. In every case, right upper sleeve lobectomy, wedge carinal resection, and one-stoma carinoplasty were applied. After tumor resection, one patient with hemoptysis and bronchopleural fistula underwent a completion pneumonectomy and died 10 days postoperatively. Bronchoscopy was necessary in 2 patients who had atelectasis in the contralateral lung. At a mean follow-up duration of 19.43 ± 8.4 months (range, 0.2-27.1 mo), 6 patients were alive and free of disease. We conclude that our one-stoma carinoplasty technique enables the resection of tumors at the right tracheobronchial angle, with acceptable morbidity and mortality rates. This method saves the unaffected part of the ipsilateral lung and can overcome high-caliber mismatch. Because of these and other advantages, we suggest that using our method first might preclude having to perform a right carinal sleeve pneumonectomy or using Barclay's method.

  13. Mobile surgical skills education unit: a new concept in surgical training.

    Science.gov (United States)

    Shaikh, Faisal M; Hseino, Hazem; Hill, Arnold D K; Kavanagh, Eamon; Traynor, Oscar

    2011-08-01

    Basic surgical skills are an integral part of surgical training. Simulation-based surgical training offers an opportunity both to trainees and trainers to learn and teach surgical skills outside the operating room in a nonpatient, nonstressed environment. However, widespread adoption of simulation technology especially in medical education is prohibited by its inherent higher cost, limited space, and interruptions to clinical duties. Mobile skills laboratory has been proposed as a means to address some of these limitations. A new program is designed by the Royal College of Surgeons in Ireland (RCSI), in an approach to teach its postgraduate basic surgical trainees the necessary surgical skills, by making the use of mobile innovative simulation technology in their own hospital settings. In this article, authors describe the program and students response to the mobile surgical skills being delivered in the region of their training hospitals and by their own regional consultant trainers.

  14. Output control of da Vinci surgical system's surgical graspers.

    Science.gov (United States)

    Johnson, Paul J; Schmidt, David E; Duvvuri, Umamaheswar

    2014-01-01

    The number of robot-assisted surgeries performed with the da Vinci surgical system has increased significantly over the past decade. The articulating movements of the robotic surgical grasper are controlled by grip controls at the master console. The user interface has been implicated as one contributing factor in surgical grasping errors. The goal of our study was to characterize and evaluate the user interface of the da Vinci surgical system in controlling surgical graspers. An angular manipulator with force sensors was used to increment the grip control angle as grasper output angles were measured. Input force at the grip control was simultaneously measured throughout the range of motion. Pressure film was used to assess the maximum grasping force achievable with the endoscopic grasping tool. The da Vinci robot's grip control angular input has a nonproportional relationship with the grasper instrument output. The grip control mechanism presents an intrinsic resistant force to the surgeon's fingertips and provides no haptic feedback. The da Vinci Maryland graspers are capable of applying up to 5.1 MPa of local pressure. The angular and force input at the grip control of the da Vinci robot's surgical graspers is nonproportional to the grasper instrument's output. Understanding the true relationship of the grip control input to grasper instrument output may help surgeons understand how to better control the surgical graspers and promote fewer grasping errors. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Parahippocampectomy as a New Surgical Approach to Mesial Temporal Lobe Epilepsy Caused By Hippocampal Sclerosis: A Pilot Randomized Comparative Clinical Trial.

    Science.gov (United States)

    Alonso-Vanegas, Mario Arturo; Freire Carlier, Iván D; San-Juan, Daniel; Martínez, Alma Rosa; Trenado, Carlos

    2018-02-01

    The parahippocampal gyrus plays an important role in the epileptogenic pathways of mesial temporal lobe epilepsy caused by hippocampal sclerosis (mTLE-HS); its resection could prevent epileptic seizures with fewer complications. This study evaluates the initial efficacy and safety of anterior temporal lobectomy (ATL), selective amygdalohipppocampectomy (SAH), and parahippocampectomy (PHC) surgical approaches in mTLE-HS. A randomized comparative pilot clinical trial (2008-2011) was performed that included patients with mTLE-HS who underwent ATL, trans-T3 SAH, and trans-T3 PHC. Their sociodemographic characteristics, visual field profiles, verbal and visual memory profiles, and Engel scale outcome at baseline and at 1 and 5 years are described, using descriptive statistics along with parametric and nonparametric tests. Forty-three patients with a mean age of 35.2 years (18-56 years), 65% female, were analyzed: 14 underwent PHC, 14 ATL, and 15 SAH. The following percentages refer to those patients who were seizure free (Engel class IA) at 1-year and 5-year follow-up, respectively: 42.9% PHC, 71.4% ATL, and 60% SAH (P = 0.304); 28.6% PHC, 50% ATL, and 53.3% SAH (P = 0.353). Postoperative visual field deficits were 0% PHC, 85.7% ATL, and 46.7% SAH (P = 0.001). Verbal and/or visual memory worsening were present in 21.3% PHC, 42.8% ATL, and 33.4% SAH (P = 0.488) and preoperative and postoperative visual memory scores were significantly different in the SAH group only (P = 0.046). PHC, ALT, and SAH show a preliminary similar efficacy in short-term seizure-free rates in patients with mTLE-HS. However, PHC efficacy in the long-term decreases compared with the other surgical techniques. PHC does not produce postoperative visual field deficits. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Clinical management IT system for enhanced recovery

    OpenAIRE

    Yi, Eunjue; Jheon, Sanghoon

    2016-01-01

    Surgical resection has a key role for the treatment of early stage lung cancer along with certain advanced cases, and minimally invasive techniques, representatively video-assisted thoracoscopic surgery (VATS), are becoming standard for lung cancer surgery. Implementation of integrated programs which could manage the whole process of patient treatment including preoperative, intraoperative and postoperative care is thought to be essential partner for successful application of minimally invasi...

  17. Clinical characteristics, surgical and neuropsychological outcomes in drug resistant tumoral temporal lobe epilepsy.

    Science.gov (United States)

    Ravat, Sangeeta; Iyer, Vivek; Muzumdar, Dattatraya; Shah, Urvashi; Pradhan, Pranjali; Jain, Neeraj; Godge, Yogesh

    2016-12-01

    Glioneuronal tumors are found in nearly one third patients who undergo surgery for pharmacoresistant epilepsy with temporal lobe being the most common location. Few studies, however have concentrated on the neurological and neuropsychological outcomes after surgery, hitherto none from India. We studied 34 patients with temporal lobe tumors and drug resistant epilepsy. These patients underwent anterior temporal lobectomy or lesionectomy based on the involvement of the hippocampus and mesial temporal structures. The clinical history, EEG, neuropsychology profile and MRI were compared. Seizure outcome was categorized using Engel's classification. At a mean follow up of 62 months, 85.29% of the patients were seizure free (Engel's Class I). All 8 patients with intraoperative electrocorticography (ECoG) guided resection were seizure free. Presence of a residual lesion was significantly associated with persistence of seizures post surgery (p = 0.002). Group analysis revealed no significant shifts in IQ and memory scores postoperatively. There was a significant improvement in the quality of life scores (total and across all subdomains) in all patients (p temporal lobe tumors and refractory epilepsy offers complete seizure freedom in majority. Complete surgical excision of the epileptogenic zone is of paramount importance in achieving seizure freedom. Intraoperative electrocorticography (EcoG) is a useful adjunct to ensure complete removal of epileptogenic zone, thus achieving optimal seizure freedom. There is a significant improvement in the quality of life scores (p < 0.001) with no negative impact of surgery on memory and intelligence. Even the patients who are not seizure free can achieve worthwhile improvement post surgery. Copyright © 2015 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Open surgical simulation--a review.

    Science.gov (United States)

    Davies, Jennifer; Khatib, Manaf; Bello, Fernando

    2013-01-01

    Surgical simulation has benefited from a surge in interest over the last decade as a result of the increasing need for a change in the traditional apprentice model of teaching surgery. However, despite the recent interest in surgical simulation as an adjunct to surgical training, most of the literature focuses on laparoscopic, endovascular, and endoscopic surgical simulation with very few studies scrutinizing open surgical simulation and its benefit to surgical trainees. The aim of this review is to summarize the current standard of available open surgical simulators and to review the literature on the benefits of open surgical simulation. Open surgical simulators currently used include live animals, cadavers, bench models, virtual reality, and software-based computer simulators. In the current literature, there are 18 different studies (including 6 randomized controlled trials and 12 cohort studies) investigating the efficacy of open surgical simulation using live animal, bench, and cadaveric models in many surgical specialties including general, cardiac, trauma, vascular, urologic, and gynecologic surgery. The current open surgical simulation studies show, in general, a significant benefit of open surgical simulation in developing the surgical skills of surgical trainees. However, these studies have their limitations including a low number of participants, variable assessment standards, and a focus on short-term results often with no follow-up assessment. The skills needed for open surgical procedures are the essential basis that a surgical trainee needs to grasp before attempting more technical procedures such as laparoscopic procedures. In this current climate of medical practice with reduced hours of surgical exposure for trainees and where the patient's safety and outcome is key, open surgical simulation is a promising adjunct to modern surgical training, filling the void between surgeons being trained in a technique and a surgeon achieving fluency in that

  19. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff

    2012-01-01

    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...

  20. The Virtual Surgical Pelvis : Anatomy Visualization for Education and Surgical Planning

    NARCIS (Netherlands)

    Smit, N.N.

    2016-01-01

    This thesis deals with visualizing anatomical data for medical education and surgical planning purposes. To this end, we have developed a detailed virtual atlas, the Virtual Surgical Pelvis (VSP),which unifies surgically relevant knowledge on pelvic anatomy. We provide methods to share the knowledge

  1. Deriving DICOM surgical extensions from surgical workflows

    Science.gov (United States)

    Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

    2007-03-01

    The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

  2. Disposable surgical face masks for preventing surgical wound infection in clean surgery

    Directory of Open Access Journals (Sweden)

    Allyson Lipp

    Full Text Available BACKGROUND: Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.g. by incorrect wear or by leaking air from the side of the mask due to poor string tension. OBJECTIVES: To determine whether disposable surgical face masks worn by the surgical team during clean surgery prevent postoperative surgical wound infection. SEARCH METHODS: We searched The Cochrane Wounds Group Specialised Register (searched 14 September 2011; The Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library 2011, Issue 3; Ovid MEDLINE (2008 to August Week 5 2011; Ovid MEDLINE (In-Process &Other Non-Indexed Citations September 13, 2011; Ovid EMBASE (2008 to 2011 Week 35; and EBSCO CINAHL (2008 to 9 September 2011. SELECTION CRITERIA: Randomized controlled trials (RCTs and quasi-randomized controlled trials comparing the use of disposable surgical masks with the use of no mask. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. MAIN RESULTS: Three trials were included, involving a total of 2113 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. AUTHORS' CONCLUSIONS: From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

  3. Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

    International Nuclear Information System (INIS)

    Smeenk, Robert M.; Kock, Mark C. J. M.; Elgersma, Otto E. H.; Schnater, Marco J.

    2011-01-01

    This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA.

  4. Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease.

    Science.gov (United States)

    Saito, Hajime; Hatakeyama, Kazutoshi; Konno, Hayato; Matsunaga, Toshiki; Shimada, Yoichi; Minamiya, Yoshihiro

    2017-09-01

    Given the extent of the surgical indications for pulmonary lobectomy in breathless patients, preoperative care and evaluation of pulmonary function are increasingly necessary. The aim of this study was to assess the contribution of preoperative pulmonary rehabilitation (PR) for reducing the incidence of postoperative pulmonary complications in non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD). The records of 116 patients with COPD, including 51 patients who received PR, were retrospectively analyzed. Pulmonary function testing, including slow vital capacity (VC) and forced expiratory volume in one second (FEV 1 ), was obtained preoperatively, after PR, and at one and six months postoperatively. The recovery rate of postoperative pulmonary function was standardized for functional loss associated with the different resected lung volumes. Propensity score analysis generated matched pairs of 31 patients divided into PR and non-PR groups. The PR period was 18.7 ± 12.7 days in COPD patients. Preoperative pulmonary function was significantly improved after PR (VC 5.3%, FEV 1 5.5%; P pulmonary complications after pulmonary lobectomy (odds ratio 18.9, 16.1, and 13.9, respectively; P pulmonary function after lobectomy in the early period, and may decrease postoperative pulmonary complications. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  5. [A surgical case of mesial temporal lobe epilepsy associated with hippocampal sclerosis and traumatic neocortical lesion].

    Science.gov (United States)

    Kitazawa, Yu; Jin, Kazutaka; Iwasaki, Masaki; Suzuki, Hiroyoshi; Tanaka, Fumiaki; Nakasato, Nobukazu

    2017-11-25

    A 26-year-old right-handed woman, with a history of left temporal lobe contusion caused by a fall at the age of 9 months, started to have complex partial seizures with oral automatism at the age of 7 years. The seizures occurred once or twice a month despite combination therapy with several antiepileptic agents. Her history and imaging studies suggested the diagnosis of epilepsy arising from traumatic neocortical temporal lesion. Comprehensive assessment including long-term video EEG monitoring, MRI, FDG-PET, MEG, and neuropsychological evaluation was performed at the age of 26 years. The diagnosis was left mesial temporal lobe epilepsy associated with hippocampal atrophy and traumatic temporal cortical lesion. The patient was readmitted for surgical treatment at the age of 27 years. Intracranial EEG monitoring showed that ictal discharges started in the left hippocampus and spread to the traumatic lesion in the left posterior superior temporal gyrus 10 seconds after the onset. This case could not be classified as dual pathology exactly, because the traumatic left temporal cortical lesion did not show independent epileptogenicity. However, the traumatic lesion was highly likely to be the source of the epileptogenicity, and she had right hemispheric dominance for language and functional deterioration in the whole temporal cortex. Therefore, left amygdalo-hippocampectomy and left temporal lobectomy including the traumatic lesion were performed according to the diagnosis of dual pathology. Subsequently, she remained seizure-free for 3 years. Comprehensive assessment of seizure semiology, neurophysiology, neuroradiology, and neuropsychology is important to determine the optimum therapeutic strategies for drug-resistant epilepsy.

  6. Consequences of persistent pain after lung cancer surgery: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Wildgaard, K; Ravn, J; Nikolajsen, L

    2011-01-01

    post-thoracotomy pain syndrome (PTPS) and its social consequences have been inconsistently investigated as most studies were either small sized, focused on a limited number of risk factors or included heterogeneous surgical procedures. The current objectives were to obtain detailed information on...... on the consequences of PTPS after thoracotomy and video-assisted thoracic surgery (VATS) from homogenous unselected nationwide data, and to suggest mechanisms for the development of PTPS....

  7. Adsorption of a textile dye "Indanthrene Blue RS (C.I. Vat Blue 4)" from aqueous solutions onto smectite-rich clayey rock.

    Science.gov (United States)

    Chaari, Islem; Feki, Mongi; Medhioub, Mounir; Bouzid, Jalel; Fakhfakh, Emna; Jamoussi, Fakher

    2009-12-30

    The adsorption of a textile dye, namely, Indanthrene Blue RS (C.I. Vat Blue 4) onto smectite-rich clayey rock (AYD) and its sulphuric acid-activated products (AYDS) in aqueous solution was studied in a batch system with respect to contact time, pH, and temperature. The adsorbents employed were characterized by X-ray diffraction, infrared spectroscopy and specific surface area, cation exchange capacity and point of zero charge were also estimated. The effect of contact time on dye adsorption showed that the equilibrium was reached after a contact time of 40 min for the both adsorbents. The optimum pH for dye retention was found 6.0 for AYDS and 7.3 for AYD. The equilibrium adsorption data were analysed using the Langmuir and Freundlich isotherms. The adsorption capacities (Q(m)) for AYD and AYDS were found 13.92 mg/g and 17.85 mg/g, respectively. The effect of temperature on the adsorption was also investigated; adsorption of Indanthrene Blue RS is an endothermic process. This study demonstrates that all the considered adsorbents can be used as an alternative emerging technology for water treatment.

  8. Minimizing surgical skin incision scars with a latex surgical glove.

    Science.gov (United States)

    Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun

    2013-04-01

    The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  9. Variability of bacterial biofilms of the "tina" wood vats used in the ragusano cheese-making process.

    Science.gov (United States)

    Licitra, G; Ogier, J C; Parayre, S; Pediliggieri, C; Carnemolla, T M; Falentin, H; Madec, M N; Carpino, S; Lortal, S

    2007-11-01

    Ragusano cheese is a "protected denomination of origin" cheese made in the Hyblean region of Sicily from raw milk using traditional wooden tools, without starter. To explore the Ragusano bacterial ecosystem, molecular fingerprinting was conducted at different times during the ripening and biofilms from the wooden vats called "tinas" were investigated. Raw milks collected at two farm sites, one on the mountain and one at sea level, were processed to produce Ragusano cheese. Raw milk, curd before and after cooking, curd at stretching time (cheese 0 time), and cheese samples (4 and 7 months) were analyzed by PCR-temporal temperature gel electrophoresis (PCR-TTGE) and by classical enumeration microbiology. With the use of universal primers, PCR-TTGE revealed many differences between the raw milk profiles, but also notable common bands identified as Streptococcus thermophilus, Lactobacillus lactis, Lactobacillus delbrueckii, and Enterococcus faecium. After the stretching, TTGE profiles revealed three to five dominant species only through the entire process of ripening. In the biofilms of the two tinas used, one to five species were detected, S. thermophilus being predominant in both. Biofilms from five other tinas were also analyzed by PCR-TTGE, PCR-denaturating gradient gel electrophoresis, specific PCR tests, and sequencing, confirming the predominance of lactic acid bacteria (S. thermophilus, L. lactis, and L. delbrueckii subsp. lactis) and the presence of a few high-GC-content species, like coryneform bacteria. The spontaneous acidification of raw milks before and after contact with the five tinas was followed in two independent experiments. The lag period before acidification can be up to 5 h, depending on the raw milk and the specific tina, highlighting the complexity of this natural inoculation system.

  10. Bacterial migration through punctured surgical gloves under real surgical conditions

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter

    2010-07-01

    Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

  11. Surgical experts: born or made?

    Science.gov (United States)

    Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger

    2013-01-01

    The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  12. Bulectomia bilateral por cirurgia torácica vídeo-assistida uniportal combinada com acesso contralateral ao mediastino anterior Bilateral bullectomy through uniportal video-assisted thoracoscopic surgery combined with contralateral access to the anterior mediastinum

    Directory of Open Access Journals (Sweden)

    Nan Song

    2013-02-01

    Full Text Available OBJETIVO: A cirurgia torácica vídeo-assistida (CTVA tem sido uma intervenção de escolha para o tratamento de pneumotórax espontâneo (PS com bolha pulmonar. Nosso objetivo foi apresentar uma abordagem de CTVA uniportal unilateral para bulectomia bilateral e avaliar sua eficácia terapêutica. MÉTODOS: Entre maio de 2011 e janeiro de 2012, cinco pacientes foram submetidos a bulectomia bilateral por essa abordagem. Todos apresentavam PS bilateral. A TCAR pré-operatória mostrou que todos os pacientes tinham bolhas bilaterais no pulmão apical. As indicações cirúrgicas, os procedimentos de operação e os desfechos foram revisados. RESULTADOS: Todos os pacientes foram submetidos com sucesso a essa abordagem para bulectomia bilateral, sem complicações intraoperatórias. A mediana de tempo para a retirada do dreno torácico foi de 4,2 dias, e a mediana do tempo de hospitalização no pós-operatório foi de 5,2 dias. A mediana de seguimento pós-operatório foi de 11,2 meses. Um paciente teve recidiva de PE do lado esquerdo três semanas após a cirurgia e foi submetido a abrasão pleural. CONCLUSÕES: A bulectomia bilateral utilizando CTVA uniportal combinada com acesso contralateral ao mediastino anterior é tecnicamente confiável e promove desfechos favoráveis para pacientes com PS que desenvolvem bolhas bilaterais no pulmão apical. Entretanto, para a realização desse procedimento cirúrgico, são necessários cirurgiões com experiência em CTVA, instrumentos toracoscópicos longos, entre outras exigências.OBJECTIVE: Video-assisted thoracoscopic surgery (VATS has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy. METHODS: Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All

  13. Global curriculum in surgical oncology.

    Science.gov (United States)

    Are, C; Berman, R S; Wyld, L; Cummings, C; Lecoq, C; Audisio, R A

    2016-06-01

    The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment. Copyright © 2016 Society of Surgical Oncology, European Society of Surgical Oncology. Published by Elsevier Ltd.. All rights reserved.

  14. Capping of the radicular exposed surface (part II). Surgical and not surgical treatment

    OpenAIRE

    Grados Pomarino, Sixto; Estrada, Andrew Alejandro; Maetahara Rubio, Denis Miguel; Guzmán Vera, Yanina Sara; Tello Barbarán, Javier

    2014-01-01

    The gingival recession treatment can be made surgical1y with a high predictability of success due to the great advance during the last ones of the mucogingival surgical techniques. The use of connective grafts in coverage of recessions has obtained high rates of success reason why these procedures are common within the modern periodontal surgical practice. Knowing that all patients do not accept the surgical treatment, many investigators have come studying the possibility of treating non-surg...

  15. Anesthetic Management of Patients Undergoing Right Lung Surgery After Left Upper Lobectomy: Selection of Tubes for One-Lung Ventilation (OLV) and Oxygenation During OLV.

    Science.gov (United States)

    Kawagoe, Izumi; Hayashida, Masakazu; Suzuki, Kenji; Kitamura, Yoshitaka; Oh, Shiaki; Satoh, Daizoh; Inada, Eiichi

    2016-08-01

    To investigate anesthesia management in patients undergoing right lung surgery after a previous left upper lobectomy (LUL) that may require special precautions since angulation of the left bronchus can hamper correct placement of a left-sided double-lumen tube (DLT), and one-lung ventilation (OLV) depending solely on the left lower lobe may lead to inadequate oxygenation. A retrospective data analysis. Single university hospital. Patients underwent right lung surgery after previous LUL. None. Anesthesia management was investigated in 18 patients who underwent right lung surgery following LUL. All intubation procedures were performed under bronchoscopic guidance to prevent airway trauma. OLV could be achieved with a left-sided DLT in 12 patients, while tubes other than this were required in 6 patients, including a right-sided DLT (n = 3) and a bronchial blocker (n = 3). The presence or absence of remarkable bronchial angulation, characterized by a combination of a wide (>140°) angle between the trachea and left main bronchus and a narrow (right lung surgery after LUL. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Sarcoma de alto grado pulmonar en paciente con síndrome constitucional e infil- trado pulmonar persistente

    Directory of Open Access Journals (Sweden)

    Peña Durán A

    2017-07-01

    Full Text Available Patient of 76 years smoker of 40 cigarettes per day until 12 years ago, with constitutional syndrome and pneumological antecedents and criteria of bronchial hyperreactivity, follow up in consultation of routine Pneumology finding in chest X-ray, an infiltrate in the right upper lobe. A thoracoabdominopelvic CT scan is requested, with a mass of almost 4 cm superior in an axillar subsegment of the right upper lobe with underlying pleural thickening, perinodular cystic lesions and doubtful anterior satellite nodule , Right and mediastinal hilar lymphadenopathy stage IIaN1M0 (stage IIA. Fibe- roptic bronchoscopy is performed with a suggestive study of chronic bronchitis. Negative bronchoalveolar and bron- choaspolar lavage samples are collected for malignant tumor cells. We conducted a guided BAG with CT scan and biopsy results showed high grade sarcoma with intense positive vimentin, moderate weak positive actin, caldesmon, S100, Melan A negative, AE1: AE3. CK7 and CK20 negative. In PET CT results, right lung neoplasm with ipsilateral hilar adenopathy is confirmed. VATS thoracic surgery is performed later, lobectomy of upper right lobes and lympha- denectomy are performed. The patient is discharged pending cáncer treatment.

  17. Myofascial involvement of supra- and infraspinatus muscles contributes to ipsilateral shoulder pain after muscle-sparing thoracotomy and video-assisted thoracic surgery.

    Science.gov (United States)

    Ohmori, Aki; Iranami, Hiroshi; Fujii, Keisuke; Yamazaki, Akinori; Doko, Yukari

    2013-12-01

    This study examined the hypothesis that ipsilateral upper extremity elevation for muscle-sparing thoracotomy procedures contributes to the postoperative shoulder pain. Prospective observational study. Medical center. ASA physical status 1-2 patients undergoing elective lung surgeries including pneumonectomy, lobectomy, and segmentectomy performed through either the anterolateral approach or video-assisted thoracotomy surgery. Postoperative observation of ipsilateral shoulder pain. Postoperative examinations of sites of shoulder pain (clavicle, anterior, lateral,or posterior aspect of acromion, posterior neck, supraspinatus, infraspinatus, and these entire areas) with or without trigger points, visual analog scale score of wound pain, and requested counts of analgesics. The number of patients who suffered from postoperative shoulder pain was 37 of 70 (52.9%). Demographic data, anterolateral/VATS ratio, VAS scores, and requested counts of rescue analgesics requirement were similar in the groups of patients with and without postoperative shoulder pain. The segmentectomy caused a significantly higher incidence of postoperative shoulder pain compared with other procedures (p shoulder pain showed defined trigger points in their painful areas. These results supported the hypothesis that myofascial involvement contributed, to some extent, to shoulder pain after muscle-sparing thoracotomy with ipsilateral upper extremity elevation. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  19. Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma.

    Science.gov (United States)

    Milanchi, S; Makey, I; McKenna, R; Margulies, D R

    2009-01-01

    The role of video-assisted Thoracoscopic Surgery (VATS) is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was retained haemothorax. Thoracotomy was avoided in 21 patients. VATS failed in two cases. On an average VATS was performed on trauma day seven (range 1-26) and the length of hospital stay was 20 days (range 3-58). There was no mortality. VATS was performed in an emergency (day 1-2), or in the early (day 2-7) or late (after day 7) phases of trauma. VATS can be performed safely for the management of thoracic traumas. VATS can be performed before or after thoracotomy and at any stage of trauma. The use of VATS in trauma has a trimodal distribution (emergent, early, late), each with different indications.

  20. Surgical competence.

    Science.gov (United States)

    Patil, Nivritti G; Cheng, Stephen W K; Wong, John

    2003-08-01

    Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.

  1. SAGES TAVAC safety and effectiveness analysis: da Vinci ® Surgical System (Intuitive Surgical, Sunnyvale, CA).

    Science.gov (United States)

    Tsuda, Shawn; Oleynikov, Dmitry; Gould, Jon; Azagury, Dan; Sandler, Bryan; Hutter, Matthew; Ross, Sharona; Haas, Eric; Brody, Fred; Satava, Richard

    2015-10-01

    The da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is a computer-assisted (robotic) surgical system designed to enable and enhance minimally invasive surgery. The Food and Drug Administration (FDA) has cleared computer-assisted surgical systems for use by trained physicians in an operating room environment for laparoscopic surgical procedures in general, cardiac, colorectal, gynecologic, head and neck, thoracic and urologic surgical procedures. There are substantial numbers of peer-reviewed papers regarding the da Vinci(®) Surgical System, and a thoughtful assessment of evidence framed by clinical opinion is warranted. The SAGES da Vinci(®) TAVAC sub-committee performed a literature review of the da Vinci(®) Surgical System regarding gastrointestinal surgery. Conclusions by the sub-committee were vetted by the SAGES TAVAC Committee and SAGES Executive Board. Following revisions, the document was evaluated by the TAVAC Committee and Executive Board again for final approval. Several conclusions were drawn based on expert opinion organized by safety, efficacy, and cost for robotic foregut, bariatric, hepatobiliary/pancreatic, colorectal surgery, and single-incision cholecystectomy. Gastrointestinal surgery with the da Vinci(®) Surgical System is safe and comparable, but not superior to standard laparoscopic approaches. Although clinically acceptable, its use may be costly for select gastrointestinal procedures. Current data are limited to the da Vinci(®) Surgical System; further analyses are needed.

  2. Video-Assisted Thoracoscopic Surgery in Patients With Clinically Resectable Lung Tumors

    Directory of Open Access Journals (Sweden)

    H. Sakai

    1996-01-01

    Full Text Available To investigate the feasibility of thoracoscopic resection, a pilot study was performed in patients with clinically resectable lung tumors. In 40 patients, Video-assisted thoracic surgery (VATS was performed because of suspicion of malignancy. There were 29 men and 11 women with a median age of 54.8 years (range 18 to 78. Preoperative indications were suspected lung cancer and tumor in 27 patients, assessment of tumor resectability in 7 patients, and probability of metastatic tumors in 6 patients. The final diagnoses in the 27 patients with suspected lung cancer were 12 primary lung cancers, 6 lung metastases, and 9 benign lesions. The success rates for VATS (no conversion to thoracotomy were 1 of 12 (8.3% for resectable stage I lung cancer, 8 of 12 (66.7% for metastatic tumors, and 9 of 9 (100% for benign tumors. With VATS, 6 of 7 patients (85.7%, possible stage III non-small cell lung cancer, an explorative thoracotomy with was avoided, significantly reducing morbidity. The reasons for conversion to thoracotomy were 1 oncological (N2 lymph node dissection and prevention of tumor spillage and 2 technical (inability to locate the nodule, central localization, no anatomical fissure, or poor lung function requiring full lung ventilation. The ultimate diagnoses were 19 lung cancers, 12 metastatic lung tumors, and 9 benign lung tumors. Our data show the limitations of VATS for malignant tumors in general use. These findings, together with the fact that experience in performing thoracoscopic procedures demonstrates a learning curve, may limit the use of thoracoscopic resection as a routine surgical procedure, especially when strict oncological rules are respected.

  3. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.

    2012-01-01

    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  4. Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma

    Directory of Open Access Journals (Sweden)

    Milanchi S

    2009-01-01

    Full Text Available Background: The role of video-assisted Thoracoscopic Surgery (VATS is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. Materials and Methods: All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. Results: Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was retained haemothorax. Thoracotomy was avoided in 21 patients. VATS failed in two cases. On an average VATS was performed on trauma day seven (range 1-26 and the length of hospital stay was 20 days (range 3-58. There was no mortality. VATS was performed in an emergency (day 1-2, or in the early (day 2-7 or late (after day 7 phases of trauma. Conclusion: VATS can be performed safely for the management of thoracic traumas. VATS can be performed before or after thoracotomy and at any stage of trauma. The use of VATS in trauma has a trimodal distribution (emergent, early, late, each with different indications.

  5. Thoracoscopic patch insulation to correct phrenic nerve stimulation secondary to cardiac resynchronization therapy.

    Science.gov (United States)

    Mediratta, Neeraj; Barker, Diane; McKevith, James; Davies, Peter; Belchambers, Sandra; Rao, Archana

    2012-07-01

    Cardiac resynchronization therapy is an established therapy for heart failure, improving quality of life and prognosis. Despite advances in technique, available leads and delivery systems, trans-venous left ventricular (LV) lead positioning remains dependent on the patient's underlying venous anatomy. The left phrenic nerve courses over the surface of the pericardium laterally and may be stimulated by the LV pacing lead, causing uncomfortable diaphragmatic twitch. This paper describes a video-assisted thoracoscopic (VATS) procedure to correct phrenic nerve stimulation secondary to cardiac resynchronization therapy. Most current ways of avoiding phrenic stimulation involve either electronic reprogramming to distance the phrenic nerve from the stimulation circuit or repositioning the lead. We describe a case where the phrenic nerve was surgically insulated from the stimulating current by insinuating a patch of bovine pericardium between the epicardium and native pericardium of the heart thus completely resolving previously intolerable and incessant diaphragmatic twitch. The procedure was performed under general anaesthesia with single-lung ventilation and minimal use of neuromuscular blocking agents. Surgical patch insulation of the phrenic nerve was performed using minimally invasive VATS surgery, as a short-stay procedure, with no complications. No diaphragmatic twitch occurred post-surgery and the patient continued to gain symptomatic benefit from cardiac synchronization therapy (New York Heart Association Class III to II), enabling return to work. In cases where the trans-venous position of a LV lead is limited by troublesome phrenic nerve stimulation, thoracoscopic surgical patch insulation of the phrenic nerve could be considered to allow beneficial cardiac resynchronization therapy.

  6. [Comparative effectiveness of surgical and non-surgical treatment for pediatric mandibular condylar fractures].

    Science.gov (United States)

    Hu, Min; Wang, Yanyi; Zhang, Lihai; Yao, Jun

    2010-12-01

    To compare the effectiveness of open reduction and conservative treatment for pediatric mandibular condylar fractures and to provide the evidence for the selection of clinical therapy. The clinical data were retrospectively analyzed from 25 patients with the mandibular condylar fractures between January 1988 and December 2006. Of them, 8 patients (11 fractures) were treated with surgical treatment (surgical group) and 17 patients (22 fractures) with non-surgical treatment (non-surgical group). In surgical group, there were 6 males (9 fractures) and 2 females (2 fractures) with an age range of 8-13 years; fracture was caused by tumbling in 7 cases and by traffic accident in 1 with an interval of 1-6 days between injury and hospitalization; and 5 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 3 cases as bilateral condylar fractures complicated by mental fractures. In non-surgical group, there were 12 males (15 fractures) and 5 females (7 fractures) with an age range of 3-12 years; fracture was caused by falling from height in 4 cases, by tumbling in 10, and by traffic accident in 3 with an interval of 1-25 days between injury and hospitalization; and 12 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 5 cases as bilateral condylar fractures (1 complicated by mental fracture). Incision healed by first intention in surgical group, and 25 cases were followed up 1-6 years with an average of 3.5 years. At 12 months after treatment, no temporomandibular joint pain, eating disorder, or limited mandibular movement occurred in 2 groups. No significant difference was observed in opening mouth extent, protrusive and lateral movements between 2 groups at 6 and 12 months (P > 0.05). During centric occlusion, mental point located at the midline with symmetric face figure. Two patients in surgical group and 3 in non-surgical group had slight snap when opening their mouths. Mandible

  7. Outcome following simultaneous bilateral thyroid lobectomy for treatment of thyroid gland carcinoma in dogs: 15 cases (1994-2010).

    Science.gov (United States)

    Tuohy, Joanne L; Worley, Deanna R; Withrow, Stephen J

    2012-07-01

    To evaluate the outcome of resection of simultaneous discrete bilateral mobile thyroid gland carcinomas (TGCs) in dogs. Retrospective case series. 15 dogs with resected simultaneous discrete bilateral mobile TGCs. Medical records (from 1994 to 2010) were searched for dogs with the appropriate diagnosis and treatment. Information collected included signalment, clinical signs, diagnostic test results, tumor mobility (mobile tumor identified by movement ≥ 1 cm in all planes during palpation), complications, adjuvant treatments, and outcome. Mobile, discrete, bilateral TGCs were removed in all dogs. Among the 15 dogs, complete parathyroidectomies were necessary in 9; parathyroid tissue was reimplanted in 4 and preserved in 2. Complications included hemorrhage and laryngeal nerve trauma, but without serious consequences. Thirteen dogs received calcitriol with or without supplemental calcium after surgery. In the immediate postoperative period, hypocalcemia developed and was corrected in 11 dogs. At the end of the study, 7 dogs continued to receive calcitriol with or without supplemental calcium, and 8 dogs required long-term thyroid hormone treatment. Six dogs received adjuvant chemotherapy. Local tumor recurrence or de novo distant metastasis was not detected at each dog's last follow-up examination. Median survival time was 38.3 months. Three dogs were lost to follow-up, 8 survived (4.3 to 77 months after surgery), and 4 died of unrelated causes. In dogs with TGCs undergoing bilateral thyroid lobectomies, a successful outcome can be expected, even when parathyroid gland tissue cannot be preserved. The role of adjuvant chemotherapy in treatment outcome was not clearly defined.

  8. A new paradigm in low-risk papillary microcarcinoma: active surveillance

    Directory of Open Access Journals (Sweden)

    Alex González Bóssolo

    2017-09-01

    Full Text Available Classical papillary thyroid microcarcinoma (PTMC is a variant of papillary thyroid carcinoma (PTC known to have excellent prognosis. It has a mortality of 0.3%, even in the presence of distance metastasis. The latest American Thyroid Association guidelines state that although lobectomy is acceptable, active surveillance can be considered in the appropriate setting. We present the case of a 37-year-old female with a history of PTMC who underwent surgical management consisting of a total thyroidectomy. Although she has remained disease-free, her quality of life has been greatly affected by the sequelae of this procedure. This case serves as an excellent example of how first-line surgical treatment may result more harmful than the disease itself.

  9. Surgical virtual reality - highlights in developing a high performance surgical haptic device.

    Science.gov (United States)

    Custură-Crăciun, D; Cochior, D; Constantinoiu, S; Neagu, C

    2013-01-01

    Just like simulators are a standard in aviation and aerospace sciences, we expect for surgical simulators to soon become a standard in medical applications. These will correctly instruct future doctors in surgical techniques without there being a need for hands on patient instruction. Using virtual reality by digitally transposing surgical procedures changes surgery in are volutionary manner by offering possibilities for implementing new, much more efficient, learning methods, by allowing the practice of new surgical techniques and by improving surgeon abilities and skills. Perfecting haptic devices has opened the door to a series of opportunities in the fields of research,industry, nuclear science and medicine. Concepts purely theoretical at first, such as telerobotics, telepresence or telerepresentation,have become a practical reality as calculus techniques, telecommunications and haptic devices evolved,virtual reality taking a new leap. In the field of surgery barrier sand controversies still remain, regarding implementation and generalization of surgical virtual simulators. These obstacles remain connected to the high costs of this yet fully sufficiently developed technology, especially in the domain of haptic devices. Celsius.

  10. Acquiring minimally invasive surgical skills

    OpenAIRE

    Hiemstra, Ellen

    2012-01-01

    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room. This thesis has led to an enlarged insight in the organization of surgical skills training during residency training of surgical medical specialists.

  11. Laparoscopic resection of hilar cholangiocarcinoma.

    Science.gov (United States)

    Lee, Woohyung; Han, Ho-Seong; Yoon, Yoo-Seok; Cho, Jai Young; Choi, YoungRok; Shin, Hong Kyung; Jang, Jae Yool; Choi, Hanlim

    2015-10-01

    Laparoscopic resection of hilar cholangiocarcinoma is technically challenging because it involves complicated laparoscopic procedures that include laparoscopic hepatoduodenal lymphadenectomy, hemihepatectomy with caudate lobectomy, and hepaticojejunostomy. There are currently very few reports describing this type of surgery. Between August 2014 and December 2014, 5 patients underwent total laparoscopic or laparoscopic-assisted surgery for hilar cholangiocarcinoma. Two patients with type I or II hilar cholangiocarcinoma underwent radical hilar resection. Three patients with type IIIa or IIIb cholangiocarcinoma underwent extended hemihepatectomy together with caudate lobectomy. The median (range) age, operation time, blood loss, and length of hospital stay were 63 years (43-76 years), 610 minutes (410-665 minutes), 650 mL (450-1,300 mL), and 12 days (9-21 days), respectively. Four patients had a negative margin, but 1 patient was diagnosed with high-grade dysplasia on the proximal resection margin. The median tumor size was 3.0 cm. One patient experienced postoperative biliary leakage, which resolved spontaneously. Laparoscopic resection is a feasible surgical approach in selected patients with hilar cholangiocarcinoma.

  12. Alcohol skin preparation causes surgical fires.

    Science.gov (United States)

    Rocos, B; Donaldson, L J

    2012-03-01

    Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires. The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire. Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes. Despite manufacturer's instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.

  13. Effects of Frequent Glove Change on Outcomes of Orthopaedic Surgical Procedures - A Multicenter Study on Surgical Gloves

    Directory of Open Access Journals (Sweden)

    Nishit Palo

    2017-10-01

    Full Text Available Introduction: Intact surgical gloves are a barrier to microorganisms migration between surgical team members and the patient. The surgical gloves are changed at various junctures but the effects of changing gloves during surgical procedures on various surgical parameters or clinical outcomes are not established. Aim: To determine rationale of glove change during orthopaedic procedures, differences amongst surgical parameters with and without changing the surgical gloves and whether frequent glove change affected surgical parameters or clinical outcomes. Materials and Methods: A prospective multicenter study conducted at three centers from January 2014 to January 2016. A 250 patients were divided into 2 groups (n=125 each in Group 1, surgical team operated with regular changing of gloves. In Group 2, only 1 set of double gloves were worn throughout the procedure. Surgical parameters or clinical outcomes were assessed for both the groups. Statistical analyses included the median, mode, range, Interquartile Range (IQR and sample standard deviation (s and independent-samples t-test. Bacterial counts were expressed as median with (IQR. Results: Surgical Timing Difference was 10 (S.D.- 4.2 minutes more in Group-1 (<0.05, Surgical Cost was higher in Group-1 by Rs.150-450 (<0.05. Outer glove micro-perforation rate was 5.85% and 8.15% in group-1 and 2 respectively with no inner glove perforation or Surgical Site Infections. Outer glove micro perforations were proportional to duration of surgery; operations lasting 120-210 and 61-120 minutes had 66.6% and 37.2% micro perforation rates respectively (p<0.05. Conclusion: Under standard operating conditions, procedures performed without glove change are shorter and cost effective than procedures performed with regular glove change with similar surgical and functional results. Judicious use of surgical gloves is a patient and environment friendly option, thereby reducing the hospital’s biomedical waste load.

  14. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.

    2008-01-01

    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  15. Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis.

    Science.gov (United States)

    Savitr Sastri, B V; Arivazhagan, A; Sinha, Sanjib; Mahadevan, Anita; Bharath, R D; Saini, J; Jamuna, R; Kumar, J Keshav; Rao, S L; Chandramouli, B A; Shankar, S K; Satishchandra, P

    2014-05-15

    Mesial temporal sclerosis (MTS) is the most common cause of drug resistant epilepsy amenable for surgical treatment and seizure control. This study analyzed the outcome of patients with MTS following anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH) over 10 years and correlated the electrophysiological and radiological factors with the post operative seizure outcome. Eighty seven patients were included in the study. Sixty seven (77.2%) patients had an Engel Class 1 outcome, 9 (11.4%) had Class 2 outcome. Engel's class 1 outcome was achieved in 89.9% at 1 year, while it reduced slightly to 81.9% at 2 years and 76.2% at 5 year follow up. Seventy seven (88.5%) patients had evidence of hippocampal sclerosis on histopathology. Dual pathology was observed in 19 of 77 specimens with hippocampal sclerosis, but did not influence the outcome. Factors associated with an unfavorable outcome included male gender (p=0.04), and a higher frequency of pre-operative seizures (p=0.005), whereas the presence of febrile seizures (p=0.048) and loss of hippocampal neurons in CA4 region on histopathology (p=0.040) were associated with favorable outcome. The effect of CA4 loss on outcome is probably influenced by neuronal loss in other subfields as well since isolated CA4 loss was rare. Abnormal post operative EEG at the end of 1 week was found to be a significant factor predicting unfavorable outcome (p=0.005). On multivariate analysis, the pre-operative seizure frequency was the only significant factor affecting outcome. The present study observed excellent seizure free outcome in a carefully selected cohort of patients with MTS with refractory epilepsy. The presence of dual pathology did not influence the outcome. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures.

    Science.gov (United States)

    Aguiar, Arthur Almeida; Lima, Luciana Cavalvanti; Araújo, Cláudia Corrêa de; Gallindo, Rodrigo Melo

    2017-12-29

    To describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents. A retrospective cross-sectional study was conducted with a population consisting of children and adolescents with abdominal non-Hodgkin's lymphoma diagnosed between September 1994 and December 2012. The sample comprised of 100 patients who underwent 113 diagnostic procedures, including urgent surgery (n=21), elective surgery (n=36), and non-surgical diagnosis (n=56). The most frequent procedures were laparotomy (46.9%) and ultrasound-guided core biopsy (25.6%). The rate of diagnostic success was 95.2% for urgent surgeries; 100% for elective surgeries and 82.1% for non-surgical procedures (p<0.05). The rates of complication during the three diagnosis procedures considered were significant (p<0.001; 95.2% of the urgent surgeries, 83.8% of the elective surgeries, and 10.7% of the non-surgical procedures). The length of time before resuming a full diet and starting chemotherapy was significantly reduced for patients who underwent non-surgical procedures when compared with the other procedures (p<0.001). Non-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease. Copyright © 2017. Published by Elsevier Editora Ltda.

  17. Simulating video-assisted thoracoscopic lobectomy: a virtual reality cognitive task simulation.

    Science.gov (United States)

    Solomon, Brian; Bizekis, Costas; Dellis, Sophia L; Donington, Jessica S; Oliker, Aaron; Balsam, Leora B; Zervos, Michael; Galloway, Aubrey C; Pass, Harvey; Grossi, Eugene A

    2011-01-01

    Current video-assisted thoracoscopic surgery training models rely on animals or mannequins to teach procedural skills. These approaches lack inherent teaching/testing capability and are limited by cost, anatomic variations, and single use. In response, we hypothesized that video-assisted thoracoscopic surgery right upper lobe resection could be simulated in a virtual reality environment with commercial software. An anatomy explorer (Maya [Autodesk Inc, San Rafael, Calif] models of the chest and hilar structures) and simulation engine were adapted. Design goals included freedom of port placement, incorporation of well-known anatomic variants, teaching and testing modes, haptic feedback for the dissection, ability to perform the anatomic divisions, and a portable platform. Preexisting commercial models did not provide sufficient surgical detail, and extensive modeling modifications were required. Video-assisted thoracoscopic surgery right upper lobe resection simulation is initiated with a random vein and artery variation. The trainee proceeds in a teaching or testing mode. A knowledge database currently includes 13 anatomic identifications and 20 high-yield lung cancer learning points. The "patient" is presented in the left lateral decubitus position. After initial camera port placement, the endoscopic view is displayed and the thoracoscope is manipulated via the haptic device. The thoracoscope port can be relocated; additional ports are placed using an external "operating room" view. Unrestricted endoscopic exploration of the thorax is allowed. An endo-dissector tool allows for hilar dissection, and a virtual stapling device divides structures. The trainee's performance is reported. A virtual reality cognitive task simulation can overcome the deficiencies of existing training models. Performance scoring is being validated as we assess this simulator for cognitive and technical surgical education. Copyright © 2011. Published by Mosby, Inc.

  18. Pleuropulmonary blastoma--case report of a patient presenting in a moribund state.

    Science.gov (United States)

    Chauke, Risenga Frank; Muthuphei, M Nelson

    2003-11-01

    A 4-year-old girl presented with an intrathoracic tumour that was pleural in origin, invading the right lower lobe. The patient underwent urgent right thoracotomy and surgical excision of the tumour and right lower lobectomy as the tumour was invading that lobe. The histological report initially reported it as a rhabdomyosarcoma, embryonal type, but after consultation it was changed to type III pleuropulmonary blastoma. The patient was treated with chemotherapy but succumbed to the disease 12 months after the diagnosis. Relevant literature on pleuropulmonary blastoma is reviewed.

  19. Using dummies for surgical skills training

    DEFF Research Database (Denmark)

    Langebæk, Rikke

    2011-01-01

    Effective acquisition of a skill requires practise. Therefore it is of great importance to provide veterinary students with opportunities to practice their surgical skills before carrying out surgical procedures on live patients. Some veterinary schools let students perform entire surgical...... procedures on research animals, in order to learn the basic skills along the way. From an ethical point of view it is questionable however to use live research animals for the sole purpose of practising surgery, and also, research animals are very costly. It is therefore necessary to identify alternative...... teaching methods for veterinary surgical training. At the Department of Small Animal Clinical Sciences, Faculty of Life Sciences, a number of low fidelity, stuffed toy animal dummies was developed for the Surgical Skills Lab in order to teach 4th year students the basic surgical skills. In the Surgical...

  20. Different effects of anterior temporal lobectomy and selective amygdalohippocampectomy on verbal memory performance of patients with epilepsy.

    Science.gov (United States)

    Boucher, Olivier; Dagenais, Emmanuelle; Bouthillier, Alain; Nguyen, Dang Khoa; Rouleau, Isabelle

    2015-11-01

    The advantage of selective amygdalohippocampectomy (SAH) over anterior temporal lobectomy (ATL) for the treatment of temporal lobe epilepsy (TLE) remains controversial. Because ATL is more extensive and involves the lateral and medial parts of the temporal lobe, it may be predicted that its impact on memory is more important than SAH, which involves resection of medial temporal structures only. However, several studies do not support this assumption. Possible explanations include task-specific factors such as the extent of semantic and syntactic information to be memorized and failure to control for main confounders. We compared preoperative vs. postoperative memory performance in 13 patients with SAH with 26 patients who underwent ATL matched on side of surgery, IQ, age at seizure onset, and age at surgery. Memory function was assessed using the Logical Memory subtest from the Wechsler Memory Scales - 3rd edition (LM-WMS), the Rey Auditory Verbal Learning Test (RAVLT), the Digit Span subtest from the Wechsler Adult Intelligence Scale, and the Rey-Osterrieth Complex Figure Test. Repeated measures analyses of variance revealed opposite effects of SAH and ATL on the two verbal learning memory tests. On the immediate recall trial of the LM-WMS, performance deteriorated after ATL in comparison with that after SAH. By contrast, on the delayed recognition trial of the RAVLT, performance deteriorated after SAH compared with that after ATL. However, additional analyses revealed that the latter finding was only observed when surgery was conducted in the right hemisphere. No interaction effects were found on other memory outcomes. The results are congruent with the view that tasks involving rich semantic content and syntactical structure are more sensitive to the effects of lateral temporal cortex resection as compared with mesiotemporal resection. The findings highlight the importance of task selection in the assessment of memory in patients undergoing TLE surgery

  1. Mesial temporal lobe epilepsy - An overview of surgical techniques.

    Science.gov (United States)

    Muzumdar, Dattatraya; Patil, Manoj; Goel, Atul; Ravat, Sangeeta; Sawant, Nina; Shah, Urvashi

    2016-12-01

    Mesial temporal lobe epilepsy is one of the commonest indications for epilepsy surgery. Presurgical evaluation for drug resistant epilepsy and identification of appropriate candidates for surgery is essential for optimal seizure freedom. The anatomy of mesial temporal lobe is complex and needs to be understood in the context of the advanced imaging, ictal and interictal Video_EEG monitoring, neuropsychology and psychiatric considerations. The completeness of disconnection of epileptogenic neural networks is paramount and is correlated with the extent of resection of the mesial temporal structures. In the Indian subcontinent, a standard but extended anterior temporal lobectomy is a viable option in view of the diverse socioeconomic, cultural and pathological considerations. The maximum utilization of epilepsy surgery services in this region is also a challenge. There is a need for regional comprehensive epilepsy care teams in a tertiary care academic hospital to form centers of excellence catering to a large population. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  2. Quantative pre-surgical lung function estimation with SPECT/CT

    International Nuclear Information System (INIS)

    Bailey, Dale L.; Timmins, Sophi; Harris, Benjamin E.; Bailey, Elizabeth A.; Roach, Paul J.; Willowson, Kathy P.

    2009-01-01

    Full text: Objectives: To develop methodology to predict lobar lung function based on SPECT/CT ventilation 6 k perfusion (V/Q) scanning in candidates for lobectomy for lung cancer. This combines two development areas from our group: quantitative SPECT based on CT-derived corrections for scattering and attenuation of photons, and SPECT V/Q scanning with lobar segmentation from CT Six patients underwent baseline pulmonary function testing (PFT) including spirometry, measurement of DLCO and cardio-pulmonary exercise testing. A SPECT/CT V/Q scan was acquired at baseline. Using in-house software each lobe was anatomically defined using CT to provide lobar ROIs which could be applied to the SPECT data. From these, individual lobar contribution to overall function was calculated from counts within the lobe and post-operative FEVl, DLCO and V02 peak were predicted. This was compared with the quantitative planar scan method using 3 rectangular ROIs over each lung.

  3. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel

    2016-09-01

    Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

  4. Combined Surgical Treatment of Gynecomastia

    Directory of Open Access Journals (Sweden)

    Yordanov Y.

    2015-05-01

    Full Text Available Surgical treatment of gynecomastia could present unique challenges for the plastic surgeon. Achieving a good balance between effectiveness of the selected approach and the satisfactory aesthetic outcome often is a difficult endeavor. Optimal surgical treatment involves a combination of liposuction and direct excision. In the present study the charts of 11 patients treated with suction-assisted liposuction and direct surgical excision were retrospectively reviewed; a special emphasis is placed on the surgical technique. The mean follow-up period of the patients was 11.6 months. No infection, hematoma, nipple-areola complex necrosis and nipple retraction was encountered in this series. The combined surgical treatment of gynecomastia has shown to be a reliable technique in both small and moderate breast enlargement including those with skin excess.

  5. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy.

    Science.gov (United States)

    Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G; Russo, Paul; Thompson, R Houston; Uzzo, Robert G; Wood, Christopher G; Gill, Inderbir S

    2015-12-01

    A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). A literature review was conducted. Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. In this report we review renal surgical anatomy. Renal mass imaging allows detailed delineation of the

  6. Nigerian Journal of Surgical Research

    African Journals Online (AJOL)

    The Nigerian Journal of Surgical Research is a publication of the Surgical Research Society with main office in Zaria, Nigeria. Zaria is home to Ahmadu Bello University (ABU), a premier university in Nigeria. The aim of The Nigerian Journal of Surgical Research is to cover developments and advances in the broad field of ...

  7. Usefulness of StereoEEG-based tailored surgery for medial temporal lobe epilepsy. Preliminary results in 11 patients.

    Science.gov (United States)

    Kubota, Yuichi; Ochiai, Taku; Hori, Tomokatsu; Kawamata, Takakazu

    2017-07-01

    Surgical options for medial temporal lobe epilepsy (MTLE) include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH). Optimal criteria for choosing the appropriate surgical approach remain uncertain. This article reports 11 consecutive cases in which electrophysiological findings of stereoelectroencephalography (SEEG) were used to determine the optimal surgical approach. Eleven consecutive patients with MTLE underwent SEEG evaluation and were placed in either the medial or the medial+lateral group based on the findings. Patients in the medial group underwent SAH using the subtemporal approach, and patients in the medial+lateral group underwent SEEG-guided anterior temporal lobectomy. SEEG findings were also compared with other examinations including flumazenil (FMZ)-positron emission tomography (PET), fluorine-18 labeled fluorodeoxyglucose (FDG)-PET, and magnetoencephalography (MEG). Results were evaluated to determine which examinations most consistently identified the epileptogenic zone. Of the 11 cases, 4 patients were placed in the medial group, and 7 patients in the medial+lateral group. Of patients, 90.9% were classified in class I of the Engel Epilepsy Surgery Outcome Scale, while 72.7% were classified in class I by the International League Against Epilepsy (ILAE) system. Analyzed by group, 100% of the medial group experienced an Engel class I outcome in the medial group, compared to 85.7% in the medial+lateral group. SEEG findings were comparable with FDG-PET results (10 of 11, 91%). Tailored surgery guided by SEEG is an electrophysiologically feasible treatment for MTLE that can result in favorable outcomes. Although seizures are thought to originate in the medial temporal lobe in MTLE, it is important for involvement of the lateral temporal cortex to be also considered in some cases. Copyright © 2017. Published by Elsevier B.V.

  8. Nationwide multicenter study on the management of pulmonary neuroendocrine (carcinoid tumors

    Directory of Open Access Journals (Sweden)

    Samira M Sadowski

    2017-12-01

    Full Text Available Background and aim: To analyze the management and outcome of patients with primary typical (TC and atypical lung carcinoids (AC in Switzerland. Methods: Retrospective analysis of patients selected from a neuroendocrine tumor (NET registry. Patients were divided into TC and AC according to pathology reports, and surgical procedures were grouped as wedge/segmentectomy, lobectomy/bilobectomy and pneumectomy. Survival analysis was performed using the Kaplan–Meier method and log-rank test. Results: Over 7 years, 113 pulmonary carcinoids (61.9% females, mean age 59.4 years were included from 19 hospitals, with pathology data on Ki67 and necrosis incomplete in 16 cases. Eighty-three TC and 14 AC underwent surgical resection with a primary tumor size of median 14.5 (range 1–80 mm and diagnosis was established in 55.8% at surgery. Mean follow-up was 30.2 ± 23.1 months. Lobectomy was performed in 54.2% and wedge resection in 17.7% of cases. Six patients received additional systemic therapy. There was a trend for larger primary lesion size and a significantly higher rate of N2–N3 status in AC. Mean survival tended to be increased in patients with TC compared to AC (86.1 vs 48.4 months, P = 0.06 and mean disease-free interval after surgical resection was 74.1 and 48.3 months for TC and AC, respectively (P = 0.74. Conclusion: AC of the lung has a more malignant behavior and a trend to a worse outcome. The results of this registry reinforce the need for standardized histological diagnosis and inter-disciplinary therapeutic decision making to improve the quality of care of patients with TC and AC.

  9. American Pediatric Surgical Association

    Science.gov (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  10. ANALISIS PERHITUNGAN DAN PELAPORAN PAJAK PERTAMBAHAN NILAI PADA PT FAJAR MAS KARYATAMA

    Directory of Open Access Journals (Sweden)

    MARINDO PUTRA

    2017-05-01

    Full Text Available Value Added Tax (VAT is Tax that imposed on any apreciation in value of the goods or services in its circulation from producers to consumers. Through the calculation dan reporting is good, then the company may be said it has complied with the applicable rules in order to enhance the national development budget of the Government. PT Fajar Mas Karyatama as a company engaged intrade of goods subject to VAT, as in general make a purchase with Input Tax which may be credited. The purpose of this study to know whether the application of VAT and VAT underpayment or overpayment in accordance with law of VAT No. 42 of 2009. This study used a comparative method. The company will account for and report the delivery of Added Value Tax in the Notice Period of Added Value Tax (VAT Period SPT. VAT calculations made by company are the basis for the report required to implement Tax Laws for the companies. Conclusion is that application of VAT in the calculating and reporting of PT Fajar Mas Karyatama was almost accordance with the VAT Act applied and through the application of VAT, namely the purchase and sale of Taxable Goods so that the sum of the difference by the number of Input Tax or Output Tax generate VAT Less/More Pay at the end each mont, it is accordance with the Law of VAT No. 42 of 2009.

  11. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

    ... procedures performed to treat pelvic floor disorders with surgical mesh: Transvaginal mesh to treat POP Transabdominal mesh to treat ... address safety risks Final Order for Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair Final Order for Effective ...

  12. Surgical treatment of parastomal hernia

    International Nuclear Information System (INIS)

    Basti, Z.; Mayer, A.

    2013-01-01

    Stoma construction is among standard surgical skills and is performed for many indications. Every stoma means huge impact on quality of life for patients even with great improvement in surgical technique and ostomy devices. All patients are very sensitive to complication of stoma and the most frequent complication is parastomal hernia. Incidence reported in literature is very high and unacceptable, it is 30-70%. Surgical approach is very demanding on technical equipment and experiences of surgeon. Authors focus on each surgical approach for treating this complication weather it´s using mesh or laparoscopic or open approach. (author)

  13. Surgical therapy in chronic pancreatitis.

    Science.gov (United States)

    Neal, C P; Dennison, A R; Garcea, G

    2012-12-01

    Chronic pancreatitis (CP) is an inflammatory disease of the pancreas which causes chronic pain, as well as exocrine and endocrine failure in the majority of patients, together producing social and domestic upheaval and a very poor quality of life. At least half of patients will require surgical intervention at some stage in their disease, primarily for the treatment of persistent pain. Available data have now confirmed that surgical intervention may produce superior results to conservative and endoscopic treatment. Comprehensive individual patient assessment is crucial to optimal surgical management, however, in order to determine which morphological disease variant (large duct disease, distal stricture with focal disease, expanded head or small duct/minimal change disease) is present in the individual patient, as a wide and differing range of surgical approaches are possible depending upon the specific abnormality within the gland. This review comprehensively assesses the evidence for these differing approaches to surgical intervention in chronic pancreatitis. Surgical drainage procedures should be limited to a small number of patients with a dilated duct and no pancreatic head mass. Similarly, a small population presenting with a focal stricture and tail only disease may be successfully treated by distal pancreatectomy. Long-term results of both of these procedure types are poor, however. More impressive results have been yielded for the surgical treatment of the expanded head, for which a range of surgical options now exist. Evidence from level I studies and a recent meta-analysis suggests that duodenum-preserving resections offer benefits compared to pancreaticoduodenectomy, though the results of the ongoing, multicentre ChroPac trial are awaited to confirm this. Further data are also needed to determine which of the duodenum-preserving procedures provides optimal results. In relation to small duct/minimal change disease total pancreatectomy represents the only

  14. Radioiodine (I-131) therapy in thyroid cancer differentiated type (abstract)

    International Nuclear Information System (INIS)

    Khan, M.S.

    1999-01-01

    Carcinoma thyroid is not an uncommon malignancy in Pakistan because of its location in iodine deficient terrain. Painless palpable (solitary) thyroid nodule is the common presentation in majority (>90%) of the patients and > 25% cold nodules in females turned malignant on biopsy whereas in males >75% of cold nodules turned malignant on historical examination. The disease is more common in females as compared to males (3:1) and in females pure papillary carcinoma is more common whereas in males mostly follicular or mixed tumors are seen. Radical surgery (thyroidectomy) is not a routine surgical treatment in our country. In teaching hospitals the routine surgical procedure is lobectomy and Isthmectomy, whereas in DHQ Hospitals less surgical procedures, e.g. tumorectomy or partial labectomy etc. are done. Therefore, in view of limited/partial surgical ablation, I-131 ablation is mandatory for better and longer survival. We have treated 118 patients of thyroid carcinoma (Differential type) at our centre (AEMC) with therapeutic dose of Radioactive iodine (I-131) during the last 13 years with encouraging results (Disease free survival). (author)

  15. Accomplishments and challenges of surgical simulation.

    Science.gov (United States)

    Satava, R M

    2001-03-01

    For nearly a decade, advanced computer technologies have created extraordinary educational tools using three-dimensional (3D) visualization and virtual reality. Pioneering efforts in surgical simulation with these tools have resulted in a first generation of simulators for surgical technical skills. Accomplishments include simulations with 3D models of anatomy for practice of surgical tasks, initial assessment of student performance in technical skills, and awareness by professional societies of potential in surgical education and certification. However, enormous challenges remain, which include improvement of technical fidelity, standardization of accurate metrics for performance evaluation, integration of simulators into a robust educational curriculum, stringent evaluation of simulators for effectiveness and value added to surgical training, determination of simulation application to certification of surgical technical skills, and a business model to implement and disseminate simulation successfully throughout the medical education community. This review looks at the historical progress of surgical simulators, their accomplishments, and the challenges that remain.

  16. Starting a robotic program in general thoracic surgery: why, how, and lessons learned.

    Science.gov (United States)

    Cerfolio, Robert J; Bryant, Ayesha S; Minnich, Douglas J

    2011-06-01

    We report our experience in starting a robotic program in thoracic surgery. We retrospectively reviewed our experience in starting a robotic program in general thoracic surgery on a consecutive series of patients. Between February 2009 and September 2010, 150 patients underwent robotic operations. Types of procedures were lobectomy in 62, thymectomy in 30, and benign esophageal procedures in 6. No thymectomy or esophageal procedures required conversion. One conversion was needed for suspected bleeding for a mediastinal mass. Twelve patients were converted for lobectomy (none for bleeding, 1 in the last 24). Median operative time for robotic thymectomy was 119 minutes, and median length of stay was 1 day. The median time for robotic lobectomy was 185 minutes, and median length of stay was 2 days. There were no operative deaths. Morbidity occurred in 23 patients (15%). All patients with cancer had R0 resections and resection of all visible mediastinal and hilar lymph nodes. Robotic surgery is safe and oncologically sound. It requires training of the entire operating room team. The learning curve is steep, involving port placement, availability of the proper instrumentation, use of the correct robotic arms, and proper patient positioning. The robot provides an ideal surgical approach for thymectomy and other mediastinal tumors. Its advantage over thoracoscopy for pulmonary resection is unproven; however, we believe complete thoracic lymph node dissection and teaching is easier. Importantly, defined credentialing for surgeons and cost analysis studies are needed. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Surgical Space Suits Increase Particle and Microbiological Emission Rates in a Simulated Surgical Environment.

    Science.gov (United States)

    Vijaysegaran, Praveen; Knibbs, Luke D; Morawska, Lidia; Crawford, Ross W

    2018-05-01

    The role of space suits in the prevention of orthopedic prosthetic joint infection remains unclear. Recent evidence suggests that space suits may in fact contribute to increased infection rates, with bioaerosol emissions from space suits identified as a potential cause. This study aimed to compare the particle and microbiological emission rates (PER and MER) of space suits and standard surgical clothing. A comparison of emission rates between space suits and standard surgical clothing was performed in a simulated surgical environment during 5 separate experiments. Particle counts were analyzed with 2 separate particle counters capable of detecting particles between 0.1 and 20 μm. An Andersen impactor was used to sample bacteria, with culture counts performed at 24 and 48 hours. Four experiments consistently showed statistically significant increases in both PER and MER when space suits are used compared with standard surgical clothing. One experiment showed inconsistent results, with a trend toward increases in both PER and MER when space suits are used compared with standard surgical clothing. Space suits cause increased PER and MER compared with standard surgical clothing. This finding provides mechanistic evidence to support the increased prosthetic joint infection rates observed in clinical studies. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Teaching surgical exposures to undergraduate medical students: an integration concept for anatomical and surgical education.

    Science.gov (United States)

    Hammer, Niels; Hepp, Pierre; Löffler, Sabine; Schleifenbaum, Stefan; Steinke, Hanno; Klima, Stefan

    2015-06-01

    Decreasing numbers of students are interested in starting a surgical career, posing substantial challenges to patient care in the next years. The anatomy course is one of the key subjects in medical training, especially in surgical disciplines. Innovative teaching concepts that integrate surgically relevant anatomy and manual dexterity might help boost student interest in surgery. A preclinical workshop entitled "Surgical exposures" was developed. A team of anatomists and surgeons introduced the surgical exposures, demonstrating the procedures on Thiel-fixed body donors. Following this introduction, students practiced the exposures in an operating room-like manner. A six-point Likert scale was used to evaluate the workshop and to compare it to the first-year dissection course. The overall evaluation result for the surgical exposures was excellent, proving to be a significantly better result when compared to the first-year dissection course. The students were more satisfied with the teaching time invested by the peers and regarded the workshop as clinically highly relevant. Furthermore, they felt that questions were addressed better and that the overall atmosphere was better than in the gross anatomy course. Subject to criticism was the course size and practicing time in both cases. The surgical exposures workshop provides preclinical students with clinically relevant anatomy and manual dexterity. It may positively influence the decision to follow a surgical career. This course, however, requires extensive teaching resources. The given concept may help implement practical medical skills in the preclinical curriculum, strengthening the professional identity of surgeons and anatomists.

  19. Percutaneous Stent-Graft Repair of a Mycotic Pulmonary Artery Pseudoaneurysm

    International Nuclear Information System (INIS)

    Chou Meichun; Liang Hueilung; Pan Huayban; Yang Chienfang

    2006-01-01

    Ruptured mycotic pulmonary pseudoaneurysm is a lethal complication. Emergent surgical repair is usually recommended, but still associated with a high mortality rate. We present a patient in whom mycotic pulmonary pseudoaneurysm was a complication after surgical lobectomy 2 weeks earlier. This patient had suffered from repeated massive hemoptysis. After emergent surgical repair of the ruptured pulmonary artery stump, another episode of massive hemorrhage occurred. The pulmonary arteriogram revealed a segmental stenosis and a large, wide-necked, lobulated pseudoaneurysm at the left proximal pulmonary artery. We deployed a balloon-expandable stent-graft (48 mm in length mounted on a 12 mm x 40 mm angioplasty balloon) across the stenotic segment and the neck of the pulmonary pseudoaneurysm. Hemostasis was achieved immediately and, under a 4-week antibiotic treatment, patient was transferred to a local hospital for medical care. This case report demonstrates the benefit of minimally invasive endovascular therapy in a critically ill patient. A literature review of the etiology and management of mycotic pulmonary pseudoaneurysm is included

  20. Molecular analysis driven video-assisted thoracic surgery resections in bilateral synchronous lung cancers: from the test tube to the operatory room.

    Science.gov (United States)

    Forti Parri, Sergio Nicola; Bonfanti, Barbara; Cancellieri, Alessandra; De Biase, Dario; Trisolini, Rocco; Zoboli, Stefania; Bertolaccini, Luca; Solli, Piergiorgio; Tallini, Giovanni

    2017-10-01

    Synchronous cancers are not such rare clinical conditions. Nevertheless, even after the 8th edition of the TNM classification of the lung cancer, the surgical approach for patients presenting with synchronous bilateral lung cancer is still under debate. The resection of both lesions in the case of synchronous bilateral lung cancer is reasonable, but, on the other hand, is the lobectomy the correct choice in the event of the single primary with a contralateral metastatic lesion? In this case report, we describe how the molecular analysis and the detection of the EGFR, KRAS and TP53 mutations in both tumours have determined in a patient the two tumours as primary and both the right surgical approach. We also discuss how molecular analysis found differences in all the three genes examined in the two lesions and allowed to exclude the clonal nature of the two tumours. In conclusion, genetic studies help to offer a more radical surgical treatment to this patient.