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Chest Tube Drainage Devices.
Semin Respir Crit Care Med2019 Jun;40(3):386-393. doi: 10.1055/s-0039-1694769.
Toth Jennifer W, Reed Michael F, Ventola Lauren K,
Abstract
Placement of a chest tube drains intrapleural fluid and air. The tube should be attached to a drainage system, such as one-, two-, or three-compartment devices, a one-way (Heimlich) valve for ambulatory drainage, a digital system, or a vacuum bottle. The frequently employed three-compartment systems, currently integrated disposable units, allow adjustment of negative pressure or no suction (water seal), and include an air leak meter on the water seal chamber to be used for demonstrating and quantifying air leak. These readings are subjective and prone to interobserver variability. Digital pleural drainage systems offer the benefits of quantification of any air leak and pleural pressure. Indwelling pleural catheters, typically utilized for malignant pleural effusion, can be drained using vacuum bottles. Knowledge of the design and functionality of each device in the setting of an individual patient's specific pleural process facilitates the selection of practical and financially prudent chest tube drainage strategies.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Medical and Surgical Management of Empyema.
Semin Respir Crit Care Med2019 Jun;40(3):361-374. doi: 10.1055/s-0039-1694699.
Godfrey Mark S, Bramley Kyle T, Detterbeck Frank,
Abstract
Infection of the pleural space is an ancient and common clinical problem, the incidence which is on the rise. Advances in therapy now present clinicians of varying disciplines with an array of therapeutic options ranging from thoracentesis and chest tube drainage (with or without intrapleural fibrinolytic therapies) to video-assisted thoracic surgery (VATS) or thoracotomy. A framework is provided to guide decision making, which involves weighing multiple factors (clinical history and presentation, imaging characteristics, comorbidities); multidisciplinary collaboration and active management are needed as the clinical course over a few days determines subsequent refinement. The initial choice of antibiotics depends on whether the empyema is community-acquired or nosocomial, and clinicians must recognize that culture results often do not reflect the full disease process. Antibiotics alone are rarely successful and can be justified only in specific circumstances. Early drainage with or without intrapleural fibrinolytics is usually required. This is successful in most patients; however, when surgical decortication is needed, clear benefit and low physiologic impact are more likely with early intervention, expeditious escalation of interventions, and care at a center experienced with VATS.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Development and Maintenance of a Pleural Disease Service: Role of the "Pleurologist".
Semin Respir Crit Care Med2019 Jun;40(3):297-304. doi: 10.1055/s-0039-1693405.
Cameron Kelsey, Teodoro Dana, Kasis Azam, Evison Matthew,
Abstract
Changes in the health care environment, increasing specialization, and the use of ultrasound have led to pleural diseases being managed by a select few. This article aims to look at the impact of current medical education paradigms, service structure, procedural education and role of the "pleurologist" in providing care to patients with pleural disease.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Derivation and Validation of an Early Diagnostic Score for Mediastinitis After Cardiothoracic Surgery.
Int J Infect Dis2019 Sep;():. doi: S1201-9712(19)30372-8.
Focaccia Siciliano Rinaldo, Medina Andrea Carolina Rodas, Bittencourt Márcio Sommer, Gualandro Danielle, Uezumi Kiyomi Kato, Santos Marcus Vinicius Barbosa, Pomerantzeff Pablo Maria Alberto, Scarpa Bruna, Leal Tatiana de Carvalho Andreuci Torres, Varejão Strabelli Tania Mara,
Abstract
OBJECTIVES:
The aim of this study was to elaborate on and validate a score for the early diagnosis of mediastinitis after cardiothoracic surgery.
METHODS:
Between 2007 and 2017, patients who experienced thoracic surgical-site infection after cardiothoracic surgery were enrolled. Laboratory, clinical, and chest CT findings were retrospectively analyzed. Patients were followed up until hospital discharge or intra-hospital death. Univariate and multivariate regression analyses were performed.
RESULTS:
950 surgical-site infections were found and analyzed (131 mediastinitis, 819 superficial/deep infections). Of the 131 mediastinitis episodes, 88% required surgical thoracic debridement,Staphylococcus aureus was identified in 43%, and overall mortality was 42%. The following variables were related to mediastinitis diagnosis: sternal diastasis (OR?=?2.5; 95% confidence interval [95%CI]: 1.2-5.3; P?=?0.012), bilateral pleural effusion (OR=1.9; 95%CI: 1.0-3.6; P?=?0.04), leukocyte count ?14,000cells/mm (Bitkover et al., 1999) (OR?=?2.5; 95%CI: 1.3-4.7; P?=?0.006), male sex (OR=2; 95%CI: 1.11-4; P?=?0.022), and positive blood culture (OR=3.0; 95%CI: 1.6-5.6; P?=?0.001). The score predicted with reasonable accuracy mediastinitis in the derivation cohort (AUC-ROC, 0.7476) and the validation cohort (AUC-ROC, 0.7149). Groups with high (31%) and low (5%) risk of mediastinitis were identified.
CONCLUSIONS:
An early diagnostic score in patients with surgical-site infection after cardiothoracic surgery identified groups with a low and high risk for mediastinitis.
Copyright © 2019. Published by Elsevier Ltd.
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Video-Assisted Bilateral Thoracoscopic Sympathotomy for Palmar Hyperhidrosis.
World Neurosurg2019 Sep;():. doi: S1878-8750(19)32466-0.
ReFaey Karim, Grewal Sanjeet S, Segura-Duran Ivan, Thomas Mathew, Wharen Robert E,
Abstract
In this video, we demonstrate a case of a 21-year-old right-handed male who presented with palmar hyperhidrosis. His symptoms started at the age of 4 and progressively worsened throughout his life. Multiple medical treatments were used without significant benefit. His symptoms worsened to the limit that it affected his work, and lifestyle. The patient was taken to the operating room in a supine position with both arms abducted 90 degrees. The right and left chest were prepped and draped in a sterile fashion. The skin incision was done on the left side first, the left lung was isolated and two 5 mm thoracoports were placed in the 6th and 3rd intercostal spaces, respectively. CO2 insufflation was used to pressure of 6 mmHg for exposure. The chest was visualized and the sympathetic chain was identified. Ribs were counted and then using cautery at a low setting was used. The sympathetic chain was transected at the level of the head of the 2nd rib. Accessory nerves of Kuntz were identified and resected. CO2 was then evacuated from the left chest using a bronchial tube exchanger and Valsalva maneuver. The lung was completely re-inflated and skin was closed in normal fashion. The same procedure was repeated on the right side. A chest X-ray was obtained intraoperatively, and no pneumothorax was observed. At the end of the procedure, both upper extremities temperature probes showed a significant increase from baseline. Informed patient consent was obtained.
Copyright © 2019. Published by Elsevier Inc.
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Non-resectable thoracic Rosai-Dorfman disease: a case report and review of the literature.
World Neurosurg2019 Sep;():. doi: S1878-8750(19)32464-7.
Lin Cheng-Kai, Tsai Yu-Tun,
Abstract
BACKGROUND:
Rosai-Dorfman disease (RDD) is a rare disease that can be triggered by either viral or bacterial infection. Several parts of the body can be involved, from the CNS to the pelvic regions had been reported. At present, there is a serious lack of guidelines as to how to treat cases of RDD involving the spine. Current trends show that surgery remains the first method of choice to cure this disease, but in refractory or recurrent RDD, repeat surgery cannot guarantee total resection. Under such circumstances, adjuvant therapy can be very useful. Here, we share our experience of treating recurrent spinal RDD.
CASE DESCRIPTION:
Our patient was a 32-year-old male patient with hepatitis B virus infection. He suffered from lower back pain with lower limb weakness after being hit by a metal pipe. Laminectomy of T11-12 was performed to decompress the spinal cord. The final pathological results demonstrated chronic inflammation. After surgery, the lower limbs improved and the patient recovered quite well. However, he returned 3 years later with the same complaints and was diagnosed with RDD. Durectomy was performed and repaired with an artificial dura. Thalidomide therapy was initiated. Currently, 9 years later, the patient has not experienced recurrence, nor any form of neurological deficit.
CONCLUSIONS:
RDD is a rare disease and can be misdiagnosed easily. Although it may resolve spontaneously, recurrence is possible. Hence, extensive follow-up is necessary. Surgery remained the first choice of surgery, however, when encountered recurrent or non-resectable RDD, adjuvant therapy such as corticosteroids, Thalidomide, radiotherapy could help. In this article, we shared our experience using Thalidomide in treating non-resectable RDD.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Impact of cervical range of motion on the global spinal alignment in ankylosing spondylitis patients with thoracolumbar kyphosis following pedicle subtraction osteotomy.
Spine J2019 Sep;():. doi: S1529-9430(19)30973-8.
Zhao Shi-Zhou, Qian Bang-Ping, Qiu Yong, Wang Bin, Huang Ji-Chen, Qiao Mu,
Abstract
BACKGROUND CONTEXT:
The head's center of gravity (COG) plumb line (PL) and C7 PL could be simultaneously positioned over the pelvis in adult spinal deformity (ASD) with normal cervical mobility. However, the position of the head in relation to the global spinal alignment has yet to be investigated in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis.
PURPOSE:
The objective of this study was to analyze the position of head in relation to the global spinal alignment in AS-related thoracolumbar kyphosis.
STUDY DESIGN/SETTING:
Retrospective single-center study.
PATIENT SAMPLE:
AS patients who underwent lumbar pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis from January 2010 to August 2016 were reviewed. Only patients with a visible ear canal on the preoperative, immediate postoperative and final follow-up radiographs were included.
OUTCOME MEASURES:
The chin-brow angle (CBVA), cervical range of motion (ROM), lumbar lordosis (LL), thoracolumar angle (TLA), thoracic kyphosis (TK), L1 pelvic angle (L1PA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), TK+LL+PI, PI-LL, maximal kyphosis (MK), deformity angular rate (DAR), T1 pelvic angle (T1PA), T1 tilt, spinosacral angle (SSA), sagittal vertical axis (SVA) COG-C7, SVA COG-femoral head (FH) and SVA C7-S were evaluated. Data regarding the health-related quality of life, including the Oswestry disability index (ODI) and visual analogue scale (VAS)-back score, were also collected preoperatively, 2 years postoperatively and at the latest follow-up.
METHODS:
The cohort was divided into patients with occiput-trunk (OT) concordance or with OT discordance according to the SVA COG-C7 ? 30mm or > 30mm, respectively. There was no funding in this study and there are no conflict of interest-associated biases.
RESULTS:
A total of 43 patients (36 males and 7 females) with a mean age of 34.2 years (range, 18 to 59 years) were identified. There were 17 patients accompanied with OT concordance and 26 patients with OT discordance preoperatively. The cervical ROM was significantly lower (24.0° vs 56.1°, P < 0.001) and SVA COG-C7 was significantly larger (71.7mm vs 7.4mm, P < 0.001) in patients with OT discordance. Furthermore, the PT was larger (41.0° vs 33.5°, P?=?0.010) in patients with OT discordance. After surgery, the whole cohort showed an improvement in LL (-8.6° vs -52.8°, P < 0.001). Moreover, the CBVA (25.4° vs 1.3°, P < 0.001) and SVA COG-C7 (46.2mm vs 21.6mm, P < 0.001) were significantly decreased following lumbar PSO. There were 13 patients accompanied with OT discordance postoperatively, and the cervical ROM was still lower (22.5° vs 42.8°, P?=?0.024) in these patients. Postoperative PT was larger (26.5° vs 20.1°, P?=?0.033) in the patients with OT discordance. At the latest follow-up, there were 17 patients accompanied with OT discordance. In these 17 patients, the cervical ROM was significantly lower (21.0° vs 47.0°, P?=?0.001) and PT was significantly higher (26.2° vs 19.2°, P?=?0.012). The ODI and VAS-back scores demonstrated no significant differences between the 2 groups preoperatively, 2 years postoperatively or at the latest follow-up.
CONCLUSIONS:
OT discordance in AS-related thoracolumbar kyphosis could be caused by the reduced cervical ROM. To maintain global spinal balance, the pelvis rotated further backward in response to the larger SVA COG-C7. Moreover, the larger SVA COG-C7 could be decreased after the lumbar PSO. Although there were radiographic differences between the patients with OT concordance and with OT discordance, there was no difference in clinical outcomes, and that a larger sample size and longer follow-up is needed.
Copyright © 2019. Published by Elsevier Inc.
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Can Knee Flexion Contracture Affect Cervical Alignment and Neck Tension? A Prospective Self-Controlled Pilot Study.
Spine J2019 Sep;():. doi: S1529-9430(19)30972-6.
Ding Yi, Liu Baoge, Qiao Hui, Yin Lu, He Wen, Si Fangda, Wang Dian,
Abstract
BACKGROUND CONTEXT:
The coordination of the alignment between the lower extremities and cervical spine helps to achieve balance and horizontal gaze during standing and walking. Malalignment in any segment can disturb the global balance, causing compensation in another segment. Knee flexion contracture (KFC) can cause spine inclination with increased C7 tilt or C7 SVA (sagittal vertical axis). Cervical alignment and the posterior muscles are essential for maintaining the horizontal gaze which are closely related to neck tension (NT).
PURPOSE:
This study aimed to determine whether KFC can affect cervical alignment and its potential effects on the posterior muscles and NT.
DESIGN:
A prospective pilot study was carried out in pre-operative (pre-op) and post-operative (post-op) phases.
PATIENT SAMPLE:
This study included 22 consecutive patients with KFC and 12 control subjects in our department who agreed to participate from between August 1, 2018 to February 28, 2019 in our department.
OUTCOME MEASURES:
Visual analog scale (VAS) and neck disability index (NDI) were used. The sagittal alignment parameters and cervical range of motion (ROM) were measured on radiographic images, and included the C0-C2 lordosis (C0-2L), C2-C7 lordosis (C2-7L), C2 SVA, C7 SVA, T1 slope (T1S), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and knee flexion angle (KA). Surface electromyography (sEMG)-based flexion-relaxation ratio (FRR) and ultrasound-based shear wave elastography (SWE) were performed.
METHODS:
The control group was matched for age, sex, and BMI with the KFC group. Patients in the KFC group underwent arthroscopic surgery to correct knee alignment. Comparisons between pre-op and post-op phases were performed using paired sample t-tests, comparisons between KFC and control groups were performed using independent samples t-tests. The correlation analysis between the parameters was performed using Spearman analysis. Funding for this study was provided by the National Natural Science Foundation of China (60,000 USD), Beijing Municipal Administration of Hospitals Incubating Program (50,000 USD), and Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (20,000 USD). There were no conflicts of interest associated with this study.
RESULTS:
The average follow-up time for this pilot study was 11.4±1.5 days. Pre-op, the KFC group had higher KA, T1S, C7 SVA, C2 SVA, C0-2L, SWE, VAS, and NDI compared with the control group, but all of these parameters were decreased significantly post-op. The LL, FRR of splenius capitis (FRRsc), and ROM of the KFC group pre-op were lower than the control group, and all of these were increased significantly post-op. There were no differences in PT, SS, C2-7 L, or TK between the KFC and control groups, or in FRR of splenius capitis (FRRutr) between pre-op and post-op phases. KA had strong correlations with LL (r=-0.83), which correlated well with C7 SVA (r=-0.75). C7 SVA correlated strongly with C2 SVA (r=0.79), which also correlated strongly with C0-2 L (r=0.76). C0-2 L correlated well with FRRsc (r=-0.65) and SWEsc (r=0.72), and both of them correlated well with VAS (r=-0.54, r=0.71) and NDI (r=-0.57, r=0.76). ROM correlated well with FRRsc (r=0.71), SWEsc (r=-0.74), VAS (r=-0.66), and NDI (r=-0.66).
CONCLUSIONS:
KFC may cause spine inclination and cranio-cervical malalignment, leading to NT and ROM reduction. The results of this pilot study may be helpful in guiding further studies concerning KFC and NT.
Copyright © 2019. Published by Elsevier Inc.
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Report from the Workforce on Diversity & Inclusion - Society of Thoracic Surgeons Members' Bias Experiences (Commentary).
Ann Thorac Surg -
Significant Improvements in Mortality after the Fontan Operation in Children with Down Syndrome.
Ann Thorac Surg2019 Sep;():. doi: S0003-4975(19)31381-5.
Sarno Lauren A, Walters Henry L, Bondarenko Igor, Thomas Ronald, Kobayashi Daisuke,
Abstract
BACKGROUND:
Down syndrome (DS) is considered a risk factor for mortality associated with the Fontan operation. The objective was to show the contemporary short-term outcome of the Fontan operation for a functionally univentricular heart in patients with DS and non-DS, along with an analysis of significant predictors for in-hospital mortality.
METHODS:
This was a retrospective study using the Society of Thoracic Surgeons Congenital Database to assess in-hospital mortality and its predictors in patients with DS and non-DS undergoing the Fontan operation over 16 years (2001-2016). The primary outcome was in-hospital mortality. Statistical analysis was performed using univariable and multivariable logistic regression models.
RESULTS:
Our study cohort consisted of 12,074 patients (81 DS and 11,993 non-DS). The overall in-hospital mortality rate significantly improved in the recent era (2009 - 2016): 2.4% to 1.3%, p<0.001. The DS group had a higher in-hospital mortality rate (12.3% vs. 1.6%, p<0.001) with an odds ratio of 8.6 [95% confidence interval: 4.4 to 17.0]. The DS group had a higher 30-day mortality rate, a longer median post-operative length of stay, and a higher incidence of post-operative complications. The multivariable model showed that DS was the strongest predictor of in-hospital mortality with an odds ratio of 11.6 [95% confidence interval 5.1 to 26.4], adjusted for other significant variables including era effect, weight and primary cardiac diagnosis.
CONCLUSIONS:
The in-hospital mortality for the Fontan operation significantly improved in the contemporary era. Down syndrome was a significant risk factor for in-hospital morbidity and mortality associated with the Fontan operation.
Copyright © 2019. Published by Elsevier Inc.
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Giant Thymoma with Benign Central Cystic Lesions in a 1-Year-Old Pug.
J Am Anim Hosp Assoc2019 Sep;():. doi: 10.5326/JAAHA-MS-6723.
Brückner Michael, Henrich Manfred,
Abstract
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Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement: Analysis of the PARTNER 2 Trials.
Circ Heart Fail2019 Aug;12(8):e005809. doi: 10.1161/CIRCHEARTFAILURE.118.005809.
Furer Ariel, Chen Shmuel, Redfors Bjorn, Elmariah Sammy, Pibarot Philippe, Herrmann Howard C, Hahn Rebecca T, Kodali Susheel, Thourani Vinod H, Douglas Pamela S, Alu Maria C, Fearon William F, Passeri Jonathan, Malaisrie S Chris, Crowley Aaron, McAndrew Thomas, Genereux Philippe, Ben-Yehuda Ori, Leon Martin B, Burkhoff Daniel,
Abstract
BACKGROUND:
Impaired left ventricular function is associated with worse prognosis among patients with aortic stenosis treated medically or with surgical aortic valve replacement. It is unclear whether reduced left ventricular ejection fraction (LVEF) is an independent predictor of adverse outcomes after transcatheter aortic valve replacement.
METHODS AND RESULTS:
Patients who underwent transcatheter aortic valve replacement in the PARTNER 2 trials (Placement of Aortic Transcatheter Valves) and registries were stratified according to presence of reduced LVEF (<50%) at baseline, and 2-year risk of cardiovascular mortality was compared using Kaplan-Meier methods and multivariable Cox proportional hazards regression. Of 2991 patients, 839 (28%) had reduced LVEF. These patients were younger, more often males, and were more likely to have comorbidities, such as coronary disease, diabetes mellitus, and renal insufficiency. Compared with patients with normal LVEF, patients with low LVEF had higher crude rates of 2-year cardiovascular mortality (19.8% versus 12.0%, <0.0001) and all-cause mortality (27.4% versus 19.2%, <0.0001). Mean aortic valve gradient was not associated with clinical outcomes other than heart failure hospitalizations (hazard ratio [HR], 0.99; CI, 0.99-1.00; =0.03). After multivariable adjustment, patients with reduced versus normal LVEF had significantly higher adjusted risk of cardiovascular death (adjusted HR, 1.42, 95% CI, 1.11-1.81; =0.005), but not all-cause death (adjusted HR, 1.20; 95% CI, 0.99-1.47; =0.07). When LVEF was treated as continuous variable, it was associated with increased 2-year risk of both cardiovascular mortality (adjusted HR per 10% decrease in LVEF, 1.16; 95% CI, 1.07-1.27; =0.0006) and all-cause mortality (adjusted HR, 1.09; 95% CI, 1.01-1.16; =0.02).
CONCLUSIONS:
In this patient-level pooled analysis of PARTNER 2 patients who underwent transcatheter aortic valve replacement, baseline LVEF was an independent predictor of 2-year cardiovascular mortality.
CLINICAL TRIAL REGISTRATION:
URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01314313, NCT02184442, NCT03222128, and NCT02184441.
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Pulmonary Artery to Left Atrium Fistula Presenting As Cardiomegaly in the Fetus: The Utility of Prenatal and Postnatal Three-Dimensional Imaging.
Circ Cardiovasc Imaging2019 Aug;12(8):e009336. doi: 10.1161/CIRCIMAGING.119.009336.
Kehr Jascha, Stirling John W, Bagnall Carol, Long Audrey, Artrip John H, Gentles Thomas L,
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Rib Hyperostosis as a Risk Factor for Poor Prognosis in Cervical Spine Injury Patients with Diffuse Idiopathic Skeletal Hyperostosis.
Spine (Phila Pa 1976)2019 Sep;():. doi: 10.1097/BRS.0000000000003252.
Sawakami Kimihiko, Watanabe Kei, Sato Tsuyoshi, Miura Kazuto, Katsumi Keiichi, Hosaka Noboru, Nomura Shinsen, Fujikawa Ryuta, Kikuchi Ren, Tashi Hideki, Minato Keitaro, Segawa Hiroyuki, Ito Takui, Ishikawa Seiichi, Hirano Toru, Endo Naoto,
Abstract
STUDY DESIGN:
Retrospective multi-center study.
OBJECTIVES:
To identify the morphological features of costovertebral joints and ribs in surgically managed cervical injury patients with diffuse idiopathic skeletal hyperostosis (DISH) and to examine its impact on their vital prognosis.
SUMMARY OF BACKGROUND DATA:
Several reports have indicated that DISH is an independent risk factor for mortality after spinal fracture. The reason for the high mortality in cervical injury patients with DISH is unclear, although some reports have suggested a possible association between pulmonary complications and mortality.
METHODS:
From 1999 to 2017, a total of 50 DISH patients (44 male) with cervical spine injuries who underwent spinal surgery were enrolled (average age 74 years). Prognosis and clinical risk factor data were collected; the morphological features of the patients' costovertebral joints and ribs were evaluated with computed tomography. The influence of each proposed risk factor and thoracic morphological feature on mortality was tested with univariate and multivariate analyses.
RESULTS:
The survival rate at 5 years after surgery was 52.3%. Nineteen (38%) patients died, and the most common cause of death was pneumonia (68%). Costovertebral bone excrescences and rib hyperostosis were found to be thoracic pathognomonic signs; their frequencies were 94% and 82%, respectively, and these conditions occurred in an average of 7.0 joints and 4.7 bones, respectively. The results of the log-rank test showed a significant difference in age, injury severity score (ISS), costovertebral bone excrescences, and rib hyperostosis. The results of age-adjusted multivariate analysis indicated that age (hazard ratio (HR) = 8.65, 95% confidence interval (CI)?=?1.10-68.28, p?=?0.041) and rib hyperostosis (HR?=?3.82, 95% CI?=?1.38-10.57, p?=?0.010) were associated with mortality.
CONCLUSIONS:
Reduced chest wall mobility associated with rib hyperostosis in cervical spine injury patients with DISH leads to a poor prognosis.
LEVEL OF EVIDENCE:
3.
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Persistent pollutants: focus on perfluorinated compounds and kidney.
Curr Opin Crit Care2019 Sep;():. doi: 10.1097/MCC.0000000000000658.
Ferrari Fiorenza, Orlando Anita, Ricci Zaccaria, Ronco Claudio,
Abstract
PURPOSE OF REVIEW:
There is increasing interest in the environmental and human damage caused by pollutants. Big efforts are continuously made to monitor their levels and identify safe thresholds. For this purpose, an essential step is to prioritize harmful substances and understand their effect on human body. Perfluorinated compounds (PFCs) deserve particular attention because of their wide diffusion and potential correlation with different diseases including glucose intolerance, hyperlipidaemia, thyroid diseases, gestational diabetes mellitus and hypertension, testicular and genitourinary cancer as well as impaired kidney function. This review focuses on the renal effects of PFCs, with the attempt to clarify their occurrence and pathogenetic mechanisms.
RECENT FINDINGS:
We reviewed MEDLINE and EMBASE citations between 31 October 2017 and 31 May 2019 and selected human studies measuring PFCs exposure, kidney function markers and the ability of haemodialysis to remove PFCs from the circulating blood. It has been currently clarified that exposure to PFCs is linked with an impaired kidney function and that they can be removed by blood purification.
SUMMARY:
Further studies are required on the potential synergic negative effect of PFCs co-exposure with other pollutants as well as animal studies about the removal capacity of different haemodialysis membranes.
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68Ga-DOTATATE: Significance of Uptake in the Tail of the Pancreas in Patients Without Lesions.
Clin Nucl Med2019 Sep;():. doi: 10.1097/RLU.0000000000002757.
Delbeke Dominique, Newman Grace, Deppen Steve, Shah Chirayu, Ndolo Josephine, Shi Chanjuan, Bailey Christina E, Jessop Aaron C, Sandler Martin P,
Abstract
PURPOSE:
To measure the SUVs in the tail of the pancreas compared with normal liver parenchyma and somatostatin receptor-positive lesions.
MATERIALS AND METHODS:
Ga-DOTATATE PET/low mAs CT of 35 patients were reviewed.
RESULTS:
There was no significant difference (P = 0.59) between the SUVaverage of normal liver and the SUVpeak of normal tail. Five patients had uptake in the tail slightly above that of normal liver that were interpreted equivocally. In one of these patients with Ga-DOTATATE uptake in a peripancreatic lymph node, proven neuroendocrine tumor underwent a distal pancreatectomy and pathologic examination revealed islet cell hyperplasia.
CONCLUSIONS:
Ga-DOTATATE uptake in the tail of the pancreas above that of normal liver indicates a somatostatin receptor-avid lesion. Uptake in the tail of the pancreas equal to the liver can be normal. Patients with uptake equivalent to the liver should undergo further anatomical imaging before procedural intervention.
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Assessment of Ergonomic Strain and Positioning During Bronchoscopic Procedures: A Feasibility Study.
J Bronchology Interv Pulmonol2019 Sep;():. doi: 10.1097/LBR.0000000000000615.
Gilbert Christopher R, Thiboutot Jeffrey, Mallow Christopher, Chen Alexander, Pastis Nicholas J, Argento A Christine, Millar Jennifer, Lavin Robert A, Lerner Andrew D, Yu Diana H, Salwen Ben, Lunz Daniel, Lee Hans J, Yarmus Lonny B,
Abstract
BACKGROUND:
Poor ergonomics place health care workers at risk for work-related overuse injuries. Repetitive and prolonged hand maneuvers, such as those performed during endoscopic procedures, may lead to musculoskeletal complaints and work-related injuries. However, the prevalence of health care-related work injuries among physicians is thought to be underreported and there is a paucity of literature investigating the impact of ergonomic strain on bronchoscopy. We designed a feasibility study to explore the differences in ergonomic strain and muscle activity of bronchoscopists.
MATERIALS AND METHODS:
A prospective study of bronchoscopic procedures was performed in a simulated environment. Preselected target areas were identified and airway sampling was performed with real-time ergonomic assessment utilizing electromyogram (EMG), grip strength, and musculoskeletal use and motion analysis.
RESULTS:
Procedural data was obtained for all procedures (78 bronchoscopies by 13 subjects) for both ergonomic and EMG scores. Experienced bronchoscopists demonstrated less EMG burden (P=0.007) and improved ergonomic positioning (P=0.007) during bronchoscopy when compared with less experienced bronchoscopists. Procedures performed with rotational-head bronchoscopes trended toward improved ergonomics (P=0.15) and lower EMG scores (P=0.88). A significant improvement in ergonomic scores was seen with the rotational-head bronchoscope when targeting the left upper lobe (P=0.036).
CONCLUSION:
Poor ergonomic positioning and excessive muscle strain appear present within bronchoscopy procedures but may be improved in those with more bronchoscopy experience. Technological advances in bronchoscope design may also have the potential to improve procedural ergonomics. Additional prospective studies are warranted to define the long-term impact on bronchoscopic ergonomics.
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Salvage of Exposed Cardiac Implants Using Fasciocutaneous Rotation Flaps.
Ann Plast Surg2019 Sep;():. doi: 10.1097/SAP.0000000000001985.
Da?delen Da?han, Aksoy Alper,
Abstract
INTRODUCTION:
Implantation rates of cardiac implantable electrophysiological devices (CIEDs) are rising, mainly because of the expansion of implantable cardioverter-defibrillators indications for primary prevention. As the CIED usage increases, CIED-related complications are also in rise. Transvenous approach and laser utilization techniques are replacing the open heart surgeries, for removal of CIED systems that are suspected to be infected. In this study, we aimed to share our new method of fasciocutaneous flap coverage results of patients with exposed CIED systems who were not eligible for the CIED replacement surgery for various reasons.
PATIENTS AND METHODS:
Patients operated with rotational fasciocutaneous flaps with addition of pectoralis fascia, owing to their exposed CIEDs between June 2016 and January 2019, were enlisted. Patients with signs of infection whether systemic or limited to the CIED pocket with or without positive blood cultures were referred to infectious diseases department and not included in this study. Patients included in the study were evaluated retrospectively in terms of demographic data, implanted CIED type, time elapsed from implantation to exposure, from referral to flap coverage operation, total follow-up time, survival ratios during follow-up, and complications related to flap coverage operation. In addition, indications for CIED implantation, patient comorbidities, and culture results obtained from the capsule encompassing the CIED battery unit were included to the evaluation.
RESULTS:
A total of 13 patients with exposed CIEDs have undergone total capsulectomy and CIED system coverage with rotational fasciocutaneous flaps. The mean patient age ± SD was 60.2 ± 13.4 years. The average time elapsed from CIED implantation to exposure was 27.3 ± 15.4 months. The average time spanned from initial referral to operation was 6 ± 1.6 days. The most prevalent comorbidity was diabetes mellitus. The average time elapsed during operation for pectoral fascia incorporated rotation flaps was 90 ± 10.6 minutes. Coagulase negative staphylococci were the dominant species (46.5%) obtained from capsule cultures. Apart from 1 case of hematoma, no early or late operation-related complication was encountered.
CONCLUSIONS:
A more precise definition of contamination and infection has to be made in guidelines, which may lead the first group to be treated without extraction. Surgical method defined in this study can be used for the treatment of patients in contaminated CIED subgroup, conserving individuals from risks of device extraction.
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Cleft lip repair: are outcomes between unilateral and bilateral clefts comparable?
J Plast Surg Hand Surg2019 Sep;():1-4. doi: 10.1080/2000656X.2019.1661848.
Chouairi Fouad, Mets Elbert J, Torabi Sina J, Alperovich Michael,
Abstract
This study sought to compare patient demographics, operative course, and peri-operative outcomes between unilateral and bilateral cleft patients. Primary cleft lip repairs were isolated from the National Surgical Quality Improvement Program Pediatric Database (NSQIP-P). Unilateral and bilateral cases of primary cleft lip were identified by ICD codes. Demographics, comorbidities, and post-operative outcomes were compared between cohorts. Patients were propensity matched to control for differences before repeating the analysis. About 4550 cleft lip repairs were evaluated over the 5-year period. Of the cases where the cleft type was identifiable, 75.5% were unilateral clefts and 24.5% were bilateral clefts. The bilateral cleft population had significantly more comorbidities including higher rates of ventilator dependence (1.0% versus 0.4%, ?=?0.02), asthma (1.6% versus 0.7%, ?=?0.011), tracheostomy (1.6% versus 0.5%, ?
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Alleviation of sepsis?induced cardiac dysfunction by overexpression of Sestrin2 is associated with inhibition of p?S6K and activation of the p?AMPK pathway.
Mol Med Rep2019 Jul;():. doi: 10.3892/mmr.2019.10520.
Wang Ziwen, Bu Lin, Yang Peng, Feng Shoujie, Xu Feng,
Abstract
Sepsis?induced myocardial injury is one of the manifestations of multiple organ dysfunction in sepsis. The aim of the present study was to determine the mechanism of alleviation of lipopolysaccharide (LPS)?induced injury on cardiomyocytes by Sestrin2. A sepsis model using LPS injection was constructed in Sprague?Dawley (SD) rats, and after 6, 12 and 24 h, rat blood was collected and cardiac troponin T (CTnT) levels were determined using ELISA. Heart specimens were excised, tumor necrosis factor?? (TNF??) and interleukin 6 (IL?6) levels were detected by ELISA, malondialdehyde (MDA) levels were estimated using colorimetric analysis, and phosphorylated (p)?S6K and p?AMP?activated protein kinase (AMPK) levels were determined by western blot analysis. In the septic rats, phenomenon of myocardial fiber rupture, interstitial edema and inflammatory cell infiltration were observed under light microscope. Following LPS injection, CTnT in serum and MDA in myocardial homogenate were increased time?dependently. TNF?? and IL?6 levels were significantly increased, with a peak at 6 h. p?S6K levels were adaptively downregulated, and levels of p?AMPK and Sestrin2 were adaptively upregulated by LPS. In LPS?injured H9c2 cells, Sestrin2 overexpression attenuated the LPS?mediated inhibitory effects on cell viability, suppressed LPS?mediated increase in CTnT, TNF??, IL?6 and MDA levels, as well as attenuated p?S6K levels and elevated p?AMPK and Sestrin2 levels. Sestrin2 interference showed the opposite effect. Sestrin2 promoted cell viability and inhibited the inflammatory responses of LPS?injured myocardial cells. The phenomena may be associated with inhibition of p?S6K and activation of the p?AMPK pathway.
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