Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-ye...Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-year.In recent years,extra-pleural pneumonectomy has decreased in popularity due to a high morbidity rate and mortality compared to pleurectomy/decortication and other therapeutic alternatives.In this review,we will discuss both procedures,outcomes,ongoing studies,and the roles of surgery in the future treatment of this disease.展开更多
Background: Chronic empyema thoracis is a debilitating illness with high morbidity and mortality, and is seen among all age groups in Nigeria. Objective: To review all cases of chronic empyema thoracis treated by pleu...Background: Chronic empyema thoracis is a debilitating illness with high morbidity and mortality, and is seen among all age groups in Nigeria. Objective: To review all cases of chronic empyema thoracis treated by pleurectomy and lung decortication and highlight the indications, challenges and the outcome. Materials and Method: In a 10-year period spanning 2007-2016, 90 patients with chronic empyema thoracis were admitted and managed in our institution. A retrospective study of 36 patients who underwent surgery was performed. Results: Ten patients (27.80%) out of 36 patients had unsuccessful one month closed chest tube drainage (CTTD). Six patients (16.67%) were referred from peripheral hospitals as chronic empyema thoracis that had failed CTTD. The remainder, 20 (55.60%) were diagnosed as chronic empyema thoracis de novo. Conclusion: Chronic empyema thoracis is a very difficult disease to manage especially in developing countries like ours, where patients present very late and the requisite facilities are inadequate.展开更多
Video assisted thoracic surgery in advanced stage postpneumonic empyema aims for thorough debridement and washout of the pleural space followed by an attempt to release the entrapped lung (decortication). When the lat...Video assisted thoracic surgery in advanced stage postpneumonic empyema aims for thorough debridement and washout of the pleural space followed by an attempt to release the entrapped lung (decortication). When the latter isn’t successful, and the patient is in a poor performance status, applying tube thoracostomy is the usual routine, to avoid conversion to thoracotomy and open decortication. Tube thoracostomy, however, is associated with complications necessitating further surgery, needs long term follow up and also entails quality of life distorting issues. To overcome these disadvantages, we instead inserted a PleurX® indwelling pleural catheter in four patients in the above situation. The method brought success (lung re-expansion and complete or partial pleurodesis) without the need for further surgery or quality of life problems in either patient. Although the use of the indwelling pleural catheter in infected pleural space is not recommended by manufacturers, we noted no complications.展开更多
BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral n...BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication.To address safety concerns associated with TPVBs,we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication.The MTP block was performed at the T9 level under ultrasound guidance,with 20 mL of 0.5%ropivacaine injected.Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels.Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement,with none exceeding a mean 24 h numeric rating scale>3.CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.展开更多
Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Met...Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Methods:A retrospective cohort study was conducted among 81 patients with single simple renal cyst who had undergone retroperitoneal laparoscopic cyst decortication from January 2017 to December 2019 in Wuxi Xishan People's Hospital.All patients were divided into three groups according to BMI:normal group(BMI<25 kg/m^(2),n=44),overweight group(BMI=25-30 kg/m^(2),n=21),and obese group(BMI>30 kg/m^(2),n=16).Multiple linear regression was conducted to investigate the correlation.Results:The three groups were comparable in terms of age,gender,maximum diameter of cyst,and cyst location.In the aspect of operation time,only the patients in obese group had longer duration when compared with those in the normal group(59.1±15.7 min vs.45.2±12.8 min,p=0.001).And the patients in the obese group had significantly longer hospital stay compared with those in the normal group(6.2±1.9 d vs.5.2±0.5 d,p=0.002)and overweight group(6.2±1.9 d vs.5.0±1.0d,p=0.001).In the analysis of multiple linear regression,it was found that operation time is significantly affected by BMI and location 2,with coefficients of 1.299 and -8.646 respectively.The influence of BMI was greater than location 2(0.335 vs.-0.289).For hospital stay,only BMI had an effect on it,with a coefficient of 0.110.Conclusion:BMI was a major factor that associated with longer operation time and hospital stay in patients with retroperitoneal laparoscopic renal cyst decortication.展开更多
Shelling of groundnut pods using manual decorticators in Kenya is characterized by high kernel breakages and low shelling efficiencies. As a result, farmers get low income due to low cost of broken kernels and a lot o...Shelling of groundnut pods using manual decorticators in Kenya is characterized by high kernel breakages and low shelling efficiencies. As a result, farmers get low income due to low cost of broken kernels and a lot of time is lost in the tedious shelling operation. To overcome this problem, pertinent parameters that influence shelling efficiency of manually operated groundnut decorticators were identified. Two manually operated decorticators were tested and modifications done on one of the decorticators to optimize its technical performance. Results of machine performance tests showed that for WBS (Wooden beater sheller) at a feed rate of 30 kg/hr and 22.6 mm clearance, shelling efficiency increased with decrease in moisture content for all the groundnut varieties. The highest shelling efficiency was 55.3% for ICGV 99568, 39.2% for ICRISAT Groundnut Variety (ICGV) 90704 and 29% for ICGV 12991 at moisture content of 5.92% wb. For RBS (Rod beater sheller) at a feed rate of 30 kg/hr and 22.6 mm clearance, the highest shelling efficiency was 58.3% for ICGV 99568, 42.7% for ICGV 90704 and 35% for ICGV 12991 at moisture content of 7% wb. Identification of the pertinent parameters showed that pod moisture content, clearance and sieve size influence performance of manually operated groundnut. Theoretical predictive models developed were optimized which showed that a maximum shelling efficiency of 88.73% can be achieved with percent damage of 4% when the sieve size is 11 mm and clearance is 16 mm with a regression coefficient of over 85%. With the modifications done on the WBS decorticator, the highest shelling efficiency of 87% was obtained at a clearance of 10 mm for ICGV 99568 which is the largest in size from the three varieties. The shelling efficiency of the modified decorticator is far above those of the RBS and WBS because the sieve sizes and clearances of the later were not optimized. The results of the theoretical optimization of the manually operated groundnut decorticator implies that farmers who shell for seeds can now obtain more seeds shelled with low breakage and therefore will get more income.展开更多
Low back pain (LBP) is one of the most prevalent, disabling and costly medical conditions affecting modern society. LBP presents a significant challenge to effective treatment due to often multifactorial or unknown et...Low back pain (LBP) is one of the most prevalent, disabling and costly medical conditions affecting modern society. LBP presents a significant challenge to effective treatment due to often multifactorial or unknown etiology. Since the 1980s, the sacroiliac (SI) joint has become increasingly recognized as a common source of LBP. In contrast to other sources of LBP such as internal disc disruption and even psychosocial factors, SI joint pain and degeneration are reliably identified with provocative manual tests and diagnostic injections. Fusion of the SI joint has been shown to provide enduring symptom relief, and minimally invasive techniques developed over the past decade have further reduced the operative risks associated with open fusion surgery. Minimally invasive SI joint fusion surgeries are typically performed by placing rigid implant components across the joint space. The implants provide mechanical fixation while bony fusion develops. Decortication of the SI joint space during the procedure produces a bleeding bone surface that allows for increased availability of autologous mesenchymal stem cells and growth factors at the fusion site. Coupled with the mechanical stability provided by the implant and autologous bone graft, decortication provides an optimal environment for bone growth and subsequent fusion of the joint. This report describes the background of SI joint disease, treatment, and the minimally invasive SImmetry? Sacroiliac Joint Fusion System (Zyga Technology, Inc., Minnetonka, MN, USA), with emphasis on the decortication instrumentation and procedure.展开更多
Spontaneous pneumothorax, primary or secondary, is a common medical emergency for which specific indications for surgical intervention are well defined in selected patients. The traditional surgical approach has been ...Spontaneous pneumothorax, primary or secondary, is a common medical emergency for which specific indications for surgical intervention are well defined in selected patients. The traditional surgical approach has been by limited thoracotomy using axillary or posterolateral incision. With the advent of video-assisted minimally invasive technique in the last 20 years the traditional approach is infrequently used. The definitive operation to prevent recurrent pneumothorax by surgical approach requires bullectomy and parietal pleurectomy. The recurrence rate after the traditional open surgical approach has been low at <2%. On the other hand, video-assisted thoracoscopic surgery, although better tolerated has a higher recurrence rate at 5% [1]. Information on post-operative morbidity and mortality are lacking. For this reason, we have reviewed our experience at one institution on the outcome of the VATS approach. We found that prolonged post- operative air leak is the most common complication and cigarette smoking remains an important associated factor.展开更多
血管再生是骨增量成功的关键因素之一。去皮质被认为是骨增量手术过程中促进血管生成的一个重要步骤。然而,关于去皮质在骨增量过程中的作用,目前的研究结论尚未统一。本文通过文献回顾,总结了去皮质在引导骨再生术(guided bone regener...血管再生是骨增量成功的关键因素之一。去皮质被认为是骨增量手术过程中促进血管生成的一个重要步骤。然而,关于去皮质在骨增量过程中的作用,目前的研究结论尚未统一。本文通过文献回顾,总结了去皮质在引导骨再生术(guided bone regeneration,GBR)、块状骨移植术(block bone grafting)和骨膜牵张成骨术(periosteal distraction osteogenesis,PDO)中的研究结果,分析了去皮质影响骨再生的机制,并探讨了研究结果不一致的原因,以期为临床医生在骨增量手术时实施去皮质提供参考。展开更多
文摘Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-year.In recent years,extra-pleural pneumonectomy has decreased in popularity due to a high morbidity rate and mortality compared to pleurectomy/decortication and other therapeutic alternatives.In this review,we will discuss both procedures,outcomes,ongoing studies,and the roles of surgery in the future treatment of this disease.
文摘Background: Chronic empyema thoracis is a debilitating illness with high morbidity and mortality, and is seen among all age groups in Nigeria. Objective: To review all cases of chronic empyema thoracis treated by pleurectomy and lung decortication and highlight the indications, challenges and the outcome. Materials and Method: In a 10-year period spanning 2007-2016, 90 patients with chronic empyema thoracis were admitted and managed in our institution. A retrospective study of 36 patients who underwent surgery was performed. Results: Ten patients (27.80%) out of 36 patients had unsuccessful one month closed chest tube drainage (CTTD). Six patients (16.67%) were referred from peripheral hospitals as chronic empyema thoracis that had failed CTTD. The remainder, 20 (55.60%) were diagnosed as chronic empyema thoracis de novo. Conclusion: Chronic empyema thoracis is a very difficult disease to manage especially in developing countries like ours, where patients present very late and the requisite facilities are inadequate.
文摘Video assisted thoracic surgery in advanced stage postpneumonic empyema aims for thorough debridement and washout of the pleural space followed by an attempt to release the entrapped lung (decortication). When the latter isn’t successful, and the patient is in a poor performance status, applying tube thoracostomy is the usual routine, to avoid conversion to thoracotomy and open decortication. Tube thoracostomy, however, is associated with complications necessitating further surgery, needs long term follow up and also entails quality of life distorting issues. To overcome these disadvantages, we instead inserted a PleurX® indwelling pleural catheter in four patients in the above situation. The method brought success (lung re-expansion and complete or partial pleurodesis) without the need for further surgery or quality of life problems in either patient. Although the use of the indwelling pleural catheter in infected pleural space is not recommended by manufacturers, we noted no complications.
基金Supported by Self-funded Research Projects of Guangxi Zhuang Autonomous Region Health Commission of China,No.Z20210063。
文摘BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication.To address safety concerns associated with TPVBs,we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication.The MTP block was performed at the T9 level under ultrasound guidance,with 20 mL of 0.5%ropivacaine injected.Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels.Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement,with none exceeding a mean 24 h numeric rating scale>3.CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.
文摘Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Methods:A retrospective cohort study was conducted among 81 patients with single simple renal cyst who had undergone retroperitoneal laparoscopic cyst decortication from January 2017 to December 2019 in Wuxi Xishan People's Hospital.All patients were divided into three groups according to BMI:normal group(BMI<25 kg/m^(2),n=44),overweight group(BMI=25-30 kg/m^(2),n=21),and obese group(BMI>30 kg/m^(2),n=16).Multiple linear regression was conducted to investigate the correlation.Results:The three groups were comparable in terms of age,gender,maximum diameter of cyst,and cyst location.In the aspect of operation time,only the patients in obese group had longer duration when compared with those in the normal group(59.1±15.7 min vs.45.2±12.8 min,p=0.001).And the patients in the obese group had significantly longer hospital stay compared with those in the normal group(6.2±1.9 d vs.5.2±0.5 d,p=0.002)and overweight group(6.2±1.9 d vs.5.0±1.0d,p=0.001).In the analysis of multiple linear regression,it was found that operation time is significantly affected by BMI and location 2,with coefficients of 1.299 and -8.646 respectively.The influence of BMI was greater than location 2(0.335 vs.-0.289).For hospital stay,only BMI had an effect on it,with a coefficient of 0.110.Conclusion:BMI was a major factor that associated with longer operation time and hospital stay in patients with retroperitoneal laparoscopic renal cyst decortication.
文摘Shelling of groundnut pods using manual decorticators in Kenya is characterized by high kernel breakages and low shelling efficiencies. As a result, farmers get low income due to low cost of broken kernels and a lot of time is lost in the tedious shelling operation. To overcome this problem, pertinent parameters that influence shelling efficiency of manually operated groundnut decorticators were identified. Two manually operated decorticators were tested and modifications done on one of the decorticators to optimize its technical performance. Results of machine performance tests showed that for WBS (Wooden beater sheller) at a feed rate of 30 kg/hr and 22.6 mm clearance, shelling efficiency increased with decrease in moisture content for all the groundnut varieties. The highest shelling efficiency was 55.3% for ICGV 99568, 39.2% for ICRISAT Groundnut Variety (ICGV) 90704 and 29% for ICGV 12991 at moisture content of 5.92% wb. For RBS (Rod beater sheller) at a feed rate of 30 kg/hr and 22.6 mm clearance, the highest shelling efficiency was 58.3% for ICGV 99568, 42.7% for ICGV 90704 and 35% for ICGV 12991 at moisture content of 7% wb. Identification of the pertinent parameters showed that pod moisture content, clearance and sieve size influence performance of manually operated groundnut. Theoretical predictive models developed were optimized which showed that a maximum shelling efficiency of 88.73% can be achieved with percent damage of 4% when the sieve size is 11 mm and clearance is 16 mm with a regression coefficient of over 85%. With the modifications done on the WBS decorticator, the highest shelling efficiency of 87% was obtained at a clearance of 10 mm for ICGV 99568 which is the largest in size from the three varieties. The shelling efficiency of the modified decorticator is far above those of the RBS and WBS because the sieve sizes and clearances of the later were not optimized. The results of the theoretical optimization of the manually operated groundnut decorticator implies that farmers who shell for seeds can now obtain more seeds shelled with low breakage and therefore will get more income.
文摘Low back pain (LBP) is one of the most prevalent, disabling and costly medical conditions affecting modern society. LBP presents a significant challenge to effective treatment due to often multifactorial or unknown etiology. Since the 1980s, the sacroiliac (SI) joint has become increasingly recognized as a common source of LBP. In contrast to other sources of LBP such as internal disc disruption and even psychosocial factors, SI joint pain and degeneration are reliably identified with provocative manual tests and diagnostic injections. Fusion of the SI joint has been shown to provide enduring symptom relief, and minimally invasive techniques developed over the past decade have further reduced the operative risks associated with open fusion surgery. Minimally invasive SI joint fusion surgeries are typically performed by placing rigid implant components across the joint space. The implants provide mechanical fixation while bony fusion develops. Decortication of the SI joint space during the procedure produces a bleeding bone surface that allows for increased availability of autologous mesenchymal stem cells and growth factors at the fusion site. Coupled with the mechanical stability provided by the implant and autologous bone graft, decortication provides an optimal environment for bone growth and subsequent fusion of the joint. This report describes the background of SI joint disease, treatment, and the minimally invasive SImmetry? Sacroiliac Joint Fusion System (Zyga Technology, Inc., Minnetonka, MN, USA), with emphasis on the decortication instrumentation and procedure.
文摘Spontaneous pneumothorax, primary or secondary, is a common medical emergency for which specific indications for surgical intervention are well defined in selected patients. The traditional surgical approach has been by limited thoracotomy using axillary or posterolateral incision. With the advent of video-assisted minimally invasive technique in the last 20 years the traditional approach is infrequently used. The definitive operation to prevent recurrent pneumothorax by surgical approach requires bullectomy and parietal pleurectomy. The recurrence rate after the traditional open surgical approach has been low at <2%. On the other hand, video-assisted thoracoscopic surgery, although better tolerated has a higher recurrence rate at 5% [1]. Information on post-operative morbidity and mortality are lacking. For this reason, we have reviewed our experience at one institution on the outcome of the VATS approach. We found that prolonged post- operative air leak is the most common complication and cigarette smoking remains an important associated factor.
文摘血管再生是骨增量成功的关键因素之一。去皮质被认为是骨增量手术过程中促进血管生成的一个重要步骤。然而,关于去皮质在骨增量过程中的作用,目前的研究结论尚未统一。本文通过文献回顾,总结了去皮质在引导骨再生术(guided bone regeneration,GBR)、块状骨移植术(block bone grafting)和骨膜牵张成骨术(periosteal distraction osteogenesis,PDO)中的研究结果,分析了去皮质影响骨再生的机制,并探讨了研究结果不一致的原因,以期为临床医生在骨增量手术时实施去皮质提供参考。
