Search

Aim: This study aims to compare biomarkers related to endothelial function during selective antegrade cerebral perfusion with moderate hypothermic lower body circulatory arrest with that of standard cardiac surgery.Material and Methods: Thirty-six consecutive patients who underwent selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest at 28°C (study group) for aneurysms of the ascending aorta were prospectively compared with 36 patients who underwent standard cardiac surgery (control group) with conventional cardiopulmonary bypass. Nitric oxide, asymmetric dimethylarginine, hydrogen sulfide and total antioxidant capacity status and lactate levels in blood specimens obtained from the vena cava inferior were studied. Clinical results and biochemical parameters were evaluated.Results: Biomarkers related to endothelial function were found to be similar between the groups except for asymmetric dimethylarginine. The asymmetric dimethylarginine levels were lower, while lactate levels were significantly higher compared to the control group. When the patients with coronary artery disease were excluded from the analysis to rule out the predominance of coronary artery disease patients in one group as a confounding factor, the asymmetric dimethylarginine levels were found to be similar between the two subgroups.Conclusion: Low plasma levels of asymmetric dimethylarginine in the study group may have a protective role in endothelial nitric oxide synthesis. When patients with coronary artery disease were excluded from both group, biomarkers related to endothelial function were similar in both groups. We consider that endothelial functions are not affected adversely during short periods of moderately hypothermic lower body circulatory arrest., Amaç: Bu çalışma, antegrad serebral perfüzyon ve distal ılımlı hipotermik sirkülatuararrest tekniğinin endotel fonksiyonuna ilişkin biyobelirteçler üzerine etkisini standart kalp cerrahisi ile karşılaştırmayı amaçlamaktadır.Materyal-Metod: Asendan aort anevrizması için 28 ° C' da selektif antegrad serebral perfüzyon ve orta derecede hipotermik alt vücut dolaşım durması uygulanan 36 hasta (standart çalışma grubu), konvansiyonel kardiyopulmoner bypass ile standart kalp ameliyatı uygulanan (kontrol grubu) 36 hasta prospektif olarak karşılaştırıldı. Vena kava inferiordan elde edilen kan örneklerinde nitrik oksit, asimetrik dimetilarginin, hidrojen sülfit ve toplam antioksidan kapasite durumu ve laktat seviyeleri incelenmiştir. Klinik sonuçlar ve biyokimyasal parametreler değerlendirildi.Bulgular: Endotel fonksiyonuyla ilgili biyobelirteçler, asimetrik dimetilarjinin dışındaki gruplar arasında benzer bulundu. Asimetrik dimetilarjinin düzeyleri düşüktü, laktat düzeyleri ise kontrol grubuna göre anlamlı derecede yüksek bulundu. Kontrol gruptaki koroner arter hastalarının baskınlığını nedeniyle çıkan sonuçlarda kafa karıştırıcı bir faktör olarak düşünülerek koroner arter hastaları analiz dışında bırakıldığında, asimetrik dimetilarjinin düzeylerinin, iki alt grup arasında benzer olduğu bulundu.Sonuç: Çalışma grubundaki düşük plazma asimetrik dimetilarjinin seviyeleri, endotelyal nitrik oksit sentezinde koruyucu bir role sahip olabilir. Koroner arter hastalığı olan hastalar her iki gruptan da dışlandığında, endotel fonksiyonuna bağlı biyobelirteçler her iki grupta da benzerdi. Bu sebeple antegrad serebral perfüzyon ve distal ılımlı hipotermik sirkülatuar arrest tekniğinin kısa dönemde endotel fonksiyonlarını etkilemediğini düşünmekteyiz.

Orientadores: Ilka de Fátima Santana Ferreira Boin, Sebastião Araújo Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: Antecedentes: A fisioterapia pré-operatória em cirurgia cardíaca (CC) visa amenizar a disfunção respiratória e prevenir ou tratar complicações pulmonares comuns no período pós-operatório (PO). Objetivos: Avaliar a influência da fisioterapia respiratória pré-operatória e a intensidade da dor pós-operatória referida em determinadas variáveis utilizadas para a mensuração da função respiratória em pacientes submetidos à CC eletiva com circulação extracorpórea (CEC). Desenho: Pesquisa prospectiva, de coorte longitudinal, por amostra de conveniência. Local: Hospital da Irmandade Santa Casa de Misericórdia de Araras. Período: Agosto a dezembro de 2007. Método: Foram estudados 35 pacientes. As variáveis que avaliaram a função respiratória: força muscular respiratória, volume corrente (VC), volume minuto (VM), frequência respiratória (FR) e capacidade vital (CV) foram obtidas nos momentos: pré-operatório (PRE-OP) e PO (1°, 3° e 5°PO). A dor PO referida foi correlacionada com a disfunção respiratória. Baseado na mediana do número de sessões de fisioterapia PRE-OP realizadas, os pacientes foram divididos em Grupo 1 (pacientes que realizaram menor número de sessões) e Grupo 2 (pacientes que realizaram maior número de sessões). Os pacientes seguiram a rotina de atendimento fisioterapêutico local no PO. Resultados: Quinze pacientes compuseram o Grupo 1 (= 6 sessões) e 20 o Grupo 2 (= 8 sessões). As comparações das variáveis categóricas medidas no PRE-OP entre os grupos (idade, peso, altura, índice de massa corpórea e tempo de CEC), além das variáveis que avaliaram a função respiratória antes da CC não apresentaram diferenças significantes, evidenciando homogeneidade da amostra. Entretanto, a variável tempo total de cirurgia (média±desvio padrão) foi maior no grupo 2 (238,2±55,1 minutos versus 197,7±55,8 minutos no grupo 1, p=0,045). Houve predomínio de sujeitos do sexo masculino (73,3% no grupo 1 e 60,0% no grupo 2) e ex-tabagistas (73,3% no grupo 1 e 50,0% no grupo 2), predominando a cirurgia de revascularização do miocárdio (66,7% no grupo 1 e 70,0% no grupo 2). Em todas as variáveis da função respiratória estudadas, os valores obtidos no período PO foram menores em relação aos do PRE-OP em ambos os grupos e permaneceram abaixo até o 5°PO, com exceção do VM. Não houve diferença estatisticamente significante no comportamento das variáveis entre os grupos em relação aos tempos, com exceção do VC, que apresentou aumento significante (p = 0,029) entre os momentos 1º PO e 5º PO e 3º PO e 5º PO apenas para o grupo 2. Quanto maior foi a dor PO referida, maior foi a FR e menores foram os valores de VM e CV. O tempo de internação hospitalar foi similar entre os grupos. Conclusões: O número de sessões de fisioterapia PRE-OP não teve influência na evolução da função respiratória no PO de CC. A intensidade da dor pós-operatória referida influenciou de forma significante o aumento da FR e a diminuição do VM e da CV Abstract: Background: Preoperative physiotherapy in cardiac surgery (CS) aims to minimize respiratory dysfunction and prevent or treat pulmonary complications common in postoperative period (PO). Purpose: To evaluate the influence of preoperative respiratory physiotherapy and the intensity of postoperative referred pain in certain variables of respiratory function measurements in patients undergoing elective CS with cardiopulmonary bypass (CPB). Design: Prospective and longitudinal cohort with a convenience sample. Setting: Hospital of the Santa Casa de Misericórdia de Araras. Period: August to december of 2007. Method: Thirty-five patients were studied. Respiratory function variables [respiratory muscle strength, tidal volume (TV), minute volume (MV), respiratory rate (RR) and vital capacity (VC)] were obtained at preoperative period (PP) and postoperative moments (1st, 3rd e 5th PO). Referred postoperative pain was correlated with respiratory dysfunction. Based on median of the number of preoperative physiotherapy sessions performed, patients were allocated into two groups: Group 1 (patients with fewer sessions) and group 2 (more sessions). Patients followed the local routine for physiotherapy at PO. Results: Fifteen patients composed the group 1 (6 sessions) and 20 the group 2 (= 8 sessions). Categorical variables obtained at PP period and compared between the two groups (age, weight, height, body mass index and CPB time), as well variables for respiratory function measurements, had not statistical differences, showing homogeneity of the casuistic. However, time of surgery (meanstandard deviation) was higher in group 2 (238.2±55.1 minutes versus 197.7±55.8 minutes in group 1, p=0.045). Overall, there was a predominance of male subjects (73.3% in group 1 and 60% in group 2), ex-smokers (73.3% in group 1 and 50.0% in group 2) and coronary artery bypass grafting (66.7 % in group 1 and 70.0% in group 2). All variables obtained in PO had lower values than those of PP for both groups, and remained bellow until the 5th PO day, with exception of the MV. When PO moments were evaluated, there was no statistical difference for variables performance between groups regarding the moments, with the exception of TV that presented significant increase (p = 0.029) between 1st and 5th PO; and 3rd and 5th PO only for group 2. Higher referred pain was seen with higher RR and with lower values of MV and VC. Both groups had similar hospital length of stay. Conclusions: The number of preoperative physiotherapy sessions had no influence on the evolution of respiratory function at the PO in CS. The intensity of postoperative referred pain influenced significantly the increase of RR and the reduction of MV and VC Mestrado Cirurgia Mestre em Ciências Médicas

The problems for fixing rib fractures are usually challenged with different rib fixators whose design strongly depends of the material selected for construction. Main issues refer to rib surgery implantation and tissue acceptance for a duration longer than the osteosynthesis. In this paper we discuss how a material selection can strongly suggest different design solutions both in shape of a rib fixator and even constraining or directing the surgical application with an invasive or noninvasive implantation. In particular, in discussing the general issues and specific experiences of the authors the paper illustrates examples of two different solutions under patent request that are dictated by the material whose selection give the design solutions with innovative aspects.

The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) is the largest professional organization in the world dedicated to pediatric and congenital heart surgery. The purpose of this article is to document the first decade of the history of WSPCHS from its formation in 2006, to summarize the current status of WSPCHS, and to consider the future of WSPCHS. The WSPCHS was incorporated in Canada on April 7, 2011, with a head office in Montreal, Canada. The vision of the WSPCHS is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The mission of the WSPCHS is to promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient’s economic means, with an emphasis on excellence in teaching, research, and community service.

Amaç: Bu çalışma, antegrad serebral perfüzyon ve distal ılımlı hipotermik sirkülatuararrest tekniğinin endotel fonksiyonuna ilişkin biyobelirteçler üzerine etkisini standart kalp cerrahisi ile karşılaştırmayı amaçlamaktadır.Materyal-Metod: Asendan aort anevrizması için 28 ° C' da selektif antegrad serebral perfüzyon ve orta derecede hipotermik alt vücut dolaşım durması uygulanan 36 hasta (standart çalışma grubu), konvansiyonel kardiyopulmoner bypass ile standart kalp ameliyatı uygulanan (kontrol grubu) 36 hasta prospektif olarak karşılaştırıldı. Vena kava inferiordan elde edilen kan örneklerinde nitrik oksit, asimetrik dimetilarginin, hidrojen sülfit ve toplam antioksidan kapasite durumu ve laktat seviyeleri incelenmiştir. Klinik sonuçlar ve biyokimyasal parametreler değerlendirildi.Bulgular: Endotel fonksiyonuyla ilgili biyobelirteçler, asimetrik dimetilarjinin dışındaki gruplar arasında benzer bulundu. Asimetrik dimetilarjinin düzeyleri düşüktü, laktat düzeyleri ise kontrol grubuna göre anlamlı derecede yüksek bulundu. Kontrol gruptaki koroner arter hastalarının baskınlığını nedeniyle çıkan sonuçlarda kafa karıştırıcı bir faktör olarak düşünülerek koroner arter hastaları analiz dışında bırakıldığında, asimetrik dimetilarjinin düzeylerinin, iki alt grup arasında benzer olduğu bulundu.Sonuç: Çalışma grubundaki düşük plazma asimetrik dimetilarjinin seviyeleri, endotelyal nitrik oksit sentezinde koruyucu bir role sahip olabilir. Koroner arter hastalığı olan hastalar her iki gruptan da dışlandığında, endotel fonksiyonuna bağlı biyobelirteçler her iki grupta da benzerdi. Bu sebeple antegrad serebral perfüzyon ve distal ılımlı hipotermik sirkülatuar arrest tekniğinin kısa dönemde endotel fonksiyonlarını etkilemediğini düşünmekteyiz. Aim: This study aims to compare biomarkers related to endothelial function during selective antegrade cerebral perfusion with moderate hypothermic lower body circulatory arrest with that of standard cardiac surgery.Material and Methods: Thirty-six consecutive patients who underwent selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest at 28°C (study group) for aneurysms of the ascending aorta were prospectively compared with 36 patients who underwent standard cardiac surgery (control group) with conventional cardiopulmonary bypass. Nitric oxide, asymmetric dimethylarginine, hydrogen sulfide and total antioxidant capacity status and lactate levels in blood specimens obtained from the vena cava inferior were studied. Clinical results and biochemical parameters were evaluated.Results: Biomarkers related to endothelial function were found to be similar between the groups except for asymmetric dimethylarginine. The asymmetric dimethylarginine levels were lower, while lactate levels were significantly higher compared to the control group. When the patients with coronary artery disease were excluded from the analysis to rule out the predominance of coronary artery disease patients in one group as a confounding factor, the asymmetric dimethylarginine levels were found to be similar between the two subgroups.Conclusion: Low plasma levels of asymmetric dimethylarginine in the study group may have a protective role in endothelial nitric oxide synthesis. When patients with coronary artery disease were excluded from both group, biomarkers related to endothelial function were similar in both groups. We consider that endothelial functions are not affected adversely during short periods of moderately hypothermic lower body circulatory arrest.

PURPOSE OF REVIEW: Advances in medical care have led to an increasing elderly population. Elderly individuals should be able to participate in society as long as possible. However, with an increasing age their adaptive capacity gradually decreases, specially before and after major life events (like hospitalization and surgery) making them vulnerable to reduced functioning and societal participation. Therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate. RECENT FINDINGS: There is high quality evidence that preoperative exercise in patients scheduled for cardiovascular surgery is well tolerated and effective. Moreover, there is circumstantial evidence suggesting preoperative exercise for thoracic, abdominal and major joint replacement surgery is effective, provided that this is offered to the high-risk patients. Postoperative exercise should be initiated as soon as possible after surgery according to fast-track or enhanced recovery after surgery principles. SUMMARY: The perioperative exercise training protocol known under the name 'Better in, Better out' could be implemented in clinical care for the vulnerable group of patients scheduled for major elective surgery who are at risk for prolonged hospitalization, complications and/or death. Future research should aim to include this at-risk group, evaluate perioperative high-intensity exercise interventions and conduct adequately powered trials. © 2014 Wolter Kluwer Health | Lippincott Williams & Wilkins.

Aim: The incidence of synchronous and metachronous lung cancers has been due to early diagnosis and curative resection of the first tumor. Tumors from other organs that metastasize to the lungs or primary lung lesions that develop after complete surgical treatment of other cancers can cause confusion regarding the diagnosis and treatment. We compared the preoperative pulmonary function tests (PFT) and surgical technique used in the first and second surgeries in cases undergoing thoracic surgery when a malignancy was found after the first complete resection of malignancy in the lung or another organ. Material and Method: We retrospectively evaluated cases undergoing multiple thoracic surgery between 2006 and 2012 at the Pamukkale University Faculty of Medicine, Department of Thoracic Surgery, and classified them as synchronous, metachronous and metastatic. The groups were evaluated for age, gender, respiratory function tests, surgical technique used, histopathological diagnosis and stage, postoperative complications and duration between surgeries. Results: The mean age was 61.80±8.53 years with a female/male rate of 2/9. There were 1 synchronous, 7 metachronous and 3 metastatic cases. The most common surgical technique for the first surgery was lobectomy with 9 cases and wedge resection for the second surgery with 8 cases. The most common histopathological type for both surgeries was adenomacarcinoma with 8 cases and 6 cases for the first and second surgeries respectively. There was no statistically significant difference between the first and second thoracotomies regarding PFT values (p>0.05), while a significant difference was present for the surgical technique used (p

Summary. + e article shows the stages of treatment of funnel chest in the Tomsk Region from 1977 to 2009. + e work provides the analysis of surgical treatment of 78 patients, including 16 children treated by G.A. Bairov’s method, 20 children were operated using suspension splint with damping arrangement, 42 patients were operated by author’s method by means of thoracoplasty with the following / xation of costosternal complex using previously chilled titanium nickelide plates, which have thermodynamic properties. + ere were also presented the main stages of new technique, including the “classical” type of surgical intervention.It has been noted that using titanium nickelide plates with the shape memory to correct funnel chest in children and adolescents is the method of choice and brings good clinical results. Key words: thorax surgery, funnel chest, thoracoplasty, titanium nickelid.s‚‡!‰“ŽŽ‘“ ‰“™‡‚’S‘€€ †‚ˆ‰Ž‡… „s“‹„€ ˜‚“‰ƒ‹SŒ-s€µ‹ ƒ‡†‡… ˜‡‚‡„€ ‚SžŒ€‹€€, ƒŒ€žSŽŽ‘“ ƒ €ž’“Ž“Ž€“’ “# ™‡‚’‘. —S€†‡s““ œSƒ‹‡ Œƒ‹‚“œS“‹ƒ€ Œ‡‚‡Ž„‡‡†‚Sž-ŽS€ ‰“™‡‚’S‘€€ †‚ˆ‰Ž‡… „s“‹„€ (sOA5) [1,3]. ¾‹‡ ˜‡-‚‡„ ‚SžŒ€‹€€, „‡‹‡‚‘… „‚‡’“ „‡ƒ’“‹€œ“ƒ„‡†‡ ‰“™“„‹S ƒ‡˜‚‡Œ‡!‰S“‹ƒ€ € ™ˆŽ„‘€‡ŽSs°Ž‘’€ ŽS‚ˆ&“Ž€€’€ ƒ‡ ƒ‹‡‚‡Ž‘ ƒ“‚‰“œŽ‡-ƒ‡ƒˆ‰€ƒ‹‡… € †‚‡Ž›‡-s“†‡œŽ‡… ƒ€-ƒ‹“’. I‡ ‰SŽŽ‘’ ‡‹“œ“ƒ‹Œ“ŽŽ‘› SŒ‹‡‚‡Œ sOA5 ˆ ‰“‹“… Œƒ‹‚“œS“‹ƒ€ ‡‹ 0,06 ‰‡ 2,3%, S ˜‡ ‰SŽŽ‘’ žS‚ˆ†“!Ž‘› SŒ‹‡‚‡Œ ‡‹ 0,2 ‰‡ 1,3 % [6, 12, 13].=€‚ˆ‚†€œ“ƒ„‡“ s“œ“Ž€“ Œ‚‡!‰“ŽŽ‘› ‰“™‡‚’S‘€… †‚ˆ‰Ž‡… „s“‹„€ ˆ ‰“‹“… €Œs€“‹ƒ€ ‡‰Ž‡… €ž ƒ“‚°#žŽ‘› € S„‹ˆSs°Ž‘› ˜‚‡†s“’ ‹‡‚S„Ss°Ž‡… ›€‚ˆ‚†€€ ‰“‹ƒ„‡-†‡ Œ‡ž‚Sƒ‹S. s ŽSƒ‹‡€%““ Œ‚“’€ ƒˆ%“ƒ‹Œˆ“‹ ’Ž‡!“ƒ‹Œ‡ ’“‹‡‰‡Œ ‹‡‚S„‡˜sSƒ‹€„€ Œ‚‡!‰“ŽŽ‘› ‰“™‡‚’S‘€… ˆ ‰“-‹“… [5, 7, 9]. •‡Œ“‚&“Žƒ‹Œ‡ŒSŽ€“ € &€‚‡„‡“ ŒŽ“‰‚“Ž€“ ’Ss‡€ŽŒSž€ŒŽ‘› € Œ‘ƒ‡„‡‹“›Ž‡s‡†€œŽ‘› ’“‹‡‰‡Œ ˜‚€ ›€‚ˆ‚†€œ“ƒ„‡’ s“œ“Ž€€ Œ‚‡!‰“ŽŽ‘› ‰“™‡‚’S‘€… †‚ˆ‰-Ž‡… „s“‹„€ €Œs€“‹ƒ€ &S†‡’ Œ˜“‚“‰ Œ "‹‡’ ŽS˜‚SŒs“Ž€€ [4, 8, 11, 14]. '‰ŽS„‡ S„‹ˆSs°Ž‘’€ € Ž“‚“&“ŽŽ‘’€ ‡ƒ‹S-µ‹ƒ€ Œ‡˜‚‡ƒ‘ ‡˜‹€’Ss°Ž‡… ‹S„‹€„€ s“œ“Ž€€ †‡s°Ž‘› Œ ‡‹Ž‡&“Ž€€ Œ‘†‡‚S ƒ˜‡ƒ‡†S ƒS’‡… ‹‡‚S„‡˜sSƒ‹€„€ ƒ˜‡ƒ‡†‡Œ ˆƒ‹SŽ‡Œ„€ „‡‚‚€†€‚ˆµ%€› €’˜sSŽ‹‡Œ € ™€„-ƒS‘€€ †‚ˆ‰€Ž‡-‚“†“‚Ž‡†‡ „‡’˜s“„ƒS [10, 13]. s €ƒƒs“-‰‡ŒSŽ€€› s.—. •‹Ss°’S›‡Œ€œS € ƒ‡SŒ‹. ‡‹’“œS“‹ƒ€, œ‹‡ ˜‚‡Œ“‰“Ž€“ ‹€‹SŽ‡Œ‡… ˜sSƒ‹€Ž‘ Œ žS†‚ˆ‰€ŽŽ‡’ ˜‚‡-ƒ‹‚SŽƒ‹Œ“ (žSŒ“‚&Sµ%€… "‹S˜ ‡˜“‚S‘€€) Œƒ“†‰S ˜‚‡€ƒ-›‡‰€‹ ƒ †‡s°&€’€ ‹“›Ž€œ“ƒ„€’€ ‹‚ˆ‰Ž‡ƒ‹€’€ [10]. ¾‹‡ ‡†?€ƒŽ€“‹ƒ€ ‹“’, œ‹‡ ƒ‹‚“’€ƒ° ˆsˆœ&€‹° „‡ƒ’“‹€œ“ƒ„€“ € „s€Ž€œ“ƒ„€“ ‚“žˆs°‹S‹‘ ›€‚ˆ‚†€œ“ƒ„‡†‡ s“œ“Ž€€, ›€-‚ˆ‚† ˆƒs‡!Ž€“‹ ƒ“†“ ‹“›Ž€œ“ƒ„ˆµ žS‰Sœˆ. I‡"‹‡’ˆ ‘“-s°µ ‰SŽŽ‡†‡ €ƒƒs“‰‡ŒSŽ€€ ˜‡ƒsˆ!€s€ SŽSs€ž ‚Sžs€œ-Ž‘› ˜‡‰›‡‰‡Œ € ‡˜‹€’€žS‘€€ ›€‚ˆ‚†€œ“ƒ„‡†‡ s“œ“Ž€€ sOA5 ƒ €ƒ˜‡s°ž‡ŒSŽ€“’ ’S‹“‚€Ss‡Œ €ž Ž€„“s€‰S ‹€‹SŽS ˜‚€ ‡˜“‚S‹€ŒŽ‡’ s“œ“Ž€€ Œ‡‚‡Ž„‡‡†‚SžŽ‡… †‚ˆ‰Ž‡… „s“‹„€.

Objective: One of the most important considerations in the care of thoracic surgery patients is the control of pain, which leads to increased morbidity and relevant mortality. Methods: Between February and May 2009, 60 patients undergoing full muscle-sparing posterior minithoracotomy were prospectivelyrandomized into two groups, according to the thoracotomy closure techniques. In the first group(group A), two holes were drilled into the sixth rib using a hand perforator, and sutures were passed through the holes in the sixth rib and were circled from the upper edge of the fifth rib, thereby compressing the intercostal nerve underneath the fifth rib. In the second group (group B), the intercostal muscle underneath the fifth rib was partially dissected along with the intercostal nerve, corresponding to the holes on the sixth rib. Two 1/0 polyglactin (Vicyrl) sutures were passed through the holes in the sixth rib and above the intercostal nerve.Results:There were 30 patients in each group. The visual analog score, observer verbal ranking scale (OVRS) scores for pain, and Ramsay sedation scores were used to follow-up on postoperative analgesia and sedation. The von Frey hair test was used to evaluate hyperalgesia of the patients. The patients in group B had lower visual analog scores at rest and during coughing. The patients in group B had lower OVRS scores than group A patients. The groups were not statistically differentin terms of the Ramsaysedation scores and von Frey hair tests.Conclusions:Thoracotomy closure bya techniquethat avoids intercostal nerve compression significantly decreases post-thoracotomy pain. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained.. From the radiographs, the most rotated vertebra, the Cobb angle, the apex and the type of the curve were determined. From the CT scans and 3D reconstructions, the exact level of the rib deformity measured was matched with the corresponding vertebral level. In this way, the most rotated vertebra and the most prominent part of the rib cage deformity were identified. The most rotated vertebra was found to be at the same level in both radiographs and CT scans in only five patients. In the rest of the patients, CT scans showed it either one level higher or lower than it appeared on the radiograph. The most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in two patients, and in the rest of the patients it was one, two or three vertebral levels lower. There was no association between the Cobb angle, vertebral rotation and rib deformity. A CT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level.

Bakgrund: Patientlag, SFS 2014:821, infördes den 1 januari, 2015, i syfte att tydliggöra och stärka patientens ställning samt främja patientens integritet, självbestämmande och delaktighet inom hälso- och sjukvård. Vårdgivarens informationsplikt utökades och förtydligades gentemot patienten, vilket innebär att informationen ska vara av en kvalitet som optimerar patientens förutsättningar att utöva sitt självbestämmande och vara delaktig i sin egen vård. Syfte: Att undersöka huruvida kapitel tre och fem i patientlag, SFS 2014:821, följs och tillämpas i den kliniska verksamheten med syfte att främja patientens delaktighet och självbestämmande. Metod: Sex patienter rekryterades från en toraxkirurgisk avdelning på ett universitetssjukhus i Sverige. Intervjudeltagarna var elektiva, thoraxkirurgiska patienter vars ingrepp utfördes med extrakorporeal cirkulation. Ett bekvämlighetsurval gjordes där urvalsgruppen innefattade en kvinna och fem män. Intervjuerna genomfördes kvalitativt och semistrukturerat, på kirurgavdelningen, 1-2 dagar innan utskrivning. Data analyserades genom kvalitativ innehållsanalys, enligt Hällberg-Graneheim och Lundman (2004). Resultat: Vårdgivaren tillger information på ett överskådligt, respektfullt och hänsynstagande sätt i syfte att främja patientdelaktiget, integritet och autonomi. Även uppföljningar i informationsflödet görs för att minska risken för missförstånd. Majoriteten deltagare är tillfredsställda med informationen de fått i samband med vårdtillfället. Deltagarna har upplevt minskad oro och ökad trygghet till följd av god information. Avdelningen anses följa patientlagens föreskrifter i detta avseende. Slutsats: Patientlag, (2014:821), följs och tillämpas på kirurgavdelningen där studien utförts. Det påvisas starkt från insamlad data att vårdpersonalen aktivt arbetar med att involvera patienter i vården. Detta genom att hålla patienten välinformerad och bjuda in till delaktighet. Background: The patient law, SFS 2014:821, was introduced in January the 1st of 2015, which has been developed to clarify and strengthen the position of patients and promote patient integrity, self-determination and participation in medical healthcare. The caregivers’ duty of giving information to the patients was clarified due to the introduction of the law. This means that the quality of the information should optimize the patient's ability to be self-determinated and involved in their care. Aim: To investigate whether chapter three and five in the patient law, SFS 2014:821, is followed and applied in the clinical practice with aim to promote patient involvement and self-determination. Method: Six patients were recruited from a thorax surgery ward at university hospital in Sweden. The participants were elective, thoracic surgical patients whose procedures were performed with extracorporeal circulation. A convenience sample was made where as the sample group included one woman and five men. The interviews were conducted qualitatively and semi- structured, on the surgical ward, 1-2 days before discharge. Data were analyzed by qualitative content analysis according to Hällberg-Graneheim & Lundman (2004). Findings: The caregiver provides information in a clear, respectful and considerate manner in purpose to promote patient participation, integrity and autonomy. Follow-ups were made to reduce the risk of misunderstandings. The majority of participants were satisfied with the information that was given during their care. They experienced reduced anxiety and increased sense of security due to good quality of information. The ward seems to follow regulations in regard to the new patient law. Conclusion: The patient law is followed in the surgical ward where the study was conducted. The collected data strongly indicated that the health staff was actively working to promote patients involvement in their health care. This by keeping the patient well informed and continuously invites patients to participate.

Bleomycin is an antibiotic agent that has anti-tumor efficiency. Dose limiting toxicity depends on pulmonary complications which can be diagnosed by clinical and radiological findings. Positron emission tomography/computed tomography screening is also useful for this purpose. We report an interstitial eosinophilic pneumonia case, diagnosed with Positron emission tomography/computed tomography and surgery, developing after bleomycin combination chemotherapy. © 2015, Anatolian Journal of Clinical Investigation. All rights reserved.

Background: The use of diaphragmatic pedicle flaps for reconstructive procedures in thoracic surgery is not very popular. Nevertheless, it provides considerable advantages. Methods: Our experience covers 10 years (1987-1997) with a total of 25 patients in whom the diaphragmatic flap was used for different purposes. In 6 patients we used the diaphragmatic flap to protect the bronchopleural fistula at its early onset, which was not beyond 12 hours from the clinical diagnosis. We performed prophylactic suture protection after neoadjuvant therapy in 9 high-risk patients who underwent pneumonectomy and in 2 who underwent sleeve lobectomy. Postpneumonectomy pericardial defect repair was performed in 4 patients. In another 4 patients the diaphragmatic flap was used after spontaneous (n = 2) and iatrogenic (n = 2) lesions of the esophagus after 24 to 72 hours. Results: No perioperative mortality was recorded. Complications were mainly related to the severe preoperative conditions of the patients: arrhythmia, respiratory insufficiency, and empyema. We report only 2 cases of minimal persistent bleeding from the chest tube, which spontaneously ceased. For those patients who survived for more than 1 year (n = 11), no diaphragmatic hernias were recorded. Bronchopleural fistulas and pericardial defects healed in all instances. The diaphragmatic flap was also effective in bronchopleural fistula. A late fistula caused by cancer relapse at the bronchial stump developed in only one patient. Excellent repair was achieved in all patients with esophageal lesions. Conclusions: We conclude that the diaphragmatic flap can be considered a practical, safe, and redundant material particularly indicated for defect or fistula closure and for suture line protection in the thoracic cavity. (J Thorac Cardiovasc Surg 1999;118:1084-9)

Background We retrospectively evaluated the invasive diagnostic techniques that were not suitable for transthoracic biopsy or bronchoscopy and the results of these techniques for advanced lung cancer cases. Methods The files of patients operated at the Department of Thoracic Surgery, Faculty of Medicine, Pamukkale University for advanced lung cancer (stages III and IV) between 2006 and 2010 were retrospectively reviewed for the analysis of definite diagnostic methods. Results The mean age of 59 patients who underwent invasive diagnostic techniques was 56.55 ± 9.42 years (32 to 75) and the female to male ratio was 1:4 (11 female:48 male). Mediastinoscopy was the most commonly used invasive technique with 20 patients (34%) while the second most common technique was video-assisted thoracoscopic surgery with 10 patients (17%). Thoracotomy was the most invasive diagnostic technique with four patients (6.5%). Conclusions Although it would be desirable to use noninvasive and minimally invasive diagnostic techniques in the diagnosis of lung cancers, we should not try to avoid using invasive diagnostic techniques in surgical practice in advanced lung cancers where other techniques may be inadequate. © 2014 Georg Thieme Verlag KG Stuttgart New York.

PURPOSE OF REVIEW: Advances in medical care have led to an increasing elderly population. Elderly individuals should be able to participate in society as long as possible. However, with an increasing age their adaptive capacity gradually decreases, specially before and after major life events (like hospitalization and surgery) making them vulnerable to reduced functioning and societal participation. Therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate. RECENT FINDINGS: There is high quality evidence that preoperative exercise in patients scheduled for cardiovascular surgery is well tolerated and effective. Moreover, there is circumstantial evidence suggesting preoperative exercise for thoracic, abdominal and major joint replacement surgery is effective, provided that this is offered to the high-risk patients. Postoperative exercise should be initiated as soon as possible after surgery according to fast-track or enhanced recovery after surgery principles. SUMMARY: The perioperative exercise training protocol known under the name 'Better in, Better out' could be implemented in clinical care for the vulnerable group of patients scheduled for major elective surgery who are at risk for prolonged hospitalization, complications and/or death. Future research should aim to include this at-risk group, evaluate perioperative high-intensity exercise interventions and conduct adequately powered trials. © 2014 Wolter Kluwer Health | Lippincott Williams & Wilkins.

Malignant pleural mesothelioma (MPM) is a relatively rare, but aggressive tumor that causes high mortality. The major risk factor involved in the etiology is environmental and occupational exposure to asbestos. The optimal modality of therapy is controversial. The present study retrospectively evaluated the data pertinent to 282 patients who were examined and treated in 11 different medical oncology centers in Turkey. There were 161 males (57.1 %) and 121 females (42.9 %), with a mean age of 56.38 ± 12.07 years. Surgery was used in 74 patients, 21 patients (28.4 %) received only chemotherapy and 28 patients (37.8 %) received chemoradiotherapy after surgery. The median survival in patients who were administered adjuvant therapy after surgery was 24 months, while the median survival in patients who had only surgery was 6 months (p = 0.029). 106 patients were administered pemetrexed-platinum combination and 35 patients were administered gemcitabine-platinum combination as front-line chemotherapy. Median survival, 1- and 2-year survival rates in patients who received platinum analogues and pemetrexed or gemcitabine combinations were found statistically similar (p = 0.15). The median survival for all patients with MPM in our study was 18 months. The main factors influencing the overall survival were stage of the disease (p = 0.020), performance status (p < 0.001), asbestos exposure (p = 0.030) and mesothelioma histological subtypes (p < 0.001). Results of our study suggest that multi-modality treatment regimens consisting of surgery, radiotherapy and chemotherapy prolong overall survival. Survival rates in patients who received combining platinum analogues with pemetrexed or gemcitabine as front-line chemotherapy were found similar. © 2012 Springer Science+Business Media, LLC.

Rationale: Accurate, early identification of patients at risk for developing acute lung injury (ALI) provides the opportunity to test and implement secondary prevention strategies. Objectives: To determine the frequency and outcome of ALI development in patients at risk and validate a lung injury prediction score (LIPS). Methods: In this prospective multicenter observational cohort study, predisposing conditions and risk modifiers predictive of ALI development were identified from routine clinical data available during initial evaluation. The discrimination of the model was assessed with area under receiver operating curve (AUC). The risk of death from ALI was determined after adjustment for severity of illness and predisposing conditions. Measurements and Main Results: Twenty-two hospitals enrolled 5,584 patients at risk All developed a median of 2 (interquartile range 1-4) days after initial evaluation in 377 (6.8%; 148 ALI-only, 229 adult respiratory distress syndrome) patients. The frequency of ALI varied according to predisposing conditions (from 3% in pancreatitis to 26% after smoke inhalation). LIPS discriminated patients who developed ALI from those who did not with an AUC of 0.80(95% confidence interval, 0.78-0.82). When adjusted for severity of illness and predisposing conditions, development of ALI increased the risk of in-hospital death (odds ratio, 4.1; 95% confidence interval, 2.9-5.7). Conclusions: ALI occurrence varies according to predisposing conditions and carries an independently poor prognosis. Using routinely available clinical data, LIPS identifies patients at high risk for ALI early in the course of their illness. This model will alert clinicians about the risk of ALI and facilitate testing and implementation of ALI prevention strategies. United States Department of Health & Human Services National Institutes of Health (NIH) - USA HL78743-01A1, 1 KL2 RR024151 Mayo Clinic Critical Care Research Committee Sanofi-Aventis Pfizer University of Missouri Vital Therapies Maquet Inc. Eli Lilly Artisan Pharma Allen Grice Ammons American Lung Association American College of Surgeons Vapotherm in industry United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Center for Advancing Translational Sciences (NCATS) United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Center for Research Resources (NCRR) - KL2RR024151 United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Heart Lung & Blood Institute (NHLBI) - K23HL087934 Walker