Robotic thymectomy: A surgical point of view

2021 ◽  

Robotic thymectomy is the most innovative surgical approach for treating disease of the anterior mediastinum. Robotic surgery offers low postoperative morbidity, faster recovery, shorter hospital stay, and better cosmetic results, without compromising surgical radicality. During the operation, the patient is placed in a supine position at the left edge of the operating table with the left hemithorax upward; the position is maintained with sandbags. The target area for the autodocking should be toward the jugulum. The first surgical step is to isolate the inferior thymic horns via the dissection that starts from the inferior portion of the mediastinal tissue and proceeds toward the right side, following the contralateral pleural reflection. Afterward, it is necessary to move toward the superior horns, following the phrenic nerve, the first landmark, to the innominate vein, our second landmark. Finally, we dissect the superior horns while searching for the thymic veins, which could appear atrophic, and clip the vessels to safely isolate the innominate vein. During this step, it is useful to use a retraction movement to progressively dissect the horns from the jugulum. The thymus gland is removed en bloc with the perithymus fat using an endoscopic bag inserted through the right port incision.

2021 ◽  
pp. 155335062110311
Author(s):  
Renxiang Jia ◽  
Shizhu Sun ◽  
Ziyi Wang ◽  
Yi Ren

The right-chest thoracoscopic surgery approach has become the preferred operation for the treatment of thymic disease. Due to the limited space in the anterior mediastinum, achieving en bloc resection of the tumor is a common difficulty. Here, we report a simple method to lift the sternum by single hook. This method has a lot of advantages, including providing a wide view of the anterior mediastinum for clear vision and being an easy operation.


1999 ◽  
Vol 2 (5) ◽  
pp. 454-463 ◽  
Author(s):  
Richard M. Conran ◽  
J. Thomas Stocker

Extralobar pulmonary sequestration (ELS) represents a mass of pulmonary parenchyma separate from the normal lung. The coexistence of congenital cystic adenomatoid malformation (CCAM) in ELS has been reported. To define this association, the clinical, gross, and histologic features of 50 ELS cases were analyzed. The age at diagnosis varied from birth to 65 years with 24% of cases diagnosed prenatally and 61% (23/38) diagnosed within the first 3 months of life. Fifty-two percent of cases were in females and 48% in males. Forty-eight percent of ELS(s) were located in the left hemithorax, 20% in the right hemithorax, 8% in the anterior mediastinum, 6% in the posterior mediastinum, and 18% beneath the diaphragm. The blood supply to the sequestration in 77% of cases was directly from the aorta. Grossly, the lung, though hypoplastic in some cases, was otherwise unremarkable. Fifty percent (23/46) of ELS cases were associated with a coexistent CCAM. In contrast to the series as a whole, 92% (11/12) of the ELS/CCAM cases, excluding those prenatally diagnosed, were diagnosed within the first 3 months and 57% occurred in females. ELS/CCAM lesions, while randomly distributed, were more frequently seen on the left side. Gross features of the ELS/CCAM cases were similar to those cases with ELS alone. All CCAM cases had a type 2 pattern on histologic examination with 48% of those cases also displaying rhabdomyomatous dysgenesis. Our findings indicate that the occurrence of CCAM in ELS is more frequent than reported in the literature and differs in presentation from ELS cases not associated with CCAM.


2018 ◽  
Vol 3 (5) ◽  
pp. 39
Author(s):  
Yéssica Elizabeth Barreto Macías ◽  
Colón Avellán Velásquez

El actual trabajo afronta una de las problemáticas más apremiantes de los actuales momentos como es el alto índice de dispendio de drogas en las Instituciones Educativas, que afectan considerablemente a la sociedad ecuatoriana. Su objetivo es analizar los lineamientos que permitan mejorar la orientación familiar, y desarrollar relaciones interpersonales apropiadas que fomenten la unión familiar, practicar principios, fomentar valores morales, y que los jóvenes aprendan a decir “no” ante una eventual propuesta de consumir compuestos prohibidos, que lo único que se consigue es materializarse en un estado no idóneo ante la comunidad, considerar que las consecuencias para la salud son devastadoras, personas que a temprana edad padecen de enfermedades que en muchas ocasiones son gravísimas, causando malestar no solamente propio sino a la familia. Puedo mencionar como aporte de este artículo; y en base a resultados establecidos que resulta primordial e importante mantener la asistencia de un profesional especializado en psicología, diálogos científicos y motivadores, conjuntamente con atención médica provocarán en la persona afectada la erradicación del consumo de drogas. Constan muchos factores que causan gran influencia negativa en las familias, partiendo de que actualmente el mundo vive la tendencia del consumismo lo que influye en sobremanera que exista menos dialogo en el hogar, la aparición de la tecnología es otra de las situaciones adversas. Los profesionales encargados de brindar orientación familiar deben considerar siempre, que el comportamiento del ser humano debe ser comprendido desde el punto de vista de su forma de pensar, solo así se desarrollara una cultura que permita a las familias tomar las decisiones acertadas al momento de formar a sus hijos, lo que en un futuro se evidenciará como seres útiles a la sociedad. PALABRAS CLAVE: Consumo de drogas; orientación familiar; valores morales.  FAMILY COUNSELING, FOR THE PREVENTION OF DRUG USE IN THIRDYEAR HIGH SCHOOL STUDENTS  ABSTRACT  The current work addresses one of the most pressing issues of current times such as the high rate of drug use in educational institutions, which greatly affect Ecuadorian society. Its objective is to analyze the guidelines for improving family orientation, and develop appropriate interpersonal relationships that promote family unity, value the principles, and that young people learn to say "no" to a possible proposal to use prohibited drugs, that the only thing that is achieved is to materialize in an unsuitable state before the community, to consider that the consequences for health are devastating, people who at an early age suffer from diseases that in many occasions are very serious, causing discomfort not only their own but also the family. I can mention as contribution of this article; and based on established results that it is essential and important to maintain the assistance of a professional specialized in psychology, scientific and motivational dialogues, together with medical care, will cause the affected person to eradicate drug use. There are many factors that cause great negative influence on families, based on the fact that the world currently lives the trend of consumerism which greatly influences that there is less dialogue at home, the emergence of technology is another of the adverse situations. The professionals responsible for providing family counseling should always consider that the behavior of the human being should be understood from the point of view of their way of thinking, only in this way will a culture be developed that allows families to make the right decisions when forming to their children, which in the future will be evident as useful beings to society. KEYWORDS: drug use; family orientation; moral values.


2019 ◽  
Vol 28 (04) ◽  
pp. 708-724
Author(s):  
ANDREA LAVAZZA ◽  
VITTORIO A. SIRONI

Abstract:The microbiome is proving to be increasingly important for human brain functioning. A series of recent studies have shown that the microbiome influences the central nervous system in various ways, and consequently acts on the psychological well-being of the individual by mediating, among others, the reactions of stress and anxiety. From a specifically neuroethical point of view, according to some scholars, the particular composition of the microbiome—qua microbial community—can have consequences on the traditional idea of human individuality. Another neuroethical aspect concerns the reception of this new knowledge in relation to clinical applications. In fact, attention to the balance of the microbiome—which includes eating behavior, the use of psychobiotics and, in the treatment of certain diseases, the use of fecal microbiota transplantation—may be limited or even prevented by a biased negative attitude. This attitude derives from a prejudice related to everything that has to do with the organic processing of food and, in general, with the human stomach and intestine: the latter have traditionally been regarded as low, dirty, contaminated and opposed to what belongs to the mind and the brain. This biased attitude can lead one to fail to adequately consider the new anthropological conceptions related to the microbiome, resulting in a state of health, both physical and psychological, inferior to what one might have by paying the right attention to the knowledge available today. Shifting from the ubiquitous high-low metaphor (which is synonymous with superior-inferior) to an inside-outside metaphor can thus be a neuroethical strategy to achieve a new and unbiased reception of the discoveries related to the microbiome.


2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Persona Paolo ◽  
Valeri Ilaria ◽  
Zarantonello Francesco ◽  
Forin Edoardo ◽  
Sella Nicolò ◽  
...  

Abstract Background During COVID-19 pandemic, optimization of the diagnostic resources is essential. Lung Ultrasound (LUS) is a rapid, easy-to-perform, low cost tool which allows bedside investigation of patients with COVID-19 pneumonia. We aimed to investigate the typical ultrasound patterns of COVID-19 pneumonia and their evolution at different stages of the disease. Methods We performed LUS in twenty-eight consecutive COVID-19 patients at both admission to and discharge from one of the Padua University Hospital Intensive Care Units (ICU). LUS was performed using a low frequency probe on six different areas per each hemithorax. A specific pattern for each area was assigned, depending on the prevalence of A-lines (A), non-coalescent B-lines (B1), coalescent B-lines (B2), consolidations (C). A LUS score (LUSS) was calculated after assigning to each area a defined pattern. Results Out of 28 patients, 18 survived, were stabilized and then referred to other units. The prevalence of C pattern was 58.9% on admission and 61.3% at discharge. Type B2 (19.3%) and B1 (6.5%) patterns were found in 25.8% of the videos recorded on admission and 27.1% (17.3% B2; 9.8% B1) on discharge. The A pattern was prevalent in the anterosuperior regions and was present in 15.2% of videos on admission and 11.6% at discharge. The median LUSS on admission was 27.5 [21–32.25], while on discharge was 31 [17.5–32.75] and 30.5 [27–32.75] in respectively survived and non-survived patients. On admission the median LUSS was equally distributed on the right hemithorax (13; 10.75–16) and the left hemithorax (15; 10.75–17). Conclusions LUS collected in COVID-19 patients with acute respiratory failure at ICU admission and discharge appears to be characterized by predominantly lateral and posterior non-translobar C pattern and B2 pattern. The calculated LUSS remained elevated at discharge without significant difference from admission in both groups of survived and non-survived patients.


2003 ◽  
Vol 34 (3) ◽  
pp. 516-526 ◽  
Author(s):  
Yuji Takano

Since the emergence of Kayne's (1994) stimulating proposal for an antisymmetric theory of phrase structure and linear order, much work has been devoted to arguing for or against his theory as well as discussing its empirical predictions. As a result, for a number of phenomena involving rightward positioning, such as rightward adjuncts, heavy NP shift, extraposition, postverbal subjects, and postverbal constituents in OV languages, there now exist both an approach consistent with Kayne's theory (the antisymmetric approach) and another not consistent with it (the symmetric approach). In such a situation, it is often difficult to show on empirical grounds that one approach is superior to the other (see Rochemont and Culicover 1997). In what follows, I describe this situation with respect to two well-known phenomena in English: rightward positioning of adjuncts and heavy NP shift. For each of these phenomena, the symmetric and antisymmetric approaches have been proposed, and both approaches can correctly account for the data discussed in previous studies. Here, I examine the approaches from a novel point of view, showing that data involving the licensing of negative polarity items allow us to differentiate them and to decide which is the right one for each of the two empirical domains. Interestingly, the relevant facts lead to different conclusions for the two phenomena. The results have important implications for the antisymmetric view of syntax.


Development ◽  
1991 ◽  
Vol 111 (2) ◽  
pp. 337-356
Author(s):  
X.B. Shi ◽  
Z.I. Qiu ◽  
W. He ◽  
J. Frankel

Stylonychia mytilus is a dorsoventrally flattened ciliate with compound ciliary structures arranged in a specific manner on the cell surface. In mirror-image (MI) doublets of this ciliate, two nearly complete sets of ciliary structures are arrayed side-by-side, one in a normal or ‘right-handed’ (RH) arrangement, the other in a reversed or ‘left-handed’ (LH) arrangement. MI-doublets exist in two forms, one with the RH component on the right, the LH component on the left, and feeding structures near the center (‘buccal-adjoining MI-doublet’); the other with the RH component on the left, the LH component on the right, and feeding structures on the lateral edges (‘buccal-opposing MI-doublet’). We describe an operation that can generate either type of MI-doublet. This operation interchanges large anterior and posterior regions of the cell, transposing the original posterior region anteriorly (P—A) and the original anterior region posteriorly (A—P), while retaining the original anteroposterior polarity of each region. Two sets of new ciliary structures then are formed in mirror-image arrangement, with the set in the P—A region oriented normally and the set in the A—P region undergoing a reversal of polarity along its anteroposterior axis. This sometimes creates end-to-end MI forms, but more commonly produces side-by-side MI-doublets through a folding together of the P—A and A—P regions. This folding occurs because one lateral edge of the cell had been removed during the operation; if the left edge was removed, the complex folds to the left and forms a buccal-adjoining MI-doublet, whereas if the right edge was removed, the complex folds to the right and forms a buccal-opposing MI-doublet. Both types can reorganize and later divide true-to-type, although the ‘buccal-opposing’ type is by far the more stable of the two. The generation of mirror-image forms is dependent on the prior abnormal juxtaposition of regions from opposite ends of the cell, and involves a coordinated respecification of large-scale organization. We interpret this response to be a consequence of intercalation of missing intervening positional values in the zone of posterior-anterior abutment.


Author(s):  
Michał Bartoszewicz

The article deals with standards of professional preparation of doctors in the scope of speaking and writing Polish. The thesis of the article is that this requirement is one of the elements of professional preparation which is not limited to knowledge but includes specific skills. Defining the threshold of minimum linguistic competence is a subtle matter. The study draws attention to the necessity of pragmatic approach to these requirements to the extent necessary to practice as a doctor or dentist. From the point of view of the doctor’s rights, a lot depends on the procedure of verifying the command of Polish language. Therefore, attention was paid to the jurisprudence of administrative courts in this area.


Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Atsuko Kato ◽  
Christian Drolet ◽  
Shi-Joon Yoo ◽  
Andrew Redington ◽  
Lars Grosse-Wortmann

Introduction: The left pulmonary artery (LPA) contributes more than the right (RPA) to total pulmonary regurgitation (PR) in patients after tetralogy of Fallot (TOF) repair, but the mechanism of this difference is not well known. We hypothesized that unilaterally increased pulmonary vascular resistance (PVR), resulting from lung compression by the enlarged and levorotated heart leads to greater PR in the LPA. This study aimed to analyze the interplay between heart and lung size, mediastinal geometry, and differential PR. Methods: This is a single-center retrospective analysis of 50 magnetic resonance studies in patients after TOF repair. Patients with more than mild discrete branch pulmonary artery stenosis were excluded. Blood flow was measured by phase-contrast velocity encoding within the branch pulmonary arteries. On the axial image with the largest total cardiac surface area, cardiac angle (α) between the thoracic anterior-posterior line and the interventricular septum, right and left lung areas as well as right and left hemithorax areas were measured (Figure). Results: There was no difference in LPA and RPA diameters. The LPA showed significantly less total forward flow (p=0.04), smaller net forward flow (p=<0.001), and greater RF (p=0.001) than the RPA. Left lung area was smaller than the right (p<0.001). RVEDVi correlated with LPA RF (R=0.48, p<0.001), but not with RPA RF. Larger RVEDVi correlated with a larger α angle (R=0.46, p<0.001), i.e. a more leftward cardiac axis and with smaller left lung area (R=-0.58, p<0.001). LPA RF, but not RPA RF, correlated inversely with left lung area indexed to the left hemithorax area (R=-0.34, p=0.02). Conclusions: An enlarged and levorotated heart - as a result of PR - is associated with smaller left lung size, and augments diastolic flow reversal in the LPA, presumably via increased left PVR. By imposing a further volume load on the RV, LPA regurgitation may thus close a positive feed-back loop of PR and RV dilatation.


1851 ◽  
Vol 2 ◽  
pp. 13
Author(s):  
James Dalmahoy
Keyword(s):  

The instrument described in the paper is made of German silver, and is about a foot in length, andof an inch in breadth; along the middle of it there is a groove for a slider. On the right edge of the groove is engraved a scale of inches, and on the left the degrees of temperature from 0° to 85° Fahrenheit, each being placed exactly opposite that point of the scale of inches which measures the corresponding tension of vapour. On the left edge of the slider is engraved a scale of equal parts, eachof an inch; on the right edge, and having the same zero, is a vernier, applicable to the scale of inches. The lines on these scales are ten times larger than those which the symbols in the dew-point formula represent, but their numerical designations are not changed.


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