scholarly journals Emergency Peri-operative Management of Ruptured Humongous Lung Abscess: A combined effort makes the difference

2021 ◽  
Author(s):  
Khalid Siddiqui ◽  
Akbar Mistry ◽  
Muhammad Saad Yousuf
Keyword(s):  
Operating Room ◽  
Lung Resection ◽  
Operative Management ◽  
Lung Abscess ◽  
Unique Case ◽  
Video Assisted ◽  
The Difference ◽  
Case Based

We are presenting a unique case, based on peri-operative management of a patient who was brought to the operating room for video-assisted thoracoscopy (VATS) for lung abscess decortication end up with right upper lobe of lung resection via thoracotomy in an emergency.

Comparison of two air sampling methods to monitor operating room air quality and assessment of air quality in two operating rooms with different ventilation systems in the national hospital of Sri Lanka

2016 ◽  
Vol 12 (3) ◽  
Author(s):  
Tshokey Tshokey ◽  
Pranitha Somaratne ◽  
Suneth Agampodi
Keyword(s):  
Air Quality ◽  
Sri Lanka ◽  
Operating Room ◽  
Ventilation System ◽  
Surgical Site Infections ◽  
National Hospital ◽  
Air Contamination ◽  
Acceptable Method ◽  
The Difference ◽  
Laminar Air Flow

Air contamination in the operating room (OR) is an important contributor for surgical site infections. Air quality should be assessed during microbiological commissioning of new ORs and as required thereafter. Despite many modern methods of sampling air, developing countries mostly depended on conventional methods. This was studied in two ORs of the National Hospital of Sri Lanka (NHSL) with different ventilation system; a conventional ventilation (CV) and a laminar air flow (LAF). Both ORs were sampled simultaneously by two different methods, the settle plate and sampler when empty and during use for a defined time period. Laboratory work was done in the Medical Research Institute. The two methods of sampling showed moderate but highly significant correlation. The OR with CV was significantly more contaminated than LAF when empty as well as during use by both methods. Overall, the difference in contamination was more significant when sampled by the sampler. Differences in contamination in empty and in-use ORs were significant in both ORs, but significance is less in LAF rooms. The consistent and significant correlation between settle plate and sampler showed that the settle plate is an acceptable method. The LAF theatre showed less contamination while empty and during use as expected. Air contamination differences were more significant when sampled with sampler indicating that it is a more sensitive method. Both CV and LAF ORs of the NHSL did not meet the contamination standards for empty theatres but met the standards for in-use indicating that the theatre etiquette was acceptable.

scholarly journals Case-based learning in integrated management of neonatal and childhood illness

2019 ◽  
Vol 6 (3) ◽  
pp. 1163
Author(s):  
Sundaram Kartikeyan ◽  
Aniruddha A. Malgaonkar
Keyword(s):  
Gender Differences ◽  
Test Scores ◽  
Test Score ◽  
Integrated Management ◽  
Childhood Illness ◽  
Cognitive Domain ◽  
Post Test ◽  
Case Based Learning ◽  
The Difference ◽  
Case Based

Background: This complete-enumeration, before-and-after type of study (without controls) was conducted on 61 third-year medical students at Rajiv Gandhi Medical College, Thane, Maharashtra state to study the difference in cognitive domain scores after attending lecture-based learning (by a pre-test) and after attending case-based learning (by a post-test).Methods: After approval from the institutional ethics committee, the purpose of the study was explained to third-year medical students and written informed consent was obtained. After curriculum-based lectures on integrated management of neonatal and childhood Illness, a pre-test was administered wherein each student was asked to fill up case sheets for five case scenarios. The maximum marks obtainable were 10 marks per case (total 50 marks).  Case-based learning was conducted in two sub-groups comprising 31 and 30 randomly assigned students by the same faculty and students in each sub-group were exposed to identical case scenarios. The post-test was conducted using case scenarios and case sheets that were identical to that of the pre-test.Results: The overall mean score increased and the difference between the case-wise pre-test and post-test scores of both female (n=35) and male (n=26) students was highly significant (p <0.00001). However, the gender differences in pre-test score (Z=1.038; p=0.299) and post-test score were not significant (Z=0.114; p=0.909).Conclusions: Using case scenarios augmented the cognitive domain scores of participating students and the gender differences in scores were not statistically significant. The post-test scores showed higher variability. Remedial educational interventions would be required for students who obtained low scores in the post-test.

Acute vertigo in the ENT emergency

2021 ◽  
Vol 70 (3) ◽  
pp. 146-155
Author(s):  
Václav Albrecht ◽  
Lukáš Školoudík ◽  
Peter Sila ◽  
Jan Mejzlík ◽  
Michal Janouch ◽  
...  
Keyword(s):  
Emergency Department ◽  
Vestibular Function ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Video Assisted ◽  
Vestibular Testing ◽  
Group A ◽  
The Difference ◽  
Group B

Summary Introduction: Acute vertigo ranks among the common reasons for visiting the emergency department. The aim of this study was to evaluate the rate of peripheral vestibular syndrome (PVS) in patients with acute vertigo examined at the ENT emergency department and to compare the agreement of physical ENT examination with video-assisted vestibular testing. Methods: Patients eamined at the ENT emergency department from January to December 2019 were evaluated retrospectively. The patients who underwent basic ENT examination without video-assisted vestibular testing form group A. The patients who underwent basic ENT examination which was followed by video head impulse test (vHIT) and videonystagmography in the next four days form group B. Results: A total of 117 patients with acute vertigo were included in group A, PVS was found in 31 patients (27%). In total, 50 patients were included in group B; PVS was found in 15 patients (30%), vestibular neuronitis was dia­gnosed most often (10 patients). The difference in the dia­gnosis of PVS by basic ENT examination (27 patients, 54%) and by video-assisted vestibular testing (15 patients, 30%) was statistically significant (P = 0.0030). The gain of the lateral (P = 0.0101) and superior (P = 0.0043) semicircular canal proved to be statistically significant, while vHIT was lower in PVS in comparison to other causes of vertigo. Conclusion: After basic ENT examination, PVS as a cause of acute vertigo was dia­gnosed in 27%. Video-assisted vestibular testing proved a statistically significant lower incidence of PVS in comparison to basic ENT examination. Accessibility of video- -assisted vestibular testing in the emergency department might allow for higher accuracy in the dia­gnosis of acute vertigo. Key words acute vertigo – vestibular function tests – video head impulse test – videonystagmography

Analysis of conversion to thoracotomy during thoracoscopic lung resection

2019 ◽  
Vol 27 (5) ◽  
pp. 381-387 ◽  
Author(s):  
Katsunari Matsuoka ◽  
Tetsu Yamada ◽  
Takahisa Matsuoka ◽  
Shinjiro Nagai ◽  
Mitsuhiro Ueda ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Thoracoscopic Surgery ◽  
Clinical Stage ◽  
Lung Resection ◽  
Open Thoracotomy ◽  
Advanced Clinical Stage ◽  
Video Assisted ◽  
Surgery Group ◽  
Intraoperative Conversion ◽  
Video Assisted Thoracoscopic Surgery

Background Video-assisted thoracoscopic surgery has been widely adopted. However, conversion to open thoracotomy is still necessary when intraoperative complications are encountered. Methods Between January 2009 and December 2014, 1566 patients underwent anatomical lung resection for lung cancer using video-assisted thoracoscopic surgery at our institution. Among these patients, 39 required conversion to open thoracotomy. We retrospectively examined the current status of conversion to thoracotomy during video-assisted thoracoscopic surgery in a single city hospital. Data were compared with those of 89 patients undergoing a scheduled thoracotomy. Results The main reason for conversion was the need for angioplasty for pulmonary artery invasion by silicotic lymph nodes (12 cases), and metastatic lymph nodes or tumors (9 cases). Univariate analysis demonstrated that the risk factors for conversion were male sex, smoking habit, induction therapy, large tumor size, and advanced stage. Multivariate analysis showed that advanced clinical stage was the only significant predictor of intraoperative conversion. Compared to the video-assisted thoracoscopic surgery group, mortality and morbidity in the conversion group were significantly higher, but there was no significant difference in mortality or morbidity between the conversion and scheduled thoracotomy groups. The conversion group showed a significantly higher rate of lethal acute exacerbation of interstitial pneumonitis than the video-assisted thoracoscopic surgery group. Conclusion The main reason for conversion was angioplasty, and advanced clinical stage was a significant predictor of intraoperative conversion. Conversion was safely performed but postoperative complications, although similar in frequency to scheduled thoracotomy cases, were more frequent than those in thoracoscopic surgery cases.

scholarly journals Osteochondral Defects in Hallux Rigidus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0019
Author(s):  
David Ciufo ◽  
Michelle Lawson ◽  
Benjamin Strong ◽  
Benedict DiGiovanni
Keyword(s):  
Outcome Measures ◽  
Demographic Data ◽  
Age Groups ◽  
Operative Management ◽  
Hallux Rigidus ◽  
Entire Cohort ◽  
Sf 36 ◽  
The Difference ◽  
Component Scores

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus, or 1st metatarsophalangeal (MTP) joint degeneration, is commonly encountered in foot and ankle practice. Operative management can include a dorsal cheilectomy, a motion sparing procedure to reduce impingement. Hallux rigidus affects patients across all age groups, and etiologies may include trauma, first ray hypermobility, pes planus, or hallux valgus. First MTP joint trauma may result in an osteochondral defect (OCD). Literature is sparse regarding OCD management in the 1st MTPJ, as is follow-up data on cheilectomy using validated outcome measures. We hypothesize that the presence of an OCD is associated with symptomatic hallux rigidus at a lower Coughlin and Shurnas grade. We also hypothesize that OCD treatment concurrent with cheilectomy leads to outcomes equivalent to patients treated with isolated hallux rigidus. Methods: A retrospective review of prospectively collected data was performed. All patients of a single surgeon were reviewed based on the CPT code (28289) for cheilectomy from 1/1/2011 to 12/31/2015. Demographic data, presence/drilling of an OCD on operative reports, and Coughlin grading were recorded. All patients had taken the FAAM and SF-36 preoperatively per the surgeon’s routine preoperative data collection. After approval by the institutional review board, all patients were contacted by telephone for follow-up and answered the FAAM, SF-36 and Patient Acceptable Symptom State (PASS) questionnaires. Visual analog scores (VAS), patient satisfaction, complications, and whether they would opt for surgery again were recorded.Paired T-tests were performed to evaluate improvement in FAAM activity of daily living (ADL), FAAM sport, SF-36 physical component scores (PCS), and SF-36 mental component scores (MCS). Two-tailed T-tests were performed to evaluate the difference in groups with and without OCDs. Results: Seventy-one patients met inclusion criteria. Follow-up was obtained from 28 patients (29 feet) for analysis, 10 with OCDs. Mean responder age was 53.1 years (32.6-70.9), with average 4 year follow-up (minimum 2 years). Patients with OCDs had lower Coughlin grade (p<0.01) and trended towards lower age (p=0.07), but similar improvement in FAAM sport (p=0.43), SF-36 PCS (p=0.33), and MCS (p=0.46). Patients with OCDs trended towards greater improvement in FAAM ADL (p=0.07). The entire cohort demonstrated significant improvements (p<0.01) in ADL, Sport, PCS, and MCS after cheilectomy. ADL and Sport scores met the MCID of 8 and 9 points, respectively. MCID is not well-defined for SF-36. One patient required subsequent fusion. Conclusion: Cheilectomy is an effective surgical option for improving function and pain in the setting of hallux rigidus, as measured at intermediate-term follow-up with validated patient outcome measures. Patients with a 1st MTP joint OCD become symptomatic at a younger age and with a lower radiographic grade of hallux rigidus. These patients demonstrate equivalent improvements in the FAAM sport, SF-36 PCS and MCS while trending towards greater improvement in the FAAM ADL score as those without OCDs. The presence and treatment of a 1st MTP joint OCD should be considered in younger patients with symptomatic hallux rigidus and lower radiographic severity.

scholarly journals Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Benoît Bédat ◽  
Etienne Abdelnour-Berchtold ◽  
Thomas Perneger ◽  
Marc-Joseph Licker ◽  
Alexandra Stefani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Thoracic Surgery ◽  
Benign Lesion ◽  
Lung Resection ◽  
Primary Lung Cancer ◽  
Forced Expiratory Volume ◽  
University Hospitals ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted

Abstract Background Compared to lobectomy by video-assisted thoracic surgery (VATS), segmentectomy by VATS has a potential higher risk of postoperative atelectasis and air leakage. We compared postoperative complications between these two procedures, and analyzed their risk factors. Methods We reviewed the records of all patients who underwent anatomical pulmonary resections by VATS from January 2014 to March 2018 in two Swiss university hospitals. All complications were reported. A logistic regression model was used to compare the risks of complications for the two interventions. Adjustment for patient characteristics was performed using a propensity score, and by including risk factors separately. Results Among 690 patients reviewed, the major indication for lung resection was primary lung cancer (86.4%) followed by metastasis resection (5.8%), benign lesion (3.9%), infection (3.2%) and emphysema (0.7%). Postoperatively, there were 80 instances (33.3%) of complications in 240 segmentectomies, and 171 instances (38.0%) of complications in 450 lobectomies (P = 0.73). After adjustment for the patient’s propensity to be treated by segmentectomy rather than lobectomy, the risks of a complication remained comparable for the two techniques (odds ratio for segmentectomy 0.91 (0.61–1.30), p = 0.59). Length of hospital stay and drainage duration were shorter after segmentectomy. On multivariate analysis, an American Society of Anesthesiologists score above 2 and a forced expiratory volume in one second below 80% of predicted value were significantly associated with the occurrence of complications. Conclusions The rate of complications and their grade were similar between segmentectomy and lobectomy by VATS.

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