scholarly journals Surgical Challenges of Chronic Empyema and Bronchopleural Fistula

2021 ◽  
Author(s):  
Yu-Hui Yang
Keyword(s):  
System Application ◽  
Standard Procedure ◽  
Lung Resection ◽  
Treatment Options ◽  
Bronchopleural Fistula ◽  
Surgical Approaches ◽  
Closure System ◽  
Chronic Empyema ◽  
Modality Approach ◽  
Single Modality

Chronic empyema has always been a clinical challenge for physicians. There is no standard procedure or treatment to deal with the situation, and multi-modality approach is often necessary. Surgical intervention plays a very crucial role in the treatment of chronic empyema. Since bronchopleural fistula is often seen in chronic empyema patients, therefore it should also be mentioned. In this chapter, the focus will be on the different treatment options, various surgical approaches, and the rationale behind every single modality. Certain specific entity will be included as well, such as tuberculosis infection, post lung resection empyema, and intrathoracic vacuum assisted closure system application. Even with the advancement of technology and techniques, chronic empyema management is still evolving, and we look forward to less traumatic ways of approach with better outcome in the future.

scholarly journals Treatment Optimization of Post-pneumonectomy Pleural Empyema

Folia Medica ◽  
2019 ◽  
Vol 61 (4) ◽  
pp. 500-505
Author(s):  
Danail B. Petrov ◽  
Dragan Subotic ◽  
Georgi S. Yankov ◽  
Dinko G. Valev ◽  
Evgeni V. Mekov
Keyword(s):  
Hospital Volume ◽  
Lung Resection ◽  
Treatment Options ◽  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Definitive Treatment ◽  
High Morbidity ◽  
Treatment Optimization ◽  
Antibiotic Solution ◽  
The Individual

Introduction: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Despite various therapeutic options developed during the last five decades it remains a major surgical challenge. Results: There is no widely accepted treatment for post-pneumonectomy pleural empyema (PPE) and the management depends mostly on the presence or absence of broncho-pleural fistula (BPF) and the patient’s general condition. In the absence of BPF, the role of surgery is still not clear because of its high morbidity and impossibility to prevent recurrences. In the earlier period, the definitive treatment consisted of open window thoracostomy followed by obliteration of the pleural cavity with antibiotic solution at the time of chest wall closure. Subsequently, the proposed different methods and modifications improved the outcome. There is an association between hospital volume and operative mortality after the lung resection. Hospital volume and the surgeon’s specialty have more influence on the outcome than the individual surgeon’s volume.Conclusions: Treatment management of PPE should be individualized. Definitive treatment options comprise aggressive surgery that is not possible in quite a high proportion of impaired patients. Hospital volume, surgeon’s volume and surgeon’s specialty may influence the prognosis.

scholarly journals The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Jin-Jiao Li ◽  
Jacqueline P. W. Chung ◽  
Sha Wang ◽  
Tin-Chiu Li ◽  
Hua Duan
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Management Strategies ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Child Bearing ◽  
Fertility Sparing

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.

Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S32-S41 ◽  
Author(s):  
Patrick P. Youssef ◽  
Albert Jess Schuette ◽  
C. Michael Cawley ◽  
Daniel L. Barrow
Keyword(s):  
Treatment Options ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Surgical Approaches ◽  
Dural Sinus ◽  
Intraoperative Angiography ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

JEH Roberts (1881–1948): Pioneer thoracic surgeon

2021 ◽  
pp. 096777201456556
Author(s):  
Raymond Hurt
Keyword(s):  
Lung Resection ◽  
Complete Recovery ◽  
First World War ◽  
Second World War ◽  
World War ◽  
X Ray ◽  
Chronic Empyema ◽  
Pressure Suction ◽  
Second World ◽  
First World

JEH Roberts was a leading figure in the new specialty of thoracic surgery before Second World War. His interest in this branch of surgery began during First World War when he served as a Major in a casualty clearing station and operated under local anaesthesia and without X-ray facilities. He reported a series of 199 cases of severe chest injury in which operation had been carried out in 67 patients – of whom 34 had made a complete recovery, a remarkable achievement in 1917. He was the first to use negative pressure suction drainage of the chest to encourage full expansion of the lung after thoracotomy, and he developed a plastic operation on the chest wall to treat chronic empyema. Together with HP Nelson, he described one-stage lobectomy for lung resection and developed a new lung tourniquet for use during this operation.

scholarly journals A proposal for a postoperative protocol for the early diagnosis of bronchopleural fistula after lung resection surgery

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Luca Bertolaccini ◽  
Elena Prisciandaro ◽  
Juliana Guarize ◽  
Lorenzo Spaggiari
Keyword(s):  
Early Diagnosis ◽  
Lung Resection ◽  
Bronchopleural Fistula

scholarly journals Glans Resurfacing in Carcinoma in situ of the Penis: A Case Report

2020 ◽  
pp. 1-5
Author(s):  
Raquel Catarino ◽  
André Cardoso ◽  
Carlos Ferreira ◽  
Diogo Pereira ◽  
Tiago Correia ◽  
...  
Keyword(s):  
Case Report ◽  
Carcinoma In Situ ◽  
Penile Cancer ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Disease Recurrence ◽  
Premalignant Lesions ◽  
Surgical Approaches ◽  
Aesthetic Result

Aims: Penile cancer is an uncommon malignancy in Western countries. There are known premalignant lesions that can progress to invasive penile cancer, namely carcinoma in situ (CIS) of the glans. Treatment options for this disease include topical chemotherapy and laser ablation, but the published literature demonstrates limited efficacy for these approaches. Surgical techniques with penile-preserving approaches are performed with the goal of removing the entire tumor and preserving as much of penis as possible. There are no large, randomized studies comparing treatment options for these lesions, and reports concerning the surgical approaches are scarce. Presentation of Case: In this study, we present a case report of a patient with CIS of the glans penis surgically treated with glans resurfacing. Discussion and Conclusions: There were no complications during follow-up, and after 20 months, the patient has no evidence of disease recurrence, has preserved urinary and erectile functions and is currently satisfied with the cosmetic appearance. CIS treatment with glans resurfacing allows the maintenance penile length and function with a good aesthetic result without compromising oncologic control. This approach also allows an accurate staging of the disease and assessment of the treatment efficacy.

scholarly journals Genetic characterization of colorectal cancer using a next generation sequencing approach to identify a specific pattern of somatic alterations in tumors arising from different anatomic sites

2016 ◽  
Author(s):  
Carmelo Laudanna ◽  
Gianluca Santamaria ◽  
Simona Migliozzi ◽  
Duarte Mendes Oliveira ◽  
Donatella Malanga ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Copy Number ◽  
Treatment Options ◽  
Copy Number Variations ◽  
Specific Pattern ◽  
Surgical Approaches ◽  
Anatomical Location ◽  
Molecular Alterations ◽  
Somatic Alterations ◽  
Novel Biomarkers

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths worldwide, with nearly 1.4 million new cases diagnosed in 2012. CRC results from the accumulation of multiple genetic and epigenetic aberrations. Tumor localization in the large intestine tract determines different surgical approaches and treatment options. Considering the heterogeneous nature of these tumors we hypothesized that different patterns of molecular alterations could be associated with a specific anatomical location. To identify distinct genomic alterations (e.g, copy number variations and mutations) associated to different CRC anatomical sites we sequenced 32 CRCs samples from different location (right-sided, left-sided etc.) using the Ion AmpliSeq™ Comprehensive Cancer Panel that covered the whole coding sequence of 409 tumor suppressor genes and oncogenes frequently altered in cancer. Interestingly left-sided tumors were generally more altered respect to right-sided ones. Cluster analysis of all samples allowed the identification of 21-gene core that were significantly mutated in all sample groups. As expected, KRAS and APC mutations were frequently in the tumors resected from different anatomical localizations. Unsupervised analysis of copy number variations reveals a core of 160-gene significantly altered. In addition to the expected SRC, MYC and CEBPA, we found interestingly genes in validation status. Despite missing a significant number of cases, gene panel provides a solid alternative approach to WES in order to characterize a signature of alterations correlated with CRC tumor and the identification of novel biomarkers in colorectal carcinoma that could be used as potential clinical target.

scholarly journals Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - Results of a survey within the EndoCert initiative

2020 ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Further Development

Abstract Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.

Distal Radioulnar Joint Osteoarthritis: An Update on Treatment Options

2021 ◽  
Author(s):  
Brian M. Katt ◽  
Amr Tawfik ◽  
Nicholas Zingas ◽  
Francis Sirch ◽  
Pedro K. Beredjiklian ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Distal Radius ◽  
Joint Instability ◽  
Conservative Therapy ◽  
Treatment Options ◽  
Distal Radioulnar Joint ◽  
Surgical Approaches ◽  
Distal Ulna ◽  
Load Bearing ◽  
Radioulnar Joint

AbstractThe distal radioulnar joint (DRUJ), the articulation between the sigmoid notch of the radius and the distal ulna, plays a pivotal role in stability and load bearing and allows for pronation and supination of the forearm. Osteoarthritis (OA) of the DRUJ commonly occurs due to distal radius trauma but may also be the result of conditions such as joint instability, septic arthritis, or primary OA. It is initially managed with conservative therapy, but surgery is often considered when nonoperative methods fail. The surgical approaches available to treat this pathology have grown over the years. The procedures have generally favorable outcomes, each with their own unique complications and considerations. This paper comprises a review of the outcomes and complications for the different procedures commonly used to surgically treat DRUJ OA.

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