Advances in Diagnostic Imaging of Hepatopulmonary Syndrome

Hepatopulmonary syndrome (HPS) is a serious pulmonary complication of progressive liver disease that leads to a poor clinical prognosis. Patients with HPS may develop acute respiratory failure, which requires intensive care and therapy. At present, the only effective treatment is liver transplantation; therefore, early diagnosis and timely treatment are of considerable significance. The three main features of HPS are liver disease, oxygenation disorder, and intrapulmonary vascular dilatation (IPVD). Diagnosing HPS is challenging due to the difficulty in detecting the presence or absence of IPVD. As such, imaging examination is very important for detecting IPVD. This paper reviews the imaging methods for diagnosing HPS such as ultrasound, dynamic pulmonary perfusion imaging, pulmonary angiography, and computed tomography.

6 Minute Walk Test (6-MWT) as a Tool for Predicting Post Operative Pulmonary Complications in Abdominal Surgeries

Background: Post operative pulmonary complications (PPC) contribute to increased morbidity and mortality. Thus pre operative assessment is required. Six minute walk test (6-MWT) is a simple and reliable test which is recently being included in pre operative evaluation. Objectives: The objective of this study is to determine the value of the six minute walk test as a reliable tool in detecting post operative pulmonary complications in patients undergoing abdominal surgery. Materials and Methods: It is a prospective observational study conducted in a tertiary care centre for a period of 3 months. 66 patients in the age group of 40-60 years undergoing elective abdominal surgery under general anaesthesia were included in this study based on universal sampling method. Patients with recent coronary syndrome, uncontrolled hypertension, cardiac diseases, pregnancy and conditions which impair walking (eg. Arthiritis) were excluded from the study. 6 minute walk test was performed before the surgery. The procedure was explained to the patients and consent was obtained. The test was conducted on a flat surface of 20m near our pre anaesthetic clinic and the patient was asked to walk for a period of 6 minutes in their own comfortable pace. The distance covered by the patients in the 6 minutes was noted. Vitals such a SpO2, heart rate, systolic and diastolic blood pressures were recorded before and after the test. The patients were followed up for the development of pulmonary complications in the post operative period. Results: Out of the 66 patients included in the study, 35 patients did not develop PPC (Group 1) and 31 patients developed PPC (Group2) including one death due to respiratory failure. The six minute walk distance in the PPC group was significantly less (p=0.0001) when compared to that of the non PPC group. Patients in the PPC group also required prolonged hospital stay. Pneumonia was the most commonly developed post operative pulmonary complication. Conclusion: Six minute walk test is a useful tool in predicting post operative pulmonary complication in patients undergoing abdominal surgery.

Spontaneous hemothorax: A rare lethal pulmonary complication of neurofibromatosis type 1

Neurofibromatosis 1 (NF1), also called von Recklinghausen’s disease, is an autosomal dominant disease characterized by multiple non-cancerous tumors of nerves and skin, and areas of abnormal pigmentation. Vasculopathy and spontaneous hemothorax are rare complications, but potentially lethal, which necessitates quick and decisive intervention to save the life of the patient. Here, we present a case of spontaneous massive haemothorax leading to hemorrhagic shock in a 66-year-old woman with neurofibromatosis type-1. She was investigated and managed successfully.

Multi-Wavelength Photobiomodulation Therapy Combined with Static Magnetic Field on Long-Term Pulmonary Complication after COVID-19: A Case Report

Introduction: Photobiomodulation therapy, alone (PBMT) or combined with a static magnetic field (PBMT-sMF), has been demonstrated to be effective in the regeneration of tissues, modulation of inflammatory processes, and improvement in functional capacity. However, the effects of PBMT-sMF on the pulmonary system and COVID-19 patients remain scarce. Therefore, in this case report, we demonstrated the use of PBMT-sMF for peripheral oxygen saturation, pulmonary function, massive lung damage, and fibrosis as a pulmonary complication after COVID-19. Case report: A 53-year-old Mexican man who presented with decreased peripheral oxygen saturation, massive lung damage, and fibrosis after COVID-19 received PBMT-sMF treatment once a day for 45 days. The treatment was irradiated at six sites in the lower thorax and upper abdominal cavity and two sites in the neck area. We observed that the patient was able to leave the oxygen support during the treatment, and increase his peripheral oxygen saturation. In addition, the patient showed improvements in pulmonary severity scores and radiological findings. Finally, the patient presented with normal respiratory mechanics parameters in the medium-term, indicating total pulmonary recovery. Conclusions: The use of PBMT-sMF may potentially lead to safe treatment of and recovery from pulmonary complications after COVID-19, with regard to the structural and functional aspects.

TP6.2.18 Initial experience with routine postoperative nasal high-flow oxygen as part of enhanced recovery following oesophagectomy for cancer

Introduction Pulmonary complications occur in up to 38% of patients undergoing oesophagectomy and are associated with significant risk of mortality. Nasal high-flow oxygen (NHFO) has previously been shown to reduce respiratory complications following major abdominal surgery, however, its use in oesophagectomy has not previously been assessed. We report our results using NHFO routinely as part of our enhanced recovery protocol (ERP) in consecutive patients undergoing oesophagectomy for cancer at a single tertiary referral centre. Methods We recently incorporated routine postoperative NHFO following oesophagectomy as part of our ERP at Royal Stoke University Hospital. We conducted a prospective study of patients undergoing surgery between November 2019 and September 2020. The primary outcome measure was complications related to delivery of NHFO. Secondary endpoints included rates of pulmonary complications and mortality within 30 days of surgery. Results Fifty patients underwent oesophagectomy during the study period. The median age was 66 years (range 43-78 years) and male to female ratio was 4:1.Majority (49/50) of patients underwent 2-stage oesophagectomy while one underwent 3-stage oesophagectomy. All patients received postoperative NHFO. There were no complications related to NHFO. The 30-day overall pulmonary complication rate was 30%.Of these, 28% developed pneumonia,4% pulmonary embolism,and 2% pleural effusions requiring drainage. There were no deaths within 30 days of surgery. Conclusion Routine postoperative NHFO in consecutive patients undergoing oesophagectomy is safe and feasible with lower pulmonary complication rates than previously reported, leading to better overall outcomes. The value of NHFO in oesophagectomy requires further evaluation in a randomized clinical trial.

Postoperative morbidity and quality of life between totally laparoscopic total gastrectomy and laparoscopy-assisted total gastrectomy: a propensity-score matched analysis

Background This study aimed to evaluate the surgical outcome and quality of life (QoL) of totally laparoscopic total gastrectomy (TLTG) compared with laparoscopy-assisted total gastrectomy (LATG) in patients with clinical stage I gastric cancer. Methods From 2012 to 2018, EGC patients who underwent TLTG (n = 223), including the first case with intracorporeal hemi-double stapling, were matched to those who underwent LATG (n = 114) with extracorporeal circular stapling, using 2:1 propensity score matching (PSM). Prospectively collected morbidity was compared between the TLTG and LATG groups in conjunction with the learning curve. The European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires QLQ-C30, STO22, and OG25 were prospectively surveyed during postoperative 1 year for patient subgroups. Results After PSM, grade I pulmonary complication rate was lower in the TLTG group (n = 213) than in the LATG group (n = 111) (0.5% vs. 5.4%, P = 0.007). Other complications were not different between the groups. The learning curve of TLTG was overcome at the 26th case in terms of the comprehensive complication index. The TLTG group after learning curve showed lower grade I pulmonary complication rate than the matched LATG group (0.5% vs. 4.7%, P = 0.024). Regarding postoperative QoL, the TLTG group (n = 63) revealed less dysphagia (P = 0.028), pain (P = 0.028), eating restriction (P = 0.006), eating (P = 0.004), odynophagia (P = 0.023) than the LATG group (n = 21). Multivariate analyses for each QoL item demonstrated that TLTG was the only common independent factor for better QoL. Conclusions TLTG reduced grade I pulmonary complications and provided better QoL in dysphagia, pain, eating, odynophagia than LATG for patients with clinical stage I gastric cancer.

The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay

Objective: To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. Review methods: Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. Results: Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = −1.68 days, 95% CI = −2.23, −1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = −0.23 days, 95% CI = −1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = −0.17, 95% CI = −0.29, −0.05). Conclusion: Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.