Clinical and sonographic evaluation of the diaphragm after plication in adults with unilateral eventration: a retrospective study

Background We aim to assess the role of diaphragm ultrasonography in evaluating the outcome of surgical diaphragmatic plication in adults with symptomatic unilateral diaphragmatic eventration. Results Forty patients with symptomatic unilateral diaphragmatic eventration underwent surgical diaphragmatic plication between 2015 and 2020. The etiology was idiopathic in 34 (85%) cases, and 37 (92.5%) of them were suffering from dyspnea. Diaphragm ultrasonography showed no diaphragmatic movement on the affected side in 10 (25%) patients and a paradoxical movement in 30 (75%) patients. Surgical diaphragmatic plication was done successfully in all cases. Postoperative complications were reported in 3 (7.5%) cases, with no mortality. There was a highly significant improvement in dyspnea at 1 week and 6 months follow-up. CXR showed a highly significant decrease in the mean height of eventration at 1 week 3.7 ± 1.2 cm (P < 0.001), and 6 months 2.6 ± 0.9 cm (P < 0.001), compared to preoperative values (10.1 ± 2.8 cm). diaphragm ultrasonography showed normal motility of the plicated cupola in all cases, and there was a highly significant decrease in the mean height of eventration at 1 week (3.1 ± 1.1 cm, P < 0.001), and 6 months (2.3 ± 0.5 cm, P < 0.001) compared to preoperative values (10.3 ± 2.2 cm). There was a highly significant increase in the diaphragm thickness at 1 week (2.7 ± 0.3 mm, P < 0.001), and 6 months (2.9 ± 0.2 mm, P < 0.001), compared to the preoperative value. There was a highly significant improvement in the degree of excursion 1 week (25 ± 4.3 mm, P < 0.001), and 6 months (28 ± 5.2 mm, P < 0.001), compared to the preoperative value (15 ± 6.2 mm). No fluid collection or surroundings organ injuries were detected. The mean FVC and FEV1 showed a highly significant improvement at 1 week (66.7 ± 6%, 78.2 ± 9.8%), and 6 months (68.8 ± 5.7%, 80.4 ± 10.3%), compared to the preoperative value (58.8 ± 8% and 70.9 ± 10.3%). Conclusions Surgical diaphragmatic plication is an effective and safe procedure that can be performed to treat symptomatic adults with unilateral diaphragmatic eventration. Diaphragm ultrasonography can be used as a simple bedside test to evaluate unilateral diaphragmatic eventration cases and their postoperative follow-up.

Sternal reconstruction and omentoplasty after mediastinitis

Deep sternal infections are serious complications after open heart surgery. We present a case of a 59-year-old female with uncontrolled diabetes who underwent aortocoronary bypass surgery in another cardiac surgery department. After the surgical intervention sternal dehiscence and wound infection occurred, which was followed by two unsuccessful attempts for sternal refixation.&nbsp;Two months after the initial procedure the patient was admitted to our institution with severe dyspnea and paradoxical movement of the thorax. Computed tomography revealed a huge defect of the sternum and metal osteosynthesis with a titanium plate and omentoplasty was performed.&nbsp;The patient was followed-up for one year with excellent postoperative result.

Endoscopic Submucosal Hydrodissection with Paradoxical Movement of the Colonoscope Using Hybrid Knife “Traction Mode” for Malignant Polyp in the Cecum

The water-jet hydro dissection technique has been shown to be effective for colorectal tumors. This case report illustrates type T hybrid knife for the elevation of the submucosal layer, cutting the mucosa and dissecting submucosal fibers. ESD was performed using ERBEJET 2 hydrodissection system and hybrid Knife. The resection was completed en bloc within 135 minutes without adverse events. Pathology examination revealed a well-differentiated adenocarcinoma confined to the shallow submucosal layer with free resection margins.

Design, additive manufacture and clinical application of a patient-specific titanium implant to anatomically reconstruct a large chest wall defect

Purpose Chest wall reconstruction of large oncological defects following resection is challenging. Traditional management involves the use of different materials that surgeons creatively shape intraoperatively to restore the excised anatomy. This is time-consuming, difficult to mould into shape and causes some complications such as dislocation or paradoxical movement. This study aims to present the development and clinical implantation of a novel custom-made three-dimensional (3D) laser melting titanium alloy implant that reconstructs a large chest wall resection and maintains the integrity of the thoracic cage. Design/methodology/approach The whole development process of the novel implant is described: design specifications, computed tomography (CT) scan manipulation, 3D computer-assisted design (CAD), rapid prototyping, final manufacture and clinical implantation. A multidisciplinary collaboration in between engineers and surgeons guided the iterative design process. Findings The implant provided excellent aesthetical and functional results. The virtual planning and production of the implant prior to surgery reduced surgery time and uncertainty. It also improved safety and accuracy. The implant sited nicely on the patient anatomy after resection following the virtual plan. At six months following implantation, there were no implant-related complications of pain, infection, dislocation or paradoxical movement. This technique offered a fast lead-time for implant production, which is crucial for oncological treatment. Research limitations/implications More cases and a long-term follow-up are needed to confirm and quantify the benefits of this procedure; further research is also required to design a solution that better mimics the chest wall biomechanics while preventing implant complications. Originality/value The authors present a novel custom thoracic implant that provided a satisfactory reconstruction of a large chest wall defect, developed and implanted within three weeks to address a fast-growing chondrosarcoma. Furthermore, the authors describe its development process in detail as a design guideline, discussing potential improvements and critical design considerations so that this study can be replicated for future cases.

Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution

Backgrounds: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Methods: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Results: A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P<0.05). Conclusions: The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery. Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.

Surgical treatment of 125 cases with congenital diaphragmatic eventration in a single institution

Backgrounds This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacy of thoracoscopy and traditional open surgery in infants with congenital diaphragmatic eventration. Methods We retrospectively analyzed the clinical data of 125 children with CDE(90 boys, 35girls; median age:12.2 months, range 1h-7years;body weight1.99-28.5kg,median body weight 7.87±4.40kg) admitted to our hospital in recent 10years, and statistically analyzed their clinical manifestations and surgical methods. Results 108 children in this group underwent surgery, of which 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication.107 patients recovered well postoperatively, except for 1 patient died of respiratory distress after surgery.Followed up for 1-9.5 years,107 patients had significantly improved preoperative symptoms.During follow-up, the location of the diaphragm was normal and no paradoxical movement was observed.Eleven of the 17 children who did not undergo surgical treatment did not see a decrease in diaphragm position after 1-6 years of follow-up.In the thoracoscopy group, the index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better than those in the open group.The difference between the two groups was statistically significant (P＜0.05). Conclusions Clinical symptoms of congenital diaphragmatic eventration varied in severity. Patients with severe symptoms should be operated.Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration,but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of short operation time, less trauma, rapid recovery, so it should be the first choice for children with congenital diaphragmatic eventration.

Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant

Background Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant. Method To design the implant manual bone threshold segmentation was performed to create a 3-D virtual model of the patient’s chest and the tumor from sub-millimeter slice computed tomography (CT) scan data. We estimated the extent of resection needed to ensure tumor-free margins by growing the tumor by two cm all around.. We designed the implant using an anatomical image of the ribs and right hemi-sternum and then fabricated a 3D model of them in titanium metal using TiMG 1 powder bed fusion technology. At surgery the implant was slotted into the defect and sutured to the ribs laterally and hemi-sternum medially. Results Histology confirmed clear all around microscopic margins. Following surgery and at 18 month follow up the patient was asymptomatic with preserved quality of life and described no pain, localized tenderness or breathlessness. There was no displacement or paradoxical movement of the implant. Conclusion Our techniques of CT segmentation, editing, computer aided design of the implant and fabrication using laser printing of a custom-made anatomical titanium alloy chest wall ribs and hemi-sternum for reconstruction is feasible, safe and provides a satisfactory result. Hence, a patient specific 3-D printed titanium chest wall implant is another useful adjunct to the surgical approach for reconstructing large chest wall defects whilst preserving the anatomical shape, structure and function of the thorax.

¿Existe una imagen del futuro? Sobre tiempos, imágenes, mundos otros y Antropoceno

Resumen: Este artículo aborda los modos como las imágenes prefiguran el tiempo por venir, el futuro. En otras palabras, lo que entendemos por el futuro, un tiempo sin historicidad, es articulado en el tiempo presente y corresponde a un paradójico movimiento entre tiempo de nostalgia y tiempo de deseo. Para explorar el tema, abordamos las nociones de profecía y predicción y posteriormente ahondamos en las imágenes técnicas, que son centrales en la producción de la era geológica conocida como Antropoceno. El Antropoceno, en tanto escenario planetario inminente, significa un particular encuentro entre las profecías apocalípticas de las religiones y el pensamiento mítico, y las predicciones catastróficas de las ciencias, derivando en una singular imagen de futuro que pareciera ser un fin y un comienzo a la vez: la conquista del Espacio y la terraformación de otros mundos, donde Marte es una suerte de espejo de la Tierra que proyecta imágenes que son simultáneamente del pasado y del futuro.Palabras Clave: Antropoceno. antropología de la imagen. historicidad. Marte. terraformación ¿Existe una imagen del futuro? Sobre tiempos, imágenes, mundos otros y Antropoceno Abstract: This article explores the ways in which images prefigure times to come, the future. In other words, what we understand as future, a time devoid of historicity, is articulated in the present and corresponds to a paradoxical movement between nostalgia and desire. To delve into the matter, we explore the notions of prophecy and prediction, then we examine technical images, which are key to the production of the geological era known as the Anthropocene. The Anthropoce, seen as an imminent planetary scenario, implies a remarkable encounter between apocalyptic prophecies, mythical thinking, and scientific catastrophic predictions which condensate in a singular image of the future that speaks of beginnings and ends: the conquest of outer space and the terraforming of other worlds where Mars mirrors the Earth and projects images that belong simultaneously to the past and the future.Keywords: Anthopocene. anthropology of the image. historicity. Mars. terraforming EXISTE UMA IMAGEM DO FUTURO? SOBRE TEMPOS, IMAGENS, OUTROS MUNDOS E O ANTROPOCENO Resumo: O artigo aborda os modos como as imagens provém o tempo por vir, o futuro. Em outras palavras, aquilo que entendemos por futuro, um tempo sem historicidade, é articulado no tempo presente e faz parte de um movimento paradoxal entre o tempo da saudade e o tempo do desejo. Para fazer essa abordagem, partimos das noções de profecia e predição, para compreender as imagens técnicas como elementos centrais da visualidade da era geológica conhecida como Antropoceno. Essa era geológica, em quanto cenário planetario iminente, significa um particular encontro entre as profecias apocalípticas das religões e o pensamiento mítico, e as predições catastróficas das ciências, dando lugar a uma singular imagem do futuro que se propõe como um final e um começão ao mesmo tempo: a conquista do Espaço e a terraformação de outros mundos, onde Marte é um tipo de espelho da Terra, que projeta imagens que são do pasado e do futuro ao mesmo tempo.Palavras-chave: Antropoceno. antropologia das imagens. historicidade. Marte. terraformação