Simplified paravertebral anesthesia technique and its application

C. Fervers (Zentralbl. F. Chir. No. 37, 1929), in order to avoid complications, inserts the needle with paravertebral anesthesia one finger away from the spinous processes towards the angle formed by the transverse process and the edge of the vertebral body (the outer end of the needle with the midline forms an angle of 20 -30 ). The designated angle is located normally in the thoracic part of the spine near the upper edge of the spinous process, in the lumbar part, in the middle of the lower edge of the spinous process. In this way, the needle easily reaches the vertebral wall, and the injected fluid washes the ramus anter. ram. communicans. During operations, the author recommends using paravertebral anesthesia only for unilateral processes, such as appendicitis, cholelithiasis, kidneys and ureters and hernias. For the purposes of differential diagnosis and therapy, paravertebral anesthesia can be used.

Method of Macromicroscopic Preparation for Determination of Fetal Anatomical Variability of the Thoracic Part of the Aorta

To obtain data about the formation of fetal macroscopic structure and topography of the thoracic part of the aorta, which can be used for age-related mapping, it is necessary to determine a standard sequence of steps during the preparation of these structures. The purpose of the study was to determine the method of the best rational sequence of actions during the preparation of areas of the posterior mediastinum in human fetuses to obtain standard results, useful for comparing in the age aspect. Materials and methods. The study was performed on 35 human fetuses of 4-10 months by macromicroscopic preparation of organs, vessels, and nerves of the posterior mediastinum. Results and discussion. In the study of fetal anatomical variability of branches and nerves of the thoracic aorta in the age aspect, the algorithm of anatomical preparation of the posterior mediastinum becomes a priority. However, in the literary sources available to us, we did not find information about the sequence of actions during the preparation of the posterior mediastinum, including the thoracic aorta in human fetuses. The innervation of the thoracic part of aorta on both sides mainly involves the branches of the II-VI thoracic nodes of the sympathetic trunk, the great visceral nerve, and the branch of the vagus nerve. Adherence to the following sequence of actions during the preparation of the posterior mediastinum, and in particular, the branches and nerves of the thoracic aorta, in human fetuses, provides not only the scientific value of the results but also the rational use of biological material. Conclusion. The proposed and tested method of dissection of nerves, visceral and parietal branches of the thoracic aorta in human fetuses provides a standard for obtaining data about their typical, individual, and age anatomical variability. The innervation of the thoracic aorta mainly involves the branches of the II-VI thoracic nodes of the sympathetic trunk, the great visceral nerve, and the branch of the vagus nerve. Nerve branches leading to the thoracic aorta from various sources enter its wall either together with blood vessels or in isolation. In human fetuses, between the right and left sympathetic trunks and the thoracic part of the aorta, in addition to the intermediate plexus or collateral trunk, a paraaortic plexus is found, the branches of which participate in the innervation of the thoracic aorta. Bilateral asymmetry of the structure and topography of the plexuses of the thoracic aorta was detected. The sequence of actions used during the preparation of the thoracic aorta in human fetuses preserves the natural appearance and relationships between the branches and nerves of the object of the study

The Outcomes of Multi-Disciplinary Treatment of Esophageal Cancer in Vajira Hospital

Background: Esophageal cancer is one of the most fatal and difficult-to-treat cancer. Multi-modality management is the key to success of improving outcomes, however, which modality is the most proper is difficult to determine. Objective: To evaluate the overall survival (OS) of patients with early or locally-advanced (E/LA) esophageal carcinoma treated in Vajira Hospital. The outcomes of the multi-modality management among patients with E/LA diseases were evaluated. Materials and Methods: The retrospective analyses of esophageal carcinoma patients who attended at Vajira Hospital between January 1, 2012 and December 31, 2016 were performed. Results: There were 86 patients with complete medical records. The median age was 60.5 years (IQR 52 to 66). Sixty-five patients (75.6%) presented with E/LA diseases. Most of the patients had primary site at thoracic part of esophagus (58 patients, 67.4%) and had squamous cell carcinoma histology (84 patients, 97.7%). Tri-modality treatment including neoadjuvant chemoradiation and esophagectomy for clinically fitted patients without evidence of mediastinal involvement and non-regional lymph node metastasis resulted in the best survival outcome [28.56 months (IQR 10.64 to 46.47)]. The OS of patients with E/LA disease was only 9.15 months (IQR 4.49 to 23.02). Male patients, non-cervical site, and non-surgical treatment were associated with the worse OS. Conclusion: The outcomes of patients with esophageal carcinoma treated in a real-world practice is still not impressive. Tri-modality management would be the best paradigm; however, it is suitable for well-selected patients. Keywords: Esophageal cancer, Multi-modality treatment, Real-world practice

Technical details of the abdominal part during full robotic-assisted minimally invasive esophagectomy

The full robotic-assisted minimally invasive esophagectomy (RAMIE) is an upcoming approach in the treatment of esophageal and junctional cancer. Potential benefits are seen in angulated precise maneuvers in the abdominal part as well as in the thoracic part, but due to the novelty of this approach the optimal setting of the trocars, the instruments and the operating setting is still under debate. Hereafter, we present a technical description of the ‘Mainz technique’ of the abdominal part of RAMIE carried out as Ivor Lewis procedure. Postoperative complication rate and duration of the abdominal part of 100 consecutive patients from University Medical Center in Mainz are illustrated. In addition, the abdominal phase of the full RAMIE is discussed in general.

Acute dyspnea as a manifestation of Forestier's disease. A case report.

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a noninflammatory disease and is characterized by ossification of the anterolateral aspect of vertebral bodies, mostly in thoracic part of the spine. Although, usually, DISH is asymptomatic, in rare cases osteophytes located in the cervical part of the spine can cause otolaryngological manifestations, such as dysphagia (most common), hoarseness and stridor. In differential diagnosis of upper respiratory tract symptoms, we should consider DISH. We present case of 82 years old male patient with acute dyspnea, who was diagnosed with osteophytes of C4-C7 vertebral bodies. In this case conservative therapy was not efficient, therefore successful surgical treatment was performed.

G.G. Levitsky. Kyphotic female pelvis. (Protocol of the meeting of the Obstetric and Gynecological Society in Kiev, book 7, 1894, p. 71)

Jewish woman, 22 years old. She gave birth once (forceps). After delivery, a vesicovaginal fistula was formed. Height is 141 cm. The limbs do not represent traces of a rickety process. Lordosis of the upper thoracic part of the spine and right-sided scoliosis of the lower thoracic part. Kyphosis lumbosacralis.

P4136Neurogenic stunned myoacardium in multiple sclerosis patients

A wide spectrum of topics regarding Multiple Sclerosis (MS) have been thoroughly studied, like immunology, nature of demyelinating lesions (DL's), therapeutics, etc. However, little is known about the influence of MS DL's on the cardiovascular system and especially in the coronary vasculature although few reports mention coronary vasospasm due to autonomic nervous system (ANS) abnormalities. Aim of this study was the detection the presence of Neurogenic Stunned Myocardium (NSM) through perfusion test. Method We enrolled 50 asymptomatic fulfilling the criteria MS patients, aged 45±7 years old and disease in our study duration of 6±13 years with EDSS= 2,5. After echocardiography and clinical examination as primary screening, pharmacologic stress thallium 201 scintigraphy and/or coronary angiography were performed to identify the incidence of NSM. Clinical characteristics of MS, type of disease, treatments as well as localization of demyelinating plaques (DP) were noted. Results 13 patients (26%) had abnormal scintigraphy test although clinical profile was not indicative. Cardiac ultrasound showed that 2 patients from this group had a critical ejection fraction (around 50%). All positive patients that underwent for coronary angiogram were negative implying coronary artery spasm as a potential mechanism for the stress positive result. A common finding of all positive patients was the localization of DP which was in the lateral horn of the lower cervical part (C5–7) and upper thoracic part (Th1–4). No correlation seems to have the presence of CAD with disease duration, EDSS and treatment approaches. Discussion Our study shows a high incidence of NSM. This finding due to the location of the DP seems to correlate with ANS disturbance and might help to distinguish patients at higher risk.

Analysis of Treatment Results of the Thoracic Part of Oesophageal Cancer

AIM: This study aims to evaluate the methods of treatment of the thoracic part of oesophagal cancer and to predict the results of treatment depending on the factors of the prognosis. MATERIALS AND METHODS: The results of treatment of 366 patients with cancer of the thoracic part of the oesophagus for 10 years (2007-2016) by the department of thoracic oncology of the Karaganda oncological dispensary were studied. RESULTS: The overall five-year survival rate, regardless of the method of treatment, was only 8.72% (28 of 321), and in the 6-10 year period 8.41% (27 of 321) lived, p < 0.05. Analysis of the overall survival of patients with cancer of the thoracic part of oesophagus showed that the method of treatment does not have a significant effect on life expectancy. A multivariate analysis of 19 grades that affect the prognosis of the disease was carried out. CONCLUSION: Radical type of treatment of the middle and lower thoracic oesophagus is surgical, in which the median of cumulative survival is 19 months. Traditional radiotherapy should be used in a limited way, as it is palliative, with a median survival of no more than 9 months. The leading factor in the prognosis for thoracic part of oesophagal cancer is the presence of regional metastases, on which the choice of method of treatment depends.

Histochemical investigation of the esophagus of the Wild bronze turkey (Meleagris gallopavo)

The aim of the present study was to investigate the thoracic part of the esophagus in the bronze turkey, using Masson’s trichrome stain and Alcian blue-PAS staining. Thirty-six clinically healthy bronze turkeys (eighteen males and eighteen females) were studied. The groups of the birds were at age 1, 7, 14, 28, 35 and 49 days. Each group consisted of three male and three female birds. The histological features of the organ were similar in the studied groups. It consisted of tunica mucosa, tunica submucosa, tunica muscularis, and tunica serosa. There were no specifics in the organ regarding the sex and the age of the birds. The esophageal glands in all of the studied groups, demonstrated intensive PAS and AB reaction, because of the mucous, produced by the epithelial glandular cells. Lamina propria exhibited a weak PAS reaction, visible in all ages, either in males, either in females.