Preoperative Small Pulmonary Nodule Localisation Using Hookwires or Coils: Strategy Selection in Adverse Events

Objective We conducted a retrospective study of adverse events associated with the preoperative procedure of computed tomography (CT)–guided hookwire or coil localisation. We analysed the experience of and process flaws in resecting ground-glass nodules (GGNs) using video-assisted thoracoscopic surgery (VATS) and determined the remedial strategy. Methods Adverse events were evaluated in 20 patients with 25 GGNs who underwent CT-guided hookwire or coil localisation before VATS. For lesions not successfully marked or detected, palpation, resection of the highly suspected area, segmentectomy or lobectomy was performed. Results Among all adverse events, 10 were dislodgement of the marking materials, 2 were breakaway of the marking materials, 4 were >2-cm distance between the lesions and the tip, one was marking material across the two adjacent lobes, 10 were pneumothorax and two were certain parts of marking materials stuck into the walls. All GGNs were resected successfully. Fifteen lesions were detected by palpation. Three GGNs were discovered after the resection of highly suspected areas. The GGNs were removed by lobectomy. Segmentectomies and lobectomies were performed directly on two and four GGNs, respectively. Conclusions When adverse events occur, a second localisation, intraoperative localisation, resection of a highly suspected area, or a segmentectomy or lobectomy can be successfully attempted using VATS for resection of GGNs.

Artery of Adamkiewicz and the clinical repercussion of its lesion in thoracoabdominal surgeries: a systematic review

The knowledge of the spinal cord irrigation is important for the therapeutic planning of aortic pathologies; however, its vasculature is complex due to the caliber of its arteries that pass through a three-dimensional network with great anatomical variability. Its clinical importance is evidenced during the preoperative procedure of thoracic and thoracoabdominal aortic surgeries, because its identification is essential for the prevention of spinal cord injuries. This study consists of a literature review, in which searches were conducted in the databases - Bireme, Science Direct, Pubmed and Lilacs. Articles published between 1999 and 2020, written in English, Portuguese or Spanish, were selected. The search was conducted using the descriptors Anatomy, Spinal Cord Irrigation and Spinal Cord Ischemia. The Adamkiewicz artery is the main artery responsible for the arterial supply to the lower part of the spinal cord. Thus, paraplegia is a complication of this type of surgical approach resulting from ischemic suffering of the spinal cord during the process. Therefore, further study on these factors should be encouraged, because the preservation of this vessel is relevant given the search for protection of the spinal cord and the maintenance of its functions in this type of procedure.

AN INSIGHT OF IMPORTANCE OF DEEPANA & PAACHANA IN PANCHAKARMA: CONCEPTUAL STUDY

Panchakarma therapy is a unique clinical treatment done for bio-purification of the body. Both Shodhana (bio- purification) and Shamana treatment (Pacification Treatment) modalities of Ayurveda place equal emphasis on Deepana and Paachana (appetizer-digestives). Deepana and Paachana karma plays important role in bringing the Sama dosha (dosha associated with ama) to Nirama (doshas without ama) state, as they mobilize the doshas from Shakha to koshtha and thus helps in easy expulsion of Doshas from the body. Deepana and Paachana Karma, as Purvakarma of Shodhana (bio-purification) procedures, are also essential. Purvakarma (preoperative procedure) refers to the body's preparation for Panchakarma procedures, and the body needs to achieve the full benefits of the treatments. Shodhana without Ama- Paachana results in further complications. As a result, the treatment is based on Srotoshodhana, Paachana, Agnideepana, and Vatanulomana. Objective: The objective is to extensively ex- plore the concept of Deepana & Paachana and elicit its applied aspect in Panchakarma therapy. Data Source: All the available information related to Deepana & Paachana is mentioned in classical texts primarily in Charaka Samhita and its related Commentaries, articles, Journals. Review Methods: The information related to Deepana & Paachana and its judicious use in Panchakarma are reviewed by comparing and analysing the different aspects of both classical tests and allied commentaries as well as contemporary authors. Conclusion: The concept of Deepana & Paachana here has been studied analytically in the radiance of proper and judicious Panchakarma practices to elicit its utility in better treatment. Keywords: Deepana, Paachana, Panchakarma, Purvakarma.

Optimising risk factors for atrial fibrillation post-cardiac surgery

Postoperative atrial fibrillation (POAF) is an ongoing complication following cardiac surgery, with an incidence of 15%–60%. It is associated with substantial mortality and morbidity, as well increased hospital stays and healthcare costs. The pathogenesis is not fully understood, but the literature suggests that POAF occurs when transient, postoperative triggers act on vulnerable atrial tissue produced by preoperative, procedure-induced and postoperative processes such as inflammation, oxidative stress, autonomic dysfunction and electrophysiological remodelling of the atrial tissues. This sets the stage for arrhythmogenic mechanisms, such as ectopic firing secondary to triggered activity and re-entry mechanisms generating POAF. Preoperative factors include advanced age, sex, ethnicity, cardiovascular risk factors, preoperative drugs, electrocardiogram and echocardiogram abnormalities. Procedural factors include: the use of cardiopulmonary bypass and aortic cross clamp, type of cardiac surgery, use of hypothermia, left ventricular venting, bicaval cannulation and exclusion of the left atrial appendage. Postoperative factors include postoperative drugs, electrolyte and fluid balance and infection. This review explores the pathogenesis of POAF and the contribution of these perioperative factors in the development of POAF. Patients can be risk stratified for targeted treatment and prophylaxis, and how these factors can be attenuated to improve POAF outcomes following cardiac surgery.

SUTURE MATERIALS AND SUTURE TECHNIQUES IN AYURVEDA – A REVIEW ARTICLE

Seevan Karma (suturing) is the closing method of surgical or traumatic wound and also last step of every operative procedure. Among these Seevan Karma of prime importance as appropriate suturing with specified thread and nee- dle leads to fast wound healing and minimized scar formation after surgery. Acharya Sushruta described the basic tents of experimental operative surgery for surgical training. The great need of such a training and describes the methods of experimental surgery using artificial objects (Non-living things) for learning the operative procedure like suturing2. In suturing or Seevan Karma using appropriate principals and instrument also describing the indica- tion, contraindication and method (Poorva Karma – preoperative procedure, Pradhan Karma- main procedure, Paschat Karma- post suturing procedure). Keywords: Seevan Karma, Sutra, Needle, Kartari

Concept of Sterilization in Ayurveda Compendia

Sterilization1 is the process of freeing an article, a surface or a medium of all microorganisms by removing or killing them. In surrounding environment, there are billions of microorganisms. Maximum of them are lived with human beings in commensalism which are not harmful but hazardous to immunocompromised host. Also, they found to be hazards to open wounds, operation theatres, labour rooms, inpatient ward. In surgery, the Sterilization has its prime importance. Without sterilization, it causes complication such as infection, impaired wound healing etc. By means of these complications, it obstructs the better recovery of operated patients as well as increases the hospital stay of patients. Acharya Sushruta has explained various surgeries and at the same time, he also described the concept of sterilization in Purvakarma (preoperative procedure). The present article describes the various methods and aspect of sterilization in classical text and also its implementation in the present scenario.