METHODS: The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity.
RESULTS: For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura.
CONCLUSION: The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.
PURPOSE: We report our experience in improving the surgical technique and its outcome.
METHODS: Seven patients underwent PN dissection via VATS and full-length transfer to musculocutaneous nerve (MCN) or motor branch of biceps (MBB) from June 2015 to June 2018. Comparisons were made with similar group of patients who underwent conventional PN transfer.
RESULTS: Mean age of patients was 21.9 years. All were males involved in motorcycle accidents who sustained complete brachial plexus injury. We found the elbow flexion recovery were earlier in full-length PN transfer. However, there was no statistically significant difference in elbow flexion strength at 3 years post-surgery.
CONCLUSION: We propose full-length PN transfer for restoration of elbow flexion in patients with delayed presentation.
OBJECTIVE: The aim of this study is to identify the postoperative ISIC changes relative to preoperative ISIC after OHS, and determine their predictors, including patient characteristics factors and IS performance parameters such as inspiration volumes (ISv) and frequencies (ISf).
METHODS: This is a prospective study with blinding procedures involving 95 OHS patients, aged 52.8±11.5 years, whose ISIC was measured preoperatively (PreopISIC) until fifth postoperative day (POD), while ISv and ISf monitored with an electronic device from POD1-POD4. Regression models were used to identify predictors of POD1 ISIC, POD2- POD5 ISIC increments, and the odds of attaining PreopISIC by POD5.
RESULTS: The ISIC reduced to 41% on POD1, increasing thereafter to 57%, 75%, 91%, and 106% from POD2-POD5 respectively. Higher PreopISIC (B=-0.01) significantly predicted lower POD1 ISIC, and, together with hyperlipedemia (B=11.52), which significantly predicted higher POD1 ISIC, explained 13% of variance. ISv at relative percentages of PreopISIC from POD1-POD4 (BPOD1=0.60, BPOD2=0.56, BPOD3=0.49, BPOD4=0.50) significantly predicted ISIC of subsequent PODs with variances at 23%, 24%, 17% and 25% respectively, but no association was elicited for ISf. IS performance findings facilitated proposal of a postoperative IS therapy target guideline. Higher ISv (B=0.05) also increased odds of patients recovering to preoperative ISIC on POD5 while higher PreopISIC (B=- 0.002), pain (B=-0.72) and being of Indian race (B=-1.73) decreased its odds.
CONCLUSION: ISv appears integral to IS therapy efficacy after OHS and the proposed therapy targets need further verification through randomized controlled trials.
METHODS AND RESULTS: The 'COlchicine for the Prevention of Perioperative Atrial Fibrillation' (COP-AF) trial is an international, blinded, randomized trial that compares colchicine to placebo in patients aged at least 55 years and undergoing major noncardiac thoracic surgery with general anesthesia. Exclusion criteria include a history of AF and a contraindication to colchicine (eg, severe renal dysfunction). Oral colchicine at a dose of 0.5 mg or matching placebo is given within 4 hours before surgery. Thereafter, patients receive colchicine 0.5 mg or placebo twice daily for a total of 10 days. The 2 independent co-primary outcomes are clinically important perioperative AF (including atrial flutter) and MINS during 14 days of follow-up. The main safety outcomes are sepsis or infection and non-infectious diarrhea. We aim to enroll 3,200 patients from approximately 40 sites across 11 countries to have at least 80% power for the independent evaluation of the 2 co-primary outcomes. The COP-AF main results are expected in 2023.
CONCLUSIONS: COP-AF is a large randomized and blinded trial designed to determine whether colchicine reduces the risk of perioperative AF or MINS in patients who have major noncardiac thoracic surgery.
METHODS: We reviewed children aged