Dataset Information

Identifying interlobar fissure in a Craig grade 4 fissureless patient by near-infrared thoracoscopy.

ABSTRACT: Traditionally, surgeons can only count on their naked eyes to identify the fissure in patients with incomplete fissures, which often cause surgical approach into the fissural parenchyma and may lead to postoperative prolonged air leak (PAL). We describe a novel technique using near-infrared (NIR) thoracoscopy with indocyanine green (ICG) to identify the fissure accurately and real-timely for the first time in a patient with totally fused oblique fissure (Craig grade 4).

SUBMITTER: Li H

PROVIDER: S-EPMC5863128 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Identifying interlobar fissure in a Craig grade 4 fissureless patient by near-infrared thoracoscopy.

Li Hao H Zhou Jian J Yang Fan F Wang Jun J

Journal of thoracic disease 20180101 1

Traditionally, surgeons can only count on their naked eyes to identify the fissure in patients with incomplete fissures, which often cause surgical approach into the fissural parenchyma and may lead to postoperative prolonged air leak (PAL). We describe a novel technique using near-infrared (NIR) thoracoscopy with indocyanine green (ICG) to identify the fissure accurately and real-timely for the first time in a patient with totally fused oblique fissure (Craig grade 4). ...[more]

PMID: 29600104

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Project description:ObjectivesThis study aimed to review the safety of a reusable sealing instrument, BiClamp(®), as an alternative to the mechanical stapler for interlobar fissure division in pulmonary lobectomy.MethodsA retrospective review was conducted of 95 patients who underwent pulmonary lobectomy performed by a single surgeon between November 2005 and March 2010. The patients were divided into two groups according to the period before and after introduction of the BiClamp(®): 29 patients who underwent fissure division with staples only (staple group) and 66 patients who underwent the same procedure mainly with the instrument (BiClamp(®) group).ResultsThere were 60 (63.2%) male and 35 (36.8%) female patients, with a mean ± SD age of 67.5 ± 10.8 years. Comparison of the characteristics of the two groups revealed that the BiClamp(®) group included significantly more cases of lobectomy by video-assisted thoracic surgery and far fewer completely lobulated lungs; 6 of 66 patients (9.1%) compared with 9 of 29 (31.0%) of the staple group. Except for 18 patients who underwent division using staples owing to thick parenchyma of the interlobar fissure, we attempted to divide the fissure of 42 patients in the BiClamp(®) group. Solo use of the BiClamp(®) was possible for 25 of 60 patients (41.7%) with an incomplete fissure. Eight patients (13.3%) needed one staple cartridge in combination with BiClamp(®), five (8.3%) needed two cartridges and four (6.7%) patients needed three (combined use). In most cases, except for right upper or middle lobectomy, the division of the interlobar fissure could be performed by sole use of the BiClamp(®). Incidence rates of prolonged air leakage and pneumonia were not significantly different between the two groups (respectively, 6.9 and 3.4% in the staple group vs 10.6 and 9.1% in the BiClamp(®) group).ConclusionsThe study results demonstrate that the division of the interlobar fissure in pulmonary lobectomy with BiClamp(®) is safe and feasible in most cases. While the results point out the limitation that division of the right upper or middle lobe may still be a challenge, they show the potential benefit of staple reduction. Less use of staples results in reduced medical costs and carbon dioxide emission, contributing to 'ecosurgery', which ultimately conserves the global environment.

Project description:IntroductionBasic studies suggest that olfactory dysfunction and functional near-infrared spectroscopy (fNIRS) can be used as tools for the diagnosis of mild cognitive impairment (MCI); however, real-world evidence is lacking. We investigated the potential diagnostic efficacy of olfactory-stimulated fNIRS for early detection of MCI and/or Alzheimer disease (AD).MethodsWe conducted a patient-level, single-group, diagnostic interventional trial involving elderly volunteers (age >60 years) suspected of declining cognitive function. Patients received open-label olfactory-stimulated fNIRS for measurement of oxygenation difference in the orbitofrontal cortex. All participants underwent amyloid PET, MRI, Mini-Mental State Examination (MMSE), and Seoul Neuropsychological Screening Battery (SNSB).ResultsOf 97 subjects, 28 (28.9%) were cognitively normal, 32 (33.0%) had preclinical AD, 21 (21.6%) had MCI, and 16 (16.5%) had AD. Olfactory-stimulated oxygenation differences in the orbitofrontal cortex were associated with cognitive impairment; the association was more pronounced with cognitive severity. Olfactory-stimulated oxygenation difference was associated with MMSE (adjusted β [aβ] 1.001; 95% CI 0.540-1.463), SNSB language and related function (aβ, 1.218; 95% CI, 0.020-2.417), SNSB memory (aβ, 1.963; 95% CI, 0.841-3.084), SNSB frontal/executive function (aβ, 1.715; 95% CI, 0.401-3.029) scores, standard uptake value ratio from amyloid PET (aβ, -10.083; 95% CI, -19.063 to -1.103), and hippocampal volume from MRI (aβ, 0.002; 95% CI, 0.001-0.004). Olfactory-stimulated oxygenation difference in the orbitofrontal cortex was superior in diagnosing MCI and AD (AUC, 0.909; 95% CI, 0.848-0.971), compared to amyloid PET (AUC, 0.793; 95% CI, 0.694-0.893) or MRI (AUC, 0.758; 95% CI, 0.644-0.871).DiscussionOur trial showed that olfactory-stimulated oxygenation differences in the orbitofrontal cortex detected by fNIRS were associated with cognitive impairment and cognitive-related objectives. This novel approach may be a potential diagnostic tool for patients with MCI and/or AD.Trial registrationCRIS number, KCT0006197 .

Project description:Chronic anal fissure (CAF) is a painful tear or crack which occurs in the anoderm. The optimal algorithm of therapy for CAF is still debated. Lateral internal sphincterotomy (LIS) is a surgical treatment, considered as the 'gold standard' therapy for CAF. It relieves CAF symptoms with a high rate of healing. Chemical sphincterotomy (CS) with nitrates, calcium blockers or botulinum toxin (BTX) is safe, with the rapid relief of pain, mild side-effects and no risk of surgery or anesthesia, but is a statistically less effective therapy for CAF than LIS. This article considers if aggressive treatment should only be offered to patients who fail pharmacological sphincterotomy. Aspects of anal fissure etiology, epidemiology and pathophysiology are considered with their meaning for further management of CAF. A molecular model of chemical interdependence significant for the chemistry of CAF healing is examined. Its application may influence the development of optimal therapy for CAF. BTX is currently considered the most effective type of CS and discussion in this article scrutinizes this method specifically. Although the effectiveness of BTX vs. LIS has been discussed, the essential focus of the article concerns identifying the best therapy application for anal fissure. Elements are presented which may help us to predict CAF healing. They provide rationale for the expansion of the CAF therapy algorithm. Ethical and economic factors are also considered in brief. As long as the patient is willing to accept the potential risk of fecal incontinence, we have grounds for the 'gold standard' (LIS) as the first-line treatment for CAF. The author concludes that, when the diagnosis of the anal fissure is established, CS should be considered for both ethical and economic reasons. He is convinced that a greater understanding and recognition of benign anal disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier, more practical stage with improved outcomes for the patient.

Dataset Information

Identifying interlobar fissure in a Craig grade 4 fissureless patient by near-infrared thoracoscopy.

Publications

Identifying interlobar fissure in a Craig grade 4 fissureless patient by near-infrared thoracoscopy.

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