In vitro comparison of two food choice methodologies for necrophagous species of the genus Thanatophilus (Coleoptera: Staphylinidae: Silphinae).

To accurately model the food webs, we need to acquire precise data on food ecology of the interacting species. This allows better understanding of the trophic interactions and for the necrophagous species this information could be used in medico-legal investigations. For this reason, we recently proposed standardized laboratory methodology to assess the foraging strategies based on parallel testing of 2 food items (meat, dead larvae) (Jakubec et al. 2021). The original methodology had 2 shortcomings. It was not suited for testing living larvae, which could prove predatory behavior of the species. The methodology was also based on parallel experimental design, where the food items are tested together, which could underestimate the maximum consumption of the tested subject for some items. To test if these concerns are valid, we improved original methodology allowing testing living larvae as well as a new sequential experimental setup, where consumption of each item is tested individually in a random order, thus theoretically giving an unbiased maximum consumption estimate. These methodologies were tested head-to-head on 3 forensically relevant species from the genus Thanatophilus (Thanatophilus micans (Fabricius 1794)(Fabricius 1794), Thanatophilus rugosus (Linnaeus, 1758), and Thanatophilus sinuatus(Fabricius, 1775)). The experiments have confirmed that all 3 species are almost strictly necrophagous, although they were capable of predation, despite the presence of preferred food (meat). The comparison also showed that the sequential design has indeed improved capability to quantify the maximal consumption of the given food item. Thus, we suggest following this methodology in future studies.

Hemiclamshell approach for left pneumonectomy.

Hemiclamshell and clamshell incisions were virtually forgotten since the introduction to cardiac surgery of median sternotomy and the exhilarating advances in minimally invasive thoracic surgery. However, in rare clinical scenarios, as in large, space-occupying lesions in thoracic cavity, the surgeon will resort to a clamshell or a hemiclamshell approach to achieve complete exposure and remove a large mass from the thoracic cavity. In this video tutorial, we demonstrate the operative steps of the hemiclamshell approach in a clinical scenario for a left pneumonectomy for T4N1M0 non-small-cell lung cancer.

Continuous endobronchial suctioning for refractory post lobectomy lung atelectasis: a case report.

The presentation of post lung resection atelectasis can vary between simple atelectasis and total lung collapse i.e., "white - out", making its treatment demanding in many occasions. We herein present the technique of continuous suctioning of the right upper lobe (RUL) by positioning a suction catheter inside the right upper lobe bronchus (RULB) through a tracheostomy in a sedated patient. This technique was used in the case of a 70-year-old patient who underwent a complicated redo thoracotomy and right lower lobectomy for lung cancer after a previous middle lobectomy via double thoracotomy for similar pathology. He had a significant ankylosis spondylitis past medical history with bamboo spine treated with long term high doses of steroids and methotrexate. Post redo surgery he developed respiratory failure with a radiologically significant RUL collapse, i.e., a "white-out", of the operated side which was refractory to usual conservative or bronchoscopic treatment. As a last resort, and in an effort to avoid high risk pneumonectomy, the patient was sedated, and a suction catheter was left inside the RULB under direct bronchoscopic guidance. This allowed the secretions inside the airways to be cleared, giving the remaining upper lobe infection time to subside, protected the stump from infective secretions and blind suctioning and led to avoidance of a high-risk pneumonectomy. The upper lobe cleared up from its collapse and patient's discharge from high dependency unit was achieved. This described maneuver can be useful in refractory cases of atelectasis when other measures have failed, in borderline patients or in patients where further surgery is technically cumbersome.

Ectopic thoracic meningioma: a diagnostically challenging case.

Whilst meningiomas are common neoplasms of the central nervous system; ectopic meningiomas are very rare. When they do occur, they are typically in the head and neck. Due to their rarity, they propose a diagnostic challenge with interesting pathological findings. To date, only seven ectopic meningiomas arising in the mediastinum have been reported in the literature. We aim to shift the focus on the diagnostic journey of this rare entity which involved various imaging and histopathological techniques. Our patient was successfully treated with no complications after four years through input from specialists and the multidisciplinary team.

Standardized Laboratory Methodology for the Evaluation of Foraging Strategies in Necrophilous Beetles: A Case Study of Necrophila (Calosilpha) brunnicollis (Coleoptera: Silphidae).

Precise data regarding feeding habits of necrobiont species are a key element of food web and evolutionary ecology. They can also be used to assess the utility and value of those species for forensic entomology, where obligatory necrophagous species in particular are considered good bioindicators of postmortem or preappearance interval. However, the feeding habits of many species are known only from anecdotal field observations, often reduced to vaguely defined categories-predatory, necrophagous, or omnivorous. To address this issue, we designed a simple, in vitro behavioral experiment allowing the quantification of food preferences. Next, we applied it on Necrophila (Calosilpha) brunnicollis (Kraatz, 1877), which is a common carrion beetle of East Asia with unresolved food preferences. The results suggest that this species is preferentially necrophagous, thus valuable for forensic research. Importantly, however, our experimental design allowed us to reveal that it also readily feeds on larvae of Diptera, although they compose a minor proportion of its diet. This methodology can be applied to other species, and it could provide evidence for future decision making in forensic research.

Preoperative training education with incentive spirometry may reduce postoperative pulmonary complications.

OBJECTIVE: To assess whether preoperative incentive spirometer training would influence the development of postoperative pulmonary complications after lung resection. METHODS: Sixty-two lung resection patients were prospectively investigated; 17 were given an incentive spirometer preoperatively and 45 did not have an incentive spirometer preoperatively. Postoperatively, both arms exercised with an incentive spirometer. The number of repetitions per day, balls raised per repetition, correct technique of exercising, and postoperative pulmonary complications were compared between the 2 groups. Univariate binary logistic regression analysis of potential predictors of postoperative pulmonary complications led to multivariate analysis of independent predictors. Receiver operating characteristic analysis established the cutoff points of predictors. RESULTS: The group with no preoperative incentive spirometer developed more postoperative pulmonary complications than the preoperative incentive spirometer group (24.4% vs. 5.9%, respectively, p = 0.045). The preoperative incentive spirometer arm achieved more repetitions per day, balls per repetition, and correct incentive spirometer technique (p = 0.002, p < 0.001, p = 0.034, respectively). Balls raised per repetition and repetitions per day postoperatively were identified as independent predictors of postoperative pulmonary complications (p = 0.032 and p = 0.021, respectively). Less than 5 repetitions per day (sensitivity 93%, specificity 77%, p < 0.001) and less than 2 balls per repetition (sensitivity 93%, specificity 77%, p < 0.001) were predictive of postoperative pulmonary complications. CONCLUSION: Preoperative incentive spirometer exposure ensured better compliance with postoperative treatment and a more accurate technique (balls raised per repetition, repetitions per day). These variables correlated with a lower postoperative pulmonary complication rate.

Clamshell incision approach for giant teratoma.

The clamshell incision (also known as a transverse or crossbow transsternal incision) was the common approach to the heart in the early days of cardiac surgery and was occasionally also used to access mediastinal tumors or both lungs. However, with the introduction of the median sternotomy, the clamshell incision was virtually forgotten, except for cardiothoracic trauma and double lung transplant. However, in rare situations, such as in large space-occupying lesions in the mediastinum, surgeons will resort to the clamshell approach to achieve exposure and complete resection.  In this video tutorial, we demonstrate the operative steps for using the clamshell approach in one of those rare clinical scenarios. The resected mass was a giant mediastinal teratoma measuring 21 x 27 x 6 cm.

Metastatic Non-Small-Cell Lung Cancer in the Setting of Unilateral Agenesis of the Left Pulmonary Artery: A Case Report and Comprehensive Literature Review.

Unilateral absence of the pulmonary artery (UAPA) represents a rare condition that is often associated with cardiac congenital abnormalities but can also be relatively asymptomatic and indolent. There is a lack of consensus regarding the management of UAPA. However, in the setting of associated complications and ongoing infection, pulmonary resection is advocated. Although rare, the association between UAPA and bronchogenic carcinoma has been previously reported in seven published cases. In the majority of these, anatomic lung resection (most commonly with pneumonectomy) was curative. We present the first reported case of ipsilateral metastatic non-small-cell lung cancer- (NSCLC-) associated UAPA in a 47-year-old patient with ventilator-dependent hypoxic respiratory failure and bronchorrhea, who had been lost to follow-up for 8 years. Initial investigations did not yield evidence of malignancy, and confirmation of metastatic disease was made intraoperatively at the time of thoracotomy. The findings demonstrated evidence of diffuse metastatic pleural disease with lymphangitic carcinomatosis and superimposed infection. The patient was palliated and passed away shortly thereafter. In the setting of UAPA, clinicians should have a high index of suspicion for the possibility of malignancy, and if proven, they should consider early resection following appropriate staging.

The Aquamantys(®) system improves haemostasis and pneumostasis in open decortication for thoracic empyema.

BACKGROUND: Decortication for thoracic empyema is associated with significant blood loss and prolonged postoperative air leak. We sought to assess the potential application of an irrigated-tip radiofrequency (RF) sealing device, in an attempt to reduce this morbidity. METHODS: Data for all patients undergoing open decortication (OD) for stage II thoracic empyema, using either conventional approach or facilitated by use of the Aquamantys(®) device, at a single thoracic surgical unit between April 2010 and July 2014, were retrospectively analysed. Unpaired t-test and Fisher's exact test were used for statistical analysis. RESULTS: Thirty-three patients, aged 54±15 years (mean ± SD), and with a Charlson comorbidity index of 2.5±1.9 were included. Preoperative and intraoperative characteristics, including surgical time, were similar in the conventional and Aquamantys(®) groups. Patients in the Aquamantys group were less likely to require red cell transfusion (9/22 vs. 10/11 patients, P=0.024) and received lower volume transfusions [0.0 (2.0) vs. 3.0 (1.6) units (median, IQR), P<0.0001]; chest drain duration was shorter [3.0 (1.0) vs. 6.5 (6.8) days, P=0.006], as was length of postoperative hospital stay [6.0 (8.7) vs. 10.0 (4.6) days, P=0.031]. There was no demonstrable difference in mortality. CONCLUSIONS: Our data indicates that the use of irrigated tip RF ablation is safe and effective in improving pneumostasis and haemostasis in decortication for thoracic empyema; and that this translates to morbidity and logistical benefit.

Attempted closure of a post-pneumonectomy oesophagopleural fistula with an Amplatzer atrial septal occluder.

Oesophagopleural fistula is a recognized complication of pneumonectomy. Surgical repair with direct closure and reinforcement with omentum, muscle or pleural flap is the mainstay of definitive treatment. However, this option might not be suitable for all patients. The authors report on the case of a 63-year old female refusing surgical repair of an oesophagopleural fistula after left pneumonectomy. A novel approach (using an Amplatzer atrial septal occluder device) for fistula closure was attempted. Despite a promising initial result, the procedure failed. This is the first report on the use of a septal occluder to try and close an oesophagopleural fistula.

Aggressive tumoral calcinosis in an infant thoracotomy scar.

The authors report a case of tumoral calcinosis (TC) in a six-month-old infant, which developed within the thoracotomy scar from previous aortic coarctation repair. After initial resection of the lesion, the child returned with a large mass of TC restricting movement of the left shoulder. Repeated total resection was successful with no recurrence in 12 months' follow-up. This is the first report of TC that developed in a postoperative scar and is unusual in its recurrence and aggressive growth. Pathogenesis, diagnosis and treatment of this rare event is discussed.

Repair of type B interrupted aortic arch using aberrant right subclavian artery.

Interrupted type B aortic arch was repaired using aberrant right subclavian artery. In order to gain the full length of this vessel it was mobilised from a left thoracotomy. The aberrant vessel provides autogenous patch material with which to enlarge the ascending aorta and left common carotid artery.