Management of air leaks post-surgical lung resection.

Airleaks are one of the most common complications associated with elective lung resection. There have been many techniques and modern advancements in thoracic surgery, however airleaks persist. This review article will discuss several interventions ranging from conservative noninvasive to surgical management of the persistent airleak. These techniques include stopping of suction on the plueravac, fibrin patches, pleurodesis, use of endobronchial valves (EBVs), return to OR for operative intervention, and lastly to send patients home with mini pleuravacs.

Factors associated with passing the European Board of Paediatric Surgery Exam.

PURPOSE: The European Board of Paediatric Surgery (EBPS) includes a written Part 1 and an oral/practical Part 2 component. The goal of this study was to describe the EBPS examination candidate pool, and to determine factors associated with successfully passing the examination. METHODS: A database including all registered candidates for the EBPS exams since 2005 was constructed. Queried information included demographics, training location, language proficiency, and written/oral scores. Logistic regression analysis was performed to elucidate variables predictive of examination success. RESULTS: Until 2013, a total of 370 candidates registered for the part 1 examination and 147 successfully passed part 2. Pass rates for part 1 were 68, 65, 20, and 0 % on first, second, third, and forth attempts, respectively. Pass rates for part 2 were 79 % for both first and second attempts. Training in a single country was associated with passing Part 1 (p = 0.048), while having completed at least some training in an English-speaking country increased the chance of passing Part 2 (p < 0.01). CONCLUSION: The pool of EBPS examination candidates is highly diverse and international. First- and second-attempt pass rates are similar for both parts. Candidates who completed all their training in non-English-speaking countries may wish to consider additional English language practice to increase their chances of success.

A meta-analysis of B-mode ultrasound, Doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion.

PURPOSE: Ovarian torsion (OT) is a true surgical emergency that requires prompt diagnosis and therapy. There are conflicting reports on the accuracy of different imaging modalities for OT. In this study, we performed a meta-analysis of all the published studies on B-mode ultrasound (US, morphological criteria), Doppler US (DUS, flow criteria), and computed tomography (CT) for the diagnosis of OT. Methods: The medical literature from 1987 to 2013 was searched for studies that evaluated US, DUS, CT, or combination of these techniques to diagnose OT in children using PubMed/MEDLINE database. The studies were screened and included if the quality criteria were met. Data were extracted using a standardized form. Reported sensitivities and specificities were pooled with 95% confidence intervals using a RevMan version 5.1 software (The Cochrane Collaboration, Oxford, United Kingdom). RESULTS: A total of 18 US studies with 716 combined patients were included, along with 15 DUS studies comprising of 1,021 patients, and 5 CT studies with a total of 107 patients. All studies reported sensitivities, while only few selected studies also reported specificities. Using morphological criteria on B-mode US (including absolute or relative ovarian size, echotexture, location, and configuration) yielded high sensitivity and specificity (average 92 and 96%, respectively); DUS was highly specific, but lacked sensitivity, while CT was the least sensitive test. CT specificities could not be calculated from the available data. CONCLUSION: This study found considerable variability of the reported sensitivities and specificities for the diagnosis of OT across all evaluated imaging modalities. Interestingly, B-mode US was the most sensitive and specific examination to detect OT. Some authors reported high diagnostic accuracy of DUS as well, but these findings have not been universally reproduced. CT had low overall sensitivity and is not recommended for the workup of suspected OT.