Simultaneous resection of coexisting pulmonary and mediastinal lesions by video-assisted thoracic surgery: a case-series study.

BACKGROUND: With the growing number of patients with coexisting pulmonary and mediastinal lesions detected, reports about simultaneous video-assisted thoracic surgery (VATS) for these concurrent diseases are still rare. To further explore the safety and effectiveness of simultaneous resection of pulmonary and mediastinal lesions by uniportal or biportal VATS, we retrospectively analyzed the clinical data of the largest series of cases to date. METHODS: From July 2018 to July 2021, all patients whose pulmonary lesions and mediastinal tumors were resected simultaneously in our institution were retrospectively reviewed. Their demographic and clinical data were collected and analyzed. RESULTS: A total of 54 patients were enrolled, of whom 44 underwent unilateral uniportal VATS, 3 underwent bilateral uniportal VATS and 7 underwent unilateral biportal VATS. Seven cases were converted to thoracotomy during surgery. For the remaining 47 patients with various demographic and clinical characteristics, most of the operations were completed within 3 h (n = 33, 70.2%) with blood loss of no more than 100 mL (n = 43, 91.5%). The duration of chest tube drainage was 5.66 ± 3.34 days, and the average daily volume was 196.90 ± 122.31 mL. Four cases of postoperative complications occurred during hospitalization. The length of postoperative hospital stay was 8.60 ± 3.63 days. No severe complications or deaths were observed during follow-up. CONCLUSIONS: Uniportal and biportal VATS are safe and effective for simultaneous resection of selected coexisting pulmonary and mediastinal lesions, but the indications and operational details need more evaluation.

SIMULTANEOUS HIATAL HERNIA PLASTICS WITH FUNDOPLICATION, LAPAROSCOPIC CHOLECYSTECTOMY AND UMBILICAL HERNIA REPAIR.

The article presents a case report of patients with multimorbid pathology - hiatal hernia with gastroesophageal reflux disease, cholecystolithiasis and umbilical hernia. Simultaneous surgery was performed in all cases - laparoscopic hiatal hernia with fundoplication, laparoscopic cholecystectomy and umbilical hernia alloplasty (in three cases - by IPOM (intraperitoneal onlay mesh) method and in one - hybrid alloplasty - open access with laparoscopic imaging). After the operation in one case there was an infiltrate of the trocar wound, in one case - hyperthermia, which were eliminated by conservative methods. The follow-up result showed no hernia recurrences and clinical manifestations of gastroesophageal reflux disease.

Abscess of the spleen in a patient with infectious endocarditis.

A patient with infective endocarditis (IE), complicated by the development of the abscess of the spleen, is described. The diagnosis of IE was verified several months after the onset of clinical symptoms (fever, hemorrhagic skin rashes, splenomegaly).The patient suspected hemorrhagic vasculitis and lymphoma of the spleen, which were not confirmed. With transesophageal echocardiography, vegetations on the aortic valve have been identified, and, according to CT, a spleen infarct with suspected abscess. A successful simultaneous operation was performed - aortic valve replacement and splenectomy. An abscess was found in the spleen. The patient is discharged in a satisfactory condition.

Free-electron laser multiplex driven by a superconducting linear accelerator.

Free-electron lasers (FELs) generate femtosecond XUV and X-ray pulses at peak powers in the gigawatt range. The FEL user facility FLASH at DESY (Hamburg, Germany) is driven by a superconducting linear accelerator with up to 8000 pulses per second. Since 2014, two parallel undulator beamlines, FLASH1 and FLASH2, have been in operation. In addition to the main undulator, the FLASH1 beamline is equipped with an undulator section, sFLASH, dedicated to research and development of fully coherent extreme ultraviolet photon pulses using external seed lasers. In this contribution, the first simultaneous lasing of the three FELs at 13.4 nm, 20 nm and 38.8 nm is presented.

Thoracic aortic stent graft placement and simultaneous screw removal for a screw hitting the aorta.

Vascular injury caused by spinal screw displacement is a rare complication of spinal fusion surgery. Here, we report a case with no perforation of the aortic wall, which we treated by means of simultaneous thoracic endovascular aorta repair (TEVAR) and screw removal. An 82-year-old female underwent corrective spinal fixation. Postoperatively, a screw became displaced from the vertebrae and contacted the outer membrane of the descending aorta. To prevent rupture of the aorta, we performed stent graft placement from the right common femoral aorta. We left a flexion-resistant catheter in the left arm and moved the patient into an abdominal position with the left arm extended upward to enable immediate insertion of a guidewire and occlusion balloon if necessary. Then we removed the displaced screw with a drill. This safe and effective method can prevent possible aortic injuries secondary to displaced spinal screws. The key to our method is the simultaneous performance of TEVAR and screw removal, made possible through patient repositioning.

Long-term efficient management of diabetic foot ulcer using simultaneous foot ulcer closure and surgical off-loading.

Foot deformity is one of the causes of foot ulcers. Foot ulcers often recur due to foot deformity. Foot ulcer healing alone does not reduce the risk factor of foot ulcer recurrence. The majority of foot ulcer patients, most of whom are elderly, have foot deformities. This limits the chances of undergoing surgical off-loading following surgery. We present a case of diabetic foot ulcer (DFU) in which surgical off-loading was performed simultaneously with foot ulcer closure that did not recur for a period of 2 years following surgery. A 70-year-old diabetic male with a DFU presented to our hospital. He underwent surgical debridement followed by reconstruction surgery (stump plasty) simultaneous with surgical off-loading (metatarsal head resection). The immediate postoperative period during which he used the off-loading device was uneventful. Following this, he used orthosis. After 2 years, the foot ulcer had not recurred, and he was able to independently perform his daily activities. Simultaneous surgery (reconstructive surgery and surgical off-loading) is less likely to limit daily activities and can reduce the ulcer recurrence rate.

[Comparison of early effectiveness and safety of simultaneous and staged bilateral unicompartmental knee arthroplasty for bilateral anteromedial compartment osteoarthritis].

OBJECTIVE: To compare the early effectiveness and safety of simultaneous bilateral and staged bilateral unicompartmental knee arthroplasty (UKA) in treatment of anteromedial compartment osteoarthritis. METHODS: The clinical data of 31 patients with bilateral anteromedial compartment osteoarthritis who underwent bilateral UKAs between January 2015 and January 2017 was retrospectively analyzed. Of them, 17 patients were treated with simultaneous bilateral UKAs (simultaneous group) and 14 patients with staged bilateral UKAs (staged group). There was no significant difference in gender, age, body mass index, osteoarthritis grading, and preoperative hip-knee-ankle angle, knee society score (KSS), visual analogue scale (VAS) score, and range of motion (ROM) of knee between the two groups ( P>0.05). The operation time, blood loss, hospitalization stay, minimum hemoglobin value during 10 days after operation, and hospitalization cost were recorded. The staged group was compared by the sum of two operations. The effectiveness was evaluated by KSS score, VAS score, ROM at 3, 6, 12 months after operation, and patient satisfaction scores were recorded at 12 months after operation. RESULTS: The operation time, hospitalization stay, and hospitalization cost of the simultaneous group were significantly lower than those of the staged group ( P<0.05). There was no significant difference in blood loss and the minimum hemoglobin value during 10 days after operation between the two groups ( P>0.05). Superficial infection occurred in 1 side of 1 case (7.1%) in staged group. Postoperative delirium occurred in 1 case (5.9%) in simultaneous group. There was no significant difference in incidence of postoperative complications between the two groups ( P=1.000). Patients in both groups were followed up 12-32 months (mean, 24.7 months). There was no significant difference in KSS score between the two groups at 3 months after operation ( t=0.896, P=0.392). KSS scores were significanly higher in simultaneous group than in staged group at 6 and 12 months after operation ( P<0.05). There was no significant difference in ROM and VAS scores between the two groups at 3, 6, and 12 months after operation ( P>0.05). At 12 months after operation, the patient satisfaction scores were significantly higher in simultaneous group than in staged group ( P<0.05). X-ray films showed no loosening of the prosthesis in the two groups. CONCLUSION: Simultaneous bilateral UKAs has the same security as staged bilateral UKAs. Meanwhile knee function recovery was better, hospitalization stay and hospitalization cost reduced, and patient satisfaction was higher in simultaneous bilateral UKAs.

Investigation of CVD graphene as-grown on Cu foil using simultaneous scanning tunneling/atomic force microscopy.

Scanning tunneling microscopy (STM) and atomic force microscopy (AFM) images of graphene reveal either a triangular or honeycomb pattern at the atomic scale depending on the imaging parameters. The triangular patterns at the atomic scale are particularly difficult to interpret, as the maxima in the images could be every other carbon atom in the six-fold hexagonal array or even a hollow site. Carbon sites exhibit an inequivalent electronic structure in HOPG or multilayer graphene due to the presence of a carbon atom or a hollow site underneath. In this work, we report small-amplitude, simultaneous STM/AFM imaging using a metallic (tungsten) tip, of the graphene surface as-grown by chemical vapor deposition (CVD) on Cu foils. Truly simultaneous operation is possible only with the use of small oscillation amplitudes. Under a typical STM imaging regime the force interaction is found to be repulsive. Force-distance spectroscopy revealed a maximum attractive force of about 7 nN between the tip and carbon/hollow sites. We obtained different contrast between force and STM topography images for atomic features. A honeycomb pattern showing all six carbon atoms is revealed in AFM images. In one contrast type, simultaneously acquired STM topography revealed hollow sites to be brighter. In another, a triangular array with maxima located in between the two carbon atoms was acquired in STM topography.

Simultaneous operation for cancer-related sigmoid colon perforation and abdominal aortic aneurysm of 76 mm in diameter.

Case: A 92-year-old woman was emergently admitted to our hospital for peritonitis caused by sigmoid colon cancer perforation, with a coexistent abdominal aortic aneurysm of 76 mm in diameter. Outcome: A 92-year-old woman was admitted to the hospital with a complaint of abdominal pain and fever of 24-h duration. On physical examination, severe tenderness with muscular defense and a palpable, pulsating mass were detected in the upper abdomen. The patient was diagnosed as having panperitonitis caused by sigmoid colon perforation. Computed tomography also revealed an infrarenal abdominal aortic aneurysm of 76 mm in diameter. We performed endovascular aneurysm repair to prevent aneurysmal rupture in the perioperative period and simultaneously performed intra-abdominal drainage and Hartmann's operation. The patient's postoperative course was uneventful. Conclusion: Simultaneous endovascular aneurysm repair and operation for peritonitis is considered a possible treatment strategy for patients at high risk of abdominal aortic aneurysm rupture.

Simultaneous thoracoscopic resection for coexisting pulmonary and thymic lesions.

BACKGROUND: The management of synchronous thymic and pulmonary lesions remains a challenge due to the lack of case series and surgical guidelines. This study aims to retrospectively review our preliminary experience and results of performing simultaneous thoracoscopic resection of coexisting diseases of the lung and thymus. METHODS: Simultaneous thoracoscopic resection was performed to remove coexisting thymic and pulmonary lesions in nine patients from August 2008 to November 2013. Patient demographics, preoperative assessment, surgical procedures and postoperative course of these patients were reviewed. RESULTS: There were four female and five male patients between 43 and 70 years old (median age, 64 years). Each patient had thymic neoplasm and solitary pulmonary lesion on chest computed tomography (CT) scan. Four patients underwent thoracoscopic lobectomy and thymectomy. One patient had thoracoscopic bronchovascular sleeve lobectomy combined with thymic cyst resection (TCR). The other four patients received pulmonary wedge resection and thymectomy (n=3)/TCR (n=1). The operation lasted from 35-480 min (median, 110 min). Intra-operative blood loss was 20-380 mL (median, 120 mL). Two patients developed post-operative pneumonia without mortality. All the patients were discharged home within 9 days after surgery. Two patients died from metastatic lung cancer 14 months after surgery. CONCLUSIONS: Simultaneous thoracoscopic resection of coexisting pulmonary and thymic lesions is safe and feasible in selected patients.

Combined total arch replacement and bypass from the ascending aorta to the bilateral profunda femoris arteries.

A 72-year-old woman who had aortic arch aneurysm was admitted. The patient was unable to walk without assistance because of aortoiliac occlusive disease. Total arch replacement and the ascending aorta to the bilateral profunda femoris artery bypass were performed during the same operation. On outpatient visits, the patient was able to walk with a cane and the ankle-brachial pressure index was markedly improved. This combined procedure is an option for patients with aortoiliac occlusive disease who are not candidates for alternate inflow procedures, especially when the patient has another indication for median sternotomy.

Simultaneous operation for cardiac disease and gastrointestinal malignancy.

AIM: To investigate the safety of performing simultaneous cardiac surgery and a resection of a gastrointestinal malignancy. METHODS: Among 3664 elective cardiac operations performed in adults at Kagoshima University Hospital from January 1991 to October 2009, this study reviewed the clinical records of the patients who underwent concomitant cardiac surgery and a gastrointestinal resection. Such simultaneous surgeries were performed in 15 patients between January 1991 and October 2009. The cardiac diseases included 8 cases of coronary artery disease and 7 cases with valvular heart disease. Gastrointestinal malignancies included 11 gastric and 4 colon cancers. Immediate postoperative and long-term outcomes were evaluated. RESULTS: Postoperative complications occurred in 5 patients (33.3%), including strokes (n = 1), respiratory failure requiring re-intubation (n = 1), hemorrhage (n = 2), hyperbilirubinemia (n = 1) and aspiration pneumonia (n = 1). There was 1 hospital death caused by the development of adult respiratory distress syndrome after postoperative surgical bleeding followed aortic valve replacement plus gastrectomy. There was no cardiovascular event in the patients during the follow-up period. The cumulative survival rate for all patients was 69.2% at 5 years. CONCLUSION: Simultaneous procedures are acceptable for the patients who require surgery for both cardiac diseases and gastrointestinal malignancy. In particular, the combination of a standard cardiac operation, such as coronary artery bypass grafting or an isolated valve replacement and simple gastrointestinal resection, such as gastrectomy or colectomy can therefore be safely performed.