: Pancoast tumors, situated at the lung's apex, pose a unique challenge due to their proximity to critical structures. The evolution in surgical techniques, particularly video-assisted thoracic surgery (VATS), offers innovative methodologies for the effective treatment of these tumors. This article provides an in-depth exploration of the advancements and applications of VATS techniques, catering specifically to Pancoast tumors. The history of VATS is traced, dissecting the divergence between conventional VATS (c-VATS) and advanced VATS (a-VATS). We spotlight how technological progressions have bolstered the prominence of these techniques. Contemporary evidence points towards a growing inclination for VATS, which is attributable to its tangible benefits. Patients undergoing VATS typically experience attenuated post-operative discomfort and an expedited return to normal mobility. An emerging subset of VATS, the uniportal VATS, marks a significant stride in minimally invasive thoracic surgery. The inception, development, and benefits of this revolutionary technique are meticulously detailed, offering readers a clear understanding of its potential. Navigating complex surgical situations, especially when the tumor impinges on the vertebrae, the article sheds light on the hybrid approach. This approach amalgamates the strengths of various techniques, furnishing surgeons with a robust framework to operate effectively. In summation, the manifold advantages of VATS, from patient recovery to pain mitigation, underscore its significance in thoracic oncology. However, for its potential to be fully harnessed, strict adherence to oncological guidelines and superior surgical acumen are imperative. This article serves as a comprehensive guide, bridging the knowledge gap and accentuating the pivotal role of VATS in the contemporary surgical landscape.
Introduction Numerous surgical approaches and hemostatic techniques are used and have been described when operating on the traumatized liver. Despite a substantial decline in operative liver trauma, there still remains a debate on the optimal surgical approach, and goals, during the initial trauma laparotomy. Hepatic resection during the first operation, including the damage control settings, is advocated and practiced in only a select few institutions and remains highly controversial. Here, we describe our success with hepatic resection, repair, and/or hepatic vascular repair, during the trauma laparotomy with our emphasis on the collaboration between the trauma and hepatobiliary surgical teams. Case Series From 207 patients with liver injuries during the study period, 7 patients had definitive liver resection or repair during the initial trauma laparotomy. One had hepatic tissue repair, 1 had hepatic vein repair, and 5 had liver resections. All the operations involved a hepatobiliary surgeon together with the trauma team. There were no fatalities in the liver operation group, no sepsis, or need for emergent angiography because of hemorrhage. Four patients needed endoscopic retrograde cholangiopancreatography (ERCP) and stenting because of biliary leak. Three patients were discharged home and 4 to rehabilitation. Discussion Hepatic resection, and/or definitive hepatic repair, may be safe and beneficial to the patients during the initial operation even in a damage control setting when the patients’ overall condition allows. We emphasize the benefit of collaboration with experienced and trained liver surgery, especially in lower volume trauma centers. ERCP is commonly needed for postoperative biliary leak and should be readily utilized.
Abstract Purpose Both β1‐ and β2‐adrenoceptor proteins were detected on the cell surface of pancreatic ductal adenocarcinoma. The current study evaluated the association between beta‐blocker use and pancreatic cancer risk. Methods We conducted a nested case‐control study in a large population representative database. Each pancreatic cancer case was matched with four controls based on age, sex, practice site, and duration of follow‐up using incidence density sampling. Beta‐blocker use was defined as any prescription prior to index date and was stratified into non‐selective and selective β 1 ‐blockers. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for pancreatic cancer risk associated with beta‐blocker use was estimated using conditional logistic regression. Results The study included 4113 patients with pancreatic cancer and 16 072 matched controls. When compared to never users, there was no association between any beta‐blocker use and pancreatic cancer risk (adjusted OR 1.06, 95% CI 0.97‐1.16, P = .16). Analysis by receptor selectivity showed use of non‐selective beta‐blockers for more than 2 years was associated with a reduced pancreatic cancer risk (OR 0.75, 95% CI 0.57‐1.00, P = .05). When compared to former users both users of selective β1‐blockers and non‐selective beta‐blockers had a reduced pancreatic cancer risk (OR 0.78, 95% CI 0.67‐0.90, P = .001) and (OR 0.67, 95% CI 0.49‐0.92, P = .01), respectively. Conclusion Beta‐blocker use was not associated with increased pancreatic cancer risk. However, long‐term use of beta‐blockers may be associated with decreased pancreatic cancer risk.
BACKGROUNDOn February 24, 2022 hostilities broke out in Ukraine resulting in a full-scale humanitarian crisis with thousands of civilians injured, twelve million persons displaced -seven million internally displaced and five million refugees fleeing the country.The crisis led to a severe disruption of routine medical services.These circumstances, combining warfare and refugees, pose major challenges to the international aid community: Treating the wounded, addressing the medical and psychosocial needs of the displaced populations, meeting routine medical needs of under-served local populations, and strengthening resilience through capacity building of the disrupted local healthcare system [1,2]. MISSIONThe State of Israel, which in all its past humanitarian missions deployed military field hospitals [3-5], decided, for the first time, to deploy a civilian field
The clinical presentation of acute appendicitis in the youngest age lacks specific signs and symptoms, and it is difficult to obtain an accurate clinical diagnosis. Once the diagnosis is made, it is necessary to determine if the appendicitis is simple and able to be managed non-surgically, or complicated, therefore requiring surgery. Together with the clinical picture and imaging, routine laboratory values play a vital role in this decision. The aim of this study is to evaluate routine blood in their ability to differentiate between complicated and uncomplicated acute appendicitis.A retrospective analysis was conducted from a single pediatric surgery department of all children 5 years of age or younger who underwent surgery for acute appendicitis between the years 2010-2020.728 children were diagnosed with acute appendicitis, and 42 children were under the age of 5 years. There was a significant difference in the C-reactive protein, white blood cell count, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio in the complicated group versus the uncomplicated group. The value of these together for prediction complicated appendicitis were 84.8% sensitivity, 80.9% specificity, 82.8% positive predictive value, and 72.8% negative predictive value. These values were all higher than both the Alvarado score and the PAS (P < .05).C-reactive protein, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio are simple laboratory parameters that can help identify complicated versus uncomplicated appendicitis in children 5 years old or younger. These universal parameters may help guide the treatment and decision to operate on a difficult to diagnose population.
