122,240 research outputs found
The implementation of an Environmental Management System in a nord-african local public administration: the case of the City Council of Marrakech (Morocco)
No full textThe implementation of an Environmental Management
System in a nord-african local public administration: the case of the City Council of Marrakech
(Morocco)
A new approach for video-assisted thoracoscopic lobectomy "the caudal position"
No full textBackground: Despite a general agreement about effectiveness of video-assisted thoracic surgery (VATS) lobectomy the surgical technique is still not standardized, and many technical variations have been described until now. We describe our technique to perform thoracoscopic lobectomy by a caudal approach. Methods: We studied a position in which the operator stays from the inferior side of the thorax, positioning the patients in a lateral sitting position. This position ensures the operator to enjoy all the benefits of the anterior and posterior approach limiting the disadvantages of both. The surgeon maneuvers are further assisted and simplified by the movement of the surgical bed. Results: We perform 23 "caudal video assisted-lobectomy" for non-small cell lung cancer. The conversion rate was 0% and we had no complications related with the new approach. Conclusions: We think that our new position could be considered a further effective technical variation to perform VATS-lobectomy
Surgical Treatment of Non Malignant Tracheal Lesions: A Single Center Experience
No full textIntroduction: Different etiologies are responsible for a wide spectrum of tracheal injuries. Some of these, such as cicatricial laryngo-tracheal stenosis and tracheoesophageal fistula (T-E) not rarely represent a challenge in tracheal surgery. Aim of this study is to retrospectively review the pattern of post-intubation lesions, extension of surgery and long term results in 49 patients.
Methods: From December 1987 to February 2007, 49 patients (23 males and 26 females), mean age 50 (range 15–78), were submit- ted to surgical treatment: cicatricial tracheal stenosis (Group A), T-E fistula (Group B), and tracheal tear (Group C). All patients were symptomatic.
Results: No post-operative deaths. In Group A (n = 34) the stricture was considered moderate (residual lumen:30–50%) in 27 patients, and severe (<30%) in 7. Tracheal resection and reconstruc- tion (RR) was performed in 24 cases, laryngo-tracheal RR in 10. Two major complications were observed (partial dehiscence of the suture). In group B (n = 10): all patients underwent tracheal RR and direct closure of the T-E fistula. One patient died 10 days postop; 1 with minimal recurrence of the T-E fistula was treated by a temporary T- tube. In group C (n = 5): 3 patients (tear of the membranous wall) were submitted to immediate tracheal suture (right thoracotomy) protected with an intercostal-muscle flap. A trans-tracheal approach trough cervico-sternotomy was adopted in one case. One patient (small sub-cricoid tear) was treated in a conservative way.
Discussion: Good surgical results in the treatment of non- neoplastic tracheal lesions are based on: (1) patient selection; (2) tim- ing of surgery; (3) preoperative therapy; (4) meticulous surgical technique
[Surgical treatment of well differentiated neuroendocrine tumours of the lung].
No full textThe bronchial tree represents the most frequent site of origin of carcinoids (around 25% of the total). The spectrum of differentiation of lung neuroendocrine tumors ranges from low-malignancy (carcinoids) to highly aggressive forms (small cell lung carcinoma) Diagnostic and therapeutic strategies therefore vary greatly. In well differentiated tumors (carcinoids) signs and symptoms are related to the airways obstruction in central forms, while peripheral forms are mostly discovered accidentally if asymptomatic. Clinical or subclinical paraneoplastic syndromes are associated in a minority of cases. Diagnostic work-up includes CT multislice, bronchial endoscopy and Octreoscan with chest Single Photon Emission Computed Tomography (SPECT). Further contribute may be added by the (68), Ga-DOTA-D-Phe(1)-Tyr(3)-ocreotide (DOTATOC) and 5-hydroxytryptophan (5-HTP) PET-CT, at present available only in a few centres, and by endobronchial ultrasound (EBUS), fluorescence bronchoscopy and virtual bronchoscopy. Surgery is the treatment of choice, while medical therapy is useful to treat the hypersecretion in paraneoplastic syndromes and to control tumor proliferation in metastatic or/and inoperable disease
Uterine Leiomyoma Metastatic to the Lung
No full textIntroduction: Uterine leiomyomas belong to a heterogeneous family of tumors with peculiar biological behaviour. Pulmonary metastases may originate from frankly malignant leiomyomas (sarcomas) as well as from so called benign metastasizing leiomyomas. Latency between hysterectomy and metastatic disease may vary from few months to several years. We report two cases with an exceptionally long latent period.
Methods: Two cases of apparently primary giant lung tumor were observed. Both presenting clinical history of fever and malaise. Chest x-ray showed in both cases a left pulmonary opacity. Preoperative work-up yielded the diagnosis respectively of epithelial and mesenchymal tumor without extrapulmonary localization (CT and PET-CT).
Results: Case N 1: 68 year-old (Z.A.), the giant lobulated tumor, invading the hilar structures, required a left pneumonectomy. Histology revealed a metastatic uterine leiomyoma. She had under- gone hysterectomy for multiple leiomyomas 21 years previously. Case N 2: 66 year-old (M.M), was submitted to left pneumonectomy for a giant tumor extended to both lobes. Also in this case metastasis from uterine leiomyoma was diagnosed and confirmed by comparison with histology from hysterectomy (performed 16 years previously). There was no peri-operative mortality. Both the patients are alive without evidence of disease 6 and 3 months after surgery.
Discussion: These cases suggest that the diagnosis of primary pulmonary sarcoma needs careful pathological assessment and follow-up of the patients submitted to hysterectomy for leiomyoma should be protracted
Digital Transformation in Thoracic Surgery: a survey among the European Society of Thoracic Surgeons
No full textOBJECTIVES: Digital transformation has drastically changed the surgical sector, but few is known about its impact on thoracic surgical practice. The aim of this paper is to report the European Society of Thoracic Surgeons (ESTS) survey results, assessing the impact of and the need for Digital Transformation in Thoracic Surgery. METHODS: A 23-item survey was designed by the ESTS Digital Transformation Working Group to assess the impact of and the need for Digital Transformation in Thoracic Surgery. All ESTS members (1668) were invited to complete the survey between 13 March and 21 May 2022 anonymously. Data analysis was descriptive calculating frequencies and percentages. Group comparison was done using chi-square test. RESULTS: The response rate was 6.3%. Surgeons from 26 European countries participated of which more than 80% were based in academic hospitals. The impact of digital transformation was rated very important (43.8%) and fundamental (22.7%) in more than two-thirds of the cases, regardless of surgeons’ age. None of the participants felt that digital transformation was of no importance and more than 85% had implemented digital platforms in their direct patient care. Almost 90% of the surgeons, currently not using digital platforms for training and education, would consider introducing them. About 70% were at least ‘somewhat satisfied’ with their current engagement in Digital Transformation in Thoracic Surgery. CONCLUSIONS: Digital transformation seems to play a major role across European Thoracic Surgery departments in direct patient care, professional networking and surgical training. However, overall satisfaction with the current status of Digital Transformation in Thoracic Surgery was rather reserved, implying the need to increase the implementation of digital solutions in the latter
Effectiveness of antireflux surgery for the cure of chronic cough associated with gastroesophageal reflux disease.
No full textBACKGROUND: The effectiveness of surgical therapy for chronic cough secondary to gastroesophageal reflux disease remains controversial. The purpose of this study was to assess the efficacy of surgery and to identify the preoperative clinical profile that could predict the positive effects of treatment on chronic cough.
STUDY DESIGN: Of 299 patients who underwent antireflux surgery between 1995 and 2010, 67 patients were affected by chronic cough and typical symptoms. In addition, 83 patients with typical symptoms were selected to form the control group, according to the parameters of age, sex, and the period of surgical activity. Preoperatively, all patients underwent a workup, including symptom assessment, barium swallow, upper gastrointestinal endoscopy, esophageal manometry, and 24-h pH recording or intraluminal impedance/pH monitoring in the absence of esophagitis. Patients with chronic cough also were administered a high-resolution computed tomography scan of the chest, a methacholine challenge test, and spirometry. Surgery was performed on patients positive for gastroesophageal reflux disease and negative for pulmonary diseases. The patients were followed up for a median of 84 months after surgery.
RESULTS: No significant differences in preoperative reflux symptoms or esophagitis were found between the two groups. After surgery, chronic cough was absent in 57 (85 %) patients. Of the ten patients who still reported chronic cough, reflux symptoms relapsed in five, two of whom developed esophagitis. In the other five patients, typical symptoms were absent, and their chronic cough had improved but had not disappeared.
CONCLUSIONS: Surgery is effective for the treatment of chronic cough secondary to gastroesophageal reflux disease, particularly if associated with severe and long-standing typical symptoms
Institutional pressures on the adoption of environmental practices: a focus on European professional football
No full textInstitutional theory is one of the most common theories in management studies. However, there are few articles on sport sustainability management in the literature that adopt an institutional perspective. In addition, no studies have yet been published that analyse the dynamics of environmental management in the football industry through the lens of institutional theory. This article aims to bridge this gap by investigating the effects of institutional pressures on the adoption of environmental practices by football organisations. Based on a survey of managers of professional football clubs and stadium owners, six different hypotheses are tested through multivariate regression. The results show the positive influence of coercive and normative pressures in the adoption of environmental governance and environmental operational practices, respectively. The article leads the way to new research avenues for sport management scholars and institutionalists, as well as providing implications for football managers and policymakers
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