1,721,078 research outputs found
COMPOSITIONS BIOADHESIVES BIFONCTIONELLES DESTINEES A L'IMPLANTOLOGIE ORALE
No full textBioadhesive solutions of bisphosphonates and Tween 20 are described, with an action that promotes ossification, useful for applications in oral implantology. With respect to the compositions currently in use, these solutions have the advantage of a greater permanence in-situ, before, during and after application of the implant, they present a more intense action of the drug, prolonged over time, and favour complete ossification around the implant
EComment. Systemic inflammation and pulmonary metastasectomy: Ideas for further development
No full textBifunctional bioadhesive compositions for oral implantology
No full textBioadhesive solutions of bisphosphonates and Tween 20 are described, with an action that promotes ossification, useful for applications in oral implantology. With respect to the compositions currently in use, these solutions have the advantage of a greater permanence in-situ, before, during and after application of the implant, they present a more intense action of the drug, prolonged over time, and favour complete ossification around the implant
From “Awake” to “Monitored Anesthesia Care” Thoracic Surgery. a 15 Years Evolution
No full textDespite general anesthesia still represents the standard to perform thoracic surgery, the interest toward alternative methods is increasing. These has evolved from the employ of just local or regional analgesia technique in completely alert patients (awake thoracic surgery), to more complex protocols entailing conscious sedation and spontaneous ventilation. The main rationale of these methods is to prevent serious complications related to general anesthesia and selective ventlation, such as tracheobronchial injury, acute lung injury, and cardiovascular events. Also, trends toward shorter hospitalization and reduced overall costs have been indicated in preliminary reports. Monitored anesthesia care thoracic surgery can be successfully employed to manage diverse oncologic conditions, such as malignant pleural effusion, peripheral lung nodules, and mediastinal tumors. Main non-oncologic indications include pneumothorax, emphysema, pleural infections, and interstitial lung disease. Furthermore, as the familiarity with this surgical practice has increased, major operations are now being performed this way. Despite the absence of randomized controlled trials, there is preliminary evidence that monitored anesthesia care protocols in thoracic surgery may be beneficial in high-risk patients, with non-inferior efficacy when compared to standard operations under general anesthesia. Monitored anesthesia care thoracic surgery should enter the armamentarium of modern thoracic surgeons, and adequate training should be scheduled in accredited residency programs
Team training for nonintubated thoracic surgery
No full textNonintubated thoracic surgery needs a specific formation of a well-trained and close-knit staff,
including surgeons, anesthesiologists, scrub nurses, operating room, and floor assistants.
Operation requires advanced surgical skill compared with normal video-assisted thoracic surgery
due to the presence of breathing or cough, patient anxiety, intolerance, or hypercapnia.
Dry laboratory and wet laboratory training may be of scant value due to the impossibility of reproducing
lung movements, whereas visiting a high-volume center or hosting an experienced team
would be of greater value.
Communication with patients, preoperatively and intraoperatively, and among the surgical team is
pivotal and should follow a precise plan, reassuring the subjects, inciting them when necessary,
with avoiding of impatience and anxiety
Role of systemic inflammation scores in pulmonary metastasectomy for colorectal cancer
Full text linkBackground: Patients with pulmonary metastases from colorectal cancer can
benefit from surgical removal.However, the biological determinants of postsurgical
outcome are not completely elucidated. We evaluated the role of host systemic
inflammation status in this setting.
Methods: The modified Glasgow prognostic score (based on serum C-reactive
protein and albumin levels) and the neutrophil-to-lymphocyte (NTL) ratio were
obtained from 44 patients who received curative-intent metastasectomy, and were
used as indicators of systemic inflammation status.We tested the impact of both of
these parameters on overall survival (OS) and progression-free survival (PFS), as
well as their correlation with other well-known prognosticators.
Results: Five-year PFS and OS rates were 18% and 49%, respectively. At univariate
analysis,multiple metastases, disease-free interval <36 months, and a Glasgow score
of 2 (P = 0.031)were significantly associated to aworse PFS rate.A NTL ratio >3 predicted
disease progression in the short-term(P = 0.036), but the effect on late events
was weaker (P = 0.079). Factors associated with worse OS were multiple metastasis
(P = 0.002), elevated carcinoembryonic antigen (P = 0.009), a Glasgowscore of 2 (P =
0.029), and a faster metastasis growth (P = 0.008).At Cox regression analysis, neither
a Glasgow score of 2, nor elevated NTL ratio showed an independent effect on survival
rates.
Conclusions: Systemic inflammation scores did not perform well as independent
survival prognosticators in patients undergoing curative-intent pulmonary
metastasectomy. Further investigation is warranted to evaluate whether these measurements
could still be useful when restricting the analysis to specific patient subcategories
or to diverse postoperative phases
Systemic Host Response in Awake Thoracic Surgery
No full textSystemic response to surgery entails the activation of hormonal, metabolic and inflammatory pathways, and may affect postoperative outcome due to interaction with host’s immunity, metabolism, organ function, coagulation, and wound healing.
In recent years, we have being actively involved with video-assisted thoracoscopic surgery performed on spontaneously ventilating patients (awake VATS), with the use of just local- or locoregional anesthesia techniques. Amongst the expected advantages of this approach, an attenuation of postoperative response has been hypothesized, potentially contributing to a more physiological recovery. In particular, our recent observation has showed that avoidance of one-lung ventilation may result into attenuated release of stress hormones and systemic inflammation biomarkers including Creactive protein and interleukin-6 in patients undergoing awake videothoracoscopic procedure. In this chapter, we review the basic knowledge on systemic host response after surgery, whit particular reference to our most recent evidences in this setting
Awake Thoracoscopic Bullaplasty
No full textStaple excision of emphysematous bullae through general anesthesia is the standard surgical treatment of bullous emphysema.
We have developed a new surgical technique entailing thoracoscopic bullaplasty performed in fully awake patients through sole epidural anesthesia.
Methods
This prospective nonrandomized trial included 35 patients undergoing awake thoracoscopic bullaplasty between 2002 and 2009. Preoperative work-up included computed tomography with algorithm for quantitative measurement of the bulla volume. Outcome measures included technical feasibility and patient’s satisfaction with the anesthesia, scored into 4 grades (1=unsatisfactory;4=excellent); ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2), and postoperative assessment of standard clinical measures at 6, 12 and 36 months.
Results
There were 29 men and 6 women with a median age of 60 years. Median volume of the bulla was 688mL. Awake bullaplasty was successfully completed in 34 patients. Perioperatively, PaO2/FiAO2 decreased significantly (ANOVA,P<0.0001) though remaining satisfactory (>300mmHg) whereas PaCO2 increased intraoperatively (ANOVA, P<0.0001) but returned to baseline values 1h after surgery (P=0.20). There was no mortality while 4 patients had air leaks longer than 7 days. Mean hospital stay was 4.9±2.2 days.
Comparisons between pre- to 6-month changes in outcome measures showed improvements (P<0.0001) in FEV1 (+0.37L), residual volume (-1.16L), dyspnea index (-2) and SMWT (+71m). These improvements lasted for up to 36 months and in no patient did operated bullae recur.
Conclusion
Our study suggests that awake thoracoscopic bullaplasty was well tolerated and easily performed in the majority of the patients and significant clinical improvements lasted for up to 36 months
Nonintubated Videothoracoscopic Operations in Thoracic Oncology
Full text linkBackground: Despite general anesthesia with one-lung ventilation represents the standard to perform thoracic
surgery operations, there is an increasing interest toward alternative methods, such as the use of local or neuroaxial
analgesia alone in fully alert or mildly sedated patients. These can be applied to perform a series of
videothoracoscopic procedures.
Material and Methods: We reviewed our own institutional experience with this kind of surgery, as well as the
most relevant literature findings available on this topic at the usual search websites (PubMed, Scopus, EMBASE).
We focused on more recent advances regarding indications, expected advantages, possible pitfalls and implications
for future research.
Results: Such an operative modality can be safely and successfully adopted to manage a series of common
malignant and non-malignant diseases. In thoracic oncology, it is mainly employed to treat malignant pleural
effusion, to remove of pulmonary lesions of any origin, and to perform mediastinal biopsies. Furthermore, even
complex procedures such anatomic lung resections and thymectomy are now being performed in this way. When
taking into the account just intermediate to major surgeries, reported conversion rates to general anesthesia range
between 2.8 and 9%. Despite the lack of randomized controlled trial, there is a general perception that non-intubated
videothoracoscopic operation may translate into a lower morbidity rate, better hematosis, and preserved
perioperative immunosurveillance. No sufficient data is available as far as long-term outcomes are concerned.
Conclusions: Non-intubated videthoracoscopic operations may be as effective as the equivalent procedures
performed with general anesthesia, while providing advantages in terms of cost and postoperative morbidity. This
surgical practice should thus be included in the armamentarium of modern era thoracic surgeons, and appropriately
designed studies should be undertaken to better define its merits and limitations
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