Midpoint transverse process to pleura block for postoperative analgesia following laparoscopic renal cyst decortication:Two case reports

BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication.To address safety concerns associated with TPVBs,we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication.The MTP block was performed at the T9 level under ultrasound guidance,with 20 mL of 0.5%ropivacaine injected.Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels.Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement,with none exceeding a mean 24 h numeric rating scale>3.CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.

Decade Experience in Pleurectomy and Lung Decortications for Chronic Empyema Thoracis

Background: Chronic empyema thoracis is a debilitating illness with high morbidity and mortality, and is seen among all age groups in Nigeria. Objective: To review all cases of chronic empyema thoracis treated by pleurectomy and lung decortication and highlight the indications, challenges and the outcome. Materials and Method: In a 10-year period spanning 2007-2016, 90 patients with chronic empyema thoracis were admitted and managed in our institution. A retrospective study of 36 patients who underwent surgery was performed. Results: Ten patients (27.80%) out of 36 patients had unsuccessful one month closed chest tube drainage (CTTD). Six patients (16.67%) were referred from peripheral hospitals as chronic empyema thoracis that had failed CTTD. The remainder, 20 (55.60%) were diagnosed as chronic empyema thoracis de novo. Conclusion: Chronic empyema thoracis is a very difficult disease to manage especially in developing countries like ours, where patients present very late and the requisite facilities are inadequate.

Indwelling Pleural Catheter Insertion Following Inefficient Thoracoscopic Decortication in Postpneumonic Empyema: Beneficial or Contraindicated?

Video assisted thoracic surgery in advanced stage postpneumonic empyema aims for thorough debridement and washout of the pleural space followed by an attempt to release the entrapped lung (decortication). When the latter isn’t successful, and the patient is in a poor performance status, applying tube thoracostomy is the usual routine, to avoid conversion to thoracotomy and open decortication. Tube thoracostomy, however, is associated with complications necessitating further surgery, needs long term follow up and also entails quality of life distorting issues. To overcome these disadvantages, we instead inserted a PleurX&reg indwelling pleural catheter in four patients in the above situation. The method brought success (lung re-expansion and complete or partial pleurodesis) without the need for further surgery or quality of life problems in either patient. Although the use of the indwelling pleural catheter in infected pleural space is not recommended by manufacturers, we noted no complications.

Effect of body mass index on the operation time and postoperative hospital stay of retroperitoneal laparoscopic renal cyst decortication

Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Methods:A retrospective cohort study was conducted among 81 patients with single simple renal cyst who had undergone retroperitoneal laparoscopic cyst decortication from January 2017 to December 2019 in Wuxi Xishan People's Hospital.All patients were divided into three groups according to BMI:normal group(BMI<25 kg/m^(2),n=44),overweight group(BMI=25-30 kg/m^(2),n=21),and obese group(BMI>30 kg/m^(2),n=16).Multiple linear regression was conducted to investigate the correlation.Results:The three groups were comparable in terms of age,gender,maximum diameter of cyst,and cyst location.In the aspect of operation time,only the patients in obese group had longer duration when compared with those in the normal group(59.1±15.7 min vs.45.2±12.8 min,p=0.001).And the patients in the obese group had significantly longer hospital stay compared with those in the normal group(6.2±1.9 d vs.5.2±0.5 d,p=0.002)and overweight group(6.2±1.9 d vs.5.0±1.0d,p=0.001).In the analysis of multiple linear regression,it was found that operation time is significantly affected by BMI and location 2,with coefficients of 1.299 and -8.646 respectively.The influence of BMI was greater than location 2(0.335 vs.-0.289).For hospital stay,only BMI had an effect on it,with a coefficient of 0.110.Conclusion:BMI was a major factor that associated with longer operation time and hospital stay in patients with retroperitoneal laparoscopic renal cyst decortication.

Epdemiology and Treatment of Pseudarthrosis of Long Bones in the Servce D Orthopedics-Traumatology of the University Hospital of Donka

Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.

Cancer-directed surgery in malignant pleural mesothelioma: extrapleural pneumonectomy and pleurectomy/decortication

Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-year.In recent years,extra-pleural pneumonectomy has decreased in popularity due to a high morbidity rate and mortality compared to pleurectomy/decortication and other therapeutic alternatives.In this review,we will discuss both procedures,outcomes,ongoing studies,and the roles of surgery in the future treatment of this disease.

The efficacy of augmentative anti-rotational plating plus decortication and autogenic bone grafting for aseptic nonunion after intramedullary nailing of femoral shaft fracture

Background:Femoral interlocking intramedullary(IM)nailing fixation is an effective method for the treatment of femoral shaft fractures.Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon.Currently,the treatment for aseptic femoral shaft nonunion is controversial.The aim of this study was to investigate the clinical effect of augmentative antirotational plating plus decortication and autogenic bone grafting for aseptic femoral shaft nonunion after IM nailing failure.Methods:A retrospective study was conducted on 25 cases of aseptic femoral shaft fracture nonunion treated with IM nailing from January 2015 to August 2019.All patients were treated by leaving the nail in situ,debridement of nonunionsites,decortication,autogenous iliac bone grafting,and augmentative antirotational plating fixation.The time to fracture union and complications were recorded.Results:All patients were followed up for 12–18 months.The union rate after revision surgery was 100%.The average union time was 5.5months(range,4-10).Subjective pain symptoms had disappeared in all patients.There were no incision infections or internal fixator fatigue fractures.Average scores of the physical function and bodily pain components of the SF-36 were 95.5(range,91-98)and 94.1(range,90-97),respectively.No other obvious complications occurred postoperatively.Conclusion:Augmentative antirotational plating plus decortication and autogenic bone grafting is an excellent choice for treating femoral shaft fracture nonunion after IM nailing;this approach has an overall high union rate and few complications.

Decortication and visual deprivation do not affect two types of directional properties of LGNd relay cells in the cat

Direction sensitivity is an important receptive property of visual cortical cells.On thesubcortical visual pathways,recent studies have shown that about 32% of LGNd relay cellsand 25% of retinal ganglion cells presented direction sensitivity.This kind of directionsensitivity was also present in LGNd neurons of decorticate cats and dark-reared cats.Zhou et al.described two different types of direction sensitive cells in

Current management of autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease （ADPKD）, the most frequent cause of genetic renal disease affecting approximately 4 to 7 million individuals worldwide and accounting for 7%-15% of patients on renal replacement therapy, is a systemic disorder mainly involving the kidney but cysts can also occur in other organs such as the liver, pancreas, arachnoid membrane and seminal vesicles. Though computed tomography and magnetic resonance imaging （MRI） were similar in evaluating 81% of cystic lesions of the kidney, MRI may depict septa, wall thickening or enhancement leading to upgrade in cyst classification that can affect management. A screening strategy for intracranial aneurysms would provide 1.0 additional year of life without neurological disability to a 20-year-old patient with ADPKD and reduce the fnancial impact on society of the disease. Current treatment strategies include reducing： cyclic adenosine monophosphate levels, cell proliferation and fluid secretion. Several randomised clinical trials （RCT） including mammalian target of rapamycin inhibitors, somatostatin analoguesand a vasopressin V2 receptor antagonist have beenperformed to study the effect of diverse drugs ongrowth of renal and hepatic cysts, and on deteriorationof renal function. Prophylactic native nephrectomy isindicated in patients with a history of cyst infection orecurrent haemorrhage or to those in whom space musbe made to implant the graft. The absence of largeRCT on various aspects of the disease and its treatmen leaves considerable uncertainty and ambiguity in many aspects of ADPKD patient care as it relates to end stage renal disease （ESRD）. The outlook of patients with ADPKD is improving and is in fact much better than that for patients in ESRD due to other causes. This review highlights the need for well-structured RCTs as a frst step towards trying newer interventions so as to develop updated clinical management guidelines.

Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report

A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia, and fever. Diagnosis of esophageal perforation follow- ing fish vertebra ingestion was made by history review, pneumomediastinum and an irregular hyperdense lesion noted in initial chest radiogram. Neck computed tomo- graphy (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tra- cheal fistula was shown by esophagogram. The initial re- sponse to treatment of fish bone removal guided by pan- endoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately, the patient’s condition finally improved after decortica- tion, mediastinotomy and perforated esophagus repair. To our knowledge, this is the first case report of esopha- geal perforation due to fish bone ingestion in infancy. In addition to particular caution that has to be taken when feeding the innocent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.

SImmetry^&regSacroiliac Joint Fusion System with SImmetry Decorticator^&reg

Low back pain (LBP) is one of the most prevalent, disabling and costly medical conditions affecting modern society. LBP presents a significant challenge to effective treatment due to often multifactorial or unknown etiology. Since the 1980s, the sacroiliac (SI) joint has become increasingly recognized as a common source of LBP. In contrast to other sources of LBP such as internal disc disruption and even psychosocial factors, SI joint pain and degeneration are reliably identified with provocative manual tests and diagnostic injections. Fusion of the SI joint has been shown to provide enduring symptom relief, and minimally invasive techniques developed over the past decade have further reduced the operative risks associated with open fusion surgery. Minimally invasive SI joint fusion surgeries are typically performed by placing rigid implant components across the joint space. The implants provide mechanical fixation while bony fusion develops. Decortication of the SI joint space during the procedure produces a bleeding bone surface that allows for increased availability of autologous mesenchymal stem cells and growth factors at the fusion site. Coupled with the mechanical stability provided by the implant and autologous bone graft, decortication provides an optimal environment for bone growth and subsequent fusion of the joint. This report describes the background of SI joint disease, treatment, and the minimally invasive SImmetry? Sacroiliac Joint Fusion System (Zyga Technology, Inc., Minnetonka, MN, USA), with emphasis on the decortication instrumentation and procedure.

Surgical Management of Pyothorax: A Series of 172 Cases

Introduction: The pyothorax or thoracic empyema is defined by the presence between the two pleural layers of a purulent liquid, or a non-purulent liquid, but with bacteriological or biochemical characteristics testifying to a microbial invasion. The use of early medical treatment prevents the passage to pleural encystment, whose management remains surgical. Material and Methods: Our study was performed retrospectively, in the department of thoracic surgery of CHU Hassan II of Fez, between 2010 and 2016, involving 172 patients operated for pyothorax. Results: Among the 172 patients included in our study, there were 110 men and 67 women. The average age was 32.11 years old. The clinical picture was dominated by pleural syndrome in 56% of cases, signs of tuberculous impregnation in 44.1% of cases. Preoperative preparation with thoracic drainage, bi-antibiotic therapy and respiratory physiotherapy was performed in 90% of cases. The attack was right in 55.8% of cases and left in 44.1%. A chest CT scan performed in all patients showed pachypleuritis in all cases. The tuberculous pyothorax accounted for 54% of cases, those by intra pleural rupture of a pulmonary hydatid cyst in 10.4%, para-pneumonic origin in 5.2% and post-traumatic in 4.06%. The origin was undetermined in 26.16%. A conservative posterolateral thoracotomy was performed in all our patients. The pulmonary release was done through the extrapleural plane in 94% of cases, and pleuropulmonary decortication performed in all cases. Atypical resection was associated in 4.3% of cases and peri-cytectomy in 13.9% of cases. Operative follow-up was simple in 79.6% of cases. The main postoperative complications were a prolonged aerial leak in 16.7%, atelectasis in 4.5%, a wall infection in 6.5%, a hemothorax refrained in 3.2% of cases. The average follow-up was 2.5 years. Conclusion:?Tuberculosis remains the most common etiology of pyothorax in our setting. Early management plays an important role in reducing the morbidity and mortality of this pathology. However, surgery remains the only effective treatment at the pleural encystment stage.

Performance Improvement for Sisal Waste Anaerobic Biodegradation by Digester Redesign and Feed Size Reduction

This Anaerobic Digestion of Sisal decortication residue (SDR) from sisal decorication unit at Hale biogas plant in Tanga (Tanzania) is presented. The study was done to address the challenges facing Katani limited at Hale biogas plant. This plant was built as pilot before building other biogas plants. These challenges were like high retention time of substrate which was SDR, low biogas productivity, high investment costs due to large tanks sizes and low plant availability. From the study, it was discovered that, when particle size was reduced biogas production increased, degradation of SDR also increased and no significant change in biogas composition. Increase in biogas yield of 30% and 129% were recorded for reduced SDR compared to raw size SDR digested at atmospheric condition and 40°C respectivelly. SDR degradation measured in TS and VS removal efficiency, showed increase in degradation of about 5% for the reduced particle size compared to raw size particle. The study concluded that SDR was good raw material for biogas production when 90% of the particles reduced to less than 2 mm. To maximize production, digestion must be conducted at high temperature around 40°C with constant monitoring and control of all para-meters. This will increase plant availability by increasing efficiency and life span of the pumps and stirrers.

Optimizing the Performance of a Manually Operated Groundnut (Arachis hypogaea) Decorticator

Shelling of groundnut pods using manual decorticators in Kenya is characterized by high kernel breakages and low shelling efficiencies. As a result, farmers get low income due to low cost of broken kernels and a lot of time is lost in the tedious shelling operation. To overcome this problem, pertinent parameters that influence shelling efficiency of manually operated groundnut decorticators were identified. Two manually operated decorticators were tested and modifications done on one of the decorticators to optimize its technical performance. Results of machine performance tests showed that for WBS (Wooden beater sheller) at a feed rate of 30 kg/hr and 22.6 mm clearance, shelling efficiency increased with decrease in moisture content for all the groundnut varieties. The highest shelling efficiency was 55.3% for ICGV 99568, 39.2% for ICRISAT Groundnut Variety (ICGV) 90704 and 29% for ICGV 12991 at moisture content of 5.92% wb. For RBS (Rod beater sheller) at a feed rate of 30 kg/hr and 22.6 mm clearance, the highest shelling efficiency was 58.3% for ICGV 99568, 42.7% for ICGV 90704 and 35% for ICGV 12991 at moisture content of 7% wb. Identification of the pertinent parameters showed that pod moisture content, clearance and sieve size influence performance of manually operated groundnut. Theoretical predictive models developed were optimized which showed that a maximum shelling efficiency of 88.73% can be achieved with percent damage of 4% when the sieve size is 11 mm and clearance is 16 mm with a regression coefficient of over 85%. With the modifications done on the WBS decorticator, the highest shelling efficiency of 87% was obtained at a clearance of 10 mm for ICGV 99568 which is the largest in size from the three varieties. The shelling efficiency of the modified decorticator is far above those of the RBS and WBS because the sieve sizes and clearances of the later were not optimized. The results of the theoretical optimization of the manually operated groundnut decorticator implies that farmers who shell for seeds can now obtain more seeds shelled with low breakage and therefore will get more income.

Formation of RRR-a-tocopherol in rumen and intestinal digestibility of tocopherols in dairy cows

Tocopherol sources in diets are often a combination of all-rac-a-tocopheryl acetate(synthetic a-tocopherol)from vitamin supplements and natural tocopherols and 2R-(4’R,8’R)-5,7,8-trimethyltocotrienol(a-tocotrienols)from the feed sources.Synthetic a-tocopherol consists of 8 different stereoisomers including 2R-(4’R,8’R)-5,7,8-trimethyltocol(RRR-a-tocopherol),2R-(4’S,8’R)-5,7,8-trimethyltocol(RSR-a-tocopherol),2R-(4’R,8’S)-5,7,8-trimethyltocol(RRS-a-tocopherol),2R-(4’S,8’S)-5,7,8-trimethyltocol(RSS-a-tocopherol),2S-(4’S,8’S)-5,7,8-trimethyltocol(SSS-a-tocopherol),2S-(4’R,8’S)-5,7,8-trimethyltocol(SRS-a-tocopherol),2S-(4’S,8’R)-5,7,8-trimethyltocol(SSR-a-tocopherol),and2S-(4’R,8’R)-5,7,8-trimethyltocol(SRR-a-tocopherol).The pre-absorption metabolism of tocopherols and tocotrienols in ruminants differs from monogastric animals due to the extensive microbial fermentation in the anaerobic rumen.The current study investigated the impact of toasting and decortication of oats on metabolism in the digestive tract(synthesis,digestion),and intestinal digestibility of tocopherols in dairy cows by using 4 ruminal and intestinal cannulated Danish Holstein cows in a 4×4 Latin square design for 4 periods.Cows were fed a total mixed ration ad libitum containing different forms of oats:whole oat,decorticated oat,toasted oat,and decorticated toasted oat,all rolled before mixed ration.Overall means across 4 treatments were statistically analyzed,testing whether overall means were different from zero.Decortication or toasting did not affect the balance or digestibility of a-tocopherols in rumen.Average across treatments showed the ruminal degradation of synthetic a-tocopherol(279 mg/d,P=0.02;P-value shows that average across treatments is different from zero),synthetic 2R-a-tocopherol(133 mg/d,P<0.01;summation of RRS-,RSR-and RSS-a-tocopherol),and 2S-a-tocopherol(190 mg/d;P<0.01,summation of SSS-,SRS-,SSR,and SRR-a-tocopherol),while RRR-a-tocopherol was formed in the rumen(221 mg/d,P=0.10).The average across treatments showed that small intestinal digestibility of tocopherols ranked in the following order:a-tocotrienol>natural a-tocopherol>synthetic a-tocopherols>2R-(4’R,8’R)-,7,8-dimethyltocol(γ-tocopherol).The average across treatments for small intestinal and feed-ileum digestibility ranked in the following order:RRR-a-tocopherol>synthetic 2R-a-tocopherol>2S-a-tocopherol.Results showed the first evidence for RRR-a-tocopherol formation under anaerobic conditions in the rumen.In addition,synthetic a-tocopherol stereoisomers,γ-tocopherol and a-tocotrienol were degraded in the rumen.There was a discrimination against absorption of synthetic 2R-and 2S-a-tocopherol in the small intestine.

The surgical-based treatment of malignant pleural mesothelioma: a literature review of a still ongoing debate

Background and Objective:Pleural mesothelioma is an aggressive disease with poor prognosis due to the tendency to relapse.Despite the lack of uniform protocols of therapy,surgery remains the cornerstone of multimodal treatment.Nevertheless,the debate on which is the optimal choice for surgical-based approach lasts over time and is based over the oncological benefits of obtaining a theoretical greater radicality rather than preserving the anatomical integrity in view of further treatments.This review is intended to summarize the topics of this dispute still ongoing.Methods:A review on the PubMed/Medline literature database of the different surgical approach was carried out,screening all the publications in English from 2000 to 2021.The search strategy has been focused on comparative studies of surgical techniques to understand if and how the choice of the type of surgery to be offered in the forefront has changed over the years.Key Content and Findings:Within the multimodal strategy the goal of surgery,performed with radical intent,is to achieve the macroscopic complete removal.Two procedures are aimed to this purpose:the lung-sacrificing surgery as the extrapleural pneumonectomy and the lung-sparing surgery as the pleurectomy/decortication extended or not to resection/reconstruction of diaphragm and pericardium.Many centers today have abandoned the most radical procedure in favor of the most conservative,but the superiority of one technique over the other remains controversial.Conclusions:In the absence of comparative randomized trials,the choice of surgical technique is determined by the experience of individual centers and by the attitude of surgeons.Further research is needed to standardize treatment protocols and to define the role of surgery in the context of multimodal therapy.

Effects of moisture content and feed rate on milling characteristics of wild apricot pits (Prunus armeniaca L.)

Milling with decortication of wild apricot pits was done in wild apricot pit decorticator working on the principle of“impact and compression”.The milling characteristics includes decortication efficiency,percentage of husk,percentage of broken kernels and output capacity was evaluated at the different levels of moisture content,i.e.,8%,10%,12%,14%and 16%(w.b.)and feed rates,i.e.,12 g/stroke,14 g/stroke,16 g/stroke,18 g/stroke and 20 g/stroke.The moisture content as well as feed rate significantly(P<0.05)affected the decortication efficiency,percentage of husk as well as brokens and output capacity.Decortication efficiency was initially increased and then decreased and opposite nature was found for the percentage of husk.Both percentage of broken kernels and output capacity decreases with the increase in moisture content,while output capacity increases with the increase in feed rate and brokens decreases with the increase in feed rate of wild apricot pits.

Initially Organized Arrangement of Orientation and Direction Sensitivities of LGNd Relay Cells in Decorticate Cats

Since Levick et al. found and studied the orientation biases of retinal ganglion cells of cats, there has been increasing interest in subcortical orientation sensitivity. Shou et al. studied the orientation sensitivity of dorsal geniculate nucleus (LGNd) relay cells of the cat in details. They found that cells with similar preferred orientation are clustered in the LGNd, which is apparent for all cell types (ON, OFF, X, Y) and cells with different receptive field locations in retina. It is suggested that the initial sorting of orientation functional columns in the visual cortex may begin in the LGNd.