Large intra-thoracic desmoid tumor with airway compression: A case report and review of the literature

Intra-thoracic desmoid tumors are exceedingly rare tumors in the pediatric population, and can present with compression of cardiopulmonary structures and respiratory compromise. Surgical and anesthetic management of these tumors are challenging. We report the case of a 14-year-old male who presented with dyspnea, found to have a large intra-thoracic mass that was critically compressing his trachea. We provide a review of the literature of desmoid tumors and discuss the management of intra-thoracic masses

Ileal lengthening through internal distraction: A novel procedure for ultrashort bowel syndrome

Purpose: Ultrashort bowel syndrome is a rare, but morbid surgical problem without effective treatment. Recent clinical analysis has demonstrated the critical influence of ileal length on ultimate enteral autonomy. Surgical techniques to increase ileal length in nondilated bowel do not exist. We describe a novel technique to lengthen ileum in children with ultrashort bowel syndrome. Methods: Beginning in May 2021 prospective candidate children were identified. Candidacy for ileal tube lengthening included diagnosis of ultrashort bowel syndrome, intact ileocecal valve with remnant ileum, and proximal intestinal stoma or draining gastrostomy. Informed consent was obtained. Following laparoscopic lysis of adhesions, a balloon catheter was inserted through a left flank stab incision and into the lumen of the remnant ileum around a purse string suture. Cecopexy was performed in the right-lower quadrant. Clips were used to mark the cecum and the proximal extent of ileum. The catheter length was fixed externally at the completion of the procedure. Serial x-rays were used to measure distraction effect while increasing tension was applied to the catheter over the subsequent weeks. Ileal tube lengthening was performed until the end of the catheter was reached or the tube was dislodged. A contrast study was performed at the completion of lengthening. Intestinal length at time of restoration of continuity and clinical outcomes were recorded. Results: Four infants were enrolled from May 2021-July 2023. Diagnoses leading to ultrashort bowel syndrome were mesenteric teratoma, necrotizing enterocolitis, and multiple intestinal atresia. At the time of restoration of intestinal continuity, a median of 1.75 cm (45 %) additional ileal length was achieved at a median of 25.5 days. There were no serious complications following ileal tube lengthening and no additional operative interventions were required. Conclusions: Ileal lengthening through internal distraction is a feasible surgical intervention to salvage ileum for infants with ultrashort bowel syndrome. Ileal tube lengthening may result in distraction enterogenesis, providing a novel intervention to increase intestinal length. Level of evidence: IV (Case series without comparison group)

Eficiência produtiva e análise econômica e financeira de usinas de cana de açúcar do estado de Sâo Paulo

A atividade de produção e beneficiamento de cana-de-açúcar tem se tornado estratégica na econômica nacional, sendo grande geradora de renda e de empregos. Neste segmento São Paulo é o estado de maior representatividade, porém, esta atividade expandiu-se em todo território nacional, o que gera competitividade as usinas paulistas, exigindo melhor gestão de suas atividades. Neste cenário, para evitar a perda de mercado ou até para garantir a sua sobrevivência, estas usinas têm que constantemente buscar formas de melhorar seu desempenho produtivo. Com base nestes aspectos, o objetivo deste estudo consistiu em determinar o grau de eficiência técnica e produtiva das usinas beneficiadores de cana-deaçúcar do Estado de São Paulo, analisando concomitantemente seu desempenho econômico e financeiro. Foram analisadas 17 usinas e, para a sua mensuração foi utilizada a análise envoltória de dados (DEA) em modelo composto de 3 insumos (estoques, imobilizado e salários) e 1 produto (faturamento bruto). Os resultados encontrados mostraram que, em síntese, do total das usinas analisadas, das eficientes (4), duas apresentaram problemas de escala; nas ineficientes, quatro têm problemas de escala, operando abaixo da escala ótima de produção e sete são ineficientes tecnicamente, desperdiçando insumos produtivos

Esophageal lung, pulmonary artery sling and congenital tracheal stenosis: A case report

Introduction: Esophageal lung is rare bronchopulmonary foregut malformation where a main stem bronchus is connected anomalously to the esophagus. We present a challenging diagnostic workup of a 14-month-old who was referred following multiple complicated hospitalizations for recurrent respiratory distress. Case presentation: A male infant born at 37 weeks was noted to be hypoxemic at birth and subsequently diagnosed with right-sided pulmonary hypoplasia, absent right main stem bronchus, a left-sided non-obstructive pulmonary artery sling, and possible tracheal stenosis via computed tomographic angiography (CTA). After a stay in the neonatal intensive care unit for persistent hypoxemia, he was discharged home on oxygen. At 4.5 months, the patient developed severe respiratory distress requiring extracorporeal membrane oxygenation, which was complicated by a stroke. During this admission, repeat CTA showed a broncho-esophageal fistula, concerning for esophageal lung. The patient was seen in consultation at our institution at 14 months given persistent respiratory insufficiency. He underwent repeat endoscopy with our multi-disciplinary Aerodigesive Clinic, confirming mild tracheal stenosis and esophageal lung. A right pneumonectomy was recommended. During the pneumonectomy, the right bronchus was confirmed to originate from the distal esophagus on endoscopy. Intraoperative bronchoscopy showed a patent central airway and left bronchopulmonary tree. The patient recovered well post-operatively without complications and was discharged home on room air. Conclusion: Diagnosing esophageal lung can be difficult and requires thorough evaluation of the adjacent anatomy, oftentimes requiring multidisciplinary evaluation with multiple radiologic and endoscopic modalities