Miniinwazyjna chirurgia torakoskopowa ze wsparciem laparoskopowym w leczeniu ewentracji przepony

Introduction: Thoracoscopic plication is an effective treatment for diaphragmatic eventration, but the procedure has some disadvantages such as inadvertent abdominal organ injuries or superficial sutures that are not strong enough. Aim of the research: In this study, we devised and tested the method of diaphragm plication through simultaneous laparoscopic- and thoracoscopic-assisted left mini-thoracotomy. Material and methods: During the period between October 2012 and March 2014 there were four patients operated on for left-sided diaphragmatic paralysis. The average age was 52.3 ±17.8 years. The preoperative examination included a routine laboratory study, spirometry, plain chest radiograph, and computed tomographic scan of the chest. The initial part of the surgery was a two-port laparoscopy to remove the adhesions between the abdominal viscera and the abdominal segment of the diaphragm using bipolar electrocautery. After that, video-assisted thoracoscopic surgery plication of the diaphragm was performed via anterior mini thoracotomy. Results: The mean operation time was 58 ±11 min, and the mean hospital stay was 9.0 ±2.1 days. All of the patients demonstrated good postoperative recovery. The descending distance of the diaphragm after the surgery ranged from two to four intercostal spaces, which was confirmed with plain chest X-ray. The follow-up ranged from 20 to 38 months and showed no recurrence of diaphragm elevation symptoms. Conclusions: Simultaneous thoraco- and laparoscopic assisted mini-thoracotomy surgery for diaphragm plication is a safe procedure with strong positive clinical effect, and it can serve as an alternative to conventional thoracoscopic approaches especially in patients with high risk of inadvertent abdominal organ injuries

Population of isomers in decay of the giant dipole resonance

The value of an isomeric ratio (IR) in N=81 isotones ($^{137}$Ba, $^{139}$Ce, $^{141}$Nd and $^{143}$Sm) is studied by means of the ($\gamma, n)$ reaction. This quantity measures a probability to populate the isomeric state in respect to the ground state population. In ($\gamma, n)$ reactions, the giant dipole resonance (GDR) is excited and after its decay by a neutron emission, the nucleus has an excitation energy of a few MeV. The forthcoming $\gamma$ decay by direct or cascade transitions deexcites the nucleus into an isomeric or ground state. It has been observed experimentally that the IR for $^{137}$Ba and $^{139}$Ce equals about 0.13 while in two heavier isotones it is even less than half the size. To explain this effect, the structure of the excited states in the energy region up to 6.5 MeV has been calculated within the Quasiparticle Phonon Model. Many states are found connected to the ground and isomeric states by $E1$, $E2$ and $M1$ transitions. The single-particle component of the wave function is responsible for the large values of the transitions. The calculated value of the isomeric ratio is in very good agreement with the experimental data for all isotones. A slightly different value of maximum energy with which the nuclei rest after neutron decay of the GDR is responsible for the reported effect of the A-dependence of the IR.Comment: 16 pages, 4 Fig

Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management

Introduction : Thoracoscopic plication is an effective treatment for diaphragmatic eventration, but the procedure has some disadvantages such as inadvertent abdominal organ injuries or superficial sutures that are not strong enough. Aim of the research : In this study, we devised and tested the method of diaphragm plication through simultaneous laparoscopic- and thoracoscopic-assisted left mini-thoracotomy. Material and methods : During the period between October 2012 and March 2014 there were four patients operated on for left-sided diaphragmatic paralysis. The average age was 52.3 ±17.8 years. The preoperative examination included a routine laboratory study, spirometry, plain chest radiograph, and computed tomographic scan of the chest. The initial part of the surgery was a two-port laparoscopy to remove the adhesions between the abdominal viscera and the abdominal segment of the diaphragm using bipolar electrocautery. After that, video-assisted thoracoscopic surgery plication of the diaphragm was performed via anterior mini thoracotomy. Results : The mean operation time was 58 ±11 min, and the mean hospital stay was 9.0 ±2.1 days. All of the patients demonstrated good postoperative recovery. The descending distance of the diaphragm after the surgery ranged from two to four intercostal spaces, which was confirmed with plain chest X-ray. The follow-up ranged from 20 to 38 months and showed no recurrence of diaphragm elevation symptoms. Conclusions : Simultaneous thoraco- and laparoscopic assisted mini-thoracotomy surgery for diaphragm plication is a safe procedure with strong positive clinical effect, and it can serve as an alternative to conventional thoracoscopic approaches especially in patients with high risk of inadvertent abdominal organ injuries

Diagnosis, management and outcomes of thoracic esophageal perforation

Introduction: Esophageal perforation has been considered a catastrophic and often life-threatening event. Aim of the research : To show the results and difficulties in the management of esophageal perforation based on the experience of our department of thoracic surgery as well as data obtained from other hospitals. Material and methods: We performed a retrospective analysis of the management of 103 patients (mean age: 49.4 ±3.1) treated during the period of 1997–2011. Open surgery historical control group (94 patients) was compared with patients (9 cases) who had undergone video-assisted thoracoscopic surgery nonresection procedure in our hospital. Results: Data analysis has revealed that 32 (31%) of all patients were not recognized as a “thoracic esophageal injury” at the first examination. Despite the fact that more than 80% of patients were hospitalized on the first day, in 42 cases (40.8%), surgical treatment was applied after 24 h (52.1 ±7.8). Sixty-percent patients of control group were complicated by postoperative morbidity resulted in higher (p < 0.05) mortality rate (35.1%) and hospital stay time (41.2 ±6.1 days), then VATS management of patients who had 11.1% postoperative mortality and 26.5 ±5.6 days of hospital stay. Conclusions : Esophageal perforations are rare pathology and due to the rarity of this condition and its often nonspecific presentation, the surgical treatment of it is delayed in more than 40% of patients, which leads to death of every third patient. Video-assisted thoracoscopic surgery with adequate drain perforation has had advantages in comparison with standard open surgical techniques in treatment of patients with delayed perforation and severe inflammatory reaction