Giant bleeding post-traumatic thoracic sarcoma management: A case report

The heterogeneity of thoracic wall tumors often represents challenging clinical entities for surgeons due to diagnostic and treatment complexities. The primary tumors, metastases, or direct invasion from intrathoracic structures comprise almost half of all cases on average that are proved to be malignant. Surgery treatment usually leaves large chest defects that require further extensive reconstruction and multimodal management including radiotherapy and chemotherapy. We report a rare case of a giant (30 cm) post-traumatic bleeding thoracic sarcoma treatment in a 70-year-old female. The use of our modified Verneuil technique to close the extensive postoperative skin defect optimized surgical wound management and provided good functional and aesthetic results. Four-year follow-up outcomes after surgical and adjuvant radiation therapy reported a high level of tumor control and showed no evidence of postoperative disease recurrence

Can environment or allergy explain international variation in prevalence of wheeze in childhood?

Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8–12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother’s smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence

An integrated approach for the surgical treatment of patients with primary hyperparathyroidism

This paper presents the treatment results of 75 patients with primary hyperparathyroidism (PHPT) caused by a solitary parathyroid adenoma (SPA). Patients in Group 1 had PHPT with concomitant diseases of the thy roid gland (TG). Group 2 consisted of patients with PHPT without thyroid disease. Group 3 included patients with PHPT and concurrent diseases of the parathyroid glands (PG) and thyroid gland, which were operated on without the use of the proposed integrated approach. Patients in groups 1 and 2 were operated on using the following techniques. Patients in group 1 underwent surgery usinga traditional incision with photodynamic visualization (PV) of the PG and exposure of the recur rent and superior laryngeal nerves (LN) (in some cases with the use of magnifying devices and neuromyog raphy). Patients in group 2 underwent surgery with minimally invasive access, utilizingendoscopic video devices and the universal retractor “Multifiks1”. During the intervention,PVof the PG and electrophysiolog ical monitoring (EM)of the recurrent LN were carried out. In groups 1 and 2, adequacy of the operationwas determined by the change in the level of intraoperative parathyroid hormone (PTH) and ionized calcium before and after the removal of the PG. Our proposed integrated method for the treatment of patients with PHPT allowed for a significant reduction in the risk of postoperative complications and consequently an improvement in quality of life

Reduced low-traumatic access thyroidectomy with central neck dissection

Background. In the year 2014 in Russia there were about 10 thousand patients with newly diagnosed thyroid cancer (TC), the bulk of which need surgical treatment. Currently, special requirements to the quality of surgical intervention, which is determined by the radicalness, minimum number of complications and a good cosmetic result. Materials and methods. In this paper we present the treatment results of 76 patients with differentiated TC, who received surgical treatment at S.P. Botkin City Clinical Hospital in 2012–2015. All patients underwent an extrafascial operation under general anesthesia in volume thyroidectomy with central lymph node dissection. The operation was carried out with reduced low-traumatic approach length 4–5 sm in front the neck without crossing prelaringeal muscules. For prophylaxis of laryngeal paresis, visualization and indenification laryngeal nerves were performed, with using magnifying devices and neuromyography. To prevent the development of hypoparathyroidism, visualization and preservation of the parathyroid glands was also conducted. To this end, among other measures, a photodynamic method of parathyroid gland visualization using a photosensitizer, a blue light source and local spectroscopy was employed. Results. In the postoperative period, there were 3 (3.9 %) cases of transient hypoparathyroidism. On the scale of intervention POSAS (Patient and observer scar assessment scale) 68 (89.5 %) patient was recognized as a excellent, and 8 (10.5 %) as good. Conclusion. Thus, thyroidectomy and central neck dissection with reduced low-traumatic approach using the suggested methodological approaches gives completeness of our surgical intervention, possibility to avoid the development of permanent specific complications, and better functional and aesthetic results

Liquid Radiation Treatments and Environmental Challenges in Georgia

მოცემული ნაშრომი იკვლევს რადიოაქტიურ ნარჩენებთან უსაფრთხო მოპყრობის ძირითად მოთხოვნებს, რომელიც შემუშვებულია საერთაშორისო სტანდარტების მოთხოვნით და საქართველოში არსებული რეალური სიტუაციის გათვალისწინებით. დღემდე ატომური ენერგიის საერთაშორისო სააგენტოს გამოცემული აქვს მრავალი დოკუმენტი, სადაც განხილულია რადიოაქტიურ ნარჩენებთან მოპყრობის დროს უსაფრთხოების საკითხები. ნაშრომი შეისწავლის ტექნოლოგიურ ხაზს თხევადი რადიაოაქტიური ნარჩენების წარმოქმნის მომენტიდან გარემოში ჩაშვებამდე.ნაშრომის აქტუალობა მდგომარეობს იმაში რომ, მედიცინის ეს უახლესი მიმართულება სულ ერთეული წლებია საქართველოში დამკვიდრდა.რაც მოითხოვს რადიაციული უსაფრთხოებას შემდგომ განვითარებას და მოდერნიზაციას.The present work investigates the main demands of safe treatment of radioactive residues which have been worked out by the International standards and with allowance of real situation existing in Georgia. Till the present time the International Agency of atomic energy has published many documents in which there are considered the issues of safety during treatment with radioactive residues. The work studies the technological line from the moment of formation of liquid radioactive residues till the discharge in the environment. The actuality of the work lies in the fact that this most new direction of the medicine has been established in Georgia only since few years which requires the further development and modernization of the radiation safety