Transthoracic Ultrasonography: Advantages and Limitations in the Assessment of Lung Cancer

Lung cancer (LC) represents the leading cause of cancer-related mortality worldwide, with most of the cases being still diagnosed in advanced stages. Recently published data estimates an increase of LC deaths worldwide from 1.6 million in 2012 to 3 million in 2035. In this context, ultrasonography (US) aspires to become the method of choice that can offer essential information concerning subpleural LC. Therefore, it is an urgent need for an objective evaluation of the role of US and US-guided biopsies as an accurate diagnosis method, as until now large studies to assess this have been seldom performed. Our main aim was to perform a review over the use of US and US-guided biopsy in the assessment of LC, and our second aim was to illustrate how US is a valuable tool in the approach of patients with LC. We also compared the advantages and disadvantages of different types of biopsy needles. Other non-invasive applications of US (contrast-enhanced US and elastography) and their usefulness for LC were also evaluated. Though transthoracic US is today underused for lung cancer diagnosis, it offers multiple advantages that seem extremely useful for the efficient management of such tumours

Preoperative risk factors in hernia recurrence: a single-center study

Background and Objectives. Hernia recurrence is still a great challenge for surgeons regarding the optimal surgical technique, the best alloplastic material and the management of risk factors (advanced age, female sex, body mass index, smoking, diabetes, the presence of connective tissue disorders, chronic cough, etc.). The present study attempts to assess the impact of these factors in hernia recurrence, as well as the integration of the prosthetic material at the tissue level, in order to reduce possible postoperative complications. Material and Methods. A retrospective study was performed on 108 patients operated (between January 2012 and December 2022) for recurrence of inguinal, umbilical and incisional hernias. Demographic data and comorbidities were analyzed in relation to hernia recurrence. Fragments of unintegrated and well-fitted mesh were sampled and examined microscopically to assess tissue-level implications. Results. The strongest factors associated with hernia recurrence were obesity (p=0.001), diabetes mellitus (p=0.003), high blood pressure (p=0.003) and atrial fibrillation (p=0.044). Microscopic analysis of unintegrated mesh fragments revealed the presence of foreign body granulomas and predominance of thin fibrillar type 3 collagen, whereas well-integrated material showed thick type I collagen fibers and low inflammatory infiltrate. Conclusions. Insufficient oxygen supply, an altered inflammatory response, and diminished proliferative capacity during the wound healing stages resulted in abnormalities in the development of mature granulation tissue. Therefore, to reduce the risk of hernia recurrence, it is essential to have a surgical treatment that must manage all these possible factors

Using the PIC16F84 Microcontroller in Intelligent Stepper Motor Control

For applications requiring critical rotorpositioning, usually stepper motors are the bestchoice. Stepper motors operate differently fromother motors; rather than voltage being appliedand the rotor spinning smoothly, stepper motorsturn on a series of electrical pulses to the motor'swindings. Each pulse rotates the rotor by an exactdegree and a series of pulses must be generated toperform a complete rotation. An intelligentcontrolling device was conceived and built basedon a PIC16F84 microcontroller and UFDC-1interface

Pethidine efficacy in achieving the ultrasound-guided oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: A prospective study

Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1) OSTAP-Placebo (treated with normal saline); 2) OSTAP-Bupivacaine (treated with 0.25% bupivacaine); and 3) OSTAP-Pethidine (treated with 1% pethidine). The efficacy of pethidine in achieving the OSTAP block was analyzed using visual analog scale (VAS), intraoperative opioid dose, opioid consumption in post anesthesia care unit, and opioid consumption in the first 24 postoperative hours. The pain scores assessed by VAS at 0, 2, 4, 6, 12, and 24 hours were significantly lower in OSTAP-Pethidine than in OSTAP-Placebo group (p < 0.001). The mean intraoperative opioid consumption was significantly lower in OSTAP-Pethidine compared to OSTAP-Placebo group (150 versus 400 mg, p < 0.001), as well as the mean opioid consumption in the first 24 hours (20.4 versus 78 mg, p < 0.001). Comparing VAS assessment between OSTAP-Bupivacaine and OSTAP-Pethidine groups, statistically significant differences were observed only for the immediate postoperative pain assessment (0 hours), where lower values were observed in OSTAP-Pethidine group (p = 0.004). There were no statistically significant differences in the incidence of postoperative nausea and vomiting (p = 0.131) between the groups. The use of 1% pethidine can be an alternative to 0.25% bupivacaine in achieving OSTAP block for laparoscopic cholecystectomy

Using ultrasonography as a teaching support tool in undergraduate medical education -time to reach a decision

Abstract Medical education and the process of teaching and learning, respectively, are constantly changing. This is induced by the pace at which knowledge, teaching methodology and its related tools are updated, the use of simulation, virtual depiction and the use of static and/or dynamic images. In this respect, X-ray images have been used in the understanding of macroanatomy ever since the beginning of the last century. Starting with the 1990s, when high-performing and relatively less costly equipment started to emerge, several experts in the field of education anticipated the huge resource that ultrasound could become in the field of medicine. The method is easy to understand, intuitive and available to anyone studying human anatomy and, subsequently, the major pathological issues during undergraduate medical studies. The present paper reviews the attempts made at using ultrasound as an educational support tool, from the first experiences in teaching anatomy (Hannover Medical School, 1996) until the recent development of an entire medical university curriculum integrating ultrasound (University of South Carolina, School of Medicine, 2006Medicine, -2011. It is an exciting journey proving beyond any doubt that the method should be learned, understood and developed in medical schools from the undergraduate stage, together with the other clinical skills

Emergency and Elective Colorectal Cancer—Relationship between Clinical Factors, Tumor Topography and Surgical Strategies: A Cohort Study

Background and Objectives: The purpose of the study was to analyze the relationships among several clinical factors and also the tumor topography and surgical strategies used in patients with colorectal cancer. Materials and Methods: We designed an analytical, observational, retrospective study that included patients admitted to our emergency surgical department and diagnosed with colorectal cancer. The study group inclusion criteria were: patients admitted during 2020–2022; patients diagnosed with colorectal cancer (including the ileocecal valve); patients who benefited from a surgical procedure, either emergency or elective. Results: In our study group, consisting of 153 patients, we accounted for 56.9% male patients and 43.1% female patients. The most common clinical manifestations were pain (73.2% of the study group), followed by abdominal distension (69.3% of the study group) and absence of intestinal transit (38.6% of the study group). A total of 69 patients had emergency surgery (45.1%), while 84 patients (54.9%) benefited from elective surgery. The most frequent topography of the tumor was the sigmoid colon, with 19.60% of the patients, followed by the colorectal junction, with 15.68% of the patients, and superior rectum and inferior rectum, with 11.11% of the patients in each subcategory. The most frequent type of procedure was right hemicolectomy (21.6% of the study group), followed by rectosigmoid resection (20.9% of the study group). The surgical procedure was finished by performing an anastomosis in 49% of the patients, and an ostomy in 43.1% of the patients, while for 7.8% of the patients, a tumoral biopsy was performed. Conclusions: Colorectal cancer remains one of the most frequent cancers in the world, with a heavy burden that involves high mortality, alterations in the quality of life of patients and their families, and also the financial costs of the medical systems