Minimally Invasive Vacuum-Assisted Closure Therapy With Instillation (Mini-VAC-Instill) for Pleural Empyema

Enthusiasm for minimally invasive thoracic surgery is increasing. Thoracoscopy plays a significant therapeutic role in the fibrinopurulent stage (stage II) of empyema, in which loculated fluid cannot often be adequately drained by chest tube alone. For some debilitated and septic patients, further procedures such as open-window thoracostomy (OWT) with daily wound care or vacuum-assisted closure (VAC) therapy are necessary. In the present article, we propose a new option of minimally invasive VAC therapy including a topical solution of the empyema without open-window thoracostomy (Mini-VAC-instill). Three patients who underwent surgery using this technique are also presented. The discussion is focused on the advantages and disadvantages of the approach

Adequate nephroprotection reduces renal complications after hyperthermic intrathoracic chemotherapy

Background and Objectives Hyperthermic intrathoracic chemotherapy (HITOC) is used for the treatment of malignant pleural tumors. Although HITOC proved to be safe, postoperative renal failure due to nephrotoxicity of intrapleural cisplatin remains a concern. Methods This single-center study was performed retrospectively in patients who underwent pleural tumor resection and HITOC between September 2008 and December 2018. Results A total of 84 patients (female n = 33; 39.3%) with malignant pleural tumors underwent surgical cytoreduction with subsequent HITOC (60 minutes; 42 degrees C). During the study period, we gradually increased the dosage of cisplatin (100-150 mg/m(2) BSA n = 36; 175 mg/m(2) BSA n = 2) and finally added doxorubicin (cisplatin 175 mg/m(2) BSA/doxorubicin 65 mg; n = 46). All patients had perioperative fluid balancing. The last 54 (64.3%) patients also received perioperative cytoprotection. Overall 29 patients (34.5%) experienced renal insufficiency. Despite higher cisplatin concentrations, patients with cytoprotection showed significantly lower postoperative serum creatinine levels after 1 week (P = .006) and at discharge (P = .020). Also, they showed less intermediate and severe renal insufficiencies (5.6% vs 13.3%). Conclusions Adequate perioperative fluid management and cytoprotection seem to be effective in protecting renal function. This allows the administration of higher intracavitary cisplatin doses without raising the rate of renal insufficiencies

Burden between Undersupply and Overtreatment in the Care of Primary Spontaneous Pneumothorax

Background The optimal treatment of primary spontaneous pneumothorax (PSP) is still controversial. The purpose of this study was to analyze the incidence of recurrence, the recurrence-free time, and to identify risk factors for recurrence after PSP. Methods We performed a retrospective analysis of 135 patients with PSP who were treated either conservatively with a chest tube ( n =87) or surgically with video-assisted thoracoscopic surgery (VATS; n =48) from January 2008 through December 2012. Results In this study, 101 (74.8%) male and 34 (25.2%) female patients were included with a mean age of 35.7 years. The indications for surgery included blebs/bullae in the radiological images ( n =20), persistent air leaks ( n =15), or the occupations/wishes of the patients ( n =13). A first ipsilateral recurrent pneumothorax (true recurrence) was observed in 31.1% of all patients (VATS: 6.25%, conservative: 44.8%). Including contralateral recurrence, the overall first recurrence rate was 41.3% (VATS: 14.6%, conservative: 57.5%). The recurrence-free time did not differ significantly between the treatment groups ( p =0.51), and most recurrences were observed within the first 6 months after PSP. Independent risk factors identified for the first recurrence were conservative therapy ( p =0.0001), the size of the PSP (conservative; p =0.016), and a body mass index <17 (VATS; 0.022). The risk for second and third recurrences of PSP was 17.5 and 70%, respectively, for both treatment groups, but it was 100% after conservative therapy. Conclusion Surgery for PSP should be selected based on the risk factors and the patient's wishes to prevent first recurrences but also to avoid overtreatment. The treatment of first and subsequent PSP recurrences should be with surgery since conservative treatment is associated with a 100% recurrence rate

Investigation of Mild Steel Corrosion in the Cement Production Associated with the Usage of Secondary Fuels

The present work deals with the corrosion of mild steel (1.0037) used as the outer construction material of the preheater of a modern industrial cement production facility. The facility uses secondary fuels, which introduce considerable amounts of corrosive species. The situation at the examination sites in the preheater zone is tracked over a period of two years including operation and shut-down periods. The investigation is focused on (i) the acquisition of the underlying physicochemical conditions, such as moisture, temperature, and contamination data at the examination site of the preheater, (ii) the multianalytical identification of the formed corrosion products using scanning electron microscopy combined with energy-dispersive X-ray analysis, infrared spectrometry, Raman spectrometry, X-ray diffractometry, and Möβbauer spectrometry, and (iii) voltammetric and EIS laboratory investigations using model solutions. It was evidenced that corrosion takes place at a temperature level of about 100°C in the presence of moisture and oxygen as well as chloride ion as a consequence of the usage of secondary fuels. Typical hot-gas corrosion could be excluded under the current conditions. Appearance, structure, and nature of the corrosion products were found to be not mainly dependent on the varied length of exposure, but on the conditions of the hosting preheater intake. In addition to different FeOOH phases and hematite, magnetite was found, dependent on the oxygen concentration in the process gas. The decisive role of oxygen as key factor for the corrosion rate was electrochemically confirmed

Programmability of Co-antidot lattices of optimized geometry

Programmability of stable magnetization configurations in a magnetic device is a highly desirable feature for a variety of applications, such as in magneto-transport and spin-wave logic. Periodic systems such as antidot lattices may exhibit programmability; however, to achieve multiple stable magnetization configurations the lattice geometry must be optimized. We consider the magnetization states in Co-antidot lattices of ≈50 nm thickness and ≈150 nm inter-antidot distance. Micromagnetic simulations were applied to investigate the magnetization states around individual antidots during the reversal process. The reversal processes predicted by micromagnetics were confirmed by experimental observations. Magnetization reversal in these antidots occurs via field driven transition between 3 elementary magnetization states – termed G, C and Q. These magnetization states can be described by vectors, and the reversal process proceeds via step-wise linear operations on these vector states. Rules governing the co-existence of the three magnetization states were empirically observed. It is shown that in an n × n antidot lattice, a variety of field switchable combinations of G, C and Q can occur, indicating programmability of the antidot lattices