Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach

Objectives: This is a prospective study to evaluate the long-term outcome and the value of a transaxillary single port thoracic sympathectomy by use of a modified paediatric cystoresectoscope in a consecutive series of patients with facial blushing and/or hyperhidrosis. Materials and methods: All patients who underwent a thoracic transsection of the sympathetic chain from T2 to T5 by use of a 7-mm single port approach and a modified urologic electroresectoscope between 1996 and 1998 were prospectively analysed regarding postoperative morbidity and outcome (clinical evaluation, visual analogue scale) in order to validate this technique. Results: 37 patients (18 men, 19 women) with an age ranging from 18 to 67 years (mean 34 years) underwent 74 bilateral video-assisted thoracic sympathectomies. The indications for sympathectomy included facial blushing in 32%, hyperhidrosis in 52%, or both in 16% of the patients. Ninety-five percent of the patients were discharged from the hospital on the next day, the 30-day mortality was zero, and there was no conversion to an open procedure. A severe complication with crossed emboli and motor aphasia was noted. A unilateral transient Horner's syndrome was observed in two patients. Three-month follow-up revealed an excellent cosmetic and functional result, with no residual pain. Complete relief of symptoms was observed in 89% and in 100% of the patients with facial blushing and palmar hyperhidrosis, respectively, after a follow-up of 34.5 months. Recurrence of the symptoms after initial regression was noted in 5.7% of the patients 3 years after surgery. Compensatory sweating of the lower extremities was significantly increased in patients with hyperhidrosis and facial blushing; however, sweating of the trunk was only increased in patients with hyperhidrosis. Improvement of quality of life was observed in 94.6% of the patients. Conclusions: Single port thoracoscopic sympathectomy by use of a modified paediatric cystoresectoscope and transsection from T2 to T5 gives an excellent cosmetic and functional outcome, with better results in patients with hyperhidrosi

Video-assisted thoracic surgery: Risks and benefits

Summary: Background: Thoracoscopy has been used throughout this century, especially in the treatment of pleural disease. The introduction of video-assistance and especially designed instruments such as stapling devices in 1992 led to a worldwide and enthusiastic application for the treatment of a variety of thoracic pathologies. Methods: This report summarizes our experience gained from 1013 consecutive VATS procedures performed since 1990 for various indications in order to clarify its role for surgery of thoracic pathologies. Results: 234 patients underwent VATS for pleural biopsy, 154 for talcage, 163 for pulmonary wedge resections in order to clarify interstitial diseasee or indetermined nodules, 126 for spontaneous pneumothorax, 91 for decortication of empyema, 63 for symphatectomy, 55 for biopsy of mediastinal lesions, 29 for pericardial effusions (fenestration), 25 for lung volume reduction surgery, 17 for excision of mediastinal cysts and 12 for excision of neurogenic tumors of the posterior mediastinum. Conclusions: Our results demonstrate that VATS has gained established acceptance for several indications, however, caution in application of VATS is clearly indicated for some diseases, especially for thoracic malignancie

An Outline of a Progressive Resolution to the Euro-area Sovereign Debt Overhang: How a Five year Suspension of the Debt Burden Could Overthrow Austerity

The present study puts forward a plan for solving the sovereign debt crisis in the euro area (EA) in line with the interests of the working classes and the social majority. Our main strategy is for the European Central Bank (ECB) to acquire a significant part of the outstanding sovereign debt (at market prices) of the countries in the EA and convert it to zero-coupon bonds. No transfers will take place between individual states; taxpayers in any EA country will not be involved in the debt restructuring of any foreign eurozone country. Debt will not be forgiven: individual states will agree to buy it back from the ECB in the future when the ratio of sovereign debt to GDP has fallen to 20 percent. The sterilization costs for the ECB are manageable. This model of an unconventional monetary intervention would give progressive governments in the EA the necessary basis for developing social and welfare policies to the benefit of the working classes. It would reverse present-day policy priorities and replace the neoliberal agenda with a program of social and economic reconstruction, with the elites paying for the crisis. The perspective taken here favors social justice and coherence, having as its priority the social needs and the interests of the working majority

Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach.

OBJECTIVES: This is a prospective study to evaluate the long-term outcome and the value of a transaxillary single port thoracic sympathectomy by use of a modified paediatric cystoresectoscope in a consecutive series of patients with facial blushing and/or hyperhidrosis. MATERIALS AND METHODS: All patients who underwent a thoracic transsection of the sympathetic chain from T2 to T5 by use of a 7-mm single port approach and a modified urologic electroresectoscope between 1996 and 1998 were prospectively analysed regarding postoperative morbidity and outcome (clinical evaluation, visual analogue scale) in order to validate this technique. RESULTS: 37 patients (18 men, 19 women) with an age ranging from 18 to 67 years (mean 34 years) underwent 74 bilateral video-assisted thoracic sympathectomies. The indications for sympathectomy included facial blushing in 32%, hyperhidrosis in 52%, or both in 16% of the patients. Ninety-five percent of the patients were discharged from the hospital on the next day, the 30-day mortality was zero, and there was no conversion to an open procedure. A severe complication with crossed emboli and motor aphasia was noted. A unilateral transient Horner's syndrome was observed in two patients. Three-month follow-up revealed an excellent cosmetic and functional result, with no residual pain. Complete relief of symptoms was observed in 89% and in 100% of the patients with facial blushing and palmar hyperhidrosis, respectively, after a follow-up of 34.5 months. Recurrence of the symptoms after initial regression was noted in 5.7% of the patients 3 years after surgery. Compensatory sweating of the lower extremities was significantly increased in patients with hyperhidrosis and facial blushing; however, sweating of the trunk was only increased in patients with hyperhidrosis. Improvement of quality of life was observed in 94.6% of the patients. CONCLUSIONS: Single port thoracoscopic sympathectomy by use of a modified paediatric cystoresectoscope and transsection from T2 to T5 gives an excellent cosmetic and functional outcome, with better results in patients with hyperhidrosis

Peranan Petani Terhadap Strategi Pembangunan Hutan Rakyat Di Bagian Hulu Sub DAS Logawa Di Kabupaten Banyumas, Jawa Tengah (Roles of Farmers on Development Strategies of Community Forests at Upstream Areas of Logawa Sub River Stream Regions in Banyumas)

Strategy approach in the development of community forests as portion for land utilization is mostly relevant in connection with quicker degradation and deforestation of natural resources at the Logawa Sub River Drainage Area Stream Regionsin Banyumas Regency in Central Java. Aims of the research were to exploite potency and problem community forestsfrom the environmental, social and economic aspects, and to formulate strategies to develop community forests to sustain management at the upstream areas of the Logawa Sub River Stream Regions. It used survey method and a descriptive analysis, i.e. a research method focusing on attention at problem solving occurring in current period, whereas the problem solved was the factual problem. Through RPA activities and by using FGD method and continued by using AHP. Testresultsof the preparation of the hierarchy with the highest weighting orscalingconsistencycriteria ofinterestto theassessorsaidconsistentlyshowsthatsocialcriteria; sub-criteriatoincreaseparticipation; alternativeto thepricefactoristhehighestpriorityis most important tonote. Results of the formulation become a grand strategy that is implemented in a great agenda or become a directed program, so it will give optimal benefits for the society by environmental, economical, and socialapproaches. The strategic formulation directed for development of small holder forests at the Logawa Sub River Stream Regions is by strengthening farmer groups of the small holder forests, through models of counseling, extension, training, and collaboration to enhance farmers' capabilities until being self service, so they have capability to eliminate obstacles happened serially step by step and to be completed starting from the most important thing, particularly how to achieve bargaining position either obtained from qualified wood or non-wood product, easiness to get capital and market access by staying to keep environmental everlasting

Pulmonary function testing after operative stabilisation of the chest wall for flail chest

Objective: This is a prospective evaluation of chest wall integrity and pulmonary function in patients with operative stabilisation for flail chest injuries. Methods: From 1990 to 1999, 66 patients (56 men, 10 women; mean age 52.6 years) with antero-lateral flail chest (≧4 ribs fractured at ≧2 sites) underwent surgical stabilisation using reconstruction plates. Clinical assessment and pulmonary function testing were performed at 6 months following surgery. Results: Fifty-five (83%) patients had various combinations of injuries of the thorax, head, abdomen and extremities. Sixty-three (95.5%) patients underwent unilateral and 3 (4.5%) patients bilateral stabilisation with a median delay of 2.8 days (range 0-21 days) from admission. The 30-day mortality was 11% (seven of 66 patients). Immediate postoperative extubation was feasible in 31 of 66 patients (47%) and extubation within 7 days following stabilisation in 56 of 66 patients (85%). No plate dislocation was observed during the follow-up. The shoulder girdle function was intact in 51 of 57 patients (90%). Chest wall complaints were noted in 6 of 57 (11%) patients, requiring removal of implants in three cases. All patients returned to work within a mean period of 8 (range 3-16) weeks following discharge. Pulmonary function testing (n=50) at 6 months after the operation revealed a significant difference of predicted vs. recorded vital capacity (VC) and forced expiratory volume in 1s (FEV1) (P=0.04 and P=0.0001, respectively; Wilcoxon signed-rank test). The median ratio of the recorded and predicted total lung capacity (TLC) was shown to be significantly higher than 0.85 (P=0.0002; Wilcoxon signed-rank test), indicating prevention of pulmonary restriction. Conclusion: Antero-lateral flail chest injuries accompanied by respiratory insufficiency can be effectively stabilised using reconstruction plates. Early restoration of the chest wall integrity and respiratory pump function may be cost effective through the prevention of prolonged mechanical ventilation and restriction-related working incapacit

The Effectiveness of LED Light Spectrum Exposure on Growth and Color Performance of Orange Clownfish, Amphiprion Percula (Lacèpède, 1802) Juvenile

Ikan badut Amphiprion percula merupakan ikan hias air laut yang diminati pasar global ikan hias karena memiliki daya tarik tersendiri pada warna jingga yang dimilikinya. Ikan badut hasil budi daya memiliki kualitas warna jingga yang cenderung memudar. Penggunaan manipulasi spektrum cahaya dalam sistem budi daya dapat memengaruhi Perubahan jumlah kromatofor yang dapat meningkatkan warna ikan menjadi terang. Tujuan penelitian ini adalah menentukan spektrum cahaya lampu LED yang tepat terhadap pertumbuhan dan kualitas warna yuwana ikan badut. Penelitian ini menggunakan Rancangan Acak Lengkap pada lima perlakuan dan tiga ulangan. Perlakuan terdiri atas empat jenis spektrum cahaya lampu LED dengan panjang gelombang berbeda yakni putih (P), merah (M), hijau (H) dan biru (B) dengan lama penyinaran 12 jam dan kontrol. Rerata panjang total awal ikan uji adalah 3,28±0,24 cm dan bobot 0,91±0,19 g. Hasil penelitian selama 60 hari pemeliharaan menunjukkan bahwa parameter respons fisiologis dan pertumbuhan terbaik adalah pada perlakuan lampu LED biru dengan kadar glukosa sebesar 40,00±2,65 mg dL-1, kadar malondialdehyde (MDA) sebesar 9,30±0,29 nmol mL-1, laju pertumbuhan spesifik (LPS) sebesar 1,71±0,05% dan efisiensi pakan (EP) sebesar 78,23±1,97%. Parameter kualitas warna terbaik pada perlakuan lampu LED biru dengan skor dalam Toca color finder (TCF) mencapai warna jingga pada bagian dorsal, caudal dan anal, red,green and blue (RGB) ratio pada warna bagian dorsal, caudal dan anal masing-masing sebesar 64,59±1,00%, 68,12±0,74%, dan 72,56±0,20% serta jumlah kromatofor sebesar 346±10 sel/ 0,1 mm-2. Spektrum cahaya lampu LED biru menghasilkan pertumbuhan dan kualitas warna terbaik pada yuwana ikan badut Amphiprion percula

Fatal myocardial infarction after lung resection in a patient with prophylactic preoperative coronary stenting†

In this report we present the case of a 77-yr-old man who underwent resection of the upper lobe of the left lung for a carcinoma, six weeks after percutaneous transluminal coronary angioplasty (PTCA) with stenting of the left anterior descending (LAD) and circumflex coronary arteries. Antiplatelet therapy with clopidogrel was interrupted two weeks before surgery to allow for epidural catheter placement and to minimize haemorrhage. The surgical procedure was uneventful. In the immediate postoperative period, however, the patient suffered severe myocardial ischaemia. Emergency coronary angiography showed complete thrombotic occlusion of the LAD stent. In spite of successful recanalization, reinfarction occurred and the patient died in cardiogenic shock. Prophylactic preoperative coronary stenting may put the patient at risk of stent thrombosis if surgery cannot be postponed for three months. In such cases, other strategies such as perioperative β-blockade for preoperative cardiac management should be considered. Br J Anaesth 2004; 92: 743-

Emulation of Condensed Fuel Flames Using a Burning Rate Emulator (BRE) in Microgravity

The Burning Rate Emulator (BRE) is a gaseous fuel burner developed to emulate the burning of condensed phase fuels. The current study details several tests at the NASA Glenn 5-s drop facility to test the BRE technique in microgravity conditions. The tests are conducted for two burner diameters, 25 mm and 50 mm respectively, with methane and ethylene as the fuels. The ambient pressure, oxygen content and fuel flow rate are additional parameters. The microgravity results exhibit a nominally hemispherical flame with decelerating growth and quasi-steady heat flux after about 5 seconds. The BRE burner was evaluated with a transient analysis to assess the extent of steady-state achieved. The burning rate and flame height recorded at the end of the drop are correlated using two steady-state purely diffusive models. A higher burning rate for the bigger burner as compared to theory indicates the significance of gas radiation. The effect of the ambient pressure and oxygen concentration on the heat of gasification are also examined