First-in-human Use of a Microsurgical Robotic System for Central Lymphatic Reconstruction

Advances in the development of robotic systems have recently enabled the use of robotic technology in reconstructive lymphatic surgery. Although the advantages of microsurgical robots must be weighed carefully against the costs, their use may allow for smaller surgical approaches and easier access to anatomically deeper structures or even smaller vessels. We report on a case of a patient with central lymphatic dilation causing abdominal pain and severely reduced physical capacity. Sonography-assisted intranodal injection of indocyanine green allowed for localization of the lymphatic cyst and anastomosis with the left ovarian vein, applying robotic-assisted microsurgery for the first time on the central lymphatic system. Following the successful reconstruction of lymphatic drainage and decompression of the cyst, the patient reported a complete regression of her preoperative symptoms. From a surgical point of view, the Symani Surgical System improved precision and allowed significantly smaller surgical access. Considering the high morbidity and rarity of pathologies of the central lymphatic system, central lymphatic surgery is to date rarely performed. With improved precision and significantly smaller surgical access, robotic-assisted microsurgery has great potential to expand the treatment options for central lymphatic lesions

Microsurgical central lymphatic reconstruction-the role of thoracic duct lymphovenous anastomoses at different anatomical levels

INTRODUCTION In recent years advances have been made in the microsurgical treatment of congenital or acquired central lymphatic lesions. While acquired lesions can result from any surgery or trauma of the central lymphatic system, congenital lymphatic lesions can have a variety of manifestations, ranging from singular thoracic duct abnormalities to complex multifocal malformations. Both conditions may cause recurrent chylous effusions and downstream lymphatic congestion depending on the anatomical location of the thoracic duct lesion and are associated with an increased mortality due to the permanent loss of protein and fluid. METHODS We present a case series of eleven patients undergoing central lymphatic reconstruction, consisting of one patient with a cervical iatrogenic thoracic duct lesion and eleven patients with different congenital thoracic duct lesions or thrombotic occlusions. RESULTS Anastomosis of the thoracic duct and a nearby vein was performed on different anatomical levels depending on the underlying central lymphatic pathology. Cervical (n = 4), thoracic (n = 1) or abdominal access (n = 5) was used for central lymphatic reconstruction with promising results. In 9 patients a postoperative benefit with varying degrees of symptom regression was reported. CONCLUSION The presented case series illustrates the current rapid advances in the field of central microsurgical reconstruction of lymphatic lesions alongside the relevant literature

Gestalten rings um Hindenburg

GESTALTEN RINGS UM HINDENBURG Gestalten rings um Hindenburg / Reibnitz, Kurt von (Public Domain) ( - ) Cover front ( - ) Title page ( - ) Contents ( - ) Erster Teil: Menschen (7) Erstes Kapitel. Der Reichspräsident (7) Zweites Kapitel. Der Reichskanzler (19) Drittes Kapitel. Die Reichskanzlerin (23) Viertes Kapitel. Des Reichskanzlers rechte Hand (27) Fünftes Kapitel. Des Reichskanzlers linke Hand (31) Siebentes Kapitel. A. A. (39) Achtes Kapitel. Die Reichsminister in der Berliner Gesellschaft (42) Neuntes Kapitel. Die Eingeweckten (45) Zehntes Kapitel. Das Reichskabinett von heute und seine Damen (50) Elftes Kapitel. Der Tschin (54) Zwölftes Kapitel. Das Preussenkabinett (59) Dreizehntes Kapitel. Die Reichstagsabgeordneten (63) Vierzehntes Kapitel. Die deutschen Gesandten (66) Fünfzehntes Kapitel. Die fremden Diplomaten (69) Sechzehntes Kapitel. Frauen in der Politik (75) Siebzehntes Kapitel. Frauuen berühmter Männer (79) Achtzehntes Kapitel. Frauen, von denen man spricht (83) Neunzehntes Kapitel. Originale (87) Zweiter Teil: Sitten (91) Erstes Kapitel. Hofzeremoniell und zeremoniell der Republik (91) Zweites Kapitel. Die Politik am weissen Tisch (97) Drittes Kapitel. Politische Bonmots (100) Vierzehntes Kapitel. Allerlei Spitznamen (103) Fünftes Kapitel. Rang- und Tischordnungen (107) Sechstes Kapitel. Orden, Titel und andere Eitelkeiten (110) Siebentes Kapitel. Das Tischgespräch (115) Achtes Kapitel. Die Kunst, einen Salon zu machen (119) Neuntes Kapitel. Von Snobs und Snobismus (123) Zehntes Kapitel. Das eiserne Korsett der Gesellschaft (127) Dritter Teil: Stätten (131) Erstes Kapitel. Berliner Klubs (131) Zweites Kapitel. Gang durch die Tiergartenstrasse (138) Drittes Kapitel. Wilhelmstrasse 66 (142) Viertes Kapitel. Historische Gaststätten (146) Fünftes Kapitel. Berlin auf dem Lande (151) Sechstes Kapitel. Potsdam (155) Siebentes Kapitel. Cecilienhof (158) Achtes Kapitel. Doorn (165) Vierter Teil: Salons (173) Erstes Kapitel. Salons der Hochfinanz (173) Zweites Kapitel. Hie Monarchie - Hie Republik (181) Drittes Kapitel. Die Goldschmidt-Rothschilds (185) Viertes Kapitel. Salons der Politik (189) Fünftes Kapitel. Salons der Presse (195) Sechstes Kapitel. Salons der Kunst (198) Siebentes Kapitel. Die alte Hofgesellschaft (202) Index (209) Cover back ( - ) ColorChart ( -

When Opportunity Knocks: Cross-Sectional Return Dispersion and Active Fund Performance

Active opportunity in the market, measured by cross-sectional dispersion in stock returns, significantly influences fund performance. Active strategies have the greatest impact on returns during periods of high dispersion, when alpha produced by the most active funds significantly exceeds that produced in other months. The outperformance of the most relative to the least active funds is also concentrated in months of high dispersion. Deciding when to invest in active funds, therefore, can be as important to generating outperformance as deciding which funds to invest in. Switching between highly active and passive funds based on dispersion produces significant alpha of over 2.7% p.a. after fees. This paper adds a new dimension to understanding how active funds can be used to generate value, by combining identification of which managers have the greatest potential to outperform the market with insight into when the market is most conducive to outperformanc