Recognition and treatment of law enforcement violence against detainees and prisoners: A survey among Israeli physicians and medical students

Introduction: Physicians regularly encounter victims of violence. Although some at-risk groups are increasingly recognized as such, the risks faced by prisoners and detainees are often overlooked. The scope of violence against them is unknown and their treatment is often hampered by unique social and institutional impediments. This article reviews the need for improved recognition and protection of such patients and the associated obstacles, while presenting information on the experience, knowledge and attitudes of physicians in Israel regarding the maltreatment of prisoners and detainees. Methods: We sent a questionnaire to physicians and medical students in Israel to enquire about their knowledge concerning examination and treatment of persons under police custody who appear to be victims of violence as well as their attitude concerning torture. Results: We received answers from443 physicians and 114 medical students. Most physicians would correctly examine and document the injuries, but only 59% would report their suspicions of violence to the Ministry of Health. Though 60% of physicians objected in principle to the use of torture, a majority endorsed the use of physical and psychological pressure during interrogation. Moreover, 29% of physicians thought it is permissible for physicians to examine detainees and verify their health so that torture can begin or continue. Discussion: Our study shows that there is a need for development and implementation of treatment and reporting protocols as well as educational programs concerning the ethical and legal requirements of physicians towards detainees and prisoners in Israel. Limitations of our study are discussed

Uniportal VATS En Bloc Anatomical Resection of Right S2, S6, and S10a

This video demonstrates a complex segmental resection via the uniportal VATS technique in a 65-year-old woman with a lesion located between S2 and S6 of the right lung. The lesion was avid in a PET-CT scan with no mediastinal uptake. The decision to perform an anatomical segmentectomy was taken in order to avoid a pneumonectomy. The video also shows some anatomical variations. The operative and postoperative courses were uneventful, and the patient discharged home on postoperative day four. The final diagnosis was adenocarcinoma

Subxiphoid uniportal video assisted thoracoscopic lobectomy in a pediatric patient

Thoracoscopic surgeries have witnessed tremendous and prompt recent development, especially in the field of uniportal video assisted thoracoscopic surgery (VATS) surgery. It is now possible to perform the most complex surgeries through this technique, which is of great benefit to the patient by significantly reducing the level of postoperative pain and complications of surgery. As surgeons gain experience in this field, their confidence and ability to push the limits and develop technologies are increasing. Performing uniportal VATS surgeries in children is a significant challenge for the surgeon due to the limited size of the thoracic cavity and the difficulty of the instrumentation. Here, we report the first case in the literature (as far as we know) of a uniportal Subxiphoid VATS lobectomy in a 2.5-year-old child. In conclusion, Subxiphoid uniportal VATS lobectomy is feasible in pediatric patients and may have some benefits over the intercostal approach

Uniportal video assisted thoracoscopic left upper bronchial sleeve lobectomy in a pediatric patient

Endo-bronchial tumors are sporadic in the pediatric population. Pneumonectomy is rarely indicated and best to be avoided if possible due to the morbidity it may cause. In children, preserving as much of the lung parenchymal tissue as possible is crucial and maintaining the integrity of the "still maturing" chest wall may reduce the risk of developing scoliosis and chest deformities in the future. The integration of minimally invasive surgical techniques and parenchymal sparing procedures rep-resents the best possible outcome for these patients. Of course, oncological principles should be re-spected when such a procedure is performed. We present the first report in the literature of a "left" upper lobe sleeve resection in an 8 year old patient via a single port video-assisted thoracoscopic surgery technique

Data Sheet 1_v1_Case report and review of literature: Resection of a huge mediastinal low-grade fibromyxoid sarcoma with neck, axillary, and lung involvement.pdf

Low-grade fibromyxoid sarcoma is an extremely rare malignant neoplasm, with an incidence of 0.18 per million, and comprises 0.6% of all soft tissue sarcomas. It has a high recurrence rate and late metastatic spread and is chemotherapy and radiotherapy insensitive. This paper reports a case of an unusually large mediastinal low-grade fibromyxoid sarcoma in a 55-year-old patient. The tumor was engulfing the main blood vessels of the mediastinum, involving the lung, and extending beyond the chest cavity to involve the cervical and axillary regions. The patient has a 21-year history of frequent surgical resections for lesions that were repeatedly misdiagnosed as neurofibroma. The tumor was successfully resected by a challenging operation that involved mediastinal mass resection, chest wall mass resection, and wedge resection of the left upper lobe of the lung. The deceivingly benign-looking histology of this tumor makes it a commonly misdiagnosed one, requiring careful assessment by pathologists to reach the right diagnosis. Surgical resection with clear margins remains the treatment of choice for these lesions. Due to the behavior of this tumor, once detected and managed, extensive long-term follow-up is always recommended.</p

A solution for fissure-less fissure-last both upper and lower video-assisted thoracic surgery lobectomies?

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Hybrid Uniportal VATS Technique for Left Upper Lobectomy With Chest Wall Resection and Reconstruction

A 60-year-old patient was diagnosed with a T3N0M0 squamous cell carcinoma. A multidisciplinary tumor board decided to perform a hybrid procedure of left upper lobectomy with resection of three involved ribs. The course of the surgery was uneventful, and the patient was discharged home on postoperative day five

Uniportal VATS Left Lower Lobectomy to Treat Intralobar Pulmonary Sequestration

This video demonstrates a uniportal VATS left lower lobectomy to treat intralobar sequestration. Special attention should be given to the arterial branch that feeds the tumor during dissection. The arterial branch usually comes directly from the descending aorta

Uniportal video assisted thoracoscopy versus open surgery for pulmonary hydatid disease-a single center experience

Background: Although rare in the Western world, the incidence of hydatid disease is still prevalent and strikingly endemic among the Palestinians. Until 2017, surgical treatment of lung pathologies was performed through the traditional incision (open thoracotomy). Uniportal video-assisted thoracoscopic surgery (VATS) approach has recently been applied in the cases of the pulmonary hydatid cysts with very satisfactory results. Methods: Between January 2010 and January 2019, 39 patients with pulmonary HC disease have been surgically treated. The cases divided into two cohorts: operations performed by thoracotomy classified as group A, (n=16). Operations performed by uniportal VATS classified as group B, (n=23). Prospectively collected data was analysed retrospectively, and the results compared between both groups. Results: No significant statistical differences were noticed in terms of demographics and comorbidity. Laboratory tests were similar except haemoglobin level, which was higher in group A (P=0.001). Despite that, blood transfusion was higher in group A (P=0.016). Moreover, operation time was longer in group A (P=0.000). Chest drainage remained longer in group A (P=0.077). The level of postoperative pain was significantly higher in group A certainly in POD 1 (P=0.000). Patients in group B discharged earlier from the hospital (P=0.011) and experienced lower complications (P=0.060). No significant difference in length of ICU stay. Neither recurrence nor 30-day mortality recorded in either group. Conclusions: Uniportal VATS can be safely applied for pulmonary hydatidosis. It also seems to have a preference in several aspects compared to open Thoracotomy approach

Nonintubated versus intubated thoracoscopic bullectomy for primary spontaneous pneumothorax: A multicenter propensity-matched analysis

Background We aimed at comparing in a multicenter propensity-matched analysis, results of nonintubated versus intubated video-assisted thoracic surgery (VATS) bullectomy/blebectomy for primary spontaneous pneumothorax (PSP). Methods Eleven Institutions participated in the study. A total of 208 patients underwent VATS bullectomy by intubated (IVATS) (N = 138) or nonintubated (NIVATS) (N = 70) anesthesia during 60 months. After propensity matching, 70 pairs of patients were compared. Anesthesia in NIVATS included intercostal (N = 61), paravertebral (N = 5) or thoracic epidural (N = 4) block and sedation with (N = 24) or without (N = 46) laryngeal mask under spontaneous ventilation. In the IVATS group, all patients underwent double-lumen-intubation and mechanical ventilation. Primary outcomes were morbidity and recurrence rates. Results There was no difference in age (26.7 +/- 8 vs 27.4 +/- 9 years), body mass index (19.7 +/- 2.6 vs 20.6 +/- 2.5), and American Society of Anesthesiology score (2 vs 2). Main results show no difference both in morbidity (11.4% vs 12.8%; p = 0.79) and recurrence free rates (92.3% vs 91.4%; p = 0.49) between NIVATS and IVATS, respectively, whereas a difference favoring the NIVATS group was found in anesthesia time (p &lt; 0.0001) and operative time (p &lt; 0.0001), drainage time (p = 0.001), and hospital stay (p &lt; 0.0001). There was no conversion to thoracotomy and no hospital mortality. One patient in the NIVATS group needed reoperation due to chest wall bleeding. Conclusion Results of this multicenter propensity-matched study have shown no intergroup difference in morbidity and recurrence rates whereas shorter operation room time and hospital stay favored the NIVATS group, suggesting a potential increase in the role of NIVATS in surgical management of PSP. Further prospective studies are warranted