Carinal surgery: experience of a single center and review of the current literature

<p>Abstract</p> <p>Background</p> <p>To report our experience for the treatment of lung tumors of the right main bronchus (RMB) invading the carina.</p> <p>Methods</p> <p>From February 2000 till January 2007 we have identified 8 cases (1.09%) requiring carinal surgery.</p> <p>Plan of action: Close cooperation with anaesthetics, long flexible ET tube, Right posterolateral thoracotomy, no irrevocable steps until resection guaranteed, mobilization of trachea and main bronchus, division of the trachea & Left main bronchus. Intubate across surgical field. Tailoring for airway size discrepancies, appropriately. Construction of the tracheobronchial anastomosis around the ventilatory tube. Skillfull reintubation, over a long boogie.</p> <p>Results</p> <p>Mortality: 12.5% due to ARDS (one patient)</p> <p>Morbidity: anastomotic stenosis requiring stent (one patient). Follow-up 52 ± 11 months.</p> <p>Recurrences: 2 patients (both with pathological N2 disease on histology).</p> <p>Conclusions</p> <p>Success of carinal surgery depends on careful patient selection, team approach and attention to detail. Patients with N2 disease carry the worst prognosis.</p

Treatment of pancoast tumors from the surgeons prospective: re-appraisal of the anterior-manubrial sternal approach

Pancoast tumours are now amenable to multimodality treatment with an acceptable survival. This is because trimodality treatment improves tumor sterilization and hence outcome. Moreover the development of an anterior approach to access the tumor, further improved the technical challenges for a sound resection

Structure and electronic properties of the quasi-one-dimensional Ba₂Co₁₋ₓZnₓS₃ series

This work focuses on the structure and physical properties of the solid solution Ba₂Co₁₋ₓZnₓS₃ (0 ≤ x ≤ 1), a family of quasi-one-dimensional sulfides with end members Ba₂CoS₃ and Ba₂ZnS₃. The structure of selected compounds with increasing Zn²⁺ content has been analysed using, neutron diffraction, TEM and EXAFS and the physical properties via magnetic susceptibility and resistivity measurements. The progressive substitution of the non-magnetic Zn²⁺ cation for Co²⁺ rapidly destroys the antiferromagnetic transition present at 46 K in the quasi one-dimensional Ba₂CoS₃, leading to paramagnetic behaviour down to the lowest investigated temperature (5K) for compounds with x > 0.25. For compounds with x ≥ 0.4, a pure CW regime is recovered around 300 K, yielding effective moments consistent with the g factor of the tetrahedrally coordinated Co²⁺ previously determined for Ba₂CoS₃. The Zn²⁺/Co²⁺ substitution also removes the metallic-like behaviour of Ba₂CoS₃ causing an increase in the value of the resistivity with all the Ba₂Co₁₋ₓZnₓS₃ compounds showing semiconducting behaviour. The negative magnetoresistance of Ba₂CoS₃ is improved by the Zn²⁺/Co²⁺ substitution, with values of – 6% for Ba₂Co₀.₇₅Zn₀.₂₅S₃, – 9% for Ba₂Co₀.₅Zn₀.₅S₃ and – 8% for Ba₂Co₀.₂₅Zn₀.₇₅S₃. However, there does not seem to be a correlation between the values of the resistivity and the magnetoresistance and the content of Zn²⁺, leading to the hypothesis that transport properties may be linked more closely to extrinsic properties

Emerging Insights into Antibiotic-Associated Diarrhea and Clostridium difficile Infection through the Lens of Microbial Ecology

Antibiotics are the main, and often only, clinical intervention for prophylactic and active treatment of bacterial infections in humans. Perhaps it is not surprising that these drugs also shift the composition of commensal bacteria inside our bodies, especially those within the gut microbial community (microbiota). How these dynamics ultimately affect the function of the gut microbiota, however, is not fully appreciated. Likewise, how antibiotic induced changes facilitate the outgrowth and pathogenicity of certain bacterial strains remains largely enigmatic. Here, we discuss the merits of a microbial ecology approach toward understanding a common side effect of antibiotic use, antibiotic-associated diarrhea (AAD), and the opportunistic bacterial infections that sometimes underlie it. As an example, we discuss how this approach is being used to address complex disease dynamics during Clostridium difficile infection

Implications of Cloud Computing on Digital Forensics

Cloud computing is a paradigm for computingservices that are delivered to users over the Internet. In cloudcomputing, users rent rather than buy their computing resources.Cloud computing likely represents the next stage in the evolutionof the Internet. But the cloud computing paradigm is stilldeveloping, with numerous unknowns and many questions openfor research. One critical question that has not received muchattention is security. A significant subset is digital forensics—that is, (1) the discovery of evidence remaining on a computerafter a security breach or attack and (2) the use of that evidenceto investigate the event and establish facts for use in legalproceedings.This paper discusses the impact that cloud computingwill have on digital forensics. From a forensic perspective,cloud computing raises a number of concerns. Most immediateis whether or not forensic practitioners will be able to analyzethe Cloud using existing techniques of digital forensics. Duringa traditional forensic examination, files on the storage media areexamined along with the entire file system structure. But this maynot be a practical model for examinations in the Cloud, wherethe computer is virtual, that is, where numerous heterogeneousresources, often geographically distributed, are combined. Otherconcerns include protecting evidence against contaminationand anticipating the legal issues that will be raised by the Cloudparadigm, with its resources spread over diverse administrativeand geopolitical domains. Comprehensive security services toprotect not only the Cloud’s resources but also the data thatresides on them may need to be instituted. The open literature todate has yet to address any of these challenges.Cloud technologies are predicted to cause a paradigm shiftin digital forensic techniques. This paper discusses the applicationof traditional digital forensic examinations to cloud forensics

The Application of a Screening Matrix for Industrial Development to Omaha, Nebraska

The following is a summary of alternative attempts made to identify manufacturing industries which have the greatest potential for industrial development in the Omaha area. The methods utilized were similar to that used in the first report submitted to the Market Strategy Committee of the Economic Development Committee. Some major revisions were made on the previous report to produce comparative matrices utilizing additional criterion variables and differing levels of weighted importance placed on selected criterion variables

Eliminating Fruit and Vegetable Planting Restrictions: How Would Markets Be Affected?

Eighty-nine percent of American households were food secure throughout the entire year in 2005, meaning that they had access, at all times, to enough food for an active, healthy life for all household members. The remaining households were food insecure at least some time during that year. The prevalence of food insecurity declined from 11.9 percent of households in 2004 to 11.0 percent in 2005, while the prevalence of very low food security remained unchanged at 3.9 percent. This report, based on data from the December 2005 food security survey, provides the most recent statistics on the food security of U.S. households, as well as on how much they spent for food and the extent to which food-insecure households participated in Federal and community food assistance programs. Survey responses indicate that the typical food-secure household in the U.S. spent 34 percent more on food than the typical food-insecure household of the same size and household composition. Just over one-half of all food-insecure households participated in one or more of the three largest Federal food assistance programs during the month prior to the survey. About 22 percent of food-insecure households—3.5 percent of all U.S. households—obtained emergency food from a food pantry at some time during the year.Food security, food insecurity, food spending, food pantry, hunger, soup kitchen, emergency kitchen, material well-being, Food Stamp Program, National School, Crop Production/Industries,