Alternatives to resectional surgery for infectious disease of the lung: from embolization to thoracoplasty

Developing a transcatheter injectable nanoclay- alginate gel for minimally invasive procedures

Shear-thinning materials have held considerable promise as embolic agents due to their capability of transition between solid and liquid state. In this study, a laponite nanoclay (NC)/alginate gel embolic agent was developed, characterized, and studied for transcatheter based minimally invasive procedures. Both NC and alginate are biocompatible and FDA-approved. Due to electrostatic interactions, the NC/alginate gels exhibit shear-thinning properties that are desirable for transcatheter delivery. The unique shear-thinning nature of the NC/alginate gel allows it to function as a fluid-like substance during transcatheter delivery and as a solid-like embolic agent once deployed. To ensure optimal performance and safety in clinical applications, the rheological characteristics were thoroughly investigated to optimize the mechanical properties of the NC/alginate gel, including storage modulus, yield stress/strain, and thixotropy. To improve physicians' experience and enhance the predictability of gel delivery, a combination of experimental and theoretical approaches was used to assess the injection force required for successful delivery of the gel through clinically employed catheters. Overall, NC/alginate gel exhibited excellent stability and tunable injectability by optimizing the composition of each component. These findings highlight the gel's potential as a robust embolic agent for a wide range of minimally invasive procedures.

Uniportal Video-assisted Thoracoscopic Surgery for Pulmonary Aspergilloma: A Report of 5 Cases

Pulmonary aspergilloma is an uncommon pulmonary disease that complicated with many other respiratory disorders. Despite advances in medication, surgical treatment continues to form the basis of aspergilloma treatment. However, the use of uniportal video-assisted thoracoscopic surgery is extremely limited in pulmonary aspergilloma. In this report, 5 patients who underwent anatomic pulmonary resection safely with uniportal video-assisted thoracoscopic surgery technique without requiring a traditional thoracotomy were presented.

Indications and Results of Reconstructive Techniques with Flaps Transposition in Patients Requiring Complex Thoracic Surgery: A 12-Year Experience

BACKGROUND

Flap transposition is an infrequent but far from exceptional thoracic surgical procedure. The aim of this retrospective study was to report our experience in a referral unit of general thoracic surgery analyzing the early results after flap transposition.

METHODS

We retrospectively analyzed the clinical records, surgical notes, and postoperative results of a cohort of patients who underwent flap transposition in our unit from November 2000 to February 2013.

RESULTS

Overall, a surgical approach adopting flap reconstruction techniques was performed in 81 patients (54 males, 27 females) with a median age of 62 years (range 20-87). Flap transposition was necessary to reconstruct chest wall after resection for malignancy (27 patients), to repair intrathoracic viscera perforation (15 patients), and to fill residual cavities secondary to pulmonary/pleural infection (39 patients). A pedicle muscle flap was transposed in most of cases (64 pts, 79 %), while in the remaining 17 cases (11 %), an omental flap was used. There were no immediate postoperative complications, while three in-hospital deaths occurred due to respiratory or multiorgan failure. Among patients undergone flap transposition to fill a residual cavity, we observed a recurrent bronchopleural fistula in three patients (7.7 %); such patients were treated by repeat flap transposition (2 cases) and by repeat cavernostomy (1 case).

CONCLUSION

Flap transposition may be indicated as part of a multimodal treatment for severely ill patients requiring complex thoracic surgery.

[Multidisciplinary approach of ventilated necrotizing pneumonia]

Les pneumopathies infectieuses peuvent se compliquer, du fait de facteurs liés aux germes, à l’hôte ou à l’interaction entre les deux, par la survenue d’une nécrose et/ou d’une destruction du parenchyme pulmonaire. La nécrose et la destruction du parenchyme pulmonaire sont à l’origine de deux entités cliniques principales, les abcès pulmonaires et les pneumonies nécrosantes (PN). Les PN sont des entités rares mais dont le pronostic est redoutable. Elles sont caractérisées par une hépatisation diffuse, possiblement bilatérale du parenchyme pulmonaire avec cavitations et nécrose. Les PN sont généralement associées à un sepsis sévère et à une insuffisance respiratoire aiguë. Nous envisagerons la physiopathologie et le traitement médical qui comprend des mesures symptomatiques, le support des différentes défaillances d’organe, en particulier respiratoires, et le traitement antibiotique. Les indications chirurgicales et leurs modalités seront aussi détaillées. Une prise en charge multidisciplinaire associant réanimateurs, pneumologues, infectiologues, radiologues, chirurgiens et kinésithérapeutes doit permettre d’améliorer les taux de survie et surtout la qualité de vie des patients à distance d’une PN.