Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy)

The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.

Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy)

The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.

Mucilage from seeds of chia (Salvia hispanica L.) used as soil conditioner; effects on the sorption-desorption of four herbicides in three different soils

The objective of this work was to determine the effect of the mucilage extracted from Chia seeds (Salvia hispanica L.) as soil amendment on soil physical properties and on the sorption-desorption behaviour of four herbicides (MCPA, Diuron, Clomazone and Terbuthylazine) used in cereal crops. Three soils of different texture (sandy-loam, loam and clay-loam) were selected, and mercury intrusion porosimetry and surface area analysis were used to examine changes in the microstructural characteristics caused by the reactions that occur between the mucilage and soil particles. Laboratory studies were conducted to characterise the selected herbicides with regard their sorption on tested soils added or not with the mucilage. Mucilage amendment resulted in a reduction in soil porosity, basically due to a reduction in larger pores (radius>10μm) and an important increase in finer pores (radius<10μm) and in partcles' surface. A higher herbicide sorption in the amended soils was ascertained when compared to unamended soils. The sorption percentage of herbicides in soils treated with mucilage increased in the order; sandy-loam<loam<clay-loam. The increase in the organic carbon content upon amendment and the natural clay content of the soils are revealed to be responsible for the higher adsorption of Diuron when compared with Terbuthylazine, Clomazone and MCPA. Desorption of the herbicides was highly inhibited in the soils treated with mucilage; only Terbuthylazine showed a slight desorption in the case of loam and clay loam-soils. This study leads to the conclusion that mucilage from Chia seeds used as soil conditioner can reduce the mobility of herbicides tested in agricultural soils with different physico-chemical properties.

Temperature Effects Explain Continental Scale Distribution of Cyanobacterial Toxins

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains.

Suicide attempts: Results from data collected in a psychiatric emergency ward in a general hospital

Introduction

Suicide behavior constitutes a public health problem worldwide. It deserves epidemiological investigation regarding “best clinical practices”, and it is fundamental since the patient's first observation at psychiatric emergencies services. These are the ideal practices to start suicide prevention, and prevent further suicidal behavior. The improvement of healthcare quality includes the adoption of clinical guidelines, which support medical care since the emergencies services. The lack of specific instruments to evaluate suicidal risk urges the scientific community to create them.

Aims

The authors aim to discuss the advantages and limitations of the application of these kinds of instruments, and the creation of models based in scientific evidence available.

Discussion

From multiple available studies, the Modified Sad-Persons Scale (MSPS) seems to be one of the most scientifically used in literature, as well as in epidemiological studies of suicide attempts and their repetition, either by nonfatal or fatal attempts. However, even this scale has been questioned by experts, and the lack of specific and sensible tests towards suicide behavior and risk of suicide attempts raises the importance of the need of further investigation towards this area. This evidence would then help the clinician in his work at emergencies wards and provide better healthcare towards preventing new suicide attempts.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Organo/LDH nanocomposite as an adsorbent of polycyclic aromatic hydrocarbons in water and soil-water systems

Polycyclic aromatic hydrocarbons (PAHs) are considered as priority pollutants because of their high risk to human health. In this paper, we addressed the issue of using hydrotalcite-based nanocomposites as adsorbents of six low molecular weight PAHs (acenaphthene, fluorene, phenanthrene, anthracene, fluoranthene and pyrene) to reduce their negative effects on the environment. A nanocomposite (HT-DDS) was prepared by intercalating the organic anion dodecylsulfate (DDS) in a Mg-Al hydrotalcite (HT), and then characterized using several analytical techniques. A Mediterranean soil was selected for being a high-risk scenario of groundwater contamination by leaching of pollutants. The nanocomposite displayed enhanced affinity for the PAHs in water as compared to carbonate-hydrotalcite (HTCO(3)) and its calcined product (HT500), and showed a high irreversibility of the adsorption process (hysteresis coefficient, H<0.15). The results revealed an increase of the pollutants retention in the soil by the addition of the nanocomposite that depended on the nanocomposite application rate and also on the hydrophobicity of each PAH. Accordingly, the use of HT-DDS as an amendment or barrier in contaminated soil is proposed for reducing the mobility of PAHs and, consequently, the adverse effect derived from rapid transport losses of the pollutants to the adjoining environmental compartments.

[Somatic tinnitus (review). A consequence of plasticity and bimodal integration in the dorsal cochlear nucleus]

Somatic tinnitus is a peculiar tinnitus type that can be defined as a tinnitus that can be modulated in intensity and/or pitch by manipulating some regions of the head and neck but also as tinnitus associated with facial pain or dysesthesis in the same area. Those areas are innervated by the trigeminal nerve and the cervical plexus. This can be explained by functional connections between the trigeminal system and the auditory brainstem and mid-brain. A literature overview shows how different messages coming from the head and neck are able to modulate the hearing information. Tinnitus is generated by an increase of the spontaneous discharges of the dorsal cochlear nucleus neurons, tonotopic reorganisation and an increase of the neural synchronism in the auditory cortex. Trigeminal stimulations have an influence on the activity of the dorsal cochlear nucleus especially in case of an associated hearing loss.

Improved outcome for children with disseminated adenoviral infection following allogeneic stem cell transplantation

Adenovirus (AdV) infections are a frequent cause of morbidity and mortality following allogeneic stem cell transplantation (SCT), and disseminated infection is associated with high mortality, particularly in paediatric SCT. Here, we describe an approach to reduce mortality from adenoviraemia by combining prospective monitoring for the occurrence of adenoviraemia using a sensitive polymerase chain reaction method, early antiviral therapy and prompt withdrawal of immunosuppression. A total of 155 consecutive paediatric SCT procedures were prospectively monitored, of which 113 (73%) transplants involved donors other than matched siblings and 126 (83%) employed T-cell depletion. Adenoviraemia was detected in 26/155 (17%) transplants and developed exclusively in patients who had received T-cell-depleted grafts. Withdrawal of immunosuppression coupled with early antiviral therapy led to resolution of adenoviraemia in 19/26 (81%) patients with only five patients succumbing to disseminate AdV infection. Survival from adenoviraemia was associated with lymphocyte recovery to above 0.3x10(9)/l. Mortality was closely linked with the absence of lymphocyte recovery because of profound T-cell depletion of the graft with CD34+ magnetic-activated cell sorting. Mortality from disseminated AdV infection was 5/26 (19%) in this study, which is significantly lower than previously reported.

[Treatment with the placement of carotid stent of jugular-carotid fistula after the insertion of hemodialysis catheter]

The use of jugular temporary catheters as vascular access for hemodialysis, entails a risk of various complications. The most frequent problems are the arterial puncture and haematoma. However, there are other less frequent potentially serious complications, which constitute a therapeutic and diagnostic challenge for the nephrologists. We present a case of a patient that developed an acute renal failure in the context of cellulites for E. Coli treated with aminoglycosid, who required renal treatment with haemodialysis. After the placement of a polyurethane double-lumen catheter with ultrasound guidance at the level of the internal jugular vein, arterial blood streaming was observed through the lumen of the catheter. The angiographic study showed the tipo of the catheter placed at the level of the aortic arch. Ultrasound exam clearly despicted the track between the internal jugular vein and the internal carotid artery. An effective closing of the fistula was achieved with the placement of a covered stent-graft with the simultaneous withdrawal of the catheter. Reviewing the literature this is the first reported case of an iatrogenic jugulo-carotid fistula secundary to placement of hemodialysis catheter resolved by the implantation of carotid stent-graft.

Vitrification of turbot embryos: preliminary assays

Successful fish embryo cryopreservation is still far from being achieved. Vitrification is considered the most promising option. Many factors are involved in the success of the process. The choice of a proper vitrification solution, the enzymatic permeabilization of embryos to increase cryoprotectant permeability, the adequate container for embryo loading, and the temperature for thawing, were the parameters considered at different developmental stages in the present study. After vitrification, embryo morphology was evaluated under stereoscopic microscopy, establishing the percentage of intact embryos. Two of the studied parameters yielded differences in this percentage, the volume of straw used for embryo loading (1 ml straws were significantly better than 0.5 ml straws, with regard to post-thawed embryo morphologies), and the thawing temperature, achieving 49% of embryos with intact morphology after thawing at 0 degrees C. After thawing, the intact embryos were incubated and periodically observed to detect morphological changes. Changes in the perivitelline space, shrinkage of the yolk and chorion ruptures as well as a progressive whitening of the embryo and yolk were observed. After 8 h all embryos showed clear signs of degradation and during this incubation period no embryo showed any developmental ability.

Effects of atrazine on periphyton under grazing pressure

An experiment was carried out using indoor experimental channels to assess the long-term effect (18 days) of herbivores (Physella acuta, Gastropoda) on periphyton communities exposed to low levels of atrazine (14 microg l(-1)). We hypothesized that herbivorism modifies the response of periphyton to atrazine. Carbon incorporation, chlorophyll-a content, biovolume and algal taxonomic composition in the channels that contained atrazine were not significantly different from the control channels (not receiving atrazine). In channels with grazers and atrazine, there was a significant reduction of carbon incorporation and algal density. In this treatment, physiognomic forms and algal composition were significantly different from the others. The biomass of grazers (measured as change in dry mass) was not significantly affected by the addition of atrazine. Grazers maintained low levels of periphyton biomass, enhancing algal cell exposition to toxicant and inhibiting any adaptation of the algae to the toxic exposure. The increase in atrazine toxicity with grazing not only affected the metabolism, but also the structure of the algal community, which suggests that effects were not transient but permanent.

Stenosis of the suprahepatic inferior vena cava as a complication of transjugular intrahepatic portosystemic shunt in Budd-Chiari patients

We report 2 patients with Budd-Chiari (BC) syndrome secondary to thrombogenic conditions who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement because of refractory ascites and impending liver failure. After TIPS placement, there was marked symptomatic relief and improvement in liver function, but the courses of both patients were complicated by the development of an inferior vena cava (IVC) syndrome caused by segmental stenosis of the suprahepatic IVC just at the outflow jet of the TIPS at 11 and 9 months later. One patient underwent liver transplantation, and the other patient, caval angioplasty and stenting. Stenosis of the IVC represents an unrecognized complication of TIPS in patients with BC syndrome.

CO(2) wedged hepatic venography in the evaluation of portal hypertension

BACKGROUND/AIMS/METHODS

During hepatic vein catheterisation, in addition to measurement of hepatic venous pressure gradient (HVPG), iodine wedged retrograde portography can be easily obtained. However, it rarely allows correct visualisation of the portal vein. Recently, CO(2) has been suggested to allow better angiographic demonstration of the portal vein than iodine. In this study we investigated the efficacy of CO(2) compared with iodinated contrast medium for portal vein imaging and its role in the evaluation of portal hypertension in a series of 100 patients undergoing hepatic vein catheterisation, 71 of whom had liver cirrhosis.

RESULTS

In the overall series, CO(2) venography was markedly superior to iodine, allowing correct visualisation of the different segments of the portal venous system. In addition, CO(2), but not iodine, visualised portal-systemic collaterals in 34 patients. In cirrhosis, non-visualisation of the portal vein on CO(2) venography occurred in 11 cases; four had portal vein thrombosis and five had communications between different hepatic veins. Among non-cirrhotics, lack of portal vein visualisation had a 90% sensitivity, 88% specificity, 94% negative predictive value, and 83% positive predictive value in the diagnosis of pre-sinusoidal portal hypertension.

CONCLUSIONS

Visualisation of the venous portal system by CO(2) venography is markedly superior to iodine. The use of CO(2) wedged portography is a useful and safe complementary procedure during hepatic vein catheterisation which may help to detect portal thrombosis. Also, lack of demonstration of the portal vein in non-cirrhotic patients strongly suggests the presence of pre-sinusoidal portal hypertension.

Nasal gliomas: main features, management and report of five cases

Nasal gliomas are neurologic malformations that should be considered in the presence of a congenital nasal mass. Appropriate pre-operative examination must be performed to identify a possible connection with CNS, which is present in 15-20% of the cases. This examination should determine whether initial craniotomy is necessary. Here, we report five cases and review the main characteristics and management of this pathology.

Beliefs and practices of urban mothers regarding "hot" and "cold" foods in childhood illnesses

Beliefs and practices of 100 urban mothers regarding "hot" and "cold" foods during four common childhood illnesses were determined by using a pretested, partly structured interview schedule. Egg, by 60% of mothers, mango by 52%, lentils by 49%, jaggery by 46% were considered "hot" properties. "Hot" foods were preferred and "cold" foods restricted in the treatment of cough and cold and illnesses with rash. In diarrhoea, "cold" foods were preferred and "hot" foods restricted. The knowledge that many food combinations and certain procedures are believed to change the properties of common food may be utilized in promoting the consumption of nutritionally balanced diets. Introduction of culturally acceptable education in nutrition which incorporates the above knowledge is likely to help in the prevention of protein-energy malnutrition and to increase parental co-operation during therapy.