36035 Blair Pl
Fremont CA 94536
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Localization of nonpalpable pulmonary nodules using CT-guided needle puncture. - World journal of surgical oncology
Surgical resection of small pulmonary nodule is challenging via thoracoscopic procedure. We describe our experience of computed tomography (CT)-guided needle puncture localization of indeterminate pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS).From January 2011 to July 2014, 78 consecutive patients underwent CT-guided marking for the localization of 91 small pulmonary nodules. We retrospectively reviewed the clinical data, technical details, surgical findings and pathologic results, and complications associated with CT-guided localization.Seventy-eight consecutive patients (36 men and 42 women) underwent CT-guided marking localization of 91 indeterminate pulmonary nodules (62 pure ground-glass opacity nodules, 27 part-solid nodules, and 2 solid nodules). The mean size of the nodules was 8.6 mm (3.0-23.0 mm). The mean pleural distance between the nodule and lung surface was 11.5 mm (3.0-31.3 mm). The mean procedure time of CT-guided localization was 15.2 min (8-42 min). All patients stood the procedures well without requiring conversion to open thoracotomy. Twenty-four patients (30.77%) developed pneumothorax after the procedures. Only one patient required retention of the puncture needle introducer for air drainage. The mean visual assessment pain score was 1.7 (0-3). Fifty-seven nodules (62.63%) were confirmed as malignances, including 45 primary lung cancer, and 34 nodules (37.37%) were confirmed as benign lesions.CT-guided needle puncture can be an effective and safe procedure prior to VATS, enabling accurate resection and diagnosis of small pulmonary nodules.
Thoracoscopic surgery for bronchobiliary fistula: a case report. - Journal of cardiothoracic surgery
The bronchobiliary fistula is an abnormal interconnection between the biliary tract and bronchial trees. It is rare but troublesome. The management of such fistula is a challenge. Surgical intervention is considered after failure of conservative treatment. Here we presented the successful video-assisted thoracoscopic surgery for secondary bronchobiliary fistula in 68-year-old hepatocellular carcinoma patient.
Influences of pleural effusion on respiratory mechanics, gas exchange, hemodynamics, and recruitment effects in acute respiratory distress syndrome. - The Journal of surgical research
Acute lung injury and acute respiratory distress syndrome (ALI/ARDS) cause substantial morbidity and mortality despite improvements in the understanding of lung injury and advances in treatment. Recruitment maneuver (RM) with high sustained airway pressures is proposed as an adjunct to mechanical ventilation to maintain alveolar patency. In addition, RM has been advocated to improve pulmonary gas exchange. However, many factors may influence responses to RM and the effect of pleural effusion (PLE) is unknown.There were four groups in this study (n = 6 in each group). Group A was the control group, group B was the PLE group, group C was ARDS with RM, and group D was ARDS with PLE and RM. RM was performed in groups C and D, consisting of a peak pressure of 45 cm H2O with positive end-expiratory pressure of 35 cm H2O sustained for 1 min. Arterial blood gas, systemic and pulmonary hemodynamics, lung water, and respiratory mechanics were measured throughout.After the induction of ALI/ARDS, there were significant decreases in partial pressure of oxygen in arterial blood, mean arterial pressure, systemic vascular resistance, and lung compliance. There were also significant increases in the alveolar-arterial O2 tension difference, partial pressure of arterial carbon dioxide, mean pulmonary arterial pressure, pulmonary vascular resistance, and lung water. The RM improved oxygenation, which was attenuated by PLE.ALI/ARDS leads to poor oxygenation and hemodynamics. RM results in improved oxygenation, but this improvement is attenuated by PLE.Copyright Â© 2014 Elsevier Inc. All rights reserved.
Is it all about cutoffs? Can DIC scores predict bleeding in APL? - Medical oncology (Northwood, London, England)
Predicting outcome with a scoring system should be interpreted with caution. In the application of the disseminated intravascular coagulation (DIC) scoring system, a key point is to use well-established cutoff values for the variables. In the article by Mitrovic et al., activated partial thromboplastin time was presented by seconds, while prothrombin time (PT) was expressed as percentage. Such expressions appear confusing and contradictory. In the DIC scoring system, scoring of PT is determined by prolongation in seconds. I cannot see the reason to use the percentage of PT in this article. Furthermore, the PT cutoff was defined as 50%, which may be entirely arbitrary. We had conducted an investigation in our hospital cohort. We had analyzed our cohort by the chi-square method to determine the correlation between DIC scores and bleeding events. We found no relationship between scores and events of bleeding or fatal bleeding. However, reanalysis using a cutoff DIC â‰§6 revealed a marginally significant difference in bleeding risk between high-score and low-score patients (P = 0.046). The difference was insignificant for life-threatening bleeding. While our experience appears to support authors' conclusion that DIC score â‰§6 is associated with bleeding in acute promyelocytic leukemia patients, we remain skeptical in regard to such manipulations. We believe subsequent studies on a large-scale basis or more accumulated data critically reviewed by experts are needed to shed lights on this important issue.
Unreliability of pulse contour-derived cardiac output in piglets simulating acute hemorrhagic shock and rapid volume expansion. - The Journal of trauma
Pulse contour-derived cardiac output for continuous hemodynamic monitoring is becoming popular in critical care. However, the data regarding its reliability during acute hemodynamic instability are inconsistent. This study was conducted to determine whether pulse contour-derived cardiac output truly reflects rapid hemodynamic changes.Hemorrhagic shock was created in seven anesthetized piglets by continuous blood withdrawal at a rate of 1 mL . kg . min for 20 minutes. Volume expansion with 10% hydroxyethyl starch 8 mL . kg was then administered for 5 minutes. Pulse contour-derived and thermodilution- derived hemodynamic parameters were compared.Baseline thermodilution-derived cardiac index was 3.2 +/- 0.4 L . min . M. After exsanguination, it decreased to 2.1 +/- 0.3 L . min . M while pulse contour-derived cardiac index increased to 4.4 +/- 0.4 L . min . M (p value <0.001). Thermodilution-derived systemic vascular resistance index (SVRI) increased to 2463 +/- 474 dyne . sec . cm . M while pulse contour-derived SVRI paradoxically decreased to 1047 +/- 368 dyne . sec . cm . M (p value <0.001). Following rapid volume expansion, thermodilution-derived cardiac index increased to 3.5 +/- 0.2 L . min . M while pulse contour-derived cardiac index decreased to 1.8 +/- 0.4 L . min . M (p value <0.001). Thermodilution-derived SVRI decreased to 2215 +/- 323 dyne . sec . cm . M while pulse contour-derived SVRI increased to 4105 +/- 1097 dyne . sec . cm . M (p value = 0.001).Pulse contour-derived hemodynamic parameters do not accurately reflect rapid hemodynamic changes, and the trend may be misleading in piglets. Physicians are advised to interpret pulse contour-derived hemodynamic parameters with caution or to use invasive monitoring to guide treatment strategy therapy.
Pulse pressure power spectrum predicts volume responsiveness in shock patients without sedation. - Shock (Augusta, Ga.)
The authors investigated whether the pulse pressure power spectrum (PPPS) could predict the effect of volume expansion (VE) in shock patients under mechanical ventilation without sedation. The PPPS within a frequency band of 0.15 to 0.75 Hz was developed with an animal model using nine domesticated piglets simulating acute hemorrhagic shock and then validated in 17 nonsedated mechanically ventilated shock patients. Hemodynamic parameters were recorded before and after VE. In the animal model under anesthesia and pressure-controlled ventilation, the absolute and proportional change of cardiac index after VE (DeltaCI and DeltaCI%) positively correlated with the square root of PPPS (SQRT-PPPS, r(2) = 0.34 and r(2) = 0.72, respectively). The correlations were weaker with PP variation averaged on 120-s sliding window (PPV120, r(2)= 0.27 and r(2)= 0.64, respectively) and PPV30 (r(2)= 0.28 and r(2)= 0.63, respectively) under pressure-controlled level 10 cmH(2)O. Defining the volume responder as DeltaCI% greater than or equal to 15%, the area under the receiver operating characteristic curve (AROC) were equivalent for SQRT-PPPS (0.91), PPV120 (0.86), and PPV30 (0.85). For the 17 patients who had spontaneous breathing movements under assisted pressure-controlled ventilation, the DeltaCI and DeltaCI% positively correlated with SQRT-PPPS (r(2) = 0.35 and r(2)= 0.73, respectively). The correlations were weaker with PPV120 (r(2)= 0.27 and r(2) = 0.42) and PPV30 (r(2) = 0.27 and r(2)= 0.40). The AROC were 0.78 for SQRT-PPPS (P = 0.047), 0.71 for PPV120 (P = 0.131), and 0.69 for PPV30 (P = 0.185). In mechanically ventilated shock patients, SQRT-PPPS predicts volume responsiveness without the need for sedation to prevent spontaneous breathing movements.
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