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Benign Thyroid Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
For benign goitre, surgery is indicated for compressive symptoms. Lobectomy is used when only one lobe is severely affected.Total thyroidectomy is appropriate if the gland is diffusely involved.Rarely, sternotomy is required for retrosternal goitre.
Tracheal and Bronchial Developmental Abnormalities, and Inflammatory Diseases including Bronchiectasis, Cystic Fibrosis and Bronchiolitis.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Some CF patients are being treated with indwelling central venous catheters to give IV antibiotics. A lobectomy may occasionally be carried out to remove a single destroyed lobe. A few in the later stages have heart plus bilateral (or sequential single) lung transplants (single lung transplants per se are mostly unsuccessful as they become infected from the contralateral lung, particularly with the use of anti-rejection drugs). In those with hepatomegaly, liver transplantation may also be carried out. Gene therapy has also being tried, but the viral carrier causes a significant pulmonary inflammatory response as shown by CT, and it is being replaced with a liposomal carrier. DNA loss in the sputum is high and about a third of cases may benefit from a (very expensive) human DNase - an enzyme which breaks down the long strands of DNA and hence reduces the viscosity of purulent sputum.
A Bronchogenic Cyst Masquerading as a Paraesophageal Hiatal Hernia
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Stephanie G. Worrell, Kiran H. Lagisetty, Rishindra M. Reddy
On re-review of her original imaging (Figure 25.1), there was no apparent connection between the esophagus and an adjacent large structure, which was felt to be cystic in nature, contrary to the original interpretation of being a portion of the stomach. A barium esophagogram was ordered to determine if the gastrointestinal tract communicated with the posterior mediastinal lesion. This showed no evidence of a paraesophageal hiatal hernia (Figure 25.2). The differential diagnosis now was focused on a bronchogenic or esophageal duplication cyst, with bronchogenic cyst being more likely based on radiologic appearance. A bronchoscopy was performed and showed a small, pin-sized, opening at the carina, confirming the likelihood of a bronchogenic cyst. Pulmonary function tests showed adequate lung function to tolerate a lobectomy if necessary.
Could kinesiology taping of the inspiratory muscles help manage chronic breathlessness? An opinion paper
Published in Progress in Palliative Care, 2022
G. Banerjee, A. Rose, M. Briggs, P. Plant, M. I. Johnson
Likewise, initial studies provide tentative evidence for improved respiratory function associated with kinesiology taping following stroke and pulmonary surgery. Park et al.32 reported improvements in PEF, FEV1, FVC and chest expansion associated with respiratory muscle taping, chest mobilization and respiratory muscle taping combined with chest mobilization (n = 10 per group). However, it was unclear as to whether kinesiology tape was used for the respiratory muscle taping intervention and if the improvements and the difference in means of outcomes were significant. Wang et al.33 found that kinesiology taping of diaphragm plus breathing exercises significantly increased the tone of stroke-affected upper trapezius, scalene, external oblique abdominal and rectus abdominis muscles compared with the unaffected side whereas breathing exercise alone produced significant increase in the tone of only upper trapezius and external oblique abdominal muscles (n = 14 per group). In post-lobectomy (for lung cancer) participants, Imperatori et al.14 found that kinesiology taping of the chest produced significant improvements in inspiratory volume (n = 26 participants) compared with sham taping control (n = 25 participants).
Hematopoietic stem cell transplantation for inherited bone marrow failure syndromes: alternative donor and disease-specific conditioning regimen with unmanipulated grafts
Published in Hematology, 2021
Yue Lu, Min Xiong, Rui-Juan Sun, Yan-Li Zhao, Jian-Ping Zhang, Xing-Yu Cao, De-Yan Liu, Zhi-Jie Wei, Jia-Rui Zhou, Dao-Pei Lu
The general characteristics of the SCN patients and donors are summarized in Tables 4 and 5. The male to female ratio was 5–3. The median age at diagnosis and HSCT was 2 months (range: 1 week–1 year) and 3.1 years (range: 2.1 years–15 years). The median disease course pre-HSCT was 3 years (range: 8 months–15 years). The median absolute neutrophil count (ANC) in PB was 150 (20–300)/L. Two patients had a family history – one with a congenital megacolon and one with development retardation. All patients had uncontrolled recurrent infection prior to HSCT. Lobectomy was performed in one patient due to severe pulmonary infection. One patient had colonic resection due to repeated infection of a congenital megacolon. ELANE deleterious genes mutations were detected in all patients. Two patients had mutations that were traced back to their parents. All patients received G-CSF treatment for a median of 36 months (range: 24 m–120 m) before HSCT and doses above the median dose of 8 μg/kg/day (range: 5–16 μg/kg/day).
Global hospital and operative costs associated with various ventral cavity procedures: a comprehensive literature review and analysis across regions
Published in Journal of Medical Economics, 2019
Brian P. Chen, Jeffrey W. Clymer, Adrian P. Turner, Nicole Ferko
Tables 3 and 4 present data for outcomes that represent unit costs, either OR time cost per minute or ward cost per day, rather than total costs. The weighted average OR time cost per minute ranged from $9.81 (robotic lobectomy, EMEA) to $34.16 (robotic hepatic resection, Americas); however, the overall weighted average across procedures for each region was $13.90 (EMEA), $14.29 (Asia-Pacific) and $24.83 (Americas) (Table 3). For the ward cost per day, the weighted average cost ranged from $31.88 (open lobectomy, Asia-Pacific) to $1,148 (laparoscopic hepatic resection, Asia-Pacific); however, the overall weighted averages across procedures for each region was $216.21 (Asia-Pacific), $574.37 (EMEA), and $966.22 (Americas) (Table 4). It should be noted that unit cost data for the Asia-Pacific region was reported by very few studies; however, existing data did show values that were typically comparable or lower than EMEA. Across studies, the geometric mean of the OR time cost per hour and ward cost per hour ratio was calculated to be $51.97; thus, 1 h of OR time was calculated to be over 50 times as costly as 1 h of ward time. In other words, reducing OR time by 30 min equates to saving approximately 1 day of ward time.