Liposarcoma gigante mediastinal. Cirugía radical con abordaje Clamshell y manejo en la Unidad de Cuidados Críticos / Giant Mediastinal Liposarcoma. Radical Surgery with Clamshell Approach and Management in Critical Care Unit

Se presenta a un paciente con liposarcoma mediastinal gigante con dolor torácico, disnea, cuyos estudios por imágenes revelaban la presencia de una gran tumoración de 42 cm en su diámetro mayor que abarcaba todo el mediastino, comprometía ambas cavidades torácicas, rechazaba los pulmones, corazón y grandes vasos. La biopsia con aguja cortante bajo guía ecográfica fue informada como liposarcoma. El paciente tuvo resección completa del tumor mediante la incisión Clamshell. En el post operatorio inmediato, presentó shock circulatorio más disfunción multiorgánica (DOMS): plaquetopenia, insuficiencia renal aguda con necesidad de soporte dialítico, injuria hepática. El soporte y monitoreo especializado en la Unidad de Cuidados Intensivos (UCI) permitió mejoría clínica y buena evolución. Salió de alta en buenas condiciones.

We present a patient with giant mediastinal liposarcoma with chest pain, dyspnea, whose imaging studies revealed the presence of a large tumor measuring 42 cm in its greatest diameter that covered the entire mediastinum, involved both thoracic cavities, rejected the lungs, heart and big glasses. The sharp needle biopsy under ultrasound guidance was reported as liposarcoma. The patient had complete resection of the tumor through the Clamshell incision. In the immediate postoperative period, he presented circulatory shock plus multiple organ dysfunction (DOMS): plateletopenia, acute renal failure with the need for dialytic support, liver injury. Specialized support and monitoring in the Intensive Care Unit (ICU) allowed clinical improvement and good evolution. He was discharged in good condition.

Recycling Potential of Natural Waste Products in the Development of Fingerprint Powders for Forensic Application

@#Introduction: The most common method to emerge latent fingermarks on non-porous surfaces is powdering by applying commercial fingerprint powders. However, the chemical composition of the powder is often toxic and poses health hazards to humans. This study was endeavoured to explore the effectiveness and potential use of natural resources for the enhancement of latent fingermarks. Methods: Eggshells and clamshells were prepared in fine powder form, and latent fingermarks were developed using each powder. Five non-porous substrates were selected for fingermarks deposition; glass, aluminium can, plastic book cover, painted wood, and compact disc. Results: Both natural powders have successfully developed high-quality finger marks with high clarity of ridge characteristics in comparison to commercial fingerprint powder (positive control) and untreated fingermark (negative control) on most of the tested surfaces tested. The sebaceous fingermarks have shown the best quality fingermarks when developed with both powders. In the ageing study, it was found that most non-porous substrates bearing latent fingermarks exposed to the destructive conditions can be successfully visualised in the early period of exposure. Conclusion: Eggshell and clamshell powders are as effective as commercial white powder but preferrable to be applied because of the low cost, abundant and non-hazardous.

Clamshell Thoracotomy for Two Cases of Blunt Traumatic Cardiac Rupture / 日本心臓血管外科学会雑誌

When a sufficient field of view in unilateral thoracotomy cannot be obtained during hemostasis surgery for severe thoracic trauma, clamshell thoracotomy is often necessary to perform aortic cross-clamping in order to avoid cardiac arrest or to treat intrathoracic injury across the chest. Here we describe two successful cases of clamshell thoracotomy for blunt traumatic cardiac rupture. Case 1 was a 41-year-old male motorcyclist, injured in a collision with a truck, who was in a state of shock when transported to our emergency department (ED). Due to the finding of fluid accumulation around the spleen on FAST (focused assessment with sonography for trauma), he underwent emergency laparotomy with gauze packing after splenectomy as damage control surgery. Because of a prolonged state of shock due to extensive right hemothorax, right anterolateral thoracotomy was performed to locate the site of active bleeding in the right mediastinal pleura. However, imminent cardiac arrest necessitated clamshell thoracotomy, which revealed a 4-cm laceration on the right atrium and two lacerations on the upper lobe of the right lung, for which suture repair was performed. His postoperative course was uneventful and he was discharged on postinjury day 57 for rehabilitation. Case 2 was a 75-year-old female motorcyclist who was injured after hitting a curb and falling. She was in a state of shock due to severe right hemothorax when admitted to our ED and underwent anterolateral thoracotomy to treat active bleeding in the right mediastinal pleura. Clamshell thoracotomy was performed because cardiac arrest was imminent, and this was followed by suture repair of a 2-cm laceration identified on the left atrium. Her postoperative course was uneventful and she was transferred to another hospital on postinjury day 37 for rehabilitation. In both cases, Clamshell thoracotomy was performed successfully for blunt traumatic cardiac rupture and the postoperative course was good with no serious complications. Clamshell thoracotomy is an effective approach for trauma resuscitation, so surgeons should be familiar with its indications, surgical techniques, and timing.

Single-Stage Repair of Thoracic Aortic Aneurysm Associated with Aortic Stenosis and Pseudocoarctation by Means of the Clamshell Approach / 日本心臓血管外科学会雑誌

A 64-year old man was admitted to our hospital with a diagnosis of aortic stenosis. Pre-operative chest CT revealed pseudocoarctation of the aorta with a hypoplastic aortic arch, elongation and kinking of the aortic arch and proximal descending aorta. There was also a large aneurysm from the distal arch to descending aorta. We performed a single-stage repair of the aortic lesion from the ascending to the descending aorta with aortic valve replacement. For the surgical approach, transverse clamshell incision was applied safely. Concomitant aortic valve replacement in surgical repair of pseudocoarctation and thoracic aneurysm was rare, and clamshell incision seemed beneficial in such single-stage repair from the aortic root to the descending aorta.

The Clamshell Incision for the Complete Repair in Pulmonary Atresia with Ventricular Septal Defect , and Major Aortopulmonary Collaterals / 대한흉부외과학회지

A 6-month old girl who had pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals underwent one-stage complete repair with unifocalization through a bilateral thoracosternotomy(clamshell incision). There were no serious postoperative compli cations, and the postoperative echocardio-graphy showed no residual ventricular septal defect or significant pulmonary artery stenosis. In this condition, great surgical variability exists regarding the sources of pulmonary blood flow. Recent clinical work has focused on a one-stage complete repair. The potential advantages of the clamshell incision are apparent in terms of mediastinal approach, postoperative results, and safety.