PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations.

Video-assisted thoracoscopic surgery has become increasingly popular due to faster recovery times and reduced postoperative pain compared with thoracotomy. However, analgesic regimens for video-assisted thoracoscopic surgery vary significantly. The goal of this systematic review was to evaluate the available literature and develop recommendations for optimal pain management after video-assisted thoracoscopic surgery. A systematic review was undertaken using procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials published in the English language, between January 2010 and January 2021 assessing the effect of analgesic, anaesthetic or surgical interventions were identified. We retrieved 1070 studies of which 69 randomised controlled trials and two reviews met inclusion criteria. We recommend the administration of basic analgesia including paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2-specific inhibitors pre-operatively or intra-operatively and continued postoperatively. Intra-operative intravenous dexmedetomidine infusion may be used, specifically when basic analgesia and regional analgesic techniques could not be given. In addition, a paravertebral block or erector spinae plane block is recommended as a first-choice option. A serratus anterior plane block could also be administered as a second-choice option. Opioids should be reserved as rescue analgesics in the postoperative period.

Repeated attacks of type III hereditary angioedema with factor XII mutation during pregnancy.

In type III hereditary angioedema (HAE type III), the phenotype is the same as type I and type II disease, but the level and function of C1-esterase inhibitor (C1-INH) is normal. Hereditary angioedema type III has been described as an oestrogen-sensitive form because it can be triggered or aggravated by exposure to high oestrogen levels as seen during pregnancy, especially when associated with Factor XII mutation. This case report describes the evolution and management of repeated angioedema attacks during pregnancy in a woman with HAE, with normal levels and function of C1-INH (type III); and a mis-sense mutation of factor XII. The physiopathology and genetic features, the unpredictability of clinical manifestations and the management during pregnancy and delivery are discussed.

Non-destructive method of characterisation of radioactive waste containers using gamma spectroscopy and Monte Carlo techniques.

During the decommissioning of the SATURNE accelerator at CEA Saclay (France), a number of concrete containers with radioactive materials of low or very low activity had to be characterised before their final storage. In this paper, a non-destructive approach combining gamma ray spectroscopy and Monte Carlo simulations is used in order to characterise massive concrete blocks containing some radioactive waste. The limits and uncertainties of the proposed method are quantified for the source term activity estimates using 137Cs as a tracer element. A series of activity measurements with a few representative waste containers were performed before and after destruction. It has been found that neither was the distribution of radioactive materials homogeneous nor was its density unique, and this became the major source of systematic errors in this study. Nevertheless, we conclude that by combining gamma ray spectroscopy and full scale Monte Carlo simulations one can estimate the source term activity for some tracer elements such as 134Cs, 137Cs, 60Co, etc. The uncertainty of this estimation should not be bigger than a factor of 2-3.