Successful treatment of persistent postoperative air leaks following the placement of an endobronchial one-way valve.

Treatment of persistent air leaks due to pulmonary resection in pathological conditions of the lung involve a very large spectrum of available methods, from chest drainage and placement of Heimlich valves to surgical repair or pleural decortication. However, in some of these patients surgery may be contraindicated. This report describes an endobronchial approach to the control of marked and prolonged air leaks in four patients using a newly designed one-way airway valve (Pulmonx Corporation; Redwood City, Ca.USA) placed into the segmental bronchus that is the source of air leakage. As the device is a one-way inspiratory airway blocker, it can be used to control persistent air leaks while maintaining the drainage of mucus. This approach potentially provides an effective nonsurgical and minimally invasive alternative addition to the armamentarium of treatments for patients who suffer with persistent post-operative air leaks where other methods have failed or in frail patients who are categorised as a high surgical risk.

[Lymphectomy in differentiated thyroid cancers: our experience]. / La linfectomia nelle neoplasie differenziate della tiroide: nostra esperienza.

INTRODUCTION: At present we are still debating on which is the most adequate therapeutic strategy concerning the size of the thyroidectomy and the extension of the lymphectomy in differentiated thyroid tumors. PATIENTS AND METHODS: From January 2000 to December 2005, 334 operations for thyroid neoplasms have been performed; 304 (91%) for differentiated tumors. In 124 cases (37%) the latero-cervical and/or the central compartment lymphectomy have been associated with thyroidectomy: 79 monolateral and central compartment lymphectomies (ML and CCL) (64%), 11 bilateral and central compartment lymphectomies (BL and CCL) (8%), and 34 central compartment lymphectomies (CCL) (28%) have been performed. RESULTS: Out of the 124 lymphectomies, in 44 cases (35.5%) we found the presence of metastasis in the lymph nodes of latero-cervical and central compartments, in 10 cases (8%) absence of metastasis in the lymph nodes of the latero-cervical and central compartments, in 25 cases (20%) presence of metastasis in the latero-cervical lymph nodes and absence of metastasis in the lymph nodes of the central compartment. In 11 cases of bilateral and central compartment lymphectomies, 5 of them (4%) had positive lymph nodes of the latero-cervical and central compartments, while the other, only 6 (5%), had positive latero-cervical lymph nodes on the same side as the neoplasia. In 34 central compartment lymphectomies there was absence of metastasis. Mortality rate was zero. There was one case (0.8%) of recurrent laryngeal nerve temporary bilateral palsy (RTBP); 4 cases (3.2%) of recurrent temporary monolateral palsy (RTMP); 2 cases (1.6%) of definitive monolateral palsy (DMP); 29 cases (23.5%) of temporary hypoparathyroidism (TH); 7 cases (5.5%) of definitive hypoparathyroidism (DH). CONCLUSIONS: Latero-cervical lymphectomy should be performed by necessity when clinical tests or pre-diagnostic exams show suspect lymph nodes, whereas central compartment lymphectomy should be performed in any case of thyroid neoplasia.

Radionuclide bone-scan abnormalities in leprosy: case reports.

Radionuclide bone scans were performed on two patients with leprosy. The resulting scan patterns simulated hypertrophic osteoarthropathy and diffuse arthritis, findings entirely consistent with the primary disease process.

Nuclear medicine and ultrasound; correlation in diagnosis of disease of liver and biliary tract.

Even though the radiocolloid scan is nonspecific it will be approximately 70%-80% accurate in predicting the presence or absence of liver disease and somewhat less accurate than that in making statements as to the specific type of disease. This compares well with other modalities. The ability of nuclear medicine techniques to provide a correct diagnosis is improved when additional isotopic techniques such as hepatic blood flow studies and 131I-rose bengal and 67Ga scanning are performed. Ultrasound scanning is also non specific. To date, the major application of ultrasound in the study of the liver has been in deciphering puzzling contour abnormalities seen on nuclear medicine scans and in demonstrating fluid-filled abnormalities. Its usefulness in diffuse and solid focal lesions has been less dramatic. More recently, however, the development of gray scale has necessitated a reevaluation of the technique. Gray scale demonstrates a large number of intrahepatic interfaces that were previously invisible, and it has already been shown to demonstrate focal disorders such as metastasis more easily than the nongray-scale method. It can also demonstrate dilated biliary radicals, the gallbladder, and gallstones. In addition, while routinely studying the liver one can evaluate diaphragmatic motion and various retroperitoneal structures such as the pancreas, lymph nodes, and abdominal vascular structures.