This is the case of an elderly woman with significant tracheobronchomalacia (TBM) who presented w... more This is the case of an elderly woman with significant tracheobronchomalacia (TBM) who presented with exertional dyspnea and cough. The patient underwent awake fiberoptic bronchoscopy, which confirmed posterior malaria with >90% narrowing of the trachea and right mainstream bronchus. The patient was treated conservatively with bronchodilators for six months without symptomatic improvement. She was referred for tracheobronchoplasty via a minimally invasive approach.<br>A four-arm robotic-assisted approach was selected. The trachea was dissected to the level of the thoracic inlet and the carina skeletonized. The left mainstem bronchus was mobilized, allowing exposure of the entire membranous trachea. The tracheoplasty was performed using four columns of interrupted horizontal mattress 4-0 vicryl sutures to a proline mesh. The bronchoplasty was performed using three columns of sutures. Frequent intraoperative bronchoscopy was performed.While tracheobronchoplasty for TBM has tra...
Background<br> The COVID-19 pandemic has resulted in a rapid increase in patients requiring... more Background<br> The COVID-19 pandemic has resulted in a rapid increase in patients requiring mechanical ventilation. For patients who survive the acute phase of infection, tracheostomy may prevent long-term sequelae of prolonged endotracheal intubation, conserve sedative and paralytic medications, and facilitate endotracheal suctioning, weaning from mechanical ventilation, and cohorting of patients in a designated weaning unit. However, the risk of spreading the COVID-19 virus through aerosolizing procedures such as tracheostomy is well documented (1). Standards for safe practice when performing tracheostomy under these circumstances are not yet established. <br> The authors describe their protocol for the performance of tracheostomy in COVID-19-infected patients with special attention to procedural technique, personal protective equipment (PPE), and minimization of participating personnel. In their experience at a tertiary care, community-based teaching hospital, their p...
The introduction of anesthesia in 1846 created unseen opportunities for surgeons. By the end of t... more The introduction of anesthesia in 1846 created unseen opportunities for surgeons. By the end of the 19th century limited esophageal resection outside the chest had already been performed and the race for successful intrathoracic esophagectomy was on. The credit for the first successful esophagectomy for an intrathoracic cancer goes to Franz Torek of New York in 1913. But it was the introduction of double lumen intubation that really boosted the number of successful esophagectomies all over the world. In the second half of the 20th century progress in surgical techniques and perioperative management resulted in a substantial reduction of postoperative mortality. Introduction of multimodality therapies has further improved long term survival. The turn of the millennium saw the development of minimally invasive esophagectomy (MIE) improving postoperative quality of life. Undoubtly new technologies and newer drugs (e.g., immunotherapy) will further allow for refinements and more persona...
Supplemental Material, sj-pdf-1-jic-10.1177_08850666211023360 for Outcomes of Barotrauma in Criti... more Supplemental Material, sj-pdf-1-jic-10.1177_08850666211023360 for Outcomes of Barotrauma in Critically Ill COVID-19 Patients With Severe Pneumonia by Victor P. Gazivoda, Mudathir Ibrahim, Aaron Kangas-Dick, Arony Sun, Michael Silver and Ory Wiesel in Journal of Intensive Care Medicine
Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with millio... more Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with millions of divers enjoying the sport worldwide. This activity presents unique physical and physiological challenges to the respiratory system, raising numerous concerns about individuals with asthma who choose to dive. Asthma had traditionally been a contraindication to recreational diving, although this caveat has been ignored by large numbers of such patients. Herein we review the currently available literature to provide evidence-based evaluation of the risks associated with diving that are posed to asthmatics. Although there is some indication that asthmatics may be at an increased risk of pulmonary barotrauma, the risk seems to be small. Thus, under the right circumstances, patients with asthma can safely participate in recreational diving without any apparent increased risk of an asthma-related event. Decisions on whether or not diving is hazardous must be made on an individual basis an...
Post-operative delirium is common, and has an incidence of 37-74% as reported in different public... more Post-operative delirium is common, and has an incidence of 37-74% as reported in different publications. The growing rates of the elderly among surgical patients makes that condition more relevant than ever, since these populations are highly susceptible to develop this condition. Contrary to the common assumption, delirium is not a unique complication of the elderly alone. Trauma and young surgical patients may also present its manifestations after major and complicated surgery in the different intensive care units. Post-operative delirium was shown to precede long term complications such as dementia. Many of the patients that develop delirium will be sent to long and complicated rehabilitation units, after being reLeased from hospitalization, thus increasing the economic burden on the medical system. Furthermore, the once recognized "ICU Psychoses" are no longer exclusive to intensive care units alone, and nowadays, infiltrate to all surgical departments. Simple, bedside...
SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESEN... more SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pneumothorax (PTX) is characterized by the presence of air within the pleural space The association between PTX and COVID-19 has not been well established in the current literature We sought to better characterize the presentation and clinical outcomes of PTX in patients with confirmed SARS-COV-2 pneumonia at our institution to better define the incidence, cause, outcomes and available treatment for this condition METHODS: All patients with a proven diagnosis of COVID19 and concomitant PTX between March 17, 2020 and May 5, 2020 were identified through hospital records Retrospective analysis of radiology records and chart review was conducted Clinical characteristics and outcomes were collected and descriptive statistics were analyzed RESULTS: 63 patients met inclusion criteria Median age was 65 5 years (IQR 54-74 75) The most prevalent medical comorbi...
The use of indocyanine green (ICG) fluorescence near-infrared (NIR) imaging during gastrointestin... more The use of indocyanine green (ICG) fluorescence near-infrared (NIR) imaging during gastrointestinal surgery has surged in recent years. Its use in esophageal surgery is actively being studied both in the clinical setting and in the lab. NIR imaging has several important applications in esophageal surgery including assessing perfusion of the gastrointestinal-esophageal anastomosis, lymphatic drainage and tracheal blood flow after mediastinal dissection. This is a review of the modern literature summarizing the current knowledge on fluorescence-guided surgery of the esophagus.
Previous studies using the viral transneuronal tracing technique demonstrated central autonomic c... more Previous studies using the viral transneuronal tracing technique demonstrated central autonomic circuits involved in the innervation of the adrenal gland. Since increasing number of data indicate laterality in the neuroendocrine system, we aimed to investigate whether the supraspinal innervation of the adrenal gland exhibits asymmetry or not. The central circuitry involved in the innervation of the left and the right adrenal gland was studied in individual rats by dual transneuronal tracing using isogenic recombinant strains (Ba-DupGreen and Ba-Duplac expressing lacZ) of Bartha strain of pseudorabies virus. Viral infection of brain nuclei (dorsal vagal nucleus, nucleus of the solitary tract, caudal raphe nuclei, A5 cell group, hypothalamic paraventricular nucleus) from the left adrenal was more severe than that from the right organ. Dual-infected neurons were present both in the brain stem and in the hypothalamus. The results indicate a predominance in the supraspinal innervation of the left adrenal gland, and that each adrenal gland is innervated both by side-specific neurons and by neurons that project to both organs.
Increased density of catecholaminergic nerves in the human polycystic ovary has been observed. Th... more Increased density of catecholaminergic nerves in the human polycystic ovary has been observed. The aim of the present study was to investigate the distribution of transsynaptically virus-labeled neurons in the central nervous system from the rat polycystic ovary to see whether is it different or not from that of cycling control rats. To induce a polycystic ovary, a single injection of estradiol valerate was given to adult female rats and 30 days later a neurotropic virus was injected into the right ovary. Rats were sacrificed 72 or 96 hours after viral infection. Weight of the ovaries of the estradiol valerate-treated rats was significantly lower compared to controls, and the histology of the ovaries of the treated rats displayed severely atretic large antral follicles. There was almost no viral labeling in the central nervous system from the ovaries showing precystic morphology, in spite of the fact that such altered organs are rich in nerve fibres. It is assumed that presently unidentified factors in the precystic ovary, presumably related to the link between the immune and the nervous system, might be involved in the infectivity of the virus, and thus be responsible for the lack of viral labeling from such an ovary.
This is the case of an elderly woman with significant tracheobronchomalacia (TBM) who presented w... more This is the case of an elderly woman with significant tracheobronchomalacia (TBM) who presented with exertional dyspnea and cough. The patient underwent awake fiberoptic bronchoscopy, which confirmed posterior malaria with >90% narrowing of the trachea and right mainstream bronchus. The patient was treated conservatively with bronchodilators for six months without symptomatic improvement. She was referred for tracheobronchoplasty via a minimally invasive approach.<br>A four-arm robotic-assisted approach was selected. The trachea was dissected to the level of the thoracic inlet and the carina skeletonized. The left mainstem bronchus was mobilized, allowing exposure of the entire membranous trachea. The tracheoplasty was performed using four columns of interrupted horizontal mattress 4-0 vicryl sutures to a proline mesh. The bronchoplasty was performed using three columns of sutures. Frequent intraoperative bronchoscopy was performed.While tracheobronchoplasty for TBM has tra...
Background<br> The COVID-19 pandemic has resulted in a rapid increase in patients requiring... more Background<br> The COVID-19 pandemic has resulted in a rapid increase in patients requiring mechanical ventilation. For patients who survive the acute phase of infection, tracheostomy may prevent long-term sequelae of prolonged endotracheal intubation, conserve sedative and paralytic medications, and facilitate endotracheal suctioning, weaning from mechanical ventilation, and cohorting of patients in a designated weaning unit. However, the risk of spreading the COVID-19 virus through aerosolizing procedures such as tracheostomy is well documented (1). Standards for safe practice when performing tracheostomy under these circumstances are not yet established. <br> The authors describe their protocol for the performance of tracheostomy in COVID-19-infected patients with special attention to procedural technique, personal protective equipment (PPE), and minimization of participating personnel. In their experience at a tertiary care, community-based teaching hospital, their p...
The introduction of anesthesia in 1846 created unseen opportunities for surgeons. By the end of t... more The introduction of anesthesia in 1846 created unseen opportunities for surgeons. By the end of the 19th century limited esophageal resection outside the chest had already been performed and the race for successful intrathoracic esophagectomy was on. The credit for the first successful esophagectomy for an intrathoracic cancer goes to Franz Torek of New York in 1913. But it was the introduction of double lumen intubation that really boosted the number of successful esophagectomies all over the world. In the second half of the 20th century progress in surgical techniques and perioperative management resulted in a substantial reduction of postoperative mortality. Introduction of multimodality therapies has further improved long term survival. The turn of the millennium saw the development of minimally invasive esophagectomy (MIE) improving postoperative quality of life. Undoubtly new technologies and newer drugs (e.g., immunotherapy) will further allow for refinements and more persona...
Supplemental Material, sj-pdf-1-jic-10.1177_08850666211023360 for Outcomes of Barotrauma in Criti... more Supplemental Material, sj-pdf-1-jic-10.1177_08850666211023360 for Outcomes of Barotrauma in Critically Ill COVID-19 Patients With Severe Pneumonia by Victor P. Gazivoda, Mudathir Ibrahim, Aaron Kangas-Dick, Arony Sun, Michael Silver and Ory Wiesel in Journal of Intensive Care Medicine
Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with millio... more Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with millions of divers enjoying the sport worldwide. This activity presents unique physical and physiological challenges to the respiratory system, raising numerous concerns about individuals with asthma who choose to dive. Asthma had traditionally been a contraindication to recreational diving, although this caveat has been ignored by large numbers of such patients. Herein we review the currently available literature to provide evidence-based evaluation of the risks associated with diving that are posed to asthmatics. Although there is some indication that asthmatics may be at an increased risk of pulmonary barotrauma, the risk seems to be small. Thus, under the right circumstances, patients with asthma can safely participate in recreational diving without any apparent increased risk of an asthma-related event. Decisions on whether or not diving is hazardous must be made on an individual basis an...
Post-operative delirium is common, and has an incidence of 37-74% as reported in different public... more Post-operative delirium is common, and has an incidence of 37-74% as reported in different publications. The growing rates of the elderly among surgical patients makes that condition more relevant than ever, since these populations are highly susceptible to develop this condition. Contrary to the common assumption, delirium is not a unique complication of the elderly alone. Trauma and young surgical patients may also present its manifestations after major and complicated surgery in the different intensive care units. Post-operative delirium was shown to precede long term complications such as dementia. Many of the patients that develop delirium will be sent to long and complicated rehabilitation units, after being reLeased from hospitalization, thus increasing the economic burden on the medical system. Furthermore, the once recognized "ICU Psychoses" are no longer exclusive to intensive care units alone, and nowadays, infiltrate to all surgical departments. Simple, bedside...
SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESEN... more SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pneumothorax (PTX) is characterized by the presence of air within the pleural space The association between PTX and COVID-19 has not been well established in the current literature We sought to better characterize the presentation and clinical outcomes of PTX in patients with confirmed SARS-COV-2 pneumonia at our institution to better define the incidence, cause, outcomes and available treatment for this condition METHODS: All patients with a proven diagnosis of COVID19 and concomitant PTX between March 17, 2020 and May 5, 2020 were identified through hospital records Retrospective analysis of radiology records and chart review was conducted Clinical characteristics and outcomes were collected and descriptive statistics were analyzed RESULTS: 63 patients met inclusion criteria Median age was 65 5 years (IQR 54-74 75) The most prevalent medical comorbi...
The use of indocyanine green (ICG) fluorescence near-infrared (NIR) imaging during gastrointestin... more The use of indocyanine green (ICG) fluorescence near-infrared (NIR) imaging during gastrointestinal surgery has surged in recent years. Its use in esophageal surgery is actively being studied both in the clinical setting and in the lab. NIR imaging has several important applications in esophageal surgery including assessing perfusion of the gastrointestinal-esophageal anastomosis, lymphatic drainage and tracheal blood flow after mediastinal dissection. This is a review of the modern literature summarizing the current knowledge on fluorescence-guided surgery of the esophagus.
Previous studies using the viral transneuronal tracing technique demonstrated central autonomic c... more Previous studies using the viral transneuronal tracing technique demonstrated central autonomic circuits involved in the innervation of the adrenal gland. Since increasing number of data indicate laterality in the neuroendocrine system, we aimed to investigate whether the supraspinal innervation of the adrenal gland exhibits asymmetry or not. The central circuitry involved in the innervation of the left and the right adrenal gland was studied in individual rats by dual transneuronal tracing using isogenic recombinant strains (Ba-DupGreen and Ba-Duplac expressing lacZ) of Bartha strain of pseudorabies virus. Viral infection of brain nuclei (dorsal vagal nucleus, nucleus of the solitary tract, caudal raphe nuclei, A5 cell group, hypothalamic paraventricular nucleus) from the left adrenal was more severe than that from the right organ. Dual-infected neurons were present both in the brain stem and in the hypothalamus. The results indicate a predominance in the supraspinal innervation of the left adrenal gland, and that each adrenal gland is innervated both by side-specific neurons and by neurons that project to both organs.
Increased density of catecholaminergic nerves in the human polycystic ovary has been observed. Th... more Increased density of catecholaminergic nerves in the human polycystic ovary has been observed. The aim of the present study was to investigate the distribution of transsynaptically virus-labeled neurons in the central nervous system from the rat polycystic ovary to see whether is it different or not from that of cycling control rats. To induce a polycystic ovary, a single injection of estradiol valerate was given to adult female rats and 30 days later a neurotropic virus was injected into the right ovary. Rats were sacrificed 72 or 96 hours after viral infection. Weight of the ovaries of the estradiol valerate-treated rats was significantly lower compared to controls, and the histology of the ovaries of the treated rats displayed severely atretic large antral follicles. There was almost no viral labeling in the central nervous system from the ovaries showing precystic morphology, in spite of the fact that such altered organs are rich in nerve fibres. It is assumed that presently unidentified factors in the precystic ovary, presumably related to the link between the immune and the nervous system, might be involved in the infectivity of the virus, and thus be responsible for the lack of viral labeling from such an ovary.
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