Uniportal VATS S9 segmentectomy: The ligamentum-based approach

Isolated resection of the lateral-basal segment (S9) is uncommon, and it is considered one of the most complex anatomic segmentectomies. First, the segmental arterial and venous supply is located deeply in the lung parenchyma, making the dissection difficult. Second, the cuboidal shape of the lateral basilar segment hampers the identification of the intersegmental plane. Although identifying the segmental arterial branches is easier from a fissure-based technique, the ligamentum-based approach emerges as a valid and safe alternative in cases of a fused fissure.

The Imaginal Characters of Neoephemera projecta Showing Its Plesiomorphic Position and a New Genus Status in the Family (Ephemeroptera: Neoephemeridae)

The newly collected imaginal materials of the species Neoephemera projecta Zhou and Zheng, 2001 from Southwestern China, which is linking the other genera of the family Neoephemeridae, are described in detail. Nymphs are also photographed for the first time. The morphology of this species shows some characters of the other genera in Neoephemeridae and several autapomorphies. However, most characters can be seen as plesiomorphies of the family. Specifically, the dorsal-oriented fimbriate gills, projected frons and slim labial palpi in nymphs plus large reddishly pigmented wings, many crossveins, 4-segmented forceps with a relatively long basal segment, fused penes and unforked anal vein show that this species is closer to the taxon Fossoriae rather than to the previously considered Potamanthidae. To reflect its primitive position, a new genus, Pulchephemera Zhou gen. n., is established for this species, Pulchephemera projecta comb. n. Its eggs and observed biology are also described.

Predictors of failure of intersegmental line creation using bronchoscopic jet ventilation for thoracoscopic pulmonary segmentectomy

Background During pulmonary segmentectomy, identification of the target segment is essential. We used bronchoscopic jet ventilation (BJV) to delineate the intersegmental plane by selectively sending air into the target segment. The purpose of this study was to investigate the factors associated with BJV failure. Methods Data were retrospectively collected from 48 patients who underwent pulmonary segmentectomy with BJV between March 2014 and May 2019 at a single center. Data were compared between BJV succeeded cases and failed cases. Results In 13 cases (27%), BJV were unsuccessful. The Brinkman index was significantly higher in failed cases (962 ± 965 failed vs. 395 ± 415 successful, P = 0.0067). The success rate was significantly lower when BJV was applied to the posterior basal segmental bronchus (B10) (B10: 1/5 (20%) vs others: 34/43 (79%), P = 0.015). Conclusion Long-term smoking and the bronchus corresponding to the posterior basal segment might make successful performance of BJV difficult.

First record of Paegniodes Eaton, 1881 (Ephemeroptera, Heptageniidae) from Thailand with description of a new species

A new species of Heptageniidae, Paegniodes sapanensissp. nov., is described based on larvae, subimagos, eggs, and COI data. The mayfly genus Paegniodes Eaton, 1881 is reported for the first time from Thailand. The larva of the new species can be distinguished from other known Paegniodes species by i) lamellae of gill I ca 1/4 of fibrilliform portion and ii) mandibles and basal segment of maxillary palp without dense setae on margin. The subimago characters useful to distinguish this new species from previously known species are i) the median stripes on abdominal terga and ii) shape of the female subgenital and subanal plates. The genetic distance between the new species and P. cupulatus (Eaton, 1871) was approximately 11%. The morphological characters of the new species are discussed and compared to other known species.

Successful treatment of bilateral empyema with bilateral fistulae using free intercostal muscle flap

Background Bilateral empyema is rare and can be life-threatening. Few cases have ever been reported about bilateral empyema with fistula on both sides. We herein report a case of bilateral empyema with bilateral fistulae that was treated with a 2-stage operation. Case presentation The patient was a 40 year-old man with uncontrolled diabetes mellitus, severe emaciation and remarkably decayed teeth. On his admission, computed tomography showed bilateral pneumothorax and pleural effusion. Thoracentesis revealed a cream-colored purulent pleural effusion from both sides of the pleural cavity. Bilateral empyema with fistulae on both sides due to a ruptured lung abscess was diagnosed. 7 days after his administration, we performed the first surgery. There were 3 fistulae in the right lateral basal segment (S9), right posterior basal segment (S10), and left posterior basal segment (S10). At the first operation, the S9 fistula was directly sutured; however, the right S10 fistula could not be closed because the surrounding tissue was fragile. The left lung fistula was deep and crater-shaped; it was closed with the suturing of a plugged free muscle flap. At the second operation, the right S10 fistula was closed with the superimposition of a pedicled intercostal muscle flap. Conclusion Patients with bilateral empyema tend to be with poor general condition and, therefore, less invasive treatments are required initially. Closure of fistulae is an essential process for the treatment of empyema with fistulae. We could manage the fistulae using several techniques with 2-stage operation. Although the efficacy of using a free intercostal muscle flap to close the fistula has not been adequately verified, it is simple and less invasive and, thus, might be a useful option in cases where the patient is too ill to undergo a more invasive operation or when the surgical approach should be done in a short time

The Diagnostic Value of 2D- Speckle Tracking Echocardiography for Identifying Subclinical Ventricular Dysfunction in Subjects with Early Repolarization Pattern

Introduction: Early repolarization pattern (ERP) has been known a benign electrocardiographic variant for decades. However, it can exist a silent substrate for arrhytmic events in accordance with the previous studies which have shown that there has been evidence of morphological changes in left ventricle (LV) in subjects with ERP. Despite structural changes in ERP subjects, it has not exactly known that whether a change in functional parameters of LV occur in these population. The aim of our study was to investigate LV functional parameters in subjects with ERP by the use of 2D- speckle tracking echocardiography (2D-STE). Method: In this study, subjects with ERP (n= 50) and subjects without ERP (n= 50) were recruited between 01.04.2018 and 01.09.2018. For each case, 2D- STE evaluation was performed by the same cardiologist. Results: Mean LV global longitudinal strain (GLS) and GLS in all apical chamber views, longitudinal peak systolic strain rate (SRS) at A3C, early diastolic strain rate (SRE) at A3C and late diastolic strain rate (SRA) at A3C in the ERP subjects were significantly lower than those in the subjects without ERP. Furthermore, LV basal segment circumferential SRS and SRE were significantly lower in ERP subjects compared to subjects without ERP. Conclusion: Our study suggests that ERP can be more associated with impaired LV longitudinal function than LV circumferential function. In addition, both LV inferolateral region and LV basal segment can be more affected functionally in ERP subjects.

Staged surgery for empyema and lung gangrene caused by pseudoaneurysm after radiofrequency ablation

Lung gangrene is a potentially fatal disease, and primary or staged surgery, depending on the patient’s condition, is reported to be useful. We describe successful management, by staged surgery, of a rare case of empyema and lung gangrene complicating lung radiofrequency ablation. The patient, who was a diabetic with colorectal pulmonary metastases, underwent embolization of a pulmonary artery pseudoaneurysm in the right basal segment that developed after lung radiofrequency ablation. He subsequently developed lung gangrene caused by lung ischaemia, and empyema, necessitating pleural decortication followed by open-window thoracostomy. Subsequently, right basal segmentectomy was performed, with thoracostoma closure. Staged surgery might be beneficial for high-risk patients with empyema and lung gangrene caused by lung ischaemia.