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Port-a-Cath or chemoport provides prolonged central venous access for cancer patients requiring prolonged chemotherapy. Prolonged use of chemoport is associated with many complications. Dislodgement and migration of chemoport catheter is a rare and reportable complication with potentially serious consequences.
The medical charts of 1222 paediatric cancer patients admitted to the Children’s Cancer Center in Lebanon who had chemoports inserted for long-term chemotherapy were retrospectively reviewed. Descriptive analysis of data was conducted.
Chemoport fracture and migration were found in seven cases with an incidence of 0.57%. The duration of chemoport use before the event of dislodgement varied from 2 months to 102 months. Non-functioning chemoport was the most common presentation. Totally, six cases were managed successfully by loop snaring, three cases by paediatric cardiology team, and three cases by interventional radiology team. One case was managed surgically during chemoport removal.
Fracture and migration of chemoport catheter is a rare complication of uncertain aetiology and with potentially serious consequences. Percutaneous retrieval, done by experienced cardiologist or interventional radiologist, is the first choice for management of this complication as it is considered as a safe and effective approach.
Motor control is a ubiquitous aspect of human function, and from its earliest origins, abnormal motor control has been proposed as being central to schizophrenia. The neurobiological architecture of the motor system is well understood in primates and involves cortical and sub-cortical components including the primary motor cortex, supplementary motor area, dorsal anterior cingulate cortex, the prefrontal cortex, the basal ganglia, and cerebellum. Notably all of these regions are associated in some manner to the pathophysiology of schizophrenia. At the molecular scale, both dopamine and γ-Aminobutyric Acid (GABA) abnormalities have been associated with working memory dysfunction, but particularly relating to the basal ganglia and the prefrontal cortex respectively. As evidence from multiple scales (behavioral, regional and molecular) converges, here we provide a synthesis of the bio-behavioral relevance of motor dysfunction in schizophrenia, and its consistency across scales. We believe that the selective compendium we provide can supplement calls arguing for renewed interest in studying the motor system in schizophrenia. We believe that in addition to being a highly relevant target for the study of schizophrenia related pathways in the brain, such focus provides tractable behavioral probes for in vivo imaging studies in the illness. Our assessment is that the motor system is a highly valuable research domain for the study of schizophrenia.
The aim of this study was to evaluate planning target volume (PTV) margins for two different locations using an electronic portal imaging device (EPID) to ensure that the correct radiation dose is delivered to the tumour when using intensity-modulated radiation therapy (IMRT).
Materials and methods:
Setup data were collected from 40 patients treated with IMRT for head and neck cancer (HN) (20 patients) and prostate cancer (20 patients). Setup errors from 720 registration images were analysed to evaluate systematic and random errors. Thereafter, optimal PTV margins were calculated based on International Commission on Radiation Units and Measurements 62 (ICRU), Stroom and Parker formulas compared with the Van Herk’s recipe.
To calculate the margins around the PTV, several different formulas have been used. Setup margins ranged between 2–4·3, 2·2–4·6 and 2·1–4·7 mm in X, Y and Z directions, respectively, for HN cases. Similarly, for the prostate site, setup margins ranged between 3·7–8·3, 3·2–6·8 and 3·3–8·2 mm in X, Y and Z directions.
To ensure better coverage of target volume, we adopted a PTV margin of 5 mm for HN PTVs and 10 mm for prostate PTVs in our department.
Amorphous/crystalline (A/C) nanolayers provide an effective model system to study the mechanical behavior and size effects of metallic glasses and crystalline metals in confined geometries. In this work, we experimentally investigated the structure–property relationship in A/C nanolayers containing HCP crystalline layers. CuTi/Ti and CuZr/Zr nanolayers were prepared by magnetron sputtering with layer thicknesses in the range 10–100 nm. The hardness values of the CuTi/Ti and CuZr/Zr nanolayers were close to those of the monolithic CuTi and CuZr, respectively. The hardness remained virtually the same for different layer thicknesses as opposed to CuTi/Cu amorphous/FCC crystalline nanolayers, which exhibit increasing strength with decreasing layer thickness. Confined layer slip model predicts that the effective flow stress of HCP crystalline layers is higher than that of the amorphous layers. As a result, the strength and size effects are governed by the mechanical behavior of the softer amorphous layer.
A retrospective space–time permutation model with non-Euclidean distance criteria was applied within a high-complexity hospital setting to quantitatively explore cluster patterns of 273 patients infected with or colonized by carbapenemase-producing Klebsiella pneumoniae during 4 years. Results were compared to standard nosocomial active-surveillance methods. Two clusters were identified in the period, suggesting that space–time strategies for cluster quantification within confined environments may be useful.
To review the safety of thyroidectomy combined with cervical neck dissection without drainage, in patients with papillary thyroid carcinoma.
Materials and methods:
Two groups were defined depending on whether cervical neck dissection was or was not performed (groups one and two, respectively).
Group one included 153 patients with central neck dissection and 52 patients with central and lateral neck dissection. Group two included 121 patients. Post-operative drainage was not used in either group. Overall, 17 patients (5 per cent) developed post-operative haematoma and/or seroma: 12 patients (6 per cent) in group one and 5 patients (4 per cent) in group two. There were no major bleeding episodes; only minor bleeding or seroma was encountered, not requiring surgical intervention. Overall, 91 per cent of patients had a post-operative stay of 1 day. The number of peri-operative local complications and length of stay did not differ significantly between the two groups.
Thyroidectomy plus cervical neck dissection without drainage is safe and effective in the treatment of papillary thyroid carcinoma.
Our objective was to determine the knowledge, attitudes, and practices of physicians and nurses on Palliative Care (PC) in Lebanon, across specialties.
We performed a cross-sectional descriptive survey using a self-administered questionnaire; the total number of completed and returned questionnaires was 868, giving a 23% response rate, including 74.31% nurses (645) and 25.69% physicians (223).
Significant differences were found between medical and surgical nurses and physicians concerning their perceptions of patients' and families' outbursts, concerns, and questions. Knowledge scores were statistically associated with practice scores and degree. Practice scores were positively associated with continuing education in PC, exposure to terminally ill patients, and knowledge and attitude scores. Acute critical care and oncology were found to have lower practice scores than other specialties.
Significance of results:
Formal education in palliative care and development of palliative care services are very much needed in Lebanon to provide holistic care to terminally ill patients.
The gate oxides of Si based MOSFET devices are subjected to a high field in order to induce defects in the oxide bulk and at the Si/SiO2 interface. The defects are characterized by a series of gate to source capacitance and conductance measurements. Shifts in the flat band voltage and the threshold voltage are observed and are related to the position of charged defects. The difference of the equivalent charge between the two types of defects is also determined. Conductance measurements are performed to determine the difference of interface states concentration as a function of the high field exposure time.
To assess energy balance in very sick medical patients requiring prolonged acute mechanical ventilation and its possible impact on outcome, we conducted an observational study of the first 14 d of intensive care unit (ICU) stay in thirty-eight consecutive adult patients intubated at least 7 d. Exclusive enteral nutrition (EN) was started within 24 h of ICU admission and progressively increased, in absence of gastrointestinal intolerance, to the recommended energy of 125·5 kJ/kg per d. Calculated energy balance was defined as energy delivered − resting energy expenditure estimated by a predictive method based on static and dynamic biometric parameters. Mean energy balance was − 5439 (sem 222) kJ per d. EN was interrupted 23 % of the time and situations limiting feeding administration reached 64 % of survey time. ICU mortality was 72 %. Non-survivors had higher mean energy deficit than ICU survivors (P = 0·004). Multivariate analysis identified mean energy deficit as independently associated with ICU death (P = 0·02). Higher ICU mortality was observed with higher energy deficit (P = 0·003 comparing quartiles). Using receiver operating characteristic curve analysis, the best deficit threshold for predicting ICU mortality was 5021 kJ per d. Kaplan–Meier analysis showed that patients with mean energy deficit ≧5021 kJ per d had a higher ICU mortality rate than patients with lower mean energy deficit after the 14th ICU day (P = 0·01). The study suggests that large negative energy balance seems to be an independent determinant of ICU mortality in a very sick medical population requiring prolonged acute mechanical ventilation, especially when energy deficit exceeds 5021 kJ per d.
We study a two-grid scheme fully discrete in time and
space for solving the Navier-Stokes system. In the first step, the
fully non-linear problem is discretized in space on a coarse grid
with mesh-size H and time step k. In the second step, the
problem is discretized in space on a fine grid with mesh-size h
and the same time step, and linearized around the velocity uH
computed in the first step. The two-grid strategy is motivated by
the fact that under suitable assumptions, the contribution of
uH to the error in the non-linear term, is measured in the
L2 norm in space and time, and thus has a higher-order than if
it were measured in the H1 norm in space. We present the
following results: if h = H2 = k, then the global error of
the two-grid algorithm is of the order of h, the same as would
have been obtained if the non-linear problem had been solved
directly on the
The non-recurrent inferior laryngeal nerve (NRILN) is a nerve anomaly that can be associated with an increased risk of vocal fold paralysis. The purpose of this study wasto report three new cases of this anomaly, underline the necessity of recognizing its possibility for the prevention of intra-operative nerve damage and a review of the literature.
Three cases of thyroid surgery associated with right NRILN are reported.
Two patients underwent bilateral thyroidectomy for a multinodular goitre and for a toxic multinodular goitre respectively. The third patient had a right lobectomy and isthmectomy for a thyroid nodule. All patients had identification of the recurrent laryngeal nerve on the left sideand NRILN on the right side. The diagnosis of the NRILN was made per-operatively on all cases. A post-operative computed tomography (CT) scan in two patients, showed a retrooesophageal aberrant right subclavian artery. Post-operatively, all patients had normal vocal fold function on laryngoscopy.
The NRILN is a rare anomaly but overlooking its possibility may lead to severe operative morbidity. This is an additional argument in favour of systematic dissection of the recurrent inferior laryngeal nerve during thyroid surgery.
Benign substernal goitres usually extend into the upper anterior mediastinum and are easily extractable through a cervical approach. Very infrequently these tumours extend into the thoracic cavity causing compression of mediastinal structures. The authors report a case of pulmonary hypertension and severe cardiac failure secondary to a long-standing substernal goitre, and support the surgical management of this disease.
Development of vocal fold paralysis in the presence of thyroid disease is strongly indicative of thyroid cancer, and requires surgical exploration. At the same time, vocal fold paralysis does not relieve the surgeon of his obligation to identify and preserve the recurrent laryngeal nerves, since the cause of the paralysis may be a benign disease, with a fair chance of functional recovery after surgery. We hereby report a case of recurrent laryngeal nerve palsy secondary to a multinodular goitre.