#rib resection

[pintsizeginger]

Yesterday was my birthday!

In the past I typically love celebrating my birthday! That normally involves either game nights with friends or a fun trip. Last year and now this year due to health issues those things have been difficult to do.. Last year I was fresh out of surgery and this year I'm just a few days away from a major surgery. Because I can't do much to celebrate I figured I would share my wishlist for surgery recovery items. Since I have fibromyalgia I need all the recovery help I can get! I'm so ready for the surgery but I also know that recovery is going to be rough!

The wishlist link is here

https://www.amazon.com/hz/wishlist/ls/21DWNBKK7SDHD?ref_=wl_share

And if you don't want to use Amazon, my PayPal and Venmo are both @SelinaMariaA and CashApp is $SelinaMAngotti

The reason for the surgery is that after having reoccurring blood clots we discovered that I have Venous Thoracic Outlet Syndrome (vTOS). So to allow my veins to work properly I'm having decompression surgery, which will be removing my first rib on the problem side and possibly removing muscle, and I will probably need vein repair too. It's been hard dealing with this, my arm and shoulder has been just getting worse and worse. I'm so thankful that my hematologist recognized it for what it is!

[lusalemaart]

art dump continued

[traveler-at-heart]

Hello there, how are you? I don't know if you take requests at the moment but i want to ask you if you could write something with Liho?

Maybe something like, Liho didn't like any partners Nat had before Yn, and since they got together Liho likes Yn, Nat thought that maybe more than the cat loves her.

And maybe Yn left some clothes in Nat's house and when Liho misses her, she went to i don't know, a jumper, and sleep on top of it. And when Nat found Liho, she send a picture to Yn, and went next to Liho like saying "i'm gonna marry her soon"

So, this isn't exaaactly the request, but it is where the story took me! In any case, I hope you enjoy it and thanks for the prompt :)

Natasha Romanoff x Fem!R

Natasha knew how to protect herself.

Don’t trust anyone, always look over your shoulder.

It’s what kept her alive for so long.

But it’s what made her lonely too.

The few people she dated took her dettachment as a challenge that they happily accepted but soon abandoned.

Others were disinterested in complicated affairs from the start, and so things didn’t move past a couple of dates.

Then, you.

Medical staff came and went around the Compound. Most of the team had enhanced capabilities to heal themselves; for her part, Natasha was too stubborn to go on her own.

That’s how she knew she was seriously injured.

“Agent Romanoff” you greeted, a wary smile on your lips as Natasha struggled to focus, the white lights hurting her eyes. “How are you feeling?”

“Confused”

“Yeah, that tracks” you nodded, turning away from the chart to look at her. “Do you remember anything?”

“An explosion…“

“And before that a bullet to your side. We were able to fix it by resecting a small portion of your liver and spleen, but you’ll need rest. For now, I’ll monitor you. Let’s think about discharging you in a couple of days”

“I can take care of myself” she objected, but struggled to sit up, pain invading her right side.

“That would be the feeling of cracked ribs” you nodded torwards her side. “I’m not asking if you want to stay, Agent. Your teammates are coming and going for missions or other engagements and you need to be monitored 24/7 for possible complications”

“What you’re saying is, I’m a prisoner here”

“Of course not” you closed the chart, smiling. “We don’t let the prisoners watch tv”

—

It had been mere hours, and Natasha was restless. There was nothing interesting in the tv, her phone was dead and it was ridiculous she was held captive here for “observation” when no one had checked on her for the last three hours.

“Sorry about that. Busy day here” you said with a smile, checking her blood pressure and the chart. “Any discomfort, pain?”

“No”

You nodded, asking for her permission to do a physical exam. Natasha scoffed but agreed with an eye roll.

“Bowel movement?” you asked, checking her pupils.

“No!”

“Ok, no need to get defensive” you placed your hands on each side of Natasha’s head. Your gentle touch made her squirm, and she was able to inspect you closer.

“You’re pretty” Natasha blurted out. You chuckled. “I am so sorry, I don’t know where that came from”

“No need to apologize” you smiled. “It’s the concussion”

“Right”

“Vitals are good, I’ll come back to check up on you in a bit” your pager went off. A large group of agents had just gotten back from a mission. “Squeeze the button if you need anything. Enjoy your stay with us, Agent Romanoff”

“When will I be able to go… home?” Natasha said, but you closed the door before she had a chance to finish her sentence.

—

Natasha hated being wrong. At midnight, the pain got bad and yet, you had to convince her she needed some medicine to ease the discomfort and rest.

But whatever you gave her worked wonders. When she openes her eyes, you were on the couch next to her bed, going through some charts and reports.

“Hey” she said. “I don’t know your name”

“Y/N” you looked up, smiling.

You sat next to her, checking her vitals as she drifted in and out of her sleep stupor. By the time she was fully awake, it was almost noon.

There you were again, munching on a cookie as you scribbled on a sheet.

“You don’t have to stay here all day”

“Oh, it’s no bother” you said, not looking up.

“No other patients right now?”

“No, it’s actually because every medic and nurse is afraid of you and they won’t bother me when I’m here”

“Glad I can be of service”

“Are you hungry? We can get you something very light to eat” you finally looked up, trying to hold back a yawn. It had been an intense night in the emergency medbay.

“What are my options?”

“Oatmeal and that’s about it”

“No coffee?”

“Nu-uh”

Natasha shruged her shoulders and nodded. You smiled, walking out of the room. At least three interns were waiting for you, asking all kinds of very stupid questions. You turned to her, as if saying, “I told you so” and left.

—

For the rest of the day, Natasha was the perfect patient, which obviously made you suspicious.

You repeated your physical exam, asked the same questions, got the answers minus the hint of sarcasm. You were about to turn and leave when she asked again.

“Wait! I can go home now, right?”

“Your hemoglobin is still a bit low and I’d like to wait at least another day”

“I can’t wait another day” Natasha said, glaring.

“Agent Romanoff, you can’t even go on missions right now. Whatever it is you’re so eager to do, I’m sure it can wait” you insisted, trying to avoid an argument after a 48 hour shift.

“It can’t” she insisted, and the monitor began to signal the rise of her blood pressure.

“Calm down” you asked, walking back to her bed. “Please tell me how can I help”

“It’s complicated”

“I’ll tell you what’s complicated. Pulling out bullet fragments from your stomach while I try to keep you from bleeding out. I was in that OR for eight hours and would like to guarantee you recover fully”

Natasha looked at you, and you sighed, sitting by the edge of her bed.

“I have a… cat”

“Oh”

“I need to feed her”

“Can’t someone else do it? A neighbour? One of the other Avengers?”

“Liho doesn’t like anyone, but me. If she hears or smells a stranger, she’ll freak out and attack them or try to run away” Natasha explained. “It’s not ideal considering my profession”

“Yeah” you nodded, thinking about what to do. Moving Natasha was not an option right now. “Let me try”

“Try what?”

“Try feeding Liho, is that her name?”

“It’s dangerous” Natasha warned you, sure it would end in disaster.

“My shift is ending, I can go right now” you ignored her warning. “If I could discharge you right now, I would. Don’t want a cat starving on my watch”

Natasha nodded, and gave you her address. You were surprised she had moved out of the Compound, but then again, a chief surgeon wasn’t privy to the Avengers every move.

The spy made you swear you’d call her if anything went wrong. As you opened the door to her apartment with the spare key, you were expecting to find a giant, feral animal waiting to sink its claws in your flesh.

“Liho” you called a couple of times, making sure the door was closed so she couldn’t escape. “I’m a friend of your mama, she’ll be back in a couple of days”

You were looking around the living room, when a thud behind your back made you jump. And there she was, a black cat with beautiful green eyes -that strangely, reminded you of Natasha’s-. You stared at each other, waiting for someone to move.

Liho did.

She let out a meow and rubbed herself against your leg.

“You’re the cutest” you cooed her, relaxing as she purred in your arms. “Why would Natasha even say you’re scary?”

While the cat jumped around, you searched for her food, cleaned her water bowl and her sandbox. Once you were done, you called Natasha.

“You owe me an apology”

“Did she scratch your eye out like Fury?” she sighed.

“No… wait. Is that how Fury lost his eye?”

Liho jumped on the kitchen counter, purring and rubbing herself against your arm.

“Is that Liho?”

“Yes. She has been purring and following me ever since I got here, Nat. She’s the sweetest cat and you were calling her crazy! In fact, you don’t owe me an apology, you owe it to Liho. Come here, gorgeous”

The cat responded to your words and Natasha smiled.

“I’ll stop by again before I go back to the hospital. Anything else you need?”

You filled a tote bag with everything on her list. Once you were done, you said goodbye to Liho. Thinking it might be funny, you took a selfie with her, smiling as she snuggled on your chest.

You sent it to Natasha, not thinking much of it.

Natasha’s blood pressure increased as soon as she saw the picture. No nurse dared to comment when she turned off the monitor with a smack.

—

“Is this really necessary?” Natasha said, fidgeting on the wheelchair.

“Humor me, Agent” you asked, pushing her to the entrance of SHIELD’s medical facilities. “This is the last time you have to follow my medical advice”

Clint was waiting for Natasha, and he looked as you wheeled her his way, clearly amused.

“How did you manage to get her to sit?”

“I have my ways” you winked at the man. Agent Barton was a far better patient, if only because you had his wife on speed dial.

“Remember, rest. Take your meds and call me if anything feels off. And say hi to Liho for me” you helped Natasha to the car, closing the door as she settled in. You waved as they drove off.

“What was that about your cat?”

“Oh, Dr. Y/L/N went to my place twice a day to feed her”

“And she survived? She must be special” Clint chuckled.

Natasha had to agree with that.

—

Liho was happy to see her human again, roaring like an engine as she rubbed herself on Natasha’s legs. After she came back from the hospital, the cat would never leave Natasha’s side.

The Russian also noticed that you had kept her place clean, and left some groceries and food for the first few days of her home recovery.

It was a strange feeling, being taken care of. Not unpleasant, truthfully, when it came from you. As she stayed in the confines of her apartment, Natasha pondered if it meant something else or if it was just wishful thinking.

You checked on her via text message, and that was all you could really manage to do, as you had back to back shifts and emergency procedures throughout the week. Still, you made sure to send some food to Natasha through delivery apps.

By the time you finally had more free time, it was a chilly Thursday night. As you were leaving the hospital and walking to your car, your phone rang.

“Please, not another emergency” you sighed, surprised at the name on the screen. “Hey, Agent Romanoff. How are you feeling?”

“I’m doing ok… but I might need your help”

“Nat, what’s wrong?” you dropped all formalities, rushing to your car.

“I’m fine, it’s Liho. I left the window open and she climbed all the way up the emergency stairs. And I tried but can’t go out and reach her”

“What do you mean you tried? You should have called me right away! Anyway, doesn’t matter, I’ll be there. Don’t do anything stupid, those are doctor’s orders”

By the time you got to Natasha’s apartment,  a storm was fast approaching.

“Hey, sorry for bothering you”

“It’s not… blood!”

“What?” Natasha looked down, at the place where you were pointing. Right on her stitches, there was a small stain of blood. “Oh, must have happened when I tried to reach for her”

“I knew I should have kept you for another week at the hospital” you grumbled, leading her to the couch. You found a gauze in your emergency kit and lifted her shirt, applying pressure. “Do not move. I’ll be right back”

“The stairs are slippery” she warned you as you stepped out the window. Natasha was surprised at how graceful your movements were.

You looked around, calling for Liho, but the clouds were covering the moon and the sky was dark, making it almost impossible to spot her.

“Ok, fine” you climbed up the steps, holding on to the rail. Taking a deep breath, you let out a high pitched call. “Kitty. Where’s my kitty?”

There small beads shone in the middle of the darkness, and you reached forward. Liho complained, clearly scared about the height. A thunder made her jump, climbing a lot higher.

“Liho, I take it back. You are crazy”

By the time you were able to reach her, it had begun pouring. You placed the cat inside your sweatshirt, to protect her from the rain and have both hands free to climb down.

“That was fun” you said, going inside soaking wet. You almost slipped and Natasha caught you by the waist. “Thanks” you said, feeling warm as her hand went around your back. You couldn’t help but look at her lips, and Natasha caught on, leaning forward.

In that moment, Liho peeked her head from the collar of your sweatshirt, protesting at the uncomfortable feeling of being drenched.

“Here, you need to dry” Natasha offered while you closed the window.

“Thanks, Nat”

She came back with a towel, yoga pants and a t-shirt. You tried not to swoon at the idea of wearing something of hers. Still, you said thanks and disappeared in the bathroom to get changed.

“Let me have a look” you asked when you came back, inspecting her abdomen. “Looks like it was just a small stitch on the edge of the wound. I’ll fix it if it’s alright with you?”

“Yeah, sure” Natasha nodded, and laid back as you prepared the sutures and wore gloves. You applied some local anesthesia and began to work.

“My technique is flawless. The scarring will be almost invisible” you promised.

“So, I can still wear bikinis?”

“Yeah” you nodded, trying to stay focused while the image of Natasha in a swimsuit floated around your head.

“I can’t thank you enough for taking care of Liho” Natasha said in a low voice, which almost made your hands tremble. “Too bad my doctor hasn’t officially discharged me, or I’d take you out to dinner”

“How about some take out instead?” you smiled, cleaning the wound and helping her up.

“That can be done for sure”

You had pizza with beer, sitting on Natasha’s living room while Liho jumped from your lap to hers. It was the best date you ever had.

Pretty soon, the alcohol and exhaustion caught up to you and when Natasha came back from the kitchen, you were fast asleep in her couch, Liho snuggled up in your chest.

Natasha smiled, covering you with a blanket. Liho purred, and your hand went up to scratch behind her ear on pure insctinct.

“I like her too, Liho” Natasha said with a smile. “She’s definitely a keeper”

[carrion--comfort]

Small life update below (medical stuff)

I was diagnosed with venous thoracic outlet syndrome earlier this year. That means that my subclavian vein, which is one of the big important ones, was getting squished as it ran through the space between my clavicle and my first rib. Thus in order for the blood to return from my arm back to my heart, it had to go around (i.e., it was getting shunted into veins that don't usually carry that much blood).

So this week I had a first rib resection via the infraclavicular approach! According to the surgeon, that space between the two bones was extremely narrow so I guess I just had an unlucky anatomical variant 🙃 but now that she took part of the rib and cleaned up the scar tissue around the vein, it has a lot more room. I will need to go back in a few weeks so she can balloon the vein, which means she is going to drive a wire into the vein and inflate a lil balloon inside it. That will break up scar tissue inside the vein.

Long and short of it is, I have a 2 week house arrest vacation from work, a sore shoulder, and the beginnings of a sick scar under my clavicle. Special shoutout to a very good friend of mine who is a family doc, because he correctly diagnosed me back in the spring with only my description of the symptoms and 1 picture of the arm.

[guardian-demon]

You lodged me in your side, sticking out between bruised ribs. A limp protests my presence, yet mortal threat stifles any thought of resection.

There is no resolution. Flesh will grow around me, concealing my presence to anyone you meet.

And still you will limp.

[punksarahreese]

could I get a tsf for recurrence please? 🥺💖

“Shit, there’s too much blood in the field,” Connor muttered as he motioned for the resident to use suction in the area surrounding the mass in question.

“Take care to get it all without compromising any more of her ribs or lung, Dr. Rhodes,” the oncologist across from him reminded, “Leaving even a bit of the tumour would make this entire operation redundant.”

“Jesus Christ, Ava, you could have picked an oncologist with less of a stick up her ass,” his words were muttered to the woman whose ribcage was cracked open under his scalpel before he nodded at the other doctor’s words, beginning the resection of the lower lung lobe riddled with cancerous tissue.

[sheinthatfandom]

Update on Jay Briscoes daughters on fightful

For those that don’t want to click its under the read more

"Currently the girls are stable, but they both have a very long road of recovery ahead of them. Gracie, 12, when she originally got to Nanticoke [hospital], she couldn't feel anything from the waist down. She was diagnosed with an L2 dislocation and an L3 and L4 fracture in her back with compression on her spinal cord. After Nanticoke got her stabilized, they transferred her to another hospital and she got feeling back in her thighs, but nothing lower than her knee. She was taken straight for a MRI and surgery on Wednesday morning around 3 AM. The doctor was able to relieve the compression on the spinal cord and surgery went as well as expected. When you have trauma to your spinal cord, it's a waiting game. With the swelling and trauma, you have to wait. She still has feeling in her thighs, but no movement as of yet. Gracie had tingling in her feet on and off today. Her progress will be a day-to-day basis for months to come. She is bruised up pretty badly, but at this time, no other injuries have been diagnosed."

Jayleigh was diagnosed with an open tibia and fibula fracture at Nanticoke, where she underwent surgery. They placed an external fixator on and sent her back to the hospital. She has been diagnosed with a C7 fracture in her neck and has been placed in a neck brace, which she will be in for six weeks. She also has an L3 and L4 fracture in her back, which can be managed with a back brace for about 12 weeks. She has a right clavicle fracture from the seatbelt as well as a broken rib on the right side. She has a small left pneumothorax, which is the air between the lung and chest wall, not inside the lung. They are just monitoring that as it's not large enough for intervention at this point, which is a blessing. Today, she was diagnosed with a perforated bowel with free fluid in her abdomen, she had some internal bleeding in her stomach area. They knew about it and they were watching it and today they were able to pinpoint it and find out where it was. That surgery went awesome, that got in there and got the bleeding under control and got her on the mend. She went to the OR for that today. They did a bowel resection, which means they took a little of it out, nothing that is long-term effects. While she was down there, the orthopedics decided to do another washout of her leg and some manipulation to the bones for better alignment. She still has the external fixator in place and they placed an NG tube down her nose to decompress her stomach. They will take it out tomorrow and this will allow her to eat."

It was stated that both girls are in a lot of pain and they were hoping for a good night's sleep. The family friends asked for continued prayers for the Pugh family. Ashley thanked everyone who has prayed, supported, donated, or helped in any way.

The donation page is here

[sayeedaqsa]

Best Scoliosis Treatment Hospitals In India

Scoliosis is a spine-related curvature that occurs during the growth of spurt and just before puberty. Scoliosis can take a bad curve due to cerebral palsy

, and muscular dystrophy, the reasons for which are unknown. Most of the cases are mild, with a few known symptoms. The complications become prominent as the children grow. Sometimes there is a requirement for surgery, at other times the brace works like a miracle for the cause.

The treatment of Scoliosis

 is not easy as it is related to the spine which is the most critical bone sequence of the body. The condition of a Scoliosis prone patient ranges from good to fair. It depends upon how early the problem has been diagnosed and treated safely.

Scoliosis can develop into four states or kinds that depend upon an age group and progresses through all, almost the same:

Congenital Scoliosis

Neuromuscular Scoliosis

Adolescence Idiopathic Scoliosis

Adult Denovo Scoliosis

Scoliosis Surgery

The anterior approach allows an additional segment motion which shares the load of the main affected segments of the spine The recovery time is less than 4 weeks

The surgery should stop the spine curve

Scoliosis can affect the Heart and Lungs. Damage occurs when the spine curvature is 70 degrees. A curve of 100 degrees can cause severe damage to the position of the Heart and Lungs.

Surgery can prevent other future trauma of spine pains and arthritis.

Scoliosis Care Management -Post Surgery

The patients can walk after 2 or 3 days after surgery and if they are okay then the patient is discharged after 6 -7 days

The more immobile the spine is kept, the better the spine will fuse after surgery

Bending and lifting are also discouraged

The patient needs to be monitored continuously for 2-3 years with X-rays

Once the bone is fused, it becomes normal

The patients are asked for activity after a thoracic fusion, between the upper and the lower thoracic and lumbar spine.

Female patients can deliver babies after the scoliosis fusion.

Various types of Scoliosis Surgeries are available in India, which is as on the age and the actual medical condition, the spine of the patient

Anterior -Posterior approach

Frontal Approach

Thoracoscopic Surgery

Thoracic Plasty

Osteotomies

Flatback Surgery

Kyphosis Surgery

Partial or Complete Vertebra Remove

Vertebral Column Resection

Indian doctors are well known for their extraordinary achievements in the field of Scoliosis surgeries in the world.

Scoliosis can be treated in a non-surgical method which depends on the curve and progression of the condition. It includes a proper fitness routine, brace, and a few sittings with your doctor to analyze the curvature.

Symptoms of Scoliosis Treatment depend upon the age and the medical condition of the patient. The most common ones are:

Uneven shoulders and blades

Uneven Hips

S or C-shaped spine posture

Unequal distance between arms and the body sphere

Ribs that stick out in one area need treatment

Uneven waist fold since birth but discovered now

We suggest you the 7 Best Scoliosis Treatment Hospitals in India

1. Kedar Ortho Hospital

Kedar Ortho Hospital, Porur Chennai is for Bone, Joint, and Spine treatment and surgery

. The 50-bed hospital has all the modern amenities to remove your Ortho or Scoliosis issues. Kedar Ortho is a dedicated accident and trauma care center. The hospital specializes in Arthroscopy

, Tetraplegics, Paraplegics, Pediatric Orthology, and Oncology

. The hospital owns stare of the art technology for top-class scoliosis and back-related surgery platform.

Address: Kedar Hospital Mugalivakkam Main Road, Porur, Chennai - 600 125

Phone : 044 2252 3407 / 2252 3445

3. Lotus Multispeciality Healthcare, Bangalore

The hospital inpatient care is cost-effective and comfort for patients from international destinations. The hospital specializes in non-communicable diseases and digital clarity for all bone-related and scoliosis issues. The hospital offers specialized solutions for a full spectrum of orthopedic disorders, treatment, surgery, and diagnostics

 including pediatric upper appendage, lower appendage, and spine conditions.

Address: #11/12, Jananakshi Arcade, opposite Sri Jananakshi school, RR Nagar, Bengaluru, Karnataka 560098

Phone: 080 2979 3922

3. Columbia Asia Hospital, Bangalore

The hospital has many branches in India and is well known for patient care and cure success. The hospital offers Shoulder Surgeries

, revision knee and hip replacement surgeries

, disc surgery

, hematoma, and spinal surgeries for a scoliosis recovery plan.

Address 26/4, Brigade Gateway, Beside Metro, Malleswaram West, Bangalore - 560 055

Phone: +91 80 6165 6262

4. Columbia India Hospital, Palam Vihar Delhi

The hospital is for advanced surgery. The hospital offers a full range of Scoliosis treatments through the fusion of joints, osteomyelitis

, congenital hip dysplasia, juvenile metabolic bone disorders, and even more.

Address: Ansal Plaza Near Gol Chakkar, Block F, Palam Vihar, Gurugram, Haryana 122017

Phone: 0124 616 5666

5. W Pratiksha Hospital, Gurgaon

The hospital offers space, bedside ultra-modern monitoring systems, and has a good 25 years of record for treating orthopedic patients.

The flagship hospital of Pratiksha Group, offers keyhole surgery for hip, shoulders adjustment, subacromial decompression, arthroscopic rotator cup repair, sue implants, stem cells rehabilitation, meniscal transplant, and more.

Address: Golf Course Ext Rd, Sushant Lok-II, Shushant Lok 2, Sector 56, Gurugram, Haryana 122011

Phone: 0124 413 1091

6. Hinduja Hospital ,Khar

Hinduja hospital is a multi-specialty hospital in Mumbai with advanced treatment and medical facilities. Automated with 26-bed ICU

Hinduja hospital is the best hospital for spine scoliosis and orthopedic treatment and surgeries. The hospital offers complex joint replacement, and cardiac and keyhole surgeries.

The hospital has an effective non-invasive treatment plan for complex bone and spine problems. The hospital offers backup rehabilitation.

Address: Marvela, 724, 11th Rd, Khar, Khar West, Mumbai, Maharashtra 400052

Phone: 022 6174 6180

7. Apollo Gleneagles Hospital, Kolkata

Apollo offers the best doctors

 and spine treatment consultations from all over the country, equipped with all modern surgical facilities and automation.

Apollo hospitals are the best spine surgery hospital

 in the country. It offers 3rd generation spinal implants in India, musculoskeletal impairments, peripheral nerve disorder treatment, sacroiliac joint dysfunction, scoliosis, metal alloys implant for crippling bones deformity, and more.

Address:156, Famous Cine Labs, Behind Everest Building, Tardeo Mumbai, Maharashtra – 400034

Phone: 022 4332 4500

Best Scoliosis Hospitals In India | HealthTripThe condition of a Scoliosis prone patient ranges from good to fair. It depends upon how early the problem has been diagnosed and treated safely.

[jcsmicasereports]

Basal cell carcinoma resection in an Ecuadorian patient with Gorlin-Goltz syndrome by Andrea Villarreal-Juris in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Gorlin-Goltz syndrome is an inherited dominant autosomal disorder characterized by a predisposition to numerous cancers. The clinical-pathological findings of this syndrome are very diverse. The objective of this report is to present an Ecuadorian patient with Gorlin-Goltz syndrome who underwent surgical resection of basal cell carcinoma compatible lesions.

Conclusion: Gorlin-Goltz syndrome encompasses a variety of clinical signs and symptoms, including important oral manifestations and skin lesions that must be recognized to achieve an early specialty referral, thus reducing the risk of malignancy through a multidisciplinary treatment.

Keywords: Basal Cell Nevus Syndrome, Gorlin-Goltz syndrome, Carcinoma, Basal Cell

Introduction

Gorlin-Goltz (G-G) syndrome or nevoid basal cell carcinoma syndrome (NBCCS) is a dominant autosomal genetic disorder with high penetrance. Fifty percent of patients who suffer from it have a mutation in the long arm of chromosome 9q22.3 in the area of the PTCH gene (protein patched homolog) (1–3), a homologue of the Drosophila patched gene (PTC), which encodes a transmembrane receptor protein (4). This protein binds to a soluble factor of the hedgehog family (Hh), thus activating the Smo (smoothened) receptor, which unblocks the transcription of several growth factors. Therefore, the PTCH gene is an oncosuppressor that is part of the Sonic Hedgehog Homolog (Shh) signaling pathway and is crucial in embryonic development, cell division control, and tumor growth (5).

Its approximate prevalence is 1 in 57000 to 1 in 256000 and the ratio of males to females is 1:1 (6). Binkley and Johnson reported this syndrome for the first time in 1951 (7), then, in 1960, Gorlin and Goltz described the association between multiple basal cell carcinoma, odontogenic keratocysts (OKC) and bifid ribs, which account for the characteristic triad (8). In 1977, Rayner et al. added additional features, including calcification of the falx cerebri and palmar/plantar fossae (9).

According to the criteria of Kimonis et al., the diagnosis of G-G syndrome requires the coexistence of at least two major criteria or one major and two minor (10).

The characteristic that is usually diagnosed first is OKC, because it can be detected during the first decade of life and appears in almost 80% of G-G syndromes.

Other manifestations include palmar and plantar ulcers that appear as shallow pits, caused by partial or complete absence of the corneal layer, which can also appear along the sides of the hands and fingers and even on the tongue; spina bifida (10,11); medulloblastoma (can be an epiphenomenon of G-G, especially in children who are ≤5years-old) (12); cardiac tumors, including fibromas and ventricular histiocytomas, usually congenital (13); hypertelorism, congenital cataract, nystagmus, coloboma and strabismus (14); and ameloblastoma (extremely rare) (15,16).

Early diagnosis of G-G syndrome and its subsequent treatment are very important due to neoplasm susceptibility (2).

The case of a patient with a previous diagnosis of Gorlin-Goltz syndrome who presented multiple lesions compatible with basal cell carcinoma is presented below.

Case Report

A 35-year-old male, living in Quito, Ecuador, without allergies; no history of tobacco or alcohol intake. His mother and his brother presented Gorlin-Goltz syndrome (G-G).

The patient presents hereditary and congenital G-G syndrome (multifocal basal cell carcinoma and maxillary keratocysts), whose manifestations began at the age of 22. He underwent surgery for bilateral keratocysts at the age of 25, and multiple biopsies of the upper left eyelid were taken since 2012. In August 2015, with a positive tumoral activity biopsy report, a wide resection involving 60% of the left upper eyelid plus flap reconstruction was performed.

Physical examination revealed multiple surgical scars on the left upper eyelid with tumoral activity on the eyelid margin, as well as on the outer third of the ipsilateral lower eyelid and on the right side.

In October, a wide resection of the left upper and lower eyelid was planned, plus reconstruction and transoperative study, which are performed without complications.

Subsequently, the patient attended scheduled control, reporting the presence of a left superciliary nodular lesion. Physical examination revealed multiple lesions located in the left superciliary region, left helix, concha, and antihelix, in the inner corner of the left lower eyelid, in the left parieto-temporal and occipito-temporal regions, and other small bilateral genian lesions. There were no alterations in the flap. Left external campimetry was limited. It was decided to perform a facial bone and skull simple and contrasted tomography (CT) and laboratory tests.

Then, resection of the previously mentioned lesions and resection of the lower eyelid with transoperative study, shield-type incision and external canthoplasty of the lower left eyelid was planned. A plastic surgeon was included in the surgical team.

Altogether, 9 skin lesions located in the left superciliary, left frontal, interparietooccipital, posterior occipital, auricular, and left retroauricular regions were resected, which were positive for basal cell carcinoma.

In the subsequent control, the patient's campimetry showed improvement.

DISCUSSION

Reports about Gorlin-Goltz syndrome are scarce in the literature (17). The rarity and phenotypic variability of this syndrome causes a delay in its diagnosis. Syndromicassociated keratocystic odontogenic tumors are often treated in the same way as nonsyndromic cases (18) and associated systemic signs can easily be missed due to lack of understanding of the syndrome. In addition, their characteristics vary globally, so doctors and even dentists must identify them in a timely manner, considering those that are more prevalent in their population or similar populations (19,20).

The pathogenesis of basal cell carcinoma (BCC) is thought to involve increased sensitivity to ultraviolet light and to involve ineffective mechanisms that repair UVinduced DNA damage. In any case, this theory is not accepted by all authors since these lesions can also appear in areas that have not been exposed to sunlight. Especially in children, patients with G-G syndrome who undergo radiotherapy for other cancers have shown to be at increased risk of radiation-induced BCC (21).

In 50% of patients with G-G syndrome, jaw keratocysts appear, characterized by a thin surrounding layer of epithelial cells, which tend to reappear locally after excision in 6 to 60% of cases, therefore, the indication for surgery should be carefully considered, also due to the possibility of intensive clinical and instrumental monitoring (22).

In recent years, new drugs have been developed to inhibit certain components of the sonic hedgehog signaling pathway. In 2013, the FDA approved vismodegib, the first small molecule to target this pathway (11). Although these agents seem promising options for patients with G-G syndrome, their efficacy is limited by adverse effects and the development of resistance (23). Logically, a more aggressive approach is necessary if basal cell carcinoma is suspected; subsequently, depending on the lesion site and the surgery type, a reconstruction can be performed, as in the case presented in this article (24,25).

CONCLUSION

Gorlin-Goltz syndrome encompasses a variety of clinical signs and symptoms, including important oral manifestations and skin lesions that must be recognized to achieve early referral to a specialty, thus reducing the risk of malignancy through multidisciplinary treatment.

Ethical responsibilities

In this case report, the informed consent of the patient was obtained. Its elaboration and all the inherent details were based on the Declaration of Helsinki.

[gstc123]

Thoracic Drainage Catheter for Fluid Removal and Relief

thoracic drainage catheter is a medical device used to remove air, fluid, or blood from the pleural space (the area between the lungs and chest wall). It is commonly employed in the treatment of conditions such as pneumothorax (collapsed lung), pleural effusion (fluid accumulation), hemothorax (blood in the pleural space), or after chest surgery or trauma.

Key features of a thoracic drainage catheter

Flexible Material: Typically made of soft, biocompatible materials like silicone or polyurethane, allowing for easy insertion and reduced tissue irritation.

Multiple Sizes: Available in various sizes and diameters to accommodate different patient needs, from small-bore catheters for air drainage to larger ones for fluid or blood drainage.

Multiple Drainage Holes: Equipped with multiple side holes near the distal end to enhance fluid or air drainage from the pleural cavity.

One-Way Valve: Many thoracic catheters include a one-way valve or a flutter valve to prevent backflow of air or fluid, ensuring that expelled air or fluids cannot re-enter the pleural space.

Radiopaque Tip: The catheter may have a radiopaque tip, allowing it to be visible on X-ray or ultrasound for accurate placement and monitoring.

Suture or Fixation Mechanism: Some catheters feature a mechanism for securing the catheter in place, such as a suture or a dedicated fixation device, to prevent accidental dislodgement.

common uses Of Thoracic Drainage Catheter

thoracic drainage catheter is commonly used in the management of various medical conditions involving the pleural space (the area between the lungs and chest wall). Some of the most common uses include.

1. Pneumothorax (Collapsed Lung)

Purpose: To remove air from the pleural space and allow the lung to re-expand. Pneumothorax can occur due to trauma, lung disease, or spontaneously, causing chest pain and difficulty breathing.

2. Pleural Effusion (Fluid in the Pleural Space)

Purpose: To drain excess fluid (such as from heart failure, infection, cancer, or liver disease) that has accumulated in the pleural cavity. Fluid accumulation can impair lung expansion and cause difficulty breathing.

3. Hemothorax (Blood in the Pleural Space)

Purpose: To drain blood that has accumulated in the pleural space, typically following trauma (e.g., rib fractures or surgical procedures) or bleeding disorders. The drainage helps prevent complications like infection or lung collapse.

4. Post-Surgical Drainage

Purpose: After thoracic surgery (e.g., lung resection, heart surgery, or esophageal surgery), a thoracic drainage catheter may be used to remove any air, blood, or fluids that may accumulate in the pleural space to ensure proper healing and lung expansion.

5. Chylothorax (Lymphatic Fluid in the Pleural Space)

Purpose: To drain chyle (a milky fluid containing lymph and fat) from the pleural cavity, often caused by injury or blockage of the thoracic duct, sometimes due to surgery, trauma, or malignancy.

6. Post-Trauma

Purpose: Following a chest tube (e.g., stab wound, rib fracture, or blunt trauma), a thoracic drainage catheter can be inserted to remove blood, air, or fluid from the pleural cavity to prevent lung collapse and improve oxygenation.

Types Of Chest Tube

1. Standard Chest Tube (Thoracostomy Tube)

Purpose: Commonly used for draining air, blood, or fluid from the pleural space, especially after trauma or surgery.

Size: Available in various sizes, typically from 8 French (small) to 40 French (large), depending on the nature of the drainage needed (e.g., air vs. blood).

Features: Often has multiple side holes near the distal end for effective drainage and can be used for both air and fluid removal. It is typically connected to a drainage system with a water seal or suction.

2. Pigtail Catheter

Purpose: A smaller, less invasive option, primarily used for drainage of air, fluid, or blood in cases where a larger chest tube might be unnecessary.

Size: Usually smaller (8-14 French) and has a coiled, pigtail-like design at the distal end to help anchor it in place and reduce the risk of dislodgement.

Features: The coiled tip helps it curl inside the pleural cavity, making it a good option for less invasive procedures and for patients requiring smaller drainage.

3. Sump Drain

Purpose: Often used for draining infected or viscous fluids (like pus) from the pleural space, including in cases of empyema or post-surgical drainage.

Size: Typically larger in diameter (18-32 French), allowing for more efficient removal of thick or clotted fluids.

Features: Has a double-lumen design (one for drainage and one for air venting), which helps to prevent clogging and maintain continuous drainage.

4.Drainage Catheters for Pneumothorax (Air Drainage Catheters)

Purpose: Primarily designed to drain air from the pleural space, such as in cases of spontaneous or post-traumatic pneumothorax.

Size: Smaller diameter (8-14 French), designed to allow air drainage while minimizing the risk of lung injury.

Features: Usually placed in a more superficial location in the pleural cavity and often connected to a simple water-seal drainage system, or in some cases, light suction.

6. Blake Drain

Purpose: A type of surgical drain commonly used for draining fluid or blood from the pleural cavity or surgical site.

Size: Typically smaller in diameter (10-24 French), designed for use in less invasive drainage applications.

Features: Made of silicone, the Blake drain has a smooth, flexible design and multiple channels to enhance drainage. It is typically used for drainage of post-surgical or chronic fluid collections.

thoracic drainage catheter is selected based on the specific medical condition being treated, the volume of air or fluid to be drained, the duration of drainage, and the patient's overall health. These catheters are critical for managing pleural conditions and supporting the healing process in a variety of clinical scenarios.

Thoracic drainage catheters come in various sizes and may be placed using a sterile technique, often with the aid of imaging (like ultrasound or X-ray) to ensure correct placement. Once in position, the catheter helps re-expand the lung and restore normal breathing function by maintaining proper pressure within the chest cavity.

[ranakaushal]

KIMS Surgical Oncology Team at KCC Successfully Operates on a Huge Rare Diaphragmatic Tumor

Primary tumors of the diaphragm are rare. Diaphragmatic tumors arise from mesenchymal tissue because of their mesodermal origin, and all varieties of these tumors have been reported. In most instances, these tumors are small and can be excised with a primary repair anticipated. In some cases, enbloc excision of the diaphragm is required, and in many instances diaphragmatic replacement is necessary using a variety of thin plastic prostheses, if a wide resection is required. Attempts at primary repair under tension, especially on the left side, may lead to diaphragmatic rupture and herniation.

A team led by Senior Surgical Oncologist, Dr. Sabyasachi Parida conducted an operation on a young man with a large left sided diaphragmatic tumor on 5th April 2024. It was so huge that he was unable to accept solid food. He had to be put on small multiple liquid feeds to keep him from losing weight.

Diaphragm is the primary respiratory muscle of the human body that acts like bellows. It separates the chest cavity and lungs from the abdominal cavity and its organs. It is normally described as a right and left diaphragm. It is a constant lifelong work like the heart and hence very important.

The tumor was compressing all adjacent organs like the stomach, colon, left lobe of liver and spleen and was densely adherent to them.

Normally, access to such a tumour requires opening up of both the abdomen and chest. A chest drain is usually required. This causes considerable pain and discomfort for the patient. However, Dr. Parida planned the abdominal incision in such a way that eventually, neither the chest incision nor the chest drain was required. The surgery was challenging and tedious as the tumor was confined between the rigid rib cage and vital and highly vascular organs like liver, spleen, stomach and multiple blood vessels all around.

Careful dissection aided by high end surgical equipment ensured both safety and speed. The entire surgery was completed in 6 hours without any intra-operative destabilization or need for blood transfusion.

The tumor measured around 24x 17 cm and weighed more than 2 kg. Such a large diaphragmatic tumor is rare and challenging to exercise.The large diaphragmatic defect was then reconstructed with a 20x 15 cm polypropylene mesh and overlaid with omentum(fat apron of abdominal cavity). He was extubated on the table and shifted to bed without the need for any intensive care support or respiratory support.

The OT team comprised of Dr. Monika Dabgotra, Consultant Anaesthetist; Mr. Bibhas Prasad Barik,OT Technician; Mrs. Kalpana Ojha, Senior OT Sister; Mikina Pradhan , Senior OT Support staff; Rosina, Rupali, Sasmita Sahani, Sasmita Mallick, Anuradha-Nursing Officers along with Residents and other staff.

KIMSCancer Center is furnished with dedicated modern modular OTs, equipped with the best and latest equipment available at major cancer centres around the world. This enables the performance of complex surgery with minimal complications. More than a decade of experience in performing complex cancer surgeries and Comprehensive Cancer management facilities have made KIMS Cancer Centre, the preferred choice of Cancer Patients and Caregivers.

[opdrazimetozdemirsblog]

✏️Note: Turkish,English,German and Arabic description

🌺Breast Reduction Surgery!

🦋👉Before the surgery; During the first examination, the patient's expectations and the reason for surgery (aesthetic concerns, neck-back pain, redness/dermatitis under the breast, etc.) are determined.

🦋The patient's age, height, weight, previous surgery(s), disease(s), family history (Diabetes, blood pressure, thyroid and cancer etc.), medications used and whether you have given birth are determined.

🦋In addition, the patient is explained in detail about the size and shape of your breasts, the structure of the skin, whether she will be married and have children or whether she will breastfeed, the new location of the nipple, and possible scars.

🦋Then, your photographs are taken with 3D (3D Vectra) imaging and more than 90% of the shape and size of the breast is shown and evaluated together with the patient.

🦋Also, scar/scar, nipple sensitivity/feeling, breastfeeding, anesthesia type and risks of surgery are explained.

🦋Preoperative blood and imaging (lung X-ray; mammography and/or USG, MRI) methods are requested.

🦋The patient may need a companion on the day of surgery and the next few days.

🦋👉Breast reduction surgery is performed in the hospital, and you may need to stay in the hospital for 1-3 days. 🦋In aesthetic breast reduction surgery, the large breast tissue is reshaped according to the person's body size.

🦋Excess breast tissue and the skin on it are removed. The nipple is moved to where it should be.

🦋Surgery time: 2.5-4 hours.

🦋No matter which method is applied, there may generally be more or less scarring on the nipple and surrounding brown tissue (NAC/Nipple Areolar Complex), depending on the person.

🦋However, these scars are evident at first, but may become indistinct over time.

🦋The extent of scars after surgery may vary depending on the size of the breast, the surgical method used, and the wound healing and skin condition of the patient.

🦋👉Anatomy: In adult women, the average upper-down diameter of the breast is 10-12 cm and its maximum thickness in the central (middle) region is approximately 5-7 cm.

🦋NAC is between 3.5-4.2 cm.

🦋The weight of a breast that is not in lactation is 150-200 grams and in lactation it is 400-500 grams.

🦋Immediately underneath the breast tissue, there are membranes (fascial structures), pectoralis major (large), pectoralis minor and ribs, respectively.

🦋The breast gland is located between the superficial and deep layers of the superficial pectoral fascia of the anterior chest wall.

🦋Breasts 2-3 at the top. Costa(rib) 6-7 at the bottom. The costa is between the sternum edge medially (inner) and the anterior axillary line (armpit) laterally (outer).

🦋Breast anatomically includes skin, breast tissue (glandular), fatty tissue, vessels, nerves and ligaments.

🦋👉Technical: The aim is to make the patient the desired size and shape, not to damage the sensory structure of the breast, to be able to breastfeed after the surgery if possible, and to leave as little scar as possible.

🦋The surgical incision is planned and named according to the vessels (pedicle) feeding the breast.

🦋👉Techniques can be counted as at least 5 techniques: upper (superior), lower (inferior), external (lateral), internal (medial), base or center (central) and one or two of them combined.

🦋Resection (tissue removal) is performed in accordance with the technique chosen for the desired breast size.

🦋There are 4 types of incision types according to pedicles (vessels); Wise or Anchor, Lollitop, Donut, Crescent. It can also be made in the form of periareolar, Inverted T, Z, J, L, I letters.

🦋The incision selected varies depending on breast size, shape and anatomical structure.

[life-take]

Oh i just realized in my chronic pain summary posts, i didnt really go into what the scalenectomy/first rib resection surgery experience was like for me, bc i think at this point TOS was only about 50% or less of my problems. But i think some people were interested in the surgery? Should I go into what that experience and recovery was like, for people considering it?

[daily-dyllan]

If you don’t mind me asking, what were the surgeries for?

bilateral first rib resections and scalenectomy with cervical rib removal to treat thoracic outlet syndrome

basically i was losing blood flow in both arms and was at high risk for blood clots due to how bad it was getting

literally completely lost my pulse in my left arm if i raised it above my head lol

[drshalabhagg]

VATS thoracoscopic surgery in delhi

 VATS (Video-Assisted Thoracoscopic Surgery) is a minimally invasive surgical technique used to diagnose and treat various conditions affecting the chest, including lung cancer. It involves using a small video camera, called a thoracoscope, and specialized instruments inserted through small incisions in the chest.

Here are some key points about VATS thoracoscopic surgery:

Procedure: During VATS, the patient is usually placed under general anesthesia. Several small incisions (around 1-2 cm) are made between the ribs, allowing the thoracoscope and instruments to be inserted. The thoracoscope transmits images of the chest cavity to a monitor, enabling the surgeon to visualize the surgical area. The surgeon then uses the instruments to perform the necessary procedures.

Advantages: VATS offers several advantages over traditional open chest surgery. These include smaller incisions, reduced pain and scarring, shorter hospital stays, quicker recovery times, and potentially fewer complications. VATS also provides a magnified view of the surgical field, allowing for precise and controlled movements.

Procedures: VATS can be used for various procedures related to lung cancer, including:

Biopsy: The surgeon can obtain tissue samples from suspicious areas for further examination and diagnosis.

Lobectomy: A lobe of the lung containing the tumor is removed.

Wedge resection: A small, localized tumor along with a margin of healthy tissue is removed.

Mediastinal lymph node dissection: Lymph nodes in the mediastinum (the central area of the chest) are sampled or removed to assess if the cancer has spread.

Recovery: Compared to open surgery, VATS generally leads to a faster recovery. Patients may experience less pain, have a shorter hospital stay (typically 2-5 days), and require less post-operative pain medication. The specific recovery timeline and instructions will vary depending on the individual case and the extent of the surgery.

Considerations: VATS may not be suitable for all patients. Factors such as the size, location, and stage of the tumor, as well as the patient's overall health, will be evaluated to determine the most appropriate surgical approach. In some cases, open surgery may be necessary if VATS is not feasible or if complications arise during the procedure.

It's important to consult with a qualified thoracic surgeon to discuss the best treatment options, including VATS thoracoscopic surgery, based on the specific circumstances of the lung condition. They can provide detailed information, address any concerns, and guide you through the decision-making process.

[sabyasachibal]

thoracic surgery in india

https://www.chestsurgerydelhi.com/ Thoracic surgery is a medical specialty that focuses on surgical procedures involving organs and structures within the thoracic (chest) cavity. It involves the diagnosis, treatment, and management of diseases or conditions affecting the lungs, esophagus, heart, and other thoracic structures. Here are some key points about thoracic surgery: https://goo.gl/maps/5nbPD3WAbiK77A856

Conditions Treated: Thoracic surgeons address a range of conditions, including: https://www.chestsurgerydelhi.com/

Lung cancer: Thoracic surgeons perform lung cancer surgeries, including tumor resections, lobectomies, pneumonectomies, and minimally invasive procedures like video-assisted thoracoscopic surgery (VATS) or robotic-assisted surgery.

Esophageal disorders: Conditions like esophageal cancer, gastroesophageal reflux disease (GERD), and esophageal motility disorders can be treated with thoracic surgery, such as esophagectomies or anti-reflux procedures.

Chest trauma: Thoracic surgeons may perform emergency surgeries for traumatic injuries to the chest, including rib fractures, lung contusions, or diaphragmatic ruptures.

Benign lung diseases: Surgery may be necessary for the management of non-cancerous conditions like lung infections, cysts, bullae, or lung volume reduction procedures for advanced emphysema.

Mediastinal tumors: Thoracic surgeons can remove tumors located in the mediastinum (central chest area) that affect structures like the thymus, lymph nodes, or other mediastinal organs.

https://goo.gl/maps/5nbPD3WAbiK77A856 Surgical Techniques: Thoracic surgery may involve traditional open surgeries or minimally invasive procedures. Minimally invasive techniques, such as VATS or robotic-assisted surgery, utilize small incisions and specialized instruments to access and operate within the chest cavity. These approaches can offer benefits such as shorter hospital stays, reduced pain, and faster recovery compared to traditional open surgery.

https://goo.gl/maps/5nbPD3WAbiK77A856 Collaboration: Thoracic surgeons often work closely with other medical specialists, including pulmonologists, oncologists, radiologists, and anesthesiologists, to ensure comprehensive and coordinated care for patients. Multidisciplinary teams collaborate to determine the most appropriate treatment plans based on each patient's specific condition and needs. https://www.chestsurgerydelhi.com/ 

https://goo.gl/maps/5nbPD3WAbiK77A856 Preoperative and Postoperative Care: Before thoracic surgery, patients undergo a thorough evaluation that may include imaging studies, pulmonary function tests, and other preoperative assessments. After surgery, patients receive postoperative care, including pain management, respiratory therapy, and monitoring for complications. Rehabilitation and follow-up care are essential for the patient's recovery and long-term management.

https://goo.gl/maps/5nbPD3WAbiK77A856 Advancements in Thoracic Surgery: Technological advancements have improved thoracic surgical techniques and outcomes. These include advanced imaging modalities, robotic-assisted surgery, and the development of minimally invasive approaches. Research and innovations continue to enhance patient care in the field of thoracic surgery. https://www.chestsurgerydelhi.com/ 

It's important to consult with a qualified thoracic surgeon for an accurate diagnosis and treatment recommendation for specific thoracic conditions. They can provide guidance on surgical options, potential risks, and expected outcomes based on individual circumstances.