Stump Site Research Articles

Shorter Drainage Tube to the Pancreatic Stump Reduces Pancreatic Fistula After Distal Pancreatectomy.

We investigated the relationship between the length of a prophylactic closed-suction drainage tube and clinically relevant postoperative pancreatic fistula (CR-POPF) in distal pancreatectomy (DP). The clinical data of 76 patients who underwent DP using a reinforced stapler for the division of the pancreas at Ehime University Hospital between December 2017 and May 2023 were retrospectively analyzed. Laparoscopic DP was performed in 41 patients (53.9%). Closed-suction drainage was performed using a 19Fr ExuFlow Round Drain with a vacuum bulb. The drainage tube length was defined as the distance between the peripancreatic stump site and the abdominal wall insertion site using abdominal radiography. CR-POPF was observed in 12 patients (15.8%). Univariate analyses demonstrated that male sex (P=0.020), American Society of Anesthesiologists Physical Status (P=0.017), current smoking (P=0.005), and drainage tube length (P<0.001) were significantly associated with CR-POPF. The optimal cut-off value of drainage tube length for CR-POPF was 220mm (area under the receiver operating characteristic curve=0.80). In multivariate analyses, drainage tube length (≥220mm) was the sole independent predictor for CR-POPF (odds ratio, 6.59; P=0.023). According to computed tomography performed ∼1 week after surgery, the median volume of peripancreatic fluid collection was significantly higher in the long drainage tube group than in the short drainage tube group (P<0.001). A drainage tube inserted at a shorter distance to the pancreatic stump may reduce the incidence of CR-POPF after DP.

Soil disturbance caused by timber harvesting in a natural forest, West Sumatera Indonesia

Logging operations in natural forests generally use bulldozers. Bulldozers skid logs from the stump site to the landing site. The bulldozer maneuvers in the felling area cause skid trails and soil compaction. Soil compaction is one of the negative impacts of logging operations. The research aim is to analyze the level of soil compaction in various bulldozer skidding intensities after logging operations. The research occurred at a natural forest area in Siberut West Sumatera, Indonesia. The results of the study showed that there was a relationship between skidding intensity and the level of soil bulk density. The more a bulldozer moves at the same skid trail, the higher the soil bulk density. The range of soil bulk density is from 0.82 g cm−3 to 1.31 g cm−3. The bulk density increases markedly after the bulldozer’s first, second, and third passes. After the fourth pass, the bulk density is relatively constant. The porosity of the soil decreases with the increase of the bulk density. On skid trails where the soil is very compact, seeds that fall on skid trails will have difficulty growing well. Requires planting on primary skid trails. Soil damage in the form of soil compaction by bulldozers needs serious attention in the Reduce Impact Logging technique.

Use of a prosthetic conduit for stent delivery in transcarotid artery revascularization for patients with unfavorable anatomy.

Transcarotid artery revascularization (TCAR) provides a safe alternative to carotid endarterectomy. The anatomic requirements include a 5-cmminimum clavicle to carotid bifurcation distance for sheath access proximal to the lesion. In the present report, we describe our experience with conduit use for patients not meeting that requirement. Patients undergoing elective TCAR with a conduit from 2021 to 2022 were retrospectively identified. After carotid artery exposure, a 6-mm prosthetic graft was anastomosed to the common carotid artery in an end-to-side fashion. After stent delivery, the conduit was ligated and oversewn. The patient demographics, procedural details, and outcomes were recorded and compared with our nonconduit TCAR experience. A total of 11 patients (64% male; age, 75± 5years) underwent TCAR with a conduit, 5 (46%) for symptomatic disease, and 77 patients underwent TCAR with no conduit, 52 (60%) with symptomatic disease (P= .50). Other than a higher rate of prior coronary interventions in the conduit group (55% vs 47%; P= .007), no significant differences were found in age, gender, race, comorbidities, or high risk for carotid endarterectomy criteria. In the conduit group, the average skin to carotid artery depth was 4.2cm (range, 1.9-6.1cm). The average clavicle to bifurcation distance was 4.4cm (range, 3.3-4.9cm) vs 6.5cm (range, 3.3-9.7cm; P= .002) in the nonconduit group. Dacron was the most common conduit material used (73%). No differences were found in the mean procedure times (121± 32 vs 129± 53minutes; P= .785) or flow reversal times (14± 5 vs 19± 13minutes; P=.989) for the conduit and nonconduit cohorts, respectively. Technical success was achieved in 100% of the conduit and nonconduit cases. Excluding one outlier of a prolonged stay (7days) for management of unrelated medical issues (gastrostomy tube placement for chronic dysphagia after mass resection and neck radiation), the mean hospital stay was 2days (1.2± 0.4 intensive care unit days) compared with 3.8± 5.7days for our nonconduit cohort (P= .2). Hypotension was the most common reason for delayed discharge for the conduit group (n=3; 27%). The average follow-up was 2.7months (range, 1-10months). For all 11 conduit patients, the stent remained patent without stenosis, thrombus, or pseudoaneurysm at the conduit stump site on surveillance duplex ultrasound. No strokes or complications had occurred at 30days in the conduit group compared with four strokes or transient ischemic attacks (P= .469) and 18 minor complications in the nonconduit group (P= .091). For patients lacking a sufficient distance between the clavicle and carotid artery bifurcation, a prosthetic conduit facilitates safe use of flow reversal for stent delivery and can be ligated at procedural completion without consequences.

Clinical Characteristics, Quality of Life, and Risk Factors of Amputation Stump Skin Disease and Stump Fungal Infection in Adult Amputees in Shanghai, China.

IntroductionThe stump site of amputees is clinically vulnerable and prone to various skin diseases. Data regarding the impact on quality of life (QoL) of amputees with amputation stump skin disease (ASSD) and risk factors of ASSD and stump fungal infection in the Shanghai area are yet unknown.ObjectiveThis study aims to evaluate the QoL of amputees with ASSD and explore the risk factors of ASSD and stump fungal infection in the Shanghai area.MethodologyA total of 104 amputees from Shanghai Hebin Rehabilitation Hospital, Otto Bock (China) Industries Co., Ltd., Shanghai Tongji Hospital, and Shanghai Rehabilitation and Vocational Training Center for the Disabled were enrolled in this study. We collected demographic, clinical, and skin fungal examination data from these amputees from April 2015 to May 2021. Dermatology life quality index (DLQI) questionnaire was used to evaluate the QoL. The risk factors for ASSD and fungal skin infection were analyzed by the univariate analyses.ResultsThe median age of the 104 amputees was 57.9 ± 11.9 years with an average amputation time of 17.7 ± 15.1 years, and 73% of cases were men. The mean DLQI score of amputees with ASSD was13.6, suggesting the severe impairment of QoL. Among amputees, 41 (39.4%) had confirmed ASSD, of whom 24 (58.5%) suffered from fungal skin infection and the remaining were subjected to intertriginous dermatitis and eczema (22%), cutaneous keratosis (12.2%), and others (7.3%). Aspergillus (50.0%) was the most common species. The other fungal organisms included Trichophyton rubrum (33.3%), Candida krusei (8.3%), T. mentagrophytes (4.2%), and C. albicans (4.2%). ASSD rather than non-ASSD was more common in men (80.4%) and summer (46.3%). Summer (OR = 3.31, 95% CI = 1.19–9.17) was an established risk factor for ASSD compared to spring. The daily artificial limb wearing time > 8 h was associated with stump fungal infection.ConclusionThe QoL of amputees with ASSD was severely affected and the ASSD was characterized by fungal infection (tinea), intertriginous dermatitis, eczema, and skin keratosis. Summer and daily prosthesis wearing > 8 h was a risk factor for ASSD. Aspergillus was the most common fungal species, especially when the stump was exposed in summer.

Efficacy of endoscopic management for anastomotic leakage after gastrectomy in patients with gastric cancer

BackgroundAnastomotic leakage (AL) after gastrectomy in gastric cancer patients is associated with high mortality rates. Various endoscopic procedures are available to manage this postoperative complication. The aim of study was to evaluate the outcome of two endoscopic modalities, clippings and stents, for the treatment of AL.Patients and methodsThere were 4916 gastric cancer patients who underwent gastrectomy between December 2007 and January 2016 at the National Cancer Center, Korea. A total of 115 patients (2.3%) developed AL. Of these, 85 patients (1.7%) received endoscopic therapy for AL and were included in this retrospective study. The endpoints were the complete leakage closure rates and risk factors associated with failure of endoscopic therapy.ResultsOf the 85 patients, 62 received endoscopic clippings (with or without detachable snares), and 23 received a stent insertion. Overall, the complete leakage closure rate was 80%, and no significant difference was found between the clipping and stent groups (79.0% vs. 82.6%, respectively; P = 0.89). The complete leakage closure rate was significantly lower in the duodenal and jejunal stump sites (60%) than esophageal sites (86.1%) and gastric sites (94.1%; P = 0.026). The multivariate analysis showed that stump leakage sites (adjusted odds ratio [aOR], 4.51; P = 0.031) and the presence of intra-abdominal abscess (aOR, 4.92; P = -0.025) were associated with unsuccessful leakage closures.ConclusionsEndoscopic therapy using clippings or stents is an effective method for the postoperative management of AL in gastric cancer patients. This therapy can be considered a primary treatment option due to its demonstrated efficacy, safety, and minimally invasive nature.

Continuous adductor canal block for the management of below-knee postamputation stump pain in a diabetic patient

Limb amputation surgery is one of the oldest surgical procedures. Below-knee amputation (BKA) surgery is indicated for advanced critical limb ischemia, diabetic foot sepsis, and major trauma. The majority of unplanned readmission after lower limb amputation surgery occurs mainly due to persistent postamputation stump pain. One of the important causes of postamputation stump pain is stump site infection. A higher rate of infection is seen in diabetic patients. Postamputation stump pain management is challenging due to the presence of mixed nociceptive and neuropathic pain component. Various modalities of treatment to control the stump pain are published in different articles. However, no single technique or drug is found superior to others. Here, we report a case of severe postamputation stump pain after BKA surgery in a diabetic patient with stump site infection. The pain was successfully managed by continuous infusion of analgesics via the adductor canal perineural catheter. After the stoppage of the infusion, the patient did not report any phantom limb pain syndrome during the 6-month follow-up.

Peripheral nerve stimulator for terminal sciatic nerve neuromas in an amputee.

Neuromas are a difficult-to-treat peripheral nerve pathology that can cause crippling pain. Optimal treatment is widely debated as pharmacological intervention frequently is not sufficient and surgical interventions are plagued with recurrence. The majority of amputees report severe and chronic stump pain. Avoiding complex surgery at the stump site would prevent infection or wound dehiscence. Recent advances in neuromodulation with external pulse emitters allow for pain relief with localized nerve stimulation. The authors describe the novel placement of a sciatic nerve stimulator in a 77-year-old man for painful stump neuromas of the common peroneal and tibial nerves.The video can be found here: https://youtu.be/96kKs3qjtqc

PHLEGMASIA CERULEA DOLENS: AN ATYPICAL COVID-19 PRESENTATION

SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The worldwide pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused numerous deaths worldwide, most directly due to resultant ARDS and respiratory failure. Physicians have seen an increased incidence of venous thromboembolic events (VTE) in COVID-19 patients postulated due to a pro-inflammatory state caused by the virus, with a resultant increase in the frequency of micro thrombotic events [1]. We present the case of a patient with severe Phlegmasia cerulea dolens (PCD) in the setting of asymptomatic COVID-19 pneumonia. CASE PRESENTATION: A 61 yo African American male with no significant past medical history presented with left leg swelling. Arterial and venous doppler ultrasound revealed an extensive thrombus throughout the left femoral and popliteal veins, with occlusion of arterial flow at the distal posterior tibial and peroneal arteries consistent with compartment syndrome and diagnosis of PCD. CT scan of the chest resulted in a finding of a large left main pulmonary artery pulmonary embolism with bilateral patchy ground-glass opacities suggestive of COVID-19 pneumonia, which was confirmed positive by rapid nasopharyngeal PCR per our admission protocol despite the absence of fever, cough, shortness of breath or exposure. He was started emergently on anticoagulation therapy, intubated prophylactically, and taken to the operating room for emergent fasciotomy. His ICU course was complicated by worsening ventilator support, acute respiratory distress syndrome, worsening kidney injury, septic shock, and persistent bleeding from his wound requiring multiple transfusions. Due to nonviability and poor healing, the extremity was amputated, with noted systemic improvement in the ensuring days. He was extubated, downgraded out of the ICU, but this improvement was short-lived. His respiratory status drastically deteriorated, requiring re-intubation for hypoxia with recurrence of septic shock due to E.coli bacteremia as well as severe bleeding from the stump site. His status-declined with multiorgan failure despite aggressive resuscitation, broad-spectrum antibiotics, blood transfusion, pressor requirement, and continuous renal replacement therapy. The decision was made by the family to withdraw life support, and the patient expired. DISCUSSION: An increased presence of coagulopathy and VTEs has been seen in COVID-19 patients in both the ICU and medical floors [2].To date, the exact mechanism that leads to thromboembolic disease has yet to be determined but is thought to be due to the familiar combination of Virchow’s triad: endothelial injury, blood stasis, and a hypercoagulable state [2-3]. CONCLUSIONS: In our case, the patient continued to deteriorate despite anticoagulation for his VTE. While not all patients with COVID-19 develop VTEs, it is important to be aware of the heightened risk for micro- and macro-thrombotic events in patients with SARS-CoV-2. Reference #1: Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19 [published online ahead of print, 2020 May 5]. J Thromb Haemost. 2020;10.1111/jth.14888. doi:10.1111/jth.14888 Reference #2: Morales MH, Leigh CL, Simon EL. COVID-19 infection with extensive thrombosis: A case of phlegmasia cerulea dolens [published online ahead of print, 2020 May 15]. Am J Emerg Med. 2020;10.1016/j.ajem.2020.05.022. doi:10.1016/j.ajem.2020.05.022 Reference #3: Helms J. High risk of thrombosis in patients in severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020 doi: 10.1007/s00134-020-06062-x DISCLOSURES: No relevant relationships by Riad Akkari, source=Web Response No relevant relationships by Brad Schwartz, source=Web Response

Timber transportation planning using bees algorithm

Timber transportation planning is among the costliest activities in forest operation. Traditionally, the goal of timber transportation planning adopted to determine feasible way to extract high timber volume from the stump site to the final destination. However, modern transportation problems are not driven by the productivity of timber itself, but also by the efficiency of forest operation. This efficiency considerations and requirements introduce a new technique in timber extraction called log fisher as a complement to common technique, cable skidder. Nevertheless, side constraints within timber transportation planning may arise when two timber extraction techniques applied, complicates to and from several problems more extensive and more complex. While cable skidders affixed only on gentle slopes, log fishers possibly applicable regardless of slope conditions. Proper evaluation required to justify decisions since the use of these two techniques in the right places will result in efficient timber transportation planning. In the present study, a new problem-solving approach using Bees Algorithm (BA) was developed. BA can provide transportation planner with a large and complex transportation planning problem solving while complying with the forest road guidelines as required by the Forestry Department of Peninsular Malaysia. Herein, timber extraction technique is considered the least-cost in the main objective function for an efficient timber transportation planning and limitation of machinery to extract timber as constraints. Preliminary results show that this problem solving is promising for timber transportation planning problems with side constraints. A description of the algorithm development and its search process presented within this study.

3-month postoperative complications after below-knee amputation in peripheral arterial disease

Purpose: The aim of this study was to evaluate the frequency and types of complications that may occur after transtibial amputation in patients with peripheral arterial disease and the risk factors affecting them. Methods: 87 patients who were diagnosed with peripheral vascular disease from January 2012 to January 2018 and underwent transtibial amputation were included. Complications occurring within 3months after transtibial amputation were retrospectively reviewed. For statistical analysis, logistic regression analysis was used and significant factors in the univariate analysis were used for statistical verification using multivariate analysis. Results: 60 patients were male and 27 patients were female and average age of patients was 71.1(±11.06) years. There were 11 superficial infection or wound dehiscence of the stump site (12.6%), 17 deep infection (19.5%), 20 stump revisions (22.9%) and above-knee amputation was performed in 9 cases (10.3%). High ESR (P < 0.028) and multiple occlusion sites in 3D CT angiography (P < 0.011) were significantly associated with the rate of stump revision and chronic renal disease (P < 0.007) was independent risk factor of mortality.Conclusions: More attention should be paid to postoperative management for the patients with chronic renal failure, preoperative high ESR and multiple stenotic lesions in 3D CT angiography.

Use of adjuvant hyperbaric oxygen therapy in a patient with traumatic inoculation of mucormycosis resulting in extremity amputation

A 64-year-old man with uncontrolled diabetes mellitus presented to the emergency department with worsening left lower extremity pain, hypotension, fever and altered mental status (figure 1). Eleven days prior, he...

EP1.17-23 Omentopexy for Post-Pneumonectomy Bronchopleural Fistula in Patients with Non-Small Cell Lung Cancer After Salvage Radiotherapy

Preoperative chemotherapy or radiotherapy could affect bronchial mucosa blood flow and also the normal healing process of bronchial stump after surgical resection. Otherwise, bronchopleural fistula (BPF) is the worst and time consuming complication in lung cancer surgery. Pneumonectomy is reported as a high risk surgery of BPF. Here, we report our successful treatment experience of BPF using omentum after salvage radiotherapy in NSCLC patient. Retrospective medical chart review A sixty-four years old male patient who had a history of chronic obstructive pulmonary disease diagnosed as squamous carcinoma in left upper lobe, clinical stage of T2aN1M0. Because interlobar artery invasion was suspicious, the patient was treated with radical radiotherapy. After 6600cGy of radiotherapy, the lesion showed marked response. Thus we decided to perform curative surgical resection, pneumonectomy. The patient had discharged in postoperative day 11 and the pathologic report was ypT1aN0M0. But after 1 week from discharge, the patient readmitted and complained of dyspnea and profound sputum. In bronchoscopy, fistula was seen. We performed the second operation. Due to hard fibrosis, direct closure of bronchial stump was not possible. Thus, we covered the stump site with omental flap in multilayers. The patient discharged uneventfully and now in disease free status almost after 2 years from initial operation.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Neoadjuvant radiation therapy and pneumonectomy are risk factors for post-operative BPF. Direct closure with buttressing biocompatible flap is the treatment of choice. But if direct closure is not possible, double-layered omentopexy could be an alternative treatment strategy.

Extent and severity of damages caused to spruce roundwood by harvesting heads in standard versus debarking configurations

Stump-site debarking has undergone a considerable shift from being common practice during the 1960s–1980s to now being almost exclusively used in eucalyptus plantations. By removing bark at the stump site, a high level of nutrients remains in the stand, and the debarked logs are less prone to act as a breeding environment for insects. With these two key advantages in mind, there has been a recent surge to adapt common harvesting heads so that they may be used for stump-site debarking of species other than eucalyptus. This study aimed to determine whether stump-site debarking affects the frequency, severity, and type of stem damage to Norway spruce (Picea abies [L.] Karst.) trees. Two harvesting heads (parallel and triangular-closing designs) were alternately operated in standard (non-debarking) and debarking configuration during winter and summer, all rest remaining equal. Damages were classified as either Type I or Type II, the former representing a depression of the wood surface caused by punctual or linear penetration of roller studs or splines and the latter referring to a larger-area gouge (fiber tear) resulting from roller slip or the delimbing knives cutting into the wood, often in combination. Results indicate that Type I Damages were significantly deeper under standard configuration (8.7 mm) than under debarking configuration (6.7 mm). Regarding Type II Damages, significantly longer damages (average of 238 cm), were caused by the triangular-closing head in debarking configuration as compared to damages caused with the standard configuration (69 cm). These results indicate that Type I Damages, under the tested conditions, are less severe with the debarking configurations but that Type II Damages could be problematic when considering the length of the gouges, as compared to standard configurations.

Photodynamic Therapy for Bronchial Microscopic Residual Disease After Resection in Lung Cancer.

The goal of lung cancer surgery is a complete tumor resection (R0 resection) with clear margins. 4% to 5% of resections have microscopic residual disease associated with worse prognosis. Definitive management is resection of residual tumor, which may not be tolerated by many patients, and definitive management is not well studied in these patients. We treated patients with stage I cancer and bronchial mucosal residual disease (MRD) with bronchoscopic photodynamic therapy (PDT). All patients who underwent definitive surgery for early-stage lung cancer were reviewed. Patients with R1 resection, stage I disease with MRD and or carcinoma in situ along the stump site were treated with bronchoscopic PDT. Patient characteristics, histology, type and site of surgery, pattern of recurrence, recurrence status, adverse events, and survival data were evaluated. Eleven patients with bronchial mucosal R1 resection were treated with PDT along the stump site. The median age was 67. Three patients had carcinoma in situ and 8 had MRD. One patient (9%) had local recurrence 1 year after PDT treatment and was treated with radiation. Four patients (36%) had no evidence of recurrence to date after a median follow-up of 4 years and the other 6 patients had evidence of regional (16%) or distant (39%) recurrence. The local control rate was 91%. One patient developed pneumonia and other had photosensitivity reaction. Bronchoscopic PDT is safe and effective in selected group of patients with non-small cell lung cancer who have MRD along the stump site.

Is endoscopic surveillance necessary for patients who undergo total gastrectomy for gastric cancer?

There have been only a few reports investigating the clinical efficacy of follow-up endoscopy for detection of recurrent gastric cancer after total gastrectomy (TG). We reviewed the records of 747 patients undergoing TG from 2003 to 2012 and enrolled 267 patients (70 with early gastric cancer (EGC) and 197 with advanced gastric cancer (AGC)), who received one or more follow-up endoscopy and contrast abdominal computed tomography (CT) scan. We found no tumor recurrence in the 70 EGC patients during the mean follow-up periods of 42.1 ± 18 and 43.2 ± 19 months by endoscopy and contrast abdominal CT scan. In 197 AGC patients, 59 patients (29.8%) had confirmed tumor recurrence during mean follow-up periods of 40.5 ± 21 and 45.3 ± 22 months. The most common pattern of tumor recurrence was distant metastasis (n = 35) followed by peritoneal metastasis (n = 11). Among the other 13 cases with loco-regional recurrence, seven cases were regional lymph node metastases, four were anastomosis site recurrences, and two were duodenal stump and jejunal loop site recurrences. Three of the four cases of anastomosis site recurrence were found by both endoscopy and contrast abdominal CT scan; one case was missed by contrast abdominal CT scan. However, the two cases with duodenal stump and jejunal loop recurrences were detected by contrast abdominal CT scan only. An annual follow-up endoscopy for gastric cancer after TG might have a limited role in the detection of tumor recurrence, especially in patients with EGC. Contrast abdominal CT scan may be sufficient as a follow-up method for recurrent gastric cancer after TG.

Soil-surface CO2 flux during the first 2 years after stump harvesting and site preparation in 14 Swedish forests

ABSTRACTStumps are a source of renewable energy (bioenergy) that can mitigate climate change. We aimed to determine whether conclusions from recent studies could be generalized for other sites by monitoring the in situ soil respiration (Rs) by a portable soil-respiration system of 14 clear-cut experimental sites during the first 2 years after stump extraction and site preparation. The sites were established all over Sweden in 2013 and 2014 and were subjected to no disturbance (Control), patch scarification (PatchS), disc trenching (DiscT), and stump harvesting (StumpH). During year 1, Rs from sites treated with PatchS and StumpH were 11% and 13% lower than Rs from Control sites. DiscT-treated sites were apt to produce lower Rs than the Control (−9%, p = .09). In the second year, there were no significant differences in Rs between treatments, as no soil disturbance type occurring after stump harvest and site preparation had higher Rs than untreated, intact soil. Our results suggest that soil disturbances resulting from stump harvest and site preparation do not generally increase Rs and thus, from this perspective, provide support for the use of stumps for bioenergy.

Long-term effects of stump harvesting and site preparation on pools and fluxes of soil carbon and nitrogen in central Sweden

ABSTRACTClear-cutting and subsequent site preparation is a common forest management practice in the Nordic countries. Slash and stumps have been suggested to replace fossil fuels in district heating plants. Stump/root removal from clear-cuts will reduce the amount of decomposable substrate in the soil and thus decrease soil CO2 emission, but stump lifting is also supposed to stimulate CO2 efflux and counteract CO2 reduction. To determine the effects of stump/root harvesting in relation to site preparation (stumps retained) on pools and fluxes of carbon (C) and nitrogen (N) after a period of 20–30 years, soil sampling was performed in four pairs of stump/root harvesting (S) and patch scarification (P) stands in central Sweden in 2009. Stump/root harvesting resulted in a significantly lower soil C pool in the humus layer. Annual heterotrophic respiration (RH) in the whole soil profile was significantly lower after the S than after the P treatment, the mean difference being 38 ± 23 g CO2–C m−2 year−1 (95% CI). This difference was larger than corresponding data from stump/root decomposition models (11–18 g CO2–C m−2 year−1), but both empirical and model data showed that stump/root harvesting will reduce heterotrophic soil CO2 emissions to the atmosphere during the actual period.

The effect of harvesting method on biomass retention and operational efficiency in low-value mountain forests

This study determined the biomass retention effects and the technical–financial performance of alternative harvesting practices, applied to mountain sites. The two alternatives were: whole-tree (WT) and tree-length (TL) harvesting. Five cable yarding sites were selected from a larger pool of available sales, and on each site two adjacent and parallel cable corridors were set up, using the same base equipment and crew. For each of the 10 corridors (i.e. 5 sites × 2 corridors), the following data were recorded: biomass retention, product output, time and fuel inputs. Opting for TL harvesting resulted in a large (66 %) and significant increase in biomass retention, which may prove attractive where intensified biomass removal may jeopardize soil fertility and biodiversity. TL harvesting also resulted in a moderate increase (13 %) of total harvesting cost. Furthermore, TL harvesting required 30 % more labour input than WT, which may represent a disadvantage when forest labour is scarce. The increased labour use in TL harvesting occurs mainly at the stump site, where accident risk is highest. For all these reasons, managers should take their decision very carefully and opt out of more efficient WT harvesting only when the risk derived from increased biomass removal is quite severe.

CT characteristic of early local recurrence after resection of the squamous cell carcinoma: comparison with CT characteristics of granulation tissue at stump site

Methods Twenty nine consecutive patients with local recurrence after definitive SCC operation from April 2006 to September 2012 were included. Preand post-operative CT from these patients were retrospectively reviewed and compared with those in ageand gender-matched 29 patients with stump deformity or granulation tissue at stump site after the definitive SCC operation, by two chest radiologists.

Preliminary results of tomotherapy for treatment of inoperable recurrent non-small cell lung cancer at bronchial stump site after right pneumonectomy.

Aim of the studyThis study aimed to prospectively investigate the clinical outcomes of curative radical helical tomotherapy (HT) applied to recurrent non-small cell lung cancer (NSCLC) at the bronchial stump site after right pneumonectomy. After right pneumonectomy, the heart shifted right laterally. The chambers of the heart closed with a recurrent mass at the bronchial stump were the right atrium and left atrium due to right shifting of the heart. The unfavorable bronchial stump recurrent cancer-heart geometry due to a right shift of the heart might serve as a reliable predictor of cardiac morbidity for aggressive radiotherapy.Material and methodsThe 23 patients received HT for the recurrent NSCLC at the bronchial stump site after right pneumonectomy between 2008 and 2011. The median age of the patients was 65 years (range 56–74).ResultsWe prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy. The median conformal index in the 23 plans was 1.21. The mean fraction of primary PTV receiving more than 95% of the prescribed dose was 97.8%. The mean V45, V50, V60 of the heart were 10.5%, 6.5%, 0.2%, respectively. The median follow-up after tomotherapy was 19.86 months. Median survival was 20 months. The 2-year OS was 39.1%.ConclusionsThe relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.