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Biomedical subjects

R B McElvein

Publications and source records attributed to R B McElvein.

15 recordsLinked to original sources

Intrapulmonary teratoma: a case report and review of the literature.

Intrapulmonary teratomas are rare; only 30 cases have been reported in the world literature. These tumors are thought to originate from the third pharyngeal pouch. They occur equally in men and women and usually are diagnosed in the second to fourth decade of life. They are more often benign than malignant, although malignant lesions may have a favorable postoperative prognosis and benign lesions may exhibit high morbidity and mortality because of their size and location. These tumors present radiographically as lobulated masses that may contain calcification or peripheral collections of air. They most often occur in the upper lobes. The computed tomographic findings of intrapulmonary teratoma are less well known but have been described in two cases. An additional case is presented with a review of the literature and a tabular summary of the characteristics of this unusual entity.

Adult

Radiographic evidence of calcification in pulmonary hamartomas.

Eight cases of solitary intrapulmonary hamartomas are presented to show the unusually high frequency of calcification (75%, six of eight cases) in this series. Possible contributory factors were high percentage of chondromatous variant (seven of eight cases), large size of the tumors, and use of computed tomography.

Aged

Procedures in the evaluation of chest disease.

The evaluation of chest disease may require one or more procedures. Bronchoscopy, both rigid and flexible, mediastinoscopy, mediastinotomy, chest tube drainage, lung biopsy, thoracoscopy, and pleural biopsy are described, with indications, contraindications, and results detailed.

Bronchoscopy

Computed tomography evaluation of pathologic processes in the potential spaces of the mediastinum.

The potential spaces of the mediastinum can be involved in a variety of disease processes and become evident by computed tomography study. The potential spaces may be distended with air, blood, inflammatory exudate, excessive fat, or tumor which separates and displaces the normal mediastinal structures. Seven cases with various pathologic processes are selected to demonstrate the computed tomography characteristics of such lesions. We emphasize the importance of computed tomography in evaluating and understanding various disease processes involving the potential spaces in an often widened mediastinum.

Adult

Solitary neurofibroma of the vagus nerve in the aortopulmonary window masquerading as a developmental cyst.

A rare case of solitary neurofibroma of the vagus nerve in the aortopulmonary window masquerading as a developmental cyst is reported. Its computed tomographic characteristics and magnetic resonance imaging are described and correlated with pathologic findings. Although the features of such imaging modalities are quite characteristic for a neurofibroma, its differentiation from "atypical" developmental cysts may be difficult.

Adult

Transthoracic exposure for anterior spinal surgery.

The anterior approach to the vertebral column is used to treat fractures, spinal deformities, and destructive lesions secondary to tumor or infection. The thoracic surgeon, working with orthopedic surgeons and neurosurgeons, is uniquely qualified to provide surgical exposure expediently and assist in postoperative care. Forty-five patients with spinal deformities secondary to trauma (18 patients), congenital anomalies (16 patients), neoplastic disease (7 patients), and inflammation (4 patients) were treated by a transthoracic (37 patients) or thoracoabdominal (10 patients) anterior approach to the vertebral column. Two patients had subsequent operations. Free and vascularized rib grafts were used for stabilization and fusion with good results and few complications (8 patients). These results indicate that interspecialty cooperation results in expedient surgical exposure and good postoperative care.

Adolescent

Percutaneous fine needle aspiration in the diagnosis and management of mediastinal cysts in adults.

Management of asymptomatic mediastinal cysts in adults is controversial. In the past, these cysts were excised primarily to establish a diagnosis. Presently, computerized tomography (CT) of the chest can diagnose the majority of mediastinal cysts, based on their smooth contour and low density; however, CT diagnosis of a mediastinal cyst based on density can be erroneous. In six patients, we established the diagnosis of mediastinal cyst by percutaneous needle biopsy (PNB) without complication. In four of the patients, PNB was done as an outpatient procedure. Follow-up in five patients ranged from three months to three years, with no increase in the size of the cyst; in the sixth patient, surgical excision showed a hygroma. Thus, diagnosis of a mediastinal cyst can be safely confirmed by PNB. We suggest that these asymptomatic patients can be followed up without the need for surgical excision.

Adult

First rib fracture: a hallmark of severe trauma.

First rib fractures occurred in 55 patients. This injury is a harbinger of major trauma with 35 patients suffering a major chest injury, and abdominal and cardiac injuries occurring in 18 and eight patients respectively. The mortality associated with this injury was high (36.3%). Neurologic lesions accounted for the majority of deaths, however, unrecognized abdominal injuries and pulmonary complications were significant causes of mortality. Brachial plexus injury (5) and Horner's syndrome (3) occurred in survivors. Three patients had an associated injury of the subclavian artery, and the importance of this association is stressed. One late-developing post-traumatic thoracic outlet syndrome occurred. A fracture of the first rib is a hallmark of severe trauma; its presence should alert the clinician to: 1) generalized massive trauma with abdominal, chest, and cardiac injuries; 2) local injury to the subclavian artery and brachial plexus and; 3) necessity of long-term followup for late-developing sequelae.

Abdominal Injuries

Infarcted extralobar pulmonary sequestration.

A 32-year-old man who presented with symptoms suggesting empyema was found at thoracotomy to have infarction of an extralobar pulmonary sequestration. He was completely relieved by excision of the sequestration after securing the systemic vascular pedicle which had undergone torsion. Recognition of the anomalous bloody supply and other congenital anomalies in such cases is emphasized.

Adult

Oncologic emergencies.

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Bronchial Neoplasms