PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “THORACIC DISEASES”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources
PubMed2000

The pathophysiology of thoracic disc disease.

Nucleus pulposus herniations are far less common in the thoracic spine than at the cervical and lumbar regions. Traditionally, diagnosis of thoracic disc herniations has been challenging because the signs and symptoms are often subtle early in their course. As a result, delays in diagnoses are common. Because they are uncommon as well as difficult to diagnosis, the neurosurgical community has sparse data on which to base good clinical decision making for the treatment of these herniations. In this review the authors seek to place the phenomenon of thoracic disc disease into the context of its pathophysiology. After a careful evaluation of the available clinical, pathological, and basic science data, a case is made that the cause of nucleus pulposus herniations in the thoracic spine is similar to those occurring in the lumbar and cervical regions. The lower incidence of herniations is ascribed primarily to the reduced allowable flexion at the thoracic level compared with the lumbar and cervical levels. To a lesser extent, the contribution of the ribs to weight-bearing may also play a role. Further review of clinical data suggests that thoracic disc herniations, like herniated cervical and lumbar discs, may be asymptomatic and may respond to conservative therapy. Similarly, good surgery-related results have been reported for herniated thoracic discs, despite the more challenging nature of the surgical procedure. The authors conclude that treatment strategies for thoracic disc herniations may logically and appropriately follow those commonly used for the cervical and lumbar levels.

Back Pain↗
PubMed2003

[Medical education and surgical residency program for general thoracic surgery].

We introduced medical education for general thoracic surgery to medical students and a new surgical residency program to instruct residents who aspire to become general thoracic surgeons. It is important to understand the etiology of thoracic diseases, methods of diagnosis for tumorous lesions, anatomy of the interior thorax, surgical therapies and indications for thoracic diseases, and management of perioperative periods in the medical education of general thoracic surgery. According to the new residency program, a surgical resident must complete a super rotating system that consists of the subjects of internal medicine, general surgery, emergency and critical care medicine, anesthesiology, pediatrics, gynecology, and local healthcare for several months each in the first two years. On the other hand, a surgical residency program includes core surgical residencies to train clinical patient-care oriented surgeons and advanced residencies in such areas as thoracic surgery, cardiovascular surgery, pediatric surgery, and digestive organ surgery. Residents who want to become general thoracic surgeons must complete 350 cases of general surgery including at least 120 cases for an operator in the first 4 or more years in core programs. After passing the board for general surgery, they can advance to a subspecialty program for thoracic surgery in the final 3 or more years to pass the board for general thoracic surgery. It is essential to train the general thoracic surgeons who empathize with patients with thoracic diseases and can contribute to overcoming thoracic diseases by practicing evidence- or science-based medicine.

Curriculum↗
PubMed2006

Complications after endovascular stent-grafting of thoracic aortic diseases.

BACKGROUND: To update our experience with thoracic aortic stent-graft treatment over a 5-year period, with special consideration for the occurrence and management of complications. METHODS: From December 2000 to June 2006, 52 patients with thoracic aortic pathologies underwent endovascular repair; there were 43 males (83%) and 9 females, mean age 63 +/- 19 years (range 17-87). Fourteen patients (27%) were treated for degenerative thoracic aortic aneurysm, 12 patients (24%) for penetrating aortic ulcer, 8 patients (15%) for blunt traumatic injury, 7 patients (13%) for acute type B dissection, 6 patients (11%) for a type B dissecting aneurysm; 5 patients (10%) with thoraco-abdominal aortic aneurysms were excluded from the analyses. Fifteen patients (32%) underwent emergency treatment. Overall, mean EuroSCORE was 9 +/- 3 (median 15, range 3-19). All procedures were performed in the theatre under general anesthesia. All complications occurring during hospitalisation were recorded. Follow-up protocol featured CT-A, and chest X-rays 1, 4 and 12 months after intervention, and annually thereafter. RESULTS: Primary technical success was achieved in all patients; procedures never aborted because of access difficulty. Conversion to standard open repair was never required. Mean duration of the procedure was 119 +/- 75 minutes (median 90, range 45-285). Mean blood loss was 254 mL (range 50-1200 mL). The mean length of the aorta covered by the SGs was 192 +/- 21 mm (range 100-360). The LSA was over-stented in 17 cases (17/47, 36%). Overall 30-day operative mortality was 6.4% (3/47). Major complications included pneumonia (n = 9), cerebrovascular accidents (n = 4), arrhythmia (n = 4), acute renal failure (n = 3), and colic ischemia (n = 1). Overall, endoleak rate was 14%. CONCLUSION: Although this report is a retrospective and not comparative analysis of thoracic aortic repair, the combined minor and major morbidity rate was lower than previous reported to results of either electively and emergency performed conventional repair.

Adolescent↗
PubMed2006

Stent-graft repair for thoracic aortic disease: results of an independent nationwide study in France from 1999 to 2001.

BACKGROUND: The purpose of this study was to assess the overall short-term outcome of stent-graft repair for thoracic aortic disease in France between June 1999 and May 2001. METHODS: This retrospective study was designed by the French National Health Insurance Fund for Salaried Workers. To ensure objectivity, data were retrieved at each center and checked by a team of medical advisors. RESULTS: Between June 1999 and May 2001, a total of 166 stent-graft repairs for thoracic aortic disease were performed in 166 patients, mainly by surgeons in the operating room (88%). Patients were classified according to the American Society of Anesthesiologists as status I or II in 24% of cases, status III in 56%, and status IV or V in 20%. The diameter of the thoracic aneurysm was less than 50 mm in 17% of cases. Seventeen patients (10%) died during the first 3 months, including 8 within the first 30 days after the procedure. A total of 49 complications were noted in 34 patients (20.5%). Endoleaks occurred in 27 patients (16.3%), including 8 that necessitated further treatment. Other stent-related complications included rupture (n = 3), aortoesophageal or tracheal fistula (n = 3), paraplegia (n = 6), stent migration (n = 2), visceral embolism (n = 5), and cerebral embolism (n = 2). There were 14 delivery-related complications (8%) at the catheterization site. Non-stent-related complications occurred in 14 (8%). CONCLUSIONS: This nationwide study demonstrates that stent-graft repair for thoracic aortic disease can be performed with acceptable postoperative morbidity. However, it is not a risk-free procedure and should continue to be used in an investigative setting.

Adult↗
PubMed1993

Abdominal staging of thoracic Hodgkin disease: CT-lymphangiography-Ga-67 scanning correlation.

A retrospective study was performed to assess whether lymphangiography and gallium-67 scanning were complementary to computed tomography (CT) in abdominal staging of disease in 94 patients with early-stage thoracic Hodgkin disease. In 51 patients with surgical or follow-up correlation, the spleen was involved in 16% (n = 8), the spleen and lymph nodes in 22% (n = 11), and only lymph nodes in 2% (n = 1). In these 51 patients, none of the imaging modalities had greater than 50% sensitivity for the detection of nodal involvement. The overall accuracy was similar (71%-82%) for each modality. Analysis of subgroups of patients with lymph nodes measuring less than 10 mm, 10-19 mm, or 20 mm or greater at CT revealed that lymphangiography and gallium scanning added little to the positive or negative predictive values of CT. The sensitivity of CT for detection of splenic disease was 11% (two of 19). On the basis of surgical or follow-up correlation in 51 patients, the authors conclude that lymphangiography and gallium scanning offer minimal or no complementary benefit.

Abdominal Neoplasms↗
PubMed2000

Calcium pyrophosphate dihydrate deposition disease causing thoracic cord compression: case report.

OBJECTIVE AND IMPORTANCE: Calcium pyrophosphate dihydrate (CPPD) deposition disease is being increasingly recognized. Spinal involvement in CPPD deposition disease is rare. When involved, the cervical and lumbar regions are commonly affected. We report a rare case of CPPD deposition disease that caused thoracic cord compression. CLINICAL PRESENTATION: A 45-year-old woman presented with clinical features suggestive of thoracic cord compression. Radiographic findings were consistent with calcification of the ligamenta flava in the lower thoracic levels causing cord compression. Calcification of the ligamentum flavum is commonly attributed to CPPD deposition disease. Evaluation for conditions that might be associated with CPPD deposition disease proved to be negative. INTERVENTION: Laminectomy with removal of the calcified ligamenta flava was performed. Histopathological examination of the excised ligaments revealed evidence of CPPD crystals. Postoperatively, the patient's spasticity decreased and sensations improved, with no significant improvement in motor power. CONCLUSION: Calcification of the ligamenta flava due to CPPD deposition disease is a rare cause of thoracic cord compression. CPPD deposition disease should be entertained in the differential diagnosis of thoracic cord compression.

Chondrocalcinosis↗
PubMed2004

Stent graft treatment of thoracic aortic disease.

This study was a retrospective analysis of both the efficacy and long-term outcome of endovascular management of thoracic aortic disease. From March 1999 to August 2003, 129 patients (110 males; 19 females) were enrolled. They were divided into four groups: aneurysms (41, 5 of which acutely ruptured, Group A), post-traumatic lesions (24, 14 acute and 10 chronic, Group B) and complicated type B dissections (42, 23 acute and 19 chronic, Group C). Twenty-two of the 129 patients with chronic type B dissection, not suitable for endovascular treatment, received medical management only (Group D). All patients underwent computed tomography (CT) scan and angiography as preoperative assessment. Stent-graft systems were Talent -Medtronic, Excluder-Gore, Zenith-Cook and Endofit-Endomed, deployed by transesophageal echocardiography (TEE) monitoring. An optimal deployment with sealing of the graft was achieved in 95.3% (102/107) of the treated patients discharged in good condition within 6 days. Five patients (3 in Group A and 2 in Group C) underwent endovascular completion of the elephant trunk technique successfully. In 5 patients affected by atherosclerotic aneurysm, in a single-time procedure, we have also treated the abdominal aortic aneurysm by endovascular. No spinal cord injuries were observed. The follow up (average: 20.82+/-10.01 months), performed with serial chest CT scans, was 100% complete. No stent-graft related complications were detected. In 2 patients with chronic dissection, an asymptomatic type II endoleak was detected. A total of 4 hospital deaths resulted in an overall operative mortality rate of 3.7%. Seven patients (6.5%) died during the follow-up period, whereas a 31.8% (7/22) mortality rate (p<0.001) was observed within the medical treatment group. Endovascular treatment of thoracic aortic diseases, even in the acute phase, may represent a valid option, especially when compared to medical therapy.

Adult↗
PubMedDate not supplied

Cardiovascular applications of magnetic resonance flow and velocity measurements.

With recent developments of MR techniques for blood flow measurements, qualitative and quantitative information on both flow volume and flow velocity in the major vessels can be obtained. MR flow quantitation uses the phase, rather than the amplitude of the MR signal, to reconstruct the images. Previous validation studies have demonstrated the accuracy of the phase shift techniques for measuring flow velocities. This technique is now being applied successfully in the cardiovascular system to quantify global and regional ventricular function, valvular heart disease, pulmonary artery disease, thoracic aortic disease, congenital heart disease, and ischemic heart disease.

Blood Flow Velocity↗
PubMed1992

MR measurement of blood flow in the cardiovascular system.

Methods for measurement of blood flow with MR were devised many years ago but have been used for diagnosis in only the past few years. The two methods of measurement that have been used most extensively are based on the principles of time of flight and phase shift. A number of factors can influence the accuracy of MR measurements of blood flow. In vitro studies using flow phantoms have verified the accuracy of the phase-shift technique for measuring flow velocities exceeding 5 m/sec, which for practical purposes, encompasses the peak flow encountered in cardiovascular disorders. The flow measurements have been used to quantify valvular heart disease, congenital heart disease, pulmonary arterial disease, thoracic aortic disease, and peripheral vascular disease.

Blood Flow Velocity↗
PubMedDate not supplied

Thoracic aortic disease: evaluation using a single MRA volume series.

OBJECTIVE: Use of MRA for thoracic aortic disease (TAD) evaluation has been limited. This report describes an initial experience with TAD evaluation using a single MRA volume series. MATERIALS AND METHODS: A single volume series, based on sequential 2D TOF MRA, was acquired in 30 cases (28 with suspected TAD and 2 normals). Each series was processed using multiplanar reconstruction (MPR) and maximum intensity projection (MIP); resulting tomographic (one base and two MPR) and MIP sets were blindly interpreted by four reviewers to detect TAD and, if present, to diagnose its specific form. For cases incorrectly interpreted, the standard MR images were subsequently interpreted. RESULTS: The TAD categories included aneurysm (n = 13), dissection (n = 9), and arch anomalies (n = 5). Sensitivities were high for TAD overall (89-100%) and TAD in ascending and descending portions; sensitivities were lower for TAD of the arch (two of four reviewers > or = 90% for TAD overall and descending TAD). Specificities for TAD overall had a wider range (67-100%), but were high for ascending, arch, and descending portions (three to four of four reviewers > or = 90% for each). Sensitivities for aneurysms (69-92%) and dissections overall (67-100%) were comparable, as they were in ascending and arch portions; descending dissection was better detected than descending aneurysm (two of four reviewers > or = 90% for ascending or arch aneurysm and for descending dissection); overall specificities (88-100 vs. 81-95%) and specificities in ascending, arch, and descending portions were also comparable (three to four of four reviewers > or = 90% for both in each portion; two of four reviewers > or = 90% for dissection overall). Each reviewer achieved > or = 70% diagnostic accuracy for TAD (one of four reviewers = 85%); accuracies for each category were comparable. Interpretation of standard MR images corrected all detection and most diagnostic (> or = 63%) errors. CONCLUSION: This initial experience with conventional TOF MRA for TAD evaluation is encouraging, but it indicates the potential for advancements in data acquisition and/or postprocessing.

Adolescent↗
PubMed2003

CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications.

Thoracic aortic dissection is the most frequent cause of aortic emergency, and unless it is rapidly diagnosed and treated, the result is death. Helical computed tomography (CT) permits the diagnosis of acute aortic dissection with a sensitivity and specificity of nearly 100%. This imaging modality also enables differentiation between proximal aortic dissection (type A in the Stanford classification) and distal aortic dissection (Stanford type B), which are treated differently and have different prognoses. In 70% of patients in whom nontraumatic acute thoracic aortic dissection is diagnosed after evaluation with helical CT, scans show the typical signs of aortic dissection, with rupture and displacement of the intima. CT also can depict other pathologic entities with similar clinical manifestations, such as intramural hematoma and penetrating atherosclerotic ulcer. Awareness of the different radiologic appearances of these disease entities is essential for differential diagnosis. More than one-third of patients with aortic dissection show signs and symptoms indicative of systemic involvement. Because branch-vessel involvement may increase morbidity and mortality, in this group of patients it is important to evaluate the entire aorta so as to determine the distal extent of the dissection and detect any systemic involvement.

Aortic Dissection↗
PubMed1994

Chest radiographic features of thoracic metastatic disease in adolescents with colon cancer.

This study describes chest radiographic features of thoracic metastatic disease (TMD) in patients referred for colon cancer to a pediatric oncology hospital. The study group was comprised of 9 patients (7 males, 2 females, age 13-19 years) with serial chest radiographs demonstrating TMD from colon cancer. All patients had a chest radiograph performed within the 2 months prior to death. The median interval from diagnosis of colon cancer to appearance of radiographic TMD was 3 months. Four of nine patients had TMD at presentation, eight of nine patients within 2 years of diagnosis. All abnormalities progressed on serial radiographs. The median interval from appearance of radiographic abnormalities to death was 2 months. Radiographic findings included pleural effusions (n = 6), lymphadenopathy (n = 5), lymphangitic carcinomatosis (n = 4), solitary pulmonary nodule (n = 2), and lobar atelectasis (n = 1). Five patients with pleural effusions initially had right-sided effusions. Radiographic TMD in adolescents with colon cancer usually occurs within 2 years of diagnosis. Once TMD manifests, the prognosis is dismal. Findings include pleural effusions, lymphadenopathy, lymphangitic carcinomatosis, solitary pulmonary nodules, and lobar atelectasis. We suggest that metastatic colon carcinoma should be included in the differential diagnosis for lymphangitic spread of tumor in adolescents.

Adenocarcinoma↗
PubMed2001

Endovascular stent-graft management of thoracic aortic diseases.

The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence.

Aortic Aneurysm, Thoracic↗
PubMed1987

Surgery for thoracic hydatid disease: a North American experience.

The clinical course of 20 patients with 22 thoracic hydatid cysts operated on from 1957 to 1984, was reviewed. Follow-up extended to 27 years (mean, 11.6 +/- 1.5 years [+/- the standard error of the mean]) and was 90% complete. Most patients originated from countries in the Mediterranean region; 5 were native Canadians. The diagnosis was suspected in all but 3 patients preoperatively. Fourteen patients had 16 primary lung cysts, 4 had infected liver cysts with intrathoracic extension, 1 had synchronous unruptured liver and lung cysts, and 1 had a thymic cyst. Nine cysts were intact, whereas 13 had ruptured preoperatively. A variety of surgical procedures was performed, including eight wedge resections and nine lobectomies. There were no early deaths, and perioperative complications were infrequent. One patient with a hepatic cyst that had ruptured into the right pleural space and right lower lobe died at 7 months of massive echinococcosis of the liver and intraabdominal sepsis. There has been no evidence of thoracic recurrence in any of our long-term survivors, although 1 patient had undergone enucleation of a left lung cyst in Greece 15 years prior to her reoperation here for a lingular recurrence. We conclude that thoracic hydatid disease is a rare entity in northeastern North America. The prevalence of ruptured cysts and infected hepatic cysts involving the lung was higher than in most other series, thereby necessitating more aggressive surgical treatment. Nevertheless, morbidity was low, and recurrence of disease was uncommon in long-term follow-up.

Adolescent↗
PubMedDate not supplied

Endovascular repair for thoracic aortic disease: tertiary single-center experience in northwestern Greece.

The purpose of this article is to report the initial experience with endovascular repair of thoracic aortic disease in a single tertiary vascular unit in northwestern Greece. Between 2003 and 2005, 16 patients were treated with endovascular techniques for various pathologies of the descending thoracic aorta. Twelve patients were treated electively and four emergently. Operative and follow-up data for a mean time of 18.4 months were retrospectively collected and analyzed. Primary technical success was obtained in 14 (87.5%) cases. No early or late deaths occurred, and there was no major operation-related complication. No paraplegia was observed in our patients. Stent graft-related complications occurred in 18.75% (one type 2 and two type 3 endoleaks), but they all had a favorable outcome. No further problems have been reported in any of our patients. Endovascular stent graft repair for diseases of the thoracic aorta seems to be a promising alternative to open surgery, especially for high-risk patients. Long-term results are needed to confirm the early benefit of this treatment option with regard to morbidity and mortality rates. The potential of this technique to be applicable even in relatively small, tertiary vascular centers might be of great benefit to patients.

Adolescent↗