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At least 253 records · Page 14Linked to original sources
PubMed2001

[Circulation support in left thoracotomy for descending thoracic aorta diseases in pediatric patients].

BACKGROUND: Complications of surgery of the descending thoracic aorta could include neurological problems such as paraparesis and paraplegia. Intestinal ischemia and acute renal failure could occur, too. During the cross-clamping time, the perfusion of the distal aorta by means of extracorporeal circulatory assistance can be useful to protect the spinal cord and the splanchnic organs and to reduce the incidence of these untoward events. The aim of this study was to verify the efficacy and suitability of this type of circulatory assistance in a pediatric age group. METHODS: From January 1996 to March 2000, in the Pediatric Cardiac Surgery Department of the Gaslini Institute (Genoa, Italy), 6 patients (mean age 39 months, mean weight 14.4 kg) were treated using extracorporeal circulatory assistance through the left thoracotomy. Indications for surgery included the removal of a migrated device previously inserted in order to close a patent ductus arteriosus in 1 patient, recurrent coarctation in 2 patients, and native coarctation with a poor collateral circulation in 3 patients. RESULTS: The early and late mortality rates as well as the morbidity rates (both neurological and splanchnic) were nil. CONCLUSIONS: Extracorporeal circulatory assistance can be helpful in pediatric patients and it can prevent neurological and renal injuries in cases of a) coarctation of the aorta with a poor collateral circulation and low distal pressure (< 40 mmHg during aortic occlusion); b) recoarctation with complex anatomy; c) other pathologies requiring prolonged descending thoracic aorta cross-clamping.

Aorta, Thoracic↗
PubMed1983

Surgical treatment and complications of thoracic hydatid disease. Report of 61 cases.

Echinococcus cysts in the thoracic cavity were diagnosed and treated in 61 patients. Diagnosis was usually made by clinical and radiological manifestations of hydatid disease. Empyema, broncho-biliary, and biliary-pleural fistulae are complications of thoracic echinococcosis. Portal hypertension, systemic venous obstruction, paraplegia, arterial emboli due to endocardial cysts are complications of echinococcus cysts. In 40 patients with uncomplicated cysts, cystectomy-capitonnage was performed. Lobectomy or segmental resection was undertaken for complicated cysts and destroyed lung parenchyma, in ten patients. Extirpation of the cyst is preferred for extrapulmonary location, and median sternotomy is applied for bilateral multiple pulmonary hydatid cysts. In our series, the incidence of surgical complications was low and there was no surgical mortality. Recurrence or pleural implantation of pulmonary echinococcus cyst have not been found during an average nine-months follow up.

Adolescent↗
PubMed1992

Thoracic magnetic resonance imaging.

Magnetic resonance imaging has played a role in the diagnosis of thoracic disease; however, the role has been limited compared with that of CT. In the past year, there were a few additional reports of MR imaging in the diagnosis of thoracic disease, which include a multi-institutional study comparing MR imaging with CT and histopathologic correlative studies evaluating gadopentetate dimeglumine-enhanced MR imaging. Furthermore, several excellent reviews of MR imaging of thoracic disease were published. In general, the recent literature supports information previously reported. In the future, developments in lung parenchymal imaging and pulmonary vascular imaging are anticipated.

Humans↗
PubMed2005

Midterm results of surgical treatment of thoracic aortic disease in dialysis patients.

BACKGROUND: We investigated the influence of dialysis on late aortic events in end-stage renal failure patients who had undergone replacement of the thoracic aorta. METHODS: Between 1990 and 2003, 28 dialysis patients underwent thoracic aortic aneurysm repair. The cause was non-dissection in 17 patients and dissection in 11 patients. Six patients needed emergency operations. After the initial operation, 10 patients in the dialysis group had a patent false channel distal to the operative area, and 7 patients in the dialysis group had untreated separate aneurysms. These lesions were defined as residual aneurysms. We performed a retrospective case-control analysis of survival and late aortic events (enlargement of the remaining thoracic aorta, sudden death and reoperation) in dialysis patients versus carefully matched non-dialysis patients. Matching criteria included age, sex, cause, operative procedures, operative date, and operative status (elective or emergency). RESULTS: Survival rates at 1 and 5 years for dialysis patients versus non-dialysis patients were 63 +/- 9% vs. 85 +/- 7% and 41 +/- 11% versus 64 +/- 13%, respectively (p = 0.02). Four of nine late deaths in the dialysis group were due to rupture of residual aneurysm. Freedom from late aortic events for dialysis patients versus non-dialysis patients was 91+/- 6% versus 92 +/- 5% and 25 +/- 14% versus 68 +/- 12% at 1 and 5 years, respectively (p = 0.0073). CONCLUSIONS: There is a high incidence of late aortic events in dialysis patients undergoing thoracic aortic aneurysm repair. This finding indicates the need for close follow-up examination of dialysis patients who have undergone surgical treatment of thoracic aortic disease.

Aged↗
PubMed2005

Long-term survival following concurrent chemoradiotherapy in patients with non-small-cell lung cancer with concomitant brain metastases only.

We report two patients with non-small-cell lung cancer (NSCLC) with concomitant metastases to the brain only who received chemotherapy with concurrent radiotherapy for the thoracic disease and brain disease, resulting in long-term survival. One patient was a 56-year-old woman who was diagnosed as having adenocarcinoma and showed T2N1 thoracic disease; the other patient was a 57-year-old man diagnosed with squamous cell carcinoma who had T1N3 thoracic disease. Both patients demonstrated multiple metastases to the brain only. Chemotherapy, consisting of cisplatin (40 mg/m2) and docetaxel (40 mg/m2), was administered on days 1 and 8, with the drugs being given separately, and the chemotherapy was repeated every 4 weeks for up to three cycles. Whole-brain irradiation (2 Gy/day; total, 36 Gy) and thoracic irradiation (2 Gy/day; total, 60 Gy) were started on days 1 and 29, respectively. Toxicities encountered were manageable by conventional therapy. The concurrent chemoradiation therapy resulted in complete regression of the brain disease in both patients. Brain disease relapsed in the female patient, but it is being controlled by the administration of gefitinib. She has survived for 53 months since the start of treatment, without new metastatic lesions or relapse of the thoracic lesions. The male patient has survived for 37 months without new metastatic lesions or relapses. Concurrent chemoradiotherapy in which radiotherapy is applied to both the brain and thoracic lesions may be effective for patients with NSCLC with metastases to the brain only.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Thoracoscopy in horses.

With the recent development of video-assisted thoracic surgery, visual inspection of the thoracic cavity has been used to provide a more accurate diagnosis and prognosis of thoracic diseases and to better manage these diseases. Equipment, techniques, and complications for standing thoracoscopy in horses are described.

Animals↗
PubMed1993

[Forum on tissue expansion. Breast reconstruction by expansion in a young woman with sequelae of thoracic amniotic disease. Apropos of a case].

Amniotic disease or congenital skin sulci disease is a clinical entity covering a broad spectrum of malformations, usually involving the limbs, skull and face. This malformation is exceptional in the thorax. The authors report the case of a 22 year old woman with sequelae of thoracic amniotic disease, consisting of unilateral mammary aplasia, atrophy of the pectoralis major and latissimus dorsi muscles and deformity of the homolateral thoracic skeleton. They describe the breast reconstruction performed by tissue expansion in this patient.

Adult↗
PubMed1991

Thoracic disc disease and stenosis.

Disc herniation and stenosis in the thoracic spine are relatively uncommon compared with their occurrence in the cervical or lumbar spine. They are usually degenerative, although trauma may be an aggravating or initiating factor. The clinical presentation includes local and/or radicular pain with or without signs and symptoms of cord dysfunction. Radicular pain may be secondary to mechanical compression or vascular impingement. MR imaging is the best way to define the specific abnormality as well as the effect on the adjacent spinal cord. CT after myelography may be useful as well, especially in those patients in whom there is involvement of the posterior ligamentous and osseous structures of the thoracic spinal canal. MR imaging may finally reveal the true incidence of thoracic disc herniation.

Humans↗
PubMed2002

[Mediastinoscopy in 165 patients].

OBJECTIVE: To investigate the value of mediastinoscopy in diagnosis of the thoracic diseases and the determination of the operative indication. METHODS: From 1979 to 2000, 165 patients were given mediastinoscopy by local infiltration anesthesia (rare cases with additional vein bacic anesthesia). The exploration and biopsy were given to the neoplasms and lymph nodes around the trachea through the pretracheal interstice. RESULTS: The diagnosis of 125 patients by mediastinoscopy accorded with the pathological diagnosis and that of 21 patients was not accorded with the pathology. The rate of definitive diagnosis was 85.6% (125/146). The other 19 cases were not included into the ground because 11 cases were not given definitive diagnosis and 8 cases with lung cancer were not be performed operation although the results of mediastinoscopy were negative. Twenty patients with lung cancer which had metastasis in the mediastium and 7 patients with malignant lymphadenoma avoided exploratory thoracotomy. CONCLUSION: The mediastinoscopy is a effective examinative method to the disease involving the lymph nodes in the mediastinum and the thoracic disease closing on the mediastinum. The mediastinoscopy in appropriate especially to the simple enlargement of lymph node in the mediastinum that is not given definitive diagnosis. The cases with lung cancer accompanied enlargement of lymph node in the mediastinum and that with tumors in the mediastinum may choose the mediastinoscopy.

Adolescent↗
PubMed1990

CT features of thoracic mycobacterial disease.

The authors review the computed tomographic (CT) features of thoracic tuberculosis and other mycobacterial infections throughout their progressive stages. The spectrum of parenchymal findings seen in mycobacterial disease as well as the chronic changes of prior tuberculosis are illustrated. Altered appearances of tuberculosis occurring in patients with preexisting chest diseases such as sarcoidosis and silicosis and those associated with acquired immunodeficiency syndrome are demonstrated. CT and conventional radiography are compared, and the advantages and complementary nature of CT are illustrated. The role of CT in evaluating complications of tuberculosis, including cavities, bronchogenic spread, bronchiectasis, and aspergilloma, is discussed.

Adult↗
PubMed2003

Descending thoracic aortic diseases: stent-graft repair.

PURPOSE: To evaluate endovascular treatment of descending thoracic aorta with commercially available self-expanding stent-grafts. MATERIALS AND METHODS: Seventy patients with aortic dissection, intramural hemorrhage, degenerative and posttraumatic aneurysm, penetrating atherosclerotic ulcer, and pseudoaneurysm underwent endovascular treatment. Eleven patients had impending rupture and were treated on an emergency basis. Stent-grafts were customized or selected on the basis of spiral computed tomographic (CT) or magnetic resonance (MR) imaging measurements. Preprocedure diagnostic angiography was performed in patients with aortic dissection and in other selected patients. All procedures were performed in an operating room and monitored with digital subtraction angiography (DSA) and transesophageal echocardiography (TEE). Follow-up was at 1, 3, 6, and 12 months after treatment and yearly thereafter. RESULTS: Stent positioning was technically successful in 68 cases. At DSA and TEE, complete aneurysm or false-lumen exclusion was achieved in 66 (97%) cases. No intraoperative mortality or complications occurred. In-hospital complications included transient monoparesis (one patient) and extension of dissection into ascending aorta (one patient) that was repaired surgically. Early endoleak was observed in five (7%) patients: In three (type 2), endoleak resolved spontaneously; in one (type 1), it was persistent; and in one (type 1), treatment was converted to surgery. At long term, one (1%) patient died of aortic rupture; another, of respiratory insufficiency. Five (7%) late endoleak (type 1, one caused by migration of the stent) cases were observed. In three (4%), endovascular treatment was successful; in two (3%), surgery was performed. In one patient with persistent postimplantation syndrome, treatment was converted to surgery after successful aneurysm sealing. Procedure failure (ie, aortic disease-related mortality or conversion to surgery) occurred in six (9%) patients. CONCLUSION: Endovascular stent-graft repair is less invasive in patients with chronic and acute descending thoracic aortic aneurysm and dissection.

Adult↗
PubMed1997

[Role of echocardiography in the diagnosis of acquired diseases of the thoracic aorta].

The diagnosis and follow-up of acquired thoracic aortic disease have greatly improved with advances in transthoracic and transoesophageal echocardiographic techniques. In emergency situations, transoesophageal echocardiography is the key diagnostic investigation for dissection, significantly speeding up surgical referral. Atherosclerosis of the aorta is the second clinical situation in which transoesophageal echocardiography confirms its superiority over other imaging techniques for the recognition of intra-aortic debris carrying a high embolic risk.

Adult↗
PubMed2005

Hybrid endograft for one-step treatment of multisegment disease of the thoracic aorta.

PURPOSE: At present, a two-step surgical approach is necessary to treat patients with coexistent pathologic conditions involving the proximal and descending thoracic aorta. A hybrid endograft is described here that enables such treatment during a single operation. MATERIALS AND METHODS: The Chavan-Haverich endograft consists of a Dacron vascular prosthesis with stainless-steel stents affixed at its distal end. After approval by the institutional review board, the endograft was prospectively implanted in 22 patients with multisegment thoracic aortic disease (13 men, nine women; median age, 64 years). Eleven patients had type A dissections (one acute, 10 chronic), four had a chronic type B dissection, and seven had atherosclerotic aneurysms of the ascending aorta or aortic arch as well as of the descending aorta. Of these patients, 11 additionally required aortic valve replacement or coronary artery bypass grafting. Via median sternotomy, the aortic arch was opened in circulatory arrest. After antegrade deployment of the stent-containing portion in the descending aorta, the proximal non-stent-containing endograft was used to reconstruct the aortic arch. Median follow-up was 14 months. RESULTS: Endograft implantation was successful in all but one patient. Complications included neurologic deficits that were transient in one case and lasting in two, two cases of vocal cord paralysis, and one death. In all patients with atherosclerotic aneurysms who received the endograft (six of seven), aneurysm thrombosis was noted at follow-up. In aortic dissections, partial or complete false-lumen thrombosis to the level of the stents occurred in all patients. None of the patients showed a progressive widening of the descending aorta. CONCLUSION: The Chavan-Haverich endograft enables one-step treatment of multisegment pathologic conditions affecting the thoracic aorta that otherwise would require two or more operations.

Aged↗