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At least 289 records · Page 16Linked to original sources
PubMed1996

Degenerative disease of the thoracic spine in central India.

Thoracic spondylosis, better termed 'degenerative thoracic spine disease', is rare and failure to recognize it is mainly due to its rarity and to the complexity of symptomatology which can lead to prolonged and continued morbidity. During the past 4 years, the authors have treated 28 patients with thoracic spine degeneration with varied clinical manifestations, ranging from local pain, radiculopathy to radiculomyelopathy. In six patients, myelopathy developed gradually, four showing features of pseudoclaudication. Two had an acute onset of myelopathy after minor trauma. Radiological examination, including CT scans in a few patients, demonstrated facetal hypertrophy, ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament. One patient had posterior osteophytosis of thoracic spine at multiple level. Surgical decompression for localised stenosis yields good results, but the prognosis for those with diffuse or segmental stenosis is guarded.

Abdominal Pain↗
PubMed2003

The role of surgery in hemoptysis caused by thoracic actinomycosis; a forgotten disease.

OBJECTIVE: Thoracic actinomycosis is a relatively uncommon anaerobic infection caused by Actinomyces israelii. Rarely, it may be complicated by an unusual but significant hemoptysis manifestation. We describe our experiences of surgical treatment for hemoptysis in patients with pulmonary actinomycosis. METHODS: From 1984 to 2002, 14 patients with thoracic actinomycosis and hemoptysis were diagnosed after thoracotomy. There were 11 male and three female patients with a mean age of 53.6 years. They all had non-specific symptoms and radiographic findings, and no case was an accurate diagnosis made at the time of hospital admission, including echo-guide aspiration, serial bronchoscopic biopsy and computed tomography biopsy. The indications of surgical intervention in our patients were for treating complications such as hemoptysis, chronic sinus discharge, or empyema, also limited to diagnostic purposes. Preoperative embolization was performed in seven cases; however, none was successful. RESULTS: Among the 14 patients, all the lesions were unilateral. The disease was confined to the lung in all patients; and chest wall involvement in one patient. The surgical procedures included were as follows: pneumonectomy (n=1), bilobectomy (n=1), lobectomy (n=10), wedge resection (n=2), and lung lesion with concomitant chest wall resection and chest wall reconstruction (n=1). Mean intraoperative and postoperative blood loss within the first 24 h was 192.3 ml, and five patients required blood transfusion. All of the specimens from the lesion site showed histological evidence of Actinomyces infection. All patients regularly took 12 million units per day of intravenous crystalline penicillin G during their hospitalization, and oral procaine penicillin for up to 2 months. During the follow-up, all patients had an uneventful postoperative course. CONCLUSIONS: A high index of suspicion for this disease is advised for the surgeon engaged in the treatment of hemoptysis. Surgical resection of pulmonary actinomycosis is effective in preventing recurrence of hemoptysis. After diagnosis, it is treated using penicillin chemotherapy for at least 2 months.

Actinomycosis↗
PubMed1997

[Role of angio-MRI in the diagnosis of thoracic aortic diseases].

MRI is a promising method of studying aortic pathology because of its non-invasive nature and the possibility of obtaining morphological (on spin-echo sequences) and functional data (gradient echo with injection of contrast). Sequences sensitive to flow may be used to obtain angiographic-type images of the thoracic aorta. MRI is therefore the investigation of choice in the diagnosis and follow-up of dissections and aneurysms, both pre- and postoperatively. MRI allows differentiation between mural thrombosis and blood flow. The presence of a pleural effusion or of bleeding around the aorta is easily demonstrated. MRI also appears to be valuable in the assessment of aortic arch abnormalities because of its wide field of vision and its different spatial planes.

Aorta, Thoracic↗
PubMed2002

[Transluminal placed endovascular graft (TPEG) for thoracic aortic disease in fifteen patients under general anesthesia].

In 15 transluminal placed endovascular graft (TPEG) operations for thoracic aortic aneurysm either from dissection or injury, we induced general anesthesia with propofol, and maintained with propofol or sevoflurane in nitrous oxide and oxygen. The temporary balloon occlusion technique used for prevention of stent migration caused hypotension (systolic pressure 30-60 mmHg) in all cases. After releasing the occluding balloon, blood pressure in each patient recovered to the prehypotension level without use of catecholamine. We experienced two emergency operations, a thoracotomy and a celiotomy, resulting from graft failure. We had sudden hypotension in two other cases. In the first patient with aortic regurgitation, coronary air embolism was suspected because of ST segment elevation, while in the other, the hypotension was due to unexpected bleeding from the femoral artery sheath. Two additional patients developed vascular injuries occurring during manipulation of the catheter or sheath. In order to manage anesthesia for TPEG, it is necessary to be aware of its complications.

Adult↗
PubMed1998

[An autopsy case of Degos' disease with ascending thoracic myelopathy].

Degos' disease is a rare multisystem vasculopathy of unknown etiology. We report a 44-year-old man who presented himself with gait and sensory disturbances mainly due to thoracic transverse myelopathy four years after the appearance of many characteristic umbilicated papules over the trunk and extremities. He did not complain of abdominal pain or discomfort. Laboratory, electrophysiological and imaging studies did not show any characteristic change, except for the increase of protein contents and cell counts in the cerebrospinal fluid. We tried methylprednisolone pulse-dose therapy (1,000 mg/day x 3 days) five times, but this patient's neurological condition worsened stepwise after it, although the appearance of new skin lesion was suppressed. Intravenous infusion of ozagrel sodium and cyclophosphamide (1,000 mg/day) were also ineffective, and this patient died of respiratory failure after showing oculomotor paresis and comatose state. Necropsy revealed Degos' disease-specific vasculopathy in the central nervous system and the gastrointestinal tract, where occlusions of small-sized arteries and veins due to the intimal thickening were evident. The tissue necrosis was macroscopically remarkable in the brainstem and the thoracic spinal cord. The efficacy of steroid therapy for this disease should be investigated more carefully.

Adult↗
PubMed1974

The renal disease of thoracic asphyxiant dystrophy.

In those children with thoracic asphyxiant dystrophy, a genetically determined disorder, who survive infancy, the development of renal disease may be life-threatening. This report will present data obtained in six patients from three families which deals with the renal abnormalities in thoracic asphyxiant dystrophy. Both functional and anatomic abnormalities are described. Abnormalities in solute transport in the proximal tubule may be the earliest sign of renal dysfunction in this syndrome. Early glomerular changes may be more important than previously recognized. Finally, the various phenotypic expressions of this disorder are considered.

Acidosis, Renal Tubular↗
PubMed2003

Non-invasive mechanical ventilation improves walking distance but not quadriceps strength in chronic respiratory failure.

BACKGROUND: In patients with chronic respiratory failure (CRF) nocturnal mechanical ventilation (NMV) confers increased exercise tolerance. The hypothesis tested in the present study was that the increased exercise performance is associated with increased quadriceps strength. METHODS: In 28 patients with CRF due to chronic obstructive pulmonary disease and restrictive thoracic disease (post-tuberculosis-sequelae, scoliosis and obesity-hypoventilation) NMV was started. Before and after 2-month NMV the exercise tests, namely shuttle and 6-min walking distance, were performed. Furthermore, quadriceps strength was measured as the twitch tension elicited by magnetic stimulation the femoral nerve (TwQ) and the maximum voluntary contraction force (MVC). RESULTS: After 2 months therapy with NMV there was significant clinical and blood gas improvement. NMV significantly improved the walking distance by approximately 18% but there was no improvement in TwQ or MVC, the data could exclude a 15% improvement in TwQ with 82% confidence. CONCLUSION: The strength of quadriceps does not change after 2 months of effective NMV in patients with CRF despite a marked increase in endurance time. Factors other than quadriceps strength account for the improved performance.

Activities of Daily Living↗
PubMed2002

Thoracic aortic disease: endovascular stents.

Aortic disease is a serious, often life-threatening condition. The keys to instituting appropriate therapy in diseases of the aorta include accurate and rapid diagnosis and anatomical assessment. Endovascular aortic repair is a new alternative to conventional surgical approaches. Because arterial rupture is a risk of this procedure, appropriate facilities for resuscitation must be present during the procedure. This paper reviews the important aspects of aortic anatomy, echocardiographic imaging of the thoracic aorta, aortic pathology, endovascular surgery, and the role of echocardiography in the evaluation of the surgical outcome.

Aortic Dissection↗