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At least 397 records · Page 22Linked to original sources
PubMed2006

[Research on complications of thoracoscopic assisted thoracic spine surgery].

OBJECTIVE: To analyze occurrence, prevention and treatment of the complications of thoracoscopic assisted spine surgery. METHODS: Retrospective review of 182 patients who underwent standard thoracoscopic technique or video-assisted thoracic surgical procedure from October 1998 to August 2004. The treatment of thoracic diseases included debridement, decompression with (or) reconstruction. The total number of complications were recorded, and its mechanism, prevention and treatment were analyzed. RESULTS: Complications occurred in 16 patients, 12 cases of perioperative complications included 3 patients suffered from pneumonia, 3 pulmonary atelectasis, 2 patients' lung injured by trocar, 1 patient obtained transient monoplegia, 2 suffered from transient intercostal nerve pain and 1 had superficial incision infection. Long-term complications occurred in 4 cases: spinal tuberculosis relapsed 2 cases (one who had diabetes obtained relapse in 8 months of post-operation and another relapsed with complex spinal tuberculosis in 4 weeks postoperation), 2 patients suffered from kyphosis deformity and pain. CONCLUSIONS: The type and incidence of complications with thoracoscopic spine surgery mainly depend on indication, operation procedures and anesthesia, only by limit surgical indication, ameliorate technique, obey surgical principle and consummate perioperative treatment can we obtain mini-invasive effect by thoracoscopic assisted spine surgery.

Adolescent↗
PubMed1990

Bone lesions mimicking disseminated malignancy after remission of thoracic sarcoidosis.

A case of chronic sarcoidosis is presented with extensive involvement of the central skeleton, mimicking disseminated malignancy. The skeletal lesions occurred several years after spontaneous remission of thoracic sarcoidosis and were not accompanied by recurrence of active thoracic disease. Bone lesions in sarcoidosis are associated with lesions of skin and nasal mucosa.

Bone Diseases↗
PubMedDate not supplied

Endovascular repair of the descending thoracic aorta: evidence for the change in clinical practice.

The purpose was to review outcome data following endovascular repair of the descending thoracic aorta from reports published between 1994 and 2004. To accomplish this task, 1,518 patients underwent endovascular repair for thoracic aortic disease; 810 thoracic aortic aneurysms, 500 type B thoracic aortic dissections, and 106 traumatic ruptures. The 30-day mortality rate was 5.5% and 6% for late postoperative deaths. The primary technical success rate was 97%, with only 15 patients requiring open conversion. Neurologic deficits occurred in 29 patients. In total, 118 endoleaks were reported; 29 were restented, and the remainder required surgical intervention. Graft infection occurred in 6 cases, and migrations were detected in 10. The conclusion reached is that endovascular repair of descending thoracic aortic disease is feasible and can be achieved with low rates of perioperative morbidity and mortality. As few long-term data exist on the durability of thoracic stent grafts, lifelong surveillance remains necessary.

Aortic Dissection↗
PubMed2002

[Preliminary experience of video-mediastinoscopy in clinical application].

OBJECTIVE: To determine the value of video-mediastinoscopy in clinical application. METHODS: The clinical data of 54 patients receiving video-mediastinoscopy were reviewed retrospectively. This operation consisted of cervical mediastinoscopy in 44 patients, parasternal mediastinoscopy in 6, and combined procedures in 4. Of these patients, 18 underwent video-mediastinoscopy for the evaluation of undifferentiated mediastinal disease. Thirty-six patients with suspected lung cancer showed enlarged mediastinal lymph nodes radiographically in the chest and underwent video-mediastinoscopy. RESULTS: Seventeen of 18 patients with undetermined mediastinal diseases had a definitive pathologic diagnosis, with an accuracy of 94.4% (17/18). In the 36 patients with suspected lung cancer, 22 were positive, and 14 negative. In the negative patients who underwent thoracotomy with resection, mediastinal lymph nodes revealed no evidence of metastasis. There were no postoperative complication and deaths. CONCLUSION: Video-mediastinoscopy as a highly effective and safe procedure could be used in the diagnosis and staging of thoracic diseases.

Adolescent↗
PubMed1989

Magnetic resonance imaging of the thorax.

The role of magnetic resonance imaging (MRI) in the evaluation of thoracic disease is emerging amidst much debate and study. Recent technical advances have led to new applications of this modality, and a reappraisal of previous conclusions seems warranted. This article reviews our 5 1/2 years' experience with thoracic MRI.

Contrast Media↗
PubMed1990

Role of fine needle aspiration cytology in the management of thoracic lesions.

Fine needle aspiration cytology was performed on 121 occasions in 100 patients with various thoracic lesions. The investigation was performed chiefly with the help of straight and lateral chest skiagrams regardless of the size or depth of the lesion. The cellular yield was 87.6%. Positive diagnosis of malignancy could be made in 50 cases. The histopathological correlation in malignant cases was 80%. Non-malignant cytology including neoplastic and inflammatory pathology was also found useful in patient management. This report highlights the versatile role of this procedure in arriving at a diagnosis and planning the treatment for malignant as well as non-malignant thoracic diseases.

Adolescent↗
PubMed1997

Noninvasive positive pressure ventilation and not oxygen may prevent overt ventilatory failure in patients with chest wall diseases.

Some patients with chest wall diseases (CWD) without respiratory failure manifest important alterations in nocturnal gas exchange, as a previous stage to the future development of daytime respiratory failure. The purpose of this study was to evaluate the efficacy of nasal intermittent positive pressure ventilation (NIPPV) during sleep in a group of obese patients and in another group with restrictive thoracic diseases (RTD), comparing the results with those obtained from conventional nocturnal oxygen therapy. From a total of 42 patients with CWD free of daytime respiratory failure, 27 (64%) were considered nocturnal oxygen desaturators without sleep apnea and were included in the study. The study protocol was completed by 21 of these patients. After 2 weeks of treatment, symptoms of dyspnea, morning headaches, and morning obnubilation improved significantly (p<0.05) in both groups of patients after NIPPV but not with oxygen. Baseline daytime PaO2 was 68+/-7 mm Hg in the obese group of patients and 73+/-11 mm Hg in the RTD group. It improved significantly with NIPPV to 73+/-5 mm Hg in obese patients (p<0.05) and to 77+/-12 mm Hg in the RTD group (p<0.05) but did not change with oxygen (68+/-8 mm Hg in the obese group and 73+/-12 mm Hg in the RTD group). Both treatments improved oxygen saturation during sleep, but oxygenation tends to be higher with oxygen than with NIPPV. Only NIPPV was able to normalize the baseline nocturnal alveolar hypoventilation. From the 21 patients treated, 19 decided to continue with long-term NIPPV, one with oxygen, and one refused treatment. We conclude that in patients with CWD who manifest nighttime oxygen desaturation and hypoventilation, early initiation of NIPPV is preferable to supplemental oxygen. Our results also suggest that NIPPV initiated before overt ventilatory failure could prevent its onset.

Female↗
PubMed1997

Thoracic neuroblastoma: what is the best imaging modality for evaluating extent of disease?

BACKGROUND: Thoracic neuroblastoma accounts for 15% of all cases of neuroblastoma. A minority of children with thoracic neuroblastoma will have dumbbell tumors, i.e., intraspinal extension, but only half these patients will have neurologic signs or symptoms. HYPOTHESIS: MR imaging is the single best test to evaluate the extent of thoracic and spinal disease in thoracic neuroblastoma after the diagnosis of a mass is established on plain film. MATERIALS AND METHODS: A retrospective multi-institutional investigation over 7 years of all cases of thoracic neuroblastoma (n = 26) imaged with CT and/or MR were reviewed for detection of the extent of disease. The chest film, nuclear bone scan, and other imaging modalities were also reviewed. The surgical and histologic correlation in each case, as well as the patients' staging and outcome, were tabulated. RESULTS: The chest radiograph was 100% sensitive in suggesting the diagnosis. MR imaging was 100% sensitive in predicting enlarged lymph nodes, intraspinal extension, and chest wall involvement. CT was 88% sensitive for intraspinal extension but only 20% sensitive for lymph node enlargement. CT was 100% sensitive in detecting chest wall involvement. Direct comparison of CT and MR imaging in six cases revealed no difference in detection of enlarged lymph nodes or chest wall involvement. Neither test was able to detect remote disease, as noted by bone scan. CONCLUSION: The chest film is 100% sensitive in suggesting the diagnosis of thoracic neuroblastoma; MR imaging appears to be the single best test for detecting nodal involvement, intraspinal extension, and chest wall involvement.

Adolescent↗
PubMed2004

Prenatal diagnosis and management of abdominal diseases in pediatric surgery.

PURPOSE: The aim of this study was to investigate the prenatal courses and management of abdominal surgical diseases. METHODS: Of the 327 patients registered with our fetal treatment board since March 2002, 83 fetuses referred to the surgical department were enrolled for the current study. The prenatal diagnosis, sequential fetal images, and perinatal courses of these cases were reviewed retrospectively. RESULTS: Of the 83 cases, abdominal diseases were suspected in 34, lung and thoracic diseases in 25, genitourinary diseases in 12, and other anomalies in 12. Meconium peritonitis (MP), intestinal obstruction, and abdominal wall defects accounted for approximately 65% of the abdominal diseases. Five patients with prenatally diagnosed lung diseases underwent fetal surgical intervention, and 17 of the 22 liveborn patients survived. In contrast, none of the patients with prenatally diagnosed abdominal anomalies underwent fetal surgical intervention, yet, 23 of the 24 liveborn patients survived. However, preterm labor and hydrops were seen frequently in the patients with giant cystic MP, suggesting a fetal critical condition. CONCLUSIONS: Although the clinical outcome of abdominal diseases seemed favorable with postnatal treatment, the current results suggested the occurrence of hidden mortality in utero and the potential need for fetal intervention for some abdominal conditions, such as MP.

Abdomen↗
PubMed2003

Lung, pleural and colon actinomycosis in an immunocompromised patient: a rare form of presentation.

Actinomycosis is caused by gram-positive filamentous organisms of the genus Actinomyces, which may spread through trauma. Most commonly, it is a cervicofacial disease due to dental infection or a thoracic disease secondary to aspiration of foreign bodies. Primary abdominal infection usually follows some form of mucosal disruption. Any organ of the human body may be involved so that a wide range of symptoms may be present. We report a rare form of actinomycosis involving the lung, pleura and colon concomitantly in an immunocompromised patient. A fine needle aspiration from a lung lesion detected the characteristic sulfur granules, and a pleural effusion culture confirmed the diagnosis. Clinical manifestations and treatment are discussed. Actinomycetes are rarely opportunistic agents in immunocompromised patients; thus the disease deserves special attention in those patients.

Actinomycosis↗
PubMed1995

A comparison of sarcoidosis and Behçet's disease.

There are several diseases which present with both ocular and thoracic disease (Table I). Behçet's disease (BD) may be confused with sarcoidosis because they are both multisystem inflammatory disorders presenting with uveitis, polyarthritis, meningitis, cardiovascular disease, erythema nodosum and other cutaneous lesions, and abnormal chest radiographs. The aetiology of both disorders continues to elude us. Hopefully, a careful study of the one may shed light and knowledge on the other.

Adult↗
PubMed1992

Noncardiac manifestations of rheumatoid arthritis in the thorax.

The noncardiac manifestations of rheumatoid arthritis (RA) in the thorax are complex and varied. The bony thorax, pleura, lung parenchyma, tracheobronchial tree, larynx, an upper airway can all be sites of disease. Drug therapy for RA can result in thoracic disease that is difficult to distinguish from the manifestations of RA itself. This article reviews the available literature pertinent to noncardiac thoracic manifestations of RA and focuses on clinical and radiographic presentations in order to provide an organized approach to patient care.

Arthritis, Rheumatoid↗
PubMed1995

Thoracoscopy versus thoracotomy: indications and advantages.

Although the diagnosis and treatment of intrathoracic diseases have been affected by the use of thoracoscopy, the indications and advantages of this procedure are poorly defined. To review the indications and results in a community practice, 52 consecutive cases of thoracoscopy were reviewed and the postoperative courses were compared to a control group of 43 simultaneous thoracotomies. Operative indications for thoracoscopy included investigation or treatment of a lung mass (n = 33), spontaneous pneumothorax (n = 10), mediastinal mass (n = 4), pleural effusion (n = 2), mesothelioma (n = 2), and a ruptured hemidiaphragm (n = 1). General endotracheal anesthesia was used in each case. Overall, thoracoscopy was successful in 40 cases (77%). Conversion to formal thoracotomy was required in 14 cases (27%) secondary to poor visualization or to aid in further dissection. Compared to thoracotomy, complication rates were less (7.6 vs 16.2%), hospital stay shorter (5.5 vs 8 days), ICU stay shorter (0 vs 2 days) and pleural drainage time less (2 vs 5 days) in the thoracoscopy group. In summary, 73% of the patients in this study who formerly would have undergone thoracotomy were successfully managed with thoracoscopy alone, with acceptable morbidity and mortality. These data define the indications, morbidity, and mortality of thoracoscopy and suggest that thoracoscopy may emerge as the procedure of choice in the diagnosis and management of many thoracic diseases.

Chest Tubes↗
PubMed1997

[Video-assisted thoracoscopic surgery--indications, technique and results].

Video-assisted thoracoscopic surgery became an important tool in the surgical treatment of various thoracic disease. Currently many interventions which routinely required thoracotomy can be performed by VATS safely and with excellent results. This includes pleurectomy, decortication, wedge-resection, bullectomy and volume reduction surgery for emphysema, biopsy and/or resection of mediastinal tumors, thymectomy for myasthenia gravis, sympathectomy and even lobectomy. The benefit of thoracoscopic surgery is reduced postoperative pain, including diminished impairment of pulmonary function, shorter hospital stay and the more rapid recovery.

Anesthesia, General↗