PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Thoracic Surgical Procedures”

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 19 recordsLinked to original sources
PubMed1995

Lung transplantation after previous thoracic surgical procedures.

BACKGROUND: This study examined results of lung transplantation after previous thoracic surgical procedures. METHODS: Twenty percent of the 69 isolated lung transplantations performed at the University of North Carolina between January 1990 and June 1993 were in patients who had undergone a previous thoracic surgical procedure, and an additional 10% had undergone a previous chest tube placement. RESULTS: No statistically significant increase in morbidity or mortality was observed between those having undergone a previous procedure or chest tube placement and all other patients. Specifically, the length of intubation, length of hospital stay, hospital mortality, or the number of patients who experienced major early complications was not significantly different between these groups. A statistically significant increase in the number of blood products used was observed in the patients with previous thoracic surgical procedures but not with patient having had previous chest tube placements. However, when the data were reanalyzed with respect to the use of cardiopulmonary bypass, those patients requiring bypass had a markedly poorer outcome that reached statistical significance in all of the parameters studied: hospital death, incidence of major complications, length of intubation, hospital stay, incidence of bleeding, and number of blood products used. CONCLUSIONS: We conclude that although increased bleeding may be encountered, lung transplantation can be performed successfully in patients who have had previous thoracic surgical procedures without increased major morbidity or mortality; however, the use of cardiopulmonary bypass has been associated with significantly increased morbidity and mortality in our patient population.

Blood Transfusion↗
PubMed2004

Thoracic surgical procedures in patients with rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) is associated with a variety of pleuropulmonary manifestations, some of which require surgical intervention. We investigated the spectrum of indications and results, as well as outcome associated with thoracic surgical procedures in rheumatoid patients. METHODS: Identification and retrospective review of medical records of 100 patients with RA at a tertiary-referral medical center undergoing thoracic surgical procedures over a 24-year period from January 1, 1976, to December 31, 1999. RESULTS: Sixty-four patients underwent surgical lung biopsy for localized lung lesions, 57 of which were nodules or masses; 24 lesions proved to be malignant. Surgical lung biopsy was undertaken in 40 patients for diffuse interstitial lung disease, 4 cases of which were found to be infectious. Five other patients underwent surgery for pleural disease, 3 of which proved to be benign pleuritis. CONCLUSION: Patients with rheumatoid disease undergo thoracic surgical procedures for a variety of indications, including benign and malignant localized lesions and pleural disease as well as diffuse parenchymal lung disease. The overall in-hospital mortality rate was low. However, the subgroup with diffuse interstitial lung disease was found to have a 20% in-hospital death rate following surgical lung biopsy.

Aged↗
PubMed1996

Video-assisted thoracic surgical procedures: the Mayo experience.

OBJECTIVE: To describe an initial 3-year experience with video-assisted thoracic surgical procedures (VATS) at Mayo Clinic Rochester. DESIGN: We review the cumulative data on 771 VATS performed between June 1, 1991, and May 31, 1994, and assess the applications for this technique. MATERIAL AND METHODS: The indications for VATS, our techniques used, and the associated mortality and morbidity are summarized. In addition, the frequency of conversion of VATS to open procedures and the reasons for choosing this strategy are discussed. RESULTS: The 771 study patients (401 male and 370 female patients) had a median age of 62 years (range, 7 to 96). For all VATS. we used one-lung general anesthesia, without carbon dioxide insufflation. Indications for performing VATS were a pulmonary nodule in 333 patients, pleural effusion in 208, pulmonary infiltrate in 117, pneumothorax in 51, mediastinal mass in 22, pleural mass in 17, air leak in 13, and other in 10. The procedure was a wedge excision in 352 patients, examination of the pleural cavity in 128, pleural biopsy in 86, talc pleurodesis in 85, wedge excision and mechanical pleurodesis in 46, decortication in 27, excision of a mediastinal mass in 12, sympathectomy in 4, and other in 16. The rate of conversion of VATS to thoracotomy was 33.1% and did not change throughout the period of the study. The most common reasons for conversion were to complete a resection of a malignant lesion or to remove a deep nodule. The overall operative mortality was 1.9%. Complications occurred in 43 patients (8.3%) who underwent VATS without conversion to an open procedure and included prolonged air leak in 14, respiratory failure in 8, pneumothorax in 6, and atrial fibrillation in 5. The median hospitalization was 5 days (range, 1 to 104). CONCLUSION: VATS is safe and useful for selected thoracic conditions. We favor conversion to thoracotomy when curative resection of a malignant lesion is intended.

Adolescent↗
PubMed1992

The utility of a double-lumen tube for one-lung ventilation in a variety of noncardiac thoracic surgical procedures.

To determine the utility of one-lung ventilation (OLV) in a variety of noncardiac thoracic surgical procedures, 200 patients were studied to document the ease of double-lumen tube (DLT) placement, associated complications, intraoperative respiratory changes, and methods for managing hypoxic events. Most tubes could be placed, repositioned when necessary, and secured within 12 minutes. By defining tube position with fiberoptic bronchoscopy, auscultatory assessment of placement was found to be incorrect in 38.0% of patients. The tip occluded the respective upper lobe orifice in 40.5% of this subgroup, the endobronchial cuff was at or above the carina in 38.7%, and in the wrong mainstem bronchus in 20.8%. During OLV, PaO2 initially fell to approximately 200 mmHg in most patients but gradually rose during the balance of the operation. Hypoxia (PaO2 less than 80 mmHg) during OLV developed in 28.5% of patients. Preoperative spirometry and arterial blood gases had no predictive value for this complication. Pulse oximetry values between 95% and 100% reliably reflected systemic arterial oxygen saturation. Hypoxia occurring during OLV was successfully reversed in 40.0% of instances by positive end-expiratory pressure (PEEP) to the ventilated lung. The addition of continuous positive airway pressure (CPAP) to the nonventilated lung reversed persistent hypoxia in virtually all cases. There was no difference in oxygenation, carbon dioxide elimination, airway pressures, or intraoperative complications noted between right and left double-lumen tubes. In conclusion, a DLT for OLV can expeditiously and safely be placed. Because auscultation for tube position is unreliable, bronchoscopic assessment of final position should be performed in every instance. Hypoxia during OLV can be detected reliably by pulse oximetry.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Chylothorax: an omnipresent reality in thoracic surgical procedures.

Loss of integrity of the thoracic duct will produce a chylous thoracic effusion. latrogenic chylothorax occurring during an intrathoracic surgical procedure in the vicinity of the thoracic duct is an omnipresent reality. The fluid is characteristically milky in appearance, sterile, and high in fat content.There seems to be a general agreement that initial management be conservative, namely, dietary control and adequate drainage. The success of conservative management will depend on collateral lymphatic channels developing. If conservative measures fail, thoracotomy for ligation of the duct is indicated. When to terminate nonoperative therapy and opt for operative is controversial.

Carcinoma, Squamous Cell↗
PubMed1999

Probable alcohol abuse or dependence: a risk factor for intensive-care readmission in patients undergoing elective vascular and thoracic surgical procedures. Mayo Perioperative Outcomes Group.

OBJECTIVE: To determine whether alcohol abuse or dependence is a risk factor for perioperative complications, increased duration of hospital stay, and increased utilization of nursing resources in patients undergoing thoracic and vascular surgical procedures. MATERIAL AND METHODS: We conducted a prospective study of all adult patients who underwent an elective vascular or thoracic surgical procedure and who received postoperative care in an intensive-care setting. Patients were screened for alcohol abuse or dependence, and actual versus expected durations of stay were evaluated. The patients' medical records were reviewed for preoperative comorbidities and perioperative complications. Fisher's exact test and the rank sum test were used in the analyses. RESULTS: Of 321 study subjects, 290 were classified as nonalcoholic and 31 as probable alcoholic patients. Patients in the probable alcohol abuse group had a significantly increased rate of alcohol withdrawal (12.9% versus 1.7%; P = 0.006) in comparison with patients in the nonalcoholic group. Patients in the probable alcohol abuse group were readmitted to an intensive-care unit more frequently (19.4% versus 7.9%; P = 0.047) and required sedation more often (32.3% versus 13.5%; P = 0.014) than those in the nonalcoholic group. No significant differences were found between the two study groups in intensive-care unit and hospital durations of stay or in utilization of nursing resources. A dismissal diagnosis of alcoholism was recorded for only one of four patients who had a documented withdrawal episode among those categorized in the probable alcoholic group and for three of five patients with alcohol withdrawal symptoms categorized in the nonalcoholic group. CONCLUSION: Except for the occurrence of alcohol withdrawal syndrome, study patients classified in the probable alcohol abuse group did not have more medical or surgical perioperative complications than patients in the nonalcoholic group. They did have significantly more intensive-care setting readmissions. Patients with documented alcohol withdrawal episodes frequently were dismissed without a diagnosis of substance abuse or dependence.

APACHE↗
PubMed2005

Pro-inflammatory cytokines after different kinds of cardio-thoracic surgical procedures: is what we see what we know?

OBJECTIVE: Due to the combination of local trauma, extracorporeal circulation (ECC), and pulmonary and myocardial reperfusion, cardiac surgery leads to substantial changes in the immune system and possibly to post-operative complications. Procedures without ECC, however, have failed to demonstrate clear advantages. We hypothesized that ECC is far less important in this context than the reperfusion/reventilation of the lung parenchyma and the surgical trauma. We therefore conducted a prospective observational study to compare immune reactions after cardiac operations with those after thoracic surgery. METHODS: Serum levels of pro-inflammatory interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha as well as C-reactive protein (CRP), lipoprotein-binding protein (LBP) and procalcitonin (PCT) were measured pre-operatively (d0), at the end of the operation (dx), 6h after the operation (dx+), on the 1st (d1), 3rd (d3), and 5th (d5) post-operative days in 108 patients (pts) undergoing elective coronary artery bypass grafting (CAB) with ECC (n=42, CPB CAB), off-pump coronary artery bypass surgery (n=24, OP CAB) without ECC or thoracic surgery (n=42, TS). RESULTS: After cardiac surgery (CS), IL-6 and IL-8 increased and reached a maximum on dx+. IL-6 returned to baseline values at d3, whereas IL-8 remained elevated until d5. No difference was found between OP CAB and CPB CAB patients. In the TS patients, IL-6 increased later (dx+) and absolute levels were lower than in the CS patients. No increase in IL-8 was noted in the TS patients. Due to the high variation in the results obtained in all three groups, there was no significant change in TNF-alpha. A comparison of TS, OP CAB, and CPB CAB revealed that the CS patients had higher levels on d0, dx, d3, and d5. Serum levels of CRP, LBP, and IL-2R increased from dx+ to d5 in all groups and reached maximum values on d3. Whereas we found no difference in CRP and IL-2R between the groups, LBP levels were significantly higher from dx+ to d3 after OP CAB. PCT was elevated from dx+ to d3 in all pts. Similar levels were noted for the TS and OP CAB patients. The CPB CAB patients showed the highest levels. CONCLUSIONS: Surgical trauma and reperfusion injury appear to represent the predominant factors resulting in immunologic changes after cardiac surgery. Cardiopulmonary bypass (CPB) may be less important for immune response and acute-phase reactions than previously suspected. In addition, our data indicate a relationship between IL-6 synthesis and the degree of surgical trauma. IL-8 appears to be elevated only after cardiac surgery whereas PCT liberation depended on the use of ECC.

Aged↗
PubMed1996

Noncardiac thoracic surgical procedures. Definitions, indications, and postoperative radiology.

The radiologist should be familiar with the various operative procedures of the chest to accurately interpret routine postoperative radiologic studies. This also will assist them in the detection of common iatrogenic problems and postoperative complications such as bleeding, air leak, and infection. Furthermore, knowledge of serious and specific complications such as cardiac herniation and post-pneumonectomy syndrome can help the radiologist play an active role in the postoperative care of such patients.

Esophagus↗
PubMed1997

[The effects of dopexamine. Transpulmonary shunt volume in thoracic surgical procedures with one-lung respiration].

OBJECTIVE: To study the influence of dopexamine on pulmonary shunt and hypoxic pulmonary vasoconstriction during major thoracic surgery with one-lung ventilation (OLV). DESIGN: Prospective, randomised, placebo-controlled study. SETTING: University hospital. PATIENTS: Twenty adult patients undergoing elective pulmonary resection. ANAESTHESIA: General anaesthesia was performed using propofol, fentanyl, N2O and vecuronium. Volume-controlled ventilation was performed to maintain normocapnia over the whole investigation period. During OLV, the tidal volume was reduced and the respiratory rate was increased to avoid a peak airway pressure exceeding 40 cm H2O. Furthermore the FiO2 was increased to 1.0 and the external PEEP was removed during OLV. INTERVENTIONS: The patients received either dopexamine at 2 micrograms/kg/min (group A, n = 10) or 0.9% saline as control (group B, n = 10) after assessing the baseline values. MEASUREMENT AND RESULTS: The following cardiorespiratory variables were recorded: Heart rate, mean arterial pressure and mean pulmonary arterial pressure. Cardiac output was measured by thermodilution using a continuous cardiac output thermodilution catheter. Arterial and mixed venous blood gas analysis were measured from simultaneously drawn samples. Cardiac index (CI), systemic vascular resistance index, pulmonary vascular resistance index, oxygen delivery index (DO2I), oxygen consumption index and the venous admixture were calculated using standard formula. Furthermore, pressure-flow-curves were constructed to analyse flow independent changes in the pulmonary vascular resistance. Data were recorded at the following times: After induction of anaesthesia in stable haemodynamics during two-lung ventilation (baseline values, T0), intraoperatively during one-lung ventilation (T1) and postoperatively after re-establishing two-lung ventilation (T2). Patients characteristics, data from the preoperative lung function testing and surgical procedures did not differ significantly between the groups. CI increased in the dopexamine group from 2.5 +/- 1.2 1.min-1.m-2 (T0) to 3.6 +/- 0.9 l.min-1.m-2 (T1) and 4.0 +/- 1.3 l.min-1.m-2 (T2). The course of the intrapulmonary right-to-left shunting did not differ between the groups. In the dopexamine-treated group the DO2I increased from 430 +/- 143 ml.min.m-2 (T0) to 652 +/- 255 ml.min.m-2 (T1) and 653 +/- 207 ml.min.m-2 (T2). Regarding the pressure-flow-curves there was no difference during OLV between the two groups indicating no major blocking effect of dopexamine on hypoxic pulmonary vasoconstriction. CONCLUSION: It is concluded that dopexamine can be used to improve haemodynamics and oxygen delivery during thoracic surgery without increasing venous admixture during one-lung ventilation.

Aged↗