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  1. Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery

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    Boodhwani, Munir; Hanet, Claude; de Kerchove, Laurent; Navarra, Emiliano; Astarci, Parla; Noirhomme, Philippe; El Khoury, Gebrine

    2016-01-01

    Background— Bilateral internal thoracic arteries (BITA) have demonstrated superior patency and improved survival in patients undergoing coronary artery bypass grafting. However, the optimal configuration for BITA utilization and its effect on long-term outcome remains uncertain. Methods and Results— We randomly assigned 304 patients undergoing coronary artery bypass grafting using BITA to either in situ or Y grafting configurations. The primary end point was 3-year angiographic patency. Secondary end points included major adverse cardiac and cerebrovascular events (ie, death from any cause, stroke, myocardial infarction, or repeat revascularization) at 7 years. More coronary targets were able to be revascularized using internal thoracic arteries in patients randomized to Y grafting versus in situ group (3.2±0.8 versus 2.4±0.5 arteries/patient; P<0.01). The primary end point did not show significant differences in graft patency between groups. Secondary end points occurred more frequently in the in situ group (P=0.03), with 7-year rates of 34±10% in the in situ and 25±12% in the Y grafting groups, driven largely by a higher incidence of repeat revascularization in the in situ group (14±4.5% versus 7.4±3.2% at 7 years; P=0.009). There were no significant differences in hospital mortality or morbidity or in late survival, myocardial infarction, or stroke between groups. Conclusions— Three-year systematic angiographic follow-up revealed no significant difference in graft patency between the 2 BITA configurations. However, compared with in situ configuration, the use of BITA in a Y grafting configuration results in lower rates of major adverse cardiovascular and cerebrovascular events at 7 years. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01666366. PMID:27406988

  2. Is bilateral internal thoracic artery grafting a safe option for chronic dialysis patients?

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    Gatti, Giuseppe; Perrotti, Andrea; Fiore, Antonio; Bergoend, Eric; Chocron, Sidney; Couetil, Jean-Paul; Sinagra, Gianfranco; Pappalardo, Aniello

    2017-06-16

    The use of bilateral internal thoracic artery (BITA) grafting has been proposed for dialysis patients with multivessel coronary artery disease, primarily because of hypothetical long-term survival benefits. To investigate the outcome of BITA grafting in dialysis patients. This was a retrospective analysis of the use of BITA grafting in 105 consecutive patients with end-stage renal failure on chronic dialysis in three European centres with extensive experience in BITA. Baseline patient characteristics, operative data, early postoperative complications and late survival were reviewed. Outcomes of patients from one of the three centres who underwent either BITA (n=40) or single internal thoracic artery (SITA) grafting (n=19) were also analysed; a one-to-one propensity score (PS)-matched analysis was performed. There were 19 (18.1%) hospital deaths. Despite differences in preoperative patient characteristics and surgical features, in each centre, hospital mortality was greater than the 75th percentile of expected operative risk (EuroSCORE II). Diseased ascending aorta and extracardiac arteriopathy were found to be predictors of hospital death (odds ratio 9.7; P=0.006) and complicated hospital course (odds ratio 2.54; P=0.035), respectively. The 7-year non-parametric estimates of freedom from all-cause death and cardiac or cerebrovascular death were 59% (95% confidence interval: 52.3-65.7%) and 75.6% (95% confidence interval: 71.2-80%), respectively. There were no significant differences in early and late outcomes between BITA and SITA PS-matched groups. BITA grafting remains a risky operation for chronic dialysis patients, even when performed routinely. No long-term survival benefits for the use of BITA versus SITA were proven. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  3. A systematic review and meta-analysis of in situ versus composite bilateral internal thoracic artery grafting.

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    Yanagawa, Bobby; Verma, Subodh; Jüni, Peter; Tam, Derrick Y; Mazine, Amine; Puskas, John D; Friedrich, Jan O

    2017-05-01

    This meta-analysis examines whether there is any advantage of coronary artery bypass graft with bilateral internal thoracic artery (BITA) as an in situ versus composite graft. We searched MEDLINE and EMBASE Databases from 1996 to 2016 for studies that compared coronary artery bypass graft with BITA as in situ versus composite graft. Data were extracted by 2 independent investigators and meta-analyzed with the use of random effects. Two randomized controlled trials (RCTs; n = 705), 2 matched (n = 1688), and 4 unadjusted observational studies (n = 3517) met inclusion criteria. Composite grafting trended towards greater distal anastomoses (+0.22, 95% confidence interval, -0.01 to +0.45 anastomoses/patient; P = .06 [4 unadjusted observational studies]) and greater distal anastomoses using an internal thoracic artery (+0.80, 95% confidence interval, 0.41-1.18 anastomoses/patient; P analysis suggested possible improvements in all-cause mortality and revascularization for in situ BITA in studies with short-term (analysis found that use of BITA as a composite graft configuration facilitated greater internal thoracic artery revascularization but both grafting strategies offer similar clinical outcomes. Our study supports the use of in situ and composite BITA for select patients but high-quality, long-term prospective trials are needed. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  4. What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study

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    S. Neragi-Miandoab

    2014-01-01

    Full Text Available Objective. Bilateral internal thoracic artery (BITA grafting provides improved graft patency and potential survival advantage in selected patients as compared to single left internal thoracic artery (LITA revascularization. The ideal functional BITA configuration remains controversial. Methods. Patients undergoing planned BITA revascularization with greater than 75% stenosis in both the left anterior descending artery (LAD and in a circumflex branch were prospectively randomized to one of two proximal free right internal thoracic artery (RITA connections directly off the aorta (Ao (n=12 or as a “t” graft off the LITA (t (n=12. The LITA was placed to the LAD in all cases, and the RITA was placed to a single lateral wall vessel. Intraoperative transit time flow measurements of all arterial grafts were performed, and RITA fractional flow parameters were compared between the 2 groups. Results. There were no differences in preoperative patient variables between the two groups. Cross-clamp times (91.5+15.3 versus 68.0+12.5 minutes, P<0.01 and total cardiopulmonary bypass times (109.0+16.2 versus 85.0+15.1 minutes, P<0.01 were shorter in the t group. The Ao group demonstrated significantly higher mean RITA flow (38.3±13.5 versus 22.1±9.5, P<0.01, mean RITA conductance (flow/mean arterial pressure (0.45±0.16 versus 0.28±0.11, P<0.01, RITA fractional flow (0.52 ± 0.15 versus 0.36 ± 0.11, P<0.01, and RITA fractional conductance (0.51 ± 0.15 versus 0.36 ± 0.11, P<0.01 than the “t” grafted patients. Thirty-day mortality and wound infection were 0% for each group. Over an average of 42.8+6.6 months of followup there were no mortalities in either group. Repeat angiography were performed in 4 patients (33% in the Ao group and 2 patients in the t group (16%. One occluded RITA graft and one ostial RITA stenosis were detected in the Ao group. Conclusions. Acute flow measurements indicate that the free RITA anastomosed to the aorta

  5. Bilateral locked facets in the thoracic spine

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    M.H.A. Willems; Braakman, R. (Reinder); B. van Linge (Bert)

    1984-01-01

    textabstractTwo cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine.

  6. A meta-analysis of adjusted hazard ratios from 20 observational studies of bilateral versus single internal thoracic artery coronary artery bypass grafting.

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    Takagi, Hisato; Goto, Shin-nosuke; Watanabe, Taku; Mizuno, Yusuke; Kawai, Norikazu; Umemoto, Takuya

    2014-10-01

    In 2001, a landmark meta-analysis of bilateral internal thoracic artery (BITA) versus single internal thoracic artery (SITA) coronary artery bypass grafting for long-term survival included 7 observational studies (only 3 of which reported adjusted hazard ratios [HRs]) enrolling approximately 16,000 patients. Updating the previous meta-analysis to determine whether BITA grafting reduces long-term mortality relative to SITA grafting, we exclusively abstracte, then combined in a meta-analysis, adjusted (not unadjusted) HRs from observational studies. MEDLINE and EMBASE were searched until September 2013. Eligible studies were observational studies of BITA versus SITA grafting and reporting an adjusted HR for long-term (≥4 years) mortality as an outcome. Meta-regression analyses were performed to determine whether the effects of BITA grafting were modulated by the prespecified factors. Twenty observational studies enrolling 70,897 patients were identified and included. A pooled analysis suggested a significant reduction in long-term mortality with BITA relative to SITA grafting (HR, 0.80; 95% confidence interval, 0.77 to 0.84). When data from 6 pedicled and 6 skeletonized internal thoracic artery studies were separately pooled, BITA grafting was associated with a statistically significant 26% and 16% reduction in mortality relative to SITA grafting, respectively (P for subgroup differences=.04). A meta-regression coefficient was significantly negative for the proportion of men (-0.00960; -0.01806 to -0.00114). Based on an updated meta-analysis of exclusive adjusted HRs from 20 observational studies enrolling more than 70,000 patients, BITA grafting seems to significantly reduce long-term mortality. As the proportion of men increases, BITA grafting is more beneficial in reducing mortality. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  7. Are two really always better than one? Results, concerns and controversies in the use of bilateral internal thoracic arteries for coronary artery bypass grafting in the elderly: a systematic review and meta-analysis.

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    Deo, Salil V; Altarabsheh, Salah E; Shah, Ishan K; Cho, Yang Hyun; McGraw, Michael; Sarayyepoglu, Basar; Medalion, Benjamin; Markowitz, Alan H; Park, Soon J

    2015-04-01

    Bilateral internal thoracic artery grafting appears to be the preferred method to achieve durable long-term coronary artery revascularization. However, data reporting the benefit of this technique in the elderly is very conflicting. We performed a systematic review of available literature (till November 2014) using multiple databases to identify studies comparing clinical events in patients undergoing coronary artery bypass grafting using either a single or double internal thoracic artery in the elderly. While early mortality was the primary end-point of inclusion, other adverse events compared were sternal wound infection (deep and superficial), stroke and peri-operative myocardial infarction. Individual and pooled odd's ratios were calculated using the Mantel-Haenzel method (random effect model); sensitivity analysis was performed. Results are presented using 95% confidence intervals. Nine retrospective studies (4479 BITA, 7733 LITA patients) fulfilled search criteria. Deep sternal wound infection was significantly higher after BITA harvest [OR 1.86 (1.3-2.5); I(2) = 0%; p internal thoracic arteries in the elderly. While other post-operative adverse events are comparable, data regarding the long-term survival advantage in this cohort is conflicting. Hence, the use of both internal thoracic arteries in this age group needs to be invidualized. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  8. Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans.

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    Moak, Jeffrey P; Eldadah, Basil; Holmes, Courtney; Pechnik, Sandra; Goldstein, David S

    2005-06-01

    Upper thoracic sympathectomy is used to treat several disorders. Sympathetic nerve fibers emanating from thoracic ganglia innervate the heart. Whether unilateral or bilateral upper thoracic sympathectomy affects cardiac sympathetic innervation in humans in vivo has been unclear. The purpose of this study was to assess whether thoracic sympathectomy decreases cardiac sympathetic innervation, as indicated by positron emission tomographic scanning after intravenous injection of the sympathoneural imaging agent 6-[18F]fluorodopamine. Nine patients with previous upper thoracic sympathectomies (four right-sided, one left-sided, four bilateral) underwent thoracic 6-[18F]fluorodopamine scanning between 1 and 2 hours after injection of the imaging agent. In each case, a low rate of entry of norepinephrine into the arm venous drainage (norepinephrine spillover) verified upper limb sympathectomy. Data were compared with those from the interventricular septum of patients with cardiac sympathetic denervation associated with pure autonomic failure and from normal volunteers. All four patients with bilateral sympathectomy had low septal myocardial 6-[18F]fluorodopamine-derived radioactivity (2,673 +/- 92 nCi-kg/cc-mCi at an average of 89 minutes after injection) compared with normal volunteers (3,634 +/- 311 nCi-kg/cc-mCi at 83 minutes, N = 22, P = .007) and higher radioactivity than in patients with pure autonomic failure (1,320 +/- 300 nCi-kg/cc-mCi at 83 minutes, N = 7, P = .003). Patients with unilateral sympathectomy had normal 6-[18F]fluorodopamine-derived radioactivity (3,971 +/- 337 nCi-kg/cc-mCi at 87 minutes). Bilateral upper thoracic sympathectomy partly decreases cardiac sympathetic innervation density.

  9. [International Relationship of Japanese General Thoracic Surgeons].

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    Okumura, Meinoshin

    2017-01-01

    Japanese thoracic surgeons have created personal relationship with European and North American surgeons. During the last 10 years, official relation between Japanese Association for Chest Surgery(JACS) and European Society of Thoracic Surgeons (ESTS) has been established besides personal interaction, and communication among the thoracic surgeons in Asia was prompted through Asia Thoracoscopic Surgery Education Program( ATEP). International relationship through academic associations is expected to contribute to encouraging general thoracic surgeons.

  10. Myocardial revascularization with both internal thoracic arteries 25 years after delayed repair for aortic coarctation.

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    Gaudino, Mario; Farina, Piero; Cammertoni, Federico; Massetti, Massimo

    2015-02-01

    Aortic coarctation has been reported to cause alterations in the internal thoracic arteries that make these vessels unsuitable to be used as grafts for myocardial revascularization, especially if coarctation repair was performed in adulthood. This is the first reported bilateral internal thoracic grafting for myocardial revascularization in a patient who had undergone aortic coarctation repair 25 years earlier.

  11. Bilateral lymphocytic alveolitis: a common reaction after unilateral thoracic irradiation

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    Martin, C.; Romero, S.; Arriero, J.M.; Hernandez, L. [Hospital General Universitario, Servicios de Neumologia, Alicante (Spain); Sanchez-Paya, J. [Hospital General Universitario, Epidemiologia, Alicante (Spain); Massuti, B. [Hospital General Universitario, Oncologia, Alicante (Spain)

    1999-04-01

    The main aim of the present study was to assess the early diagnostic value of bronchoalveolar lavage (BAL) in radiation-induced lung injury in patients with breast carcinoma. Twenty-six females receiving postoperative radiotherapy for breast cancer were evaluated before and 0, 15, 30, 60 , and 180 days after radiotherapy. History, physical examination, chest radiographs, and pulmonary function tests were obtained. BAL, including lymphocyte subsets analysis, was limited to the second evaluation after radiotherapy. A group of 21 healthy females were used as control. Findings after radiotherapy in asymptomatic patients were compared with findings in a group of patients with radiation pneumonitis. Irradiated patients showed a significantly (p<0.01) greater percentage (29.5{+-}15.7%) of BAL lymphocytes than controls (6.2{+-}3.3%). No statistical differences existed in BAL findings between the irradiated and unirradiated sides of the chest. Percentages of BAL lymphocytes did not differ significantly between patients who developed subsequent pneumonitis (24.5{+-}13.5%) and those who did not develop pneumonitis (32.8{+-}16.5%). Patients with pneumonitis at the time of BAL had significantly higher (p<0.05) alveolar CD4 subset cells (24.8{+-}10.2%) than asymptomatic patients (15.2{+-}8.9%). Maximal reductions in total lung capacity (p<0.01), and residual volume (p<0.05) occurred 60 days after irradiation. The early lymphocytic alveolitis induced by unilateral thoracic radiotherapy in most patients with breast cancer is always bilateral and does not predict the subsequent development of radiological evidence of pneumonitis. (au) 38 refs.

  12. A case of severe congenital kyphoscoliosis secondary to multiple bilateral thoracic pedicle aplasia

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    Geoffray, Anne; Leloutre, Beatrice; Albertario, Marco; Bechard-Sevette, Nancy [Fondation Lenval Children' s Hospital, Department of Pediatric Imaging, Nice (France); Clement, Jean-Luc [Fondation Lenval Children' s Hospital, Department of Orthopedic and Spine Surgery, Nice (France)

    2008-07-15

    A 9-month-old boy with congenital kyphoscoliosis secondary to multiple bilateral thoracic pedicle aplasias is presented. This anomaly has rarely been described in the literature. Plain films showed absence of thoracic pedicles bilaterally from T2 to T9, which was better demonstrated on CT multiplanar and 3-D reformatted images. There were no neurological symptoms even though the deformity progressed rapidly. Congenital kyphosis or kyphoscoliosis is often related to spinal anomalies that are located on the anterior aspect of the vertebrae. However, posterior anomalies may also be responsible and should be recognized before neurological complications occur. (orig.)

  13. [The internal thoracic blood vessels (internal thoracic arteries and veins) and their practical significance].

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    Jelicić, N; Djordjević, Lj; Stosić, T

    1996-01-01

    Internal thoracic blood vessels (A. et Vv. thoracicae internae) are parietal vessels of the thoracic anterior wall. Because of their position, they are often exposed to injuries during the fracture of the ribs and the sternal bone. These facts require a general knowledge about the anatomical variations of these vessels, specifically the knowledge concerning their mutual relationship, their anastomoses and their distance from the lateral margins of the sternal bone. Due to the poor and different data in the available literature, we directed our investigations towards the study and confirmation of the described anatomical variations of the internal thoracic blood vessels. In this study we investigated the distance between the internal thoracic artery and the lateral margins of the sternal bone, the level of its bifurcation, the number of the internal thoracic veins and anastomoses between them. The investigation was carried out on 300 formalin specimens consisting of the anterior wall of the thorax (persons of different ages and sexes) by using the method of dissection and the method of contrast injection. In adults (200 specimens), the distance between the arterial trunk and the lateral margin of the sternal bone was not equal in the first fifth or sixth intercostal spaces, but in children up to five years of age (100 specimens), the distance was almost the same. In adults, the internal thoracic artery was nearest to the sternal bone in the first intercostal space, but going downward the artery was gradually more and more distant from the sternum and in the sixth intercostal space the distance measured approximately from 11 mm to 13 mm. In children, the distance of the artery from the lateral margin of the sternal bone, just in the above mentioned intercostal spaces, was from 5 mm to 10 mm. There was no difference according to sex in any of the two groups. Most frequently, the internal thoracic artery gave off its terminal branches at the level of the sixth costal

  14. Bilateral duplication of the internal auditory canal

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    Weon, Young Cheol; Kim, Jae Hyoung; Choi, Sung Kyu [Seoul National University College of Medicine, Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si (Korea); Koo, Ja-Won [Seoul National University College of Medicine, Department of Otolaryngology, Seoul National University Bundang Hospital, Seongnam-si (Korea)

    2007-10-15

    Duplication of the internal auditory canal is an extremely rare temporal bone anomaly that is believed to result from aplasia or hypoplasia of the vestibulocochlear nerve. We report bilateral duplication of the internal auditory canal in a 28-month-old boy with developmental delay and sensorineural hearing loss. (orig.)

  15. Cirurgia de revascularização miocárdica: uso de enxerto bilateral de artéria torácica interna sem circulação extracorpórea Surgical myocardial revascularization: off-pump use of bilateral internal thoracic artery grafting

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    Walter José Gomes

    2008-01-01

    Full Text Available FUNDAMENTO: Avanços na cirurgia de revascularização miocárdica (RM introduziram benefícios adicionais, como a técnica sem uso da circulação extracorpórea (CEC e a utilização do enxerto bilateral de artéria torácica interna (ATI. A cirurgia de RM sem uso da CEC tem sido associada a melhora dos resultados imediatos e a redução da incidência de complicações perioperatórias, e o uso bilateral de enxertos de ATI oferece aumento de sobrevida e redução de eventos cardiovasculares a longo prazo. OBJETIVO: Apresentar a experiência inicial com o emprego combinado desses avanços na cirurgia de RM. MÉTODOS: Foram estudados 35 pacientes consecutivos submetidos a RM sem CEC, com enxertos bilaterais de ATIs, sendo a ATI esquerda dirigida para a artéria descendente anterior e a ATI direita anastomosada aos ramos da artéria circunflexa. As co-morbidades predominantes foram infarto do miocárdio prévio em 71,4% dos pacientes, diabetes melito em 34,2% e insuficiência renal em 14,2%. RESULTADOS: Nenhum paciente apresentou alteração do eletrocardiograma ou elevação enzimática no pós-operatório. O número de pontes por paciente variou de 2 a 4 (mediana de 3 pontes/paciente. A permanência hospitalar pós-operatória esteve entre 3 e 12 dias (média de 4,7 + 1,7 dias. Não houve casos de infecção ou deiscência esternal, mas um paciente apresentou acidente vascular cerebral no quarto dia de pós-operatório e faleceu. A duração do seguimento tardio foi de 4 a 48 meses. Não houve óbitos tardios, 31 pacientes estão assintomáticos e 3 têm angina residual. CONCLUSÃO: A combinação desses avanços técnicos na cirurgia de revascularização cirúrgica mostrou-se eficaz e pode contribuir para a melhora dos benefícios a longo prazo.BACKGROUND: Advances in surgical myocardial revascularization (MR have introduced additional benefits with the off-pump (OP technique and the use of bilateral internal thoracic artery (ITA grafting

  16. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules

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    Yao, Feng; Yang, Haitang

    2016-01-01

    Background Surgical treatment is thought to be the most effective strategy for multiple small nodules. However, in general, one-stage bilateral resection is not recommended due to its highly invasive nature. Methods Clinical records of patients undergoing one-stage bilateral resections of multiple pulmonary nodules between January 2009 and September 2014 in a single institution were retrospectively reviewed. Results Simultaneous bilateral pulmonary resection by conventional video-assisted thoracic surgery (VATS) was undertaken in 29 patients. Ground glass opacity (GGO) accounted for 71.9% (46/64) of total lesions, including 26 pure GGO and 20 mixed GGO lesions. One case underwent bilateral lobectomy that was complicated by postoperative dyspnea. Lobar-sublobar (L/SL) resection and bilateral sublobar resection (SL-SL) were conducted in 16 and 12 cases, respectively, and most of these cases had uneventful postoperative courses. There was no significant difference with regard to postoperative complications (P=0.703), duration of use of chest drains (P=0.485), between one- and two-stage groups. Mean postoperative follow-up in cases of primary lung cancer was 31.4 (range, 10–51) months. There was neither recurrence nor deaths at final follow-up. Conclusions Single-stage bilateral surgery in selected cases with synchronous bilateral multiple nodules (SBMNs) is feasible and associated with satisfactory outcomes. PMID:27076942

  17. The Senescence Process of Internal Thoracic Artery

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    Francesco Rivasi

    2013-04-01

    Full Text Available OBJECTIVE. The Internal Thoracic Artery (ITA is the most widely used arterial conduit for coronary artery by-pass, because it is very rarely affected by atherosclerosis. However, the state of its wall at the time of grafting procedure could influence the long-term outcome of coronary artery by-pass. METHODS. We have investigated 20 specimens of distal human ITA, derived from 14 male patients and 6 female patients, aged between 68 and 77 years, operated for atherosclerotic coronary artery disease. The specimens, collected after surgical skeletonization during coronary artery by-pass procedures, were fixed in 10% neutral buffered formalin and then paraffin embedded. Besides to haematoxylin-eosin, histochemistry for elastic fibers (Weigert‘s staining, Van Gieson‘s staining, Verhoeff‘s staining and immunohistochemistry for muscle cells (smooth muscle actin, caldesmon, desmin and CD34 have been performed, applying the standard avidin-biotin complex (ABC method. RESULTS. A degenerative pathology, most likely due to aging, characterized by the fragmentation of the internal and external elastic membranes and by the consumption of the elastic network of the tunica media has been microscopically observed in a quarter of our patients, without the achievement of classical signs of overt atherosclerosis (cholesterol deposition, lipidic infiltration, endothelial ulceration, intimal calcification, which could compromise the long-term patency of the graft. CONCLUSIONS. The degenerative change is followed by a remodelling process, based on the proliferation of unspecialized muscle like cells, able to preserve the architecture and the stability of the arterial wall and consequently its functional long-term behaviour. [J Interdiscipl Histopathol 2013; 1(2.000: 58-61

  18. Bilateral thoracic outlet syndrome: An uncommon presentation of a rare condition in children

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    Arif Khan

    2012-01-01

    Full Text Available We report an adolescent girl who had left-sided neurogenic thoracic outlet syndrome (TOS due to impingement of the scalenus anterior muscle with bilateral changes on nerve conduction studies and responded well to surgical decompression. A 13-year-old Caucasian girl presented with intermittent pain, swelling, erythema, tingling and numbness of the palmar aspect of her left hand. Nerve conduction studies revealed bilateral ulnar sensory and motor conduction abnormalities, suggesting early compressive neuropathy in the asymptomatic arm as well. She underwent surgical exploration when it was noted that the scalenus anterior itself was impinging on the brachial plexus. She had a good clinical response to scalenectomy. The diagnosis of neurogenic TOS remains difficult as no single test has been accepted as a gold standard. But, once diagnosed using clinical symptoms, nerve conduction studies, electromyography and radiological investigations, it is a treatable condition with good prognosis.

  19. Feasibility study of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    孙立新

    2014-01-01

    Objective To investigate the feasibility of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting(OPCABG).Methods Upon the approval of institutional Ethics Committee and informed consent,forty patients ASAⅡorⅢaged 52-77 yr with BMI(body mass index)<30

  20. Local anaesthetic toxicity after bilateral thoracic paravertebral block in patients undergoing coronary artery bypass surgery.

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    Ho, A M-H; Karmakar, M K; Ng, S K; Wan, S; Ng, C S H; Wong, R H L; Chan, S K C; Joynt, G M

    2016-09-01

    We conducted a small pilot observational study of the effects of bilateral thoracic paravertebral block (BTPB) as an adjunct to perioperative analgesia in coronary artery bypass surgery patients. The initial ropivacaine dose prior to induction of general anaesthesia was 3 mg/kg, which was followed at the end of the surgery by infusion of ropivacaine 0.25% 0.1 ml/kg/hour on each side (e.g. total 35 mg/hour for a 70 kg person). The BTPB did not eliminate the need for supplemental opioids after CABG in the eight patients studied. Moreover, in spite of boluses that were within the manufacturer's recommendation for epidural and major nerve blocks, and an infusion rate that was only slightly higher than what appeared to be safe for epidural infusion, potentially toxic total plasma ropivacaine concentrations were common. We also could not exclude the possibility that the high ropivacaine concentrations were contributing to postoperative mental state changes in the postoperative period. Also, one patient developed local anaesthetic toxicity after the bilateral paravertebral dose. As a result, the study was terminated early after four days. The question of whether paravertebral block confers benefits in cardiac surgery remains unanswered. However, we believe that the bolus dosage and the injection rate we used for BTPB were both too high, and caution other clinicians against the use of these doses. Future studies on the use of BTPB in cardiac surgery patients should include reduced ropivacaine doses injected over longer periods.

  1. Bilateral thoracic paravertebral nerve blocks for placement of percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis: a case series

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    Kalava, Arun; Clendenen, Steven; McKinney, J Mark; Bojaxhi, Elird; Greengrass, Roy A

    2016-01-01

    Background and Aims To assess the efficacy of bilateral thoracic paravertebral nerve blocks (PVB) in providing procedural anesthesia and post-procedural analgesia for placement of percutaneous radiologic gastrostomy tubes (PRG) in patients with amyotrophic lateral sclerosis (ALS). Methods We prospectively observed 10 patients with ALS scheduled for PRG placement that had bilateral thoracic PVBs at thoracic 7, 8, and 9 levels with administration of a mixture of 3 mL of 1% ropivacaine, 0.5 mg/mL dexamethasone, and 5 μg/mL epinephrine at each level. The success of the block was assessed after 10 minutes. PRG placement was done in the interventional radiology suite without sedation. All patients were followed up via phone 24 hours after the procedure. Results All 10 patients had successful placement of PRG with PVBs as the primary anesthetic. Segmental anesthesia over the surgical site in all cases was successful with first attempt of the blocks. Three patients had significant hypotension after the block, requiring boluses of vasopressors and intravenous fluids. All patients reported high levels of satisfaction and sleep quality on the night of the procedure. Conclusions Bilateral thoracic PVBs provided satisfactory procedural anesthesia and post-procedural analgesia, and thus, seem promising as a safe alternative to sedation in ALS patients having PRG placement. PMID:28913488

  2. Bilateral hypoplasia of the internal carotid arteries with basilar aneurysm

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    Briganti, F.; Tortora, F.; Elefante, A. [Universita di Napoli Federico II, Dipartimento di Scienze Neurologiche, Cattedra di Neuroradiologia, 80131, Napoli (Italy); Maiuri, F. [Universita di Napoli Federico II, Department of Neurological Sciences, Neurosurgery Service, Napoli (Italy)

    2004-10-01

    We report a rare case of bilateral hypoplasia of the internal carotid arteries with an associated aneurysm of the basilar tip, studied by CT angiography, MR angiography and digital angiography. The patient became symptomatic with an episode of loss of consciousness, likely due to reduced blood perfusion. The other 20 reported cases of bilateral carotid hypoplasia (only four of which with an associated aneurysm) are reviewed. The findings of noninvasive procedures (including narrowing of the carotid canals on CT) may lead to a correct diagnosis before angiography is performed; they may also help to differentiate angiographic narrowing of the hypoplastic internal carotids from the string sign often observed in some acquired conditions. (orig.)

  3. Constipation following bilateral of internal iliac artery aneurysms

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    S Morita

    2012-09-01

    Full Text Available A 72-year-old man presented with constipation. He was hypertensive and suffered from chronic constipation. On arrival, the patient was fully conscious, and his vital signs were stable. He requested an enema because this treatment had proved effective in the past. On physical examination, a hard palpable mass was detected in the lower abdomen. Computed tomography was performed with contrast media. It revealed an abdominal aortic aneurysm (AAA and bilateral internal iliac artery aneurysms (IIAAs; the latter obstructing the sigmoid colon. We believe that this obstruction was the cause of constipation. The patient underwent Y-graft replacement for the treatment of the AAA and bilateral IIAAs. The surgery was successful, and constipation has not recurred since. As constipation is the most common digestive disorder in the general population, all physicians should be aware that chronic constipation can be caused by bilateral IIAAs.

  4. Micromorphology of Skeletonized and Pedicled Internal Thoracic and Radial Arteries.

    Science.gov (United States)

    Mamchur, Sergey; Bokhan, Nikita; Vecherskii, Yuri; Malyshenko, Egor

    2015-01-01

    The objective of the study was to estimate the internal thoracic arteries (ITA) and radial arteries (RA) micromorphologic features by light microscopy after harvesting them using the skeletonization and pedicled methods in patients undergoing coronary artery bypass grafting. The micromorphologic characteristics of ITA and RA were studied by luminous microscopy in 61 patients undergoing coronary artery bypass grafting. A total of 122 ITA and RA segments harvested during surgery, fixed in formalin, and stained with hematoxiline and eosin were evaluated. The mean intima-media thickness of ITA was 9.2 and 134.7 µm and that of RA was 9.1 and 334.2 µm, respectively. In the distal segment of ITA the media-intima relation was 1.5 times bigger than in the proximal segment. None of ITA specimens contained atherosclerotic plaques or lipid inclusions. Atherosclerotic plaques were found in 3 (5%) RA specimens. Other degenerative changes were detected in 30%-74.2% of the specimens: splitting of internal elastic lamina, reduced tortuosity of the internal elastic lamina, and thickening and detachment of the intima; their incidence was associated with the skeletonization of the vessels. In conclusion, the incidence of ITA and RA degenerative changes varies from 30%-74.2% and its increase is associated with the skeletonization of the vessels, which is statistically significant. The media of the RA is 2.5 times thicker than that of the ITA (P < 0.01). This fact shows that RA has higher spasmogenic potential than that of ITA. The distal segment of the ITA has 1.5 times bigger media-intima relation than the proximal segment. Therefore, in case of enough graft length, it is recommended to avoid the distal segment and cut it off.

  5. Successful Recovery and Transplantation of 11 Organs Including Face, Bilateral Upper Extremities, and Thoracic and Abdominal Organs From a Single Deceased Organ Donor.

    Science.gov (United States)

    Tullius, Stefan G; Pomahac, Bohdan; Kim, Heung Bae; Carty, Matthew J; Talbot, Simon G; Nelson, Helen M; Delmonico, Francis L

    2016-10-01

    We report on the to date largest recovery of 11 organs from a single deceased donor with the transplantation of face, bilateral upper extremities, heart, 1 lung, liver (split for 2 recipients), kidneys, pancreas, and intestine. Although logistically challenging, this case demonstrates the feasibility and safety of the recovery of multiple thoracic and abdominal organs with multiple vascular composite allotransplants and tissues. Our experience of 8 additional successful multiple vascular composite allotransplants, thoracic, and abdominal organ recoveries suggests that such procedures are readily accomplishable from the same deceased donor.

  6. Bilateral internal auditory canal gangliogliomas mimicking neurofibromatosis Type II

    Directory of Open Access Journals (Sweden)

    Kristopher G Hooten

    2016-01-01

    Conclusion: This is the first reported case of bilateral IAC/CPA gangliogliomas. When evaluating bilateral IAC/CPA lesions with unusual imaging characteristics, ganglioglioma should be included in the differential diagnosis.

  7. Rib Composite Flap With Intercostal Nerve and Internal Thoracic Vessels for Mandibular Reconstruction.

    Science.gov (United States)

    Zhang, Bin; Li, Ke-Yi; Jiang, Li-Cheng; Meng, Zhen; Wang, Xiu-Mei; Cui, Fu-Zhai; Zhu, Ying-Nan; Wu, Ya-Ping

    2016-10-01

    The purpose of this study was to present the outcome and discuss the feasibility of rib composite flap with intercostal nerve and internal thoracic vessels for reconstructing mandibular defect. Rib composite flaps have been used in 82 patients for reconstructing benign tumor-caused large mandibular defects: 66 of the 82 patients were reconstructed using rib composite flap with intercostal nerve and internal thoracic vessels, whereas the other 16 patients were reconstructed using rib composite flap with internal thoracic vessels, without intercostal nerve. After operation, clinical observation, imageological examination, and sensory detection were used to evaluate the effect of reconstruction. All rib composite flaps with intercostal nerve and internal thoracic vessels were successfully harvested and transplanted. Both immediate and long-term examination showed good appearance reconstruction. All followed-up patients conveyed good satisfaction degree with function and appearance reconstruction. Postoperative panoramic x-ray examination showed new bone formation between the transplanted rib and mandibular stump. Good recoveries of mandibular nerve sensory were observed when followed up after reconstruction surgery. Rib composite flap with intercostal nerve and internal thoracic vessels could be a promising method for reconstruction of mandibular defects.

  8. Thoracic Outlet Syndrome Following Breast Implant Rupture

    Directory of Open Access Journals (Sweden)

    Raakhi Mistry, MBChB

    2015-03-01

    Full Text Available Summary: We present a patient with bilateral breast implant rupture who developed severe locoregional silicone granulomatous lymphadenopathy. Poly Implant Prothese silicone implants had been used for bilateral breast augmentation 5 years prior. Extracapsular implant rupture and bilateral axillary lymphadenopathy indicated explantation, capsulectomy, and selective lymph node excision. Histology demonstrated silicone lymphadenopathy with no evidence of malignancy. Over the subsequent 12 months, she developed progressive locoregional lymphadenopathy involving bilateral cervical, axillary, and internal mammary groups, resulting in bilateral thoracic outlet syndrome. We report the unusual presentation, progression, and the ultimate surgical management of this patient.

  9. Thoracic outlet syndrome following breast implant rupture.

    Science.gov (United States)

    Mistry, Raakhi; Caplash, Yugesh; Giri, Pratyush; Kearney, Daniel; Wagstaff, Marcus

    2015-03-01

    We present a patient with bilateral breast implant rupture who developed severe locoregional silicone granulomatous lymphadenopathy. Poly Implant Prothese silicone implants had been used for bilateral breast augmentation 5 years prior. Extracapsular implant rupture and bilateral axillary lymphadenopathy indicated explantation, capsulectomy, and selective lymph node excision. Histology demonstrated silicone lymphadenopathy with no evidence of malignancy. Over the subsequent 12 months, she developed progressive locoregional lymphadenopathy involving bilateral cervical, axillary, and internal mammary groups, resulting in bilateral thoracic outlet syndrome. We report the unusual presentation, progression, and the ultimate surgical management of this patient.

  10. Stochastic Discount Factor Approach to International Risk-Sharing:A Robustness Check of the Bilateral Setting

    NARCIS (Netherlands)

    Hadzi-Vaskov, M.; Kool, C.J.M.

    2007-01-01

    This paper presents a robustness check of the stochastic discount factor approach to international (bilateral) risk-sharing given in Brandt, Cochrane, and Santa-Clara (2006). We demonstrate two main inherent limitations of the bilateral SDF approach to international risk-sharing. First, the discount

  11. Effects of Bilateralism and the MFN Clause on International Trade

    DEFF Research Database (Denmark)

    Lampe, Markus

    2009-01-01

    This study contributes to a revised picture of nineteenth-century bilateralism. Employing a new disaggregated data set, it argues that bilateral treaties did not implement general free trade, but instead reduced tariffs unevenly through commodity-specific preferences, especially favoring manufact...

  12. Long-term internal thoracic artery bypass graft patency and geometry assessed by multidetector computed tomography

    DEFF Research Database (Denmark)

    Zacho, Mette; Lilleoer, Nikolaj Thomas; Kelbaek, Henning

    2012-01-01

    The left internal thoracic artery (LITA) undergoes vascular remodelling when used for coronary artery bypass grafting. In this study we tested the hypothesis that the extent of the LITA remodelling late after coronary artery bypass grafting assessed by multidetector computed tomography is related...

  13. Bilateral masseter and internal pterygoid muscle hypertrophy: a diagnostic challenge.

    Science.gov (United States)

    Andreadis, Dimitrios; Stylianou, Florentia; Link-Tsatsouli, Iris; Markopoulos, Anastasios

    2014-01-01

    To describe an unusual case of bilateral masseter and pterygoid muscle hypertrophy. A 53-year-old female patient presented with a bilateral, painless swelling at the parotid areas without improvement after using antibiotics/systemic corticosteroids/nonsteroidal anti-inflammatory agents. Her medical history included thyroid nodules, but no dental/occlusal disorders were observed. The initial differential diagnosis included salivary gland/jaw bone/masseter pathology, but the CT/MRI revealed only an increase in the size of the masseter and pterygoid muscles. The patient was informed of the benign nature of the swelling and was advised to discontinue the use of nonsteroidal anti-inflammatory agents. The bilateral hypertrophy of masseter muscles should be considered in differential diagnosis in cases of unilateral or bilateral swelling of the parotid or lateral mandible area. © 2013 S. Karger AG, Basel.

  14. Technical strategy in a patient with symptomatic thoracic aneurysm near the origin of the left subclavian artery and left internal thoracic artery coronary graft.

    Science.gov (United States)

    Babic, Srdjan D; Radak, Djordje J; Sotirovic, Vuk A; Unic-Stojanovic, Dragana R; Babic, Dusan S; Popov, Petar Z; Sagic, Dragan Z

    2012-11-01

    Thoracic endovascular aortic repair (TEVAR) is a safe and reliable technique utilized in the treatment for aortic aneurysms. However, in up to 40% of patients, devices are typically placed over the left subclavian artery (LSA) origin. In this report, we present a case of a successful TEVAR procedure following the transposition of the LSA with protective carotico-axillary/carotid bypass in a patient with a patent left internal thoracic artery (LITA)-left anterior descending (LAD) coronary artery bypass graft and right internal carotid artery (ICA) occlusion. © 2012 Wiley Periodicals, Inc.

  15. Bilateral internal carotid agenesis: value of CT angiography and correlation to embryogenesis

    Energy Technology Data Exchange (ETDEWEB)

    Pilleul, F.; Rouviere, O. [Dept. of Radiology, Hopital Edouard Herriot, Lyon (France); Guibaud, L.; Pracros, J.P. [Dept. of Pediatric Imaging, Hopital Debrousse, Lyon (France); Badinand, N. [Dept. of Pediatric Neurology, Hopital Debrousse, Lyon (France)

    2001-05-01

    Bilateral internal carotid artery agenesis is an uncommon disease, difficult to differentiate from bilateral carotid artery thrombosis. A few case reports have described the contribution of conventional angiogram to make the diagnosis and recognize the anatomic details of this rare malformation. Advantages of CT angiography as a non-invasive radiologic tool are discussed in this case report. (orig.)

  16. Analysis of transit time flow of the right internal thoracic artery anastomosed to the left anterior descending artery compared to the left internal thoracic artery.

    Science.gov (United States)

    Milani, Rodrigo; Moraes, Daniela de; Sanches, Aline; Jardim, Rodrigo; Lumikoski, Thais; Miotto, Gabriela; Santana, Vitor Hugo; Brofman, Paulo Roberto

    2014-01-01

    We evaluated with transit time flow the performance of the right and left thoracic arteries when used as a graft for the left anterior descending artery. Fifty patients undergoing surgery for myocardial revascularization without cardiopulmonary bypass were divided into two groups. In group A patients received graft of right internal mammary artery to the anterior interventricular branch. In group B patients received graft of left internal mammary artery to the same branch. At the end of the operation the flow was assessed by measuring transit time. In group A, mean age was 60.6 ± 9.49 years. The average height and weight of the group was 80.4 ± 10.32 kg and 169.2 ± 6.86 cm. The average number of grafts per patient in this group was 3.28 ± 1.49. The mean flow and distal resistance obtained in right internal thoracic artery was 42.1 ± 23.4 ml/min and 2.8 ± 0.9 respectively. In group B, the mean age was 59.8 ± 9.7 years. The average height and weight of this group was 77.7 ± 14.22 kg and 166.0 ± 8.2 cm. The average number of grafts per patient in this group was 3.08 ± 0.82. The mean flow and distal resistance observed in this group was 34.2 ± 19.1 ml/min and 2.0 ± 0.7. There were no deaths in this series. Right internal mammary artery presented a similar behavior to left internal mammary artery when anastomosed to the anterior interventricular branch of the left coronary artery. There was no statistical difference between the measured flow obtained between both arteries.

  17. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

    Directory of Open Access Journals (Sweden)

    Jaiswal Atin

    2013-12-01

    Full Text Available 【Abstract】Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic dis- placed proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, internal

  18. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

    Institute of Scientific and Technical Information of China (English)

    Atin Jaiswal; Naiman Deepak Kachchhap; Rupak Chaterjee; Yashwant Singh Tanwar; Masood Habib; Satya Prakash Singh

    2013-01-01

    Fractures of the proximal humerus are uncommon in young patients.Although bilateral fracture of proximal humerus itself is rare,association with epilepsy and electrocution is frequent.Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature.We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient,which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

  19. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates.

    Science.gov (United States)

    Jaiswal, Atin; Kachchhap, Naiman Deepak; Chaterjee, Rupak; Tanwar, Yashwant Singh; Habib, Masood; Singh, Satya Prakash

    2013-01-01

    Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

  20. Trismus as manifestation of bilateral internal capsule genu infarction

    NARCIS (Netherlands)

    Aries, M.J.H.; Vroomen, Patrick C. A. J.; van der Hoeven, Johannes H.; De Keyser, Jacques

    Acute trismus can have different causes. We describe the presentation, course and radiological findings of a 34-year-old man who developed acute trismus and MRI findings consistent with the combination of an old and fresh infarction in the genu of the internal capsule. We believe it is important to

  1. Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain: a randomized controlled trial of thoracic thrust manipulation vs non-thrust mobilization.

    Science.gov (United States)

    Salom-Moreno, Jaime; Ortega-Santiago, Ricardo; Cleland, Joshua Aland; Palacios-Ceña, Maria; Truyols-Domínguez, Sebastian; Fernández-de-las-Peñas, César

    2014-06-01

    The purpose of this study was to compare the effects of thoracic thrust manipulation vs thoracic non-thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity. Fifty-two patients (58% were female) were randomly assigned to a thoracic spine thrust manipulation group or of thoracic non-thrust mobilization group. Pressure pain thresholds (PPTs) over C5-C6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle and neck pain intensity (11-point Numerical Pain Rate Scale) were collected at baseline and 10 minutes after the intervention by an assessor blinded to group allocation. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome. The primary analysis was the group * time interaction. No significant interactions were found with the mixed-model ANOVAs for any PPT (C5-C6: P>.252; second metacarpal: P>.452; tibialis anterior: P>.273): both groups exhibited similar increases in PPT (all, Pthrust manipulation experienced a greater decrease in neck pain (between-group mean difference: 1.4; 95% confidence interval, 0.8-2.1) than did those receiving thoracic spine non-thrust mobilization (P2.1), and between-group effect size was also large (SMD = 1.3) in favor of the manipulative group. The results of this randomized clinical trial suggest that thoracic thrust manipulation and non-thrust mobilization induce similar changes in widespread PPT in individuals with mechanical neck pain; however, the changes were clinically small. We also found that thoracic thrust manipulation was more effective than thoracic non-thrust mobilization for decreasing intensity of neck pain for patients with bilateral chronic mechanical neck pain. Copyright © 2014 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  2. Enhancement of bilateral cortical somatosensory evoked potentials to intact forelimb stimulation following thoracic contusion spinal cord injury in rats.

    Science.gov (United States)

    Bazley, Faith A; Maybhate, Anil; Tan, Chuen Seng; Thakor, Nitish V; Kerr, Candace; All, Angelo H

    2014-09-01

    The adult central nervous system is capable of significant reorganization and adaptation following neurotrauma. After a thoracic contusive spinal cord injury (SCI) neuropathways that innervate the cord below the epicenter of injury are damaged, with minimal prospects for functional recovery. In contrast, pathways above the site of injury remain intact and may undergo adaptive changes in response to injury. We used cortical somatosensory evoked potentials (SSEPs) to evaluate changes in intact forelimb pathways. Rats received a midline contusion SCI, unilateral contusion SCI, or laminectomy with no contusion at the T8 level and were monitored for 28 days post-injury. In the midline injury group, SSEPs recorded from the contralateral forelimb region of the primary somatosensory cortex were 59.7% (CI 34.7%, 84.8%; c(2) = 21.9; dof = 1; p = 2.9 ×10(-6)) greater than the laminectomy group; SSEPs from the ipsilateral somatosensory cortex were 47.6% (CI 18.3%, 77%; c(2) = 10.1; dof = 1; p = 0.001) greater. Activation of the ipsilateral somatosensory cortex was further supported by BOLD-fMRI, which showed increased oxygenation at the ipsilateral hemisphere at day seven post-injury. In the unilateral injury group, ipsilesional side was compared to the contralesional side. SSEPs on day 14 (148%; CI 111%, 185%) and day 21 (137%; CI 110%, 163%) for ipsilesional forelimb stimulation were significantly increased over baseline (100%). SSEPs recorded from the hindlimb sensory cortex upon ipsilesional stimulation were 33.9% (CI 14.3%, 53.4%; c(2) = 11.6; dof = 1; p = 0.0007) greater than contralesional stimulation. Therefore, these results demonstrate the ability of SSEPs to detect significant enhancements in the activation of forelimb sensory pathways following both midline and unilateral contusive SCI at T8. Reorganization of forelimb pathways may occur after thoracic SCI, which SSEPs can monitor to aid the development of future therapies.

  3. Laparoscopic repair of a bilateral internal inguinal hernia with supravesical hernia – a case report

    Science.gov (United States)

    Kawaguchi, Tsutomu; Itoh, Tadao; Yoshii, Kazuhiro; Otsuji, Eigo

    2015-01-01

    Introduction Supravesical hernia is an exceptional subtype of internal inguinal hernia, and it is located between the median umbilical ligament and the medial umbilical ligament. The hernia is classified as two types: internal supravesical hernia and external supravesical hernia. Presentation of case Herein we report a rare case of external supravesical hernia successfully treated by laparoscopic procedure. The patient who complained right inguinal protrusion and mild frequent urination was diagnosed as right inguinal hernia and potential of left inguinal hernia using computed tomography. He underwent laparoscopic bilateral hernia repair, and intraoperative findings revealed right external supravesical hernia and left internal inguinal hernia. Discussion Laparoscopic hernia repair may make it possible to avoid overlooking of internal hernia such as supravesical hernia. Moreover it was possible to cover the hernia orifice and dissected layer of the dorsal site of urine bladder using bilateral approach in the current case. Conclusion In conclusions, laparoscopic hernia repair might be a surgical option for supravesical hernia. PMID:26263448

  4. Bilateral internal carotid artery occlusion associated with the antiphospholipid antibody syndrome.

    Science.gov (United States)

    Anand, Pria; Mann, Sharan K; Fischbein, Nancy J; Lansberg, Maarten G

    2014-01-01

    A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies.

  5. Bilateral Internal Carotid Artery Occlusion Associated with the Antiphospholipid Antibody Syndrome

    Directory of Open Access Journals (Sweden)

    Pria Anand

    2014-03-01

    Full Text Available A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies.

  6. Transient Occlusion of Bilateral Internal Iliac Arteries Facilitates Bloodless Operative Field in Subcapsular Prostatectomy

    Directory of Open Access Journals (Sweden)

    Takumi Takeuchi

    2012-01-01

    Full Text Available Transurethral resection of the prostate is the gold standard of surgical treatment for benign prostatic hyperplasia (BPH. Nevertheless, open subcapsular prostatectomy is still performed for large BPH. While enucleation of prostatic adenoma is being performed, unneglectable bleeding can occur and surgeons need to rush to remove adenomas, often using fingers and in a blinded fashion. The blood supply to the prostatic capsule and adenoma can be reduced to a marked extent in subcapsular prostatectomy if the bilateral internal iliac arteries are transiently occluded. Thus, a bloodless operative field is reasonably acquired during enucleation of adenoma, which would, otherwise, be a cause for concern to surgeons due to bleeding. It is not always applicable, but it could be an option if the estimated volume of BPH is more than 100 mL. In two cases, bilateral internal iliac arteries were occluded with Bulldog clamps, and then adenomas of 159 and 97 g were enucleated.

  7. Diffuse thyroid metastases and bilateral internal jugular vein tumor thrombus from renal cell cancer

    OpenAIRE

    Jha, Priyanka; Shekhar, Mallika; Wan, Jennifer; Mari-Aparici, Carina

    2016-01-01

    Renal cell cancer rarely metastasizes to the thyroid gland, and it has been reported to present as a solitary mass. We present a case of diffuse thyroid cancer metastases from renal cell cancer. Bilateral internal jugular vein tumor thrombi were also present. To the best of our knowledge, this is the first description of diffuse thyroid metastases from renal cell cancer in the English literature. Renal cell cancer metastases should be considered in the differential of thyroid imaging abnormal...

  8. Internal Disciplinary Procedures – Internet and Social Media. Dilemmas of Bilateral Relations

    OpenAIRE

    Berski, Adrian

    2016-01-01

    Nowadays, Social Media and the Internet are useful and powerful tools within society. It provides great convenience to conduct activities within the job market such as: free web advertising, talent hunting or collecting precious marketing data. However, in some cases, Social Media and the Internet can be a “bone of contention” between the employer and employee relationship. The main purpose of this essay is to demonstrate bilateral relations between internal disciplinary procedures between...

  9. Survey of International Members of the American Thoracic Society on Climate Change and Health.

    Science.gov (United States)

    Sarfaty, Mona; Kreslake, Jennifer; Ewart, Gary; Guidotti, Tee L; Thurston, George D; Balmes, John R; Maibach, Edward W

    2016-10-01

    The American Thoracic Society (ATS), in collaboration with George Mason University, surveyed international members of the society to assess perceptions, clinical experiences, and preferred policy responses related to global climate change. A recruitment email was sent by the ATS President in October 2015 to 5,013 international members. Subsequently, four reminder emails were sent to nonrespondents. Responses were received from 489 members in 68 countries; the response rate was 9.8%. Half of respondents reported working in countries in Asia (25%) or Europe (25%), with the remainder in South America (18%), North America (Canada and Mexico) (18%), Australia or New Zealand (9%), and Africa (6%). Survey estimate confidence intervals were ± 5% or smaller. A high percentage of international ATS survey respondents judged that climate change is happening (96%), that it is driven by human activity (70%), and that it is relevant to patient care ("a great deal"/"a moderate amount") (80%). A majority of respondents also indicated they are already observing health impacts of climate change among their patients; most commonly as increases in chronic disease severity from air pollution (88%), allergic symptoms from exposure to plants or mold (72%), and severe weather injuries (69%). An even larger majority anticipated seeing these climate-related health impacts in the next two decades. Respondents further indicated that physicians and physician organizations should play an active role in educating patients, the public, and policy makers on the human health effects of climate change. International ATS respondents, like their counterparts in the U.S., observed that human health is already adversely affected by climate change, and support responses to address this situation.

  10. Comparative analysis of the patency of the internal thoracic artery in the CABG of left anterior descending artery: 6-month postoperative coronary CT angiography evaluation.

    Science.gov (United States)

    Deininger, Maurilio Onofre; Moreira, Luiz Felipe Pinho; Dallan, Luiz Alberto Oliveira; Oliveira, Orlando Gomes de; Magalhães, Daniel Marcelo Silva; Coelho, José Reinaldo de Moura; Deininger, Eugênia di Giuseppe; Lopes, Norland de Souza; Queiroga, Ricardo Wanderley; Belmont, Elizabeth Ferreira

    2014-01-01

    To assess the patency of the pedicled right internal thoracic artery with an anteroaortic course and compare it to the patency of the left internal thoracic artery , in anastomosis to the left anterior descending artery in coronary artery bypass grafting by using coronary CT angiography at 6 months postoperatively. Between December 2008 and December 2011, 100 patients were selected to undergo a prospective coronary artery bypass grafting procedure without cardiopulmonary bypass. The patients were randomly divided by a computer-generated list into Group-1 (G-1) and Group-2 (G-2), comprising 50 patients each, the technique used was known at the beginning of the surgery. In G-1, coronary artery bypass grafting was performed using the left internal thoracic artery for the left anterior descending and the free right internal thoracic artery for the circumflex, and in G-2, coronary artery bypass grafting was performed using the right internal thoracic artery pedicled to the left anterior descending and the left internal thoracic artery pedicled to the circumflex territory. The groups were similar with regard to the preoperative clinical data. A male predominance of 75.6% and 88% was observed in G-1 and G-2, respectively. Five patients migrated from G-1 to G-2 because of atheromatous disease in the ascending aorta. The average number of distal anastomoses was 3.48 (SD=0.72) in G-1 and 3.20 (SD=0.76) in G-2. Coronary CT angiography in 96 re-evaluated patients showed that all ITAs, right or left, used in situ for the left anterior descending were patent. There were no deaths in either group. Coronary artery bypass grafting surgery involving anastomosis of the anteroaortic right internal thoracic artery to the left anterior descending artery has an outcome similar to that obtained using the left internal thoracic artery for the same coronary site.

  11. Paraneoplastic Internal Jugular Vein Thrombosis Leading to Diagnosis of Bilateral Ovarian Ependymoma

    Directory of Open Access Journals (Sweden)

    Irappa Madabhavi

    2014-01-01

    Full Text Available Ovarian ependymomas are extremely rare tumors of the ovary. We present a case of a 67-year-old lady presented to us with swelling in the right side of neck for 2 months followed by pelvic pain, lower abdominal distention, and weight loss for 1 month. Her coagulation profile, blood chemistry, lipid profile, and tumor markers were within normal limits. Neck Doppler ultrasonography revealed thrombus in the right internal jugular vein and CT scan of the abdomen showed bilateral ovarian masses. Patient was subjected to debulking surgery for suspected ovarian cancer and microscopy revealed a highly cellular tumor composed of small cells with hyperchromatic, round-to-oval nuclei with scanty cytoplasm, and perivascular pseudorosettes. Diagnosis was confirmed by immunophenotype showing strong positivity to glial fibrillary acidic protein, estrogen receptors, and progesterone receptors. Patient was successfully managed with anticoagulants, adjuvant chemotherapy with BEP regimen, and letrozole. After ruling out other common conditions for thrombosis in this age group, this seems to be a paraneoplastic presentation of ovarian malignancy that preceded the diagnosis of ependymoma by 2 months. To the best of our knowledge this is the first case report in the world literature as “paraneoplastic internal jugular vein thrombosis leading to diagnosis of bilateral ovarian ependymoma.”

  12. Comparison of thermal damage of the internal thoracic artery using ultra high radiofrequency and monopolar diathermy.

    Science.gov (United States)

    Bulat, Cristijan; Pešutić-Pisac, Valdi; Capkun, Vesna; Marović, Zlatko; Pogorelić, Zenon; Družijanić, Nikica

    2014-10-01

    The internal thoracic artery (ITA) has been accepted worldwide as a first choice conduit for myocardial revascularisation. It still remains questionable what is the best method for ITA harvesting in a skeletonized fashion according to structural integrity of artery, as a risk factor of early and late graft failure. The purpose of this study was to determine the impact of the ultra-high radiofrequency energy used for ITA harvesting on arterial structural integrity, in particular on the endothelial layer. Seventy-four ITA specimens were divided into two groups depending on device used for harvesting (radiofrequency-knife (RF) or electrocauter (EC)). Thermal damage on arterial structural integrity was measured using light microscope, morphometric imaging analysis and immunohistochemical methods. Thermal damage of endothelium was 2.8 times higher in EC than in RF group (p = 0.041) and 5 times higher in patients older than 66 years of age (p = 0.002). Extent of endothelial damage (graded from 0 to 3) was significantly higher in EC group (p = 0.03). Also, in EC group, in patients older than 66 years of age higher proportion of extent of endothelial damage was found (p = 0.027). The endothelial damage was more often in EC than in RF group as in the patients older than 66 years of age. Demonstrated results suggest that the radiosurgery in comparison to conventional electrocautery is safe and effective method, and significantly reduces thermal damage to endothelial layer of artery. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  13. Doppler echocardiographic criteria in patency assessment of composite grafts from left internal thoracic artery

    Directory of Open Access Journals (Sweden)

    Maria Claudia A. Leitão

    2013-06-01

    Full Text Available OBJECTIVES: The purpose of our study was to establish, with an entirely noninvasive method, transthoracic Doppler echocardiography, criteria for patency of composite left internal thoracic artery grafts when placed on the left anterior descending artery and other branches of the left coronary system. METHODS: The control group comprised 20 patients with single graft and 20 patients with composite graft; all forty having their patency confirmed by coronary angiogram (CA. In this control group, two Doppler echocardiographic variables, diastolic mean velocity-time and integral diastolic peak velocity to systolic peak velocity ratio were recorded. For each variable, established cut-off points were established, using the ROC (Receiver Operator Characteristic curves, to identify criteria which could differentiate the composite grafts. Only patients with composite grafts were included in the 159-patients study group. The criteria established by the cut-off points in the control group were then applied to detect patency using a diastolic fraction of > 0.5 as the gold standard. The sensitivity, specificity, and positive and negative predictive values of these two criteria were determined. RESULTS: In the control group, cut-off points of 0.71 and 0.09m were established for the diastolic peak velocity/systolic peak velocity ratio and for diastolic mean velocity-time integral, respectively. In the study group phase, the sensitivity and negative predictive value of the diastolic peak velocity/systolic peak velocity > 0.71 criterion were 36% and 11%, respectively. Diastolic mean velocity-time integral > 0.09m criterion, were 40% and 10.48%. The specificities and positive predictive values of each criterion were 100%. CONCLUSION: Values reaching the criteria established for each variable indicate high probability of composite graft patency. Lower values have a large proportion of false negatives and are not conclusive as patency criteria.

  14. [Sternal re-entry using the retractor for harvesting internal thoracic artery].

    Science.gov (United States)

    Niinami, H; Takeuchi, Y

    2002-06-01

    The number of redo cardiac operations, especially coronary artery bypass grafting (CABG), has recently been increasing mainly due to the failure of saphenous vein grafts. Re-opening a median sternotomy is troublesome, because of possible adhesion of the heart to the sternum. Preoperative computed tomography is quite useful and helpful in determining the degree of the adhesion of the heart and ascending aorta to the back of the sternum. We report here a safe and useful technique for sternal re-entry using a retractor for harvesting the internal thoracic artery (ITA). When re-opening a median sternotomy the incision is made to the sternal wires; the wires are then cut and removed. Small rake retractors, which are connected to the ITA retractor, are hooked to both ends of the left side of the sternum. The ITA retractor is gently wound up to lift up the sternum. An oscillating saw is then applied to divide the anterior table of the sternum. When the posterior table of the sternum is carefully divided, the left side of the sternum is automatically elevated slightly. Complete division of the sternum can be confirmed by this slight elevation. If the left side of the sternum is elevated a little bit more by the ITA retractor, the dissection of the adhesion between the sternum and the heart can be performed without assistance. This technique is most beneficial for a case of redo CABG with the use of the left ITA, but it can be applied in any patients who previously underwent median sternotomy.

  15. Diffuse thyroid metastases and bilateral internal jugular vein tumor thrombus from renal cell cancer.

    Science.gov (United States)

    Jha, Priyanka; Shekhar, Mallika; Wan, Jennifer; Mari-Aparici, Carina

    2016-12-01

    Renal cell cancer rarely metastasizes to the thyroid gland, and it has been reported to present as a solitary mass. We present a case of diffuse thyroid cancer metastases from renal cell cancer. Bilateral internal jugular vein tumor thrombi were also present. To the best of our knowledge, this is the first description of diffuse thyroid metastases from renal cell cancer in the English literature. Renal cell cancer metastases should be considered in the differential of thyroid imaging abnormalities arising in the setting of known renal cell carcinoma, particularly late in the course of disease. This is frequently associated with internal jugular vein thrombi, which should be evaluated with an abnormal thyroid. Thyroglobulin levels are usually normal in such patients.

  16. REPORT ON FIRST INTERNATIONAL WORKSHOP ON ROBOTIC SURGERY IN THORACIC ONCOLOGY

    Directory of Open Access Journals (Sweden)

    Giulia Veronesi

    2016-10-01

    Full Text Available A workshop of experts from France, Germany, Italy and the United States took place at Humanitas Research Hospital Milan, Italy, on 10-11 February 2016, to examine techniques for and applications of robotic surgery to thoracic oncology. The main topics of presentation and discussion were: robotic surgery for lung resection; robot-assisted thymectomy; minimally invasive surgery for esophageal cancer; new developments in computer-assisted surgery and medical applications of robots; the challenge of costs; and future clinical research in robotic thoracic surgery. The following article summarizes the main contributions to the workshop. The Workshop consensus was that, since video-assisted thoracoscopic surgery (VATS is becoming the mainstream approach to resectable lung cancer in North America and Europe, robotic surgery for thoracic oncology is likely to be embraced by an increasing numbers of thoracic surgeons, since it has technical advantages over VATS, including intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high definition stereoscopic vision. These advantages may make robotic surgery more accessible than VATS to trainees and experienced surgeons, and also lead to expanded indications. However the high costs of robotic surgery and absence of tactile feedback remain obstacles to widespread dissemination. A prospective multicentric randomized trial (NCT02804893 to compare robotic and VATS approaches to stage I and II lung cancer will start shortly.

  17. Report on First International Workshop on Robotic Surgery in Thoracic Oncology.

    Science.gov (United States)

    Veronesi, Giulia; Cerfolio, Robert; Cingolani, Roberto; Rueckert, Jens C; Soler, Luc; Toker, Alper; Cariboni, Umberto; Bottoni, Edoardo; Fumagalli, Uberto; Melfi, Franca; Milli, Carlo; Novellis, Pierluigi; Voulaz, Emanuele; Alloisio, Marco

    2016-01-01

    A workshop of experts from France, Germany, Italy, and the United States took place at Humanitas Research Hospital Milan, Italy, on February 10 and 11, 2016, to examine techniques for and applications of robotic surgery to thoracic oncology. The main topics of presentation and discussion were robotic surgery for lung resection; robot-assisted thymectomy; minimally invasive surgery for esophageal cancer; new developments in computer-assisted surgery and medical applications of robots; the challenge of costs; and future clinical research in robotic thoracic surgery. The following article summarizes the main contributions to the workshop. The Workshop consensus was that since video-assisted thoracoscopic surgery (VATS) is becoming the mainstream approach to resectable lung cancer in North America and Europe, robotic surgery for thoracic oncology is likely to be embraced by an increasing numbers of thoracic surgeons, since it has technical advantages over VATS, including intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision. These advantages may make robotic surgery more accessible than VATS to trainees and experienced surgeons and also lead to expanded indications. However, the high costs of robotic surgery and absence of tactile feedback remain obstacles to widespread dissemination. A prospective multicentric randomized trial (NCT02804893) to compare robotic and VATS approaches to stages I and II lung cancer will start shortly.

  18. Bilateral internal carotid artery occlusion. Comparison among MRI, hemodynamics and clinical feature

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Yasumasa; Tsuda, Harumi; Nabatame, Hidehiko; Akiguchi, Ichiro; Kameyama, Masakuni

    1987-10-01

    Four cases of bilateral internal carotid occlusion are reported with respect to clinical features, hemodynamics and various image diagnosis. MRI is applied to three cases. The patients comprised 2.08 % of all cerebral occlusive diseases treated during the past five years at our clinic. One case is of abrupt onset and three cases are progressing profiles. In one of these cases, collateral circulation is supplied mainly by leptomeningeal anastomosis of the posterior cerebral artery and posterior pericallosal artery branching from the basilar artery. In two of them, they are supplied through the circle of Willis. Middle cerebral artery occlusion, occlusion supra occlusionem, however, causes decisive ischemic lesion in its teritory. Applying MRI, complicated ischemic lesions, such as lacunar infarction, paraventricular lesion, deep white matter lesion and border zone infarction can clearly be identified. In the case of total aphasia, the lesions responsible are demonstrated clearly by MRI, but only vaguely by X-ray CT.

  19. Trauma-associated bleeding from the bilateral internal iliac arteries resolved using angiographic embolization.

    Science.gov (United States)

    Aygün, Ali; Karaca, Yunus; Ayan, Emin; Suha, Türkmen; Dinç, Hasan

    2013-11-01

    Pelvic fracture is associated with high mortality. The management of major pelvic injuries remains one of the most important issues in modern trauma care. A 39-year-old male patient presented at the emergency department after being hit with a 500 kg load. His general condition was average with unstable vital signs. Pelvic tomography revealed fractured bone structure, thickening secondary to hematoma in both iliopsoas muscles, and hemorrhage-related active extravasation in the left internal iliac trace. The patient's hemodynamics worsened despite fluid and blood replacement, and angiographic embolization was scheduled. Bilateral embolization of the iliac artery was performed. Control angiography confirmed that full embolization was established. The patient was monitored in intensive care, but expired after three days due to acute kidney failure, disseminated intravascular coagulation, and multi-organ failure. Angiographic embolization is a technique improves hemorrhage control in pelvic trauma but can also increase risk of complications such as ischemia and necrosis.

  20. Bilateral external and internal pudendal veins embolization treatment for venogenic erectile dysfunction

    Directory of Open Access Journals (Sweden)

    Daniel Lee, BBA, BS

    2017-03-01

    Full Text Available Erectile dysfunction (ED or impotence is estimated to affect around 20-30 million men in the United States (Rhoden et al, 2002. Vascular etiology is purported to be the most prevalent cause of ED in the elderly population, with venogenic ED being the most common subtype (Shafik et al, 2007; Rebonato et al, 2014. A patient, who developed severe venogenic ED, was referred to interventional radiology after ineffective pharmaceutical treatments. Selective embolization of bilateral external and internal pudendal veins was performed through accessing the deep dorsal vein of penis. Subsequent venogram verified successful embolization with stasis within the outflow of the deep dorsal vein of penis. Close to 6 weeks after the procedure, the patient purports to be able to achieve approximately 65% of full penile erection and complete penile erection with penile stimulation and 0.25 mL injection of alprostadil after 25 minutes.

  1. Does Bilateral Market and Financial Integration Explains International Co-Movement Patterns1

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    Mobeen Ur Rehman

    2016-05-01

    Full Text Available This study aims to explore the relationship between market integration, foreign portfolio equity holding and inflation rates on international stock market linkages between Pakistan and India. To measure stock equity interlinkage, we constructed international co-movement index through rolling beta estimation. Market integration variable between these two countries is constructed using the International Capital Asset Pricing Model (ICAPM. To check the impact of market integration, foreign portfolio equity holding and inflation rate on Pakistan-Indian stock market co-movement, we applied autoregressive distributed lag (ARDL estimation. ARDL estimation is applied due to different stationarity levels of the included variables. The level of convergence speed is measured by the introduction of error correction term (ECT followed by variance decomposition analysis. Results of the study indicated presence of long term relationship among the included variables along with significance variance in bilateral co-movement due to inflation rate differential. The significance of inflation rate differences between these two countries are in accordance with portfolio balance theory stating that investors possess information about the macroeconomic variables thereby readjusting their portfolios for effective diversification.

  2. Endovascular treatment for hemothorax via contralateral internal thoracic artery branch after Nuss procedure – A case report

    Directory of Open Access Journals (Sweden)

    Daisuke Kanamori

    2017-02-01

    Full Text Available The Nuss procedure is performed widely as a standard surgical treatment for pectus excavatum. Compared to conventional methods, the Nuss procedure excels in cosmetic terms and involves fewer complications. A 14-year-old boy developed right hemothorax with a sudden shock one month after the Nuss procedure. We identified the bleeding from left internal thoracic artery (ITA branch and achieved hemostasis by endovascular coil embolization. To the best of our knowledge, this is the first to report that the ITA on the contralateral side of the hemothorax was responsible for the bleeding.

  3. Barriers to the universal adoption of bilateral internal mammary artery grafting.

    Science.gov (United States)

    Umakanthan, Jeremiah; Jeyakumar, Panch; Umakanthan, Branavan; Jeyakumar, Nikeshan; Senthilkumar, Nadarajah; Saraswathy, Mathioli R; Umakanthan, Padminidevi; Umakanthan, Janani; Sial, Tamoor; Abrina, Sofia; Buendia, Frances M; Pan, Irene; Kamath, Ramadas K; Pathmarajah, Canagaratnam; Sivalingam, Kanagaratnam; Nathan, Shan A; Sunder, Shun K; Mahendra, Tom; Umakanthan, Ramanan

    2015-04-01

    The left internal mammary artery (LIMA) graft is considered the "gold standard" of coronary artery bypass grafting (CABG). This conduit provides increased survival, symptomatic relief, increased freedom from myocardial infarction, and increased freedom from re-intervention when compared to saphenous venous grafting. It has a remarkable long term patency rate with clinical and angiographic outcomes that are unmatched by other conduits. Given the fact that patients often require more than one graft during a coronary revascularization procedure, the prospect of bilateral internal mammary artery (BIMA) grafting has been very appealing to some surgeons. BIMA grafting has been extensively studied via multiple retrospective and prospective cohort studies and findings have indicated that BIMA grafting can have an increased survival benefit when compared to LIMA grafting alone. As a result, this technique has accrued increasing popularity over the course of the last decade. Yet, questions still remain on whether BIMA grafting is the optimal treatment modality for patients in terms of long-term prognosis. There is limited data at the present time from randomized controlled trials and only 4-12% of CABGs performed today utilize BIMA grafting. Concerns regarding perioperative complications, which patient subsets are at higher risks for complications from the technique, and the technical challenges involved in utilizing and teaching the technique have limited its widespread use.

  4. A meta-analysis comparing bilateral internal mammary artery with left internal mammary artery for coronary artery bypass grafting.

    Science.gov (United States)

    Weiss, Aaron J; Zhao, Shan; Tian, David H; Taggart, David P; Yan, Tristan D

    2013-07-01

    Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over left internal mammary artery (LIMA) for coronary artery bypass grafting (CABG). We performed an updated meta-analysis of published studies comparing BIMA versus LIMA in CABG operations and assessed differences in long-term survival. Electronic searches for studies comparing BIMA versus LIMA were performed using three databases from 1972 to December 2012. Studies with at least four years of follow-up and at least 100 patients in each group were included for review. We used a random-effect model and pooled hazard ratios from across all included studies. No randomized controlled trials and 27 observational studies totaling 79,063 patients (19,277 BIMA, 59,786 LIMA) were included for final analysis. The BIMA group demonstrated significantly better long-term survival than the LIMA group [hazard ratio, 0.78; confidence interval, 0.72-0.84; Panalysis, we demonstrate an increase in long-term survival in patients receiving BIMA as a primary grafting strategy over those receiving a LIMA. Although no randomized controlled trials were included in this meta-analysis, the survival benefit seen with a BIMA cannot be overlooked when determining which operation to perform in CABG patients. Until the long-term results of the ART trial are published, we offer best available evidence in favor of BIMA over LIMA for CABG surgery.

  5. Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Nadgir, R.N.; Ahmed, T. [University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, PA 19104, Philadelphia (United States); Loevner, L.A.; Moonis, G.; Slawek, K.; Imbesi, S. [Neuroradiology Section, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, PA 19104, Philadelphia (United States); Chalela, J. [Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, PA 19104, Philadelphia (United States)

    2003-05-01

    Single-vessel cervical arterial dissections typically occur in young adults and are a common cause of cerebral ischemia and stroke. Although the pathogenesis of multivessel dissection is unclear, it is thought to be a consequence of underlying collagen vascular disease. We present a 34-year-old previously healthy man who developed bilateral internal carotid and vertebral artery dissection following chiropractic manipulation. (orig.)

  6. Congenital bilateral absence of the common carotid artery and internal carotid artery: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    YUE Xuan-ye; XI Gang-ming; ZHANG Ying-chun; ZHOU Shao-hua; YE Fei

    2006-01-01

    Absence of the common carotid artery(CCA) and/or internal carotid artery (ICA) is a kind of rare congenital anomaly. This paper reports one patient with bilateral absence of the CCA and ICA who suffered from cerebral infarction. And the relative literatures of the possible cause and collateral circulation were reviewed.

  7. Bilateral versus single internal mammary coronary artery bypass grafting in Sweden from 1997-2008.

    Directory of Open Access Journals (Sweden)

    Magnus Dalén

    Full Text Available BACKGROUND: Prior observational studies have suggested better outcomes in patients who receive bilateral internal mammary arteries (BIMA during coronary artery bypass grafting (CABG compared with patients who receive a single internal mammary artery (SIMA. The aim of this study was to analyze the association between BIMA use and long-term survival in patients who underwent primary isolated CABG. METHODS AND RESULTS: Patients who underwent primary isolated non-emergent CABG in Sweden between 1997 and 2008 were identified. The SWEDEHEART registry and other national Swedish registers were used to acquire information about patient characteristics and outcomes. Unadjusted and multivariable adjusted regression models were used to estimate the association between BIMA use and early mortality, long-term survival, and a composite of death from any cause or rehospitalization for myocardial infarction, heart failure, or stroke in the overall cohort and in a propensity score-matched cohort. The study population consisted of 49702 patients who underwent CABG with at least one internal mammary artery, and 559 (1% of those had BIMA grafting. In the adjusted analyses, BIMA use was not associated with better survival compared with SIMA use in the overall cohort (hazard ratio (HR for death: 1.16, 95% confidence interval (CI: 0.97 to 1.37 or in the matched cohort (HR: 1.04, 95% CI: 0.78 to 1.40. The results were similar for early mortality and the composite endpoint. Reoperation for sternal wound complications was more common among BIMA patients (odds ratio: 1.71, 95% CI: 1.01 to 2.88. CONCLUSIONS: BIMA grafting was performed infrequently and was not associated with better outcomes compared with SIMA grafting in patients undergoing non-emergent primary isolated CABG in Sweden during 1997-2008.

  8. Cerebro-retinal ischemia after bilateral occlusion of internal carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Bogousslavsky, J.; Regli, F.

    1985-05-01

    Six patients with occlusion of internal carotid arteries (ICAs) were prospectively followed during a mean period of 14 months. Prior to demonstration of occlusions, four patients suffered a mild stroke, and three isolated transient ischemic attacks (TIAs) or amaurosis fugax. All patients remained alive and with an unchanged functional ability. During follow-up, one patient suffered amaurosis fugax and TIAs followed by a mild stroke, three suffered isolated TIAs or amaurosis fugax, two suffered reversible cerebro-retinal ischemia of more than 24 hours, and one remained symptomfree. In three cases, delayed cerebro-retinal ischemia distal to one of the occluded ICAs was systematically triggered by orthostatic, cardiogenic or iatrogenic hypotension, and resolved after adequate medical treatment or restoration of a functional collateral circulation by endarterectomy of a tightly stenosed ipsilateral external carotid artery (ECA), suggesting hemodynamic phenomena. In three cases, micro-emboli originating from a stump or an ulcerated ipsilateral common carotid artery and migrating through well-developed ECA collateral channels explained delayed episodes of ipsilateral TIAs or amaurosis fugax, which disappeared in two cases after adequate anticoagulant therepy was introduced. Bilateral occlusion of ICA may be a relatively benign condition, if the patients are carefully controlled and treated.

  9. The value of an intercâmbio: brazilian student mobility, bilateralism & international education

    Directory of Open Access Journals (Sweden)

    Eric Spears

    2014-05-01

    Full Text Available Brazil’s emergence in the global economy as a member of the BRIC (Brazil, Russia, India, China, and South Africa states has prompted the federal government to establish the Brazilian Scientific Mobility Program (Science Without Borders in order to advance the country’s social capital and infrastructure in STEM (Science, Technology, Engineering, and Math related disciplines and industries. Public and private investment in the Scientific Mobility Program has transformed the way in which Brazilian government, universities, and citizenry places value the intercâmbio (student exchange experience in the United States. STEM-related disciplines are now disproportionately funded versus social sciences, humanities, and fine arts fields. This development has altered the way in which student mobility in the United States is given worth and changed the trajectory of international education in Brazil. This research provides a conceptual analysis of the Brazilian Scientific Mobility Program by using a critical political economy perspective. The essay conceptualizes the Science Without Borders initiative at global, national, and local levels. This research also explores what implications the bilateral U.S.-Brazil Educational Partnership may have on future policy, practice, and ultimately, funding of Brazilian student mobility. A emergência do Brasil no âmbito da economia mundializada como participante do BRIC (Brasil, Rússia, Índia, China e África do Sul mobilizou o governo federal brasileiro a estabelecer um programa estatal de mobilidade acadêmica (Programa Ciência sem Fronteiras de modo a fazer avançar o capital social do país (general intellect e a infraestrutura em STEM (Ciência, Tecnologia, Engenharia e Matemática relacionadas à indústria. Investimentos públicos e privados no programa de mobilidade acadêmica transformaram o modo como o governo brasileiro e as universidades valorizam o intercâmbio estudantil com os Estados Unidos. As

  10. Anesthetic management for bilateral simultaneous thoracic surgery%同期双侧肺部手术的麻醉处理

    Institute of Scientific and Technical Information of China (English)

    周玉萍; 李明星

    2011-01-01

    目的 总结同期双侧肺部手术的麻醉经验,旨在探讨最佳麻醉方案.方法 2005年8月-2010年11月共完成同期双侧肺部手术33例,其中12例双侧肺大疱气胸患者行两侧大疱切除,8例双侧肺癌患者行两侧肺叶切除,9例一侧肺癌对侧肺结节患者行一侧肺叶切除及对侧肺部分切除,4例两肺结节患者行双肺部分切除.麻醉医师参加外科术前讨论,根据病变性质和范围、术前肺功能情况、手术计划判定双侧同期手术的可能性,依据疾病的种类及不同的手术方案,个体化确定麻醉和呼吸管理的方法.结果 所有病例的麻醉均获得满意的效果.平均麻醉时间为(4.20±1.59)h,平均手术时间为(3.89±1.65)h,平均重症监护病房停留时间为(4.47士3.03)d,平均住院时间为(12.43±6.16)d.结论 同期双侧肺部手术麻醉处理的关键在于依据手术种类和肺功能情况评估患者能否耐受同期手术,谨慎实施先完成手术侧的单肺通气管理.%Objective To summarize our anesthesia experience for patients undergoing double-lung operation, so as to bring forward the best scheme.Methods Thirty-three double-lung operation anesthesia was performed in our department during August 2005 to November 2010.Among them, 12 patients were with bilateral bullae undergoing bilateral bullae resection, 8 patients with bilateral lung cancer undergoing bilateral pulmonary lobectomy, and 4 patients with pulmonary nodules undergoing bilateral lung resection.We participated in the surgery discussions before operation, and individualized anesthesia scheme was determined according to lesion property, pathological involvement and pulmonary function, and discussed the possibility of bilateral surgery during corresponding period The difference of diseases and surgery options were also concerned.Results Satisfactory anesthesia was achieved in all the cases.The average anesthesia time was (4.20 ± 1.59) h, average operation time was (3.89

  11. The Impact of Cultural Distance on Bilateral Arm's Length Exports An International Business Perspective

    NARCIS (Netherlands)

    Slangen, Arjen H. L.; Beugelsdijk, Sjoerd; Hennart, Jean-Francois

    2011-01-01

    Prior studies have argued and regularly found that cultural distance is negatively related to bilateral export flows, which are the sum of arm's length and intra-firm exports. However, these macro-level studies overlook the firm-level insights that arm's length exports are a substitute for arm's

  12. The Impact of Cultural Distance on Bilateral Arm's Length Exports An International Business Perspective

    NARCIS (Netherlands)

    Slangen, Arjen H. L.; Beugelsdijk, Sjoerd; Hennart, Jean-Francois

    2011-01-01

    Prior studies have argued and regularly found that cultural distance is negatively related to bilateral export flows, which are the sum of arm's length and intra-firm exports. However, these macro-level studies overlook the firm-level insights that arm's length exports are a substitute for arm's len

  13. [Bilateral thoracoscopic sympathectomy in treatment of palmar and axillary hyperhydrosis - a summary of 22 cases. A role for one day surgery in thoracic surgery?].

    Science.gov (United States)

    Kocsis, Akos; Agócs, László; Kostic, Szilárd; Lévay, Bernadett; Török, Klára; Rényi-Vámos, Ferenc

    2012-10-01

    The procedure of the ETS is carried out by two ports, a videothoracoscop and a diathermy instrument are introduced into the pleural cavity. After the identification of the sympathetic chain, the relevant ganglia are divided or excised. 22 patient underwent bilateral video assisted thoracoscopic T2-T4 sympathectomy in a half-way sitting position for palmar and axillary hyperhydrosis between December 2008 and January 2011. 5 male and 17 female patients with a mean age of 39.9 years, (19-63) underwent the above procedure. The mean operation time was 36 minutes, (30-61 minutes). No postoperative complications were detected. The authors believe that two port VATS sympathectomy is a safe and effective method for the treatment of hyperhydrosis even as one day surgical procedure.

  14. INFX GUIDE: DEPARTMENT OF ENERGY BILATERAL AGREEMENTS FOR COOPERATION IN THE FIELD OF RADIOACTIVE WASTE MANAGEMENT (INFX: INTERNATIONAL INFORMATION EXCHANGE)

    Energy Technology Data Exchange (ETDEWEB)

    Harman, K. M.; Lakey, L. T.; Leigh, I. W.; Jeffs, A. G.

    1985-07-01

    As the U. S. Department of Energy (DOE) and DOE contractors have increased the magnitude and scope of their cooperative activities with other nations in the nuclear fuel cycle and waste management field, a need has developed for ready sources of information concerning foreign waste management programs, DOE technology exchange policies, bilateral fuel cycle and waste management agreements and plans and activities to implement those agreements. The INFX (International InLormation E~change) Guide is one of a series of documents that have been prepared to provide that information. The INFX Guide has been compiled under the charter of PNL's International Support Office (IPSO) to maintain for DOE a center to collect, organize, evaluate and disseminate information on foreign and international radioactive waste management programs. Because the information in this document is constantly subject to change, the document is assembled in loose-leaf form to accommodate frequent updates.

  15. Bilateral segmental absence of the internal carotid artery with rete compensation associated with absence of basilar artery: case report.

    Science.gov (United States)

    Kim, Myoung Soo; Lee, Seung-Joon; Lee, Chae Heuck; Park, Hyo Il

    2006-06-01

    Bilateral ICA absence is a rare lesion. Collateral circulation to the middle and anterior cerebral arteries in the absence of one or both ICAs may develop transcranial anastomoses from the external carotid system, a so-called CRM. Very rarely, theses arterial channels are observed in humans. In the following case study, a 38-year-old man presented himself. He had a headache and scalp laceration after having had an accident. A right external carotid angiography identified anastomoses to distal intracranial vessel through the internal maxillary artery, but the intracranial vessels were only faintly visible. A right ascending pharyngeal arteriography showed an abnormal course and anastomoses with the intracranial vessel. The right ICA was absent. The left external carotid angiography demonstrated a network of tortous arteries in the region of the cavernous and petrous portion of ICA. The plexus of vessels on the left side communicated with the proximal part of the cavernous segment of the ICA. Both vertebral angiographies demonstrated a sudden diminution in caliber at the level of vertebrobasilar junction. There was an anomalous arterial collateral circulation originating from vertebral muscular and meningeal branch. There was also an absence of the basilar artery (BA). This is the first case with CRM associated with bilateral segmental ICA and BA absence. The cause of this bilateral segmental ICA and BA absence may be maldevelopment of vessel connective tissue or extracellular matrix.

  16. Bilateral dissection of the internal carotid artery at the base of the skull due to blunt trauma: incidence and severity.

    Science.gov (United States)

    Alimi, Y; Di Mauro, P; Tomachot, L; Albanese, J; Martin, C; Alliez, B; Juhan, C

    1998-11-01

    Between January 1, 1992 and December 31, 1996, a total of 1095 head trauma vicims were admitted in our intensive care unit. If CT scans demonstrated ischemic brain lesions, arteriography to visualize supraaortic vessels was performed. Carotid artery dissection was observed in ten patients (0.91%) and was bilateral in eight patients (0.73%). In the bilateral carotid artery dissection (BCAD) group, there were five women and three men, with a mean age of 35.2 years (range: 17 to 54 years). Injuries resulted from traffic accidents in seven patients and a fall in one patient. Upon admission, six patients presented with alteration of consciousness and three with hemiplegia or hemiparesia, associated with aphasia in two cases. In two other cases, hemiplegia occurred 24 hr and 13 days after the accident. All patients had brain infarction, which was unilateral in five cases and bilateral in three cases. The severity of lesions was graded on the basis of arteriographic findings as follows: Type I, wall involvement without significant stenosis or dilation; Type II, arterial dissection with stenosis >70% (Type IIA) or dilatation >50% (Type IIB) and the normal diameter of the proximal or distal internal carotid artery; and Type III, thrombosis of the internal carotid artery. Lesions were asymmetrical in six patients, including two with Type II and III lesions and four with Type I and II lesions, and symmetrical in two patients, including one with bilateral Type III lesions and one with bilateral Type II lesions. Surgery was performed in two patients with Type II lesions, including one case associated with contralateral carotid thrombosis. The intrapetrous carotid artery was exposed by an ear-nose-throat (ENT) surgeon and repaired by interposition grafting. Follow-up in these two surgical cases was 28 and 31 months. In the remaining six cases, medical treatment was performed. Outcome in nonsurgical cases was variable: death in two cases at 31 and 43 days after the accident

  17. A Procedure of Combination of Sequential Internal Thoracic Artery Grafting and Cooley's Technique for Complicated Case With Multi-vessel Disease,Left Ventricular Aneurysm and Mitral Regurgitation

    Institute of Scientific and Technical Information of China (English)

    Meng-ya LIANG; Guang-xian CHEN; Zhong-kai WU; Xi ZHANG

    2009-01-01

    @@ INTRODUCTION Left ventricular aneurysm and ischemic mitral regurgitation are two of most common complications of acute myocardial infarction (AMI).Combination of both these two fatal complications is not rare and the management of these complicated cases is always a challenge to cardiac surgeon because of its relatively high mortality[1]. We reported a rare case of AMI in which a singlestage correction of mitral valve replacement with preservation of mitral apparatus, sequential left internal thoracic artery (ITA) grafting and Cooley's technique.

  18. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma

    Science.gov (United States)

    Travis, William D.; Brambilla, Elisabeth; Noguchi, Masayuki; Nicholson, Andrew G.; Geisinger, Kim R.; Yatabe, Yasushi; Beer, David G.; Powell, Charles A.; Riely, Gregory J.; Van Schil, Paul E.; Garg, Kavita; Austin, John H. M.; Asamura, Hisao; Rusch, Valerie W.; Hirsch, Fred R.; Scagliotti, Giorgio; Mitsudomi, Tetsuya; Huber, Rudolf M.; Ishikawa, Yuichi; Jett, James; Sanchez-Cespedes, Montserrat; Sculier, Jean-Paul; Takahashi, Takashi; Tsuboi, Masahiro; Vansteenkiste, Johan; Wistuba, Ignacio; Yang, Pan-Chyr; Aberle, Denise; Brambilla, Christian; Flieder, Douglas; Franklin, Wilbur; Gazdar, Adi; Gould, Michael; Hasleton, Philip; Henderson, Douglas; Johnson, Bruce; Johnson, David; Kerr, Keith; Kuriyama, Keiko; Lee, Jin Soo; Miller, Vincent A.; Petersen, Iver; Roggli, Victor; Rosell, Rafael; Saijo, Nagahiro; Thunnissen, Erik; Tsao, Ming; Yankelewitz, David

    2015-01-01

    Introduction Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. Methods An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. Results The classification addresses both resection specimens, and small biopsies and cytology. The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with ≤5 mm invasion (MIA) to define patients who, if they undergo complete resection

  19. The Perils of Entanglement: Bilateral Donors, Faith-Based Organisations and International Development (abstract

    Directory of Open Access Journals (Sweden)

    Gerard Clarke

    2013-02-01

    Full Text Available The faith and development interface has become a significant feature of development discourse and policy over the last 15 years. While most of the recent literature treats it as a welcome and positive development, leading to productive engagement between donors and faith communities, the new interface has also proven challenging for donors and faith leaders alike. This chapter explores recent initiatives by European bilateral donors to engage with faith-based organisations (FBOs and efforts by faith communities to create conditions for productive engagement. It also examines some of the resulting controversies and suggests that both donors and FBOs have some distance to travel in creating the conditions and mechanisms that would enable them to work together effectively to combat poverty and social exclusion.

  20. The Sino-French 2012 Conference in Thoracic Oncology:an international academic platform for in-depth exchange on comprehensive research

    Institute of Scientific and Technical Information of China (English)

    Dong-Rong Situ; Philippe Dartevelle; Thierry Le Chevalier; Lan-Jun Zhang

    2013-01-01

    The Sino-French 2012 Conference in Thoracic Oncology,held November t7-18,2012,was hosted by the Department of Thoracic Surgery at Sun Yat-sen University Cancer Center and organized in collaboration with two prestigious French hospitals:Institute Gustave Roussy and Marie Lannelongue Hospital.The conference was established by leading experts from China and France to serve as an international academic platform for sharing novel findings in basic research and valuable clinical practice experiences.Hot topics including innovation in surgical techniques,diagnosis and staging of early-stage lung cancer,minimally invasive surgery,multidisciplinary treatment of lung cancer,and progress in radiotherapy for lung cancer were explored.Highlights of the conference presentations are summarized in this report.

  1. Endovascular Treatment of Isolated Bilateral Internal Ili- ac Artery Aneurysms with a Branched Endograft: A Case Report

    Directory of Open Access Journals (Sweden)

    SeyedEbrahim Kassaian

    2015-10-01

    Full Text Available Isolated bilateral internal iliac artery (IIA aneurysm is a rare and potentially lethal disease. Endovascular repair of this disorder is a matter of debate. A symptomatic 68-year-old male presented with severe pelvic pains. Computed tomography revealed a leaking 46-mm aneurysm in the right IIA, a 27-mm aneurysm in the left IIA, and ectatic changes at a diameter of 31 mm in the right common iliac artery (CIA. Due to lower rates of morbidity and mortality, an endovascular approach was chosen instead of open surgical repair. However, due to anatomical constraints, an endograft had to be implanted in a healthy aorta in order to support an iliac branch endograft in the left CIA. Subsequently, following coil embolization of the left IIA, an iliac stent graft was extended to the right external iliac artery (EIA. Two-year follow-up CT imaging showed complete exclusion of all the aneurysms and patency of the pelvic visceral arteries. The patient is currently asymptomatic.Endovascular repair of bilateral isolated IIAs can be a feasible treatment option. However, due to limited availability of sizes in iliac branch devices currently on the market, a main body device is sometimes required to be deployed in a healthy aorta for additional endograft support.

  2. The China-Canada Bilateral Investment Treaty after Its Signatures:A Comment Based on International Law

    Institute of Scientific and Technical Information of China (English)

    Kong Qingjiang

    2014-01-01

    As a result of the long-haul efforts, a bilateral invest-ment treaty was signed by China and Canada. Due to the inability to com-plete its domestic ratification procedure on the Canadian part, the treaty, which is supposed to facilitate the investment relationship between the two countries, is pending for its due effect. Contrary to the general expectation of Chinese scholars, prospective investors and possibly Chinese officials in-volved, there emerged arguments in Canada that the treaty warrants closer scrutiny . A brief legal analysis of the article shows that the investment trea-ty not only is not so distinguishable from other bilateral investment agree-ments but lags behind the investment chapter of the NAFTA to which Cana-da is a party for years. A further look at the critiques pinpoints that the ar-guments are unwarranted and many of them are either derivative from mis-understanding of the treaty or due to political bias. The article further ar-gues that, in accordance with both the customary rules of international law on signed but unratified treaties’ legal effect, as evidenced by Article 18 of the Vienna Convention on the Law of Treaties, and the discourses of the publicists in this regard, Canada shall refrain from taking measures against Chinese investors which contravene the aims and purpose of the BIT as the Chinese signatory is waiting for the BIT being given its due force.

  3. Diferenças histomorfométricas entre as artérias torácicas internas esquerda e direita em humanos Histomorphometric differences between the left and right internal thoracic arteries in humans

    Directory of Open Access Journals (Sweden)

    Maria Flavia L. Ribeiro

    2008-03-01

    Full Text Available OBJETIVO: O uso do enxerto de artéria torácica interna esquerda (ATIE é atualmente reconhecido como a melhor opção na cirurgia de revascularização miocárdica, proporcionando menor incidência tardia de eventos cardiovasculares e maior sobrevida. Conseqüentemente, houve grande incremento nas últimas décadas do uso bilateral das artérias torácicas internas (ATIs, com demonstração de melhora adicional de sobrevida em longo-termo. O objetivo desse trabalho foi estudar a estrutura histológica das ATIs esquerda e direita (ATID, com a análise histomorfométrica seqüencial e comparativa entre os segmentos das duas artérias. MÉTODOS: Foram estudados espécimes de ATIs retirados de 18 cadáveres, divididos em nove segmentos proporcionais. Cortes de cada segmento foram corados com técnica de hematoxilina-eosina e Verhoeff-Van Gieson. Foram analisados os seguintes parâmetros: perímetro da luz arterial, espessura da íntima, espessura da camada média e quantidade de fibras elásticas da camada média. RESULTADOS: O perímetro interno de ambas as ATIs diminuiu ao longo do percurso, dos segmentos mais proximais para os mais distais. Os segmentos proximais da ATID apresentaram perímetro significativamente maiores do que os da ATIE. A análise da espessura da íntima revelou não existir diferença significativa entre ATIE e ATID, exceto no segmento 1. A espessura da camada média diminuiu ao longo da extensão das ATIs, não havendo diferença estatística entre elas, exceto no segmento 9. O número de lâminas elásticas nos segmentos distais da ATIE foi estatisticamente superior ao da ATID. CONCLUSÃO: Portanto, os dados do presente estudo sugerem haver diferenças estruturais entre as ATIs direita e esquerda.OBJECTIVE: The use of the left internal thoracic artery in coronary artery bypass surgery is currently recognized as the best option, providing lesser incidence of cardiovascular events and superior long-term survival. As a

  4. Needlescopic video-assisted thoracic surgery for reversal of thoracic sympathectomy.

    Science.gov (United States)

    Wong, Randolph H L; Ng, Calvin S H; Wong, Jasper K W; Tsang, Susanna

    2012-03-01

    Thoracic sympathectomy is a commonly performed surgical procedure for the treatment of palmar hyperhidrosis. However, one major complication of such a procedure is compensatory truncal hyperhidrosis. We describe an extreme case of compensatory truncal hyperhidrosis and anhidrosis over the head and neck region which led to a heatstroke. Bilateral reoperative needlescopic video-assisted thoracic surgery was performed for the reversal of thoracic sympathectomy with an interposition intercostal nerve graft. The patient's truncal hyperhidrosis resolved gradually over 1 month following the reversal procedure.

  5. Laparoscopic repair of a bilateral internal inguinal hernia with supravesical hernia – a case report

    OpenAIRE

    2015-01-01

    Introduction: Supravesical hernia is an exceptional subtype of internal inguinal hernia, and it is located between the median umbilical ligament and the medial umbilical ligament. The hernia is classified as two types: internal supravesical hernia and external supravesical hernia. Presentation of case: Herein we report a rare case of external supravesical hernia successfully treated by laparoscopic procedure. The patient who complained right inguinal protrusion and mild frequent urination ...

  6. Multimodality approach in the diagnosis and management of bilateral giant juvenile breast fibroadenoma.

    Science.gov (United States)

    Rafeek, Noora; Rangasami, Rajeswaran; Dhanraj, Kamakshi; Joseph, Santhosh

    2016-10-06

    Juvenile giant fibroadenoma is a very rare breast disease affecting young girls of premenarche and adolescent ages. It is a benign fibroepithelial tumour characterised by stromal and epithelial proliferation that causes rapidly growing breast mass. Bilateral symmetrical involvement is extremely rare. In this article, we describe this entity in a girl aged 13 years who presented with bilateral gigantically enlarged breasts. Ultrasonography and MRI showed large, multilobulated masses involving both breasts entirely. Endovascular embolisation of bilateral internal mammary arteries and lateral thoracic arteries supplying the masses was performed prior to surgery to reduce their vascularity. The patient subsequently underwent excision of bilateral breast masses and reduction mammoplasty. Histopathologically, bilateral breast masses were confirmed to be juvenile fibroadenomas.

  7. Off-pump sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system

    Institute of Scientific and Technical Information of China (English)

    YU Yang; YAN Xiao-lei; WEI Hua; YANG Jun-feng; GU Cheng-xiong

    2011-01-01

    Background Off-pump coronary artery bypass surgery (OPCAB) has been widely applied in recent years as a less invasive method of myocardial revascularization. This study evaluated the sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system during OPCAB.Methods From April 2004 to August 2010, patients with diffuse right coronary lesions were studied retrospectively and divided into two groups. Group 1 included seventeen patients who underwent this surgery while group 2 included twenty-one patients without right coronary artery surgical therapy. All patients presented with symptoms of angina. Blood flow of bridged vessels was measured. The perioperative ventricular parameters including left ventricular ejection fraction and end diastolic diameter were compared. During follow-up, myocardial nuclide imaging and coronary angiography were carried out.Results Off-pump coronary artery bypass was performed with an average of 3.6 grafts per patient. Hospital mortality was zero. At the time of follow-up, the patients in group 1 recovered better than in group 2 (P<0.05). In both groups, the mean New York Heart Association (NYHA) class and ejection fraction increased significantly (P<0.001) and the mean left ventricular end-diastolic diameter decreased significantly (P <0.05). Myocardial blood supply of inferior wall in group 1 was obviously improved by myocardial nuclide imaging. Coronary angiography for eight patients in group 1 verified that there was blood flow to myocardium in the arterialized vein.Conclusions Sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during OPCAB. A postoperative improvement in the cardiac functions and the quality of life was documented, increasing our expectation for extensive application.

  8. Thoracic sympathectomy

    DEFF Research Database (Denmark)

    Hashmonai, Moshe; Cameron, Alan E P; Licht, Peter B

    2016-01-01

    for current practice. METHODS: The literature was reviewed using the PubMed/Medline Database, and pertinent articles regarding the indications for thoracic sympathectomy were retrieved and evaluated. Old, historical articles were also reviewed as required. RESULTS AND CONCLUSIONS: Currently, thoracic......BACKGROUND: Thoracic sympathetic ablation was introduced over a century ago. While some of the early indications have become obsolete, new ones have emerged. Sympathetic ablation is being still performed for some odd indications thus prompting the present study, which reviews the evidence base...... cases of angina, arrhythmias and cardiomyopathy. Thoracic sympathetic ablation is indicated in several painful conditions: the early stages of complex regional pain syndrome, erythromelalgia, and some pancreatic and other painful abdominal pathologies. Although ischaemia was historically the major...

  9. Thoracic Splenosis

    Directory of Open Access Journals (Sweden)

    Dr. Vandana Jeebun

    2006-01-01

    Full Text Available A 22-year old man presented with the history of productive cough and also complained of some weight loss. Examination was essentially unremarkable. On detailed investigations like chest X-ray, CT thorax, Fine Needle Aspiration Cytology, Tc-99m scan, a diagnosis of thoracic splenosis was then made. To conclude, thoracic splenosis is a rare entity that needs patient’s reassurance and radiological surveillance. It should also be considered as differential diagnoses of the pleural based masses.

  10. The International Trade Policy for Technology Transfers: Legal and Economic Dilemmas on Multilateralism versus Bilateralism

    DEFF Research Database (Denmark)

    Tang, Yi Shin

    In the book, the Researcher addresses the importance of international technology transfers for economic development, as well as the underlying causes for the different institutional arrangements that promote such activity. The work provides a systematic interpretation of the wide range of interests...

  11. Use of a retractor designed to harvest an internal thoracic artery graft during cardiac surgery for patients with a unilateral lung.

    Science.gov (United States)

    Suehiro, S; Shibata, T; Sasaki, Y; Murakami, T; Hosono, M; Fujii, H; Kinoshita, H

    1999-10-01

    Adequate exposure of the heart is required for safe cardiac surgery. We performed open heart surgery for 2 patients with a unilateral lung. In one patient, coronary artery bypass grafting was performed 13 years after left pneumonectomy for lung cancer. Mitral valve replacement was performed in the other patient whose left lung was entirely collapsed due to tuberculosis. The heart was markedly deviated to the left in both patients. A retractor designed to harvest the internal thoracic artery was very useful to obtain a good operative view of the heart. The operations were uncomplicated, and postoperative recovery was uneventful in both patients.

  12. Oclusão bilateral das artérias carótidas internas, sífilis meningovascular e SIDA: relato de caso Internal carotid bilateral occlusion, meningovascular syphilis and AIDS: case report

    Directory of Open Access Journals (Sweden)

    FLORISBERTO LAMBRECHT

    1999-06-01

    Full Text Available Relatamos um caso de obstrução bilateral na origem das artérias carótidas internas, apresentando como sinais/sintomas associados hemiparesia e hipoestesia superficial e profunda à direita, associada a sífilis meningovascular em paciente com SIDA. Tomografia de crânio apresentou pequenas lesões hipodensas, com predomínio à esquerda, e arteriografia evidenciou oclusão bilateral das artérias carótidas. A associação entre lues e SIDA não é infrequente, porém o quadro oligossintomático do paciente, provavelmente devido a oclusão arterial lenta e gradual chama a atenção.We report a case of bilateral occlusion of internal carotid arteries ,presenting with right hemiparesis and hypoesthesia, associated to meningovascular syphilis in a patient with AIDS. CT scan showed few small hypodense lesions, with a predominance on the left side, and the angiography showed bilateral occlusion of the carotid arteries. The association between syphilis and AIDS is not unusual, but the paucity of symptoms, probably due to a slow and gradual occlusion is not commonly reported.

  13. A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures

    Directory of Open Access Journals (Sweden)

    Gultekin Gulbahar

    2015-01-01

    Full Text Available First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

  14. Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

    Institute of Scientific and Technical Information of China (English)

    Xiang HU; Qiang ZHAO

    2011-01-01

    Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left antetior descending coronary arteries is unclear.This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library.Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years,there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right intemal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery

  15. Delayed pan-hypopituitarism as a complication following endovascular treatment of bilateral internal carotid artery aneurysms. A case report and review.

    Science.gov (United States)

    Hall, Jonathan; Caputo, Carmela; Chung, Carlos; Holt, Michael; Wang, Yi Yuen

    2015-04-01

    Pan-hypopituitarism has been reported in patients who are subsequently found to have a cerebral aneurysm and there have been reports of pituitary dysfunction immediately following both surgical and endovascular treatment. The authors report a rare case of delayed pan-hypopituitarism following endovascular treatment of bilateral internal carotid artery aneurysms with coil embolisation and flow-diverting stents.

  16. Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach.

    Science.gov (United States)

    Yi, Gijong; Shine, Brian; Rehman, Syed M; Altman, Douglas G; Taggart, David P

    2014-08-12

    Although the potential survival benefit of bilateral internal mammary artery (BIMA) grafting in comparison with single internal mammary artery (SIMA) grafting has been emphasized by many investigators, the use of BIMA is still low in clinical practice in the absence of randomized trials and long-term results. In the current study, we aimed to assess if there is a long-term survival benefit of BIMA up to 10 years after coronary bypass surgery. We selected published articles comparing survival between SIMA and BIMA patients with follow-up duration of more than a mean of 9 years. We evaluated the log hazard ratio with 95% confidence interval for included studies by using a random-effects meta-analysis. Nine eligible observational studies provided 15 583 patients (8270 SIMA and 7313 BIMA) for meta-analysis. Five studies used propensity score methods for statistical adjustment, 2 with a propensity score-based patient-matching method and 3 with quintile-based stratification. A significant reduction in mortality by using BIMA was observed (hazard ratio, 0.79; 95% confidence interval, 0.75-0.84); no study showed any significantly harmful effect of BIMA on survival. Subgroups of studies using different statistical approaches-unmatched, quintile-based propensity score analysis, and propensity score-based exact patient matching-all showed the survival benefit of BIMA grafting. BIMA grafting appears to have better survival with up to 10 years follow-up in comparison with SIMA grafting. Long-term survival benefit of BIMA seems to continue in the second decade after surgery. An ongoing randomized trial comparing SIMA and BIMA groups will add evidence on this issue. © 2014 American Heart Association, Inc.

  17. Prenatal diagnosis of bilateral pulmonary agenesis: a case report.

    Science.gov (United States)

    Lee, Kyung A; Cho, Jeong Yeon; Lee, Seung Mi; Jun, Jong Kwan; Kang, Jieun; Seo, Jeong-Wook

    2010-01-01

    We report a case of bilateral pulmonary agenesis (BPA), which was suspected during a prenatal US examination and diagnosed by fetal magnetic resonance imaging (MRI). BPA is an extremely rare congenital anomaly and, although many fetal structural defects can be detected with a high degree of confidence after introducing high-resolution US, the prenatal diagnosis of BPA remains problematic. Other thoracic abnormalities, such as a congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, and pulmonary sequestration, should be excluded from the list of possible diagnoses before coming to the conclusion of BPA, because BPA is absolutely incompatible with extrauterine life, and an accurate internal diagnosis can prevent a futile intervention from being performed.

  18. Prenatal Diagnosis of Bilateral Pulmonary Agenesis: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung A; Cho, Jeong Yeon; Lee, Seung Mi; Jun, Jong Kwan; Kang, Ji Eun; Seo, Jeong Wook [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    We report a case of bilateral pulmonary agenesis (BPA), which was suspected during a prenatal US examination and diagnosed by fetal magnetic resonance imaging (MRI). BPA is an extremely rare congenital anomaly and, although many fetal structural defects can be detected with a high degree of confidence after introducing high-resolution US, the prenatal diagnosis of BPA remains problematic. Other thoracic abnormalities, such as a congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, and pulmonary sequestration, should be excluded from the list of possible diagnoses before coming to the conclusion of BPA, because BPA is absolutely incompatible with extrauterine life, and an accurate internal diagnosis can prevent a futile intervention from being performed.

  19. Thoracic Sympathectomy for Severe Refractory Multivessel Coronary Artery Spasm.

    Science.gov (United States)

    Cardona-Guarache, Ricardo; Pozen, Jonah; Jahangiri, Arehzo; Koneru, Jayanthi; Shepard, Richard; Roberts, Charlotte; Abbate, Antonio; Cassano, Anthony

    2016-01-01

    Coronary artery spasm is a rare but potentially fatal disease. Herein, we report a case of recurrent ST-segment myocardial infarctions and ventricular fibrillation complicating severe multivessel coronary artery spasm successfully treated with bilateral thoracic surgical sympathectomy.

  20. The second best arterial graft: a propensity analysis of the radial artery versus the free right internal thoracic artery to bypass the circumflex coronary artery.

    Science.gov (United States)

    Tranbaugh, Robert F; Dimitrova, Kamellia R; Lucido, David J; Hoffman, Darryl M; Dincheva, Gabriela R; Geller, Charles M; Balaram, Sandhya K; Ko, Wilson; Swistel, Daniel G

    2014-01-01

    We sought to determine if the radial artery (RA) or the free right internal thoracic artery (RITA) is the better conduit to bypass the circumflex coronary artery during coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA). Propensity matching was performed on 2488 CABG-LITA patients from 2 affiliated centers, resulting in 528 pairs who received either a RA at one center or a free RITA at the other center to bypass the circumflex coronary artery from 1995 to 2009. Kaplan Meier estimated 1-, 5-, 10-, and 15-year survival rates were 99%, 95%, 85%, and 76% for RA patients, respectively, and 97%, 92%, 80%, and 71% for RITA patients, respectively (P = .060). Major adverse events (MAEs) were fewer in the RA group (7.6% vs 14.0%; P = .001) and use of the RA was a significant predictor of reduced MAEs (odds ratio [OR], 0.48; P = .002) in all patients and especially in diabetic (OR, 0.32; P = .003), older (OR, 0.40; P = .009), obese (OR, 0.15; P < .001), and chronic obstructive pulmonary disease (COPD) (OR, 0.05; P = .016) patients. However, survival was better with RA only in COPD (hazard ratio, 0.49; P = .045) and older (hazard ratio, 0.71; P = .050) patients. Overall RA patency (83.9%) was similar to RITA patency (87.4%) at a mean of 5.1 ± 3.8 years (P = .155). Long-term survival is similar in CABG-LITA patients using either a RA or free RITA graft to bypass the circumflex coronary artery. RA grafting has fewer MAEs, a similar patency to RITA, and improves survival in older and COPD patients. The choice of the second arterial conduit should be guided by patient profiles and surgeon preferences. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  1. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis.

    Science.gov (United States)

    Buttar, Sana N; Yan, Tristan D; Taggart, David P; Tian, David H

    2017-09-01

    A substantial body of evidence demonstrates that myocardial revascularisation using bilateral internal mammary arteries (BIMA) improves long-term survival compared with single/left internal mammary artery (LIMA) grafting. To date, limited analyses have been made regarding other short-term and long-term outcomes in BIMA strategy. The primary aim of the present review is to update the difference in long-term survival between BIMA and LIMA grafting and to thoroughly investigate other secondary short-term and long-term clinical outcomes between these two grafting procedures. Electronic searches were performed using three databases from their inception to November 2015. Relevant studies comparing long-term survival between BIMA and LIMA grafting were identified. Data were extracted by two independent reviewers and analysed according to predefined clinical outcomes. Twenty-nine observational studies were identified, with a total of 89 399 patients. Overall, BIMA cohort had significantly improved long-term survival compared with LIMA cohort (HR 0.78; p<0.00001). BIMA cohort also had significantly reduced hospital mortality rates (1.2% vs 2.1%, p=0.04), cerebrovascular accidents (1.3% vs 2.9%, p=0.0003) and need for revascularisation (4.8% vs 10%, p=0.005), although the incidence of deep sternal wound infection (DSWI) was increased (1.8% vs 1.4%, p=0.0008) in this grafting strategy. Long-term cardiac-free, myocardial infarction-free and angina-free survivals were also superior for the BIMA cohort. BIMA grafting is associated with enhanced overall long-term outcomes compared with LIMA grafting. While the BIMA cohort demonstrates an increased incidence of DSWI, the survival benefits and other morbidity advantages outweigh this short-term risk. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Growth hormone abuse and bodybuilding as aetiological factors in the development of bilateral internal laryngocoeles. A case report.

    Science.gov (United States)

    Moor, James W; Khan, M Iqbal J

    2005-07-01

    A 36-year-old man presented with hoarseness and stridor. He was an elite professional bodybuilder and admitted to having abusing anabolic steroids and growth hormone in the recent past. A CT scan showed bilateral laryngocoeles. The patient was initially managed with intravenous corticosteroids and broad-spectrum antibiotics, and the stridor resolved sufficiently to permit discharge from the hospital. He proceeded to undergo endoscopic marsupialisation of his laryngocoeles and to date has made a full recovery. This is the first reported case where anabolic steroid and growth hormone abuse combined with an elite bodybuilder's exercise regime has been implicated in the aetiology of bilateral laryngocoeles.

  3. The use of the Thoracic Morbidity and Mortality system for the internal analysis of performance: a case-matched temporal audit.

    Science.gov (United States)

    Salati, Michele; Pompili, Cecilia; Refai, Majed; Xiumè, Francesco; Sabbatini, Armando; Brunelli, Alessandro

    2014-05-01

    The aim of the present study was to evaluate the usefulness of the Thoracic Morbidity and Mortality (TMM) scoring system in auditing the quality of care of our unit. We analysed the performance of our unit comparing the incidence of complications and mortality occurring after anatomic lung resections during two different periods: early period (January 2000 to December 2009: 830 lobectomy, 134 pneumonectomy and 78 segmentectomy) and recent period (January 2010 to August 2012: 191 lobectomy, 8 pneumonectomy and 19 segmentectomy). The cardiopulmonary complications as traditionally defined in the European Society of Thoracic Surgeons (ESTS) database were also classified according to the TMM system: this method grades the postoperative adverse events from 1 to 5 reflecting an increasing severity of management regardless the type of complication. Complications graded higher than 2 are regarded as major complications. To account for confounders, several baseline and surgical factors were used to build a propensity score that was applied to match the patients of the most recent group with their early-group counterparts. These two matched groups were compared in terms of cardiopulmonary morbidity (codified by ESTS definitions) and mortality rates and incidence of major complications according to the TMM system. The propensity score analysis yielded 209 well-matched pairs of patients operated on in the two periods. The two groups had similar rates of ESTS-defined cardiopulmonary complications (recent: 38 patients vs early: 37 patients, P = 0.9). The use of the TMM system revealed a higher incidence of major (grade > 2) complications rate in the recent period (recent: 29 patients vs early: 14 patients, P = 0.02). The TMM scoring system for classifying the postoperative complications revealed a decline of quality of care of our unit otherwise undetected by applying traditional outcome measures. This tool can be used as an additional graded outcome endpoint to refine internal

  4. [Bilateral blood pressure measurement before and after coronary bypass surgery: an absolute necessity].

    Science.gov (United States)

    Ernst, J M; van Bergen, P F; Schepens, M A; Brutel de la Rivière, A; Plokker, H W

    1999-09-11

    Anginous symptoms and a difference in blood pressure between the two arms prompted angiography in two patients, men aged 66 and 50 years. The examination revealed coronary sclerosis and a stenosis in the left subclavian artery. The symptoms disappeared after percutaneous dilatation of the subclavian artery, followed by a coronary bypass operation (CABG) using an internal thoracic artery (a branch of the subclavian artery). In two other patients, men aged 61 and 71 years, who had undergone an arterial CABG 12 years previously, anginous symptoms were the manifestation of a narrowed subclavian artery. The symptoms disappeared after balloon dilatation of the subclavian artery and revascularization of the anterior interventricular branch (left artery descendens) and embolization of the internal thoracic artery graft (internal mammarian artery graft), respectively. Stenosis or occlusion of the proximal subclavian artery may attenuate the blood flow in the ipsilateral A. thoracica interna graft. The diagnosis can simply be made by bilateral blood pressure measurement.

  5. Effect of bilateral thoracic sympathectomy with single hole and thoracoscopy in palmar hyperhidrosis patients%单孔法胸腔镜下双侧胸交感神经链切断术治疗手汗症疗效观察

    Institute of Scientific and Technical Information of China (English)

    蒋仲敏; 朱强; 臧琦; 王伟

    2011-01-01

    Objective To observe the effect of bilateral thoracic sympathectomy with single hole and thoracoscopy in palmar hyperhidrosis patients. Method 105 palmar hyperhidrosis patients were underwent general anesthesia with tracheal intubation. Bilateral thoracic sympathectomy were underwent with single hole (the diameter was 5 mm) and thoracoscopy. Result All the operation were favorable. After operation, the symptom disappeared . The average operation time was 24 min.and the temperature increased for 2. 6 t. The chest wall incision pain score was 3. 0 ±0. 6,and the average hospital stay time was 1.5. The scar disapeared 3 months after operation. Conclusion The effect of bilateral thoracic sympathectomy with single hole and thoracoscopy in palmar hyperhidrosis patients is satisfactory.%目的 观察单孔法胸交感神经链切断术治疗原发性手汗症的手术可行性和疗效.方法 在全麻单腔气管插管下,通过单孔(直径5 mm)途径于针状胸腔镜下行双侧胸交感神经链切断术治疗原发性手汗症105例.结果 手术均顺利.术后全部患者手部多汗症状全部消失,平均手术时间(双侧)24 min,手温平均升高2.6℃.术后24 h胸壁切口处疼痛评分(3.0±0.6)分.术后住院时间平均1.5d.术后3个月切口疤痕几乎消失.结论 单孔法胸腔镜下双侧胸交感神经链切断术治疗原发性手汗症方法可行,疗效满意.

  6. Bilateral internal carotid artery and vertebral artery dissections with retinal artery occlusion after a roller coaster ride - case report and a review.

    Science.gov (United States)

    Ozkan Arat, Yonca; Volpi, John; Arat, Anıl; Klucznik, Richard; Diaz, Orlando

    2011-01-01

    We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides.

  7. Dez anos de experiência com artéria torácica interna direita através do seio transverso na revascularização da artéria circunflexa e seus ramos Ten years of experience with the right thoracic internal artery through transversus sinus in the left circunflex artery and his branches

    Directory of Open Access Journals (Sweden)

    Luís Roberto Gerola

    1993-12-01

    angioplastia, 7 apresentaram infarto do miocárdio não fatal e 1 paciente foi reoperado por oclusão das duas artérias torácicas internas. Foram realizados 69 cateterismos pós-operatórios, sendo 38 imediatos e 31 tardios, num período que variou de 3 a 120 meses (média de 51,6 meses. No período pós-operatório imediato, ATIE estava pérvia em 37 casos (97% e a ATID em 36 (95%. No reestudo tardio, a ATIE estava pérvia em 30 pacientes (97% e a ATID em 29 (92,7%. A análise atuarial mostrou que a percentagem de casos que apresentavam a ATIE pérvia foi de 97,6% em 1 ano e de 93,8% aos 5-10 anos de seguimento, enquanto que a incidência de casos em que a ATID estava pérvia foi de 92,1% em 1 ano e de 84,1% em 5 e 10 anos. Os resultados apresentados mostram que a revascularização de ramos da artéria coronária esquerda com as ATI E e ATI D proporciona aos pacientes uma boa evolução tardia, em decorrência da baixa incidência de eventos cardíacos durante o período estudado. A alta incidência de enxertos pérvios em 10 anos, com a utilização da ATID posicionada através do seio transverso, sugere que esta opção técnica deve ser sempre lembrada na revascularização da artéria circunflexa e seus ramos.From April 1983 to November 1993,185 patients were submitted to myocardial revascularization using bilateral thoracic internal artery. The left internal thoracic artery was used to left anterior descending artery and the right internal thoracic artery was used through transversus sinus to circunflex artery and his branches. We performed 38 angiographic studies during the late follow-up and demonstrated that the right internal thoracic artery was patent in 29 patients (92.7% and the left internal thoracic artery in 30 (97%. We conclude that myocardial revascularyzation should be performed using bilateral internal thoracic artery routinely.

  8. Trajeto extrapleural, para-hilar da artéria torácica interna esquerda pediculada nos enxertos coronarianos The positioning of the internal thoracic artery extra-pleural and perihilar in coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Hermes de Souza Felippe

    2012-12-01

    Full Text Available Variante técnica relacionada ao posicionamento da artéria torácica interna esquerda pediculada extrapleural e para-hilar, evitando aderências ao mediastino anterior e protegendo o enxerto de possíveis lesões durante eventuais reoperações.The positioning of the internal thoracic artery extra-pleural and perihilar in coronary artery bypass grafting to avoiding anterior aderences and prevent unnecessary damage arterial.

  9. Histomorphometric analysis of newly formed bone after bilateral maxillary sinus augmentation using two different osteoconductive materials and internal collagen membrane.

    Science.gov (United States)

    Kolerman, Roni; Samorodnitzky-Naveh, Gili R; Barnea, Eitan; Tal, Haim

    2012-02-01

    Deproteinized bovine bone mineral (DBBM) and human freeze-dried bone allograft (FDBA) were compared in five patients undergoing bilateral maxillary sinus floor augmentation using DBBM on one side and FDBA on the contralateral side. After 9 months, core biopsy specimens were harvested. Mean newly formed bone values were 31.8% and 27.2% at FDBA and DBBM sites, respectively (P = .451); mean residual graft particle values were 21.5% and 24.2%, respectively (P = .619); and mean connective tissue values were 46.7% and 48.6%, respectively (P = .566). Within the limits of the present study, it is suggested that both graft materials are equally suitable for sinus augmentation.

  10. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias.

    Science.gov (United States)

    Travis, William D; Costabel, Ulrich; Hansell, David M; King, Talmadge E; Lynch, David A; Nicholson, Andrew G; Ryerson, Christopher J; Ryu, Jay H; Selman, Moisés; Wells, Athol U; Behr, Jurgen; Bouros, Demosthenes; Brown, Kevin K; Colby, Thomas V; Collard, Harold R; Cordeiro, Carlos Robalo; Cottin, Vincent; Crestani, Bruno; Drent, Marjolein; Dudden, Rosalind F; Egan, Jim; Flaherty, Kevin; Hogaboam, Cory; Inoue, Yoshikazu; Johkoh, Takeshi; Kim, Dong Soon; Kitaichi, Masanori; Loyd, James; Martinez, Fernando J; Myers, Jeffrey; Protzko, Shandra; Raghu, Ganesh; Richeldi, Luca; Sverzellati, Nicola; Swigris, Jeffrey; Valeyre, Dominique

    2013-09-15

    In 2002 the American Thoracic Society/European Respiratory Society (ATS/ERS) classification of idiopathic interstitial pneumonias (IIPs) defined seven specific entities, and provided standardized terminology and diagnostic criteria. In addition, the historical "gold standard" of histologic diagnosis was replaced by a multidisciplinary approach. Since 2002 many publications have provided new information about IIPs. The objective of this statement is to update the 2002 ATS/ERS classification of IIPs. An international multidisciplinary panel was formed and developed key questions that were addressed through a review of the literature published between 2000 and 2011. Substantial progress has been made in IIPs since the previous classification. Nonspecific interstitial pneumonia is now better defined. Respiratory bronchiolitis-interstitial lung disease is now commonly diagnosed without surgical biopsy. The clinical course of idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia is recognized to be heterogeneous. Acute exacerbation of IIPs is now well defined. A substantial percentage of patients with IIP are difficult to classify, often due to mixed patterns of lung injury. A classification based on observed disease behavior is proposed for patients who are difficult to classify or for entities with heterogeneity in clinical course. A group of rare entities, including pleuroparenchymal fibroelastosis and rare histologic patterns, is introduced. The rapidly evolving field of molecular markers is reviewed with the intent of promoting additional investigations that may help in determining diagnosis, and potentially prognosis and treatment. This update is a supplement to the previous 2002 IIP classification document. It outlines advances in the past decade and potential areas for future investigation.

  11. Evaluation of false-positive results on Tc myocardial scintigraphy in patients with coronary artery bypass grafting including left internal thoracic artery-left anterior descending artery grafting

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Koichi; Shibata, Takahiro [Jikei Univ., Tokyo (Japan). School of Medicine; Imai, Kamon

    2000-11-01

    Stress myocardial scintigraphy in patients who have undergone coronary artery bypass grafting (CABG) frequently shows false-positive results. To investigate the reason for these false-positive results, two different stress tests-adenosine triphosphate (ATP) stress testing and ergometer exercise testing, and Tc-tetrofosmin myocardial scintigraphy were performed with a 1-day stress/rest protocol. The subjects were 6 patients with a history of myocardial infarction (MI) and 14 patients with a history of angina pectoris (AP) who had undergone CABG that included left internal thoracic artery-left anterior descending artery grafting. Graft patency was confirmed with coronary angiography. Short-axis images were reconstructed with single photon emission tomography. The severity of perfusion defects on short-axis images was evaluated quantitatively with a normal database as severity score, and the difference in severity score between stress and rest was defined as fill-in. Fill-in on the ATP stress test was 3.1{+-}7.0 in the AP group and 16.3{+-}13.2 in the MI group (p<0.01). Fill-in on the exercise stress test was 2.7{+-}8.3 in the AP group and 34.8{+-}20.6 in the MI group (p<0.01). In the MI group, fill-in on the exercise stress test was significantly greater than that on the ATP stress test (p<0.05). The exercise time and the amount of exercise stress in patients with MI were significantly greater than those in patients with AP. In conclusion, coronary flow reserve may play a role in false positive-finding on myocardial perfusion scintigraphy in patients who have undergone CABG. (author)

  12. Extradural synovial thoracic cyst.

    Science.gov (United States)

    Hodges, S D; Fronczak, S; Zindrick, M R; Lorenz, M A; Vrbos, L A

    1994-11-01

    SUMMARY OF BACKGROUND DATA. Case studies documenting the incidence of thoracic intraspinal, extradural synovial cysts are limited. The occurrence of synovial cysts is associated with varied symptoms that differ among cervical, thoracic, and lumbar regions. The clinical appearance may be similar to other spinal diseases. METHODS. This report describes symptoms exhibited by and care provided for a patient with extradural synovial thoracic cyst.

  13. Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity-matched analysis.

    Science.gov (United States)

    Ogawa, Shinji; Okawa, Yasuhide; Sawada, Koshi; Goto, Yoshihiro; Yamamoto, Masanori; Koyama, Yutaka; Baba, Hiroshi; Suzuki, Takahiko

    2016-02-01

    Deep sternal wound infection (DSWI), especially in patients with diabetes mellitus (DM), is a major concern after coronary artery bypass grafting (CABG) with bilateral internal mammary artery (BIMA) grafts. We evaluated the risk of DSWI and other clinical outcomes between continuous insulin infusion therapy (CIT) and insulin sliding scale therapy (IST) in a cohort of DM patients who underwent CABG with BIMA. The clinical records of DM patients who underwent isolated CABG with BIMA were retrospectively reviewed. The study population consisted of 95 patients who received CIT and 126 patients who received IST. Furthermore, a one-to-one matched analysis based on estimated propensity scores for patients who received CIT or IST yielded two groups comprising 58 patients each. The proportion of patients with DSWI, overall survival rates and major adverse cardiac events were compared between the two groups in the overall and the propensity-matching cohort. The prevalence of DSWI requiring debridement and closure was significantly reduced in the CIT group compared with that in the IST group [1/95 (1.1%) vs 9/126 (7.1%), P = 0.031]; these results were not attenuated even after propensity-matching analysis [0/58 (0%) vs 6/58 (10.3%), P = 0.031]. The mean preoperative glucose levels were similar between the two groups (157.5 ± 54.6 vs 176.1 ± ±70 mg/dl, P = 0.063), whereas the mean glucose values were significantly lower on the first and second operative days in the CIT group than in the IST group (132.9 ± 44.1 vs 197.8 ± 78.6 mg/dl, P propensity-matching models. The CIT approach reduced the variability in glucose concentration and resulted in fewer instances of DSWI after CABG with BIMA grafts. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. Bilateral Distal Femoral Nailing in a Rare Symmetrical Periprosthetic Knee Fracture

    Directory of Open Access Journals (Sweden)

    Marcos Carvalho

    2014-01-01

    Full Text Available The authors report a case of a 78-year-old polytrauma patient, with severe thoracic trauma and bilateral symmetrical periprosthetic femoral fractures after a violent car accident. After the primary survey, with the thoracic trauma stabilized, neurovascular lesions excluded, and provisional immobilization applied, both fractures were classified as OTA: 33-A3, Rorabeck Type II, and closed reduction and internal fixation with distal femoral nails were performed. At 5 months of follow-up, the patient was able to walk with crutches and clear radiologic signs of fracture consolidation could be seen. At 24 months, the patient walked without any walking aid and had recovered her previous functional status. This surgical option allowed the authors to achieve relative stability using an intramedullary technique, preserving fracture hematoma in an osteopenic patient, and was found to be successful in recovering the patient’s previous functional status and satisfaction after major trauma.

  15. Impact of lumbar spine posture on thoracic spine motion and muscle activation patterns.

    Science.gov (United States)

    Nairn, Brian C; Drake, Janessa D M

    2014-10-01

    Complex motion during standing is typical in daily living and requires movement of both the thoracic and lumbar spine; however, the effects of lumbar spine posture on thoracic spine motion patterns remain unclear. Thirteen males moved to six positions involving different lumbar (neutral and flexed) and thoracic (flexed and twisted) posture combinations. The thoracic spine was partitioned into three segments and the range of motion from each posture was calculated. Electromyographical data were collected from eight muscles bilaterally. Results showed that with a flexed lumbar spine, the lower-thoracic region had 14.83 ° and 15.6 1 ° more flexion than the upper- and mid-thoracic regions, respectively. A flexed lumbar spine significantly reduced the mid-thoracic axial twist angle by 5.21 ° compared to maximum twist in the mid-thoracic region. Functional differences emerged across muscles, as low back musculature was greatest in maintaining flexed lumbar postures, while thoracic erector spinae and abdominals showed bilateral differences with greater activations to the ipsilateral side. Combined postures have been previously identified as potential injury modulators and bilateral muscle patterns can have an effect on loading pathways. Overall, changes in thoracic motion were modified by lumbar spine posture, highlighting the importance of considering a multi-segmented approach when analyzing trunk motion. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Bilateral surgical reconstruction for internal jugular veins disease in patients with chronic cerebrospinal venous insufficiency and associated multiple sclerosis.

    Science.gov (United States)

    Spagnolo, Salvatore; Scalise, Filippo; Barbato, Luciano; Grasso, Maria Antonietta; Tesler, Ugo F

    2014-10-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by morphologic alterations involving efferent cerebral vascular paths. CCSVI has been implicated as a contributing factor to multiple sclerosis (MS) but this theory is highly controversial. We report 3 cases of CCSVI patients with MS who had undergone internal jugular veins (IJVs) angioplasty to restore vessels patency. All patients reported significant symptomatic improvement after angioplasty until symptoms recurred after restenosis of the treated IJVs. Surgical IJVs reconstruction was performed. Patients' symptoms gradually improved and the benefits were maintained at the 1-year follow-up.

  17. Thoracic spine pain

    Directory of Open Access Journals (Sweden)

    Aleksey Ivanovich Isaikin

    2013-01-01

    Full Text Available Thoracic spine pain, or thoracalgia, is one of the common reasons for seeking for medical advice. The epidemiology and semiotics of pain in the thoracic spine unlike in those in the cervical and lumbar spine have not been inadequately studied. The causes of thoracic spine pain are varied: diseases of the cardiovascular, gastrointestinal, pulmonary, and renal systems, injuries to the musculoskeletal structures of the cervical and thoracic portions, which require a thorough differential diagnosis. Facet, costotransverse, and costovertebral joint injuries and myofascial syndrome are the most common causes of musculoskeletal (nonspecific pain in the thoracic spine. True radicular pain is rarely encountered. Traditionally, treatment for thoracalgia includes a combination of non-drug and drug therapies. The cyclooxygenase 2 inhibitor meloxicam (movalis may be the drug of choice in the treatment of musculoskeletal pain.

  18. Imaging of thoracic textiloma.

    Science.gov (United States)

    Ridene, Imene; Hantous-Zannad, Saoussen; Zidi, Asma; Smati, Belhassen; Baccouche, Ines; Kilani, Tarek; Ben Miled-M'rad, Khaoula

    2011-03-01

    Intrathoracic textiloma or gossypiboma, a retained surgical sponge in the thoracic cavity, is an exceptional but serious complication following thoracic or abdominal surgery. The purpose of this work is to highlight the topographic features of thoracic textiloma and to describe imaging aspects, and, particularly, computed tomography (CT) features. Eight patients have been operated in our thoracic surgery department for thoracic gossypiboma. In the past, three patients had undergone hepatic surgery and the five others had a history of thoracic surgery. All the patients had a chest radiograph, five of them had a thoracic ultrasonography, all had a chest CT, and one patient had a chest magnetic resonance imaging (MRI). In patients with a history of abdominal surgery, the foreign body was located in the parenchyma of the right lower lobe. In the other patients, the foreign body was either intrapleural or mediastinal. Ultrasonography suggested the diagnosis of textiloma in three of the five patients by demonstrating a non-calcified hyperechoic mass with acoustic shadow. At CT, the gossypiboma was a low-attenuating mass containing trapped gas lucencies in six patients and it was a high-attenuating mass in two patients. MRI showed a diaphragmatic defect in one patient with an intrapulmonary gossypiboma that migrated from the abdomen. The CT aspect of thoracic gossypiboma may be different according to pleural or parenchymal location. The spongiform appearance, characteristic in abdominal gossypiboma, is not the only CT presentation of thoracic gossypiboma. The confrontation of the surgical history with the CT signs helps to have a preoperative diagnosis. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  19. Surgical thoracic sympathectomy induces structural and biomechanical remodeling of the thoracic aorta in a porcine model.

    Science.gov (United States)

    Angouras, Dimitrios C; Dosios, Theodosios J; Dimitriou, Constantinos A; Chamogeorgakis, Themistocles P; Rokkas, Chris K; Manos, Themistoklis A; Sokolis, Dimitrios P

    2012-01-01

    Sympathetic innervation exerts marked effects on vascular smooth muscle cells, including a short-term homeostatic (vasoconstrictor) and a direct trophic action promoting differentiation. However, the role of sympathetic nervous system in long-term structural and functional modulation of the aortic wall is yet undefined. Six Landrace pigs underwent bilateral thoracic sympathectomy from the stellate to T8 ganglion, whereas 10 pigs underwent sham operation. Animals were sacrificed 3 mo postoperatively. Histometrical examination was performed on specimens from the thoracic (TA) and abdominal aorta (AA) utilizing an image-processing system. A uniaxial tensile tester was utilized for biomechanical evaluation; parameters of extensibility, strength, and stiffness of aortic tissue were calculated. Structural aortic remodeling of sympathectomized animals was observed, including increased inner aortic diameter in TA (15.3 ± 0.4 versus 10.4 ± 0.2 mm, P sympathectomy, TA was equally extensible but manifested augmented strength (1344 ± 73 versus 1071 ± 52 kPa, P = 0.004) and stiffness (6738 ± 478 versus 5026 ± 273 kPa, P = 0.003), in accordance with extracellular matrix protein accumulation in that region. Differences in the AA were non-significant. Chronic thoracic sympathetic denervation causes significant structural and biomechanical remodeling of the thoracic aorta. Possible clinical implications for patients undergoing thoracic sympathectomy or chronically treated with sympathetic blockers require further investigation. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Information Update Research Fellowship for International Young Scientists NSFC Announced Results of Preliminary Evaluation of Bilateral Cooperative Research Projects With Danish National Research Foundation NSFC Announced Results of Preliminary Evaluation of Bilateral Cooperative Research Projects with DFG News in Brief: NSFC set up Department of Medical Sciences NSFC Announced Approved Cooperative Projects With France and Germany NSFC Announced Results of Preliminary Evaluation of Bilateral Cooperative Research Projects With Academy of Finland NSFC Announced Application Guide for Cooperative Research Projects with K. T. Li Foundation NSFC Announced Results of Preliminary Evaluation of Bilateral Cooperative Research projects With Japan Science and Technology Agency NSFC Announced Application Guide for Cooperative Research Projects With Royal Society of Edinburgh for 2010 NSFC Announced a List of proved Cooperative Projects With Three International Organizations

    Science.gov (United States)

    2009-01-01

    Research Fellowship for International Young Scientists NSFC Announced Results of Preliminary Evaluation of Bilateral Cooperative Research Projects With Danish National Research Foundation NSFC Announced Results of Preliminary Evaluation of Bilateral Cooperative Research Projects with DFG News in Brief: NSFC set up Department of Medical Sciences NSFC Announced Approved Cooperative Projects With France and Germany NSFC Announced Results of Preliminary Evaluation of Bilateral Cooperative Research Projects With Academy of Finland NSFC Announced Application Guide for Cooperative Research Projects with K. T. Li Foundation NSFC Announced Results of Preliminary Evaluation of Bilateral Cooperative Research projects With Japan Science and Technology Agency NSFC Announced Application Guide for Cooperative Research Projects With Royal Society of Edinburgh for 2010 NSFC Announced a List of proved Cooperative Projects With Three International Organizations

  1. 后路内固定融合术治疗脊柱胸腰段骨折的疗效观察%The curative effect observation on arthrodesis posterior internal fixation used in thoracic lumbar spine fractures

    Institute of Scientific and Technical Information of China (English)

    林建新; 林建民; 肖胜捷

    2014-01-01

    目的:探讨胸腰椎段骨折采用后路内固定融合术治疗的效果。方法选取胸腰椎段骨折患者90例,研究组(50例)采用后路内固定融合术治疗,对照组(40例)采用前路内固定术治疗,对比两组术前术后神经功能与伤椎情况,手术效果以及不良情况。结果研究组的神经功能与伤椎情况改善均更显著;研究组总有效率为94.0%;对照组为82.5%;研究组不良情况率为2.0%,对照组为10.0%;研究组手术效果明显更优( P<0.05)。结论胸腰椎段骨折采用后路内固定融合术治疗,效果显著,安全性高,值得临床推广应用。%Objective To discuss the curative effect of arthrodesis posterior internal fixation used in thoracic lumbar spine fractures. Methods 90 cases of patients with thoracic lumbar spine fractures were selected,the research group(50cases) were cured by arthrodesis posterior internal fixation,the control group(40cases)were cured by anterior fixation,then compared the situation of nerve function and injured vertebral before and after operation,surgical effect and adverse conditions. Results After the operation,the situation of nerve function and injured vertebral of the research group all improved more apparently;the total effective rate of the research group was 94.0%,and the rate of the control group was 82.5%;the rate of adverse situation of the research group was 2.0%.and the rate of the control group was 10.0%;the surgical effect of the research group was significantly better(P < 0.05). Conclusion The curative effect on arthrodesis posterior internal fixation used in thoracic lumbar spine fractures is significant,and there has high safety,it is worth promoting.

  2. THORACIC AND CARDIOVASCULAR SURGERY

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    5.2 Upper respiratory tract, lung960697 Analysis of surgical treatment in474 patients with small cell lung cancer. BaiLianqi (白连启), et al. Beijing Res Inst TuberThorac Tumor, Beijing 101149. Chin J ThoracCardiovasc Surg 1996; 12(4): 211-213 The author summarized the effect and indi-cation of surgical resection of small cell lungcancer in 474 patients from 1957 to the end of

  3. Dissecção robótica da artéria torácica interna direita por esternotomia mediana Robotic dissection of the right internal thoracic artery through median sternotomy

    Directory of Open Access Journals (Sweden)

    Fabio Biscegli Jatene

    2010-06-01

    Full Text Available A utilização de sistemas robóticos em cirurgia cardíaca visa à diminuição do trauma operatório. A revascularização do miocárdio totalmente endoscópica, assistida por robô DaVinci (Intuitive Surgical, Sunnyvale, Califórnia é factível e seu aprendizado deve ser realizado em etapas. O primeiro passo é o preparo da artéria torácica interna esquerda, já por via totalmente endoscópica. O caso apresentado propõe a dissecção da artéria torácica interna direita por esternotomia completa. Propõe um novo passo rumo ao procedimento completamente endoscópico, visando à diminuição de lesões decorrentes da curva de aprendizado.The use of robotic systems in cardiac surgeries aims at decreasing the surgical trauma.The use of robotic systems in cardiac surgeries aims at decreasing the surgical trauma. The totally endoscopic myocardial revascularization, assisted by the DaVinci robot (Intuitive Surgical, Sunnyvale, California is feasible and the learning process must be carried out in steps. The first step is the preparation of the left internal thoracic artery, through the totally endoscopic approach. The case presented here proposes the dissection of the right internal thoracic artery through complete sternotomy. It proposes a new step directed at the totally endoscopic procedure, aiming at decreasing the injuries caused by the learning curve.

  4. Endovascular treatment of thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2013-01-01

    performed with explantation of stent-graft and open aortic in situ recontruction, followed by esophagectomy and the creation of cervical and gastrical stoma. Conclusion. Having in mind initial results of the 3 main vascular clinics in Belgrade, Serbia, economical situation in our country, as well as the published international results, endovascular treatment of thoracic aortic diseases is indicated in hemodinamicaly unstable patients with acute traumatic aneurysm, or in stabile patients older than 65, as well as in case of chronic diseases of the thoracic aorta in patients with significant comorbid conditions or in patients older than 65 years. Endovascular procedures on the thoracic aorta could be performed, hower, only in high-volume centers with experience in routine open surgery of thoracic aorta.

  5. Differential ventilation with spontaneous respiration for bilateral emphysema.

    Science.gov (United States)

    Chakravarthy, Murali; Jawali, Vivek

    2007-06-01

    In patients with bilateral bullous disease and empyema in one lung, controlled ventilation may be hazardous and result in severe hypoxia. A 50-year-old man with bullous disease and thoracic empyema on the left side was operated on under general anesthesia with spontaneous respiration using differential lung ventilation.

  6. 双侧内囊前肢毁损术治疗难治性焦虑症%Bilateral anterior internal capsulotomy for refractory anxiety disorders

    Institute of Scientific and Technical Information of China (English)

    孙发发; 潘宜新; 曹春燕; 李永超; 林国珍; 孙伯民; 占世坤

    2015-01-01

    Objective To study the clinical effect of bilateral anterior internal capsulotomy on patients with refractory anxiety disorders.Methods Twenty-one patients with anxiety disorders,failed to pharmacological and cognitive behavior therapies for 5 years and admitted to our hospital from November 2009 to January 2012,were chosen; they received MRI-guided stereotactic bilateral anterior capsulotomy.The coordinates of the lesion target were determined under high resolution MRI directly and confirmed by intra-operative impedance test and high frequency stimulation.The lesions were received radiofrequency at 80 ℃ for 60 seconds.Pre-and post-operative mini-mental state examination (MMSE),self-rating anxiety scale (SAS),Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA) were performed by the same psychiatrists.Results In the 21 patients,8 had anxiety-free,10 had significant improvement,and 3 had no significant improvement.No serious surgery-related complications were noted.Nine patients had mild cognitive deficit and transient dysmnesia only at 1-2 weeks after operation.Personality changes,such as lack of motivation,apathy and indolence,appeared in 4 patients.Psychiatric evaluations demonstrated significant decrease of SAS,HAMD and HAMA scores after operation as compared with those before operation (P<0.05).However,the difference of MMSE scores between pre-and post-operation was not statistically significant (P>0.05).Conclusion MRI guided stereotactic bilateral capsulotomy is precise,safe and much an effective treatment for refractory anxiety disorders,whcih is promising to alleviate the symptoms of anxiety and depression,as well as improving the quality of life.%目的 分析立体定向下双侧内囊前肢毁损术治疗难治性焦虑症的临床疗效. 方法 收集上海交通大学附属瑞金医院功能神经外科自2009年11月至2012年1月收治的21例难治性焦虑症患者临床资料,所有患者均在MRI计算机工作

  7. The Society of Thoracic Surgeons Clinical Practice Guidelines on Arterial Conduits for Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Aldea, Gabriel S; Bakaeen, Faisal G; Pal, Jay; Fremes, Stephen; Head, Stuart J; Sabik, Joseph; Rosengart, Todd; Kappetein, A Pieter; Thourani, Vinod H; Firestone, Scott; Mitchell, John D

    2016-02-01

    Internal thoracic arteries (ITAs) should be used to bypass the left anterior descending (LAD) artery when bypass of the LAD is indicated (class of recommendation [COR] I, level of evidence [LOE] B). As an adjunct to left internal thoracic artery (LITA), a second arterial graft (right ITA or radial artery [RA]) should be considered in appropriate patients (COR IIa, LOE B). Use of bilateral ITAs (BITAs) should be considered in patients who do not have an excessive risk of sternal complications (COR IIa, LOE B). To reduce the risk of sternal infection with BITA, skeletonized grafts should be considered (COR IIa, LOE B), smoking cessation is recommended (COR I, LOE C), glycemic control should be considered (COR IIa, LOE B), and enhanced sternal stabilization may be considered (COR IIb, LOE C). As an adjunct to LITA to LAD (or in patients with inadequate LITA grafts), use of a RA graft is reasonable when grafting coronary targets with severe stenoses (COR IIa, LOE: B). When RA grafts are used, it is reasonable to use pharmacologic agents to reduce acute intraoperative and perioperative spasm (COR IIa, LOE C). The right gastroepiploic artery may be considered in patients with poor conduit options or as an adjunct to more complete arterial revascularization (COR IIb, LOE B). Use of arterial grafts (specific targets, number, and type) should be a part of the discussion of the heart team in determining the optimal approach for each patient (COR I, LOE C).

  8. Bilateral ankle edema with bilateral iritis.

    Science.gov (United States)

    Kumar, Sunil

    2007-07-01

    I report two patient presented to me with bilateral symmetrical ankle edema and bilateral acute iritis. A 42-year-old female of Indian origin and 30-year-old female from Somalia both presented with bilateral acute iritis. In the first patient, bilateral ankle edema preceded the onset of bilateral acute iritis. Bilateral ankle edema developed during the course of disease after onset of ocular symptoms in the second patient. Both patients did not suffer any significant ocular problem in the past, and on systemic examination, all clinical parameters were within normal limit. Lacrimal gland and conjunctival nodule biopsy established the final diagnosis of sarcoidosis in both cases, although the chest x-rays were normal.

  9. Ruptured thoracic intraspinal dermoid cyst in a patient with skeletal abnormalities of thoracic spine – A case report

    Directory of Open Access Journals (Sweden)

    Mrudang Raval

    2015-06-01

    Full Text Available Spinal dermoids are congenital multi- or unilocular benign cystic tumors lined by squamous epithelium containing skin appendages. The tumours become acutely symptomatic following infection or rupture. We present a very rare case of ruptured thoracic spinal dermoid cyst in a 12 year old girl with congenital vertebral abnormalities, who presented with back ache of recent onset and a 5 year history of unnoticed slipping of footwear while walking. Magnetic resonance imaging reveals a lesion in the thoracic spine with fat droplets in bilateral frontal horns of lateral ventricle and cisterns of brain. Other additional findings were also noted.

  10. Comparison of two different teaching patterns about scores of interns in thoracic surgical department%两种教学模式下胸外科实习医生学习结果的比较

    Institute of Scientific and Technical Information of China (English)

    孙晓宏; 陈玲; 庞作良

    2014-01-01

    Objective To investigate the effectiveness of PBL teaching pattern and LBL one on interns in clinical practice of thoracic oncological surgery .Methods Two different classes of clinical medical specialty in Xinjiang Medical University were selected as study target .The class with 46 students accepted PBL teaching pattern ( Problem-based learning group ) and the other class with 43 students accepted LBL teaching pattern ( Lecture-based learning group ) . The effectiveness of these two different teaching group were compared . Results Those average scores of problem-finding, problem-solving, specific knowledge understanding , clinical skills applying , doctor-patient relationship treating and doctor-nurse relationship treating in PBL group are significantly higher than those of LBL group .Conclusions The teaching pattern of PBL can improve the effectiveness of medical student's learning in the clinical practice of thoracic oncological surgery , enhance their capability of patients treatment .The PBL teaching method in practice of thoracic oncological surgery has certain promotion value .%目的:探讨基于问题式的教学模式(PBL)和传统讲授式教学模式(LBL)在胸部肿瘤外科临床实习学生带教中的效果。方法选择2013级新疆医科大学厚博学院5年制临床医学专业的两个不同班级作为研究对象,其中一个班级有学生46人,按PBL教学模式给予带教,另外一个班级有学生43人,按传统LBL教学模式给予带教,实习结束后进行2个班级学生实习效果的比较。结果 PBL教学模式班级学生发现问题、解决问题、专业知识掌握、临床技能掌握及医患关系和医护关系处理方面的成绩均优于传统LBL教学模式班级。结论 PBL教学模式不仅能够提高学生的学习成绩和能力,同时还能增强学生的临床操作技能,值得在胸部肿瘤外科临床实习带教中推广应用。

  11. Trombosis yugular interna bilateral asociada a trombofilia después de la inducción ovárica por infertilidad Bilateral internal jugular thrombosis associated with thrombophilia after ovarian induction for infertility

    Directory of Open Access Journals (Sweden)

    Fernando Vázquez

    2002-08-01

    Full Text Available Los eventos tromboembólicos son complicaciones poco frecuentes del tratamiento hormonal de la infertilidad y generalmente están asociados al síndrome de hiperestimulación ovárico (SHO. La trombosis venosa yugular es infrecuente y ante su presencia se debería sospechar la existencia de algún factor predisponente. Describimos una paciente de 31 años, sin antecedentes de importancia, no fumadora, a la cual se le realizó un único ciclo de estimulación hormonal para fertilización in vitro por esterilidad primaria con factor masculino. Durante la octava semana de embarazo gemelar desarrolló una trombosis yugular interna bilateral, en ausencia de SHO u otros factores predisponentes aparentes. En la evaluación para trombofilia se detectó la presencia del Factor V Leiden y la mutación del gen de la protrombina G 20210, que junto con el estímulo hormonal, se interpretaron como los factores predisponentes. Se anticoaguló con heparina de bajo peso molecular. No está recomendado el rastreo sistemático de trombofilia antes del tratamiento hormonal, pero podría ser considerado en pacientes de alto riesgo o en quienes desarrollan trombosis en ausencia de un factor predisponente claro.Thromboembolic events are an infrequent complication of hormonal treatment for infertility and are generally related to the hyperstimulated ovarian syndrome (HOS. Jugular vein thrombosis is an unusual site of thrombosis and when present one should look for a predisposing factor. We describe a 31-year-old woman, with no previous medical history, non-smoker, who received a single cycle of hormonal stimulation for in vitro fertilisation due to primary infertility. During her eighth week of a twin pregnancy, she consulted the emergency room where the diagnosis of bilateral jugular thrombosis was confirmed, in absence of HOS or any known predisposing factor. In subsequent studies, the presence of Factor V Leyden and a mutation of G 20210 prothrombin were found

  12. Retention of the Eosinopenic Response After Bilateral Sympathectomy in the Dog

    Science.gov (United States)

    1951-09-11

    ARMY MEDICAL RESEARCH LABs„ F0RT KNOX9 KY» (REPORT NO* 65) RETENTION OF THE E05IN0PENSC RESPONSE AFTER BILATERAL SYMPATHECTOMY IN THE DOS NELSON...OP THE EOSBSOPENlC RESPONSE AFTER BILATERAL SIMPATHEGTOMT IN THE DOG OBJECT To determine If removal of the thoracic and abdominal sympathetic...Bilateral removal of th© thoracic and abdominal sympathetic chains in the dog does not prevent the marked decrease in th© circulating ©ösinöphils

  13. Study of Bone Grafting like Cone Pedicle for Thoracic and Lumbar Fracture in GSS Internal Fixation%胸腰段椎体骨折GSS内固定术经锥弓根等植骨的研究

    Institute of Scientific and Technical Information of China (English)

    唐凯

    2015-01-01

    Objective:To research on bone grafting like cone pedicle for thoracic and lumbar fracture in GSS internal fixation.Method:From February 2011 to February 2014,60 patients with thoracic and lumbar fracture in our hospital were given the fusion treatment of GSS internal fixation of pedicle screw-rod system, bone grafting in vertebral arch and posterolateral bone grafting.Result:After the operation, these patients were given postoperative follow-up.It was found that incision of 60 cases was primary healing.The X-ray showed that their spinal sequence and physiological curvature largely returned to normal.The height of vertebral body returned to 78%- 98% of the normal height.The reset rate was as high as 98%.Improvement in pain symptom and function was over 96%.No loose or fractured screw rods and no complications of spinal cord and nerve root injury were found.Conclusion:After the research, it is found that for the operation of thoracic and lumbar fracture, the application of vertebral arch bone grafting and vertebral plate posterior bone grafting, which stabilized the front, middle and posterior column of vertebral body, can avoid fractured screw as well as rod and loose pedicle screw.At the same time, it can avoid the vertebral body lose its height and also lighten the pain of the patients.Therefore, it will be the main trend of treatment of thoracic and lumbar fracture.%目的:对胸腰段椎体骨折GSS内固定术经锥弓根等植骨的研究。方法:回顾性分析本院2011年2月-2014年2月采用GSS椎弓根钉棒系统内固定加经椎弓椎椎体内植骨及后外侧植骨融合术治疗的60例胸腰椎骨折患者的临床资料。结果:术后随访,伤口均一期愈合,X线片显示脊柱序列和生理曲度基本恢复正常,椎体高度恢复到正常椎体高度的78%~98%,复位率达到98%,疼痛症状及功能改善96%以上,无脊髓及神经根损伤加重并发症,无螺钉棒松动、断裂,无矫形丢失无脊髓及

  14. Maximal blood flow acceleration analysis in the early diastolic phase for in situ internal thoracic artery bypass grafts: a new transit-time flow measurement predictor of graft failure following coronary artery bypass grafting.

    Science.gov (United States)

    Handa, Takemi; Orihashi, Kazumasa; Nishimori, Hideaki; Fukutomi, Takashi; Yamamoto, Masaki; Kondo, Nobuo; Tashiro, Miwa

    2015-04-01

    Maximal graft flow acceleration (max df/dt) determined by transit-time flowmetry (TTFM) in the diastolic phase was assessed as a possible predictor of graft failure in coronary artery bypass patients. Max df/dt was retrospectively measured in 57 in situ left internal thoracic artery grafts. TTFM data were fitted to a 5-polynomial curve, which was derived from the first-derivative curve to measure max df/dt (5-polymial max df/dt). Abnormal TTFM was defined as a mean flow of 5 or diastolic filling ratio of polynomial max df/dt between each group pair (P polynomial max df/dt was significantly lower in the Ab-N/F group compared with the other groups (Ab-N/F: 0.89 ± 0.41 vs N/P: 4.74 ± 3.18, N/F: 2.23 ± 0.65, Ab-N/P: 2.70 ± 1.31 ml/s(2), P polynomial max df/dt were, respectively, 72.7 and 80.4% (cut-off value, 1.918 ml/s(2)) for all grafts and 100 and 88.2% (cut-off value, 1.273 ml/s(2)) for abnormal TTFM grafts. The TTFM 5-polymial max df/dt value in the early diastolic phase may be a promising predictor of future graft failure. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  15. Thoracic ectopia cordis.

    Science.gov (United States)

    Shad, Jimmy; Budhwani, Keshav; Biswas, Rakesh

    2012-09-30

    Ectopia cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect in fusion of the anterior chest wall resulting in extra thoracic location of the heart. Its estimated prevalence is 5.5-7.9 per million live births. The authors had one such case of a 15-h-old full-term male neonate weighing 2.25 kg with an externally visible, beating heart over the chest wall. The neonate had difficulty in respiration with peripheral cyanosis. Patient died of cardiorespiratory arrest before any surgical intervention could be undertaken inspite of best possible resuscitative measures.

  16. Complete thoracic ectopia cordis.

    Science.gov (United States)

    Alphonso, N; Venugopal, P S; Deshpande, R; Anderson, D

    2003-03-01

    Thoracic ectopia cordis is a rare congenital defect with very few reported survivors after surgical correction. We report a case of complete thoracic ectopia cordis with double outlet right ventricle. The diagnosis was established antenatally and a repair was undertaken soon after birth. The child remained stable and was extubated on the fifth post-operative day. Forty-eight hours later the child succumbed to an unexplained respiratory arrest. Also presented is a review of the different surgical strategies for this unusual condition.

  17. Understanding Thoracic Outlet Syndrome

    Directory of Open Access Journals (Sweden)

    Julie Freischlag

    2014-01-01

    Full Text Available The diagnosis of thoracic outlet syndrome was once debated in the world of vascular surgery. Today, it is more understood and surprisingly less infrequent than once thought. Thoracic outlet syndrome (TOS is composed of three types: neurogenic, venous, and arterial. Each type is in distinction to the others when considering patient presentation and diagnosis. Remarkable advances have been made in surgical approach, physical therapy, and rehabilitation of these patients. Dedicated centers of excellence with multidisciplinary teams have been developed and continue to lead the way in future research.

  18. Spinal Arthrodesis Posterior Internal Fixation in Thoracic Lumbar Fracture Analysis of the Application Effect%脊柱胸腰段骨折中后路内固定融合术的应用效果分析

    Institute of Scientific and Technical Information of China (English)

    余建

    2015-01-01

    目的:探讨脊柱胸腰段骨折中后路内固定融合术的应用效果.方法:采用回顾性方法分析,选取我院自2011年2月~2013年2月以来收治的63例脊柱胸腰段骨折患者的临床资料,随机将其分为对照组(31例)和观察组(32例) ,对照组给予前路内固定融合术治疗,观察组给予后路内固定融合术治疗,比较2组患者治疗效果.结果:2组患者手术成功率、并发症、术中出血量、上、下床活动时间等均有显著差异(P<0.05);术后随访1年,2组椎体前缘、后缘高度、后凸Cobb角及椎管占位率均无明显差异(P>0.05).结论:后路内固定融合术治疗脊柱胸腰段骨折具有显著疗效,可有效减少并发症,提高患者生活质量,值得临床推广应用.%Objective:To investigate the thoracic lumbar spine fractures in the application effect of internal fixation posterior arthrode-sis.Methods:A retrospective method to analyze and select our hospital from February 2011 to February 2013 has been treated, 63 cases of thoracic lumbar spine fractures in patients with clinical data, its randomly divided into control group (31 cases) and observation group (32 cases) and control group given anterior internal fixation fusion treatment, observation group was given arthrodesis posterior internal fixation treatment, compared two groups of patients with therapeutic effect.Results: Two groups of patients with surgical success rate, complications, intraoperative blood loss, ambulation time had significant difference (P <0.05);Postoperative follow-up of 1 year, fan-terior edge, trailing edge height, the two groups of the protruding after Cobb Angle and vertebral canal placeholder rate had no obvious difference (P >0.05).Conclusion:Lumbar arthrodesis posterior internal fixation treatment of thoracic spine fractures with significant curative effect, can effectively reduce the complications and improve patient quality of life, worthy of clinical popularization and

  19. Bilateral Duane syndrome and bilateral aniridia.

    Science.gov (United States)

    Khan, Arif O; Aldahmesh, Mohammad

    2006-06-01

    Duane retraction syndrome has been reported in association with structural abnormalities of the eye, including epibulbar dermoid, keratoconus, iris dysplasia, heterochromia iridis, persistent fetal vasculature, cataract, choroidal coloboma, microphthalmia, and optic nerve dysplasia. A novel association, that of bilateral Duane syndrome with bilateral aniridia, is the subject of this report.

  20. Force Display and Bi-Lateral Master-Slave Control with an Internal Model under the Consideration of Human Cross-Over Model

    Science.gov (United States)

    Kawahata, Nagakatsu; Nishizawa, Masanori; Itoh, Youichirou; Yoshida, Hiroaki

    Human behavior for controlling machines is quite adaptive but restrictive in gain, phase, frequency bandwidth and so on. It is often assumed by a cross-over model especially for compensatory tracking task. Force display system is increasingly important in robotics, remote manipulations, machine handling and etc. The control system design for force display and/or bi-lateral master-slave manipulator is not so easy because of gain limits, mechanical vibration, human-induced oscillation and others. Proposed is a control system design for force display and/or bi-lateral master-slave manipulator based on model-following control under the concept of human crossover model in compensatory tracking. Experimental results are also shown for an actual force display device designed by the proposed method.

  1. THORACIC SPINE FRACTURES

    Institute of Scientific and Technical Information of China (English)

    戴力扬

    2001-01-01

    Objective. To investigate the unique characteristics and treatment of thoracic spine fractures.Methods. Severty-seven patients with thoracic spine fractures were retrospectively reviewed. Of these, therewere 37 compressior fractures, 34 fracture-dislocations, 3 burst fractures and 3 burst-dislocations. Twenty-six pa-tients had a complete lesion of the spinal cord, 14 sustained a neurologically incomplete injury, and 37 wereneurologically intact. Fifty-three patients were treated nonoperatively and 24 treated operatively.Results. All patients were followed up for 2 ~ 15 years. None of the 26 patients with a complete lesion recov-ered any significant function. Of 37 neurologically intact patients, 13 had local pain although all of them re-mained normal function. Two of 14 patients with incomplete paraplegia returned to normal, 7 recovered some func-tion and 5 did not recovered.Conclusions. E ecause of the unique anatomy and biomechanics of the thoracic spine, the classification common-ly applied to thoracolumbar fractures is not suitable for thoracic fractures. Fusion and instrumentation are indicat-ed when the fractures are unstable, while patients with incomplete lesion of the spinal cord may be the candidatesfor supplemented decompression.

  2. Thoracic sympathectomy and cardiopulmonary responses to exercise.

    Science.gov (United States)

    Inbar, Omri; Leviel, D; Shwartz, I; Paran, H; Whipp, B J

    2008-09-01

    The purpose was to study the effect of endoscopic thoracic sympathectomy (ETS) for palmar and/or axillary hyperhidrosis on physiological responses at rest, and during sub-maximal and maximal exercise in ten healthy patients (7 females and 3 males 18-40 years old) with idiopathic palmar and/or axillary hyperhidrosis. T2-T3 thoracoscopic sympathectomy was performed using a simplified one stage bilateral procedure. Physiological variables were recorded at rest and during sub-maximal (steady-state) and maximal treadmill exercise immediately prior to and 70 days (+/-7.5, SD) after bilateral ETS. Exercise performance capacity and peak VO(2) were not found to be different following bilateral ETS than prior to the ETS. However, heart rate was significantly reduced at rest (14%), at sub-maximal exercise (12.3%), and at peak exercise (5.7%), together with a significant increase in oxygen pulse (11.8, 12.7, and 7.8%, respectively). The rate pressure product (RPP) was also significantly reduced following the surgical procedure at all three study stages, while all other physiological variables measured remained unchanged. It is suggested that thoracic-sympathetic denervation affects the heart, sweating, and circulation of the respective denervated region but does not affect exercise performance or mechanical/physiologic efficiency, despite a significant reduction in heart rate (both at rest and during exercise). The latter was, most likely, fully compensated by an increase in stroke volume and less likely by an improved muscle O(2) extraction due to more efficient blood distribution, keeping the work-rate and oxygen uptake unaffected.

  3. Bilateral orbital cavernous haemangiomas.

    OpenAIRE

    Fries, P D; Char, D. H.

    1988-01-01

    Simultaneous bilateral orbital lesions are rare. The differential diagnosis includes orbital pseudotumour, metastasis, leukaemia, lymphoma, Wegener's granulomatosis, and neurofibromatosis. We report what we believe to be the first case of bilateral orbital cavernous haemangiomas.

  4. Bilateral otogenic cerebellar abscesses.

    Directory of Open Access Journals (Sweden)

    Nadkarni T

    1993-01-01

    Full Text Available An unusual presentation of bilateral otogenic cerebellar abscesses observed in two of our patients is reported. Both gave a history of otorrhoea, fever, headache, vomiting and had bilateral cerebellar signs and conductive hearing loss. The abscesses were detected on computerised tomography. X-rays revealed bilateral mastoiditis. The therapy followed was excision of abscesses, mastoidectomy and antibiotic therapy.

  5. Differential diagnosis of bilateral thalamic lesions; Differenzialdiagnose bilateral Thalamuslaesionen

    Energy Technology Data Exchange (ETDEWEB)

    Linn, J.; Brueckmann, H. [Universitaetsklinikum Muenchen (Germany). Abt. fuer Neuroradiologie; Hoffmann, L.A. [Universitaetsklinikum Muenchen (Germany). Inst. fuer Klinische Neuroimmunologie; Danek, A. [Universitaetsklinikum Muenchen (Germany). Klinik und Poliklinik fuer Neurologie

    2007-03-15

    A multitude of different diseases can result in bilateral thalamic lesions. These include vascular pathologies requiring prompt therapeutic intervention, such as basilar thrombosis or thrombosis of the internal cerebral veins, as well as tumors, infectious or demyelinating diseases, and toxic-metabolic lesions. Therefore, detailed knowledge of the typical radiological findings for the various diseases is essential for determining the correct diagnosis. This review provides a synopsis of the radiological findings for the most important bithalamic lesions and an overview of the literature.

  6. 一期后路病灶清除植骨融合内固定治疗胸椎结核%ONE-STAGE POSTERIOR DEBRIDEMENT, BONE GRAFT, AND INTERNAL FIXATION FOR THORACIC TUBERCULOSIS

    Institute of Scientific and Technical Information of China (English)

    陈宣维; 林建华; 陈雷; 陈飞; 许卫红; 韦超

    2011-01-01

    Objective To evaluate the clinical effectiveness and advantages of one-stage posterior debridement, bone graft, and internal fixation for thoracic tuberculosis. Methods The data were retrospectively analysed, from 21 cases of thoracic tuberculosis undergoing one-stage posterior debridement, bone graft, and internal fixation between June 2007 and November 2009. There were 16 males and 5 females with an average age of 42.2 years (range, 22-73 years). The average disease duration was 13.2 months (range, 7-21 months). The lesions were located at the level of T5,6 (1 case), T6,7 (1 case), T8,9 (4 cases), T9,10 (3 cases), Tio, n (5 cases), Tn, 12 (6 cases), and T9-11 (1 case). According to the Frankel grading criterion, the neurological function was rated as grade B in 2 cases, grade C in 6 cases, grade D in 10 cases, and grade E in 3 cases. The preoperative Cobb angle was (26.3 ± 9.2)°. The erythrocyte sedimentation rate (ESR) was (35.9 ± 11.2) mm/1 hour. Results Thoracic tuberculosis was confirmed in postoperative pathological examination in all 21 cases. All incisions healed primarily without fistules formation. The average follow-up time for 21 patients was 16.2 months (range, 1-3 years). Bony fusion was achieved within 7-12 months (mean, 9 months) without pseudoarthrosis. No loosening and breakage of internal fixation were found, and no local recurrence occurred. The ESR decreased to (25.1 ± 8.9) mm/1 hour at 1 week postoperatively, showing significant difference when compared with preoperative value (t=5.935, P < 0.01); it decreased to (14.1± 4.6) mm/1 hour at 3 months postoperatively. According to Frankel grade, the neurological function was significantly improved at 1 year after operation (x2=13.689, P=0.003). The average Cobb angle was (17.1 ± 4.5)° at 1 years postoperatively, showing significant difference when compared with preoperative value (t=7.476, P < 0.01). Conclusion One-stage posterior debridement, bone graft, and internal fixation has a

  7. May 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-06-01

    Full Text Available No abstract available. Article truncated after first 150 words. The May 2014 Arizona Thoracic Society meeting was held on Wednesday, 5/28/2014 at Scottsdale Shea Hospital beginning at 6:30 PM. There were 13 in attendance representing the pulmonary, critical care, sleep and radiology communities. A discussion was held regarding the Arizona Thoracic Society relationship with the American Lung Association. Several members volunteered to talk to the lung association regarding common ground to strengthen the relationship. The wine tasting with the California, New Mexico and Colorado Thoracic Societies at the American Thoracic Society International Meeting was a big success. There were about 55 at the meeting. The tasting will probably be held again next year. At the ATS meeting data was presented that pirfenidone was effective in reducing the progression of idiopathic pulmonary fibrosis (IPF. The data was published in the New England Journal of Medicine on 8/29/14 (1. Lewis Wesselius is one of the investigators enrolling patients in a phase ...

  8. April 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated at 150 words. The April 2014 Arizona Thoracic Society meeting was held on Wednesday, 4/23/2014 at Scottsdale Shea Hospital beginning at 6:30 PM. There were 15 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. It was announced that there will be a wine tasting with the California, New Mexico and Colorado Thoracic Societies at the American Thoracic Society International Meeting. The tasting will be led by Peter Wagner and is scheduled for the Cobalt Room in the Hilton San Diego Bayfront on Tuesday, May 20, from 4-8 PM. Guideline development was again discussed. The consensus was to await publication of the IDSA Cocci Guidelines and respond appropriately. George Parides, Arizona Chapter Representative, gave a presentation on Hill Day. Representatives of the Arizona, New Mexico and Washington Thoracic Societies met with their Congressional delegations, including Rep. David Schweikert, to discuss the Cigar Bill, NIH funding, and the Medicare Sustainable Growth ...

  9. February 2014 Arizona Thoracic Society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-02-01

    Full Text Available No abstract available. Article truncated at 150 words. The February 2014 Arizona Thoracic Society was a dinner meeting sponsored by Select Specialty Hospital and held on Wednesday, 2/26/2014 at Shea Hospital beginning at 6:30 PM. There were 14 in attendance representing the pulmonary, critical care, sleep, and radiology communities. Gerald Swartzberg was presented a plaque as the Arizona Thoracic Society clinician of the year by George Parides (Figure 1. A discussion was held about having a wine tasting in San Diego at the ATS International Conference. Peter Wagner (Slurping Around with PDW has agreed to lead the conference. It was decided to extend invitations to the New Mexico, Colorado and California Thoracic Societies along with the Mayo Clinic. A question was raised about guideline development. It was felt that we should review the Infectious Disease Society of America Valley Fever guidelines and determine if the Arizona Thoracic Society might have something to contribute. Three cases were presented: Lewis ...

  10. Effect of Thoracic Stretching, Thoracic Extension Exercise and Exercises for Cervical and Scapular Posture on Thoracic Kyphosis Angle and Upper Thoracic Pain

    OpenAIRE

    Yoo, Won-gyu

    2013-01-01

    [Purpose] The purpose of this study was to investigate the effect of thoracic stretching, a thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain. [Subject] A 36-year-old male, who complained of upper thoracic pain at the T1–4 level with forward head and round shoulders, was the subject. [Methods] He performed thoracic stretching (session 1), a thoracic extension exercise (session 2), and muscle exercises for cervical an...

  11. Chronobiology of Acute Aortic Dissection in the Marfan Syndrome (from the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions and the International Registry of Acute Aortic Dissection).

    Science.gov (United States)

    Siddiqi, Hasan K; Luminais, Steven N; Montgomery, Dan; Bossone, Eduardo; Dietz, Harry; Evangelista, Arturo; Isselbacher, Eric; LeMaire, Scott; Manfredini, Roberto; Milewicz, Dianna; Nienaber, Christoph A; Roman, Mary; Sechtem, Udo; Silberbach, Michael; Eagle, Kim A; Pyeritz, Reed E

    2017-03-01

    Marfan syndrome (MFS) is an autosomal dominant connective tissue disease associated with acute aortic dissection (AAD). We used 2 large registries that include patients with MFS to investigate possible trends in the chronobiology of AAD in MFS. We queried the International Registry of Acute Aortic Dissection (IRAD) and the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) registry to extract data on all patients with MFS who had suffered an AAD. The group included 257 patients with MFS who suffered an AAD from 1980 to 2012. The chi-square tests were used for statistical testing. Mean subject age at time of AAD was 38 years, and 61% of subjects were men. AAD was more likely in the winter/spring season (November to April) than the other half of the year (57% vs 43%, p = 0.05). Dissections were significantly more likely to occur during the daytime hours, with 65% of dissections occurring from 6 a.m. to 6 p.m. (p = 0.001). Men were more likely to dissect during the daytime hours (6 a.m. to 6 p.m.) than women (74% vs 51%, p = 0.01). These insights offer a glimpse of the times of greatest vulnerability for patients with MFS who suffer from this catastrophic event. In conclusion, the chronobiology of AAD in MFS reflects that of AAD in the general population.

  12. Managment of thoracic empyema.

    Science.gov (United States)

    Sherman, M M; Subramanian, V; Berger, R L

    1977-04-01

    Over a ten year period, 102 patients with thoracic empyemata were treated at Boston City Hospital. Only three patients died from the pleural infection while twenty-six succumbed to the associated diseases. Priniciples of management include: (1) thoracentesis; (2) antibiotics; (3) closed-tube thoracostomy; (4) sinogram; (5) open drainage; (6) empyemectomy and decortication in selected patients; and (7) bronchoscopy and barium swallow when the etiology is uncertain.

  13. Thoracic textilomas: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Machado, Dianne Melo; Zanetti, Glaucia; Araujo Neto, Cesar Augusto; Nobre, Luiz Felipe; Meirelles, Gustavo de Souza Portes; Silva, Jorge Luiz Pereira e; Guimaraes, Marcos Duarte; Escuissato, Dante Luiz; Souza Junior, Arthur Soares; Hochhegger, Bruno; Marchiori, Edson, E-mail: edmarchiori@gmail.com [Hospital Universitario Antonio Pedro (HUAP/UFF), Niteroi, RJ (Brazil)

    2014-09-15

    Objective: the aim of this study was to analyze chest CT scans of patients with thoracic textiloma. Methods: this was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. Results: the majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). Conclusions: it is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication. (author)

  14. [Thoracic actinomycosis: three cases].

    Science.gov (United States)

    Herrak, L; Msougar, Y; Ouadnouni, Y; Bouchikh, M; Benosmane, A

    2007-09-01

    Actinomycosis is a rare condition which, in the thoracic localisation, can mimic cancer or tuberculosis. We report a series of three case of thoracic actinomycosis treated in the Ibn Sina University Thoracic Surgery Unit in Rabat, Morocco. CASE N degrees 1: This 45-year-old patient presented a tumefaction on the left anterior aspect of the chest. Physical examination identified a parietal mass with fistulisation to the skin. Radiography demonstrated a left pulmonary mass. Transparietal puncture led to the pathological diagnosis of actinomycosis. The patient was given medical treatment and improved clinically and radiographically. CASE N degrees 2: This 68-year-old patient presented repeated episodes of hemoptysis. The chest x-ray revealed atelectasia of the middle lobe and bronchial fibroscopy demonstrated the presence of a bud in the middle lobar bronchus. Biopsies were negative. The patient underwent surgery and the histology examination of the operative specimen revealed pulmonary actinomycosis. The patient recovered well clinically and radiographically with antibiotic therapy. CASE N degrees 3: This 56-year-old patient presented cough and hemoptysis. Physical examination revealed a left condensation and destruction of the left lung was noted on the chest x-ray. Left pleuropulmonectomy was performed. Histological analysis of the surgical specimen identified associated Aspergillus and Actinomyces. The outcome was favorable with medical treatment. The purpose of this work was to recall the radiological, clinical, histological, therapeutic, outcome aspects of this condition and to relate the problems of differential diagnosis when can suggest other diseases.

  15. Key Questions in Thoracic Surgery

    OpenAIRE

    Subotic, Dragan R.

    2016-01-01

    This 1000-page textbook encompasses much more than the title suggests. In fact, the title “Key questions in thoracic surgery and pulmonology” would be more fitting. The specific format of the book, with precise questions and evidence-based, but equally clear answers covering all relevant fields of pulmonology and thoracic surgery, makes this 40-chapter book a “must read” not only for residents, but also for senior pulmonologists and thoracic surgeons.

  16. Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma

    Directory of Open Access Journals (Sweden)

    Abdurrahman Aycan

    2016-01-01

    Full Text Available A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS. The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI showed an image of a mass compressing the medulla.

  17. [Mitral valve replacement after previous coronary artery bypass grafting with functioning left internal thoracic artery graft: effectiveness of the method using a direct vision retrosternal approach; report of a case].

    Science.gov (United States)

    Sakata, Junichi; Saito, Tatsuya; Fujii, Akira; Tsukamoto, Masaru; Date, Osamu; Yokoyama, Hideo; Abe, Tomio; Nakase, Atsunobu; Ohori, Katsumi

    2014-08-01

    Performing a redo-sternotomy when a mammary artery graft is patent can be rather difficult. We previously reported a redo-sternotomy technique involving direct visualization with a retrosternal dissection (DR) method using a Kent's retractor. The DR method in detail is as follows: 1) A midline skin incision is extended to the abdomen about 5 cm. 2) The bilateral costal arches are divided from the rectal muscle. 3). A pair of retractors is placed under the costal arch. 4) A stainless steel wire is applied to the previous sternal wire at the center of the sternum. 5) The retractor and sternal wire are lifted up using the Kent's retractor to widen the retrosternal space. 6) The sternum and sub-sternal tissue are carefully divided using an electronic scalpel or metal retractor with an entirely sternal length. 7) Routine sternotomy is performed using a Stryker. Herein, we report a patient who had undergone cardiac surgery, coronary artery bypass grafting (CABG), using a left internal mammary artery and mitral annuloplasty 2 years previously, and then developed mitral regurgitation caused by infectious endocarditis. He successfully underwent redo-sternotomy and mitral valve replacement using the DR method. In a patient with a patent internal mammary artery, the DR method greatly reduces the risk of graft injury.

  18. Bilateral ekstrauterin graviditet

    DEFF Research Database (Denmark)

    Kirkegaard, Ida; Kruse, Christina

    2009-01-01

    Bilateral tubal pregnancies are extremely rare and they are usually found after assisted reproductive techniques have been applied. A rare case of bilateral tubal pregnancy after natural conception, occurring in a woman without any predisposing factors for ectopic pregnancy, is presented....... The condition was diagnosed during laparoscopic surgery, and she was optimally treated with conservative tubal surgery. A short review of the literature is provided and discussed along with the clinical features, diagnostic difficulties and treatment options of bilateral tubal pregnancy. Udgivelsesdato: 2009...

  19. Determination of Effective Thoracic Mass

    Directory of Open Access Journals (Sweden)

    Jeffrey H. Marcus

    1996-01-01

    Full Text Available Effective thoracic mass is an important parameter in specifying mathematical and mechanical models (such as crash dummies of humans exposed to impact conditions. A method is developed using a numerical optimizer to determine effective thoracic mass (and mass distribution given a number of acceleration signals and a force signal response. Utilizing previously reported lateral and frontal impact tests with human cadaveric test specimens in a number of different conditions, the effective thoracic mass is computed. The effective thoracic masses are then computed for a variety of crash dummies exposed to identical test conditions.

  20. Endoscopic thoracic sympathectomy for primary palmar hyperidrosis.

    Science.gov (United States)

    Prasad, Arun; Ali, Mudasir; Kaul, Sunil

    2010-08-01

    Primary hyperhidrosis is a disorder that is characterized by excessive sweating in disproportion to that required for thermoregulation. In most cases, this is aggravated by emotional factors and by heat. Hyperhidrosis can be seen in the palms of the hands, armpits, soles of the feet and face. The principal characteristic of this disease is the intense discomfort of patients, which affects their social and professional life. Treatment modalities include topical application of aluminum chloride, iontophoresis, anticholinergics, botulinum toxin injection, liposuction, excision of sweat glands, and thoracic sympathectomy. Between January 1998 and August 2007, a prospective study of endoscopic thoracic sympathectomies for palmar hyperhidrosis was undertaken based on case histories and a prospective pre- and postoperative questionnaire survey. The sample comprised of 322 patients with a mean age of 24 years. At Apollo Hospital, New Delhi, India, bilateral video-assisted thoracoscopic T3 level sympathectomies were performed in all cases. All patients had immediate cessation of palmar hyperhidrosis. The mean postoperative stay was 1.1 days. A questionnaire was completed based on their response to a telephone conversation or e-mail. A paired t test and Wilcoxon test was performed on these data and it showed significant improvement in quality of life. Compensatory sweating was found to be the most troublesome side effect for all patients. It was seen in 63% of the patients. This is similar to other reports of compensatory sweating; however, the figure decreases to 29% if we disregard the percentage of patients who reported only mild compensatory sweating. In view of the low morbidity and zero mortality rate of this surgical technique, we recommend it as a method of treatment for palmar hyperhidrosis. Thoracic sympathectomy eliminates palmar hyperhidrosis with minimal recurrence (1% in our series) and produces a high rate of patient satisfaction.

  1. Bilateral spontaneous chylothorax after severe vomiting in children

    Science.gov (United States)

    Rodrigues, Antonio Lucas Lima; Romaneli, Mariana Tresoldi das Neves; Ramos, Celso Dario; Fraga, Andrea de Melo Alexandre; Pereira, Ricardo Mendes; Appenzeller, Simone; Marini, Roberto; Tresoldi, Antonia Teresinha

    2016-01-01

    Abstract Objective: To report the case of a child with bilateral chylothorax due to infrequent etiology: thoracic duct injury after severe vomiting. Case description: Girl, 7 years old, with chronic facial swelling started after hyperemesis. During examination, she also presented with bilateral pleural effusion, with chylous fluid obtained during thoracentesis. After extensive clinical, laboratory, and radiological investigation of the chylothorax etiology, it was found to be secondary to thoracic duct injury by the increased intrathoracic pressure caused by the initial manifestation of vomiting, supported by lymphoscintigraphy findings. Comments: Except for the neonatal period, chylothorax is an infrequent finding of pleural effusion in children. There are various causes, including trauma, malignancy, infection, and inflammatory diseases; however, the etiology described in this study is poorly reported in the literature. PMID:27178371

  2. Effect of thoracic stretching, thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain.

    Science.gov (United States)

    Yoo, Won-Gyu

    2013-11-01

    [Purpose] The purpose of this study was to investigate the effect of thoracic stretching, a thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain. [Subject] A 36-year-old male, who complained of upper thoracic pain at the T1-4 level with forward head and round shoulders, was the subject. [Methods] He performed thoracic stretching (session 1), a thoracic extension exercise (session 2), and muscle exercises for cervical and scapular posture (session 3). [Results] The upper thoracic pressure pain threshold increased after session 1, session 2, and session 3. The thoracic kyphosis angle decreased after session 1, session 2, and session 3. [Conclusion] We suggest that intervention for thoracic pain or kyphotic thoracic correction should use not only an approach for extending the thoracic muscles, but also an approach treating muscles in the cervical and scapular region.

  3. Bilateral diaphragm paralysis after simultaneous cardiac surgery and Nuss procedure in the infant

    Directory of Open Access Journals (Sweden)

    Yuichi Tabata

    2015-01-01

    Full Text Available The case of a 15-month-old boy with bilateral diaphragm paralysis after simultaneous cardiac surgery for tetralogy of Fallot, and Nuss procedure for pectus excavatum, is presented. Extubated one day after his first operation, the boy suffered severe respiratory distress soon after, due to bilateral diaphragmatic paralysis. Diaphragm paralysis restricted abdominal respiration, while thoracic respiration was inhibited by metallic bar after the Nuss Procedure, which combined prevented extubation for 47 days. Thoracoplasty, such as the Nuss Procedure, should not be performed simultaneously with cardiac surgery because abdominal and thoracic respiration can be restricted in infants, causing prolonged, severe, post-surgical respiratory failure.

  4. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification predicts occult lymph node metastasis in clinically mediastinal node-negative lung adenocarcinoma

    Science.gov (United States)

    Yeh, Yi-Chen; Kadota, Kyuichi; Nitadori, Jun-ichi; Sima, Camelia S.; Rizk, Nabil P.; Jones, David R.; Travis, William D.; Adusumilli, Prasad S.

    2016-01-01

    OBJECTIVES We investigated the role of the 2011 International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) classification in predicting occult lymph node metastasis in clinically mediastinal node-negative lung adenocarcinoma. METHODS We reviewed lung adenocarcinoma patients who had clinically N2-negative status, were evaluated by preoperative positron emission tomography combined with computed tomography (PET/CT) and had undergone lobectomy or pneumonectomy at Memorial Sloan Kettering Cancer Center (n = 297). Tumours were classified according to the 2011 IASLC/ATS/ERS classification. The associations between occult lymph node metastasis and clinicopathological variables were analysed using Fisher's exact test and logistic regression analysis. RESULTS Thirty-two (11%) cN0-1 patients had occult mediastinal lymph node metastasis (pN2) whereas 25% of cN1 patients had pN2 disease. Increased micropapillary pattern was associated with increased risk of pN2 disease (P = 0.001). On univariate analysis, high maximum standard uptake value of the primary tumour on PET/CT (P = 0.019) and the presence of micropapillary (P = 0.014) and solid pattern (P = 0.014) were associated with occult pN2 disease. On multivariable analysis, micropapillary pattern was positively associated with risk of pN2 disease (odds ratio = 3.41; 95% confidence intervals = 1.42–8.19; P = 0.006). CONCLUSIONS The presence of micropapillary pattern is an independent predictor of occult mediastinal lymph node metastasis. Our observations have potential therapeutic implications for management of early-stage lung adenocarcinoma. PMID:26377636

  5. Bilateralism and free trade

    NARCIS (Netherlands)

    S. Goyal (Sanjeev); S. Joshi

    1999-01-01

    textabstractIn recent years, there has been a great deal of research on the relative merits of multilateralism and bilateralism and their implications for the nature of the trading regime between countries. In this paper we explore the scope of bilateral free-trade agreements as a foundation for

  6. [Hemorrhagic bilateral renal angiomyolipoma].

    Science.gov (United States)

    Benjelloun, Mohamed; Rabii, Redouane; Mezzour, Mohamed Hicham; Joual, Abdenbi; Bennani, Saâd; el Mrini, Mohamed

    2003-09-01

    Renal angiomyolipoma is a rare benign tumour, often associated with congenital diseases especially de Bourneville's tuberous sclerosis. Bilateral angiomyolipoma is exceptional. The authors report a case of bilateral renal angiomyolipoma in a 33-year-old patient presenting with haemorrhagic shock. In the light of this case and a review of the literature, the authors discuss the diagnostic and therapeutic aspects of this disease.

  7. Bilateral microform cleft lip

    OpenAIRE

    Pace, David; Attard Montalto, Simon; Grech, Victor E.

    2006-01-01

    Microform cleft lip (MCL), also called congenital healed cleft lip or cleft lip "frustré", is a rare congenital anomaly. MCL has been described as having the characteristic appearance of a typical cleft lip which has been corrected in utero. We present a girl with bilateral microform cleft lip associated with a preauricular sinus and bilateral camptodactyly.

  8. Thoracic damage control surgery.

    Science.gov (United States)

    Gonçalves, Roberto; Saad, Roberto

    2016-01-01

    The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis patients. This article aims to revise the various damage control techniques in thoracic organs that must be known to the surgeon engaged in emergency care. RESUMO A cirurgia de controle de danos surgiu com a filosofia de se aplicar manobras essenciais para controle de sangramento e contaminação abdominal, em doentes traumatizados, nos limites de suas reservas fisiológicas. Este conceito se estendeu para as lesões torácicas, onde manobras relativamente simples, podem abreviar o tempo operatório de doentes in extremis. Este artigo tem como objetivo, revisar as diversas técnicas de controle de dano em órgãos torácicos, que devem ser de conhecimento do cirurgião que atua na emergência.

  9. Bilateral assymetric epidural hematoma

    Directory of Open Access Journals (Sweden)

    Edmundo Luis Rodrigues Pereira

    2015-01-01

    Full Text Available Background: Acute bilateral extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5-10% of all extradural hematomas. However, higher mortality rates have been reported in previous series. Case Description: The authors described the case of a 28-year-old male presenting head injury, comatose, Glasgow Coma Scale of 6, anisocoric pupils without puppilary light reflex. Computed tomography showed asymmetric bilateral epidural hematomas, effacement of the lateral ventricles and sulci, midline shift and a bilateral skull fracture reaching the vertex. Surgical evacuation was performed with simultaneous hematoma drainage. Patient was discharged on the 29 th postoperative day with no neurological deficit. Conclusion: The correct approach on bilateral epidural hematomas depends on the volume, moment of diagnosis, and neurological deficit level. Simultaneous drainage of bilateral hematomas has been demonstrated to be an effective technique for it, which soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.

  10. Prospective Evaluation of Thoracic Ultrasound in the Detection of Pneumothorax

    Science.gov (United States)

    Schwarz, K. W.; Hamilton, D. R.; Kirkpatrick, A. W.; Billica, R. D.; Williams, D. R.; Diebel, L. N.; Sargysan, A. E.; Dulchavsky, S. A.

    2000-01-01

    Introduction: Pneumothorax (PTX) occurs commonly in trauma patients and is confirmed by examination and radiography. Thoracic ultrasound (VIS) has been suggested as an alternative method for rapidly diagnosing PTX when X-ray is unavailable as in rural, military, or space flight settings; however, its accuracy and specificity are not known. Methods: We evaluated the accuracy of thoracic U/S detection of PTX compared to radiography in stable, emergency patients with a high suspicion of PTX at a Level-l trauma center over a 6-month period. Following University and NASA Institutional Review Board approval, informed consent was obtained from patients with penetrating or blunt chest trauma, or with a history consistent with PTX. Whenever possible, the presence or absence of the " lung sliding" sign or the "comet tail" artifact were determined by U/S in both hemithoraces by residents instructed in thoracic U/S before standard radiologic verification of PTX. Results were recorded on data sheets for comparison to standard radiography. Results: Thoracic VIS had a 94% sensitivity; two PTX could not be reliably diagnosed due to subcutaneous air; the true negative rate was 100%. In one patient, the VIS exam was positive while X ray did not confirm PTX; a follow-up film 1 hour later demonstrated a small PTX. The average time for bilateral thoracic VIS examination was 2 to 3 minutes. Conclusions: Thoracic ultrasound reliably diagnoses pneumothorax. Presence of the "lung sliding" sign conclusively excludes pneumothorax. Expansion of the FAST examination to include the thorax should be investigated.

  11. 应用改良AF脊柱内固定系统经皮微创内固定治疗胸腰椎压缩骨折%The Application of Improved AF Spinal Internal Fixation System With Percutaneous Minimally Invasive Internal Fixation for the Treatment of Thoracic and Lumbar Vertebral Compression Fracture

    Institute of Scientific and Technical Information of China (English)

    李晓龙; 王志军

    2015-01-01

    Objective To explore the efficacy of the AF spinal internal fixation system with percutaneous minimally invasive internal fixation for the treatment of thoracic and lumbar vertebral compression fracture. Methods Collected in our hospital 48 cases of thoracolumbar compression fractures, application of improved percutaneous minimally invasive internal fixation of AF spinal internal fixation system in the treatment of thoracolumbar compression fractures, postoperative review X-ray for curative effect analysis. Results 48 cases of compression injury vertebral height of vertebral body than preoperative obviously restoration, 90%of the average recovery to normal height of vertebral body Conclusion Application of improved percutaneous minimally invasive internal ifxation of AF spinal internal fixation system in the treatment of thoracolumbar compression fractures curative effect is distinct.%目的:探讨应用AF脊柱内固定系统经皮微创内固定治疗胸腰椎压缩骨折的疗效。方法收集本院48例胸腰椎压缩骨折,应用改良AF脊柱内固定系统经皮微创内固定治疗胸腰椎压缩骨折,术后复查X片进行疗效分析。结果48例压缩的伤椎椎体高度比术前明显得到恢复,平均恢复至正常椎体高度的90%。结论应用改良AF脊柱内固定系统经皮微创内固定治疗胸腰椎压缩骨折疗效显著。

  12. THE EUROPEAN UNION’S BILATERAL APPROACH

    Directory of Open Access Journals (Sweden)

    Ludmila BORTA

    2014-12-01

    Full Text Available The EU is a world economic power and a major trading partner for most countries. All the time, this region has been interested and has acted towards a free and fair trade. The decrease and even the elimination of tariff and non-tariff barriers in the world trade are among the main objectives of the EU strategy for international trade. At the moment, the elusive outcome of the WTO Doha Round has led to the proliferation of bilateral trade agreements worldwide. Although the EU remains committed to further development of the multilateral trading system, however, the EU still has appealed also to the development of bilateral trade relations. The aim of this paper is to illustrate the current bilateral dimension of the common commercial policy of the EU. In conclusion, to describe this bilateral approach of the EU we are using one word, namely “diversity”.

  13. Bilateral Chylothorax Complicating a Case of Chronic Lymphocytic Leukemia: A Case Report.

    Science.gov (United States)

    Sharma, Munish; Sharma, Divakar

    2017-04-06

    Chylothorax occurs when lymphatic fluid leaks from the thoracic duct and accumulates in the pleural space. Bilateral chylothorax caused by chronic lymphocytic leukemia (CLL) has been rarely reported in the literature. Sludging of lymph might be the underlying cause. We present a case of bilateral chylothorax in a patient with CLL.We also briefly discuss etiology, possible pathogenesis in our case along with diagnostic options and treatment modalities.

  14. Bilateral chylothorax complicating a case of chronic lymphocytic leukemia: a case report

    OpenAIRE

    Munish Sharma; Divakar Sharma

    2017-01-01

    Chylothorax occurs when lymphatic fluid leaks from the thoracic duct and accumulates in the pleural space. Bilateral chylothorax caused by chronic lymphocytic leukemia (CLL) has been rarely reported in the literature. Sludging of lymph might be the underlying cause. We present a case of bilateral chylothorax in a patient with CLL.We also briefly discuss etiology, possible pathogenesis in our case along with diagnostic options and treatment modalities.

  15. Bilateral chylothorax complicating a case of chronic lymphocytic leukemia: a case report

    Directory of Open Access Journals (Sweden)

    Munish Sharma

    2017-04-01

    Full Text Available Chylothorax occurs when lymphatic fluid leaks from the thoracic duct and accumulates in the pleural space. Bilateral chylothorax caused by chronic lymphocytic leukemia (CLL has been rarely reported in the literature. Sludging of lymph might be the underlying cause. We present a case of bilateral chylothorax in a patient with CLL.We also briefly discuss etiology, possible pathogenesis in our case along with diagnostic options and treatment modalities.

  16. Bilateral Control - Operational enhancements

    OpenAIRE

    Altınışık, Ahmet; Altinisik, Ahmet

    2006-01-01

    A succinct definition of the word bilateral is having two sides [1]. In robotics the term bilateral control is used to define the specific interaction of two systems by means of position and/or force. Bilateral systems are composed of two sides named master and slave side. The aim of such an arrangement is such that position command dictated by master side is followed by a slave side, and at the same time the force sensation of the remote environment experienced by slave is transferred to the...

  17. Pregnancy following bilateral salpingectomy

    DEFF Research Database (Denmark)

    Oturai, Annette Bang

    2008-01-01

    This report presents a rare case of spontaneous pregnancy following bilateral salpingectomy. A woman with a history of bilateral salpingectomy was admitted to hospital because of abdominal pain and positive urine HCG. Surprisingly, ultrasound confirmed a live intrauterine fetus. The pregnancy...... was unwanted, and the woman decided to terminate the pregnancy. She was offered diagnostic examination to localise a potential fistula, but she declined. In a MEDLINE search of English literature this is only the second case of spontaneous pregnancy following bilateral salpingectomy Udgivelsesdato: 2008/4/21...

  18. Staged bilateral carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Engell, Hans Christian

    1986-01-01

    In a series of 56 staged bilateral carotid endarterectomies, new neurologic symptoms developed in 5% and 20% following the first and second procedure, respectively. All complications were transient or minor. The incidence of postendarterectomy hypertension was significantly higher following...

  19. Bilateral guaifenesin ureteral calculi.

    Science.gov (United States)

    Whelan, Chris; Schwartz, Bradley F

    2004-01-01

    We report on a patient with bilateral ureteral calculi composed of guaifenesin metabolite as determined by infrared spectroscopy. These stones may be associated with excessive guaifenesin intake related to the current popularity of ephedrine preparations.

  20. Acordos bilaterais de comércio como estratégia de inserção regional e internacional do Chile Bilateral trade agreements as Chile's strategy for regional and international insertion

    Directory of Open Access Journals (Sweden)

    Renata Rossetto Lopes

    2010-12-01

    Full Text Available O trabalho analisa a mudança na estratégia de inserção regional e internacional do Chile no começo dos anos 1990, com ênfase em acordos comerciais bilaterais, depois de ter praticado a abertura comercial generalizada desde meados da década de 1970. A opção por acordos bilaterais foi adotada pelo primeiro governo democrático, como parte da orientação de manter e aprofundar a abertura externa empreendida pela ditadura, e conseguiu ampliar as vendas externas e diversificar produtos e destinos. As exportações têm papel decisivo na economia chilena, aberta e pequena, e os 24 acordos bilaterais de comércio com diferentes países e regiões, além de outros em negociação, podem ser explicados pelo esgotamento das possibilidades de ampliar o comércio por meio de reduções adicionais da tarifa externa unilateral, hoje em 6% para quase todos os produtos. A formação de uma rede de acordos bilaterais ampla e diversificada, contudo, tem também interesses políticos, estratégicos e de segurança em relação a vizinhos e a países próximos, além de evitar que o Chile precise se integrar, como membro pleno, a blocos regionais para garantir seus interesses, o que amplia as possibilidades de lidar com diferentes e importantes parceiros no âmbito internacional.The paper analysis the change of Chile's regional and international strategy of insertion through bilateral trade agreements in the beginning of the 90s, after a generalized trade opening since the middle of the 70s. The bilateral trade agreements strategy was set up by the democratic governments as part of the direction of maintaining and deepening the unilateral trade liberalization undertaken by the dictatorship, enlarging exports and diversifying products and markets. Exports have a decisive role in Chile's economy, open and small. The 24 bilateral trade agreements already signed with different countries and regions (besides others under negotiation can be explained by the

  1. Echinoderms have bilateral tendencies.

    Science.gov (United States)

    Ji, Chengcheng; Wu, Liang; Zhao, Wenchan; Wang, Sishuo; Lv, Jianhao

    2012-01-01

    Echinoderms take many forms of symmetry. Pentameral symmetry is the major form and the other forms are derived from it. However, the ancestors of echinoderms, which originated from Cambrian period, were believed to be bilaterians. Echinoderm larvae are bilateral during their early development. During embryonic development of starfish and sea urchins, the position and the developmental sequence of each arm are fixed, implying an auxological anterior/posterior axis. Starfish also possess the Hox gene cluster, which controls symmetrical development. Overall, echinoderms are thought to have a bilateral developmental mechanism and process. In this article, we focused on adult starfish behaviors to corroborate its bilateral tendency. We weighed their central disk and each arm to measure the position of the center of gravity. We then studied their turning-over behavior, crawling behavior and fleeing behavior statistically to obtain the center of frequency of each behavior. By joining the center of gravity and each center of frequency, we obtained three behavioral symmetric planes. These behavioral bilateral tendencies might be related to the A/P axis during the embryonic development of the starfish. It is very likely that the adult starfish is, to some extent, bilaterian because it displays some bilateral propensity and has a definite behavioral symmetric plane. The remainder of bilateral symmetry may have benefited echinoderms during their evolution from the Cambrian period to the present.

  2. CTA Showed Bilateral Internal Carotid Artery Hypoplasia in 1 Cases%CTA示两侧颈内动脉发育不全1例

    Institute of Scientific and Technical Information of China (English)

    丁玉国

    2015-01-01

    两侧颈内动脉缺损还是很少见,是一种非常罕见的畸形,在临床上多以蛛网膜下腔出血或体检发现动脉瘤后发现本病。我们发现这例两侧颈内动脉发育不全合并有动脉瘤,动脉瘤发生多由血流动力学发生改变后引起,正好本例表现为左侧后交通比较发达,血运大所致。脑血管CTA作为一种无创的检查方式,而且对本病可以很好的明确诊断,可作为两侧颈内动脉缺损的首选检查方法。%On both sides of the internal carotid artery defect is rare, is a very rare deformity, clinical y in subarachnoid hemor hage or more medical examination found aneurysm after finding the disease. We found that this case on both sides of the internal carotid artery hypoplasia with aneurysm, aneurysm occurred caused by hemodynamic changes after more, just in this case is left after the traf ic is developed, blood supply caused by large. Cerebral CTA as a noninvasive examination way, and to a clear diagnosis, the disease can be very good can be used as the first choice for the internal carotid artery defect on both sides.

  3. Thoracic endometriosis: 3 case reports

    Institute of Scientific and Technical Information of China (English)

    Song Ying-na; Lang Jing-he; Zhu Lan

    2006-01-01

    Abstract:Thoracic endometriosis is a rare disorder. It can be divided into pleural and pulmonary parenchymal endometriosis according to the site of the lesion. In this article 3 typical cases of thoracic endometriosis (case 1 is pleural endometriosis, case 2 and 3 are pulmonary parenchymal endometriosis) were described, and the various presentations, pathogenesis, diagnosis, and therapies of thoracic endometriosis were reviewed. The pathogenesis of thoracic endometriosis has not been established clearly yet. Recurrent right-sided pneumothorax or hemoptysis that occurs within days of the onset of menstruation is the most common manifestation. The correlation between the patient's symptoms and menses is essential to establish the diagnosis. Radiographic studies, bronchoscopy, and thoracoscopy may support the diagnosis. Pathologic evidence is not present universally. Therapeutic interventions include medical and surgical options, which should be individualized for each patient.

  4. Revascularização da artéria marginal com uso da artéria torácica interna direita pediculada retroaórtica sem circulação extracorpórea Off-pump grafting of the circumflex artery with pedicled retro-aortic right internal thoracic artery graft

    Directory of Open Access Journals (Sweden)

    Walter J. Gomes

    2005-03-01

    Full Text Available OBJETIVO: A revascularização miocárdica (RM sem circulação extracorpórea (CEC tem demonstrado proporcionar redução da mortalidade e da morbidade. Também o uso bilateral das artérias torácicas internas (ATIs pode oferecer benefício adicional, conferindo maior sobrevida. Apresentamos técnica de revascularização miocárdica utilizando ambas ATIs pediculadas, com a ATI direita (ATID, passada retroaórtica, para revascularizar os ramos da artéria circunflexa (ACx, sem CEC. MÉTODO: Foram estudados 26 pacientes submetidos à RM sem CEC, com enxertos bilaterais de ATIs, sendo a ATI esquerda (ATIE dirigida para a artéria descendente anterior (ADA e a ATID, pediculada através do seio transverso, anastomosada aos ramos da ACx. Foram analisados 21 pacientes do sexo masculino e cinco do feminino, a idade variou entre 42 e 74 anos. As co-morbidades associadas foram infarto do miocárdio prévio em 18 (69% pacientes, diabetes mellitus em 10 (38%, insuficiência renal em quatro (7,7% e AIDS em um (3,8% doente. RESULTADOS: Nenhum paciente apresentou alteração de ECG ou elevação enzimática no pós-operatório. As pontes por paciente variaram de 2 a 4 (média de 3,0 pontes/paciente. Não houve infecção ou deiscência esternal. Um paciente apresentou AVC no 4º PO e faleceu. A permanência hospitalar pós-operatória variou entre 3 e 12 dias (média 5,8±2,0 dias. A duração do seguimento tardio foi de 2 a 38 meses. Não houve eventos cardiovasculares ou óbitos tardios. CONCLUSÕES: Esta técnica, possibilitando a revascularização dos ramos da artéria circunflexa com enxerto de ATI direita pediculada, sem uso de CEC, potencialmente amplia os benefícios da cirurgia de revascularização miocárdica.OBJECTIVE: Off-pump coronary artery bypass surgery (OPCAB has been demonstrated to provide a reduction of cardiovascular events and mortality. Also, the bilateral use of the internal thoracic arteries (ITAs can offer additional benefits

  5. 放疗联合双侧髂内动脉灌注化疗治疗晚期宫颈癌%Analysis of curative effect of radiotherapy combined with bilateral internal iliac arterial infusion chemotherapy on advanced cervical cancer

    Institute of Scientific and Technical Information of China (English)

    苏永强; 刘英杰; 李俊

    2016-01-01

    Objective To analyze the effects of radiotherapy combined with bilateral internal iliac arterial infusion chemotherapy on advanced cervical cancer .Methods Fifty patients with advanced cervical cancer from January 2012 to December 2013 were selected as the research objects .They were randomly divided into two groups , the control group was only given radiotherapy treatment , the observation group were given bilateral internal iliac artery infusion chemotherapy treatment based on the control group , followed-up 1 year after treatment , and then compared the clinical efficacy , adverse reactions and the follow-up results of two groups .Results The effective rate in the observation group was 84%, and 56%in the control group, the difference was significant(P0.05).In addition, the main side effects of observation group were myelosuppression and gastrointestinal tract reaction , major adverse reactions in control group were delayed injury and intestinal injury of urinary system .Conclusions The effect of radiotherapy combined with bilateral in-ternal iliac arterial infusion chemotherapy on advanced cervical cancer is definite , can effectively improve the survival rate of 1 year, significantly reduce the recurrence rate in 1 year, is worth clinical promotion .%目的:分析放疗联合双侧髂内动脉灌注化疗治疗晚期宫颈癌的疗效。方法以解放军第一五二中心医院2012年1月至2013年12月收治的50例晚期宫颈癌患者为研究对象,随机将其分为两组,对照组患者给予单纯放疗治疗,观察组患者在对照组基础上联合双侧髂内动脉灌注化疗治疗,治疗后随访1年,比较两组临床疗效、不良反应及随访结果。结果观察组治疗有效率为84.0%,对照组为56.0%,两组比较差异有统计学意义(P<0.05)。观察组1年复发率、转移率分别为24.0%、16.0%,对照组为52.0%、44.0%,两组比较差异有统计学意义(P<0.05),两组1年生存

  6. Feasibility of endoscopic transumbilical thoracic sympathectomy in a porcine model.

    Science.gov (United States)

    Zhang, Jixue; Zhu, Lihuan; Yang, Shengsheng; Chen, Long; Li, Dazhou; Zheng, Heping; Chen, Weisheng

    2013-07-01

    Thoracoscopic sympathectomy is an effective treatment for palmar hyperhidrosis. Current methods are associated with risks of chronic neuropathic pain and a visible chest scar. We developed a novel surgical technique for the performance of sympathectomy by embryonic natural orifice transumbilical endoscopic surgery with a flexible endoscope in a porcine model. Transumbilical flexible endoscopic thoracic sympathectomies were performed in seven farm pigs (three acute and four 4-week survivals). Under general anaesthesia, animals were intubated and mechanically ventilated with a dual lumen endotracheal tube through tracheostomy. A newly developed long transabdominal trocar was placed through the umbilicus. After insertion of a gastroscope through this trocar, a small incision was created on both sides of the diaphragm by a needle-knife. Then the gastroscope was inserted into the thoracic cavity, and the sympathetic chain was identified at the desired thoracic level and ablated. Operation time, safety and feasibility were recorded in all animals. The transumbilical thoracic sympathectomies were successfully completed in all pigs with a mean operation time of 66.7 ± 9.4 min. Intraoperative bleeding occurred in one pig during the electrosurgical incision of diaphragm tissue, which was successfully controlled by hot biopsy forceps. No other acute intraoperative complications were observed in any cases. In the acute group, the length of the diaphragm incision ranged from 4 to 5 mm in three pigs. In the survival group, the animals recovered promptly from surgery. In three pigs, a small pneumothorax was found in the postoperative chest X-ray, but all of them were completely resolved with conservative treatment. Autopsy showed all bilateral T3 sympathetic chains were successfully ablated and no evidence of vital structure injury or diaphragmatic hernia. Transumbilical flexible endoscopic thoracic sympathectomy is technically feasible, simple and safe in a porcine model. This

  7. Escleritis posterior bilateral Bilateral posterior scleritis

    Directory of Open Access Journals (Sweden)

    A. Zurutuza

    2011-08-01

    Full Text Available La escleritis posterior es un proceso inflamatorio de la parte posterior de la esclera. Su prevalencia es muy baja y el diagnóstico puede resultar complicado por la ausencia de signos oculares externos. Es más frecuente en mujeres. Cuando aparece en pacientes jóvenes no suele tener otras patologías asociadas, pero en mayores de 55 años hasta un tercio de los casos tienen relación con alguna enfermedad sistémica, sobre todo la artritis reumatoide. El diagnóstico de esta patología puede requerir un abordaje multidisciplinar y la colaboración de oftalmólogos con neurólogos, internistas o reumatólogos. En este artículo se describe un caso de escleritis posterior bilateral idiopática.Posterior scleritis is an inflammatory process of the posterior part of the sclera. Its prevalence is very low and its diagnosis can be complicated due to the absence of external ocular signs. It is more frequent in women. In young patients it does not usually have other associated pathologies, but in those over 55 years nearly one-third of the cases have a relation with some systemic disease, above all rheumatoid arthritis. The diagnosis of this pathology can require a multidisciplinary approach and the collaboration of ophthalmologists with neurologists, internists or rheumatologists. This article describes a case of idiopathic bilateral posterior scleritis.

  8. RADIOGRAPHIC THORACIC ANATOMY OF THE RED PANDA (AILURUS FULGENS).

    Science.gov (United States)

    Makungu, Modesta; du Plessis, Wencke M; Barrows, Michelle; Groenewald, Hermanus B; Koeppel, Katja N

    2016-09-01

    The red panda ( Ailurus fulgens ) is classified as an endangered species by the International Union for Conservation of Nature and Natural Resources. The natural distribution of the red panda is in the Himalayas and southern China. Thoracic diseases such as dirofilariasis, hypertrophic cardiomyopathy, tracheal obstruction, lung worm infestation, and pneumonia have been reported in the red panda. The aim of this study was to describe the normal radiographic thoracic anatomy of captive red pandas as a species-specific reference for routine health examinations and clinical cases. Right lateral (RL) and dorsoventral (DV) inspiratory phase views of the thorax were obtained in 11 adult captive red pandas. Measurements were made and ratios calculated to establish reference ranges for the mean vertebral heart score on the RL (8.34 ± 0.25) and DV (8.78 ± 0.34) views and the mean ratios of the caudal vena cava diameter to the vertebral body length above tracheal bifurcation (0.67 ± 0.05) and tracheal diameter to the width of the third rib (2.75 ± 0.24). The majority of animals (10/11) had 14 thoracic vertebrae, except for one animal that had 15 thoracic vertebrae. Rudimentary clavicles were seen in 3/11 animals. The ovoid, oblique cardiac silhouette was more horizontally positioned and elongated in older animals. A redundant aortic arch was seen in the oldest animal. The trachea was seen with mineralized cartilage rings in all animals. The carina was clearly seen in the majority of animals (10/11). Variations exist in the normal radiographic thoracic anatomy of different species. Knowledge of the normal radiographic thoracic anatomy of the red panda should prove useful for routine health examinations and in the diagnosis of thoracic diseases.

  9. [Clinical evaluation of in-plane ultrasound-guided thoracic paravertebral block using laterally intercostal approach].

    Science.gov (United States)

    Xu, T; Li, M; Tian, Y; Song, J T; Ni, C; Guo, X Y

    2017-02-18

    To evaluate the feasibility and success rate of in-plane ultrasound-guided paravertebral block using laterally intercostal approach. In the study, 27 patients undergoing elective thoracic surgery were selected to do paravertebral block preoperatively. The fifth intercostal space was scanned by ultrasound probe which was placed along the long axis of the rib and 8 cm lateral to the midline of the spine. The needle was advanced in increments aiming at the space between the internal and innermost intercostal muscles. Once the space between the muscles was achieved, 20 mL of 0.5% (mass fraction) ropivacaine was injected and a catheter was inserted. Whether the tip of catheter was in right place was evaluated by ultrasound image. The block dermatomes of cold sensation were recorded 10, 20 and 30 min after the bolus drug was given. Then 0.2% ropivacaine was infused with 6 mL/h via the catheter by an analgesia pump postoperatively. The block dermatomes of cold sensation and pain score were recorded 1, 6, 24 and 48 h postoperatively. The first attempt success rate of catheteration was 81.48% (22/27); the tips of catheter were proved in right places after the second or third attempt in 5 patients. The median numbers of the block dermatomes 10, 20 and 30 min after the bolus drug was given were 2, 3, 4; the median numbers of block dermatomes were 5, 5, 5, 4, and of pain score were 1, 1, 2, 2 at 1, 6, 24, 48 h postoperatively; no case of bilateral block, pneumothorax or vessel puncture occurred. Thoracic paravertebral block using laterally intercostal approach is feasible, which has high success rate of block and low rate of complications.

  10. Unilateral or Bilateral Thoracocentesis for Bilateral Pleural Effusion. A Prospective Study.

    Science.gov (United States)

    Ferreiro, Lucía; San José, María Esther; Gude, Francisco; Lama, Adriana; Suárez-Antelo, Juan; Golpe, Antonio; Toubes, M Elena; González-Barcala, Francisco Javier; Álvarez-Dobaño, José Manuel; Valdés, Luis

    2016-04-01

    In the absence of firm recommendations, we analyzed whether unilateral thoracic puncture is sufficient for bilateral pleural effusion (PE), or if the procedure needs to be performed in both sides. Prospective study of patients seen consecutively for bilateral PE during a period of 3 years and 9 months. All patients underwent simultaneous bilateral thoracocentesis. The standard protocol variables collected in our hospital served as study parameters. Size of PE, presence of chest pain or fever, or accompanying lung abnormalities, different attenuation values on chest computed tomography, presence of loculated pleural fluid, and radiological resolution in a single side were also evaluated. A total of 36 patients (19 men; mean age 68.5 ± 16.5 years) were included. The etiology of the effusion was different in each side in only 2 patients (5.6%). In 6/32 cases (18.8%), the biological analysis of the pleural fluid (in terms of transudate/exudate) from both sides did not correspond with the etiological diagnosis of the effusion. Correlation between biochemical parameters analyzed in the fluid from both sides (Pearson's correlation coefficient) ranged between 0.74 (LDH) and 0.998 (NT-proBNP). As different diagnoses in each side were found in only 2 patients, the circumstances in which bilateral diagnostic thoracocentesis would be necessary could not be determined. Simultaneous bilateral thoracocentesis does not appear to be recommendable. Larger series are needed to establish which factors might suggest the need for simultaneous puncture of both PE. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

  11. Bilaterally Incarcerated Morgagni Hernia

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    Zuhal Demirhan Yananli

    2013-06-01

    Full Text Available Morgagni hernia is a rare congenital diaphragmatic hernia. It is seen rarely bilaterally. Patients are usually asymptomatic. Therefore, diagnosis may be delayed until adulthood. Significant morbidity can occur in case complications arise and diagnosis is delayed. The patient, a 74 year-old female, presented in this article, was admitted to the emergency department with abdominal pain, vomiting, and shortness of breath. The plain abdominal radiograph of the patient revealed bowel obstruction and suspicious appearence in favor of the diaphragmatic hernia on both sides of the sternum. Computed tomography revealed bilaterally incarcerated Morgagni hernia with strangulated omentum in the right side of the sternum and a part of colon in the left side of sternum. Incarcerated organs were withdrawn to peritoneal cavity and defects of hernia were sutured primarily on laparatomy. Because bilateral incarcerated Morgagni hernia can be seen rarely, this case was reported.

  12. Bilateral inferior turbinate osteoma

    Science.gov (United States)

    Sahemey, R.; Warfield, A.T.; Ahmed, S.

    2016-01-01

    Osteomas are the most common benign osteoclastic tumours of the paranasal sinuses. However, nasal cavity and turbinate osteomas are extremely rare. Only nine middle turbinate, three inferior turbinate and one inferior turbinate osteoma cases have been reported to date. The present case report describes the management and follow-up of symptomatic bilateral inferior turbinate osteoma. A 60-year-old female presented with symptoms of bilateral nasal obstruction and right-sided epiphora. Radiological investigation found hypertrophic bony changes involving both inferior turbinates. The patient was managed successfully by endoscopic inferior turbinectomies in order to achieve a patent airway, with no further recurrence of tumour after 3 months postoperatively. To the best of our knowledge, this is the first reported case of bilateral inferior turbinate osteoma. We describe a safe and minimally invasive method of tumour resection, which has a better cosmetic outcome compared with other approaches. PMID:27534890

  13. Stereotactic bilateral anterior internal capsulotomy for refractory depression disorders%立体定向双侧内囊前肢毁损术治疗难治性抑郁症

    Institute of Scientific and Technical Information of China (English)

    田帅伟; 潘宜新; 林国珍; 李永超; 孙伯民

    2015-01-01

    目的 评估立体定向双侧内囊前肢毁损术治疗难治性抑郁症的疗效及并发症情况.方法 收集上海瑞金医院功能神经外科自2008年3月至2012年12月应用立体定向双侧内囊前肢毁损术治疗的21例抑郁症患者临床资料,术前及术后1年应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、简易精神状态检查量表(MMSE)对患者精神状态进行评估及比较,以评价治疗效果. 结果 (1)抑郁症患者术后HAMD、HAMA量表评分与术前差异有统计学意义(P<0.05),MMSE评分差异无统计学意义(P>0.05).(2)术后1年,临床控制6例,显著改善8例,进步5例,无效2例,总体有效率90.5%(19/21).(3)并发症:3例患者出现轻度认知障碍短暂记忆障碍,均于1周内消失;3例患者术后有情感淡漠,懒散;2例患者术后出现体质量增加,所有患者均无颅内出血、神经损伤等严重并发症. 结论 立体定向双侧内囊前肢毁损术有确切的疗效,对于难治性抑郁症可作为一种补充治疗手段.%Objective To investigate the effect ofstereotactic bilateral internal capsulotomy on patients with refractory depression disorders and thier complications.Methods Twenty-one patients with treatment-resistant depression,admitted to and underwent stereotactic bilateral internal capsulotomy in our hospital from March 2008 to December 2012,were chosen.Their clinical data were retrospectively analyzed; before and one year after operation,Hamilton depression rating scale (HAMD),Hamilton anxiety rating scale (HAMA) and mini-mental state examination (MMSE) were performed by psychiatrist to evaluate the treatment efficacy.Results (1) The total scores of HAMA and HAMD after operation were significantly lower than those before operation (P<0.05),while no obvious difference in the MMSE scores was noted between before and after operation.(2) One year after the operation,6 patients met the criterion of clinical control,8 improved

  14. Bilateral Primary Intraocular Lymphoma

    Directory of Open Access Journals (Sweden)

    Mehrdad Karimi

    2011-01-01

    Full Text Available Purpose: To report a case of bilateral primary intraocular lymphoma. Case report: A 33-year-old man presented with bilateral blurred vision since two years ago. Examination revealed large keratic precipitates, anterior chamber reaction, posterior subcapsular cataracts, and vitreous infiltration. After a short trial of topical and periocular steroids, diagnostic 25-gauge pars plana vitrectomy was performed and cytologic evaluation of the aspirate confirmed a diagnosis of intraocular lymphoma. The patient was subsequently managed with intravitreal methotrexate in both eyes and responded favorably. Central nervous system workup for lymphoma was negative. Conclusion: Primary intraocular lymphoma should be considered in young adults suffering from chronic recalcitrant panuveitis.

  15. Neurological manifestations of thoracic myelopathy.

    Science.gov (United States)

    Takenaka, Shota; Kaito, Takashi; Hosono, Noboru; Miwa, Toshitada; Oda, Takenori; Okuda, Shinya; Yamashita, Tomoya; Oshima, Kazuya; Ariga, Kenta; Asano, Masatoshi; Fuchiya, Tsuyoshi; Kuroda, Yusuke; Nagamoto, Yukitaka; Makino, Takahiro; Yamazaki, Ryoji; Yonenobu, Kazuo

    2014-07-01

    Investigation of preoperative manifestations of thoracic myelopathy in a large population has not been reported. The aim of this study was to identify symptoms specific to anatomical pathology or compressed segments in thoracic myelopathy through investigation of preoperative manifestations. Subjects were 205 patients [143 men, 62 women; mean age, 62.2 (range 21-87 years)] with thoracic myelopathy who underwent surgery at our affiliate institutions from 2000 to 2011. The disease distribution included ossification of the ligamentum flavum (OLF) in 106 patients, ossification of the posterior longitudinal ligament (OPLL) in 17, OLF with OPLL in 17, intervertebral disc herniation (IDH) in 23, OLF with IDH in 3, and spondylosis in 39. We assessed (1) initial and preoperative complaints, (2) neurological findings, (3) Japanese Orthopaedic Association scores (JOA, full score, 11 points), (4) the compressed segments, and (5) preoperative duration. Multivariate analyses were performed to examine potential relationships between preoperative manifestations and anatomical pathology or compressed segments. The multivariate analyses revealed relationships between lower limb muscle weakness and T10/11 anterior compression; lower limb pain and T11/12 anterior compression; low back pain and T11/12 compression; and hyporeflexia in the patellar tendon reflex/foot drop and T12/L1 anterior compression. This study elucidated symptoms specific to anatomical pathology or compressed segments in thoracic myelopathy. These relationships can be helpful in the initial investigation of thoracic diseases, although additional measures such as MRI or CT are necessary for definitive diagnosis.

  16. Is there any further advantage of using more than one internal mammary artery? Literature review and analysis.

    Science.gov (United States)

    Parissis, Haralabos; Soo, Alan W; Al-Alao, Bassel

    2013-02-01

    The use of the internal mammary artery reduces the incidence of late adverse effects and improves survival after coronary artery bypass grafting. Therefore, internal mammary artery grafts ought to be used in all patients undergoing coronary artery bypass grafting (level II evidence), although in the UK, only 95% of the patients receive an internal mammary artery graft. This is due to factors such as poor left ventricular function, old age, previous radiation to the thoracic cavity, or emergency surgery. As there are biological similarities between the left and right internal mammary artery, one can extrapolate that the use of 2 internal mammary artery grafts may provide additional benefits. Bilateral internal mammary artery grafting can be safely performed in most patients (level II evidence). The late survival in patients with bilateral internal mammary artery grafts is favorable. However, there is as yet no completed randomized trial on this subject. Thus the lack of robust data makes previous reports amenable to criticism. This review examines published data on bilateral internal mammary artery revascularization spanning the last 15 years, and addresses the advantages and disadvantages of arterial conduits in coronary surgery.

  17. Estudo histomorfométrico seqüencial da artéria torácica interna esquerda Sequential histomorphometric study of the left internal thoracic artery

    Directory of Open Access Journals (Sweden)

    Maximiliano C. Kneubil

    2006-12-01

    Full Text Available OBJETIVO: O uso de enxertos de artéria torácica interna esquerda (ATIE é atualmente reconhecido como a melhor opção na cirurgia de revascularização miocárdica, proporcionando menor incidência de eventos cardiovasculares e maior sobrevida. Entretanto, com a expansão do uso dos enxertos arteriais, faz se necessário melhor entendimento da estrutura histológica da ATIE. Portanto, o objetivo deste trabalho foi estudar a estrutura histológica da ATIE e a análise histomorfométrica seqüencial e comparativa entre os diferentes segmentos. MÉTODO: Foram estudados espécimes de ATIE retirados de 18 cadáveres, divididos em nove segmentos proporcionais. Cortes de cada segmento foram corados com técnica de Verhoeff-Van Gieson. Foram analisados os seguintes parâmetros: perímetro da luz arterial, espessura da íntima, espessura da camada média, número de fibras elásticas da camada média e a densidade de fibras elásticas. RESULTADOS: Os dados obtidos mostraram que perímetro da ATIE mostra tendência a diminuir ao longo de sua extensão, a espessura da íntima é aumentada nos segmentos proximais, a espessura da camada média diminui ao longo de sua extensão, o número de lâminas elásticas se concentra nos segmentos intermediários, a densidade de lâminas elásticas é diminuída nos segmentos proximais e distais. CONCLUSÃO: Portanto, os achados do presente estudo confirmam a heterogeneidade da estrutura histológica seqüencial da ATIE.OBJECTIVE: The use of left internal thoracic artery (LITA in coronary artery bypass surgery is currently recognized as the best option, providing lower incidences of cardiovascular events and superior long-term survival. Now, incremental utilization of these grafts makes a reassessment of its histological structure necessary. Therefore, the purpose of this study was to examine and compare the sequential histological structure of LITA. METHOD: Specimens of LITA harvested from 18 cadavers, divided into

  18. Bilateral Naevus Of OTA

    Directory of Open Access Journals (Sweden)

    Ahmad Qazi Masood

    2001-01-01

    Full Text Available Naevus of Ota is a type of dermal melanocytic naevus characterized by extensive blue patch of dermal melanocytic pigmentation of the sclera and the skin adjacent to the eye. The condition is usually unilateral. Here we report a patient with bilateral naevus of Ota in view of the rarity of this condition.

  19. Bilateral chronic subdural hematoma

    DEFF Research Database (Denmark)

    Andersen-Ranberg, Nina Christine; Poulsen, Frantz Rom; Bergholt, Bo

    2016-01-01

    OBJECTIVE Bilateral chronic subdural hematoma (bCSDH) is a common neurosurgical condition frequently associated with the need for retreatment. The reason for the high rate of retreatment has not been thoroughly investigated. Thus, the authors focused on determining which independent predictors ar...

  20. Pediatric thoracic trauma: Current trends.

    Science.gov (United States)

    Pearson, Erik G; Fitzgerald, Caitlin A; Santore, Matthew T

    2017-02-01

    Pediatric thoracic trauma is relatively uncommon but results in disproportionately high levels of morbidity and mortality when compared with other traumatic injuries. These injuries are often more devastating due to differences in children׳s anatomy and physiology relative to adult patients. A high index of suspicion is of utmost importance at the time of presentation because many significant thoracic injuries will have no external signs of injury. With proper recognition and management of these injuries, there is an associated improved long-term outcome. This article reviews the current literature and discusses the initial evaluation, current management practices, and future directions in pediatric thoracic trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. CT of thoracic aortic aneurysms.

    Science.gov (United States)

    Posniak, H V; Olson, M C; Demos, T C; Benjoya, R A; Marsan, R E

    1990-09-01

    Aneurysms of the thoracic aorta are most often the result of arteriosclerotic disease. Other causes include degeneration of the medial layer of the aortic wall, either idiopathically or due to genetic disorders such as Marfan syndrome; aortic dissection; trauma; syphilis and other bacterial infection; noninfective aortitis; and congenital anomaly. We review normal anatomy of the aorta and discuss our technique and interpretation of computed tomography (CT) in the evaluation of the thoracic aorta. We illustrate the CT appearance of different types of aortic aneurysms as well as discuss the use of CT for assessing complications of aneurysms, for postoperative follow-up, and in the differentiation of aortic aneurysm from a paraaortic mass.

  2. Lateral Thoracic Maningocele : Anaesthetic Implications

    Directory of Open Access Journals (Sweden)

    Nazeer Ahmed K

    2008-12-01

    Full Text Available Meningomyelocele is a broad term representing herniation of extracranial contents through a congenital defect in the vertebral column. If only cerebrospinal fluid (CSF and meninges herniate, it is termed as a meningocele. A meningoencephalocele is herniation of neural elements along with meninges. Anaesthetic challenges in management of thoracic meningomyelocele include securing the airway with intubation in lateral or supine position, intraoperative prone position with its associated complications and accurate assessment of blood loss and prevention of hypothermia. We report a case of a thoracic meningocele posted for resection and discuss its anaesthetic implications

  3. Totally Endoscopic (VATS) First Rib Resection for Thoracic Outlet Syndrome.

    Science.gov (United States)

    George, Robert S; Milton, Richard; Chaudhuri, Nilanjan; Kefaloyannis, Emmanuel; Papagiannopoulos, Kostas

    2017-01-01

    Thoracic outlet syndrome (TOS) causes neurologic symptoms in 95% of cases and vascular symptoms in 5% of cases. Surgical resection is curative. Endoscopic-assisted transaxillary first rib resection has been previously reported. In this study we report a totally endoscopic video-assisted thoracoscopic surgery (VATS) approach using tailored endoscopic instruments. Ten patients (8 women; average age, 32.3 ± 5.6 years) with TOS underwent VATS first rib resection following failure of symptom improvement with physiotherapy. Symptoms were: unilateral neurogenic (n = = 7), bilateral neurogenic (n = = 2), and bilateral arterial compression (n = = 1). Three standard VATS ports were utilized. The parietal pleura and periosteum overlying the first rib were stripped avoiding injury to the neurovascular bundle. The rib was transected with an endoscopic rib cutter and resected completely in a piecemeal fashion using endoscopic bone nibblers. All periosteal remnants were trimmed releasing the neurovascular bundle completely. Patients were discharged within 72 hours following surgery. One patient had the contralateral side treated 18 months later and another patient is awaiting the second surgery. At follow-up, 9 patients had complete resolution of their main symptoms. One patient with neurogenic TOS developed mild functional and sensational loss of the non-dominant hand that improved within 8 months with physiotherapy. VATS first rib resection for TOS provides, unlike the classic approaches, a superior, magnified, and well-illuminated view of the thoracic inlet. It allows good posterior trimming of the first rib, release of brachial plexus, and an aesthetically pleasing result, especially in female patients. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Long-term results of thoracic sympathectomy for primary hyperhidrosis.

    Science.gov (United States)

    Stefaniak, Tomasz J; Ćwigoń, Marta

    2013-05-01

    The side effects following thoracic sympathectomy for primary hyperhidrosis include pain and compensatory/ reflex sweating. The aim of the study was the evaluation of the results of the endoscopic sympathicotomy with clips with emphasis on the frequency of side effects following the operation. Two-hundred-eighty-three patients were qualified to thoracic T3-T4 sympathicotomy with clips. In all cases bilateral procedure in prone position with CO2 insufflation was performed. The subjective intensity of disease was evaluated by VAS scale (0--no sweating; 10--maximal possible sweating) while the recurrence of the sweating in primary localization, intensity and dynamics of compensatory and plantar sweating were evaluated post-operatively. Follow-up data were obtained during office visits 3, 12 and 36 months after surgery. The overall follow-up response was 74.6%. There was no mortality. Perioperative morbidity included 6 cases of pneumothorax. The mean duration of surgery was 57 minutes bilaterally. The postoperative intercostal pain was present in all patients (100%) with mean duration of 21.88 days but in 72.6% of cases it did not demand any medication as early as 48 hours after surgery. Strong or very strong compensatory sweating was observed in 17.5% of cases 3 months after ETS, in 14.1% after 12 months and in 23.6% after 36 months. Thoracic sympathicotomy with clips is a safe treatment that provides satisfactory longterm results. The incidence of side-effects (intercostal pain, compensatory sweating) is high and does not change with time in most of the cases.

  5. Bilateral Symmetrical Parietal Extradural Hematoma

    African Journals Online (AJOL)

    had multiple episodes of vomiting. ... careful planning, adequate exposure, judicious surgical approach, and time ... Key words: Bilateral extradural hematoma, CT scan, double ... Figure 4: Intraoperative photograph showing bilateral trephine.

  6. Permanent occlusion of bilateral internal carotid arteries after intermittent occlusion of bilateral carotid arteries: a new rat model for vascular dementia%间断性闭塞双侧颈动脉后永久性闭塞双侧颈内动脉:一种新的大鼠血管性痴呆模型

    Institute of Scientific and Technical Information of China (English)

    王晓亮; 王乃东; 王其新; 郭慧玲; 郭云良; 谢俊霞

    2012-01-01

    Objective To modify a classic two-vessel occlusion (2VO) modeling method in order to decrease the systematic errors in the behavioral experiments such as Morris water maze.Methods Thirty-two adult male Wistar rats were randomly allocated into classic 2VO model,modified model,sham operation and sham ligation groups (n =8 in each group).Only the bilateral common carotid arteries were ligated in the classic 2VO model group; the common carotid arteries were clipped intermittently,and the origins of pterygopalatine arteries of the internal carotid arteries were high selectively ligated in the modified model group; the common carotid arteries were only ligated intermittently in the sham ligation group; and only the common carotid arteries and the upper segment of pterygopalatine artery branches were separated in the sham operation group.The rat behavior was evaluated using the pupillary light reflex,Morris water maze and eight-arm radial maze.HE staining was used to observe the histological changes.Results The Morris water maze escape latency (F =72.169 - 163.102,all P < 0.001) and the number of reference memory errors of eight-arm radial maze (F =33.515-74.726,all P <0.001) in the modified model and the classic 2VO model groups were longer and higher than those in the sham operation group.The pupillary light reflex of the rats was lost in the classic 2VO model group and the pupillary light reflex of the rats was normal in other groups.The reaching platform time in the classic 2VO model group was significantly longer than that in the modified model and sham operation groups (P <0.001).The percentage of target quadrant dwell time was also decreased significantly (at day 7 after procedure:F =13.770,P <0.001 ; at day 90 after procedure:F =14.780,P <0.001).HE staining showed pathological changes such as the cells decrease in hippocampal CA1 region and leukoaraiosis in the modified model and the classic 2VO model groups.In addition,there were more vacuole

  7. Thoracic aortic catastrophes : towards the endovascular solution

    NARCIS (Netherlands)

    Jonker, F.H.W.

    2010-01-01

    Descending thoracic aortic catastrophes include a variety of acute pathologies of the descending thoracic aorta, which are all associated with high morbidity and mortality rates, requiring immediate intervention. For this thesis, we explored the management and outcomes of several thoracic aortic cat

  8. Thoracic tumors : prognostic and thearapeutic improvements

    NARCIS (Netherlands)

    Jong, Wouter Karst de

    2008-01-01

    Thoracic tumors are a major burden of disease in many countries. Non-small cell lung cancer and small-cell lung cancer are the most common thoracic malignancies, both tumors are one of the most well-known of the less common thoracic tumors. In this thesis, new ways in estimating the prognosis of pat

  9. Thoracic hyperextension injury with complete “bony disruption” of the thoracic cage: Case report of a potentially life-threatening injury

    Directory of Open Access Journals (Sweden)

    Bailey James

    2012-05-01

    Full Text Available Abstract Background Severe chest wall injuries are potentially life-threatening injuries which require a standardized multidisciplinary management strategy for prevention of posttraumatic complications and adverse outcome. Case presentation We report the successful management of a 55-year old man who sustained a complete “bony disruption” of the thoracic cage secondary to an “all-terrain vehicle” roll-over accident. The injury pattern consisted of a bilateral “flail chest” with serial segmental rib fractures, bilateral hemo-pneumothoraces and pulmonary contusions, bilateral midshaft clavicle fractures, a displaced transverse sternum fracture with significant diastasis, and an unstable T9 hyperextension injury. After initial life-saving procedures, the chest wall injuries were sequentially stabilized by surgical fixation of bilateral clavicle fractures, locked plating of the displaced sternal fracture, and a two-level anterior spine fixation of the T9 hyperextension injury. The patient had an excellent radiological and physiological outcome at 6 months post injury. Conclusion Severe chest wall trauma with a complete “bony disruption” of the thoracic cage represents a rare, but detrimental injury pattern. Multidisciplinary management with a staged timing for addressing each of the critical injuries, represents the ideal approach for an excellent long-term outcome.

  10. Bilateral tibial hemimelia I.

    Science.gov (United States)

    Suganthy, J; Rassau, Marina; Koshi, Rachel; Battacharjee, Suranjan

    2007-05-01

    Congenital absence of tibia is a rare anomaly. We report a case of bilateral tibial hemimelia born to phenotypically normal parents. The two amputated legs with tibial dysplasia obtained from a 3-year-old boy were studied by radiography and anatomical dissection. The radiological evaluation revealed a normal hip joint. The lower end of femur was normal without any bifurcation, shortening or bowing. Fibula was present on both legs and there was no sign of bowing or doubling. Both right and left tibiae were absent. In addition, on the right side, five tarsal bones, two metatarsals and the corresponding digital rays were absent. On the left side, three tarsal bones were absent. Dissection of the amputated segments showed the presence of extensor digitorum longus, peroneus tertius, peroneus longus and brevis, gastrocnemius, and soleus. Following bilateral knee disarticulation the patient was fitted with prosthesis and is doing well.

  11. Acute bilateral emphysematous pyelonephritis

    Science.gov (United States)

    Surur, John

    2011-01-01

    The author reports the case of a well and fit patient who presented herself to the emergency department and was found to have bilateral emphysematous pyelonephritis. She was admitted to the intensive care where she was initially treated conservatively with antibiotics, percutaneous drainage and continuous renal replacement therapy, but her condition deteriorated. She underwent a left total nephrectomy and a partial right nephrectomy that resulted in remarkable improvement. The patient started passing urine spontaneously, so no haemofiltration was required. She was discharged home and her case was followed-up by an urologist and nephrologist. This case lays emphasis on thoroughly investigating and managing a patient with bilateral emphysematous pyelonephritis and, in relation to its management, on the dilemma of whether the treatment of choice should be conservative or surgical. PMID:22707665

  12. Bilateral matrix-exponential distributions

    DEFF Research Database (Denmark)

    Bladt, Mogens; Esparza, Luz Judith R; Nielsen, Bo Friis

    2012-01-01

    In this article we define the classes of bilateral and multivariate bilateral matrix-exponential distributions. These distributions have support on the entire real space and have rational moment-generating functions. These distributions extend the class of bilateral phasetype distributions of [1]...

  13. Bilateral akillesseneruptur hos nyretransplanterede

    DEFF Research Database (Denmark)

    Skovgaard, D; Feldt-Rasmussen, B F; Nimb, L

    1996-01-01

    Increased incidence of tendinitis and tendon ruptures is reported in recipients of a kidney transplant. Two cases of bilateral achilles tendon rupture after minimal trauma are described. Tendon ruptures are more frequent in individuals with kidney disease in dialysis or after transplantation...... compared with patients receiving other organ transplantations. It is therefore more likely that tendon ruptures are related to metabolic changes associated with kidney disease rather than with transplantation or with glucocorticoid treatment per se. Clinical symptoms of achilles tendinitis should...

  14. Ischemic Bilateral Opercular Syndrome

    OpenAIRE

    Aysel Milanlioglu; Mehmet Nuri Aydın; Alper Gökgül; Mehmet Hamamcı; Mehmet Atilla Erkuzu; Temel Tombul

    2013-01-01

    Opercular syndrome, also known as Foix-Chavany-Marie syndrome, is a paralysis of the facial, pharyngeal, masticatory, tongue, laryngeal, and brachial muscles. It is a rare cortical form of pseudobulbar palsies caused by vascular insults to bilateral operculum. Its clinical presentations include anarthria, weakness of voluntary muscles involving face, tongue, pharynx, larynx, and masticatory muscles. However, autonomic reflexes and emotional activities of these structures are preserved. In the...

  15. Bilateral lunate intraosseous ganglia

    Energy Technology Data Exchange (ETDEWEB)

    Pablos, J.M. [Department of Radiology, Hospital San Juan de Dios, Seville (Spain); Valdes, J.C. [Department of Radiology, Cemedi, Seville (Spain); Gavilan, F. [Department of Pathology, Hospital Universitario Virgen del Rocio, Seville (Spain)

    1998-12-01

    An intraosseous ganglion is a relatively uncommon, benign, cyst-like lesion that occurs in young and middle-aged adults. Most commonly seen adjacent to the hip, ankle, knee, or wrist, they are histologically identical to their soft tissue counterparts. A review of the literature revealed only two previously reported examples of bilateral symmetrical ganglia of the lunate bones. (orig.) With 3 figs., 10 refs.

  16. [Spontaneous bilateral Petit hernia].

    Science.gov (United States)

    Fontoura, Rodrigo Dias; Araújo, Emerson Silveira de; Oliveira, Gustavo Alves de; Sarmenghi Filho, Deolindo; Kalil, Mitre

    2011-01-01

    Petit's lumbar hernia is an uncommon defect of the posterior abdominal wall that represents less than 1% of all abdominal wall hernias. It is more often unilateral and founded in young females, rarely containing a real herniated sac. There are two different approaches to repair: laparoscopy and open surgery. The goal of this article is to report one case of spontaneous bilateral lumbar Petit's hernia treated with open surgery.

  17. Bilateral Malignant Brenner Tumour

    Directory of Open Access Journals (Sweden)

    Nasser D Choudhary, S.Manzoor Kadri, Ruby Reshi, S. Besina, Mansoor A. Laharwal, Reyaz tasleem, Qurrat A. Chowdhary

    2002-10-01

    Full Text Available Bilateral malignant Brenner tumour ofovary is extremely rate. A case ofmalignant Brenner tumourinvolving both the ovaries with mctastasis to mesentery in a 48 year femalc is presented. Grosslyo'arian masses were firm with soft areas, encapsulated and having bosselated external surfaces.Cut sections showed yellowish white surface with peripheral cysts (in both tumours. Microscopyrevealed transitional cell carcinoma with squamoid differentiation at places. Metastatic deposits werefound in the mesentery. Endometrium showed cystic glandular hyperplasia.

  18. The Flail and Pulseless Upper Limb: an Extreme Case of Traumatic Scapulo-thoracic Dissociation

    Directory of Open Access Journals (Sweden)

    Maria SW

    2015-07-01

    Full Text Available Scapulo-thoracic dissociation is an infrequent injury resulting from high energy trauma which is often associated with severe neurological and vascular injuries which may be unrecognised at the time of presentation. A 24 year-old female presented with bilateral rib fractures, pneumothorax, liver and kidney injuries following a road traffic accident. She also sustained fractures of her right scapula, odontoid, right transverse processes of the thoracic and lumbar vertebrae and a closed fracture of her right femur. Her right upper limb was later noted to be flail and pulseless, due to complete right brachial plexus injury, scapula-thoracic dissociation and subclavian artery avulsion. We managed the upper limb injuries non-operatively, and focused on resuscitation of the patient. Early exploration of the complete brachial plexus injury was not undertaken in spite of the possible associated poor functional outcome as there was no life-threatening indication.

  19. Distraction Osteogenesis of Multiple Ribs for the Treatment of Acquired Thoracic Dystrophy.

    Science.gov (United States)

    Piper, Merisa L; Delrosario, Lawrence; Hoffman, William Y

    2016-03-01

    Acquired thoracic dystrophy is a complication associated with early open repair of pectus excavatum resulting from extensive cartilage resection. The condition can cause serious functional and physiologic impairments, including cardiac compression and restrictive pulmonary function. We describe a 17-year-old boy with acquired thoracic dystrophy after Ravitch repair of pectus excavatum during infancy, whom we treated with distraction osteogenesis. The patient had a marked deformity of the chest wall and general hypoplasia of the central portion of the ribcage, with resultant symptomatic dyspnea on exertion and reduced pulmonary function. After osteotomies and distraction osteogenesis of bilateral ribs 4-8 using customized distraction devices, he had improved thoracic contour, resolution of dyspnea, and decreased restrictive pulmonary symptoms. This case suggests that distraction osteogenesis, already used extensively in craniomaxillofacial and orthopedic surgery, may be a novel method for management of this condition.

  20. Thoracic Block Technique Associated with Positive End-Expiratory Pressure in Reversing Atelectasis

    Directory of Open Access Journals (Sweden)

    Luciana Carnevalli Pereira

    2015-01-01

    Full Text Available A preschool four-year-old male patient had been admitted to the Mandaqui Hospital with a diagnosis of lobar pneumonia, pleural effusion, and right lung atelectasis. Treatment consisted of antibiotics and physiotherapy sessions, using a technique described in the literature as Insufflation Technique to Reverse Atelectasis (ITRA, which consists of a thoracic block of healthy lung tissue, leaving only the atelectasis area free, associated with the use of invasive or noninvasive mechanical ventilation with positive airway pressure for reversal of atelectasis. Two physiotherapy sessions were conducted daily. The sessions lasted 20 minutes and were fractionated into four series of five minutes each. Each series bilateral thoracic block was performed for 20 seconds with a pause lasting for the same time. Associated with the thoracic block, a continuous positive airways pressure was used using a facial mask and 7 cm H2O PEEP provided via CPAP. Conclusion. ITRA technique was effective in reversing atelectasis in this patient.

  1. Pneumomediastinum and bilateral pneumothorax following near drowning in shallow water

    Directory of Open Access Journals (Sweden)

    Santhiya Govindaraj

    2011-10-01

    Full Text Available We report pneumomediastinum, bilateral pneumothorax and acute respiratory distress syndrome in a victim of near drowning who was intoxicated and did not have thoracic or neck trauma. Chest radiograph revealed the above findings, later confirmed by computed tomography. He was in shock and also had gastrointestinal (GI bleeding and renal dysfunction. With adequate resuscitative measures including fluids, blood transfusions, intercostal tube drainage and mechanical ventilation he made a complete recovery. Good prognostic indicators in near drowning patients include higher Glasgow Coma Scale, short submersion time and quick resuscitative measures even in the presence of serious cardiorespiratory or hemodynamic compromise.

  2. Pneumomediastinum and bilateral pneumothorax following near drowning in shallow water

    Directory of Open Access Journals (Sweden)

    Stalin Viswanathan

    2011-09-01

    Full Text Available We report pneumomediastinum, bilateral pneumothorax and acute respiratory distress syndrome in a victim of near drowning who was intoxicated and did not have thoracic or neck trauma. Chest radiograph revealed the above findings, later confirmed by computed tomography. He was in shock and also had gastrointestinal (GI bleeding and renal dysfunction. With adequate resuscitative measures including fluids, blood transfusions, intercostal tube drainage and mechanical ventilation he made a complete recovery. Good prognostic indicators in near drowning patients include higher Glasgow Coma Scale, short submersion time and quick resuscitative measures even in the presence of serious cardiorespiratory or hemodynamic compromise.

  3. Pneumomediastinum and bilateral pneumothorax following near drowning in shallow water.

    Science.gov (United States)

    Govindaraj, Santhiya; Viswanathan, Stalin

    2011-07-01

    We report pneumomediastinum, bilateral pneumothorax and acute respiratory distress syndrome in a victim of near drowning who was intoxicated and did not have thoracic or neck trauma. Chest radiograph revealed the above findings, later confirmed by computed tomography. He was in shock and also had gastrointestinal (GI) bleeding and renal dysfunction. With adequate resuscitative measures including fluids, blood transfusions, intercostal tube drainage and mechanical ventilation he made a complete recovery. Good prognostic indicators in near drowning patients include higher Glasgow Coma Scale, short submersion time and quick resuscitative measures even in the presence of serious cardiorespiratory or hemodynamic compromise.

  4. Pneumomediastinum and bilateral pneumothorax following near drowning in shallow water

    Science.gov (United States)

    Govindaraj, Santhiya; Viswanathan, Stalin

    2011-01-01

    We report pneumomediastinum, bilateral pneumothorax and acute respiratory distress syndrome in a victim of near drowning who was intoxicated and did not have thoracic or neck trauma. Chest radiograph revealed the above findings, later confirmed by computed tomography. He was in shock and also had gastrointestinal (GI) bleeding and renal dysfunction. With adequate resuscitative measures including fluids, blood transfusions, intercostal tube drainage and mechanical ventilation he made a complete recovery. Good prognostic indicators in near drowning patients include higher Glasgow Coma Scale, short submersion time and quick resuscitative measures even in the presence of serious cardiorespiratory or hemodynamic compromise. PMID:24765331

  5. Thoracic manifestations of ovarian hyperstimulation syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Levin, M.F.; Hutton, L.C.; Kaplan, B.R. [University of Western Ontario, London, ON (Canada)

    1995-02-01

    In order to determine the thoracic manifestations of severe ovarian hyperstimulation syndrome, the medical records and available images of 771 patients who had received gonadotropins to induce superovulation, were reviewed. In 22 patients (3%) severe hyperstimulation syndrome was diagnosed clinically and confirmed with ultrasonography (US). Pleural effusion occurred in five of these (23%), one of whom required thoracentesis. Atelectasis and internal jugular vein thrombosis developed in one patient, and ventilation-perfusion mismatch occurred in another. The study concluded that respiratory distress in patients with ovarian hyperstimulation syndrome was most likely due to lung restriction. Pulmonary manifestations formed an important part of this syndrome, and radiologic input were considered necessary for assessment, monitoring and management. 10 refs., 2 figs., 1 tab.

  6. O valor de um intercâmbio: mobilidade estudantil brasileira, bilateralismo & internacionalização da educação. The value of an intercâmbio: brazilian student mobility, bilateralism & international education

    Directory of Open Access Journals (Sweden)

    Eric Spears

    2014-05-01

    Full Text Available Brazil’s emergence in the global economy as a member of the BRIC (Brazil, Russia, Índia, China, and South Africa states has prompted the federal government to establish the Brazilian Scientific Mobility Program (Science Without Borders in order to advance the country’s social capital and infrastructure in STEM (Science, Technology, Engineering, and Math related disciplines and industries. Public and private investment in the Scientific Mobility Program has transformed the way in which Brazilian government, universities, and citizenry places value the intercâmbio (student exchange experience in the United States. STEM-related disciplines are now disproportionately funded versus social sciences, humanities, and fine arts fields. This development has altered the way in which student mobility in the United States is given worth and changed the trajectory of international education in Brazil. This research provides a conceptual analysis of the Brazilian Scientific Mobility Program by using a critical political economy perspective. The essay conceptualizes the Science without Borders initiative at global, national, and local levels. This research also explores what implications the bilateral U.S.-Brazil Educational Partnership may have on future policy, practice, and ultimately, funding of Brazilian student mobility. A emergência do Brasil no âmbito da economia mundializada como participante do BRIC (Brasil, Rússia, Índia, China e África do Sul mobilizou o governo federal brasileiro a estabelecer um programa estatal de mobilidade acadêmica (Programa Ciência sem Fronteiras de modo a fazer avançar o capital social do país (general intellect e a infraestrutura em STEM (Ciência, Tecnologia, Engenharia e Matemática relacionadas à indústria. Investimentos públicos e privados no programa de mobilidade acadêmica transformaram o modo como o governo brasileiro e as universidades valorizam o intercâmbio estudantil com os Estados Unidos. As

  7. Arterial vascularization of the thoracic pars of the thymus in pigs

    Directory of Open Access Journals (Sweden)

    Sérgio Salazar Drummond

    1996-12-01

    Full Text Available The systematization of the thymic vessels was analysed in 30 foetuses and newborn pigs. These vessels were dissected after injection of colored Neoprene Latex 450. The thymus thoracic portion was directly or indirectly irrigated by branches from the trunk braquiocephalic, subclavians, internal thoracics, superficial cervical arteries, as well as from the thyreocervical trunk. The total number of collateral vessels varied from two to nine, and three the most frequently found.

  8. Ischemic Bilateral Opercular Syndrome

    Directory of Open Access Journals (Sweden)

    Aysel Milanlioglu

    2013-01-01

    Full Text Available Opercular syndrome, also known as Foix-Chavany-Marie syndrome, is a paralysis of the facial, pharyngeal, masticatory, tongue, laryngeal, and brachial muscles. It is a rare cortical form of pseudobulbar palsies caused by vascular insults to bilateral operculum. Its clinical presentations include anarthria, weakness of voluntary muscles involving face, tongue, pharynx, larynx, and masticatory muscles. However, autonomic reflexes and emotional activities of these structures are preserved. In the present case, an 81-year-old male presented with acute onset of anarthria with difficulties in chewing, speaking, and swallowing that was diagnosed with opercular syndrome.

  9. Ischemic bilateral opercular syndrome.

    Science.gov (United States)

    Milanlioglu, Aysel; Aydın, Mehmet Nuri; Gökgül, Alper; Hamamcı, Mehmet; Erkuzu, Mehmet Atilla; Tombul, Temel

    2013-01-01

    Opercular syndrome, also known as Foix-Chavany-Marie syndrome, is a paralysis of the facial, pharyngeal, masticatory, tongue, laryngeal, and brachial muscles. It is a rare cortical form of pseudobulbar palsies caused by vascular insults to bilateral operculum. Its clinical presentations include anarthria, weakness of voluntary muscles involving face, tongue, pharynx, larynx, and masticatory muscles. However, autonomic reflexes and emotional activities of these structures are preserved. In the present case, an 81-year-old male presented with acute onset of anarthria with difficulties in chewing, speaking, and swallowing that was diagnosed with opercular syndrome.

  10. Bilateral optic neuropathy with bilateral putaminal lesions: a case report.

    Science.gov (United States)

    Togawa, Jumpei; Ohi, Takekazu

    2015-01-01

    Bilateral optic neuropathy with bilateral putaminal lesions may be caused by methanol or cyanide poisoning or mitochondrial disorders including Leber hereditary optic neuropathy and Leigh syndrome. We report the case of a 34-year-old Japanese man who developed bilateral visual loss 5 days after the development of gastrointestinal symptoms. Magnetic resonance imaging of the brain on admission revealed high-intensity signal areas in the bilateral putamina on diffusion-weighted and T2-weighted images as well as a high-intensity signal area in the left middle cerebellar peduncle that had been identified 3 years previously. We diagnosed bilateral optic neuropathy with bilateral putaminal lesions caused by preceding infection-triggered demyelination. We administered methylprednisolone, but his vision did not recover.

  11. ANAESTHETIC MANAGEMENT OF A CASE OF TEMPOROMANDIBULAR JOINT ANKYLOSIS POSTED FOR BILATERAL BREAST SURGERY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Athaluri Vishnu

    2014-07-01

    Full Text Available BACKGROUND: Temporomandibular joint (TMJ ankylosis is associated with partial or complete restriction of mouth opening and poses a significant problem to the anesthesiologist making the airway management very challenging. Alternative methods of securing the airway should be kept ready because conventional laryngoscopy and intubation are impossible. Thoracic epidural anesthesia (TEA is one of the options to avoid general anesthesia in this case. We aimed to manage a case of bilateral modified radical mastectomy with TMJ ankylosis solely under thoracic epidural anesthesia. METHODOLOGY: Female patient of 32 years of age, with bilateral TMJ ankylosis with no mouth opening was posted for bilateral breast surgery. Thoracic epidural was instituted at T4-T5 interspace and 18G epidural catheters was secured. Alternative airway management strategies were included in our plan if thoracic epidural fails. OBSERVATION: Adequate preparation of the patient, counseling about anesthetic plan of management, placement of epidural catheter by an experienced anesthesiologist helped in the successful management of this case. CONCLUSION: Regional anesthesia techniques are safer alternatives to provide intraoperative anesthesia with difficult airway for bilateral breast surgeries.

  12. Robotic Surgery for Thoracic Disease.

    Science.gov (United States)

    Yamashita, Shin-Ichi; Yoshida, Yasuhiro; Iwasaki, Akinori

    2016-01-01

    Robotic surgeries have developed in the general thoracic field over the past decade, and publications on robotic surgery outcomes have accumulated. However, controversy remains about the application of robotic surgery, with a lack of well-established evidence. Robotic surgery has several advantages such as natural movement of the surgeon's hands when manipulating the robotic arms and instruments controlled by computer-assisted systems. Most studies have reported the feasibility and safety of robotic surgery based on acceptable morbidity and mortality compared to open or video-assisted thoracic surgery (VATS). Furthermore, there are accumulated data to indicate longer operation times and shorter hospital stay in robotic surgery. However, randomized controlled trials between robotic and open or VATS procedures are needed to clarify the advantage of robotic surgery. In this review, we focused the literature about robotic surgery used to treat lung cancer and mediastinal tumor.

  13. [Endoscopic thoracic sympatecomy for hyperhidrosis].

    Science.gov (United States)

    Smati, Belhassen; Marghali, Adel; Abid, Mohamed; Bakhtri, Malek; Ben Youssef, Atef; Mestiri, Taher; Djilani, Habiba; Kilani, Tarek

    2007-06-01

    Hyperhidrosis is a benin affection representing a social and professional problems and occupational handicaps in young patient. Endoscopic thoracic sympathectomy thus provides a radical treatment for severe palmar and axillary hyperhidrosis. We describe the technique used in our institut and present results From 1995 to 2002, 32 patients were operated on for hyperhidrosis. There were 17 mens and 15 women raging in age from 15 to 32 years The intervention consisting on destruction by electrocoagulation to the sympathetic trunk There was no major complication and the mean postoperative hospital stay was 2 days. The disappearance of the palmar sweating was immediately after operation. 7 patients complained of compensatory sweating Endoscopic thoracic sympathectomy for hyperhidrosis is a safe effect technique for treating palmar and axillary hyperhidrosis. Compensatry sweeting represent the major that necessite a preable information

  14. Robotic Surgery for Thoracic Disease

    Science.gov (United States)

    Yoshida, Yasuhiro; Iwasaki, Akinori

    2016-01-01

    Robotic surgeries have developed in the general thoracic field over the past decade, and publications on robotic surgery outcomes have accumulated. However, controversy remains about the application of robotic surgery, with a lack of well-established evidence. Robotic surgery has several advantages such as natural movement of the surgeon’s hands when manipulating the robotic arms and instruments controlled by computer-assisted systems. Most studies have reported the feasibility and safety of robotic surgery based on acceptable morbidity and mortality compared to open or video-assisted thoracic surgery (VATS). Furthermore, there are accumulated data to indicate longer operation times and shorter hospital stay in robotic surgery. However, randomized controlled trials between robotic and open or VATS procedures are needed to clarify the advantage of robotic surgery. In this review, we focused the literature about robotic surgery used to treat lung cancer and mediastinal tumor. PMID:26822625

  15. Anatomic characteristics of thoracic pedicle-rib complex for internal fixation%胸椎椎弓根-肋骨复合体螺钉置入内固定的应用解剖学特征

    Institute of Scientific and Technical Information of China (English)

    邢文华; 贾连顺; 霍洪军; 杨学军

    2011-01-01

    背景:上、中胸椎周围结构复杂,椎弓根的横径相对窄小,如再合并发育畸形,导致螺钉不能置入,或者置入后造成副损伤,置钉安全性和有效性得不到保证.目的:提出"椎弓根-肋骨复合体"的概念,观察其形态结构,分析其在解剖学上置入螺钉的可行性.方法:观察6具成人尸体胸椎标本(T1~12)椎弓根及椎弓根-肋骨复合体的形态结构,测量下列参数:横径、纵径、椎弓根一肋骨复合体轴线螺钉置入最长值、椎弓根-肋骨复合体轴线螺钉横断而角及椎弓根-肋骨复合体轴线螺钉与椎弓板的夹角.结果与结论:椎弓根-肋骨复合体是-立体结构,椎弓根与肋骨不在同一平面,且两者位置关系随不同节段而发生变化.横径为13.O~17.3 mm,纵径为5.8~8.0 mm,椎弓根-肋骨复合体轴线螺钉胃入最长值为43.4~60.5 mm,椎弓根-肋骨复合体轴线螺钉横断面角为15.4°~36_7°,椎弓根-肋骨复合体轴线螺钉与椎弓板的夹角为76.2°~85.4°.提示沿胸椎经椎弓根-肋骨复合体轴线置入螺钉内固定时,安全范围较大.应用于临床时,可作为椎弓根螺钉内固定的一种补充,特别是在无法完成椎弓根螺钉置入的胸椎平面.%BACKGROUND: The surrounding structures of trie thoracic vertebra are complicated, and the thoracic pedicle is thinner thanlumbar pedicle anatomically, particularly iri some cases of scoliosis or other spine deformity, resulting in impossible implantationof pedicle screws or post-implantation injury. Therefore, the safety and efficacy of pedicle screw fixation cannot be guaranteed.OBJECTIVE: To study the applied anatomy of the pedicle-rib complex and to perform !he biomechanical test for screw insertionthrough the pedicle-rib complex in the thoracic spine.METHODS: Six specimens of adult cadaveric thoracic spine (T1-13) were used to observe modality of pedicle and pedicle-ribcomplex. The following parameters were measured: pedicle

  16. Bilateral accessory thoracodorsal artery.

    Science.gov (United States)

    Natsis, Konstantinos; Totlis, Trifon; Tsikaras, Prokopios; Skandalakis, Panagiotis

    2006-09-01

    The subscapular artery arises from the third part of the axillary artery and gives off the circumflex scapular and the thoracodorsal arteries. Although anatomical variations of the axillary artery are very common, the existence of a unilateral accessory thoracodorsal artery has been described in the literature only once. There are no reports of bilateral accessory thoracodorsal artery, in the literature. In the present study, a bilateral accessory thoracodorsal artery, originating on either side of the third part of the axillary artery, is described in a 68-year-old female cadaver. All the other branches of the axillary artery had a typical origin, course, distribution and termination. This extremely rare anatomical variation apart from the anatomical importance also has clinical significance for surgeons in this area. Especially, during the dissection or mobilization of the latissimus dorsi that is partly used for coverage problems in many regions of the body and also in dynamic cardiomyoplasty, any iatrogenic injury of this accessory artery may result in ischemia and functional loss of the graft.

  17. Nanotechnology applications in thoracic surgery.

    Science.gov (United States)

    Hofferberth, Sophie C; Grinstaff, Mark W; Colson, Yolonda L

    2016-07-01

    Nanotechnology is an emerging, rapidly evolving field with the potential to significantly impact care across the full spectrum of cancer therapy. Of note, several recent nanotechnological advances show particular promise to improve outcomes for thoracic surgical patients. A variety of nanotechnologies are described that offer possible solutions to existing challenges encountered in the detection, diagnosis and treatment of lung cancer. Nanotechnology-based imaging platforms have the ability to improve the surgical care of patients with thoracic malignancies through technological advances in intraoperative tumour localization, lymph node mapping and accuracy of tumour resection. Moreover, nanotechnology is poised to revolutionize adjuvant lung cancer therapy. Common chemotherapeutic drugs, such as paclitaxel, docetaxel and doxorubicin, are being formulated using various nanotechnologies to improve drug delivery, whereas nanoparticle (NP)-based imaging technologies can monitor the tumour microenvironment and facilitate molecularly targeted lung cancer therapy. Although early nanotechnology-based delivery systems show promise, the next frontier in lung cancer therapy is the development of 'theranostic' multifunctional NPs capable of integrating diagnosis, drug monitoring, tumour targeting and controlled drug release into various unifying platforms. This article provides an overview of key existing and emerging nanotechnology platforms that may find clinical application in thoracic surgery in the near future.

  18. Bilateral spontaneous pneumothorax secondary to aspiration pneumonia induced by a wristwatch lodged at the pharyngoesophageal junction.

    Science.gov (United States)

    Kawai, Chihiro; Miyao, Masashi; Kotani, Hirokazu; Tamaki, Keiji

    2015-06-01

    Bilateral spontaneous pneumothorax secondary to disease is rare and seldom encountered in forensic autopsies; however, traumatic bilateral pneumothorax occurs often. Herein, we present a forensic case involving a 50-year-old woman who died 4 days after ingesting a wristwatch. Postmortem computed tomography and autopsy findings demonstrated that the wristwatch was lodged at the pharyngoesophageal junction, that she had a bilateral pneumothorax unaccompanied by any thoracic wound, and that macular hemorrhagic lesions on the lung surfaces were responsible for the pneumothorax. A histological examination of the macular lesions revealed that they were aspiration pneumonia foci with many birefringent foreign materials. Furthermore, a necrotic process secondary to aspiration pneumonia with a one way check-valve hyperinflation caused by foreign materials in the bronchioles was the most probable pathogenesis of her pneumothorax. To our knowledge, this is the first reported case of a bilateral secondary spontaneous pneumothorax caused by a large foreign body at the pharyngoesophageal junction leading to death.

  19. Can bilateral trade agreements help induce free trade?

    OpenAIRE

    Riezman, Raymond Glenn

    1999-01-01

    There has been growing debate about whether bilateral trade agreements are damaging multilateral efforts to eliminate barriers to international trade. This paper develops a model in which trading blocks always charge optimal tariffs and make trade agreements based on strategic considerations. We ask a very simple question. Does the fact that trading blocks can form bilateral trade agreements make Free trade less likely to occur? The answer is that it depends on the size distribution of the tr...

  20. Thailand in Regional and Bilateral Free Trade Agreements

    OpenAIRE

    Rattanaphan, Chalakorn

    2009-01-01

    The Regional Trade Agreements (RTAs) and the bilateral Free Trade Agreements (FTAs) have increasingly been a new wave of international trade around the world. The countries who seek to establish these agreements, be regionally or bilaterally, realize that the trade agreements are in fact tools to increase trade with their trading partners, to extend and expand their foreign markets, as well as to encourage foreign investments but the overall goal is to strengthen economic tie with the trading...

  1. Bilateral sudden sensorineural hearing loss following unilateral temporal bone fracture.

    Science.gov (United States)

    Hunchaisri, Niran

    2009-06-01

    Temporal bone fractures usually cause unilateral sensorineural hearing loss (SNHL) by fracture that violated otic capsule of that side. Bilateral SNHL from unilateral temporal bone fracture were rarely seen. Labyrinthine concussion was considered to be the pathogenesis in these cases. This article reports an additional case of bilateral SNHL from unilateral temporal bone fracture but in a different pattern of SNHL which may result from an occlusion of the internal auditory artery.

  2. Etiologies of bilateral pleural effusions

    Science.gov (United States)

    Puchalski, Jonathan T.; Argento, A. Christine; Murphy, Terrence E.; Araujo, Katy L.B.; Oliva, Isabel B.; Rubinowitz, Ami N.; Pisani, Margaret A.

    2017-01-01

    Summary Background To evaluate the safety, etiology and outcomes of patients undergoing bilateral thoracentesis. Methods This is a prospective cohort study of 100 consecutive patients who underwent bilateral thoracenteses in an academic medical center from July 2009 through November 2010. Pleural fluid characteristics and etiologies of the effusions were assessed. Mean differences in levels of fluid characteristics between right and left lungs were tested. Associations between fluid characteristics and occurrence of bilateral malignant effusions were evaluated. The rate of pneumothorax and other complications subsequent to bilateral thoracentesis was determined. Results Exudates were more common than transudates, and most effusions had multiple etiologies, with 83% having two or more etiologies. Bilateral malignant effusions occurred in 19 patients, were the most common single etiology of exudative effusions, and were associated with higher levels of protein and LDH in the pleural fluid. Among 200 thoracenteses performed with a bilateral procedure, seven resulted in pneumothoraces, three of which required chest tube drainage and four were ex vacuo. Conclusions More often than not, there are multiple etiologies that contribute to pleural fluid formation, and of the combinations of etiologies observed congestive heart failure was the most frequent contributor. Exudative effusions are more common than transudates when bilateral effusions are present. Malignancy is a common etiology of exudative effusions. This study suggests that the overall complication rate following bilateral thoracentesis is low and the rate of pneumothorax subsequent to bilateral thoracentesis is comparable to unilateral thoracentesis. PMID:23219348

  3. Idiopathic Bilateral Bloody Tearing

    Directory of Open Access Journals (Sweden)

    Emrullah Beyazyıldız

    2015-01-01

    Full Text Available Bloody tear is a rare and distinct clinic phenomenon. We report a case presenting with the complaint of recurrent episodes of bilateral bloody tearing. A 16-year-old girl presented to our clinic with complaint of bloody tearing in both eyes for 3 months. Bloody tearing was not associated with her menses. A blood-stained discharge from the punctum was not observed during the compression of both nasolacrimal ducts. Nasolacrimal passage was not obstructed. Imaging studies such as dacryocystography and gradient-echo magnetic resonance imaging (MRI of nasolacrimal canal were normal. Intranasal endoscopic evaluation was normal. We collected samples from bloody tears two times and pathological examination was performed. Pathological analysis showed lots of squamous cells and no endometrial cells; dysplastic cells were found. Further evaluations for underlying causes were unremarkable. No abnormalities were found in ophthalmologic, radiologic, and pathologic investigations. This condition is likely a rare abnormality and the least recognized aetiology for the idiopathic phenomenon.

  4. [Bilateral cochlear implantation].

    Science.gov (United States)

    Kronenberg, Jona; Migirov, Lela; Taitelbaum-Swead, Rikey; Hildesheimer, Minka

    2010-06-01

    Cochlear implant surgery became the standard of care in hearing rehabilitation of patients with severe to profound sensorineural hearing loss. This procedure may alter the lives of children and adults enabling them to integrate with the hearing population. In the past, implantation was performed only in one ear, despite the fact that binaural hearing is superior to unilateral, especially in noisy conditions. Cochlear implantation may be performed sequentially or simultaneously. The "sensitive period" of time between hearing loss and implantation and between the two implantations, when performed sequentially, significantly influences the results. Shorter time spans between implantations improve the hearing results after implantation. Hearing success after implantation is highly dependent on the rehabilitation process which includes mapping, implant adjustments and hearing training. Bilateral cochlear implantation in children is recommended as the proposed procedure in spite of the additional financial burden.

  5. Bilateral acute corneal calcification.

    Science.gov (United States)

    Freddo, T F; Leibowitz, H M

    1985-04-01

    A 38-year-old man with brittle, juvenile onset diabetes mellitus and bilateral severe dry eyes with recurrent corneal ulcers developed atypical band-shaped calcifications of both corneas during a 24-hour period. Serum calcium, phosphate, and carbon dioxide levels all were within normal limits. The patient was mildly uremic but was not in renal failure. When EDTA chelation failed to clear the deposits, partial keratectomies were performed in both eyes and the specimens were examined by light and electron microscopy, including energy dispersive x-ray analysis. Microscopic studies revealed an atypical calcific keratopathy which involved neither Bowman's layer nor the most superficial stromal lamellae. The deposits were confined to deeper lamellae in the anterior stroma and by electron microscopy were composed of extracellular crystalline aggregates. Energy dispersive x-ray analysis of these aggregates confirmed the presence of calcium and phosphate. Corneal dessication appeared to be a major contributing factor in the rapid formation of these deposits.

  6. Bilateral Antepartum Mastitis

    Directory of Open Access Journals (Sweden)

    Peyman Alibeigi

    2010-12-01

    Full Text Available Antepartum mastitis is a rare condition, whereas postpartum orlactation mastitis is a common problem. This report introducesa case of complicated bilateral antepartum mastitis, which wastreated successfully by drain insertion and antibiotic therapy.The patient was a 23-year-old woman in the 23rd week of herfirst pregnancy. Her chief complaint was progressive swelling,redness and radicular pain in both breasts, which had beenstarted gradually from the 18th week of pregnancy. The patientwas admitted to hospital, and received oral and intravenous antibioticsempirically, which was not effective. The patient wastreated by drainage and oral antibiotic therapy. Based on theapproaches employed and the outcomes achieved it is suggestedthat early surgical insertion in the presence of fluid collection inantepartum mastitis will shorten hospitalization and course ofintravenous antibiotic therapy.Iran J Med Sci 2010; 35(4: 327-330.

  7. Multilateral, regional and bilateral energy trade governance

    Energy Technology Data Exchange (ETDEWEB)

    Leal-Arcas, Rafael; Grasso, Costantino; Rios, Juan Alemany (Queen Mary Univ. of London (United Kingdom))

    2014-12-01

    The current international energy trade governance system is fragmented and multi-layered. Streamlining it for greater legal cohesiveness and international political and economic cooperation would promote global energy security. The current article explores three levels of energy trade governance: multilateral, regional and bilateral. Most energy-rich countries are part of the multilateral trading system, which is institutionalized by the World Trade Organization (WTO). The article analyzes the multilateral energy trade governance system by focusing on the WTO and energy transportation issues. Regionally, the article focuses on five major regional agreements and their energy-related aspects and examines the various causes that explain the proliferation of regional trade agreements, their compatibility with WTO law, and then provides several examples of regional energy trade governance throughout the world. When it comes to bilateral energy trade governance, this article only addresses the European Union’s (EU) bilateral energy trade relations. The article explores ways in which gaps could be filled and overlaps eliminated whilst remaining true to the high-level normative framework, concentrating on those measures that would enhance EU energy security.

  8. Clinical innovations in Philippine thoracic surgery

    OpenAIRE

    Jose Luis. J. Danguilan

    2016-01-01

    Thoracic surgery in the Philippines followed the development of thoracic surgery in the United States and Europe. With better understanding of the physiology of the open chest and refinements in thoracic anesthetic and surgical approaches, Filipino surgeons began performing thoracoplasties, then lung resections for pulmonary tuberculosis and later for lung cancer in specialty hospitals dealing with pulmonary diseases—first at the Quezon Institute (QI) and presently at the Lung Center of the P...

  9. Intraoperative prediction of compensatory sweating for thoracic sympathectomy.

    Science.gov (United States)

    Fujita, Takeo; Mano, Masayuki; Nishi, Hideyuki; Shimizu, Nobuyoshi

    2005-09-01

    Postoperative compensatory sweating (PCS) is an important problem impacting on quality of life for patients after endoscopic thoracic sympathectomy (ETS). The present study investigated whether intraoperative palmar temperature and blood flow are useful for assessing PCS after ETS. Retrospectively, results were evaluated for ETS in 27 consecutive patients with primary palmar hyperhidrosis between 1996 and 2002. For all patients, bilateral nerve conduction to the palms was interrupted. The relationship between the range of PCS and intraoperative changes in palmar temperature and blood flow was investigated. PCS developed in all cases. After completion of ETS, mean blood flow and temperature increased respectively. Significant correlations were found between the range of PCS and increases in palmar temperature (p<0.05) and blood flow (p<0.05). Intraoperative monitoring of increases in palmar temperature and blood flow may be useful in patients with primary hyperhidrosis, to predict the range of PCS after ETS.

  10. Differences in thoracic injury causation patterns between seat belt restrained children and adults.

    Science.gov (United States)

    Arbogast, Kristy B; Locey, Caitlin M; Zonfrillo, Mark R

    2012-01-01

    The objective of this research was to delineate age-based differences in specific thoracic injury diagnoses for seat belt restrained rear seat occupants and describe the associated injury causation in order to provide insight into how the load of the seat belt is transferred to occupants of various sizes. Using data from the Crash Investigation Research and Engineering Network (CIREN), 20 cases of rear seated, lap and shoulder belt restrained occupants with AIS2+ thoracic injuries in frontal crashes were reviewed. Seven were children and adolescents age 8-15 years, 5 were 16-24 years, 3 were 25-54 years, and 5 were 55+ years. Six of the seven 8-15 year olds sustained injuries to the lung in the form of pulmonary contusion or pneumothorax. Only three of the seven sustained a skeletal (sternum or rib) fracture; only one of these three involved multiple ribs bilaterally. In contrast, four of the five 16-24 year olds sustained at least one rib fracture - often multiple and bilateral. The adult cohort (25+ years) was involved in predominantly more minor crashes; however they all sustained complex rib fractures - seven of the eight involved multiple ribs, four of the eight were also bilateral. Belt compression - either from the shoulder belt or the lap belt - was identified as the primary cause of the thoracic injuries. Often, there was clear evidence of the location of belt loading from AIS 1 chest contusions or abrasions. These findings have implications for age-based thoracic injury criteria suggesting that that different metrics may be needed for different age groups.

  11. Bilateral agenesis of the superior vena cava associated with congenital hydrothorax.

    Science.gov (United States)

    Römer, S; Opgen-Rhein, B; Chaoui, R; Scheer, I; Czernik, C; Obladen, M

    2006-11-01

    Agenesis of the superior vena cava is a rare anomaly that is generally asymptomatic in the neonate. We report a male neonate with bilateral (total) agenesis of the superior vena cava with obstructed thoracic duct and subsequent congenital hydrothorax, anomalies that were detected by prenatal ultrasound at 25 weeks' gestation. The cardiac anomaly was confirmed by postnatal magnetic resonance angiography. The chylothorax disappeared with conservative therapy.

  12. Robotic selective postganglionic thoracic sympathectomy for the treatment of hyperhidrosis.

    Science.gov (United States)

    Coveliers, Hans; Meyer, Mark; Gharagozloo, Farid; Wisselink, Willem; Rauwerda, Jan; Margolis, Marc; Tempesta, Barbara; Strother, Eric

    2013-01-01

    The surgical management of hyperhidrosis is controversial. Robotic surgical systems with their high-definition magnified 3-dimensional view and increased maneuverability in a confined space may facilitate the technique of selective sympathectomy (ramicotomy). We present a case series of patients undergoing selective postganglionic thoracic sympathectomy using robotic technology. This study is a case series analysis of patients who underwent selective postganglionic thoracic sympathectomy from July 2006 to November 2011. The operation was performed on a video-assisted thoracoscopic surgery (VATS) platform. The robot was used for pleural dissection and division of the postganglionic sympathetic fibers and the communicating rami. The success of sympathectomy was assessed by intraoperative temperature measurement of the ipsilateral upper extremity, patient interviews, and scoring of the symptomatic nature of hyperhidrosis based on the Hyperhidrosis Disease Severity Scale. There were 110 sympathectomies performed in 55 patients (25 men, 30 women). Simultaneous bilateral sympathectomy was performed in all patients. Median age was 28 years (range, 16 to 65 years). There was no conversion to thoracotomy. Complications were minor and were seen in 5 of 55 patients (9%). There were no deaths. Median hospital stay was 1 day (range, 1 to 4 days). Of the 55 patients, 53 (96%) had sustained relief of their hyperhidrosis at a median follow-up of 24 months (range, 3 to 36 months), and compensatory sweating was seen in 4 patients (7.2%). Robotic thoracoscopic selective sympathectomy is an effective, feasible, and safe procedure with excellent relief of hyperhidrosis and low rates of compensatory sweating and complications. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Bilateral Psoas Haematomata Complicating Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Jacob A. Akoh

    2014-01-01

    Full Text Available Background. The challenge in managing patients undergoing renal transplantation is how to achieve optimum levels of anticoagulation to avoid both clotting and postoperative bleeding. We report a rare case of severe postoperative retroperitoneal bleeding including psoas haematomata complicating renal transplantation. Case Report. SM, a 55-year-old female, had a past history of aortic valve replacement, cerebrovascular event, and thoracic aortic aneurysm and was on long-term warfarin that was switched to enoxaparin 60 mg daily a week prior to her living donor transplantation. Postoperatively, she was started on a heparin infusion, but this was complicated by a large retroperitoneal bleed requiring surgical evacuation on the first postoperative day. Four weeks later, she developed features compatible with acute femoral neuropathy and a CT scan revealed bilateral psoas haematomata. Following conservative management, she made steady progress and was discharged home via a community hospital 94 days after transplantation. At her last visit 18 months after transplantation, she had returned to full fitness with excellent transplant function. Conclusion. Patients in established renal failure who require significant anticoagulation are at increased risk of bleeding that may involve prolonged hospitalisation and more protracted recovery and patients should be carefully counselled about this.

  14. Silicosis with bilateral spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Fotedar Sanjay

    2010-01-01

    Full Text Available Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax.The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature.

  15. Thoracic aorta stent grafting through transapical access.

    NARCIS (Netherlands)

    Saouti, N.; Vos, J.A.; Heuvel, D. van de; Morshuis, W.J.; Heijmen, R.H.

    2015-01-01

    BACKGROUND: To describe the transapical approach for thoracic endovascular aortic repair (TEVAR). METHODS: Three patients, 2 elective and 1 emergent, with thoracic aorta aneurysm are described with vascular or direct aortic inaccessible access, who underwent TEVAR through transapical access. The tec

  16. [Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy: anesthesia in 445 cases].

    Science.gov (United States)

    Tejedor, A; Anglada, M T; Pons, M; Callejas, M A; Gomar, C

    2010-11-01

    To demonstrate the safety of outpatient or short-stay bilateral videothoracoscopy-assisted thoracic sympathectomy. The medical records of 445 who underwent bilateral videothoracoscopy-assisted thoracic sympathectomy were reviewed; the same protocols were used to guide these outpatient or short-stay procedures in all cases. Intravenous anesthesia was provided. An orotracheal tube allowed for carrying out the sympathectomy procedure during short periods of apnea. A 2% lidocaine solution was infused through the thoracic drains, which were removed soon after surgery. Data on intraoperative respiratory variables, pain, and intra- and postoperative complications were gathered. The data for patients undergoing the procedure on an outpatient or short-stay basis were compared. No significant differences in demographic or perioperative variables were found between the 2 groups. In 3.6% of the patients in the series, there was a record of a postoperative pulmonary complication: 4 therapeutic minithoracotomies; 1 subcutaneous emphysema without radiologic changes; 9 residual pneumothoraces, 2 requiring pleural drainage; 1 chylothorax; and 1 delayed hemothorax. With the exception of the late-developing hemothorax, all complications were diagnosed and treated in the immediate postoperative period. In the outpatient surgery group, unplanned admissions because of patient refusal to leave occurred in 6.5% of the cases. The low incidence of complications, and especially the finding that complications are detected in the early recovery period, indicate that this procedure can be performed on an outpatient basis.

  17. [Video-assisted thoracic sympathectomy - the results from a center outpatient surgery program].

    Science.gov (United States)

    R Velho, Tiago; Junqueira, Nádia; Sena, André; Guerra, Nuno; Caldeira, João; Gallego, Javier; Nobre, Ângelo

    2016-01-01

    The outpatient surgery program from our department has started in 2014 to improve patient access to surgery and to reduce the surgical waitlist. Focused on the thoracic surgery, the most common intervention is the surgical treatment of primary hyperhidrosis by thoracic sympathectomy by video-assisted thoracoscopic surgery (VATS). It is performed according to the patient's symptoms, with section or application of surgical clips between R2-R5. Retrospective study including all the patients submitted to thoracic sympathectomy by video- -assisted thoracoscopy surgery from our department's outpatient surgery program from January 2014 to January 2016. In our outpatient program we performed 198 thoracic sympathectomy by VATS. The mean age of the patients was 32,8 years old. 63,6% of the patients were females and 36.4% were males. From the 198 endoscopic thoracic sympathectomy performed, 181 (91,4%) were performed bilatellary with section between R3-R5, 12 (6,1%) were performed with the application of surgical clips in R2-R4 and 3 (1.5%) could not be performed due to the presence of pleuropulmonary adhesions. One of the patients was re-operated due to recurrent symptoms and another patients had surgery to remove the surgical clips (bilaterally in R2) due to exaggerated abdominal compensatory hyperhidrosis. Three patients had pneumothorax. The surgical treatment of primary hyperhidrosis was the most frequent procedure in our outpatient surgery program. The procedure without the use of a thoracic drainage allowed its inclusion in the outpatient surgery program. Excluding 3 patients, all the patients were discharged within 12 hours after the surgery. The good results and the reduction of the surgical waitlist encourage the cardiothoracic outpatient surgery program.

  18. Pros and cons of immediately sequential bilateral cataract surgery (ISBCS).

    Science.gov (United States)

    Grzybowski, Andrzej; Wasinska-Borowiec, Weronika; Claoué, Charles

    2016-01-01

    Immediately sequential bilateral cataract surgery (ISBCS) is currently a "hot topic" in ophthalmology. There are well-documented advantages in terms of quicker visual rehabilitation and reduced costs. The risk of bilateral simultaneous endophthalmitis and bilateral blindness is now recognized to be minuscule with the advent of intracameral antibiotics and modern management of endophthalmitis. Refractive surprises are rare for normal eyes and with the use of optical biometry. Where a general anesthetic is indicated for cataract surgery, the risk of death from a second anesthetic is much higher than the risk of blindness. A widely recognized protocol from the International Society of Bilateral Cataract Surgeons needs to be adhered to if surgeons wish to start practicing ISBCS.

  19. Bilateral Adrenal Incidentalomas: A Rare Presentation of Lung Cancer

    Directory of Open Access Journals (Sweden)

    Halit Diri

    2015-01-01

    Full Text Available Adrenal incidentalomas are found incidentally during a radiologic examination performed for indications other than an adrenal disease, and 15% of them are bilateral adrenal masses. This study describes a 51-year-old male smoker patient admitted with diabetes mellitus. An abdominal ultrasonography performed due to his anemia revealed bilateral adrenal masses. His chest X-ray showed abnormal 10 cm opacity at the right upper lung, and brain, thorax, and abdomen CT scans showed multiple lesions compatible with lung cancer metastases. The pathological examination of the transthoracic lung biopsy specimen was consistent with lung adenocarcinoma. Findings in this patient indicate that, in middle aged patients with bilateral adrenal mass and a history or finding of any malignancy, the first diagnosis which should be considered is adrenal metastasis, and confirming the diagnosis by adrenal biopsy may be useless. Furthermore, screening all smoking patients by chest X-ray or thoracic CT for lung cancer may not be accepted as a routine procedure, but in smokers admitted to a hospital due to signs and symptoms attributed to a pulmonary disease, at least a chest X-ray should be requested.

  20. Bilateral Transport Cost, Infrastructure, Common Bilateral Ties and Political Stability

    National Research Council Canada - National Science Library

    Danielken Molina

    2008-01-01

    .... Using these new indexes we find that not only distance but infrastructure, political stability, common bilateral ties and open sky agreements as well are other important channels through which...

  1. Traumatic bilateral hip dislocation with bilateral sciatic nerve palsy

    Institute of Scientific and Technical Information of China (English)

    Ajay Pal Singh; Amarjit Singh Sidhu; Arun Pal Singh

    2010-01-01

    Bilateral hip dislocation rarely occurs.In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic acci-dent is reported.Both hips were emergently reduced under general anaesthesia.Acetabular reconstruction was done bilaterally due to the unstable hips.The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty.The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was aug-mented by tendon transfer.Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time.To the best of our knowledge, this kind of injury has not been reported in the English .language literature.

  2. Bilateral nonunited femoral neck fracture in a child with osteopetrosis.

    Science.gov (United States)

    Steinwender, G; Hosny, G A; Koch, S; Grill, F

    1995-01-01

    We report a case of osteopetrosis with bilateral nonunited femoral neck and coxa vara in a 7-year-old boy. There was a history of traumatic transcervical left femoral neck fracture unsuccessfully treated by internal fixation. We performed a bilateral subtrochanteric valgus osteotomy. K-Wire fixation failed on the right side due to hardness of the bone. Finally, internal fixation with an angular plate after predrilling of the femoral neck offered stability. Bone union was achieved on both sides, resulting in full recovery of normal physical activity.

  3. Bilateral trade, openness and asset holdings

    OpenAIRE

    Peter, Alexandra

    2010-01-01

    This paper analyzes the relationship between bilateral trade flows, trade openness, and asset holdings in a three-country stochastic general equilibrium model. The threecountry model set-up enables me to disentangle and separate the effects bilateral trade flows and trade openness have on bilateral portfolio patterns. I find that both factors independently influence bilateral asset holdings. Higher bilateral trade as well as higher trade openness lead to a higher bilateral foreign asset posit...

  4. Multiple thoracic vertebral compression fractures caused by non-accidental injury: case report with radiological-pathological correlation

    Energy Technology Data Exchange (ETDEWEB)

    Twomey, Eilish L.; Iemsawatdikul, Kriengkrai; Stephens, Boyd G.; Gooding, Charles A. [Department of Radiology, University of California at San Francisco, 505 Parnassus Avenue, Box 0628, 94143-0628, San Francisco, CA (United States)

    2004-08-01

    We report a 21-month-old boy with multiple contiguous thoracic vertebral compression fractures involving eight vertebral bodies, attributable to non-accidental injury. No subluxation was associated, however, there was extensive injury to the upper cervical and lower lumbar regions of the spinal cord. Anterosuperior beaking, thought to represent a previous injury, was evident in a mid-lumbar vertebra. Clinical examination revealed bilateral retinal hemorrhages and retinoschisis. Death occurred as a result of severe brain edema with bilateral subdural and subarachnoid hemorrhages. Radiological-pathological correlation is presented. (orig.)

  5. Radiologic findings of thoracic trauma

    Directory of Open Access Journals (Sweden)

    Akgul Ozmen C

    2017-08-01

    Full Text Available Cihan Akgul Ozmen,1 Serdar Onat,2 Delal Aycicek3 1Department of Radiology, 2Department of Chest Surgery, Dicle University School of Medicine, Diyarbakir, 3Radiology Unit, Siirt State Hospital, Siirt, Turkey Introduction: Chest trauma may be blunt or penetrating and the chest is the third most common trauma region. It is a significant cause of mortality. Multidetector computed tomography (MDCT has been an increasingly used method to evaluate chest trauma because of its high success in detecting tissue and organ injuries. Herein, we aimed to present MDCT findings in patients with blunt and penetrating chest trauma admitted to our department. Methods: A total of 240 patients admitted to the emergency department of our hospital between April 2012 and July 2013 with a diagnosis of chest trauma who underwent MDCT evaluations were included. Most of the patients were male (83.3% and victims of a blunt chest trauma. The images were analyzed with respect to the presence of fractures of bony structures, hemothorax, pneumothorax, mediastinal organ injury, and pulmonary and vascular injuries. Results: MDCT images of the 240 patients yielded a prevalence of 41.7% rib fractures, 11.2% scapular fractures, and 7.5% clavicle fractures. The prevalence of thoracic vertebral fracture was 13.8% and that of sternal fracture was 3.8%. The prevalence of hemothorax, pneumothorax, pneumomediastinum, and subcutaneous emphysema was 34.6%, 62.1%, 9.6%, and 35.4%, respectively. The prevalence of rib, clavicle, and thoracic vertebral fractures and pulmonary contusion was higher in the blunt trauma group, whereas the prevalence of hemothorax, subcutaneous emphysema, diaphragmatic injury, and other vascular lacerations was significantly higher in the penetrating trauma group than in the blunt trauma group (p<0.05. Conclusion: MDCT images may yield a high prevalence of fracture of bony structures, soft tissue lacerations, and vascular lesions, which should be well understood by

  6. [Transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis: a novel surgical approach].

    Science.gov (United States)

    Lin, Min; Tu, Yuan-rong; Lai, Fan-cai; Li, Xu; Chen, Jian-feng; Luo, Rong-gang; Lin, Jian-bo

    2013-11-05

    To evaluate the cosmetic effect and safety of transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis (PH). Retrospective study was conducted for 326 PH cases undergoing transaxillary concealing single incision endoscopic thoracic bilateral sympathectomy during January 2009 and March 2011. All operations were successfully performed without severe complication and mortality. No conversion into open technique was necessary. The mean unilateral operative duration was 5.8 (5-8) min. It was calculated from the time of skin incision to the application of dressing over wound. The mean follow-up period was 25 (8-38) months. All patients achieved excellent cosmetic effects with undetectable incision. Transaxillary concealing single incision endoscopic thoracic sympathectomy is a safe and effective procedure for treating primary PH. Incision is undetectable with excellent cosmetic effect. It is worthy of wider popularization.

  7. Perfusion Index: An Indicator of Success During Endoscopic Thoracic Sympathectomy for Hyperhidrosis.

    Science.gov (United States)

    Jeng, Eric I-Hun; Gravenstein, Nikolaus; Klodell, Charles T

    2017-08-01

    Endoscopic thoracic sympathectomy (ETS) is indicated for refractory hyperhidrosis. The pulse oximetry-derived perfusion index (PI) quantifies pulsatile blood flow at the oximeter. Thoracic sympathectomy increases blood flow; thus we postulate it will reliably increase PI. We evaluated the ipsilateral finger PI as a predictor of successful sympathectomy during ETS. After institutional review board approval and informed consent, 100 adult patients undergoing bilateral ETS were studied. Finger and earlobe pulse oximetry probes were placed. Hemodynamic variables and PI were continuously monitored. PI data were collected before and every minute after sympathectomy for 5 minutes and then at 10 minutes. We defined a successful sympathectomy by at least a 50% increase of the PI on the ipsilateral arm. A repeated measures analysis of variance was conducted to determine overall model significance (p ≤ 0.05). Left sympathectomy was associated with a mean 240% increase in PI (p thoracic sympathectomy. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Minimal Access Posterior Approach for Extrapleural Thoracic Sympathectomy: A Cadaveric Study and Cases.

    Science.gov (United States)

    Raskin, Jeffrey S; Liu, Jesse J; Sun, Hai; Nemecek, Andrew; Balaji, Seshadri; Raslan, Ahmed M

    2016-09-01

    Operatively, video-assisted thoracoscopic sympathectomy (VATS) involves pleural entry and poses risk in small children and patients with pulmonary disease. A conventional posterior sympathectomy is more invasive than VATS. We investigated a cadaveric feasibility study of a minimal access posterior approach for endoscopic extrapleural sympathectomy and discuss this minimal approach in children with cardiac sympathectomy. A posterior endoscopic extrapleural approach for thoracic sympathectomy was performed using lightly embalmed cadavers; surgical corridor depth, width, and associated pleural violation were recorded. Two pediatric cases undergoing secondary prevention for breakthrough cardiac dysrhythmias using this approach are discussed: case 1, a 9-year-old girl with refractory long QT syndrome; and case 2, a 13-year-old boy with hypertrophic cardiomyopathy. The cadaveric study supported 100% identification of a craniocaudal-oriented sympathetic chain using an 18-mm tubular retractor, and a 10% pleural violation rate. There were no clinically significant pneumothoracies in either proof of concept cases. Minimal access posterior extrapleural sympathectomy is feasible to expose the sympathetic chain in the thoracic region with good visualization using either endoscopic or microscopic magnification. Single-position bilateral thoracic sympathectomy can be performed in pediatric patients with life-threatening ventricular arrhythmias. Based on the cadaveric study and the 2 preliminary cases, we believe that a posterior minimal access approach allows safe and effective access to the thoracic sympathetic chain for causes requiring sympathectomy using single positioning, with minimal risk of pneumothorax or Horner syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Bilateral, independent juvenile nasopharyngeal angiofibroma

    DEFF Research Database (Denmark)

    Mørkenborg, Marie-Louise; Frendø, M; Stavngaard, T;

    2015-01-01

    BACKGROUND: Juvenile nasopharyngeal angiofibroma is a benign, vascular tumour that primarily occurs in adolescent males. Despite its benign nature, aggressive growth patterns can cause potential life-threatening complications. Juvenile nasopharyngeal angiofibroma is normally unilateral, originating...... from the sphenopalatine artery, but bilateral symptoms can occur if a large tumour extends to the contralateral side of the nasopharynx. This paper presents the first reported case of true bilateral extensive juvenile nasopharyngeal angiofibroma involving clinically challenging pre-surgical planning...... embolisation. Radical removal performed as one-step, computer-assisted functional endoscopic sinus surgery was performed. The follow-up period was uncomplicated. CONCLUSION: This case illustrates the importance of suspecting bilateral juvenile nasopharyngeal angiofibroma in patients presenting with bilateral...

  10. Bilateral Olecranon Tophaceous Gout Bursitis

    OpenAIRE

    Güzelali Özdemir; Alper Deveci; Kemal Andıç; Niyazi Erdem Yaşar

    2017-01-01

    In this case, we present a patient with the diagnosis of bilateral olecranon tophaceous gout. After the surgical treatment, there was no limitation of range of motion or wound problem at 6th month control.

  11. Bilateral Olecranon Tophaceous Gout Bursitis

    Directory of Open Access Journals (Sweden)

    Güzelali Özdemir

    2017-01-01

    Full Text Available In this case, we present a patient with the diagnosis of bilateral olecranon tophaceous gout. After the surgical treatment, there was no limitation of range of motion or wound problem at 6th month control.

  12. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle

    2017-01-01

    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...... shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45...

  13. 两种不同内固定材料和植骨材料治疗胸腰椎椎体骨折的疗效分析%Effect of two different internal fixation and bone graft on patients with thoracic or lumbar spinal fracture

    Institute of Scientific and Technical Information of China (English)

    孟新文; 边江; 禹晓东

    2011-01-01

    目的:研究经后路复位内固定并行伤椎植骨对胸、腰椎骨折的治疗效果.方法:对椎体压缩性骨折和爆裂性骨折使用AF或钉棒系统复位固定后,经伤椎椎弓根向伤椎植入自固化磷酸钙人工骨和同种异体骨的治疗结果进行分析.结果:治疗432例 468椎,手术后椎体高度即刻恢复100%的319椎;95%以上80椎;90%以上60椎;80%以上的9椎.398例获得随访,随访10月~8年,伤椎均获得骨性愈合,脊柱稳定性及运动功能恢复良好.结论:胸、腰椎椎体骨折经AF或钉棒系统复位固定后,伤椎植入自固化磷酸钙人工骨和同种异体骨的疗效确切,效果优良.%Objective:To investigate the effect of two different internal fixation system and bone graft on patients with thoracic or lumbar spinal fracture. Methods: From April,2001 to June,2008, 468 body of vertebral in 432 patients suffered from compression fracture or blowout fracture were randomly selected to be treated with AF fixation system and screw - baculum fixation system, then artificial bone of calcium acid phosphate and homogeneity bone were transplanted into the vertebral body of fracture through neck of vertebra. Postoperatively, radiographic finding and clinical results were observed. Results: Instantly after operation, the height of 319 vertebral body were recovered completely ( 100% ), 80 recovered 95%, 60 recovered 90% and 9 recovered 80%. A total of 398 patients were followed - up after surgery, ranging from 10 months to 8 years. Radiographs showed all patients have got the bone union, the movement function of spine was significantly relieved and none suffered from low back pain or radicular pain. Neither complications nor instrumentation failure were observed. Conclusion:Internal fixation system and transplantation of bone graft through neck of vertebra could be recommended for treatment of thoracic or lumbar spinal fracture.

  14. Bilateral Morgagni Hernia in Adult

    Directory of Open Access Journals (Sweden)

    Ali Celik

    2014-03-01

    Full Text Available       Morgagni hernia is a congenital anterior diaphragma hernias. Although it generally seen in childhood and on the right side, rarely seen bilaterally and adult. Computarize tomography is helpful in diagnosis for this lesions asymptomatic in adult. In this article, bilaterally morgagni hernia diagnosed a sixty-five year old male patient looked for due to dyspne was presented.

  15. Pediatric isolated bilateral iliac aneurysm.

    Science.gov (United States)

    Chithra, R; Sundar, R Ajai; Velladuraichi, B; Sritharan, N; Amalorpavanathan, J; Vidyasagaran, T

    2013-07-01

    Aneurysms are rare in children. Isolated iliac artery aneurysms are very rare, especially bilateral aneurysms. Pediatric aneurysms are usually secondary to connective tissue disorders, arteritis, or mycotic causes. We present a case of a 3-year-old child with bilateral idiopathic common iliac aneurysms that were successfully repaired with autogenous vein grafts. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  16. Bilateral cleft lip nasal deformity

    OpenAIRE

    Singh Arun; Nandini R.

    2009-01-01

    Bilateral cleft lip nose deformity is a multi-factorial and complex deformity which tends to aggravate with growth of the child, if not attended surgically. The goals of primary bilateral cleft lip nose surgery are, closure of the nasal floor and sill, lengthening of the columella, repositioning of the alar base, achieving nasal tip projection, repositioning of the lower lateral cartilages, and reorienting the nares from horizontal to oblique position. The multiplicity of procedures in the li...

  17. Bilateral sarkoidose i glandula parotis

    DEFF Research Database (Denmark)

    Hahn, Pernille; Krogdahl, Annelise; Godballe, Christian

    2012-01-01

    We describe an unusual case of sarcoidosis in which the patient presented with a bilateral swelling of the parotid salivary glands and no other manifestation of the disease. Sarcoidosis is a multisystem granulomatous disorder of unknown cause in which there may be multiple exocrine involvement......, including the salivary glands. This case emphasises the importance of including sarcoidosis in the differential diagnosis of bilateral parotid swelling....

  18. Uniportal video-assisted thoracic surgery left superior segmentectomy with systematic lymphadenectomy in the semiprone position.

    Science.gov (United States)

    Lin, Zongwu; Xi, Junjie; Xu, Songtao; Wang, Qun

    2016-08-01

    A 63-year-old male was referred to our hospital with two existing lesions in bilateral lungs. Computed tomography (CT) showed a 15-mm ground-glass opacity (GGO) in the superior segment of left lower lung (S6) and a 5-mm GGO in the center of the right upper lobe. The preoperative clinical diagnosis was stage I primary lung cancer for the left lesion while the right lesion needed follow-up. Uniportal video-assisted thoracic surgery (VATS) left superior segmentectomy in the semiprone position was performed in this case and the right upper lobe was kept untouched. Frozen section examination confirmed the diagnosis of lung adenocarcinoma, and systematic lymphadenectomy with non-grasping en bloc dissection technique was then performed. A chest tube was placed at the posterior part of the incision through the dorsal thoracic cavity to the apex. The postoperative pathologic diagnosis was minimally invasive adenocarcinoma, staged T1aN0M0.

  19. PET-Based Thoracic Radiation Oncology.

    Science.gov (United States)

    Simone, Charles B; Houshmand, Sina; Kalbasi, Anusha; Salavati, Ali; Alavi, Abass

    2016-07-01

    Fluorodeoxyglucose-PET is increasingly being integrated into multiple aspects of oncology. PET/computed tomography (PET/CT) has become especially important in radiation oncology. With the increasing use of advanced techniques like intensity-modulated radiation therapy and proton therapy, PET/CT scans have played critical roles in the target delineation of tumors for radiation oncologists delivering conformal treatment techniques. Use of PET/CT is well established in lung cancer and several other thoracic malignancies. This article details the current uses of PET/CT in thoracic radiation oncology with a focus on lung cancer and describes expected future roles of PET/CT for thoracic tumors.

  20. The Political Economy of Bilateralism and Multilateralism: Institutional Choice in Trade and Taxation

    OpenAIRE

    Rixen, Thomas; Rohlfing, Ingo

    2005-01-01

    Trade relations are governed by the multilateral GATT, whereas the avoidance of international double taxation rests on a network of around 2000 bilateral treaties. Given the two regimes’ similar economic rationales this difference between bilateralism in international double tax avoidance and multilateralism in the trade regime poses an empirical puzzle. In this paper we develop an answer to this puzzle. Differentiating between different stages of international cooperation, we first describe ...

  1. Ⅰ期手术经后路病灶清除内固定治疗儿童胸椎结核%One-stage debridement and bone grafting with internal fixation via posterior approach for treatment of children thoracic spine tuberculosis

    Institute of Scientific and Technical Information of China (English)

    蓝旭; 许建中; 罗飞; 刘雪梅; 葛宝丰

    2013-01-01

    目的:探讨Ⅰ期手术经后路结核病灶清除植骨融合内固定治疗儿童胸椎结核的效果.方法:2005年6月至2010年12月采用病灶清除植骨融合内固定治疗儿童胸椎结核9例,其中男7例,女2例;年龄3~12岁,平均7岁;病史3个月~1年,平均6个月.患儿均有不同程度胸背痛、肋间神经痛以及脊柱后凸畸形,同时伴有低热、盗汗、消瘦等全身症状.术前X线片、CT、MRI检查提示病变部位多发生于T4-T9节段.胸段后凸角35°~72°,平均48.2°.术前脊髓功能ASIA分级:B级2例,C级5例,D级2例.术后定期复查X线片了解后凸角变化和椎间植骨融合情况,采用ASIA分级评定术后脊髓功能恢复情况.结果:术中无大血管或脊髓损伤,术后随访16~38个月,平均24个月.所有患儿结核症状消失,无结核复发、切口感染、窦道形成或内固定失败等并发症,复查血沉正常.术后4~8个月复查X线片提示椎间植骨均获骨性愈合,内固定位置正常.最后随访后凸角12°~30°,平均19.5°,脊髓功能ASIA分级:C级2例,D级2例,E级5例.脊髓功能均有不同程度改善.结论:Ⅰ期经后路清除胸椎结核病灶彻底,椎管减压可靠,矫形效果显著,行自体或同种异体骨植骨钉棒系统内固定可有效重建胸段脊柱的稳定性.%Objective:To investigate the outcome of the children with thoracic spine tuberculosis who underwent radical debridement,reconstruction with bone autograft or allograft and internal fixation via posterior approach. Methods: From June 2005 to December 2010,9 children with thoracic spine tuberculosis underwent radical debridement,reconstruction with bone autograft or allograft and internal fixation via posterior approach including 7 males and 2 females with an average age of 7 years old ranging from 3 to 12 years. The course of the disease ranged from 3 months to 1 year (averaged 6 months). All the patients had continuous thoracic and back pain

  2. A Rare Entity: Traumatic Thoracic Aortic Injury in a Patient with Aberrant Right Subclavian Artery.

    Science.gov (United States)

    Patel, Hiten Mohanbhai; Banerjee, Shubhabrata; Bulsara, Shahzad; Sahu, Tapish; Sheorain, Virender K; Grover, Tarun; Parakh, Rajiv

    2017-05-01

    Aberrant right subclavian artery is an uncommon entity incidence ranging from 0.5 to 2.5%. Management of thoracic aortic injury in the presence of such anomalies can be a challenge. We present here a case of traumatic aortic injury, which was incidentally found to have an asymptomatic aberrant right subclavian artery. The patient was managed by an endovascular repair of thoracic aortic injury with an endograft and a right carotid to subclavian artery bypass as a hybrid procedure. A 40-year male patient was brought to the emergency in shock with an alleged history of road traffic accident an hour back. After initial resuscitation as per advance trauma life support protocol, imaging revealed thoracic aortic injury with aberrant right subclavian artery with multiple rib and bilateral humerus fracture. After primary stabilization of arm fractures, the patient was shifted to a hybrid operation room. As the aortic injury was within 10 mm of the origin of both subclavian arteries, it was decided to cover the origin of both subclavian arteries and land the endograft distal to the left carotid artery origin. Since there was a right dominant vertebral artery on imaging, right carotid to right subclavian artery bypass was done with expanded polytetrafluoroethylene graft to prevent posterior circulatory stroke along with thoracic endovascular aortic repair to seal the thoracic aortic injury. After endovascular repair of thoracic aortic injury, left subclavian artery perfusion was maintained through left vertebral artery; and hence, revascularization of left subclavian artery was deferred. After management of all fractures, the patient was discharged 3 weeks after the date of admission without any complications. At 6 months follow-up, patient was stable and images showed patent bypass graft and sealed aortic injury. In a trauma setting with multiple injuries, hybrid procedure with a thoracic endograft is associated with low mortality and morbidity; hence, it is the treatment

  3. Unusual Bilateral Rim Fracture in Femoroacetabular Impingement

    Directory of Open Access Journals (Sweden)

    Claudio Rafols

    2015-01-01

    Full Text Available This is a report of one case of bilateral acetabular rim fracture in association with femoroacetabular impingement (FAI, which was treated with a hip arthroscopic procedure, performing a partial resection, a labral reinsertion, and a subsequential internal fixation with cannulated screws. Up to date, there are in the literature only two reports of rim fracture and “os acetabuli” in association with FAI. In the case we present, the pincer and cam resection were performed without complications; the technique used was published previously. With this technique the head of the screw lays hidden by the reattached labrum. We removed partially the fractured rim fragment and the internal fixation of the remaining portion was achieved with a screw. In the event of a complete resection of the fragment, it would have ended with a LCE angle of 18° and a high probability of hip instability. We believe that this bilateral case helps establish the efficacy and reproducibility of the technique described by Larson.

  4. Treatment of nonspecific thoracic spine pain with trigger point dry needling and intramuscular electrical stimulation: a case series.

    Science.gov (United States)

    Rock, Jodie M; Rainey, Charles E

    2014-10-01

    Case Series. Myofascial trigger points (MTrPs) are a common occurrence in many musculoskeletal issues and have been shown to be prevalent in both subjects with nonspecific low back pain and whiplash associated disorder. Trigger point dry needling (DN) has been shown to reduce pain and improve function in areas such as the cervical and lumbar spine, shoulder, hip, and knee, but has not been investigated in the thoracic spine. The purpose of this case series was to document the use of DN with intramuscular electrical stimulation (IES) in subjects with nonspecific thoracic spine pain. The subjects were both active duty military males aged 31 and 27 years who self-referred to physical therapy for thoracic spinal pain. Physical examination demonstrated thoracic motor control dysfunction, tissue hypertonicity, and tenderness to palpation of bilateral thoracic paraspinal musculature in both subjects. This indicated the presence of possible MrTPs. Objective findings in the first subject included painful thoracic flexion and bilateral rotation in each of these planes of movement. Pain reduction was observed when postural demands of the spine and trunk musculature were reduced through positional changes. Patient 1 demonstrated pain with posterior to anterior (P/A) pressure at T9 to T12. The second subject had bilaterally limited and painful thoracic rotation actively with normal passive rotation and demonstrated pain with P/A pressure at T4 to T7. The subjects were treated with DN and IES for a total of two visits each. DN was performed to paraspinal and multifidus musculature at the levels of elicited pain with P/A testing and IES set at a frequency level of 4 (1.5Hz) for 20 minutes. Subject 1 reported reduced pain with standing flexion from a 62mm VAS score on initial evaluation to 26mm at his second visit. Subject 2 reported being "quite a bit better" in symptoms on the GROC following his second treatment. His VAS score reported following weightlifting activities changed

  5. Simultaneous bilateral shoulder and bilateral central acetabular fracture dislocation: What to do?

    Institute of Scientific and Technical Information of China (English)

    Hardik Sheth; Abhijeet Ashok Salunke; Ramesh Panchal; Jimmy Chokshi; G.I.Nambi; Saranjeet Singh; Amit Patel

    2016-01-01

    Musculoskeletal injuries following seizures have a high morbidity and mortality.These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations.We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure.Present study highlights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures.Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery.Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.

  6. An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death.

    Science.gov (United States)

    Gries, Cynthia J; White, Douglas B; Truog, Robert D; Dubois, James; Cosio, Carmen C; Dhanani, Sonny; Chan, Kevin M; Corris, Paul; Dark, John; Fulda, Gerald; Glazier, Alexandra K; Higgins, Robert; Love, Robert; Mason, David P; Nakagawa, Thomas A; Shapiro, Ron; Shemie, Sam; Tracy, Mary Fran; Travaline, John M; Valapour, Maryam; West, Lori; Zaas, David; Halpern, Scott D

    2013-07-01

    Donation after circulatory determination of death (DCDD) has the potential to increase the number of organs available for transplantation. Because consent and management of potential donors must occur before death, DCDD raises unique ethical and policy issues. To develop an ethics and health policy statement on adult and pediatric DCDD relevant to critical care and transplantation stakeholders. A multidisciplinary panel of stakeholders was convened to develop an ethics and health policy statement. The panel consisted of representatives from the American Thoracic Society, Society of Critical Care Medicine, International Society for Heart and Lung Transplantation, Association of Organ Procurement Organizations, and the United Network of Organ Sharing. The panel reviewed the literature, discussed important ethics and health policy considerations, and developed a guiding framework for decision making by stakeholders. A framework to guide ethics and health policy statement was established, which addressed the consent process, pre- and post mortem interventions, the determination of death, provisions of end-of-life care, and pediatric DCDD. The information presented in this Statement is based on the current evidence, experience, and clinical rationale. New clinical research and the development and dissemination of new technologies will eventually necessitate an update of this Statement.

  7. Partner countries for Dutch bilateral development assistance 1962-2015

    NARCIS (Netherlands)

    Kazimierczuk, A.; Dietz, A.J.; Vink, de N.

    2016-01-01

    The Netherlands has been an active supporter of international development aid. Dutch development cooperation started in response to Truman's 'Four point programme' announced in 1949. It began as technical assistance, channelled through multilateral channels. Bilateral aid started in 1962 and was int

  8. Spanish Bilateral Initiatives for Education in Latin America

    Science.gov (United States)

    Cortina, Regina; Sanchez, Maria Teresa

    2007-01-01

    The research presented in this article concerns la Agencia Espanola de Cooperacion Internacional (Spanish Agency for International Cooperation--AECI) and its growing presence in Latin America since the late 1990s. The aim is to evaluate the transformative potential that bilateral funding can have on educational reform in the region. The article…

  9. Fractures of the bilateral distal radius and scaphoid: a case report

    Directory of Open Access Journals (Sweden)

    Ozkan Korhan

    2008-03-01

    Full Text Available Abstract Introduction Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Case presentation A patient with bilateral comminuted, displaced distal fractures of the radius and bilateral fractures of the scaphoid was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating. Conclusion Rigid internal fixation of distal radius and scaphoid fractures is mandatory to start early active rehabilitation of the wrist without the need for wrist immobilization with a plaster or external skeletal fixation.

  10. Experience Of Thoracic Surgery Performed Under Difficult ...

    African Journals Online (AJOL)

    Results: Thoracic surgery was performed in 32 patients in Medina Hospital. Most of these ... We had two post-operative complications and 2 patients died after having surgery for .... (long standing chest drains, pleural fenestration) and being in ...

  11. March 2016 Arizona thoracic society ntoes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-03-01

    Full Text Available No abstract available. Article truncated at 150 words. The March 2016 Arizona Thoracic Society meeting was held on Wednesday, March 23, 2016 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 17 in attendance representing the pulmonary, critical care, sleep, and radiology communities. Of note, Dr. Elijah Poulos drove from Flagstaff to attend the meeting. Dr. Rick Robbins gave a summary of ATS Hill Day and the possibility of collecting dues for the Arizona Thoracic Society along with American Thoracic Society dues. Dr. Robbins also presented the results of emailing the Table of Contents of the Southwest Journal of Pulmonary and Critical Care to the ATS members in Arizona, New Mexico, Colorado, and Nevada along with listing the contents in Inspirations the California Thoracic Society newsletter. The number of page views doubled over usual the following day. Dr. George Parides presented a short presentation on whether coccidioidomycosis nodules ...

  12. An Official American Thoracic Society Research Statement

    DEFF Research Database (Denmark)

    Slatore, Christopher G; Horeweg, Nanda; Jett, James R

    2015-01-01

    : In this research statement from the American Thoracic Society, a multidisciplinary group of clinicians, researchers, and patient advocates reviewed available evidence for pulmonary nodule evaluation, characterized six focus areas to direct future research efforts, and identified fundamental gaps in knowledge...

  13. Lhermitte Sign as a Presenting Symptom of Thoracic Spinal Pathology: A Case Study

    Directory of Open Access Journals (Sweden)

    Adam Hills

    2015-01-01

    Full Text Available A 54-year-old male with ankylosing spondylitis presented with complaints of progressively worsening bilateral leg weakness and difficulty ambulating of 2-week duration. He also felt a sharp, electric, shock-like sensation radiating from his lower back into his legs upon flexing the trunk. There was no history of trauma or other inciting events within the 2 weeks prior to presentation. Thoracic MRI at this visit showed a three-column fracture at T11-T12. He underwent spinal fusion surgery and within 2 days after surgery the radiating electrical sensation with spinal flexion had completely resolved.

  14. Thoracic Meningioma In Combination With Severe Lumbar Spinal Stenosis Presenting With Atypical Neurological Deficit

    Directory of Open Access Journals (Sweden)

    Kehayov Ivo I.

    2015-03-01

    Full Text Available We report on a case of a 47-year-old female patient with a long history of low back pain irradiating bilaterally to the legs. Twenty days before admission to our clinic, she had developed progressive weakness in the legs, more pronounced on the left side. The initial neurological examination revealed signs of damage to both the cauda equina and the spinal cord. The neuroimaging studies (computed tomography, myelography and magnetic-resonance tomography found spinal stenosis most severe at L4-L5 level, and right lateral thoracic intradural-extramedullary tumor at T9-T10 level.

  15. Intramedullary thoracic spinal cord meningioma: a rare case report and review of the literature.

    Science.gov (United States)

    Yuan, Dun; Liu, Dingyang; Yuan, Xian-rui; Xi, Jian; Ding, Xi-ping

    2013-12-01

    A 33-year-old male presented with a thoracic spinal intramedullary meningioma manifesting as bilateral asymmetric progressive weakness in the lower extremities. Preoperative magnetic resonance imaging (MRI) showed an intramedullary mass at the T1-T3 level. Intraoperative inspection found that the spinal cord was markedly swollen with a normal surface while dural attachment was not confirmed. Gross total removal of the tumor was achieved. The morphologic and immunohistochemical findings were compatible with the diagnosis of meningioma. Postoperatively, the patient recovered from preoperative paraplegia. Although extremely rare, meningiomas should be considered when diagnosing intramedullary tumors. Georg Thieme Verlag KG Stuttgart · New York.

  16. Non-intubated anesthesia in thoracic surgery-technical issues.

    Science.gov (United States)

    Kiss, Gabor; Castillo, Maria

    2015-05-01

    Performing awake thoracic surgery (ATS) is technically more challenging than thoracic surgery under general anesthesia (GA), but it can result in a greater benefit for the patient. Local wound infiltration and lidocaine administration in the pleural space can be considered for ATS. More invasive techniques are local wound infiltration with wound catheter insertion, thoracic wall blocks, selective intercostal nerve blockade, thoracic paravertebral blockade and thoracic epidural analgesia, offering the advantage of a catheter placement which can also be continued for postoperative analgesia.

  17. Paralisia facial bilateral Bilateral facial paralysis: a case report

    Directory of Open Access Journals (Sweden)

    J. Fortes-Rego

    1976-03-01

    Full Text Available É apresentado um caso de diplegia facial surgida após meningite meningocócica e infecção por herpes simples. Depois de discutir as diversas condições que o fenômeno pode apresentar-se, o autor inclina-se por uma etiologia herpética.A case of bilateral facial paralysis following meningococcal meningitis and herpes simplex infection is reported. The author discusses the differential diagnosis of bilateral facial nerve paralysis which includes several diseases and syndromes and concludes by herpetic aetiology.

  18. Bilateral spontaneous hemotympanum: Case report

    Directory of Open Access Journals (Sweden)

    Economou Nicolas C

    2006-10-01

    Full Text Available Abstract Background The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media. A rare case of spontaneous bilateral hemotympanum in a patient treated with anticoagulants is presented herein. Case presentation A 72-year-old male presented with acute deterioration of hearing. In the patient's medical history aortic valve replacement 1 year before presentation was reported. Since then he had been administered regularly coumarinic anticoagulants, with INR levels maintained between 3.4 and 4.0. Otoscopy revealed the presence of bilateral hemotympanum. The audiogram showed symmetrical moderately severe mixed hearing loss bilaterally, with the conductive component predominating. Tympanograms were flat bilaterally with absent acoustic reflexes. A computerized tomography scan showed the presence of fluid in the mastoid and middle ear bilaterally. Treatment was conservative and consisted of a 10-day course of antibiotics, anticongestants and temporary interruption of the anticoagulant therapy. After 3 weeks, normal tympanic membranes were found and hearing had returned to previous levels. Conclusion Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder.

  19. Calcification of thoracic aorta - solar eclipse sign.

    Science.gov (United States)

    Dhoble, Abhijeet; Puttarajappa, Chethan

    2008-08-29

    Calcification of thoracic aorta is very common in old people, especially ones with hypertension. This can sometime be visible on plain chest radiograph. We present a case of a male patient who had extensive deposition of calcium in the thoracic aorta. The relationship between aortic calcification and coronary atherosclerosis remains contentious. Computed tomography of the thorax can display this calcification which appears like 'solar eclipse'.

  20. Puncture of thoracic lesions under sonographic guidance.

    OpenAIRE

    Afschrift, M; Nachtegaele, P; Voet, D; Noens, L.; Van Hove, W; Van der Straeten, M; Verdonk, G

    1982-01-01

    Thirty-six punctures of thoracic lesions have been performed with a compound B-scanner or a real-time linear-array scanner for guidance. Twenty-three fluid collections were punctured and aspiration biopsies were performed on 13 echogenic lesions. All the punctures were successful at the first attempt. No complications occurred. The results confirm the usefulness of sonography for guiding punctures of thoracic fluid effusions and solid masses. Usually a static B-scanner is sufficient, but when...

  1. Bilateral Ultrasound Guided Supraclavicular Block in a Patient on Antiplatelet Drugs

    Directory of Open Access Journals (Sweden)

    Lokesh Kumar KS

    2015-04-01

    Full Text Available A 63 year old male hypertensive and diabetic patient, with coronary artery and chronic obstructive pulmonary disease, presented with bilateral both bone forearm fracture. Open reduction and internal fixation was done successfully with bilateral ultrasound guided supraclavicular block. The problems associated with peripheral nerve block in an Ischemic Heart Disease (IHD patient on antiplatelet therapy are discussed.

  2. The examination of soft tissue compliance in the thoracic region for the development of a spinal manipulation training mannequin

    Science.gov (United States)

    Starmer, David J.; Duquette, Sean A.; Stainsby, Brynne E.; Giuliano, Anthony M.

    2015-01-01

    Purpose: To determine if the soft tissue compliance of the thoracic paraspinal musculature differs based on gender and body type to help create a foam human analogue mannequin to assist in the training of spinal manipulative therapy. Methods: 54 volunteers were grouped based on their gender and body types. In the prone position, thoracic paraspinal soft tissue compliance was measured at T1, T3 T6, T9 and T12 vertebrae levels bilaterally using a tissue compliance meter. Results: There was no significant difference in tissue compliance when comparing the genders except at T1 (p=0.026). When comparing body types, significantly higher tissue compliance was found between endomorphs and the other groups. No significant difference was found between ectomorphs and mesomorphs. The compliance for the participants in this study ranged from 0.122 mm/N to 0.420 mm/N. Conclusion: There are significant differences in thoracic spine soft tissue compliance in healthy asymptomatic patients between genders in the upper thoracic spine, and between different body types throughout the thoracic spine. It may be beneficial to create multiple versions of practice mannequins to simulate variations amongst different patients. PMID:26136607

  3. Bilateral zeta functions and their applications

    OpenAIRE

    Shibukawa, Genki

    2011-01-01

    We introduce a new type of multiple zeta functions, which we call bilateral zeta functions, analogous to the Barnes zeta functions. The bilateral zeta function is a periodic function and shares certain basic properties of Barnes zeta function. Especially, we prove that the bilateral zeta function has a nice Fourier series expansion and the Barnes zeta function can be expressed as a finite sum of bilateral zeta functions. By these properties of the bilateral zeta functions, We obtain simple pr...

  4. Thoracic trauma: analysis of 100 consecutive cases

    Directory of Open Access Journals (Sweden)

    Maíra Benito Scapolan

    2010-09-01

    Full Text Available Objective: To analyze thoracic trauma assisted by the EmergencyService of Hospital da Irmandade da Santa Casa de Misericórdia deSão Paulo. Methods: One hundred patients with thoracic trauma wereassisted throughout six months in 2006. Data from their records werecollected and a protocol of thoracic trauma was fulfilled. The RevisedTrauma Score was used to evaluate gravity of injury and to calculatethe survival index. Results: Prevalence of trauma injury in male from20 to 29 years old was observed. Out of all patients, 44 had blunttrauma and 56 penetrating trauma (78.6% presented stab woundsand 21.4% gun shots. Up to the settings of injuries, 23% were in thethoracoabdominal transition, 7% in the precordium and 70% in theremainder thoracic area. In those with the thoracoabdominal transitioninjury, 22.7% were hemodynamically unstable and 77.3% stable.Thoracoabdominal injury patients presented 40.9% of diaphragmwound and all were stable. Of those with precordium wound, 37.5%presented cardiac injury. In cardiac onset, 66.7% presented stableand 33.3% unstable. Thoracic drainage was the most accomplishedsurgical procedure (71%. Conclusions: The thoracic trauma patientis most prevalently young male with stab wound penetrating injury,without associated injuries, hemodynamically stable, presentinghemothorax, with high probability of survival.

  5. Clinical innovations in Philippine thoracic surgery.

    Science.gov (United States)

    Danguilan, Jose Luis J

    2016-08-01

    Thoracic surgery in the Philippines followed the development of thoracic surgery in the United States and Europe. With better understanding of the physiology of the open chest and refinements in thoracic anesthetic and surgical approaches, Filipino surgeons began performing thoracoplasties, then lung resections for pulmonary tuberculosis and later for lung cancer in specialty hospitals dealing with pulmonary diseases-first at the Quezon Institute (QI) and presently at the Lung Center of the Philippines although some university and private hospitals made occasional forays into the chest. Esophageal surgery began its early attempts during the post-World War II era at the Philippine General Hospital (PGH), a university hospital affiliated with the University of the Philippines. With the introduction of minimally invasive thoracic surgical approaches, Filipino thoracic surgeons have managed to keep up with their Asian counterparts although the problems of financial reimbursement typical of a developing country remain. The need for creative innovative approaches of a focused multidisciplinary team will advance the boundaries of thoracic surgery in the Philippines.

  6. Extra corporal membrane oxygenation in general thoracic surgery: a new single veno-venous cannulation

    Directory of Open Access Journals (Sweden)

    Kanaan Reem

    2011-04-01

    Full Text Available Abstract Extracorporeal membrane oxygenation (ECMO is used in severe respiratory failure to maintain adequate gas exchange. So far, this technique has not been commonly used in general thoracic surgery. We present a case using ECMO for peri-operative airway management for pulmonary resection, using a novel single-site, internal jugular, veno-venous ECMO cannula.

  7. Bilateral ureteropelvic disruption following blunt abdominal trauma: Case report

    Directory of Open Access Journals (Sweden)

    Kikuchi Hiroko

    2011-07-01

    Full Text Available Abstract Background Ureteral injury occurs in less than 1% of blunt abdominal trauma cases, partly because the ureters are relatively well protected in the retroperitoneum. Bilateral ureteral injury is extremely rare, with only 10 previously reported cases. Diagnosis may be delayed if ureteric injury is not suspected, and delay of 36 hours or longer has been observed in more than 50% of patients with ureteric injury following abdominal trauma, leading to increased morbidity. Case presentation A 29-year-old man was involved in a highway motor vehicle collision and was ejected from the front passenger seat even though wearing a seatbelt. He was in a preshock state at the scene of the accident. An intravenous line and left thoracic drain were inserted, and he was transported to our hospital by helicopter. Whole-body, contrast-enhanced computed tomography (CT scan showed left diaphragmatic disruption, splenic injury, and a grade I injury to the left kidney with a retroperitoneal haematoma. He underwent emergency laparotomy. The left diaphragmatic and splenic injuries were repaired. Although a retroperitoneal haematoma was observed, his renal injury was treated conservatively because the haematoma was not expanding. In the intensive care unit, the patient's haemodynamic state was stable, but there was no urinary output for 9 hours after surgery. Anuresis prompted a review of the abdominal x-ray which had been performed after the contrast-enhanced CT. Leakage of contrast material from the ureteropelvic junctions was detected, and review of the repeat CT scan revealed contrast retention in the perirenal retroperitoneum bilaterally. He underwent cystoscopy and bilateral retrograde pyelography, which showed bilateral complete ureteral disruption, preventing placement of ureteral stents. Diagnostic laparotomy revealed complete disruption of the ureteropelvic junctions bilaterally. Double-J ureteral stents were placed bilaterally and ureteropelvic

  8. 后路漂浮法减压内固定治疗严重黄韧带骨化型胸椎管狭窄症%Treatment of Thoracic Spine Stenosis by Laminectomy Using “Lamina Floating” Technique and Internal Fixation with Severe Ossification of the Ligamentum Flavum by Pedicle Screw

    Institute of Scientific and Technical Information of China (English)

    陈建梅; 姚晓东; 黄丽花; 李金泉; 徐皓

    2012-01-01

    Objective To evaluate the effect of laminectomy using "lamina floating" technique and internal fixation by pedicle screw to thoracic spine stenosis with severe ossification of the ligamentum flavum (OLF-TSS). Methods From January 2007 to October 2010,15 patients of OLF-TSS in the hospital treated with laminectomy using "lamina floating" technique and internal fixation by pedicle screw were retrospectively analyzed according to Japanese Orthopaedic Association (JOA) scoring system and complications. Results The mean follow-up period was 10. 3 months (ranging from 5 months to 3 years). According to the JOA scoring system,excellent in 10 cases,good in 3 cases, the excellent and good rate was 86. 7%. 2 cases with cerebrospinal fluid leakage were recovered after repaired with back fascia. Conclusion Laminectomy using "lamina floating" technique is a safe and effective method for decompression of OLF-TSS, and internal fixation by pedicle screw can effectively rebuild spinal stability post-operation. So laminectomy using "lamina floating" technique and internal fixation by pedicle screw is a good choice for severe ossification of the ligamentum flavum thoracic spine stenosis.%目的 探讨经后路漂浮法减压及内固定术治疗严重黄韧带骨化型胸椎管狭窄症的疗效.方法 2007年1月至2010年10月,我科收治严重黄韧带骨化型胸椎管狭窄症15例,根据Miyakoshit分型均为融合型,其中男7例,女8例;年龄40~67岁,平均56岁.所有患者术前均行X线、CT、MRI检查,并采用后路漂浮法减压+椎弓根钉内固定术.通过JOA评分、并发症发生情况评估疗效.结果 术后15例均获得随访,随访5个月~3年,平均10.3个月.根据JOA评分进行疗效评价,优10例,良3例,可2例,优良率86.7%.其中2例出现硬脊膜撕裂,经腰背筋膜修复后痊愈.结论 后路漂浮法可以安全有效地对受压胸髓实现减压,椎弓根钉内固定可以提供脊柱稳定,是治疗黄韧带骨化型胸椎管狭窄症的良好术式.

  9. Cytomegalovirus Immunoglobulin After Thoracic Transplantation

    Science.gov (United States)

    Grossi, Paolo; Mohacsi, Paul; Szabolcs, Zoltán; Potena, Luciano

    2016-01-01

    Abstract Cytomegalovirus (CMV) is a highly complex pathogen which, despite modern prophylactic regimens, continues to affect a high proportion of thoracic organ transplant recipients. The symptomatic manifestations of CMV infection are compounded by adverse indirect effects induced by the multiple immunomodulatory actions of CMV. These include a higher risk of acute rejection, cardiac allograft vasculopathy after heart transplantation, and potentially bronchiolitis obliterans syndrome in lung transplant recipients, with a greater propensity for opportunistic secondary infections. Prophylaxis for CMV using antiviral agents (typically oral valganciclovir or intravenous ganciclovir) is now almost universal, at least in high-risk transplants (D+/R−). Even with extended prophylactic regimens, however, challenges remain. The CMV events can still occur despite antiviral prophylaxis, including late-onset infection or recurrent disease, and patients with ganciclovir-resistant CMV infection or who are intolerant to antiviral therapy require alternative strategies. The CMV immunoglobulin (CMVIG) and antiviral agents have complementary modes of action. High-titer CMVIG preparations provide passive CMV-specific immunity but also exert complex immunomodulatory properties which augment the antiviral effect of antiviral agents and offer the potential to suppress the indirect effects of CMV infection. This supplement discusses the available data concerning the immunological and clinical effects of CMVIG after heart or lung transplantation. PMID:26900989

  10. A novel approach to treat women patients with palmar hyperhidrosis: transumbilical thoracic sympathectomy with an ultrathin gastroscope.

    Science.gov (United States)

    Chen, Weisheng; Chen, Long; Zhu, Lihuan; Yang, Shengsheng; Feng, Xuegang; Zhang, Jixue; Cheng, Xianjin; Liu, Daoming; Wang, Wen

    2013-12-01

    Primary palmar hyperhidrosis is very common in women. Video-assisted thoracic sympathectomy is recognized as an effective treatment for patients with severe hyperhidrosis, which has usually been performed with more than 2 skin incisions. We developed a novel approach for thoracic sympathectomy in women with palmar hyperhidrosis through the umbilicus using an ultrathin gastroscope. The approach requires only 1 tiny incision, which is hidden in the umbilicus. Under general anesthesia, patients were intubated with a dual-lumen endotracheal tube. Through the incision in the umbilicus, a newly developed long trocar was inserted into the abdominal cavity. After insertion of the ultrathin gastroscope through this trocar, a small incision was created on the both sides of diaphragm by a needle knife. The endoscope was introduced into the thoracic cavity through the incision made in the left or right diaphragm. The sympathetic chain was identified at the desired thoracic level and ablated. From January 10, 2010, to November 30, 2011, 25 women underwent transumbilical-diaphragmatic thoracic sympathectomy. The mean operating room time for the entire bilateral procedure was 56.9 ± 6.9 minutes. There were no significant postoperative complications. The symptoms disappeared in all patients. Compensatory sweating was reported in 56%. All of the patients were satisfied with the surgical results and the cosmetic outcome of the incision. Transumbilical thoracic sympathectomy with the ultrathin flexible endoscope was a safe and effective option for women with severe palmar hyperhidrosis that provided excellent cosmetic outcomes. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Simultaneous bilateral patellar tendon rupture

    Directory of Open Access Journals (Sweden)

    Diogo Lino Moura

    Full Text Available ABSTRACT Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.

  12. Neuromagnetic fields accompanying unilateral and bilateral voluntary movements: topography and analysis of cortical sources.

    Science.gov (United States)

    Kristeva, R; Cheyne, D; Deecke, L

    1991-08-01

    Movement-related magnetic fields (MRMFs) accompanying left and right unilateral and bilateral finger flexions were studied in 6 right-handed subjects. Six different MRMF components occurring prior to, and during both unilateral and bilateral movements are described: a slow pre-movement readiness field (RF, 1-0.5 sec prior to movement onset); a motor field (MF) starting shortly before EMG onset; 3 separate "movement-evoked" fields following EMG onset (MEFI at 100 msec; MEFII at 225 msec; and MEFIII at 320 msec); and a "post-movement" field (PMF) following the movement itself. The bilateral topography of the RF and MF for both unilateral and bilateral movements suggested bilateral generators for both conditions. Least-squares fitting of equivalent current dipole sources also indicated bilateral sources for MF prior to both unilateral and bilateral movements with significantly greater strength of contralateral sources in the case of unilateral movements. Differences in pre-movement field patterns for left versus right unilateral movements indicated possible cerebral dominance effects as well. A single current dipole in the contralateral sensorimotor cortex could account for the MEFI for unilateral movements and bilateral sensorimotor sources for bilateral movements. Other MRMF components following EMG onset indicated similar sources in sensorimotor cortex related to sensory feedback or internal monitoring of the movement. The results are discussed with respect to the possible generators active in sensorimotor cortex during unilateral and bilateral movement preparation and execution and their significance for the study of cortical organization of voluntary movement.

  13. The transpedicular corpectomy through simple posterior approach combined with internal fixation and prosthetic vertebral replacement for thoracic and lumbar spine metastatic tumor%单纯后路经椎弓根椎体次全切除内固定联合人工椎体置换治疗胸腰椎转移瘤

    Institute of Scientific and Technical Information of China (English)

    燕太强; 郭卫; 杨荣利; 董森; 李晓

    2011-01-01

    Objective To evaluate the clinical outcome of the transpedicular corpectomy through simple posterior approach combined with intemal fixation and prosthetic vertebral replacement for thoracic and lumbar spine metastatic tumor.Methods From January 2007 to March 2010, 21 patients with thoracic and lumbar spine metastatic tumors (9 males, 12 females; 16 in thoracic spine, 5 in lumbar spine) underwent the transpedicular corpectomy through simple posterior approach combined with internal fixation and prosthetic vertebral replacement.The mean age was 58 years (range, 39-77 years).The average pre-operative VAS score was 7.4 (range, 5-10).According to the pre-operative Frankel grades for spinal cord, 3 cases obtained grade C, 6 grade D and 12 grade E.Pre-operative ECOG grades showed 1 case with grade 2, 18 with grade 3 and 2 with grade 4.Results The mean operative time was 3.5 hours (range, 2-5 hours), with no intra-operative death.The mean intra-operative blood loss was 2150 ml (range, 800-5000ml).1 patient died of multiple organ failure two weeks postoperatively.A11 patients with pain reported lower VAS scores postoperatively (with average being 3.1; range, 1-4.5).Of the Frankel grades, 1 patient with grade C reported no change after surgery, while 1 patient with grade C was improved to grade D and 6 patients with grade D to grade E.3 cases (14.3%)were re-operated half year to 1 year after surgery due to recurrence.In the last follow-up, 20 patients had already been followed up for an average of 13 months (range, 3-24months).Among them, 13 cases died of the primary disease with an average survival of 10 months.The remaining surviving patients reported ECOG grades from grade 1 to grade 3.Conclusions The transpedicular corpectomy through simple posterior approach combined with internal fixation and prosthetic vertebral replacement for thoracic and lumbar spine metastatic tumor can provide plentiful decompression and achieve favorable surgical results.It can effectively

  14. Pigmented villonodular synovitis of the thoracic spine.

    Science.gov (United States)

    Roguski, Marie; Safain, Mina G; Zerris, Vasilios A; Kryzanski, James T; Thomas, Christine B; Magge, Subu N; Riesenburger, Ron I

    2014-10-01

    Pigmented villonodular synovitis (PVNS) is a proliferative lesion of the synovial membranes. Knees, hips, and other large weight-bearing joints are most commonly affected. PVNS rarely presents in the spine, in particular the thoracic segments. We present a patient with PVNS in the thoracic spine and describe its clinical presentation, radiographic findings, pathologic features, and treatment as well as providing the first comprehensive meta-analysis and review of the literature on this topic, to our knowledge. A total of 28 publications reporting 56 patients were found. The lumbar and cervical spine were most frequently involved (40% and 36% of patients, respectively) with infrequent involvement of the thoracic spine (24% of patients). PVNS affects a wide range of ages, but has a particular predilection for the thoracic spine in younger patients. The mean age in the thoracic group was 22.8 years and was significantly lower than the cervical and lumbar groups (42.4 and 48.6 years, respectively; p=0.0001). PVNS should be included in the differential diagnosis of osteodestructive lesions of the spine, especially because of its potential for local recurrence. The goal of treatment should be complete surgical excision. Although the pathogenesis is not clear, mechanical strain may play an important role, especially in cervical and lumbar PVNS. The association of thoracic lesions and younger age suggests that other factors, such as neoplasia, derangement of lipid metabolism, perturbations of humoral and cellular immunity, and other undefined patient factors, play a role in the development of thoracic PVNS. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Thoracic wall reconstruction after tumor resection

    Directory of Open Access Journals (Sweden)

    Kamran eHarati

    2015-10-01

    Full Text Available Introduction: Surgical treatment of malignant thoracic wall tumors represents a formidable challenge. In particular, locally advanced tumors that have already infiltrated critical anatomic structures are associated with a high surgical morbidity and can result in full thickness defects of the thoracic wall. Plastic surgery can reduce this surgical morbidity by reconstructing the thoracic wall through various tissue transfer techniques. Sufficient soft tissue reconstruction of the thoracic wall improves life quality and mitigates functional impairment after extensive resection. The aim of this article is to illustrate the various plastic surgery treatment options in the multimodal therapy of patients with malignant thoracic wall tumors.Material und methods: This article is based on a review of the current literature and the evaluation of a patient database.Results: Several plastic surgical treatment options can be implemented in the curative and palliative therapy of patients with malignant solid tumors of the chest wall. Large soft tissue defects after tumor resection can be covered by local, pedicled or free flaps. In cases of large full-thickness defects, flaps can be combined with polypropylene mesh to improve chest wall stability and to maintain pulmonary function. The success of modern medicine has resulted in an increasing number of patients with prolonged survival suffering from locally advanced tumors that can be painful, malodorous or prone to bleeding. Resection of these tumors followed by thoracic wall reconstruction with viable tissue can substantially enhance the life quality of these patients. Discussion: In curative treatment regimens, chest wall reconstruction enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. In palliative disease treatment, stadium plastic surgical techniques of thoracic wall reconstruction provide palliation of tumor-associated morbidity and can therefore improve

  16. Thoracic CT in the ED: a study of thoracic computed tomography utilisation.

    LENUS (Irish Health Repository)

    Williams, E

    2010-02-01

    The aim of this retrospective study was to investigate the use of thoracic Computed Tomography (CT) in the Emergency Department of a Dublin Academic Teaching Hospital over a six month period. Data was retrieved using the hospital\\'s computerised information system. There were 202 referrals in total for thoracic CT from the Emergency Department during this time period. The most common indication for thoracic CT referral was for the investigation of pulmonary embolism with 127 (63%) referrals. There were 40 (25%) referrals for suspected malignancy and lung disease, whilst 8 (4%) of the referrals were for investigation of thoracic aortic dissection, 8 (4%) for infection, and 6 (3%) were for investigation of thoracic injury. Only 8 (4%) of all referrals were for investigation of injury as a result of chest trauma.

  17. [Video-assisted thoracic surgery, lung transplantation and mediastinitis: major issues in thoracic surgery in 2010].

    Science.gov (United States)

    Borro, José M; Moreno, Ramón; Gómez, Ana; Duque, José Luis

    2011-01-01

    We reviewed the major issues in thoracic surgery relating to the advances made in our specialty in 2010. To do this, the 43(rd) Congress of the Spanish Society of Pneumology and Thoracic Surgery held in La Coruña and the articles published in the Society's journal, Archivos de Bronconeumología, were reviewed. The main areas of interest were related to the development of video-assisted thoracic surgery, lung transplantation and descending mediastinitis. The new tumor-node-metastasis (TNM) classification (7(th) edition), presented last year, was still a topical issue this year. The First Forum of Thoracic Surgeons and the Update in Thoracic Surgery together with the Nurses' Area have constituted an excellent teaching program.

  18. [Gastrontestinal hemorrhage following thoracic surgery].

    Science.gov (United States)

    Durić, O; Tvrtković, R; Budalica, M

    1976-01-01

    The authors discuss eight cases who suffered hemorrhaging stress ulcers out of 200 cases on whom Thoracotomies were performed. Presented is the common factor of the onset of this complication, it's diagnosis, and therapy. Listed below are the diagnoses and operative procedures used on these eight patients. Cysta Aerea Permagna Lobi Inf. Pulm. Dexter/operation: Mytomis Longitudinalis Ooesophagi. Caverna Bronchiectatica Permagna Lobi Inferior Pulmo Dexter/operation: Lobestomia Typica. Echinococcus Heaptis Complicatus, Empyema Pleurae Dexter/opetation: Decorticatio. Haemathorax Spontaneous Lobus Sinister/operation: Decorticatio Pleurae Sinister. Echi Comp. Cupolae Hepatis Permagnus/operation: Thoracotomia Phrenotomia, evacuatio, Triplex Drainage. Bronchiectasiae Lobi Medius et Inferior Pulmo Dexter/operation: Biblobectomia Typica. Carcinoma Bronchi Lobi Inferior Pulmo Dexter/operation: Lobectomia Typica. Gastric problems had troubled four of these eight patients in their past history. Bleeding in three patients occurred three days postoperatively, and in the remaining five, thirty days following their operation. Six patients had to be treated conservatively because of serious contraindications to reoperation. Four of them expired. Autopsy revealed: Pyothorax, Dehiscention Bronchi, Empyema, and Gastritis Errosiva with multiulcerations, hemoragia, and dilatation of the right heart. Two patients with recent stress ulcers were reoperated on, and were cured. The authors estimate that the occurrence of hemorrhaging stress ulcer following thoracic surgery are basically due to Hypoxia. The chain of events whic brought about the stress ulcer, however, began even before the operation, continued throughout the operation, and appeared postoperatively due to postoperative complications. The authors point out that these complications can be foreseen (early and late), but firstly, an attempt should be made to treat the patient with conservative therapy. Inasmuch as the hemorrhaging

  19. Bilateral breast in brothers - abreast

    Directory of Open Access Journals (Sweden)

    Altamash Mohammed Yusuf Shaikh

    2013-01-01

    Full Text Available Gynecomastia is a common occurrence in pubertal age group, and is physiological in up to 65 percent of cases. When occurs in the family it should be investigated in order not to miss on a treatable etiology. Two brothers within the same family, presenting with bilateral gynecomastia of different causes and requiring different treatment are presented.

  20. Bilateral acetabular fracture without trauma

    OpenAIRE

    De Rosa, M. A.; G. Maccauro; D’Arienzo, M.

    1999-01-01

     In the absence of trauma fracture of the acetabulum is an extremely rare injury. We describe a 70 year old man who spontaneously developed fractures in both acetabulae due to bony insufficiency. It was successfully treated by bilateral total hip replacement.

  1. Spontaneous bilateral quadriceps tendon rupture.

    Science.gov (United States)

    Vigneswaran, N; Lee, K; Yegappan, M

    2007-11-01

    Spontaneous bilateral quadriceps tendon ruptures are uncommon. We present a 30-year-old man with end-stage renal failure, who sustained this injury, and subsequently had surgical repair of both tendons on separate occasions. He has since regained full range of movement of both knees.

  2. Simultaneous bilateral primary spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Arife Zeybek

    2014-04-01

    Full Text Available Simultaneous bilateral primary pneumothorax is a very rare (1.6 / 100,000 and life-threatening condition. Clinical presentation may vary from mild dyspnea to tension pneumothorax. It may be milder particularly in younger patients, but more severe in patients with advanced age, and tube thoracostomy is a life preserver in the latter group. Since mortality and recurrence rates following tube thoracostomy are high, endoscopic approaches to bilateral hemithorax have been reported in literature. Apical wedge resection and pleural procedures are recommended in video thoracoscopy or mini thoracotomy even if no bulla and/or bleb are detected. Bilateral surgical interventions and additional pleural procedures are associated with increased rate of post-operative complications and longer postoperative hospital-stays. As a first-line approach, the surgical method toward any side of lung with air leakage following a previous tube thoracostomy is considered less invasive, especially in younger patients. Here, we present a case of simultaneous bilateral primary spontaneous pneumothorax (SBPSP in a 21-year old male with no history of smoking and chronic pulmonary disease. A unilateral surgical intervention was performed, and no recurrence was observed during 5-year follow up.

  3. Bilateral familial nevus of Ota.

    Science.gov (United States)

    Goyal, Sunali; Uwaydat, Sami H; Phillips, Paul H; Schaefer, G Bradley

    2014-12-01

    Nevus of Ota is a benign congenital melanocytic lesion found most commonly in people of Asian ancestry. It is associated with an increased risk of glaucoma and uveal melanomas. Most cases are sporadic and unilateral. We present the first reported case of a brother and sister with familial, bilateral nevus of Ota.

  4. Arterial supply of the thoracic lobes of the thymus in dogs of the Great Dane race.

    Directory of Open Access Journals (Sweden)

    Rosana Marques Silva

    2007-09-01

    Full Text Available The origins, numbers and type of arterial branches responsible for the blood supply of thoracic lobes of the thymus were studied in 28 stillborn dogs of the Great Dane, of which 18 were males and 10 were females. The arterial systems of these animals were filled with aqueous solution of Neoprene Latex “450”, 50%. After, the specimens were fixed in 10% formaldehyde aqueous solution. The lobes of the thymus were supplied by direct or indirect arterial branches coming from the right and left internal thoracic arteries, pericardiacophrenicas arteries, right and left costocervicais trunks, and left subclavian artery. The left subclavian artery and brachiocephalic trunk emitted direct branches towards the left thoracic lobe of the thymus.

  5. Bilateral angular carpal deformity in a dog with craniomandibular osteopathy.

    Science.gov (United States)

    Pettitt, R; Fox, R; Comerford, E J; Newitt, A

    2012-01-01

    A four-month-old West Highland White Terrier was presented to the Small Animal Teaching Hospital at the University of Liverpool with the complaint of a bilateral angular carpal deformity. A 20° valgus deformity was present in both thoracic limbs, centred on the distal radial physes. Both distal ulnas were grossly thickened and there was concomitant thickening of the rostral mandible and calvarium. The dog exhibited signs of resentment on palpation of the mandible and signs of pain were elicited on flexion and extension of both elbow joints. No signs of pain were evident on palpation of the ulnas or calvarium. Radiographic images of both ulnas showed marked amorphous periosteal new bone formation. The distal ulnar physes were closed centrally and both elbow joints had humeroulnar subluxation. Radiographic changes to the calvarium and mandibular rami were consistent with a diagnosis of craniomandibular osteopathy. A bilateral ulna ostectomy was performed to correct the angular limb deformity and elbow subluxations. Histology of the ostectomised pieces showed changes consistent with craniomandibular osteopathy.

  6. Bilateral osteochondritis dissecans of the elbow treated by Herbert screw fixation.

    Science.gov (United States)

    Inoue, G

    1991-09-01

    The case of a 15-year-old boy, a high-performance motocross rider, who developed bilateral osteochondritis dissecans of the elbow is described. Both lesions were successfully treated by Herbert screw internal fixation.

  7. CETA - BILATERAL TRADE AGREEMENT BETWEEN THE EU AND CANADA

    Directory of Open Access Journals (Sweden)

    Ludmila Borta

    2014-04-01

    Full Text Available The international trade for wide world countries in the means more growth, more jobs and access on more products at competitive prices. The European Union is a major economy and an important trading partner for many countries and regions in the world. To stimulate growth and to create jobs in the Union, this economy has concluded multilateral trade agreement (under the World Trade Organisation and a number of bilateral (preferential trade agreements. The aim of this paper is to present an example of fully elimination of tariffs and tariff lines under a bilateral trade agreement. In this case, we have analysed Comprehensive Economic and Trade Agreement (CETA negotiated by the European Union and Canada. For both sides of Atlantic, the CETA is supposed to bring the solution for today's issues concerning the important trading aspects and, also, to facilitate the EU-Canada bilateral trade by creating competition.

  8. Thoracic limb morphology of the red panda (Ailurus fulgens) evidenced by osteology and radiography.

    Science.gov (United States)

    Makungu, Modesta; Groenewald, Hermanus B; du Plessis, Wencke M; Barrows, Michelle; Koeppel, Katja N

    2015-07-15

    The red panda (Ailurus fulgens) is distributed primarily in the Himalayas and southern China. It is classified as a vulnerable species by the International Union for Conservation of Nature. The aim of this study was to describe the normal osteology and radiographic anatomy of the thoracic limb of the red panda. Radiography of the right thoracic limb was performed in seven captive adult red pandas. Radiographic findings were correlated with bone specimens from three adult animals. The scapula was wide craniocaudally and presented with a large area for the origin of the teres major muscle. The square-shaped major tubercle did not extend proximal to the head of the humerus. The medial epicondyle was prominent. A supracondylar foramen was present. The radial tuberosity and sesamoid bone for the abductor digiti I longus were prominent. The accessory carpal bone was directed palmarolaterally. Metacarpal bones were widely spread. The thoracic limb morphology of the red panda evidenced by osteology and radiography indicated flexibility of the thoracic limb joints and well-developed flexor and supinator muscles, which are important in arboreal quadrupedal locomotion. Knowledge gained during this study may prove useful in identifying skeletal material or remains and diagnosing musculoskeletal diseases and injuries of the thoracic limb.

  9. Thoracic limb morphology of the red panda (Ailurus fulgens) evidenced by osteology and radiography.

    Science.gov (United States)

    Makungu, Modesta; Groenewald, Hermanus B; Du Plessis, Wencke M; Barrows, Michelle; Koeppel, Katja N

    2015-07-15

    The red panda (Ailurus fulgens) is distributed primarily in the Himalayas and southern China. It is classified as a vulnerable species by the International Union for Conservation of Nature. The aim of this study was to describe the normal osteology and radiographic anatomy of the thoracic limb of the red panda. Radiography of the right thoracic limb was performed in seven captive adult red pandas. Radiographic findings were correlated with bone specimens from three adult animals. The scapula was wide craniocaudally and presented with a large area for the origin of the teres major muscle. The square-shaped major tubercle did not extend proximal to the head of the humerus. The medial epicondyle was prominent. A supracondylar foramen was present. The radial tuberosity and sesamoid bone for the abductor digiti I longus were prominent. The accessory carpal bone was directed palmarolaterally. Metacarpal bones were widely spread. The thoracic limb morphology of the red panda evidenced by osteology and radiography indicated flexibility of the thoracic limb joints and well-developed flexor and supinator muscles, which are important in arboreal quadrupedal locomotion. Knowledge gained during this study may prove useful in identifying skeletal material or remains and diagnosing musculoskeletal diseases and injuries of the thoracic limb.

  10. Thoracic limb morphology of the red panda (Ailurus fulgens evidenced by osteology and radiography

    Directory of Open Access Journals (Sweden)

    Modesta Makungu

    2015-02-01

    Full Text Available The red panda (Ailurus fulgens is distributed primarily in the Himalayas and southern China. It is classified as a vulnerable species by the International Union for Conservation of Nature. The aim of this study was to describe the normal osteology and radiographic anatomy of the thoracic limb of the red panda. Radiography of the right thoracic limb was performed in seven captive adult red pandas. Radiographic findings were correlated with bone specimens from three adult animals. The scapula was wide craniocaudally and presented with a large area for the origin of the teres major muscle. The square-shaped major tubercle did not extend proximal to the head of the humerus. The medial epicondyle was prominent. A supracondylar foramen was present. The radial tuberosity and sesamoid bone for the abductor digiti I longus were prominent. The accessory carpal bone was directed palmarolaterally. Metacarpal bones were widely spread. The thoracic limb morphology of the red panda evidenced by osteology and radiography indicated flexibility of the thoracic limb joints and well-developed flexor and supinator muscles, which are important in arboreal quadrupedal locomotion. Knowledge gained during this study may prove useful in identifying skeletal material or remains and diagnosing musculoskeletal diseases and injuries of the thoracic limb.

  11. Bilateral acute retinal necrosis after herpetic meningitis

    Directory of Open Access Journals (Sweden)

    Katsura T

    2012-04-01

    Full Text Available Keisho Hirota1,2, Masayuki Akimoto1,3, Toshiaki Katsura21Department of Ophthalmology, Kyoto Medical Center, National Hospital Organization, 2Internal Medicine, Kyoto Medical Center, 3Clinical Research Center, Kyoto Medical Center, Kyoto, JapanPurpose: The report of a case of bilateral acute retinal necrosis after herpetic meningitis.Case report: A 47-year-old man was admitted with the chief complaint of persistent high fever and transient loss of consciousness. Although his general condition improved after intravenous acyclovir administration, the patient presented with visual loss in both eyes 4 days after admission. Visual acuity in his right eye was 20/200 and his left eye had light perception alone. Both eyes showed panretinal arteritis diagnosed as acute retinal necrosis. Panretinal photocoagulation was performed for both eyes. Progression of retinal detachment was prevented in both eyes; however, visual acuity of the left eye was totally lost because of neovascular glaucoma. Visual acuity of the right eye recovered to 20/20.Conclusion: Although cases of bilateral acute retinal necrosis have been reported after herpetic encephalitis, this condition is rare after herpetic meningitis. Prophylactic acyclovir therapy and early panretinal photocoagulation may prevent retinal detachment and improve the prognosis. Neurologists and ophthalmologists should be aware that not only herpetic encephalitis but also herpetic meningitis can lead to acute retinal necrosis within a very short interval.Keywords: acute retinal necrosis, herpetic meningitis, herpes simplex, varicella zoster virus

  12. Simultaneous bilateral cataract surgery: economic analysis; Helsinki Simultaneous Bilateral Cataract Surgery Study Report 2.

    Science.gov (United States)

    Leivo, Tiina; Sarikkola, Anna-Ulrika; Uusitalo, Risto J; Hellstedt, Timo; Ess, Sirje-Linda; Kivelä, Tero

    2011-06-01

    To present an economic-analysis comparison of simultaneous and sequential bilateral cataract surgery. Helsinki University Eye Hospital, Helsinki, Finland. Economic analysis. Effects were estimated from data in a study in which patients were randomized to have bilateral cataract surgery on the same day (study group) or sequentially (control group). The main clinical outcomes were corrected distance visual acuity, refraction, complications, Visual Function Index-7 (VF-7) scores, and patient-rated satisfaction with vision. Health-care costs of surgeries and preoperative and postoperative visits were estimated, including the cost of staff, equipment, material, floor space, overhead, and complications. The data were obtained from staff measurements, questionnaires, internal hospital records, and accountancy. Non-health-care costs of travel, home care, and time were estimated based on questionnaires from a random subset of patients. The main economic outcome measures were cost per VF-7 score unit change and cost per patient in simultaneous versus sequential surgery. The study comprised 520 patients (241 patients included non-health-care and time cost analyses). Surgical outcomes and patient satisfaction were similar in both groups. Simultaneous cataract surgery saved 449 Euros (€) per patient in health-care costs and €739 when travel and paid home-care costs were included. The savings added up to €849 per patient when the cost of lost working time was included. Compared with sequential bilateral cataract surgery, simultaneous bilateral cataract surgery provided comparable clinical outcomes with substantial savings in health-care and non-health-care-related costs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  13. Expression of p-PPARγ in the aging thoracic aorta of spontaneously hypertensive rat and inhibitory effect of rosiglitazone

    Institute of Scientific and Technical Information of China (English)

    Hai-FengYuan; Xiao-Lin Niu; Deng-Feng Gao; Guang-Hua Hao; An-Qi Song; Jin Wei

    2014-01-01

    To investigate the expression of phosphorylated peroxisome proliferators-activated receptor γ (p-PPARγ) in the aging thoracic aorta of spontaneously hypertensive rat (SHR) and the inhibitory effect of rosiglitazone on the phosphorylation of PPARγ. Methods: 16, 32 and 64 week-old Wistar-Kyoto rats (WKY) and SHR were randomly and respectively divided into WKY, SHR and SHR+rosiglitazone group (9 in each group). The rats in SHR+rosiglitazone group were treated with rosiglitazone (5 mg/kg, intragastrically) for 56 d, whereas normal saline was applied in WKY and SHR groups. Systolic blood pressure (SBP) of rats was measured by tail cuff method. Histopathological damage of thoracic aorta was analyzed using Hematoxylin-Eosin (HE) staining. Immunohistochemical staining and western blot were performed to test the level of p-PPARγ protein in the thoracic aorta arising from each group. Results: The SBP in 16, 32 and 64 week-old SHR were significantly higher as compared with those in matched WKY rats (P<0.05, respectively). HE staining showed increased content of smooth muscle cell, wrinkled lining endothelium and increased thickness of internal elastic lamina in the thoracic aorta of SHR. Immunohistochemical staining and western blot indicated that the levels of p-PPARγ in the thoracic aorta arising from SHR were obviously higher than those in the thoracic aorta arising from WKY rats (P<0.05, respectively). Importantly, the high SBP, histopathological abnormalities of the thoracic aorta and elevated p-PPARγ expression were prominently abrogated by rosiglitazone treatment in SHR (P<0.05, respectively). Furthermore, the SBP, histopathological abnormalities of the thoracic aorta and p-PPARγexpression were positively correlated with age in SHR (P<0.05, respectively). Conclusions: The PPARγ phosphorylation was observed in the thoracic aorta of SHR and its expression was increased by the increase of age. Furthermore, rosiglitazone inhibited the PPARγ phosphorylation and

  14. Thoracic aortic aneurysm: reading the enemy's playbook.

    Science.gov (United States)

    Elefteriades, John A

    2008-05-01

    The vast database of the Yale Center for Thoracic Aortic Disease--which includes information on 3000 patients with thoracic aortic aneurysm or dissection, with 9000 catalogued images and 9000 patient-years of follow-up--has, over the last decade, permitted multiple glimpses into the "playbook" of this virulent disease. Understanding the precise behavioral features of thoracic aortic aneurysm and dissection permits us more effectively to combat this disease. In this monograph, we will first review certain fundamentals--in terms of anatomy, nomenclature, imaging, diagnosis, medical, surgical, and stent treatment. After reviewing these fundamentals, we will proceed with a detailed exploration of lessons learned by peering into the operational playbook of thoracic aortic aneurysm and dissection. Among the glimpses afforded in the behavioral playbook of this disease are the following: 1 Thoracic aortic aneurysm, while lethal, is indolent. Mortality usually does not occur until after years of growth. 2 The aneurysmal ascending thoracic aorta grows slowly: about 0.1 cm per year (the descending aorta grows somewhat faster). 3 Over a patient's lifetime, "hinge points" at which the likelihood of rupture or dissection skyrockets are seen at 5.5 cm for the ascending and 6.5 cm for the descending aorta. Intervening at 5 cm diameter for the ascending and 6 cm for the descending prevents most adverse events. 4 Symptomatic aneurysms require resection regardless of size. 5 The yearly rate of rupture, dissection, or death is 14.1% for a patient with a thoracic aorta of 6 cm diameter. 6 The mechanical properties of the aorta deteriorate markedly at 6 cm diameter (distensibility falls, and wall stress rises)--a finding that "dovetails" perfectly with observations of the clinical behavior of the thoracic aorta. 7 Thoracic aortic aneurysm and dissection are largely inherited diseases, with a predominantly autosomal-dominant pattern. The specific genetics are being elucidated at the

  15. Asian perspective in surgery: thoracic surgery in Turkey.

    Science.gov (United States)

    Turna, Akif

    2016-08-01

    Turkey with a population of 78 million is located between Asia and Europe geographically and culturally. There are 577 active pure thoracic surgeon and 37 thoracic surgery teaching units. Thoracic surgeons usually deal with lung cancer patients due to relatively higher rate of tobacco usage as well as inflammatory diseases such as pulmonary hydatid disease, bronchiectasis and empyema. Minimally invasive thoracic surgery has been a new approach which is being adapted by increasingly more surgeons. There are a number of reasons to predict that the number of thoracic surgical cases will be increased and new generation of thoracic surgeons will be operating more minimally invasive resectional surgeries for most lung cancer in future.

  16. Thoracic fractures and dislocations in motorcyclists

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H.; Deeb, Z.L.; Rothfus, W.E.

    1987-06-01

    Motorcyclists who are involved in accidents generally suffer severe multiple injuries, some of which are not readily apparent on initial examination. One such subtle injury is fracture, with or without dislocation, in the upper thoracic spine. The severe spinal cord damage produced by the injury is often overshadowed by cerebral or cervical injury. Proper diagnosis is further hampered by the fact that the upper thoracic region is difficult to examine radiographically on plain films, particularly when using portable equipment. Of a group of 14 motorcyclists having 26 fractures and/or dislocations in the thoracic region, 12 had 24 injuries between T3 and T8. These 24 injuries represented 56% of the fractures and/or dislocations encountered in a larger study of trauma to the thoracic vertebral column. All of these were flexion injuries, suffered when the individual was thrown from the motorcycle and struck a large, solid object. In three cases, the diagnosis was delayed as much as 48 h because proper films were not obtained initially. Because of the serious consequences of delayed treatment, we recommended that all motorcyclists who have sustained severe trauma be examined by overpenetrated film of the upper thoracic region.

  17. Thoracic sympathectomy: a review of current indications.

    Science.gov (United States)

    Hashmonai, Moshe; Cameron, Alan E P; Licht, Peter B; Hensman, Chris; Schick, Christoph H

    2016-04-01

    Thoracic sympathetic ablation was introduced over a century ago. While some of the early indications have become obsolete, new ones have emerged. Sympathetic ablation is being still performed for some odd indications thus prompting the present study, which reviews the evidence base for current practice. The literature was reviewed using the PubMed/Medline Database, and pertinent articles regarding the indications for thoracic sympathectomy were retrieved and evaluated. Old, historical articles were also reviewed as required. Currently, thoracic sympathetic ablation is indicated mainly for primary hyperhidrosis, especially affecting the palm, and to a lesser degree, axilla and face, and for facial blushing. Despite modern pharmaceutical, endovascular and surgical treatments, sympathetic ablation has still a place in the treatment of very selected cases of angina, arrhythmias and cardiomyopathy. Thoracic sympathetic ablation is indicated in several painful conditions: the early stages of complex regional pain syndrome, erythromelalgia, and some pancreatic and other painful abdominal pathologies. Although ischaemia was historically the major indication for sympathetic ablation, its use has declined to a few selected cases of thromboangiitis obliterans (Buerger's disease), microemboli, primary Raynaud's phenomenon and Raynaud's phenomenon secondary to collagen diseases, paraneoplastic syndrome, frostbite and vibration syndrome. Thoracic sympathetic ablation for hypertension is obsolete, and direct endovascular renal sympathectomy still requires adequate clinical trials. There are rare publications of sympathetic ablation for primary phobias, but there is no scientific basis to support sympathetic surgery for any psychiatric indication.

  18. Thoracic CT findings at hypovolemic shock

    Energy Technology Data Exchange (ETDEWEB)

    Rotondo, A.; Angelelli, G. [Bari Univ. (Italy). Dept. of Radiology; Catalano, O. [S. Maria delle Grazie Hospital, Pozzuoli, Naples (Italy). Dept. of Radiology; Grassi, R. [Cardarelli Hospital, Naples (Italy). Dept. of Radiology; Scialpi, M. [S.S. Annunziata Hospital, Taranto (Italy). Dept. of Radiology

    1998-07-01

    Purpose: To describe and discuss the thoracic CT features of hypovolemic shock. Material and Methods: From a group of 18 patients with signs of hypovolemia on contrast-enhanced abdominal CT, 11 were selected for our study as having also undergone a complete chest examination. Pulse rate, blood pressure, trauma score value, Glasgow coma scale value, surgical result, and final outcome were retrospectively evaluated. The CT features analyzed were: decreased cardiac volume, reduced caliber of the thoracic aorta, aortic branches and caval venous system, increased enhancement of the aorta, and increased enhancement of the pulmonary collapses/contusions. Results: All 11 subjects presented severe injuries and hemodynamic instability; 7 were stable enough to undergo surgery; only 1 of the 11 survived. Two patients showed none of the features of thoracic hypovolemia. All the other patients presented at least two signs: reduced caliber of the thoracic aorta in 7 cases; decreased volume of the cardiac chambers and increased aortic enhancement in 6; decreased caliber of the aortic vessels in 4; decreased caliber of the caval veins in 3; and increased enhancement of the pulmonary collapses/contusions in 3. Conclusions: In patients with hypovolemia, CT may show several thoracic findings in addition to abdominal ones. Knowledge of these features is important for distinguishing them from traumatic injuries. (orig.)

  19. Bilateral carpal valgus deformity in hand-reared cheetah cubs (Acinonyx jubatus).

    Science.gov (United States)

    Bell, Katherine M; van Zyl, Malan; Ugarte, Claudia E; Hartman, Angela

    2011-01-01

    Four hand-reared cheetah cubs (Acinonyx jubatus) exhibited progressively severe bilateral valgus deformity of the carpi (CV) during the weaning period. Radiographs of the thoracic limbs suggested normal bone ossification, and serum chemistry was unremarkable. All affected cubs developed CV shortly after the onset of gastroenteritis, which was treated medically, and included use of a prescription diet. A sudden decrease in growth rate was associated with gastrointestinal disease. Before gastroenteritis and CV, affected cubs had higher growth rates than unaffected cubs, despite similar mean daily energy intake. Return to normal thoracic limb conformation was consequent to dietary manipulation (including a reduction in energy intake and vitamin and mineral supplementation), as well as decreased growth rates and recovery from gastroenteritis. The cause of the CV is likely to have been multi-factorial with potentially complex physiological interactions involved. © 2010 Wiley-Liss, Inc.

  20. Vertebral body enhancement mimicking sclerotic osseous lesions in the setting of bilateral brachiocephalic vein thrombosis.

    Science.gov (United States)

    Berritto, Daniela; Abboud, Salim; Kosmas, Christos; Riherd, Daniel; Robbin, Mark

    2015-02-01

    Contrast enhancement of the vertebral body marrow may be seen secondary to collateral venous blood flow via the vertebral venous plexus in the setting of superior vena cava obstruction. We report a 48-year-old woman presenting with bilateral brachiocephalic vein obstruction and multilevel thoracic spine hyperdensities as seen on venous-phase CT angiography (CTA), initially concerning for sclerotic neoplastic lesions. A contrast-enhanced CT of the neck obtained 1 day prior to the chest CTA did not demonstrate any osseous abnormality, and inspection of the chest CTA demonstrated filling of perivertebral venous collateral vessels. The abnormal vertebral body enhancement was therefore feltsecondary to retrograde collateral venous flow via the basivertebral venous plexus in the setting of functional SVC obstruction. Vertebral body enhancement should be considered in patients with thoracic central venous obstruction when enhancement or apparent sclerosis of the vertebral bodies is seen on CTA.

  1. Successful management of bilateral patellar tendon rupture in a dog.

    Science.gov (United States)

    Shipov, A; Shahar, R; Joseph, R; Milgram, J

    2008-01-01

    A seven-year-old, 41 kg, intact, cross breed dog, was presented with a history of bilateral hind limb lameness after falling from a height of 1 m. Clinical and radiographic findings were consistent with bilateral patellar tendon rupture. Surgical repair was performed bilaterally. The tendons were sutured primarily, and an internal splint of nylon leader was added. Good apposition of the severed tendon ends had been achieved intraoperatively; however, post operative radiographs showed supra-trochlear displacement of both patellae. The casts used to immobilize the stifle joints slipped distally and three days post operatively the tendon repair had broken down, bilaterally. Revision surgery was undertaken and the tendons were re-sutured. Nylon leader was placed through holes that had been drilled in the patellae and tibiae. The stifle joints were immobilized with type I external skeletal fixators (ESFs). Both freeform polymethylmethacrylate (PMMA) connecting bars were found to be broken at the level of the stifle joints two days later, without any disruption of the primary tendon repair. Each connecting bar was replaced with two connecting bars of PMMA reinforced with 3 mm steel wire. The dog was fully weight-bearing with a reduced range of motion in flexion immediately after removal of the ESFs at six weeks and was still sound 18 months post-operatively. Primary tendon repair in combination with adequate immobilization allowed for an excellent outcome in a complicated bilateral pathology.

  2. Quilotórax bilateral masivo en postoperatorio de gastrectomía subtotal Bilateral chylothorax after gastric surgery

    Directory of Open Access Journals (Sweden)

    E. Medina

    2005-12-01

    Full Text Available Quilotórax es el acúmulo de linfa en la cavidad pleural por obstrucción o rotura del conducto torácico. La etiología más frecuente es la neoplásica; se relaciona también con traumatismos y iatrogénica. Se presenta el caso de una mujer de 76 años con quilotórax bilateral, predominantemente derecho, durante el postoperatorio de una gastrectomía subtotal. Debutó con clínica de insuficiencia respiratoria y la evolución fue favorable sin precisar tratamiento reparador quirúrgico.Chylothorax is a lymphatic effusion of chylous in the pleural space due to thoracic duct obstruction or injury. The most frequent aetiology is cancer; it is also related to chest trauma and iatrogenic. We describe the case of bilateral chylothorax in a 76-year-old woman, right predominant, during the post-operational phase of gastric surgery. This presented itself with respiratory insufficiency and tachycardia without initial haemodynamic compromise. It presented a favourable evolution after conservative treatment, cessation of oral intake and TPN and chest tube during 10 to 14 days.

  3. High-energy bilateral talar neck fractures secondary to motocross injury.

    Science.gov (United States)

    White, S L; Harpaz, N T; Jolly, G P; Gorecki, G A

    1999-01-01

    The authors present a case of bilateral Hawkins type II talar neck fractures sustained during a motocross race in a 23 year old man. Due to the complexity of the injuries, open reduction with internal fixation and primary subtalar joint arthrodesis was performed bilaterally. This is one of the few cases of bilateral talar neck fractures reported in the literature in the past 15 years and one of the first utilizing open reduction and internal fixation with concomitant subtalar joint arthrodesis as a primary treatment.

  4. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    Directory of Open Access Journals (Sweden)

    Tsuyoki Minato

    2016-01-01

    Full Text Available We present a rare case of spinal epidural hematoma (SEH after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.

  5. Lymphoscintigraphy SPECT/CT: Instrumental Navigator in Repair of Thoracic Duct Injury

    Energy Technology Data Exchange (ETDEWEB)

    Abaziz, Aini; Yusop, Syahrir M. [Universiti Kabangsaan Malaysia Medical Centre, Kuala Lumpur (Malaysia); Tahir, Mohd Fadzil Mohd; Lim, Yew Cheng [Gleneagles Intan Medical Centre, Kuala Lumpur (Malaysia); Gallowitsch, Hans-Jurgen [Nuclear Medicine and PETCT Centre, Klagenfurt (Australia)

    2016-06-15

    A 25-year-old female underwent resection of a large mediastinal tumour which was complicated by copious chylothorax, being worse on the left side. Minimally-in-vasive video-assisted thoracoscopic surgery (VATS) via a left-sided approach was performed and the severed ends of the thoracic duct were ligated. This only achieved temporary reduction of the amount of chylothorax, leading to a second attempt to repair the persistent leak. This prompted the surgeon to take a different approach from the previous two attempts. It was deemed too risky and potentially futile to further attempt to go after the leakage sites bilaterally. Hence, the surgeon performed a right thoracotomy to ligate the thoracic duct proximal to the leakage sites at the aortic hiatus. this successfully stopped the leak permanently. Planar lymphoscintigraphy lacks accurate anatomical depiction which SPECT-CT could offer. Conversely, anatomical imaging failed to locate the site of the leak. SPECT/CT Lymphoscintigraphy overcomes the limitation of either imaging alone, and has been reported to be valuable in documenting and depicting sites of injury. In this case, the SPECT-CT depiction and confirmation of bilateral leakage sites was pivotal in guiding the surgeon to take a different approach and achieve a permanent solution to the persistent chloroethoxy.

  6. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    Science.gov (United States)

    Minato, Tsuyoki; Miyagi, Masayuki; Saito, Wataru; Shoji, Shintaro; Nakazawa, Toshiyuki; Inoue, Gen; Imura, Takayuki; Minehara, Hiroaki; Matsuura, Terumasa; Kawamura, Tadashi; Namba, Takanori; Takahira, Naonobu; Takaso, Masashi

    2016-01-01

    We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case. PMID:26989542

  7. 3D geometric reconstruction of thoracic aortic aneurysms

    Directory of Open Access Journals (Sweden)

    Mohiaddin Raad H

    2006-11-01

    Full Text Available Abstract Background The thoracic aortic aneurysm (TAA is a pathology that involves an expansion of the aortic diameter in the thoracic aorta, leading to risk of rupture. Recent studies have suggested that internal wall stress, which is affected by TAA geometry and the presence or absence of thrombus, is a more reliable predictor of rupture than the maximum diameter, the current clinical criterion. Accurate reconstruction of TAA geometry is a crucial step in patient-specific stress calculations. Methods In this work, a novel methodology was developed, which combines data from several sets of magnetic resonance (MR images with different levels of detail and different resolutions. Two sets of images were employed to create the final model, which has the highest level of detail for each component of the aneurysm (lumen, thrombus, and wall. A reference model was built by using a single set of images for comparison. This approach was applied to two patient-specific TAAs in the descending thoracic aorta. Results The results of finite element simulations showed differences in stress pattern between the coarse and fine models: higher stress values were found with the coarse model and the differences in predicted maximum wall stress were 30% for patient A and 11% for patient B. Conclusion This paper presents a new approach to the reconstruction of an aneurysm model based on the use of several sets of MR images. This enables more accurate representation of not only the lumen but also the wall surface of a TAA taking account of intraluminal thrombus.

  8. Reduction of uterus dose in clinical thoracic computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Danova, D.; Keil, B.; Kaestner, B.; Klose, K.J.; Heverhagen, J.T. [Marburg Univ. (Germany). Dept. of Diagnostic Radiology; Wulff, J.; Fiebich, M.; Zink, K. [Univ. of Applied Sciences Giessen-Friedberg (Germany). Inst. of Medical Physics and Radiation Protection

    2010-12-15

    Purpose: The aim of this study was to investigate the potential dose reduction in the uterus as a result of lead apron protection during thoracic CT scans. Moreover, the distribution of the radiation dose in the uterus was determined in order to obtain information about the ratio of internally and externally scattered radiation. Materials and Methods: The uterus doses during thoracic CT were determined by measuring organ doses using an Alderson-RANDO {sup registered} -Phantom and thermoluminescent dosimeters. A 0.25 mm lead equivalent protective apron was used to shield the abdominal area. Three measurement conditions were evaluated: without lead apron, covered with lead apron and wrapped with lead apron. The uterus dose with and without shielding describes the mean value and standard deviation of all examinations and all measurement points in the organ. Results: The uterus dose by thoracic CT was measured to be approximately 66.5 {+-} 3.1 {mu}Gy. If the abdomen is covered with a 0.25 mm Pb equivalent lead apron in the front area and on both sides, the uterus dose is reduced to 49.4 {+-} 2.8 {mu}Gy (26 % reduction, p < 0.001). If a lead apron is wrapped around the abdomen, providing 0.50 mm Pb shielding in the anterior section due to overlap, and 0.25 mm Pb in the posterior section and on both sides, the uterus dose is reduced even more to 43.8 {+-} 2.5 {mu}Gy (34 % reduction, p < 0.001). The dose distribution when the lead apron covers the abdomen shows that the shielding is effective for the scatter radiation that comes from the anterior part. Moreover, the wrapped apron protects the uterus from all directions and is even more effective for dose reduction than the covering apron. Conclusion: Our findings demonstrate that protective aprons are an effective dose reduction technique without additional costs and little effect on patient examination time. (orig.)

  9. Medical image of the week: atherosclerotic aneurysm of aortic arch and descecnding thoracic aorta

    Directory of Open Access Journals (Sweden)

    Parasram M

    2016-02-01

    Full Text Available No abstract available. Article truncated after 150 words. A 94-year-old Spanish-speaking woman presented to the hospital with intermittent episodes of dyspnea and abdominal pain for one week. Her past medical history was notable for 30 pack-year smoking history and hypertension, which was reportedly controlled with medical therapy. Physical exam showed trace peripheral edema bilaterally, intact peripheral pulses, and a mild abdominal bruit. Work up at the emergency department revealed a non-ST elevation myocardial infarction with troponin T of 0.34 ng/mL but no ST-wave abnormality on electrocardiography. Chest x-ray displayed an incidental thoracic aneurysm (Figure 1. Chest computed tomography with contrast demonstrated a continuous aneurysm of the aortic arch and descending thoracic aorta with diameters measuring 6.8 cm and 6 cm, respectively (Figure 2A and 2B. Eccentric thrombi are noted in the aortic arch and the descending aorta. Interestingly, the distal descending thoracic aorta curves as it transitions to the abdominal aorta, which is evidence of a tortuous descending ...

  10. Thoracic Meningioma In Combination With Severe Lumbar Spinal Stenosis Presenting With Atypical Neurological Deficit.

    Science.gov (United States)

    Kehayov, Ivo I; Raykov, Stephan D; Hubavenska, Iveta N; Davarski, Atanas N; Kitova, Tanya T; Zhelyazkov, Christo B; Kitov, Borislav D

    2015-01-01

    We report on a case of a 47-year-old female patient with a long history of low back pain irradiating bilaterally to the legs. Twenty days before admission to our clinic, she had developed progressive weakness in the legs, more pronounced on the left side. The initial neurological examination revealed signs of damage to both the cauda equina and the spinal cord. The neuroimaging studies (computed tomography, myelography and magnetic-resonance tomography) found spinal stenosis most severe at L4-L5 level, and right lateral thoracic intradural-extramedullary tumor at T9-T10 level. The patient underwent two neurosurgical procedures. The first stage included microsurgical resection of the thoracic lesion and the second stage aimed at decompressing the lumbar spinal stenosis. To avoid missing a diagnosis of thoracic lesions, it is necessary to perform a thorough neurological examination of the spinal cord motor and sensory functions. In addition, further MRI examination of upper spinal segment is needed if the neuroimaging studies of the lumbar spine fail to provide reasonable explanation for the existing neurological symptoms.

  11. Comparison of techniques for transdiaphragmatic thoracic drainage after diaphragmatic defect closure in dogs: a cadaveric study

    Science.gov (United States)

    Yoon, Hun-Young; Mann, F. A.; Lee, Suhwon

    2013-01-01

    Four thoracic evacuation techniques for pneumothorax elimination after diaphragmatic defect closure were compared in 40 canine cadavers. After creating a defect in the left side of the diaphragm, thoracic drainage was performed by thoracostomy tube insertion through the defect and a small (DD-SP) or large (DD-LP) puncture created in the caudal mediastinum, or through both the diaphragmatic defect and intact contralateral diaphragm with a small (DI-SP) or large (DI-LP) puncture in made in the caudal mediastinum. Differences in intrapleural pressure (IPP) between the right and left hemithoraxes after air evacuation along with differences in IPP before making a defect and after air evacuation in each hemithorax were calculated. A difference (p ≤ 0.0011) in IPP between the left and right hemithoraxes after air evacuation as well as before making a defect and after air evacuation in the right hemithorax was detected for the DD-SP group. No significant differences (p ≥ 0.0835) were observed for the DI-LP, DD-LP, or DI-SP groups. Creation of a large mediastinal puncture or thoracic evacuation through both a diaphragmatic defect and intact contralateral diaphragm can facilitate proper pneumothorax elimination bilaterally after diaphragmatic defect closure in dogs with a small puncture in the caudal mediastinum. PMID:23814472

  12. Video-assisted thoracic surgery for superior posterior mediastinal neurogenic tumour in the supine position

    Directory of Open Access Journals (Sweden)

    Darlong Laleng

    2009-01-01

    Full Text Available Video-assisted thoracic surgery (VATS for a superior posterior mediastinal lesion is routinely done in the lateral decubitus position similar to a standard thoracotomy using a double-lumen endotracheal tube for one-lung ventilation. This is an area above the level of the pericardium, with the superior thoracic opening as its superior limit and its inferior limit at the plane from the sternal angle to the level of intervertebral disc of thoracic 4 to 5 vertebra lying behind the great vessels. The lateral decubitus position has disadvantages of the double-lumen endotracheal tube getting malpositioned during repositioning from supine position to the lateral decubitus position, shoulder injuries due to the prolonged abnormal fixed posture and rarer injuries of the lower limb. There is no literature related to VATS in the supine position for treating lesions in the posterior mediastinum because the lung tissue falls in the dependent posterior mediastinum and obscures the field of surgery; however, VATS in the supine position is routinely done for lesions in the anterior mediastinum and single-stage bilateral spontaneous pneumothorax. Thus, in the selected cases, ′VATS in supine position′ allows an invasive procedure to be completed in the most stable anatomical posture.

  13. Acute Paraparesis Caused by a Giant Cell Tumor of the Thoracic Spine

    Directory of Open Access Journals (Sweden)

    Liang-Chun Chao

    2014-12-01

    Full Text Available Giant cell tumor (GCT is a benign but locally aggressive skeletal neoplasm of young adults. GCT located in the spine is relatively rare and may need a combination of surgical and adjunctive therapies. Here we present a patient who had intermittent thoracic back pain for two weeks and experienced an acute episode of decreased muscle power of both lower limbs. Magnetic resonance (MR imaging examinations of the thoracic spine revealed that the patient had severe spinal canal compression caused by pathological fracture due to a tumor within the seventh thoracic vertebra. She underwent an emergent surgical intervention for total removal of the tumor and spinal reconstruction with autologous rib grafts and instruments. Postoperatively, the patient made an uneventful recovery of muscle power of bilateral lower limbs. She subsequently received adjuvant radiotherapy. In a follow-up period of 36 months, the patient had no clinical or radiological evidence of tumor recurrence. Even though spinal location for GCT is a rare event, it should be included in the differential diagnosis in patients with osteolytic lesions or pathological fractures of the vertebra, especially in young female patients sustaining no trauma who had a clinical history of persistent low back pain.

  14. Change of paradigm in thoracic radionecrosis management.

    Science.gov (United States)

    Dast, S; Assaf, N; Dessena, L; Almousawi, H; Herlin, C; Berna, P; Sinna, R

    2016-06-01

    Classically, muscular or omental flaps are the gold standard in the management of thoracic defects following radionecrosis debridement. Their vascular supply and antibacterial property was supposed to enhance healing compared with cutaneous flaps. The evolution of reconstructive surgery allowed us to challenge this dogma. Therefore, we present five consecutive cases of thoracic radionecrosis reconstructed with cutaneous perforator flaps. In four patients, we performed a free deep inferior epigastric perforator (DIEP) flap and one patient had a thoracodorsal perforator (TDAP) flap. Median time healing was 22.6 days with satisfactory cutaneous covering and good aesthetic results. There were no flap necrosis, no donor site complications. We believe that perforator flaps are a new alternative, reliable and elegant option that questions the dogma of muscular flaps in the management of thoracic radionecrosis.

  15. National Quality Forum Metrics for Thoracic Surgery.

    Science.gov (United States)

    Cipriano, Anthony; Burfeind, William R

    2017-08-01

    The National Quality Forum (NQF) is a multistakeholder, nonprofit, membership-based organization improving health care through preferential use of valid performance measures. NQF-endorsed measures are considered the gold standard for health care measurement in the United States. The Society of Thoracic Surgeons is the steward of the only six NQF-endorsed general thoracic surgery measures. These measures include one structure measure (participation in a national general thoracic surgery database), two process measures (recording of clinical stage and recording performance status before lung and esophageal resections), and three outcome measures (risk-adjusted morbidity and mortality after lung and esophageal resections and risk-adjusted length of stay greater than 14 days after lobectomy). Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Endoprótese ramificada de artéria ilíaca interna no tratamento de aneurisma aórtico associado a aneurisma bilateral das artérias ilíacas comuns Branched stent-graft to the internal iliac artery for treatment of aortic aneurysm associated with bilateral common iliac artery aneurysm

    Directory of Open Access Journals (Sweden)

    Marcelo Martins da Volta Ferreira

    2006-09-01

    Full Text Available A embolização das artérias ilíacas internas é usualmente realizada durante a correção endovascular dos aneurismas aorto-ilíacos, visando prevenir a ocorrência de endoleak. Entretanto, é freqüente a associação desse procedimento com inúmeras seqüelas pós-operatórias, em decorrência da diminuição do fluxo sangüíneo pélvico. Em virtude disso, torna-se necessário o desenvolvimento de dispositivos e estratégias para a preservação das artérias ilíacas internas durante a correção endovascular dos aneurismas aorto-ilíacos. Descrevemos aqui o emprego pioneiro de uma endoprótese ramificada Helical Sidebranch (Cook para a artéria ilíaca interna, realizado com sucesso técnico imediato e controle pós-operatório satisfatório.Embolization of internal iliac arteries is usually performed during endovascular repair of aortoiliac aneurysms, with the aim of preventing occurrence of endoleaks. However, the association of this procedure with several postoperative sequelae is frequent, due to reduced pelvic blood flow. For this reason, there is the need to develop devices and strategies to preserve internal iliac arteries during endovascular repair of aortoiliac aneurysms. In this study, we describe a pioneering use of a Helical Sidebranch (Cook branched stent-graft to the internal iliac artery, which was performed with immediate technical success and satisfactory postoperative control.

  17. Thoracic Pneumorrhachis in Patient with Lumbar Fractures; a Case Report

    Directory of Open Access Journals (Sweden)

    Amir Ghafarzad

    2014-03-01

    Full Text Available 800x600 Pneumorrhachis as a relatively rare condition may be an indication of substantial intra-spinal column injury. Here we report a 39-year-old man was admitted because of low back pain and dyspenea after locating between motor vehicle and wall three days before admission. On arrival, physical exams and vital signs were normal. Computed tomography (CT scan showed bilateral pleural effusion, fracture of ribs number 8, 9 and 10 in lower left side of thorax, fracture of vertebra in L2-L4, and air bubbles in upper thoracic spinal canal.  Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:Arial;}

  18. Failures and complications of thoracic drainage

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    Đorđević Ivana

    2006-01-01

    Full Text Available Background/Aim. Thoracic drainage is a surgical procedure for introducing a drain into the pleural space to drain its contents. Using this method, the pleura is discharged and set to the physiological state which enables the reexpansion of the lungs. The aim of the study was to prove that the use of modern principles and protocols of thoracic drainage significantly reduces the occurrence of failures and complications, rendering the treatment more efficient. Methods. The study included 967 patients treated by thoracic drainage within the period from January 1, 1989 to June 1, 2000. The studied patients were divided into 2 groups: group A of 463 patients treated in the period from January 1, 1989 to December 31, 1994 in whom 386 pleural drainage (83.36% were performed, and group B of 602 patients treated form January 1, 1995 to June 1, 2000 in whom 581 pleural drainage (96.51% were performed. The patients of the group A were drained using the classical standards of thoracic drainage by the general surgeons. The patients of the group B, however, were drained using the modern standards of thoracic drainage by the thoracic surgeons, and the general surgeons trained for this kind of the surgery. Results. The study showed that better results were achieved in the treatment of the patients from the group B. The total incidence of the failures and complications of thoracic drainage decreased from 36.52% (group A to 12.73% (group B. The mean length of hospitalization of the patients without complications in the group A was 19.5 days versus 10 days in the group B. The mean length of the treatment of the patients with failures and complications of the drainage in the group A was 33.5 days versus 17.5 days in the group B. Conclusion. The shorter length of hospitalization and the lower morbidity of the studied patients were considered to be the result of the correct treatment using modern principles of thoracic drainage, a suitable surgical technique, and a

  19. Thoracic pain in a collegiate runner.

    Science.gov (United States)

    Austin, G P; Benesky, W T

    2002-08-01

    This case study describes the process of examination, re-examination, and intervention for a collegiate runner with mechanical thoracic pain preventing athletic participation and limiting daily function. Unimpaired function fully returned in less than 3 weeks with biweekly sessions to re-establish normal and painfree thoracic mechanics via postural hygiene, exercise, mobilization, and manipulation. The outcome of this case study supports the original hypothesis that the pattern of impairments was in fact responsible for the functional limitations and disability in this athlete. At the time of publication the athlete was without functional limitations and had fully returned to competitive sprinting for the university track team.

  20. Thoracic Ectopia Cordis in an Ethiopian Neonate

    OpenAIRE

    Tadele, Henok; Chanie, Abeje

    2017-01-01

    Background Ectopia Cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect with failure of fusion of the sternum with extra thoracic location of the heart. The estimated prevalence of this case is 5.5 to 7.9 per million live births. Case Presentation We had a case of a 16-hour-old male neonate weighing 2.9kg with externally visible, beating heart over the chest wall. Initial treatment included covering the heart with steri...

  1. Bilateral pallidotomy for generalized dystonia Palidotomia bilateral para distonias generalizadas

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    Hélio A. G. Teive

    2001-06-01

    Full Text Available OBJECTIVE: To evaluate the efficacy and safety of bilateral pallidotomies in five patients with generalized dystonia. BACKGROUND: Generalized dystonias are frequently a therapeutic challenge, with poor responses to pharmacological treatment. GPi (globus pallidus internus pallidotomies for Parkinson's disease ameliorate all kinds of dyskinesias/dystonia, and recent studies reported a marked improvement of refractory dystonias with this procedure. METHODS: Five patients with generalized dystonias refractory to medical treatment were selected; one posttraumatic and four idiopathic. The decision to perform bilateral procedures was based on the predominant axial involvement in these patients. Dystonia severity was assessed with the Burke-Fahn-Marsden Dystonia Scale (BFM. Simultaneous procedures were performed in all but one patient, who had a staged procedure. They were reevaluated with the same scale (BFM by an unblinded rater at 1, 2, 3, 30, 60, 90, 120 and 180 days post-operatively. RESULTS: The four patients with idiopathic dystonia showed a progressive improvement up to three months; the patient with posttraumatic dystonia relapsed at three months. One patient had a marked improvement, being able to discontinue all the medications. A mean decrease in the BFM scores of 52,58% was noted. One patient had a trans-operative motor seizure followed by a transient hemiparesis secondary to rack hemorrhage; other was lethargic up to three days after the procedure. CONCLUSIONS: Our results show that bilateral GPi pallidotomies may be a safe and effective approach to medically refractory generalized dystonias; it can also be speculated that the posttraumatic subgroup may not benefit with this procedure.As distonias generalizadas são freqüentemente um desafio terapêutico, com pobres respostas aos tratamentos farmacológicos. As cirurgias estereotáxicas, como a palidotomia, têm sido utilizadas com êxito no tratamento da doença de Parkinson e estudos

  2. Bilateral Lhermitte-Duclos disease

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    Bozbuga Mustafa

    2010-01-01

    Full Text Available Lhermitte-Duclos disease (LDD is a pathologic entity with progrediating, diffuse hypertrophy chiefly of the stratum granulosum of the cerebellum. Typically LDD is a unilateral lesion of the cerebellum or in vermis. Here we report a case of LDD with bilateral lesions of cerebellar hemispheres managed surgically. A 28-year-old woman presented with one-year history of progressive headache, nausea, vomiting, and blurred vision. Neurologic examination revealed a bilateral mild papilledema, mild dysmetria, and dysdiadochokinesia. The cerebellar lesions caused moderate mass effect in posterior fossa with hydrocephalus, and Chiari type I malformation. We performed the suboccipital-retrosigmoid approach, and removed completely the left intracerebellar mass. Symptoms related to elevated intracranial pressure disappeared in a short period postoperatively.

  3. Immediate Sequential Bilateral Cataract Surgery

    DEFF Research Database (Denmark)

    Kessel, Line; Andresen, Jens; Erngaard, Ditte

    2015-01-01

    The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence......-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were...... performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery...

  4. Genetics Home Reference: familial thoracic aortic aneurysm and dissection

    Science.gov (United States)

    ... Conditions familial TAAD familial thoracic aortic aneurysm and dissection Printable PDF Open All Close All Enable Javascript ... collapse boxes. Description Familial thoracic aortic aneurysm and dissection ( familial TAAD ) involves problems with the aorta , which ...

  5. Minimally invasive thoracic sympathectomy for palmar hyperhidrosis via a single unilateral incision approach by the pleura videoscope.

    Science.gov (United States)

    Yang, Yunhai; Zeng, Liping; An, Zhou; Wang, Luming; Hu, Jian

    2014-05-01

    Palmar hyperhidrosis is a common disease that causes intense significant embarassment for patients. Bilateral single-port thoracoscopic sympathectomy is an effective surgical treatment with high success rates and improvement in quality of life. In order to reduce surgical invasion and to seek better cosmetic results, we describe a novel protocol for thoracic sympathectomy in the treatment of palmar hyperhidrosis. Between January 2012 and September 2012, bilateral thoracic sympathectomy was performed through the anterior mediastinal pleura using the pleural videoscope with a single unilateral skin incision in 10 men and 6 women. In total, 16 patients were cured, and the skin temperature increased by a mean of 2.7±0.6°C. The average operation time was 67.9±15.8 minutes, with a postoperative hospital stay of 1.9±0.6 days and operative bleeding of less than 20 mL. All operations were successful, with no severe complications or perioperative mortality. Follow-up of 9.8±2.3 months (range, 7-14 months) showed that palmar sweating improved in all patients, and the effective rate was 100%. A single unilateral incision for two-sided thoracic sympathectomy through the anterior mediastinal pleura is an effective, feasible, safe, and minimally invasive procedure with excellent cosmetic results.

  6. Reconstruction of bilateral axillary post burn contracture in a 3 year old: A case report

    Institute of Scientific and Technical Information of China (English)

    Krishna kumar. A; SUN Bing-wei

    2010-01-01

    A 2 year old male child was admitted with history of accidental pouring by boiling water all over the body resulting in 51% surface area burns involving the posterior and lateral thoracic region, both the upper limbs in the proximal regions near the shoulder, anterior and posterior abdomen and pubic region with second and third degree severe burns. After correcting the dehydration a series of procedures were performed including anti-shock, wound debridement under GA, etc. At 20 days post-burn, after making sure the wound was healthy a partial thickness skin grafting was done. During rehabilitation, bilateral axillary suffered contracture with hypertrophic scar(Fig 1).

  7. Compensation following bilateral vestibular damage

    Directory of Open Access Journals (Sweden)

    Bill J Yates

    2011-12-01

    Full Text Available Bilateral loss of vestibular inputs affects far fewer patients than unilateral inner ear damage, and thus has been understudied. In both animal subjects and human patients, bilateral vestibular hypofunction (BVH produces a variety of clinical problems, including impaired balance control, inability to maintain stable blood pressure during postural changes, difficulty in visual targeting of images, and disturbances in spatial memory and navigational performance. Experiments in animals have shown that nonlabyrinthine inputs to the vestibular nuclei are rapidly amplified following the onset of BVH, which may explain the recovery of postural stability and orthostatic tolerance that occurs within 10 days. However, the loss of the vestibulo-ocular reflex and degraded spatial cognition appear to be permanent in animals with BVH. Current concepts of the compensatory mechanisms in humans with BVH are largely inferential, as there is a lack of data from patients early in the disease process. Translation of animal studies of compensation for BVH into therapeutic strategies and subsequent application in the clinic is the most likely route to improve treatment. In addition to physical therapy, two types of prosthetic devices have been proposed to treat individuals with bilateral loss of vestibular inputs: those that provide tactile stimulation to indicate body position in space, and those that deliver electrical stimuli to branches of the vestibular nerve in accordance with head movements. The relative efficacy of these two treatment paradigms, and whether they can be combined to facilitate recovery, is yet to be ascertained.

  8. Spontaneous bilateral fracture of patella.

    Science.gov (United States)

    Moretti, Biagio; Speciale, Domenico; Garofalo, Raffaele; Moretti, Lorenzo; Patella, Silvio; Patella, Vittorio

    2008-03-01

    Bilateral patellae fractures represent a rare entity, accounting for approximately 2.9% of all lesions interesting in this anatomical district. In most cases found in the published work, they are described as stress fractures or as complications of chronic diseases such as osteoporosis, renal failure and secondary hyperparathyroidism. Although many pathogenetic mechanisms have been supposed, none have been proved for certain. Insufficiency fractures of the patellae are rare events and no data has been published on their incidence. We present a case of bilateral fracture of the patellae due to an indirect trauma occurring in an 85-year-old patient affected by Parkinson's disease, osteoporosis and diffuse degenerative osteoarthritis. X-ray of the knees (anteroposterior and lateral) and magnetic resonance imaging evaluation confirmed the fractures. The patient was treated conservatively. She had a good result, returning to her previous autonomous ambulation. This case is unusual because there was no direct trauma to the knees because of bilaterality, but confirmed previous observations about insufficiency fractures of patellae in the presence of comorbidity. Insufficiency fractures of patellae can be an insidious condition in elderly people. Prepatellar pain, a common symptom in the relapse phase of degenerative arthritis of the knee, should not be underestimated, particularly in patients with diseases influencing metabolism of bone and with an elevated risk of fall. A periodical clinical and instrumental follow up should be done in these patient. Moreover, we underline the necessity of a multidisciplinary approach.

  9. Combination of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery for bilateral lung lesions: report of two cases and review of the literature.

    Science.gov (United States)

    Wang, Linlin; Ge, Lihui; Yang, Xueying

    2017-06-01

    Uniportal video-assisted thoracic surgery (VATS) is carried out to reduce postoperative pain after treatment of thoracic diseases. Here, we report a novel method that combines a subxiphoid and intercostal uniportal VATS approach that can be used to treat bilateral pulmonary lesions simultaneously. The first case is a 50-year-old female with bilateral pulmonary lesions who received left lower lobectomy associated with right middle lobe wedge resection synchronously; the other case is a 14-year-old male who was admitted for resection of bilateral lung metastases as a result of previous osteosarcoma. We combined a subxiphoid approach with intercostal uniportal surgical procedure for bilateral pulmonary lesions. Less postoperative pain, faster postoperative recovery, and a better aesthetic effect are possible superiorities of this method if patients are selected carefully. Our results show that the combining of a subxiphoid approach with intercostal uniportal VATS is a feasible and efficient surgical procedure for bilateral pulmonary lesions, with good outcomes. Moreover, this procedure is more suitable for patients with bilateral pulmonary lesions.

  10. Asian perspective in surgery: thoracic surgery in Turkey

    OpenAIRE

    Turna, Akif

    2016-01-01

    Turkey with a population of 78 million is located between Asia and Europe geographically and culturally. There are 577 active pure thoracic surgeon and 37 thoracic surgery teaching units. Thoracic surgeons usually deal with lung cancer patients due to relatively higher rate of tobacco usage as well as inflammatory diseases such as pulmonary hydatid disease, bronchiectasis and empyema. Minimally invasive thoracic surgery has been a new approach which is being adapted by increasingly more surge...

  11. Thoracic Injuries in earthquake-related versus non-earthquake-related trauma patients: differentiation via Multi-detector Computed Tomography

    Directory of Open Access Journals (Sweden)

    Zhi-hui Dong

    2011-01-01

    Full Text Available PURPOSE: Massive earthquakes are harmful to humankind. This study of a historical cohort aimed to investigate the difference between earthquake-related crush thoracic traumas and thoracic traumas unrelated to earthquakes using a multi-detector Computed Tomography (CT. METHODS: We retrospectively compared an earthquake-exposed cohort of 215 thoracic trauma crush victims of the Sichuan earthquake to a cohort of 215 non-earthquake-related thoracic trauma patients, focusing on the lesions and coexisting injuries to the thoracic cage and the pulmonary parenchyma and pleura using a multi-detector CT. RESULTS: The incidence of rib fracture was elevated in the earthquake-exposed cohort (143 vs. 66 patients in the non-earthquake-exposed cohort, Risk Ratio (RR = 2.2; p<0.001. Among these patients, those with more than 3 fractured ribs (106/143 vs. 41/66 patients, RR=1.2; p<0.05 or flail chest (45/143 vs. 11/66 patients, RR=1.9; p<0.05 were more frequently seen in the earthquake cohort. Earthquake-related crush injuries more frequently resulted in bilateral rib fractures (66/143 vs. 18/66 patients, RR= 1.7; p<0.01. Additionally, the incidence of non-rib fracture was higher in the earthquake cohort (85 vs. 60 patients, RR= 1.4; p<0.01. Pulmonary parenchymal and pleural injuries were more frequently seen in earthquake-related crush injuries (117 vs. 80 patients, RR=1.5 for parenchymal and 146 vs. 74 patients, RR = 2.0 for pleural injuries; p<0.001. Non-rib fractures, pulmonary parenchymal and pleural injuries had significant positive correlation with rib fractures in these two cohorts. CONCLUSIONS: Thoracic crush traumas resulting from the earthquake were life threatening with a high incidence of bony thoracic fractures. The ribs were frequently involved in bilateral and severe types of fractures, which were accompanied by non-rib fractures, pulmonary parenchymal and pleural injuries.

  12. Effect of a combined thoracic and backward lifting exercise on the thoracic kyphosis angle and intercostal muscle pain.

    Science.gov (United States)

    Yoo, Won-Gyu

    2017-08-01

    [Purpose] This study developed a combined thoracic and backward lifting exercise for thoracic kyphosis angle and intercostal muscle pain. [Subject and Methods] The subject was a 41-year-old man who complained of upper thoracic and intercostal pain. He performed the combined thoracic and backward lifting exercise for 15 days. [Results] The initial VAS score for the intercostal area was 4/10. The VAS score decreased to 1/10 after the thoracic exercise combined with backward lifting. The initial thoracic kyphosis angle was 38° and it decreased to 32° after the exercise period. [Conclusion] Therefore, backward lifting and thoracic extension is a good posture for activating the different layers of muscle that are attached to the ribs. The kyphosis angle is also reduced by providing sufficient resistance during the thoracic exercise.

  13. Thoracic cord compression caused by contiguous multilevel ossification of ligamentum flavum in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    WANG Kai; CHEN Xin

    2007-01-01

    Objective:To explore the epidemiology, clinical presentation, radiology and surgical treatment outcome in Chinese patients with myelopathy caused by contiguous multilevel ossification of ligamentum flavum.Methods: Medical notes and imaging data of 18 Chinese patients (14 males and 4 females, aged 43-72 years, mean: 57 years ) with myelopathy caused by contiguous multilevel ossification of ligamentum flavum were studied retrospectively in this article. The diagnosis was based on clinical examination, X-ray films, computerized tomography ( CT) and magnetic resonance imaging (MRI) scanning results and pathological results. Sixteen patients were treated by laminectomy and two by laminoplasty. The average follow-up duration was 34 months ( range, 28-49 months ). The outcome was evaluated by Japanese Orthopaedics Association (JOA) score.Results: The average time for occurring clinical symptoms was 7.5 months (range, 2 days-16 months). All the 18 cases presented with clinical evidences of chronic and progressive thoracic spinal cord compression, which included bilateral leg weakness, spastic gait, numbness in lower limbs, paresthesia in terminal and perineum, and urinary incontinence. Neurological examination revealed severe spastic paraparesis, absence of abdominal reflexes, and reduction of the sensory function below the compression level. The mean JOA score before operation was 3. 6 (range, 0-6). MRI and CT scans of the thoracic spine confirmed the presence of contiguous multilevel ossification of the ligamentum flavum. The mean recovery rate after surgery in terms of JOA score was 66.3% (range, 33.3%-100%), with a mean final JOA score of 8. 3. Thoracic decompression laminectomy or laminoplasty could result in a good postoperative outcome.Conclusions: Contiguous multilevel ossification of the ligamentum flavum is not a common cause of myelopathy in Chinese population and should be treated as early as possible. MRI and CT scan examinations may diagnose the presence of

  14. Bilateral Morgagni hernia: operative discovery of appendix lying on superior pulmonary vein.

    Science.gov (United States)

    Lammy, S; Stewart, M; Carnochan, F M; Walker, W S

    2013-08-01

    A patient presented having an acute abdomen on a background of a twelve-month history of worsening asthma. Computed tomography showed giant bilateral intrathoracic hernias extending to both thoracic apices. Our case was unusual as the defect was bilateral and left-sided. Surgical repair revealed each hernia sac measuring >20 cm and to contain the entirety of the small bowel and colon (including retroperitoneal bowel). The appendix was discovered adjacent to right superior pulmonary vein. Both sacs were excised and the defects dissected and transfixed in a single stage operation. In the post-operative stage, he developed a 6.3 cm fluid collection anterior to the right atrium and a left-sided pleural effusion. Morgagni hernias can escape detection and be attributed to other diagnoses courtesy of false localising signs on clinical examination and symptoms in the history.

  15. March 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-03-01

    Full Text Available No abstract available. Article truncated after 150 words. The March 2017 Arizona Thoracic Society meeting was held on Wednesday, March 22, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There 11 attendance representing the pulmonary, critical care, sleep, thoracic surgery and radiology communities. There was a discussion of supporting the Tobacco 21 bill which had been introduced into the Arizona State Legislature. The bill was assigned to the House Commerce Committee but was not scheduled for a hearing by the Chair-Representative, Jeff Wininger from Chandler. It seems likely that the bill will be reintroduced in the future and the Arizona Thoracic Society will support the bill in the future. Three cases were presented: 1. Dr. Bridgett Ronan presented a 57-year-old man with cough and shortness of breath. His physical examination and spirometry were unremarkable. A thoracic CT scan showed large calcified and noncalcified pleural plaques and mediastinal lymphadenopathy. …

  16. Thoracic empyema caused by Campylobacter rectus.

    Science.gov (United States)

    Ogata, Tomoyuki; Urata, Teruo; Nemoto, Daisuke; Hitomi, Shigemi

    2017-03-01

    We report a case of thoracic empyema caused by Campylobacter rectus, an organism considered as a periodontal pathogen but rarely recovered from extraoral specimens. The patient fully recovered through drainage of purulent pleural fluid and administration of antibiotics. The present case illustrates that C. rectus can be a cause of not only periodontal disease but also pulmonary infection.

  17. Evolution of Thoracic Surgery in Canada

    Directory of Open Access Journals (Sweden)

    Jean Deslauriers

    2015-01-01

    Full Text Available BACKGROUND: Canada’s contributions toward the 21st century’s practice of thoracic surgery have been both unique and multilayered. Scattered throughout are tales of pioneers where none had gone before, where opportunities were greeted by creativity and where iconic figures followed one another.

  18. Evaluation of Registration Methods on Thoracic CT

    DEFF Research Database (Denmark)

    Murphy, K.; van Ginneken, B.; Reinhardt, J.;

    2011-01-01

    EMPIRE10 (Evaluation of Methods for Pulmonary Image REgistration 2010) is a public platform for fair and meaningful comparison of registration algorithms which are applied to a database of intra-patient thoracic CT image pairs. Evaluation of non-rigid registration techniques is a non trivial task...

  19. Small size new silastic drains: life-threatening hypovolemic shock after thoracic surgery associated with a non-functioning chest tube.

    Science.gov (United States)

    Clark, Gregory; Licker, Marc; Bertin, Daniel; Spiliopoulos, Anastase

    2007-03-01

    We report a case of a massive haemothorax following bilateral surgical resection of apical bullae. Occult bleeding was not recognized until the onset of a life-threatening circulatory collapse associated with metabolic acidosis and a fall in haemoglobin level. Using a thoracotomy, large amounts of blood were evacuated from the thoracic cavity and bleeding originating from ruptured pleural adhesion was easily controlled. Thrombotic material with talc particles was found to obstruct the 19-French 4-channel Blake drain. Although this new silastic Blake tube has been recommended in cardiac surgical patients, extending its indication in thoracic surgery, particularly when talc pleurodesis is used, should be questioned given the enhanced postoperative prothrombotic state and risk of drain obstruction. In conclusion, caution should be exercised when new small-sized material is introduced in clinical practice, especially after talc pleurodesis following thoracic surgery.

  20. [Trans-areola single port endoscopic thoracic sympathectomy for the treatment of palmar hyperhidrosis: a new surgical approach].

    Science.gov (United States)

    Tu, Yuan-rong; Lai, Fan-cai; Li, Xu; Lin, Min; Duan, Hong-bing; Fu, Cheng-guo; Zhan, Hua-hui; Zheng, Yi-wen

    2011-11-29

    To evaluate the cosmetic effects and safety profiles of trans-areola single port endoscopic thoracic sympathectomy. A retrospective study was conducted for 45 males and 7 females with palmar hyperhidrosis undergoing trans-areola single port endoscopic thoracic bilateral sympathectomy during April and June 2011. All operations were successfully performed without severe morbidity and mortality. No conversion to open technique was necessary. The mean unilateral operative duration was 6 minutes (range: 5 - 8). The time was calculated from the time of skin incision to that of dressing application over wound. The mean hospitalization duration was 2.2 days (range: 2 - 3). The mean follow-up period was 2.8 months (range: 1 - 7). All patients achieved excellent cosmetic effects. No incision scar was found. Trans-areola single port endoscopic thoracic sympathectomy is a safe and effective therapeutic procedure for primary palmar hyperhidrosis. The incision is undetectable with excellent cosmetic effects. The trans-areola route is a new ideal and promising approach for endoscopic thoracic sympathectomy.

  1. Thoracic sympathectomy for upper extremity ischemia.

    Science.gov (United States)

    Hoexum, Frank; Coveliers, Hans M; Lu, Joyce J; Jongkind, Vincent; Yeung, Kakkhee K; Wisselink, Willem

    2016-12-01

    Thoracic sympathectomy is performed in the management of a variety of disorders of the upper extremity. To evaluate the contemporary results of thoracic sympathectomy for upper extremity ischemia a systematic review of the literature was conducted. We performed a PubMed, EMBASE and Cochrane search of the literature written in the English language from January 1975 to December 2015. All articles presenting original patient data regarding the effect of treatment on symptoms or on the healing of ulcers were eligible for inclusion. Individual analyses for Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP) were performed. We included 6 prospective and 23 retrospective series with a total of 753 patients and 1026 affected limbs. Early beneficial effects of thoracic sympathectomy were noticed in 63-100% (median 94%) of all patients, in 73-100% (median 98%) of PRD patients and in 63-100% (median 94%) of SRP patients. The beneficial effect was noted to lessen over time. Long-term beneficial effects were reported in 13-100% (median 75%) of all patients, in 22-100% (median 58%) of PRD patients, and in 13-100% (median 79%) of SRD patients. Complete or improved ulcer healing was achieved in 33-100% and 25-67% respectively, of all patients. Thoracic sympathectomy can be beneficial in the treatment of upper extremity ischemia in select patients. Although the effect in patients with PRD will lessen over time, it may still reduce the severity of symptoms. In SRD, effects are more often long-lasting. In addition, thoracic sympathectomy may maximize tissue preservation or prevent amputation in cases of digital ulceration.

  2. Right thoracic curvature in the normal spine

    Directory of Open Access Journals (Sweden)

    Masuda Keigo

    2011-01-01

    Full Text Available Abstract Background Trunk asymmetry and vertebral rotation, at times observed in the normal spine, resemble the characteristics of adolescent idiopathic scoliosis (AIS. Right thoracic curvature has also been reported in the normal spine. If it is determined that the features of right thoracic side curvature in the normal spine are the same as those observed in AIS, these findings might provide a basis for elucidating the etiology of this condition. For this reason, we investigated right thoracic curvature in the normal spine. Methods For normal spinal measurements, 1,200 patients who underwent a posteroanterior chest radiographs were evaluated. These consisted of 400 children (ages 4-9, 400 adolescents (ages 10-19 and 400 adults (ages 20-29, with each group comprised of both genders. The exclusion criteria were obvious chest and spinal diseases. As side curvature is minimal in normal spines and the range at which curvature is measured is difficult to ascertain, first the typical curvature range in scoliosis patients was determined and then the Cobb angle in normal spines was measured using the same range as the scoliosis curve, from T5 to T12. Right thoracic curvature was given a positive value. The curve pattern was organized in each collective three groups: neutral (from -1 degree to 1 degree, right (> +1 degree, and left ( Results In child group, Cobb angle in left was 120, in neutral was 125 and in right was 155. In adolescent group, Cobb angle in left was 70, in neutral was 114 and in right was 216. In adult group, Cobb angle in left was 46, in neutral was 102 and in right was 252. The curvature pattern shifts to the right side in the adolescent group (p Conclusions Based on standing chest radiographic measurements, a right thoracic curvature was observed in normal spines after adolescence.

  3. CETA - BILATERAL TRADE AGREEMENT BETWEEN THE EU AND CANADA

    OpenAIRE

    Ludmila Borta

    2014-01-01

    The international trade for wide world countries in the means more growth, more jobs and access on more products at competitive prices. The European Union is a major economy and an important trading partner for many countries and regions in the world. To stimulate growth and to create jobs in the Union, this economy has concluded multilateral trade agreement (under the World Trade Organisation) and a number of bilateral (preferential) trade agreements. The aim of this paper is to present an e...

  4. Bilateral cleft lip nasal deformity

    Directory of Open Access Journals (Sweden)

    Singh Arun

    2009-01-01

    Full Text Available Bilateral cleft lip nose deformity is a multi-factorial and complex deformity which tends to aggravate with growth of the child, if not attended surgically. The goals of primary bilateral cleft lip nose surgery are, closure of the nasal floor and sill, lengthening of the columella, repositioning of the alar base, achieving nasal tip projection, repositioning of the lower lateral cartilages, and reorienting the nares from horizontal to oblique position. The multiplicity of procedures in the literature for correction of this deformity alludes to the fact that no single procedure is entirely effective. The timing for surgical intervention and its extent varies considerably. Early surgery on cartilage may adversely affect growth and development; at the same time, allowing the cartilage to grow in an abnormal position and contributing to aggravation of deformity. Some surgeons advocate correction of deformity at an early age. However, others like the cartilages to grow and mature before going in for surgery. With peer pressure also becoming an important consideration during the teens, the current trend is towards early intervention. There is no unanimity in the extent of nasal dissection to be done at the time of primary lip repair. While many perform limited nasal dissection for the fear of growth retardation, others opt for full cartilage correction at the time of primary surgery itself. The value of naso-alveolar moulding (NAM too is not universally accepted and has now more opponents than proponents. Also most centres in the developing world have neither the personnel nor the facilities for the same. The secondary cleft nasal deformity is variable and is affected by the extent of the original abnormality, any prior surgeries performed and alteration due to nasal growth. This article reviews the currently popular methods for correction of nasal deformity associated with bilateral cleft lip, it′s management both at the time of cleft lip repair

  5. Amelogenesis imperfecta with bilateral nephrocalcinosis.

    Science.gov (United States)

    Poornima, P; Katkade, Shashikant; Mohamed, Roshan Noor; Mallikarjuna, Rachappa

    2013-05-24

    A 12-year-old patient presented with a severe delay of eruption in permanent maxillary and mandibular incisors. On examination, there was over-retained primary teeth and delayed eruption of permanent teeth. Retained primary teeth showed light yellow discolouration whereas permanent teeth were distinct yellow with thin or little enamel. Subsequent imaging revealed all the premolars except maxillary left first premolar showed signs of intra-alveolar coronal resorption, nephrocalcinosis with bilateral multiple calculi and small papillary tip calcifications, marked increase in alkaline phosphatase. Subsequent dental treatment for restoring the functional and aesthetic requirement followed by appropriate treatment for renal problem was undertaken.

  6. Thoracic Idiopathic Scoliosis Severity Is Highly Correlated with 3D Measures of Thoracic Kyphosis.

    Science.gov (United States)

    Sullivan, T Barrett; Reighard, Fredrick G; Osborn, Emily J; Parvaresh, Kevin C; Newton, Peter O

    2017-06-07

    Loss of thoracic kyphosis has been associated with thoracic idiopathic scoliosis. Modern 3-dimensional (3D) imaging systems allow more accurate characterization of the scoliotic deformity than traditional radiographs. In this study, we utilized 3D calculations to characterize the association between increasing scoliosis severity and changes in the sagittal and axial planes. Patients evaluated in a scoliosis clinic and determined to have either a normal spine or idiopathic scoliosis were included in the analysis. All underwent upright, biplanar radiography with 3D reconstructions. Two-dimensional (2D) measurements of the magnitude of the thoracic major curve and the thoracic kyphosis were recorded. Image processing and MATLAB analysis were utilized to produce a 3D calculation of thoracic kyphosis and apical vertebral axial rotation. Regression analysis was performed to determine the correlation of 2D kyphosis, 3D kyphosis, and apical axial rotation with the magnitude of the thoracic major curve. The 442 patients for whom 2D and 3D data were collected had a main thoracic curve magnitude ranging from 1° to 118°. Linear regression analysis of the 2D and 3D T5-T12 kyphosis versus main thoracic curve magnitude yielded significant models (p scoliosis magnitude increased, at a rate of more than half the increase in the main thoracic curve magnitude. Analysis confirmed a surprisingly strong correlation between scoliosis severity and loss of 3D kyphosis that was absent in the 2D analysis. A similarly strong correlation between curve magnitude and apical axial rotation was evident. These findings lend further credence to the concept that scoliosis progresses in the coronal, sagittal, and axial planes simultaneously. The findings of this study suggest that 3D assessment is critical for adequate characterization of the multiplanar deformity of idiopathic scoliosis and deformity in the sagittal plane is linked to deformity in the coronal plane. Increasing severity of coronal

  7. Dry needling for the management of thoracic spine pain.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-07-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars.

  8. Bilateral chylothorax in a patient with chronic central vein thrombosis and chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Avdhesh Bansal

    2015-01-01

    Full Text Available The chylothorax is not a common presentation, and bilateral chylothorax in patients with chronically high central venous pressure secondary to venous thrombosis is a rare in incidence. We reported a case of bilateral chylothorax in a patient of chronic deep vein thrombosis (DVT in central veins with chronic thromboembolic pulmonary hypertension who presented with 2 weeks history of increased breathlessness, bilateral chest discomfort and weakness. Work-up with chest X-ray and ultrasonography-chest showed gross left sided and mild right sided pleural effusion, thoracocentesis was consistent with chylothorax. Contrast enhanced computed tomography-chest showed multiple collateral formation of left side subclavian vein, venous Doppler showed old DVT in right and left subclavian veins and two-dimensional echocardiogram showed finding of severe pulmonary hypertension. After 24 h of fasting and conservative management, pleural drain became clear and decreased in the amount. Patient′s video assisted thoracoscopic surgery was done, and thoracic duct was ligated and cut down at diaphragmatic level and bilateral talc pleurodesis done. Patient improved clinically and radiologically.

  9. Thoracic computerized tomographic (CT findings in 2009 influenza A (H1N1 virus infection in Isfahan, Iran

    Directory of Open Access Journals (Sweden)

    Mojtaba Rostami

    2011-01-01

    Full Text Available Background: Pandemic 2009 H1N1 influenza A virus arrived at Isfahan in August 2009. The virus is still circulating in the world. The abnormal thoracic computerized tomographic (CT scan findings vary widely among the studies of 2009 H1N1 influenza. We evaluated the thoracic CT findings in patients with 2009 H1N1 virus infection to describe findings compared to previously reported findings, and to suggest patterns that may be suggestive for 2009 influenza A (H1N1 in an appropriate clinical setting. Methods: Retrospectively, the archive of all patients with a diagnosis of 2009 H1N1 influenza A were reviewed, in Al-Zahra Hospital in Isfahan, central Iran, between September 23 rd 2009 to February 20 th 2010. Out of 216 patients with confirmed 2009 influenza A (H1N1 virus, 26 cases with abnormal CT were enrolled in the study. Radiologic findings were characterized by the type and pattern of opacities and zonal distribution. Results: Patchy infiltration (34.6%, lobar consolidation (30.8%, and interstitial infiltration (26.9% with airbronchogram (38.5% were the predominant findings in our patients. Bilateral distribution was seen in 80.8% of the patients. Only one patient (3.8% showed ground-glass opacity, predominant radiographic finding in the previous reports and severe acute respiratory syndrome (SARS. Conclusions: The most common thoracic CT findings in pandemic H1N1 were patchy infiltration, lobar consolidation, and interstitial infiltration with airbronchogram and bilateral distribution. While these findings can be associated with other infections; they may be suggestive to 2009 influenza A (H1N1 in the appropriate clinical setting. Various radiographic patterns can be seen in thoracic CT scans of the influenza patients. Imaging findings are nonspecific.

  10. Bilateral Monteggia fracture in adults

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    Ristić Dejan

    2011-01-01

    Full Text Available Introduction. In 1814 Giovanni Monteggia first described two cases of fractures of the proximal third of ulna with dislocation of the radial head. These fractures are more common in children than in adults, and mutual Monteggia fracture is a rare complication. This study presents a treatment course of a patient with bilateral Monteggia fracture. Case report. A 55- year-old patient was injured by falling in the yard. Radiography showed bilateral Monteggia fracture type II (by the Badon classification. Operative treatment of fracture was done by a compression plate on the right side and by the zuggurtung technique on the left one. Closed repositioning of the radial head was done on both sides. The patient was wearing a plaster splint for the upper arm for 21 days. After removing the fixation, the function of the elbow was determined by the Broberg Morrey score (BM which was on the right side 45.5 and on the left side 47.5. After the proper physical therapy, four months after the surgery, BM score was 100 on the right side, and 93 on the left one. Conclusion. Surgical treatment and early rehabilitation is the key for the return of good function of both elbows.

  11. Bilateral zosteriform extragenital lichen sclerosus.

    Science.gov (United States)

    Kumar, Piyush; Jha, Abhijeet Kumar; Mallik, Sambeet Kumar; Raihan, Mohammed

    2014-01-01

    A 35-year-old man presented with asymptomatic eruption on both forearms and lower aspects of the legs for 6 months. The lesions first appeared on his inner aspects of the wrist, the dorsal surface of the hands, and legs and progressed to involve proximal aspects of the extremities. There was no significant past history. On examination, multiple pearly white papules and depigmented atrophic plaques were found bilaterally on the flexors of the arms and the extensors of the legs. The lesions were arranged in a linear manner, following the lines of Blaschko (Figures 1 and 2). The surface of the atrophic plaques was notable for prominent telangiectasia, giving an erythematous appearance. The genitalia, oral cavity, palms, and soles were spared. Systemic examination was noncontributory. Lichen striatus and extragenital lichen sclerosus (ELS) were considered the differential diagnosis. Clinically, the age of the patient, the absence of scaling, and the presence of atrophic plaques and telangiectasia were in favor of ELS. A punch biopsy from an atrophic plaque was performed, and it revealed hyperkeratosis, atrophic epidermis, basal layer vacuolar degeneration, mild lymphocytic infiltration in the dermis, edema, and homogenization of collagen of the upper portion of the dermis (Figures 3 and Figure 4). Histopathologic findings were consistent with lichen sclerosus. A diagnosis of bilateral zosteriform ELS was made.

  12. The management of thoracic inlet syndrome associated with Hurler's syndrome: a novel surgical technique.

    LENUS (Irish Health Repository)

    Ahsan, Rauf M

    2012-02-01

    A 21-year-old male developed significant swelling of his tongue after a respiratory arrest. The patient had a history of Hurler\\'s syndrome. Magnetic resonance imaging (MRI) angiogram delineated that the swelling was due to compression of his internal jugular veins at the level of the first rib, resulting in thoracic inlet obstruction. The standard surgical treatment of thoracic inlet obstruction was not suitable in this patient\\'s case due to his short thick neck and his characteristic Hurler\\'s syndrome body habitus. Therefore, a novel surgical strategy was used to decompress his head and neck vessels. The manubrium was widened using an iliac crest bone graft, stabilised using internal fixation plates and reconstructed with a pectoral muscle flap.

  13. Postmortem genetic testing should be recommended in sudden cardiac death cases due to thoracic aortic dissection.

    Science.gov (United States)

    Gago-Díaz, Marina; Ramos-Luis, Eva; Zoppis, Silvia; Zorio, Esther; Molina, Pilar; Braza-Boïls, Aitana; Giner, Juan; Sobrino, Beatriz; Amigo, Jorge; Blanco-Verea, Alejandro; Carracedo, Ángel; Brion, María

    2017-04-08

    Acute thoracic aortic dissections and ruptures, the main life-threatening complications of the corresponding aneurysms, are an important cause of sudden cardiac death. Despite the usefulness of the molecular diagnosis of these conditions in the clinical setting, the corresponding forensic field remains largely unexplored. The main goal of this study was to explore and validate a new massive parallel sequencing candidate gene​ assay as a diagnostic tool for acute thoracic aortic dissection autopsy cases. Massive parallel sequencing of 22 thoracic aortic disease candidate genes performed in 17 cases of thoracic aortic dissection using AmpliSeq and Ion Proton technologies. Genetic variants were filtered by location, type, and frequency at the Exome Aggregation Consortium and an internal database and further classified based on the American College of Medical Genetics and Genomics (ACMG) recommendations published in 2015. All prioritized results were confirmed by traditional sequencing. From the total of 10 potentially pathogenic genetic variants identified in 7 out of the 17 initial samples, 2 of them were further classified as pathogenic, 2 as likely pathogenic, 1 as possibly benign, and the remaining 5 as variants of uncertain significance, reaching a molecular autopsy yield of 23%, approximately. This massive parallel sequencing candidate gene approach proved useful for the molecular autopsy of aortic dissection sudden cardiac death cases and should therefore be progressively incorporated into the forensic field, being especially beneficial for the anticipated diagnosis and risk stratification of any other family member at risk of developing the same condition.

  14. Traumatismo torácico bilateral: A propósito de 1 caso

    Directory of Open Access Journals (Sweden)

    Orlando Iglesias Pérez

    2002-12-01

    Full Text Available Se presenta un caso de traumatismo torácico bilateral extenso con tórax batiente, el cual fue tratado con inmovilización de las partes blandas torácicas, con alambres de Steinman pasados de manera caudocefálica, lo que provocó la estabilización de la caja y el mejoramiento rápido de las funciones ventilatorias y se logró la retirada oportuna de la intubación endotraqueal y la eliminación del proceso séptico asociado, lo que por la severidad y la utilización de un sistema de fijación externa, lo hace un caso anecdótico e interesante, y permite inducir la utilización de esta forma de tratamiento en casos similaresA case of extensive bilateral thoracic trauma with beating thorax was presented. The patient was treated with inmobilization of the thoracic soft parts by using Steinman wires that were passed through in a caudocephalic way, which caused the stabilization of the chest and the rapid improvement of the ventilatory functions. It made possible the opportune withdrawal of the endotracheal intubation and the elimination of the associated septic process. This is an anecdotic and interesting case due to its severity and to the utilization of an external fixation system. It allows to induce the application of this treatment in similar cases

  15. Treatment of bilateral mammary ptosis and pectus excavatum through the same incision in one surgical stage

    Directory of Open Access Journals (Sweden)

    Fernando Passos Rocha

    Full Text Available CONTEXT: Congenital deformities of the anterior thoracic wall are characterized by unusual development of the costal cartilages. All these medical conditions are frequently associated with a variety of breast deformities. Several surgical techniques have been described for correcting them, going from sternochondroplasty to, nowadays, minimally invasive techniques and silicone prosthesis implantation. CASE REPORT: The present article reports the case of a young female patient who presented bilateral mammary ptosis and moderate pectus excavatum that caused a protrusion between the eighth and the tenth ribs and consequent esthetic disharmony. The proposed surgical treatment included not only subglandular breast implants of polyurethane, but also resection of part of the rib cartilage and a bone segment from the eighth, ninth and tenth ribs by means of a single submammary incision in order to make the scar minimally visible. Correction through a single incision benefited the patient and provided an excellent esthetic result. CONCLUSIONS: The techniques used to repair bilateral mammary ptosis and pectus excavatum by plastic and thoracic surgery teams, respectively, have been shown to be efficient for correcting both deformities. An excellent esthetic and functional result was obtained, with consequent reestablishment of the patient's self-esteem.

  16. Calcium signalling indicates bilateral power balancing in the Drosophila flight muscle during manoeuvring flight.

    Science.gov (United States)

    Lehmann, Fritz-Olaf; Skandalis, Dimitri A; Berthé, Ruben

    2013-05-06

    Manoeuvring flight in animals requires precise adjustments of mechanical power output produced by the flight musculature. In many insects such as fruit flies, power generation is most likely varied by altering stretch-activated tension, that is set by sarcoplasmic calcium levels. The muscles reside in a thoracic shell that simultaneously drives both wings during wing flapping. Using a genetically expressed muscle calcium indicator, we here demonstrate in vivo the ability of this animal to bilaterally adjust its calcium activation to the mechanical power output required to sustain aerodynamic costs during flight. Motoneuron-specific comparisons of calcium activation during lift modulation and yaw turning behaviour suggest slightly higher calcium activation for dorso-longitudinal than for dorsoventral muscle fibres, which corroborates the elevated need for muscle mechanical power during the wings' downstroke. During turning flight, calcium activation explains only up to 54 per cent of the required changes in mechanical power, suggesting substantial power transmission between both sides of the thoracic shell. The bilateral control of muscle calcium runs counter to the hypothesis that the thorax of flies acts as a single, equally proportional source for mechanical power production for both flapping wings. Collectively, power balancing highlights the precision with which insects adjust their flight motor to changing energetic requirements during aerial steering. This potentially enhances flight efficiency and is thus of interest for the development of technical vehicles that employ bioinspired strategies of power delivery to flapping wings.

  17. New Curious Bilateral q-Series Identities

    Directory of Open Access Journals (Sweden)

    Frédéric Jouhet

    2012-10-01

    Full Text Available By applying a classical method, already employed by Cauchy, to a terminating curious summation by one of the authors, a new curious bilateral q-series identity is derived. We also apply the same method to a quadratic summation by Gessel and Stanton, and to a cubic summation by Gasper, respectively, to derive a bilateral quadratic and a bilateral cubic summation formula.

  18. Comminuted fracture of the thoracic spine.

    LENUS (Irish Health Repository)

    Cashman, J P

    2012-02-03

    BACKGROUND: Road deaths fell initially after the introduction of the penalty points but despite this, the rate of spinal injuries remained unchanged. AIMS: We report a patient with a dramatic spinal injury, though without neurological deficit. We discuss the classification, management and economic impact of these injuries. METHODS: We describe the management of a patient with a comminuted thoracic spinal fracture without neurological injury. We conducted a literature review with regard to the availability of literature of the management of these injuries. RESULTS: This 17-year-old female was managed surgically and had a good functional outcome. There is no clear consensus in the published literature on the management of these injuries. CONCLUSIONS: Comminuted thoracic spinal factures are potentially devastating. Such a patient presents challenges in determining the appropriate treatment.

  19. March 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated after 150 words. The March 2014 Arizona Thoracic Society meeting was a special meeting. In conjunction with the Valley Fever Center for Excellence and the Arizona Respiratory Center the Eighteenth Annual Farness Lecture was held in the Sonntag Pavilion at St. Joseph's Hospital at 6 PM on Friday, April 4, 2014. The guest speaker was Antonio "Tony" Catanzaro, MD from the University of California San Diego and current president of the Cocci Study Group. There were 57 in attendance representing the pulmonary, critical care, sleep, and infectious disease communities. After opening remarks by Arizona Thoracic Society president, Lewis Wesselius (a former fellow under Dr. Catanzaro at UCSD, John Galgiani, director of the Valley Fever Center for Excellence, gave a brief history of the Farness lecture before introducing Dr. Catanzaro. The lecture is named for Orin J. Farness, a Tucson physician, who was the first to report culture positive coccidioidomycosis (cocci or Valley Fever. ...

  20. RESPIRATORY REEDUCATION IN THORACIC CONTUSION RECOVERY

    Directory of Open Access Journals (Sweden)

    Aurelia PREDA

    2015-04-01

    Full Text Available Respiratory reeducation is a way to recover the thoracic contusion. Correcting dyspnea induced by pain, decreases the required postcontuzional recovery time and, therefore, the required social reintegration time. This is achieved an increasing of the pacient life quality, and significant savings of human and material resources: reducing medical and somato-functional recovery costs, reducing the sick leave payment and the work days off to. The „TES” device has been designed in order to improve respiratory reeducation and to recover the thoracic contusion. A study showed that the postcontuzional recovery was significantly increased by using the physical exercises of respiratory reeducation. The „TES” device demonstrated his role in this.

  1. Incidental Cardiac Findings on Thoracic Imaging.

    LENUS (Irish Health Repository)

    Kok, Hong Kuan

    2013-02-07

    The cardiac structures are well seen on nongated thoracic computed tomography studies in the investigation and follow-up of cardiopulmonary disease. A wide variety of findings can be incidentally picked up on careful evaluation of the pericardium, cardiac chambers, valves, and great vessels. Some of these findings may represent benign variants, whereas others may have more profound clinical importance. Furthermore, the expansion of interventional and surgical practice has led to the development and placement of new cardiac stents, implantable pacemaker devices, and prosthetic valves with which the practicing radiologist should be familiar. We present a collection of common incidental cardiac findings that can be readily identified on thoracic computed tomography studies and briefly discuss their clinical relevance.

  2. [Thoracic ectopia cordis with tetralogy of fallot].

    Science.gov (United States)

    Ben Khalfallah, A; Annabi, N; Ousji, M; Hadrich, M; Najai, A

    2003-01-01

    Ectopia cordis; very rare congenital malformation, characterized by an evisceration of the heart through a parietal defect. The thoracic localization is most frequent. We report the case of a full term baby girl without follow-up of the pregnancy, presenting a beating mass in thoracic position, expansive to the effort, covered by a translucent membrane corresponding to an ectopique position of the heart. Transthoracic echocardiography shows cardiac malformation: Fallot tetralogy. The precocious diagnosis is possible by prenatal ultrasound examination after 12th week of pregnancy. The surgical treatment remain the only hope for these neonates. It's results depends on the associated malformations and the neonatal complications especially the infections. The prognosis remains poor in spite of the progress of surgical techniques.

  3. Palpation of the upper thoracic spine

    DEFF Research Database (Denmark)

    Christensen, Henrik Wulff; Vach, Werner; Vach, Kirstin;

    2002-01-01

    procedure. RESULTS: Using an "expanded" definition of agreement that accepts small inaccuracies (+/-1 segment) in the numbering of spinal segments, we found--based on the pooled data from the thoracic spine--kappa values of 0.59 to 0.77 for the hour-to-hour and the day-to-day intraobserver reliability......OBJECTIVE: To assess the intraobserver reliability (in terms of hour-to-hour and day-to-day reliability) and the interobserver reliability with 3 palpation procedures for the detection of spinal biomechanic dysfunction in the upper 8 segments of the thoracic spine. DESIGN: A repeated....... INTERVENTION: Three types of palpation were performed: Sitting motion palpation and prone motion palpation for biomechanic dysfunction and paraspinal palpation for tenderness. Each dimension was rated as "absent" or "present" for each segment. All examinations were performed according to a standard written...

  4. Myelopathy with syringomyelia following thoracic epidural anaesthesia.

    Science.gov (United States)

    Aldrete, J A; Ferrari, H

    2004-02-01

    Under general anaesthesia and muscle relaxation, a thoracic epidural catheter was inserted at the T8-T9 level in a 7-year-old boy scheduled to have a Nissen fundoplication to provide postoperative analgesia. After 4 ml of lignocaine 1.5% was injected through the catheter, hypotension resulted. Fifty-five minutes later 5 ml of bupivacaine 0.25% produced the same effect. In the recovery room a similar injection resulted in lower blood pressure and temporary apnoea. Sensory and motor deficits were noted the next day and four days later magnetic resonance imaging demonstrated spinal cord syringomyelia extending from T5 to T10. Four years later, dysaesthesia from T6 to T10 weakness of the left lower extremity and bladder and bowel dysfunction persist. The risks of inserting thoracic epidural catheters in patients under general anaesthesia and muscle relaxation are discussed, emphasising the possibility of spinal cord injury with disastrous consequences.

  5. Thoracic radiology in kidney and liver transplantation.

    Science.gov (United States)

    Fishman, Joel E; Rabkin, John M

    2002-04-01

    Renal transplantation accounts for more than half of all solid organ transplants performed in the U.S., and the liver is the second most commonly transplanted solid organ. Although abdominal imaging procedures are commonplace in these patients, there has been relatively little attention paid to thoracic imaging applications. Preoperative imaging is crucial to aid in the exclusion of infectious or malignant disease. In the perioperative time period, thoracic imaging focuses both on standard intensive care unit care, including monitoring devices and their complications, and on the early infections that can occur. Postoperative management is divided into three time periods, and the principles governing the occurrence of infections and malignancies are reviewed. Anatomic and pathologic aspects unique to kidney and liver transplantation patients are also discussed.

  6. [Digital thoracic radiology: devices, image processing, limits].

    Science.gov (United States)

    Frija, J; de Géry, S; Lallouet, F; Guermazi, A; Zagdanski, A M; De Kerviler, E

    2001-09-01

    In a first part, the different techniques of digital thoracic radiography are described. Since computed radiography with phosphore plates are the most commercialized it is more emphasized. But the other detectors are also described, as the drum coated with selenium and the direct digital radiography with selenium detectors. The other detectors are also studied in particular indirect flat panels detectors and the system with four high resolution CCD cameras. In a second step the most important image processing are discussed: the gradation curves, the unsharp mask processing, the system MUSICA, the dynamic range compression or reduction, the soustraction with dual energy. In the last part the advantages and the drawbacks of computed thoracic radiography are emphasized. The most important are the almost constant good quality of the pictures and the possibilities of image processing.

  7. Properties of bilateral spinocerebellar activation of cerebellar cortical neurons

    Directory of Open Access Journals (Sweden)

    Pontus eGeborek

    2014-10-01

    Full Text Available We aimed to explore the cerebellar cortical inputs from two spinocerebellar pathways, the spinal border cell-component of the ventral spinocerebellar tract (SBC-VSCT and the dorsal spinocerebellar tract (DSCT, respectively, in the sublobule C1 of the cerebellar posterior lobe. The two pathways were activated by electrical stimulation of the contralateral lateral funiculus (coLF and the ipsilateral LF (iLF at lower thoracic levels. Most granule cells in sublobule C1 did not respond at all but part of the granule cell population displayed high-intensity responses to either coLF or iLF stimulation. As a rule, Golgi cells and Purkinje cell simple spikes responded to input from both LFs, although Golgi cells could be more selective. In addition, a small population of granule cells responded to input from both the coLF and the iLF. However, in these cases, similarities in the temporal topography and magnitude of the responses suggested that the same axons were stimulated from the two LFs, i.e. that the axons of individual spinocerebellar neurons could be present in both funiculi. This was also confirmed for a population of spinal neurons located within known locations of SBC-VSCT neurons and dorsal horn DSCT neurons. We conclude that bilateral spinocerebellar responses can occur in cerebellar granule cells, but the VSCT and DSCT systems that provide the input can also be organized bilaterally. The implications for the traditional functional separation of VSCT and DSCT systems and the issue whether granule cells primarily integrate functionally similar information or not are discussed.

  8. Trade of permits for greenhouse gas emissions: Bilateral trade need not be the answer

    OpenAIRE

    Burguet, Roberto; Sempere, Jaume

    2010-01-01

    The Kyoto Protocol sets national quotas on GHG emissions and allows international trade of these quotas. Taking terms-of-trade effects into account, we argue that this trade is characterized by asymmetric, identity-dependent externalities, and show that bilateral trade of permits may not be sufficient for an efficient allocation of emissions. We derive conditions under which bilateral trade does improve the allocation of permits. The conditions are strong. In this sense, we argue that, for em...

  9. Simple technique for maximal thoracic muscle harvest.

    Science.gov (United States)

    Marshall, M Blair; Kaiser, Larry R; Kucharczuk, John C

    2004-04-01

    We present a modification of technique for standard muscle flap harvest, the placement of cutaneous traction sutures. This technique allows for maximal dissection of the thoracic muscles even through minimal incisions. Through improved exposure and traction, complete dissection of the muscle bed can be performed and the tissue obtained maximized. Because more muscle bulk is obtained with this technique, the need for a second muscle may be prevented.

  10. Thoracic surgery in India: challenges and opportunities

    OpenAIRE

    Yendamuri, Sai

    2016-01-01

    India has the dubitable honor of being ranked first in the world with regards to lung disease burden. A good proportion of this disease burden is amenable to surgical treatment. However, patients have limited access to quality thoracic surgical care due to a number of obstacles. This review article summarizes these obstacles and the implied opportunities that exist in this nascent surgical discipline in the world’s second most populous country.

  11. Thoracic surgery in India: challenges and opportunities.

    Science.gov (United States)

    Yendamuri, Sai

    2016-08-01

    India has the dubitable honor of being ranked first in the world with regards to lung disease burden. A good proportion of this disease burden is amenable to surgical treatment. However, patients have limited access to quality thoracic surgical care due to a number of obstacles. This review article summarizes these obstacles and the implied opportunities that exist in this nascent surgical discipline in the world's second most populous country.

  12. Monitoring and improving care in thoracic surgery

    OpenAIRE

    Numan, R.C.

    2016-01-01

    Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This increasing complexity demands a multidisciplinary approach rearranging pre-, peri- and postoperative care in a way safety, efficiency and high quality are guaranteed. The safety and quality of healthca...

  13. Chondromyxoid fibroma of two thoracic vertebrae

    Energy Technology Data Exchange (ETDEWEB)

    Bruder, E. [Department of Pathology, University Hospital of Zuerich, Ch-8091 Zuerich (Switzerland); Zanetti, M. [Department of Radiology, University Clinic Balgrist, Zuerich (Switzerland); Boos, N. [Department of Orthopedic Surgery, University Clinic Balgrist, Zuerich (Switzerland); Hochstetter, A.R. von [Department of Pathology, University Hospital, Zuerich (Switzerland)

    1999-05-01

    We report on a case of chondromyxoid fibroma involving two adjacent thoracic vertebrae with features of aggressive behaviour on radiographs, CT and MRI. Histology revealed typical chondromyxoid fibroma with unusually coarse calcifications. Chondromyxoid fibroma of the spine is rare, and only 30 of these tumours have been reported so far. Involvement of two contiguous vertebral bodies by chondromyxoid fibroma, as reported here, appears exceptional. (orig.) With 5 figs., 29 refs.

  14. Thoracic Cavernous Lymphangioma Provoking Massive Chyloptysis

    Directory of Open Access Journals (Sweden)

    Robert Ferguson MD

    2013-09-01

    Full Text Available Chyloptysis is a relatively rare embodiment of disease that encompasses a lengthy differential and provides many diagnostic and therapeutic challenges. Presented here is the case of a young woman with massive chyloptysis due to a thoracic cavernous lymphangioma arising in the peripartum period. The severity of her condition mandated the use of cardiopulmonary bypass to resect her lymphangioma. We believe that the extent of her symptoms, etiology of disease, and surgical management represent a unique scenario in the literature.

  15. [Septic arthritis of thoracic facet joint].

    Science.gov (United States)

    Ben Abdelghani, K; Gérard-Dran, D; Combe, B

    2009-08-01

    Septic arthritis of the facet joint is a rare condition. We report a case of septic arthritis of both a thoracic facet joint and a wrist. Clinical manifestations were consistent with a spondylodiscitis. Magnetic resonance imaging of the spine demonstrated infection of facet joints of T1 and T2. A surgical biopsy of the wrist isolated a type B streptococcus. The same organism was found in urine culture. The patient had an uneventful recovery on antibiotics.

  16. [Our experience with bilateral cochlear implantation].

    Science.gov (United States)

    Carmel, Eldar; Taitelbaum-Swead, Ricky; Migirov, Lela; Hildesheimer, Minka; Kronenberg, Jona

    2008-03-01

    Cochlear implantation is a standard method of hearing rehabilitation among patients with severe to profound bilateral sensorineural hearing loss. In recent years there have been an increasing number of studies showing superior hearing with bilateral cochlear implantation in comparison with a unilateral procedure. In this study we present our experience with 15 patients, children and adults, who had bilateral cochlear implant surgery. Speech perception test results demonstrated a hearing benefit in bilateral cochlear implantation in comparison with a unilateral device, mainly by improvement in the identification of speech in noise tests.

  17. Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

    Directory of Open Access Journals (Sweden)

    Hong-Fei Nie

    2013-01-01

    Full Text Available Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS, MacNab classification, and Oswestry disability index (ODI. At the final follow up (mean: 17 months; range: 6–41 months, patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery.

  18. [Thoracic sympathectomy in primary hyperhidrosis: patient satisfaction].

    Science.gov (United States)

    Galbis-Caravajal, José Marcelo; Sales-Badía, J Gabriel; Cuenca-Torres, María; Miquel-Miquel, Javier; Esturi-Navarro, Rafael; Ortega-Monzó, Carmen

    2006-05-01

    To evaluate satisfaction among patients who underwent thoracic sympathectomy for primary hyperhidrosis and the possible complications after a minimum of 14 months after surgery. We performed a retrospective study in 108 patients who underwent thoracic sympathectomy and who responded to all the questions asked in a telephone interview. The sample was composed of 21 men and 87 women, with a mean age of 29.73 years. In all patients, surgery was performed with general anesthesia in a single intervention. Special emphasis was placed on the degree of satisfaction (whether patients would recommend this type of surgery) and the possible negative effects or complications experienced by patients or attributed by them to the procedure. Patients were contacted a minimum of 14 months after the intervention. The most frequent complication was compensatory sweating (81.5%). Pain at the site of trocar insertion was reported by 6.5%. There were few immediate and long-term complications. The degree of satisfaction reached 90.7%. Video-assisted thoracic sympathectomy is safe and effective. Despite compensatory sweating, overall satisfaction was very high. However, satisfaction gradually decreased in the months after the intervention. Patients with hyperhidrosis with significant or principal axillary involvement could benefit from botulinic toxin administration as the first-line therapy.

  19. [Videothoracospy in thoracic trauma and penetrating injuries].

    Science.gov (United States)

    Lang-Lazdunski, L; Chapuis, O; Pons, F; Jancovici, R

    2003-03-01

    Videothoracoscopy represents a valid and useful approach in some patients with blunt chest trauma or penetrating thoracic injury. This technique has been validated for the treatment of clotted hemothorax or posttraumatic empyema, traumatic chylothorax, traumatic pneumothorax, in patients with hemodynamic stability. Moreover, it is probably the most reliable technique for the diagnosis of diaphragmatic injury. It is also useful for the extraction of intrathoracic projectiles and foreign bodies. This technique might be useful in hemodynamically stable patients with continued bleeding or for the exploration of patients with penetrating injury in the cardiac area, although straightforward data are lacking to confirm those indications. Thoracotomy or median sternotomy remain indicated in patients with hemodynamic instability or those that cannot tolerate lateral decubitus position or one-lung ventilation. Performing video-surgery in the trauma setting require expertise in both video-assisted thoracic surgery and chest trauma management. The contra-indications to videothoracoscopy and indications for converting the procedure to an open thoracotomy should be perfectly known by surgeons performing video-assisted thoracic surgery in the trauma setting. Conversion to thoracotomy or median sternotomy should be performed without delay whenever needed to avoid blood loss and achieve an adequate procedure.

  20. October 2012 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-10-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on 10/24/2012 at Scottsdale Shea beginning at 6:30 PM. There were 23 in attendance representing the pulmonary, critical care, sleep, infectious disease, pathology, and radiology communities. An announcement was made that the Colorado Thoracic Society has accepted an invitation to partner with the Arizona and New Mexico Thoracic Societies in the Southwest Journal of Pulmonary and Critical Care Medicine. Discussions continue to be held regarding a combined Arizona Thoracic Society meeting with Tucson either in Casa Grande or electronically. Six cases were presented: Dr. Tim Kuberski, chief of Infectious Disease at Maricopa Medical Center, presented a 48 year old female who had been ill for 2 weeks. A CT of the chest revealed a left lower lobe nodule and a CT of the abdomen showed hydronephrosis and a pelvic mass. Carcinoembryonic antigen (CEA was elevated. All turned out to be coccidioidomycosis on biopsy. CEA decreased …

  1. July 2015 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-07-01

    Full Text Available No abstract available. Article truncated at 150 words. The July 2015 Arizona Thoracic Society meeting was held on Wednesday, July 23, 2015 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 16 in attendance representing the pulmonary, critical care, sleep, and radiology communities. It was decided to continue holding the meeting on the fourth Wednesday of the odd numbered months. Lewis Wesselius relayed a request from the Mayo Clinic regarding a survey on how physicians in Arizona treat Valley Fever. There were no objections to using our mailing list to send out the survey. Dr. Parides formed a committee to encourage younger clinicians to attend the Arizona Thoracic Society meetings. Richard A. Robbins was chose as the Arizona Thoracic Society's nominee for clinician of the year. There were 3 case presentations: 1. George Parides presented a 58-year-old woman with a past medical history of cavitating coccidioidomycosis in both ...

  2. CT findings in severe thoracic sarcoidosis

    Energy Technology Data Exchange (ETDEWEB)

    Hennebicque, Anne-Sophie; Brillet, Pierre-Yves; Moulahi, Hassen; Brauner, Michel W. [UFR Bobigny, Department of Radiology, Federation MARTHA and EA 2363, Bobigny Cedex (France); Nunes, Hilario; Valeyre, Dominique [UFR Bobigny, Department of Pneumology, Federation MARTHA and EA 2363, Bobigny Cedex (France)

    2005-01-01

    Severe thoracic sarcoidosis includes manifestations with significant clinical and functional impairment and a risk of mortality. Severe thoracic sarcoidosis can take on various clinical presentations and is associated with increased morbidity. The purpose of this article was to describe the CT findings in severe thoracic sarcoidosis and to explain some of their mechanisms. Subacute respiratory insufficiency is a rare and early complication due to a high profusion of pulmonary lesions. Chronic respiratory insufficiency due to pulmonary fibrosis is a frequent and late complication. Three main CT patterns are identified: bronchial distortion, honeycombing and linear opacities. CT can be helpful in diagnosing some mechanisms of central airway obstruction such as bronchial distortion due to pulmonary fibrosis or an extrinsic bronchial compression by enlarged lymph nodes. An intrinsic narrowing of the bronchial wall by endobronchial granulomatous lesions may be suggested by CT when it shows evidence of bronchial mural thickening. Pulmonary hypertension usually occurs in patients with end-stage pulmonary disease and is related to fibrotic destruction of the distal capillary bed and to the resultant chronic hypoxemia. Several other mechanisms may contribute to the development of pulmonary hypertension including extrinsic compression of major pulmonary arteries by enlarged lymph nodes and secondary pulmonary veno-occlusive disease. Aspergilloma colonization of a cavity is the main cause of hemoptysis in sarcoidosis. Other rare causes are bronchiesctasis, necrotizing bronchial aspergillosis, semi-invasive pulmonary aspergillosis, erosion of a pulmonary artery due to a necrotic sarcoidosis lesion, necrosis of parenchymal sarcoidosis lesions and specific endobronchial macroscopic lesions. (orig.)

  3. Cushing syndrome after bilateral lensectomy.

    Science.gov (United States)

    Scherrer, Karin Sofia; Weitz, Marcus; Eisenack, Johannes; Truffer, Béatrice; Konrad, Daniel

    2015-03-01

    Iatrogenic Cushing syndrome induced by oral and parenteral corticosteroid administration is a well-known complication, and necessary precautions have to be taken. Cushing syndrome, however, following treatment with glucocorticoid-containing eye drops is a very rare complication. To the best of our knowledge, there have been only four reported cases in the literature. Herein, we present an infant boy who developed Cushing syndrome after receiving dexamethasone-containing eye drops after bilateral cataract extraction to prevent postoperative inflammatory complications. At the age of 5 months, after approx. 3 months of dexamethasone therapy, the patient presented with cushingoid facies, nephrocalcinosis and failure to grow. Iatrogenic Cushing syndrome was diagnosed and dexamethasone-containing eye drops were reduced and eventually stopped. Follow-up examinations revealed catch-up growth. Ocularly administered corticosteroids may have substantial systemic side effects in infants.

  4. Comparison of the trabeculae structure of the spongy bone of the bilateral pastern bones in racehorses based on the imaging analysis of radiograms.

    Science.gov (United States)

    Dzierzecka, M; Czerwinski, E

    2010-01-01

    On the basis of a digital analysis of radiograms it was checked if, and to what extent, the extended loading of one of the sides of the body of racehorses leads to differences in the microstructure of the spongy bone of the bilateral pastern bones of the thoracic limbs. The research material consisted of radiograms of the pastern bones of the right and left thoracic limbs of racehorses. On the basis of computer image radiological analysis with the use of the "Trabecula,, programme, a quantative evaluation of the structure of the spongy bone of the pastern bones was conducted. It was noted that the differences between the right and the left pastern bones, despite extensive loading of the left thoracic limb, were not statistically significant as far as all studied parameters of the trabecula structure of the spongy bone were concerned.

  5. Three-dimensional finite element modeling and biomechanical simulation for evaluating and improving postoperative internal instrumentation of neck-thoracic vertebral tumor en bloc resection%用三维有限元方法评价并改进全脊椎切除术后内固定模式

    Institute of Scientific and Technical Information of China (English)

    赵庆华; 李吉鹏; 张永兴; 梁鹤; 王雪鹏; 晏鹏; 吴小峰

    2015-01-01

    vertebral bodies of MPI and MPAI modeling was less than that of complete vertebral modeling.No significant differences existed between each other.But as for stress shielding effect reduction,MPI was slightly better than MPAI.Conclusion From biomechanical point of view,two internal instrumentations with neck-thoracic tumor en bloc resection may achieve an excellent stability with no significant differences.But with better stress conduction,MPI is more advantageous in postoperative reconstruction.

  6. Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation

    OpenAIRE

    Rajendra Nehete; Anita Nehete; Sandeep Singla; Harshad Adhav

    2012-01-01

    In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally s...

  7. Bilateral metachronous breast cancer with bilateral recurrences: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Park, So Hyun; Sohn, Yu Mee [Dept. of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of); Kim, Eun Kyung [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-05-15

    The incidence of bilateral breast cancer has been reported to range from 0.4% to 14%, and it increases gradually as a result of improved early detection capabilities and longer survival times. We report a rare case where the bilateral breast cancers occurred as a metachronous bilateral breast cancer with bilateral recurrences, detected by mammography, and the rapid growth of tumor that manifested as microcalcification and skin thickening within 3 months.

  8. Imaging of thoracic trauma; Radiologie des Thoraxtraumas

    Energy Technology Data Exchange (ETDEWEB)

    Uffmann, M.; Herold, C.J. [Universitaetsklinik Vienna (Austria). Inst. fuer Radiodiagnostik; Fuchs, M. [Universitaetsklinik Vienna (Austria). Inst. fuer Unfallchirurgie

    1998-08-01

    Blunt trauma to the chest results from transfer of kinetic energy to the human body. It may cause a wide range of mostly life-threatening injuries, including fractures of the thoracic skeleton, disintegration of the pleural space, contusion or laceration of pulmonary parenchyma and damage to the mediastinal structures. For a systematic approach it may be helpful to follow an organ-based evaluation of thoracic trauma. However, it should be borne in mind that subtle injuries may be associated with serious complications. Trauma to the chest may affect different anatomic compartments at the same time, requiring and extending diagnostic approach. Conventional radiography plays a major role in diagnosting thoracic trauma, complemented by ultrasound examination of the pleura and abdomen. It is well documented that CT scanning represents a major technological improvement for assessment of thoracic trauma. With the advent of fast helical CT scanning this method becomes more applicable for severly traumatized patients and potentially replaces other time-consuming procedures. State-of-the-art imaging of both projection and cross-sectional techniques provides useful information for immediate and appropriate treatment mandatory in patients with thoracic trauma. (orig.) [Deutsch] Das Trauma des Thorax ist Folge einer erheblichen, meist stumpfen Gewalteinwirkung auf den Brustkorb und geht mit einem weiten Spektrum an groesstenteils lebendsbedrohlichen Organverletzungen einher. Aus Gruenden der Uebersichtlichkeit koennen die thorakalen Verletzungen in solche des Skeletts, der Pleura, der Lungen und der mediastinalen Strukturen eingeteilt werden. Haeufig besteht jedoch eine enge Verzahnung der Pathologien, und einzelne Symptome koennen Indikatoren fuer weitere, schwerwiegende Verletzungen sein. Darueber hinaus sind extrathorakale Koerperpartien und Organsysteme oftmals mitbetroffen, so dass eine umfassende diagnostische Strategie angewendet werden muss. Die schnelle Erstversorgung

  9. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

    Energy Technology Data Exchange (ETDEWEB)

    Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)

    2015-06-15

    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

  10. Cardiopulmonary sympathetic afferent excitation of lower thoracic spinoreticular and spinothalamic neurons.

    Science.gov (United States)

    Ammons, W S

    1990-12-01

    1. Responses of spinoreticular (SRT) and spinothalamic (STT) neurons located in the T7-T9 segments to cardiopulmonary sympathetic afferent (CPS) stimuli were studied in 27 cats that were anesthetized with alpha-chloralose. 2. CPS stimulation excited 32 SRT and 10 STT neurons. Each neuron was also excited by stimulation of the left greater splanchnic nerve (SPL) and had a somatic receptive field that was most commonly located on the upper abdomen and over the lower rib cage. An additional 12 SRT and 3 STT neurons received input from SPL and somatic structures but failed to respond to CPS stimulation. 3. CPS stimulation evoked early responses (23 cells) or both early and late responses (19 cells) that had average latencies of 12.7 +/- 1.8 and 88.2 +/- 13.1 (SE) ms, respectively. Latencies of responses to SPL stimulation were significantly shorter and averaged 8.1 +/- 0.9 and 46.1 +/- 7.1 ms. Magnitudes of early responses to SPL stimulation were significantly greater than responses to CPS stimulation; however, late responses were not different. 4. Responses to CPS stimulation were inhibited by a prior conditioning stimulus applied to SPL. Greatest inhibition occurred at a conditioning-test interval of 40 ms, and inhibition lasted for at least 300 ms. Inhibition of responses to SPL stimulation could be evoked by conditioning stimuli applied to CPS; however, the inhibition was significantly less than that evoked by SPL stimulation on responses to CPS stimulation. 5. Thirty-eight neurons were tested for responses to injection of bradykinin (4 micrograms/kg) into the left atrium. Discharge rate of 17 cells increased from 5 +/- 2 to 12 +/- 4 Hz. Four cells were tachyphylactic to repeated injections. Injections of bradykinin into the thoracic aorta did not significantly alter cell activity. Bilateral cervical vagotomy had no effect on responses to intracardiac bradykinin. 6. The results indicate that lower thoracic SRT and STT neurons are excited by CPS stimuli including

  11. Thoracic surgery associations, societies, and clubs: which organizations are right for you?

    Science.gov (United States)

    Schieman, Colin; Grondin, Sean C; Gelfand, Gary A J

    2011-08-01

    Determining which organizations to join can be challenging given the wide selection of associations, societies, and clubs available to practicing thoracic surgeons. This article briefly reviews 7 important North American thoracic surgery organizations (the American Association for Thoracic Surgery, the Canadian Association of Thoracic Surgeons, the General Thoracic Surgical Club, the Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, the Western Thoracic Surgical Association, and Women in Thoracic Surgery). The authors also review the criteria that may assist in deciding which organizations best meet a surgeon's career goals and personal expectations. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    Science.gov (United States)

    Celik, Evrim Coşkun; Ozbaydar, Mehmet; Ofluoglu, Demet; Demircay, Emre

    2012-07-01

    Simultaneous and spontaneous bilateral quadriceps tendon rupture is an uncommon injury that is usually seen in association with multiple medical conditions and some medications. We report a case of simultaneous and spontaneous bilateral quadriceps tendon rupture that may be related to the long-term use of a statin.

  13. Acral osteolysis in bilateral compartment syndrome

    Directory of Open Access Journals (Sweden)

    Iram Saeed

    2008-08-01

    Full Text Available Carpal tunnel syndrome is a common neurological condition with rare yet potentially serious cutaneous and skeletal complications. We present a case of mutilating/ulcerating bilateral carpal tunnel syndrome in a 63 year old female. Radiographs showed symmetrical acral osteolysis in the index and middle fingers distal phalanges bilaterally. Carpal tunnel decompressions provided symptomatic relief.

  14. Concurrent bilateral ectopic pregnancy: a rarity

    Directory of Open Access Journals (Sweden)

    Prabhleen Kaur

    2015-08-01

    Full Text Available Bilateral ectopic pregnancy is a rare twin gestation with only a few cases reported in the literature. We report a 30 year old woman without any high risk factor for ectopic pregnancy, who had concurrent bilateral ectopic pregnancy. A 30 year old female presented to the Gynecology emergency department complaining of vaginal bleeding and abdominal pain. The presumptive diagnosis of ruptured left sided ectopic pregnancy was made on basis of clinical findings and ultrasound finings. An emergency laparotomy was done revealed a hemoperitoneum of 1.5 liters, a ruptured left tubal pregnancy with active bleeding and right tubal un-ruptured ectopic was found. A bilateral salpingectomy was performed. Histopathology confirmed presence of chorionic villi in both tubes. In theory, laparoscopic salpingostomy is the best surgical approach in bilateral tubal pregnancy. However, bilateral salpingectomy may be necessary when both tubes are extensively damaged or are actively bleeding. Successful pregnancies have been reported after conservative surgical treatment of bilateral ectopic, but the risk of recurrence is high. Our decision for an emergency laparotomy followed by bilateral salpingectomy was based on the fact that the patient presented with acute abdomen and was haemodynamically unstable and there was extensive bilateral tubal damage. As the incidence of ectopic pregnancies is increasing concurrently with the incidences of pelvic inflammatory disease and use of assisted fertility techniques; it may be that these and ldquo;rare ectopics and rdquo; will become less uncommon. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1197-1199

  15. Spontaneous bilateral adrenal hemorrhage following cholecystectomy.

    Science.gov (United States)

    Dahan, Meryl; Lim, Chetana; Salloum, Chady; Azoulay, Daniel

    2016-06-01

    Postoperative bilateral adrenal hemorrhage is a rare but potentially life-threatening complication. This diagnosis is often missed because the symptoms and laboratory results are usually nonspecific. We report a case of bilateral adrenal hemorrhage associated with acute primary adrenal insufficiency following laparoscopic cholecystectomy. The knowledge of this uncommon complication following any abdominal surgery allows timey diagnosis and rapid treatment.

  16. Thoracic fistulas of the pancreas and their complications in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Fritsch, R.; Schirg, E.; Buerger, D.

    1981-08-01

    The article reports on two thoracic fistulas of the pancreas in infants. Anamnesis revealed that recurring abdominal pain had occured in those children for years; at the time of their admission to hospital there was considerable dyspnoea with thoracic pain depending on the respiration. Fistulas of the pancreas with thoracic connection were identified as the cause. The article goes into the details of genesis, differential diagnosis and course of the disease.

  17. Totally videoscopic bilateral, simultaneous lumbar sympathectomy: original modification – preliminary report

    Directory of Open Access Journals (Sweden)

    Tomasz Stefaniak

    2010-03-01

    Full Text Available Introduction: Lumbar sympathectomy seems to be technically a much more demanding procedure than thoracic sympathectomy.Nevertheless, some patients require this particular procedure. In our centre, the operation is performed nosooner than 12 months after initial thoracic sympathectomy as a simultaneous bilateral retro-peritoneoscopic procedure.Aim: To evaluate early effectiveness of totally videoretroperitoneoscopic lumbar sympathectomy from a posteriorapproach.Material and methods: Between June 2008 and June 2009, there were 12 patients operated on for primary plantarhyperhidrosis in the Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland.A bilateral procedure was performed in 6 patients, and in 6 other cases (initial ones the procedure had to be split dueto too slow progress of the procedure (learning curve.Results: Mean operation time was 92.5 ±27.16 min (for 6 bilateral procedures and 84 ±20.17 min (for the initial12 unilateral procedures. There was no postoperative mortality. Morbidity involved post-sympathectomy syndromepresenting as moderate burning pain in the buttocks and thighs up to 4 weeks postoperatively. Postoperative stay was1 day in 7 cases and 2 days in 3 cases (due to long train travel awaiting the patient on his/her way home. In themajority of patients, early postoperative results were very good, expressed by both the subjective opinion of thepatient and gravimetric results. In one case dryness of the feet was so severe that the patient had to consult a dermatologist.Conclusions: We believe that videoretroperitoneoscopic lumbar sympathectomy from a posterior approach is a goodmethod of treatment for primary hyperhidrosis with plantar symptoms, but should be reserved for surgeonsexperienced in laparoscopic and retroperitoneoscopic surgery.

  18. Danish Exports and Danish Bilateral Aid

    DEFF Research Database (Denmark)

    Hansen, Henrik; Rand, John

    countries. This Evaluation Study presents an econometric analysis of Danish exports to 144 countries over the period from 1981 to 2010. The analysis is based on the gravity model of bilateral trade; a structural model developed over decades and now the central model in analyses of bilateral trade flows...... and trade policies. The main result of the study is that Danish bilateral aid has a positive and statistically significant impact on Danish exports to the recipient countries. Bilateral development assistance may affect exports through several channels. Three of the main channels are direct aid tying......; increasing recipient income where higher income leads to higher imports, and decreased trade costs, say due to improved information about cultural and administrative customs and practices. Thus, as for preferential trade arrangements, bilateral aid has two potential economic effects; trade creation working...

  19. Bilateral zeta functions and their applications

    CERN Document Server

    Shibukawa, Genki

    2011-01-01

    We introduce a new type of multiple zeta functions, which we call bilateral zeta functions, analogous to the Barnes zeta functions. The bilateral zeta function is a periodic function and shares certain basic properties of Barnes zeta function. Especially, we prove that the bilateral zeta function has a nice Fourier series expansion and the Barnes zeta function can be expressed as a finite sum of bilateral zeta functions. By these properties of the bilateral zeta functions, We obtain simple proofs of some formulas, for example the reflection formula for the multiple gamma function, the inversion formula of the Dedekind eta function, Ramanujan's formula, Fourier expansion of the Barnes zeta function and multiple Iseki's formula.

  20. The International Trade Network

    OpenAIRE

    Bhattacharya, K.; Mukherjee, G.; Manna, S. S.

    2007-01-01

    Bilateral trade relationships in the international level between pairs of countries in the world give rise to the notion of the International Trade Network (ITN). This network has attracted the attention of network researchers as it serves as an excellent example of the weighted networks, the link weight being defined as a measure of the volume of trade between two countries. In this paper we analyzed the international trade data for 53 years and studied in detail the variations of different ...

  1. Robotic selective postganglionic thoracic sympathectomy for the treatment of hyperhidrosis

    National Research Council Canada - National Science Library

    Coveliers, Hans; Meyer, Mark; Gharagozloo, Farid; Wisselink, Willem; Rauwerda, Jan; Margolis, Marc; Tempesta, Barbara; Strother, Eric

    2013-01-01

    ... maneuverability in a confined space may facilitate the technique of selective sympathectomy (ramicotomy). We present a case series of patients undergoing selective postganglionic thoracic sympathectomy using robotic technology...

  2. [Inadvertent thoracic duct puncture during right axially central venous cannulation].

    Science.gov (United States)

    Kawashima, Shingo; Itagaki, Taiga; Adachi, Yushi; Ishii, Yasuhiro; Taniguchi, Midzuki; Doi, Matsuyuki; Sato, Shigehito

    2010-10-01

    A case of inadvertent thoracic duct puncture during right axially central venous cannulation is reported. The catheterization was performed under the real time ultrasound guidance technique and the coronal view image was continuously displayed. After confirming the feelings of venous puncture, clear yellow fluid was aspired into the connected syringe to the needle. Initially, an accidental thoracic puncture with subsequent pleural fluid aspiration was suspected;however, no finding of pleural effusion was observed with ultrasound imaging and computed tomography. Thus, an accidental thoracic duct puncture and the subsequent lymph fluid aspiration were suspected. Even in a right side approach for central venous catheterization, thoracic duct injury might ensure.

  3. The Askin tumour. Neuroactodermic tumour of the thoracic wall; Tumor de Askin: tumor neuroectodermico de la pared toracica

    Energy Technology Data Exchange (ETDEWEB)

    Velazquez, P.; Nicolas, A. I.; Vivas, I.; Damaso Aquerreta, J.; Martinez-Cuesta, A. [Clinica Universitaria de Navarra. Pamplona (Spain)

    1999-07-01

    The Askin tumours is an extremely rare and malignant process in the thoracic pulmonary region during infancy and youth. The differential diagnosis has to be considered with other thoracic wall tumours that are more common in pediatrics like the undifferentiated neuroblastoma, the embionic rabdomiosarcoma, the Ewing sarcoma and the linfoma. A retrospective examination was carried out on 473 thoracic wall tumours from 1994 to 1997 at our centre, resulting in 4 patients with an anatomopathologically tested Askin tumour (ages from 13-21). All the cases were studied using simple radiography and CT. In two cases MRI was also used. The most common clinical manifestation was a palpable painful mass in the thoracic wall. In the simple radiograph the main finding was a large mass of extrapleural soft material, with costal destruction ( n=3) and a pleural effusion (n=2). In the CT study the mass was heterogeneous, with internal calcifications in one case. CT and MRI showed invasion in the mediastinum (n=1), medular channel (n=1) and phrenic and sulphrenic extension (n=1). The Askin tumour should be included in the differential diagnosis of thoracic wall masses in infant-youth ages. There are no specific morphological characteristics. Both CT and MRI are useful for the diagnosis, staging and follow up. (Author) 11 refs.

  4. The Nuss technique for Jeune asphyxiating thoracic dystrophy repair in siblings.

    Science.gov (United States)

    Kikuchi, Noriaki; Kashiwa, Hideo; Ogino, Toshihoko; Kato, Mituhiro; Hayasaka, Kiyoshi

    2010-08-01

    Jeune syndrome, or asphyxiating thoracic dysplasia, is an autosomal recessive osteochondrodysplasia. Four forms of Jeune syndrome have been proposed: lethal, severe, mild, and latent. In the severe form, respiratory failure leads to death in early infancy. We present 2 cases of a mild variant of Jeune syndrome in a 14-year-old girl and her 9-year-old brother, who were referred to us because of characteristic concave deformities of bilateral middle-lower chest walls without cardiopulmonary distress or renal failure. In addition, both showed short statue (-2.1 and -2.5 SD), progressive retinal dystrophy, and metaphyseal dysplasia (cone-shaped metaphysis and metacarpal brachydactyly). The chest wall deformity was treated at the age of 9 years in the sister and at the age of 7 years in the brother. According to the Nuss procedure, 2 bent bars were inserted into the thoracic cavity from each lateral intercostal space at the midaxillary line and pulled out over the lower end of the sternum. The ends of inserted bars were fixed to soft tissue over the sternum with nonabsorbable sutures. Conjoined costal cartilage around the sternum restricts the number of bars that can be positioned. A single bar for deformity of each side could not achieve complete reconstruction, but the patients and their parents were satisfied with the results cosmetically.

  5. Nonintubated Needlescopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis: A Randomized Controlled Trial.

    Science.gov (United States)

    Chen, Jian-Feng; Lin, Min; Chen, Ping; Quan, Du; Li, Xu; Lai, Fan-Cai; Tu, Yuan-Rong

    2016-08-01

    Conventional endoscopic thoracic sympathectomy (ETS) is usually performed with 5-mm thoracoscope under general anesthesia with endotracheal intubation. Needlescopic thoracic sympathectomy under total intravenous anesthesia without intubation has rarely been attempted. This randomized controlled trial assesses the feasibility and safety of this minimally invasive therapeutic procedure in managing primary palmar hyperhidrosis. From July 2012 to July 2014, 221 patients with severe primary palmar hyperhidrosis underwent bilateral ETS and were randomly allocated to group A or group B. Patients in group A (n=108) underwent nonintubated ETS using a needle endoscope, whereas those in group B (n=113) underwent traditional transaxillary single-port ETS using a 5-mm thoracoscope. ETS was successfully performed in all patients. The palms of all patients became dry and warm immediately after surgery. The mean resuscitation time was significantly shorter in nonintubated patients than in intubated patients (Pthoracic sympathectomy is a safe, effective, and minimally invasive therapeutic procedure, which has the advantages of a smaller incision with less pain, shorter resuscitation time, and better cosmetic results.

  6. Artéria torácica interna enxertada: patência e estado funcional em repouso e após dobutamina Internal thoracic artery graft (ITAG: patency and functional status at rest and during dobutamine-stress echocardiography

    Directory of Open Access Journals (Sweden)

    José Sebastião de Abreu

    2008-01-01

    Full Text Available FUNDAMENTO: A artéria torácica interna enxertada (ATIE patente usualmente tem fração diastólica (FD> 50% do fluxo. O estado funcional pode ser avaliado pelo índice de reserva coronariano (IRC. OBJETIVO: Avaliar, pela ecocardiografia e pelo Doppler em nível supraclavicular, a patência e o estado funcional da ATIE. MÉTODOS: Foram coletados prospectivamente e analisados os dados de 66 pacientes submetidos a ecocardiograma sob estresse com dobutamina (EED. O grupo I (GI ocorreu com 49 ATIE sem estenose. No grupo II (GII (10 ATIE havia estenose significativa (> 50% e 50%, ocorreu em 49 ATIE (GI=40, GII=8 e GIII=1 no repouso e em 61 ATIE (GI=49, GII=10 e GIII=2 durante EED. Sensibilidade, especificidade, valor preditivo positivo (VPP, valor preditivo negativo (VPN e acurácia foram, respectivamente, em repouso, 81%, 86% ,98%, 35 % e 82%; e no EED, 100%, 71%, 97%, 100% e 97%. As ATIE com FD>50% em repouso estavam patentes e as com FD1,8, isso ocorreu em 42 ATIE (39 do GI, 2 do GII e 1 GIII, verificando-se sensibilidade = 79%; especificidade = 85,7%; VPP = 94%; VPN = 59%; e acurácia = 80,9%. O IRC no GI foi maior (p=0,02 que em GII e GIII. CONCLUSÃO: Em nosso estudo, a avaliação não-invasiva da ATIE foi efetiva para verificar patência e estado funcional.BACKGROUND: The patent internal thoracic artery graft (ITAG usually has a diastolic fraction (DF > 50% of the flow. The functional assessment can be evaluated by the coronary reserve index (CRI. OBJECTIVE: The objective was to evaluate the patency and functional status of the ITAG through echocardiography and Doppler. METHODS: Data from sixty-six patients who underwent dobutamine-stress echocardiography (DSE were prospectively collected and analyzed. Group I (GI had 49 ITAG without stenosis, Group II (GII, 10 ITAG with significant stenosis (> 50% and 50%, it was observed in 49 ITAG (GI= 40, GII= 8 and GIII= 1 at rest and in 61 ITAG (GI=49, GII=10 and GIII=2 during DSE. The sensitivity

  7. [Treatment of thoracic disc herniation. Case report].

    Science.gov (United States)

    Picado-Baca, Mauricio Leonardo; Mireles-Cano, José Nicolás; León-Meza, Víctor Manuel; García-González, Oscar Guillermo; Ramos-Trujillo, Alejandro

    2016-01-01

    Herniated thoracic intervertebral disc is a rare cause of spinal cord compression. Its frequency varies from 0.15% to 1.7% of all disc herniations, and produces symptoms in 0.5% to 0.8%. Case 1. A 50-year-old woman, with pain and burning sensation in left hemithorax of four months of onset. It was treated as a herpetic syndrome, with no improvement. She was seen after thirteen days of exacerbation of clinical symptoms. The physical examination showed asymmetric paraparesis, lower left pelvic limb 1/5, and right pelvic limb 3/5¸ sensory level T8, with left Babinski positive. A thoracic disc herniation in space T8-T9 was diagnosed. A 55-year-old patient with a history of presenting pain in lumbar area of 5 years onset. She also had radicular pain that radiated to the right pelvic limb, with intensity 10/10 on a Visual Analogue Scale. Her physical examination showed muscle strength 5/5, with normal sensitivity in all dermatomes and tendon reflexes, and a positive right Babinski. Thoracic disc herniation T7-T8 level was diagnosed. Due to anatomical conditions that define this type of hernia, the extracavitary posterolateral approach should be the recommended surgical procedure when the simultaneously performed anterior decompression and fixation with posterior instrumentation are the treatments proposed. Despite the different anatomical structures of this special area, it was possible to obtain satisfactory results for both clinical cases. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  8. Thoracic sympathetic block reduces respiratory system compliance

    Directory of Open Access Journals (Sweden)

    Fábio Ely Martins Benseñor

    Full Text Available CONTEXT AND OBJECTIVE: Thoracic epidural anesthesia (TEA following thoracic surgery presents known analgesic and respiratory benefits. However, intraoperative thoracic sympathetic block may trigger airway hyperreactivity. This study weighed up these beneficial and undesirable effects on intraoperative respiratory mechanics. DESIGN AND SETTING: Randomized, double-blind clinical study at a tertiary public hospital. METHODS: Nineteen patients scheduled for partial lung resection were distributed using a random number table into groups receiving active TEA (15 ml 0.5% bupivacaine, n = 9 or placebo (15 ml 0.9% saline, n = 10 solutions that also contained 1:200,000 epinephrine and 2 mg morphine. Under general anesthesia, flows and airway and esophageal pressures were recorded. Pressure-volume curves, lower inflection points (LIP, resistance and compliance at 10 ml/kg tidal volume were established for respiratory system, chest wall and lungs. Student’s t test was performed, including confidence intervals (CI. RESULTS: Bupivacaine rose 5 ± 1 dermatomes upwards and 6 ± 1 downwards. LIP was higher in the bupivacaine group (6.2 ± 2.3 versus 3.6 ± 0.6 cmH2O, p = 0.016, CI = -3.4 to -1.8. Respiratory system and lung compliance were higher in the placebo group (respectively 73.3 ± 10.6 versus 51.9 ± 15.5, p = 0.003, CI = 19.1 to 23.7; 127.2 ± 31.7 versus 70.2 ± 23.1 ml/cmH2O, p < 0.001, CI = 61 to 53. Resistance and chest wall compliance showed no difference. CONCLUSION: TEA decreased respiratory system compliance by reducing its lung component. Resistance was unaffected. Under TEA, positive end-expiratory pressure and recruitment maneuvers are advisable.

  9. Idiopathic thoracic aortic aneurysm at pediatric age.

    Science.gov (United States)

    Marín-Manzano, E; González-de-Olano, D; Haurie-Girelli, J; Herráiz-Sarachaga, J I; Bermúdez-Cañete, R; Tamariz-Martel, A; Cuesta-Gimeno, C; Pérez-de-León, J

    2009-03-01

    A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

  10. Video-Assisted Thoracic Sympathectomy for Hyperhidrosis.

    Science.gov (United States)

    Milanez de Campos, Jose Ribas; Kauffman, Paulo; Gomes, Oswaldo; Wolosker, Nelson

    2016-08-01

    By the 1980s, endoscopy was in use by some groups in sympathetic denervation of the upper limbs with vascular indications. Low morbidity, cosmetic results, reduction in the incidence of Horner syndrome, and the shortened time in hospital made video-assisted thoracic sympathectomy (VATS) better accepted by those undergoing treatment for hyperhidrosis. Over the last 25 years, this surgical procedure has become routine in the treatment of hyperhidrosis, leading to a significant increase in the number of papers on the subject in the literature.

  11. Operativ behandling af thoracic outlet syndrome

    DEFF Research Database (Denmark)

    Birkeland, Peter; Stiasny, Jerzy

    2012-01-01

    We present three cases with longstanding true neurogenic thoracic outlet syndrome. All patients had aching pain in the shoulder, arm and ulnar border of the hand. On examination, we found atrophy of the hand muscles. Electromyography revealed signs of compromised function of the inferior trunk...... of the brachial plexus. At surgery, we found and severed a fibrous band that compressed the inferior trunk. Postoperatively, the pain subsided and fine hand movements improved. One patient had no cervical rib, however, in the two other cases we found rudimentary cervical ribs. Magnetic resonance imaging...

  12. Thoracic ectopia cordis with anatomically normal heart.

    Science.gov (United States)

    Gonçalves, Flávio Donizete; Novaes, Fernando Rotatori; Maia, Marcelo Alves; Barros, Francisco de Assis

    2007-01-01

    Ectopia cordis is a rare congenital malformation, which is commonly associated with other intracardiac defects. At two-day-old full-term baby girl was admitted to Santa Casade Misericórdia Hospital Montes Claros, NG, Brazil, with thoracic ectopia cordis. A transthoracic echocardiographic study did not identify any associated congenital heart diseases. The infant underwent surgical treatment using a rib graft to create a neo-sternum. She was discharged after presenting a good outcome on the 20th postoperative day.

  13. Digital subtraction angiography of the thoracic aorta

    Energy Technology Data Exchange (ETDEWEB)

    Grossman, L.B.; Buonocore, E.; Modic, M.T.; Meaney, T.F.

    1984-02-01

    Forty-three patients with acquired and congenital abnormalities of the thoracic aorta were studied using digital subtraction angiography (DSA) after an intravenous bolus injection of 40 ml of contrast material. Abnormalities studied included coarctation, pseudocoarctation, Marfan syndrome, cervical aorta, double aortic arch, aneurysm, dissection, and tumor. Twenty-four patients also had conventional angiography. DSA was accurate in 95% of cases; in the other 5%, involving patients with acute type I dissection, the coronary arteries could not be seen. The authors concluded that in 92% of their patients, DSA could have replaced the standard aortogram.

  14. Heterochronic bilateral ectopic pregnancy after ovulation induction.

    Science.gov (United States)

    Zhu, Bo; Xu, Gu-feng; Liu, Yi-feng; Qu, Fan; Yao, Wei-miao; Zhu, Yi-min; Gao, Hui-juan; Zhang, Dan

    2014-08-01

    Ectopic pregnancy is identified with the widely-applied assisted reproductive technology (ART). Bilateral ectopic pregnancy is a rare form of ectopic pregnancy which is difficult to be diagnosed at the pre-operation stage. In this paper, we presented an unusual case of heterochronic bilateral ectopic pregnancy after stimulated intrauterine insemination (IUI), where there has been a delay of 22 d between the diagnoses of the two ectopic pregnancies. Literature was reviewed on the occurrence of bilateral ectopic pregnancy during the past four years in the MEDLINE database. We found 16 cases of bilateral ectopic pregnancy reported since 2008, and analyzed the characteristics of those cases of bilateral ectopic pregnancy. We emphasize that ovulation induction and other ARTs may increase the risk of bilateral ectopic pregnancy. Because of the difficulty in identification of bilateral ectopic pregnancy by ultrasonography, the clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operation inspection of both side fallopian tubes in any ectopic pregnancy case.

  15. Bilateral optic neuropathy in acute cryptococcal meningitis

    Institute of Scientific and Technical Information of China (English)

    Qi Zhe Ngoo; Li Min Evelyn Tai; Wan Hazabbah Wan Hitam; John Tharakan

    2016-01-01

    We reported a case of cryptococcal meningitis presenting with bilateral optic neuropathy in an immunocompetent patient. A 64-year-old Malay gentleman with no medical comorbidities presented with acute bilateral blurring of vision for a week, which was associated with generalised throbbing headache and low grade fever. He also had som-nolence and altered consciousness. Visual acuity in both eyes was no perception of light with poor pupillary reflexes. Extraocular muscle movements were normal. Anterior segments were unremarkable bilaterally. Fundoscopy revealed bilateral optic disc swelling. CT scan of the brain showed multifocal infarct, but no meningeal enhancement or mass. Cerebrospinal fluid opening pressure was normal, while its culture grew Cryptococcus neoformans. A diagnosis of cryptococcal meningitis with bilateral optic neuropathy was made. Patient was treated with a six-week course of intravenous flu-conazole and started concomitantly on a fortnight's course of intravenous amphotericin B. After that, his general condition improved, but there was still no improvement in his visual acuity. On reviewing at two months post-initiation of treatment, fundi showed bilateral optic atrophy. Bilateral optic neuropathy secondary to cryptococcal meningitis was rare. The prognosis was guarded due to the sequelae of optic atrophy. Anti-fungal medication alone may not be sufficient to manage this condition. However, evidence for other treatment modalities is still lacking and further clinical studies are required.

  16. Fratura bilateral de primeira costela em mergulho com colete salva-vidas Bilateral first rib fracture in a dive with life vest

    Directory of Open Access Journals (Sweden)

    Pietro de Almeida Sandri

    2010-06-01

    Full Text Available As fraturas de primeira costela são incomuns e geralmente associadas a grandes traumas torácicos a ponto de servirem como associação com a gravidade do trauma. As fraturas isoladas bilaterais de primeira costela sem grandes traumas torácicos são raramente descritas na literatura. Os sintomas podem passar despercebidos e serem minimizados dificultando o diagnóstico desta condição. O presente relato mostra um trauma direto sobre a região supraclavicular com sintomas de contusão do plexo braquial numa queda de jet ski com uso de salva-vidas. É feita uma revisão da literatura mostrando as diversas faces do problema discutindo-se o tratamento desta condição.First rib fractures are uncommon and are generally related to major thoracic traumas, so much so that they indicate the severity of the trauma. Isolated bilateral first rib fractures without major thoracic trauma are rarely described in the literature. Symptoms may go unnoticed and could be minimal, making diagnosis of this condition difficult. The present report presents a direct trauma of the supraclavicular region with symptoms of contusion of the brachial plexus, caused by a fall from a jet ski using a life vest. A review was done of literature indicating the various facets of the problem and discussing treatment of this condition.

  17. Fístula de enxerto coronariano da artéria torácica interna esquerda para artéria pulmonar esquerda após cirurgia de revascularização miocárdica: causa rara de isquemia miocárdica Left internal thoracic artery to left pulmonary artery fistula after coronary artery bypass graft surgery: a rare cause of myocardial ischemia

    Directory of Open Access Journals (Sweden)

    Gustavo Luiz Gouvêa de Almeida Júnior

    2005-11-01

    Full Text Available Descrevemos o caso de um paciente que, seis anos após cirurgia de revascularização do miocárdio, desenvolveu dispnéia aos pequenos esforços. Foi documentada isquemia miocárdica por método de medicina nuclear e a cineangiocoronariografia mostrou todos os enxertos patentes com grande fístula da artéria torácica interna esquerda para artéria pulmonar esquerda. O paciente foi tratado com fechamento cirúrgico da fístula, tendo ótima evolução pós-operatória.We report a patient who developed dyspnea on mild exertion six years after coronary artery bypass graft surgery (CABG. Myocardial ischemia was documented by radionuclide imaging, and coronary angiography showed patency of all grafts and a large fistula between the left internal thoracic artery (LITA and the left pulmonary artery (LPA. The patient was submitted to surgical closure of the fistula and made an excellent recovery.

  18. Sound localization ability of young children with bilateral cochlear implants.

    NARCIS (Netherlands)

    Beijen, J.W.; Snik, A.F.M.; Mylanus, E.A.M.

    2007-01-01

    OBJECTIVE: To evaluate the benefit of bilateral cochlear implantation in young children. STUDY DESIGN: Clinical trial comparing a group of bilaterally implanted children with a group of unilaterally implanted children. SETTING: Tertiary referral center. PATIENTS: Five bilaterally implanted children

  19. A rat model for isolated bilateral lung contusion from blunt chest trauma.

    Science.gov (United States)

    Raghavendran, Krishnan; Davidson, Bruce A; Helinski, Jadwiga D; Marschke, Cristi J; Manderscheid, Patricia; Woytash, James A; Notter, Robert H; Knight, Paul R

    2005-11-01

    Lung contusion affects 17%-25% of adult blunt trauma patients, and is the leading cause of death from blunt thoracic injury. A small animal model for isolated bilateral lung contusion has not been developed. We induced lung contusion in anesthetized rats by dropping a 0.3-kg weight onto a precordial protective shield to direct the impact force away from the heart and toward the lungs. Lung injury was characterized as a function of chest impact energy (1.8-2.7 J) by measurements of arterial oxygenation, bronchoalveolar lavage (BAL) albumin and cytology, pressure-volume mechanics, and histopathology. Histology confirmed bilateral lung contusion without substantial cardiac muscle trauma. Rats receiving 2.7 J of chest impact energy had 33% mortality that exceeded prospectively defined limits for sublethal injury. Hypoxemia in rats with maximal sublethal injury (2.45 J) met criteria for acute lung injury at lung volumes at 48 h. We concluded that an impact energy of 2.45 J induces isolated, bilateral lung contusion and provides a useful model for future mechanistic pathophysiological assessments.

  20. Trends and current status of general thoracic surgery in Japan revealed by review of nationwide databases.

    Science.gov (United States)

    Okumura, Meinoshin

    2016-08-01

    Nationwide databases of cases treated for thoracic disease have been established by several academic associations in Japan, which contain information showing trends and current status in regard to surgical treatment. The Japanese Association of Thoracic Surgery (JATS), Japanese Association of Chest Surgery (JACS), Japan Lung Cancer Society (JLCS), Japanese Respiratory Society (JRS), and Japan Society for Respiratory Endoscopy (JSRE) have maintained databases of lung cancer cases treated in Japan. In 1986, the number of general thoracic surgery cases was 15,544, which increased to 75,306 in 2013. Furthermore, the number of lung cancer operations performed in 2013 was 37,008, occupying 49.1% of all general thoracic operations. Also, the proportions of adenocarcinoma, female patients, aged patients, stage I disease, and limited resection procedures are increasing in lung cancer surgery cases. While the 5-year overall post-operative survival rate of lung cancer patients was 47.8% in those undergoing surgery in 1989, it was 69.6% in those of 2004, which means 22% increase during 15 years. JATS, JACS, and the Japanese Association for Research of the Thymus (JART) have maintained retrospective databases of thymic epithelial tumor cases. The number of mediastinal tumors surgically treated is also increasing and was 4,780 in 2013, among which thymoma was the most prevalent. The Japanese Association for Lung and Heart-Lung Transplantation has developed a prospective nationwide database of lung transplantation cases in Japan, which contains clinical data for 466 patients who received lung transplantation or heart-lung transplantation from 1998 to 2015. Nationwide databases are currently being utilized for clinical studies and will also contribute to international projects related to the Union for International Cancer Control (UICC) tumor, node, and metastasis (TNM) classification system.

  1. Bilateral Petit’s Triangle Hernia

    Directory of Open Access Journals (Sweden)

    Sanjay Kumar Bhasin, Arshad Bashir Khan, Sanjay Sharma

    2006-07-01

    Full Text Available Lumbar traingle hernia that occurs through lumbar triangles is very rare type of hernia. Only about 300 cases havebeen reported till date. Bilateral Petit’s triangle hernia find further rarity and the case under reference is probably thefirst ever reported case of Primary bilateral Petit’s triangle hernia. The present case is of a 46 years old married,multigravida female who presented with 1 year duration of LBA and subsequently notice of swelling both sides oflow back. FNAC revealed lipoma and on exploration it turned out to be rarest extra peritoneal bilateral Petit’s trianglehernia, fat as contents.

  2. [Bilateral persistent hyaloid artery. A case report].

    Science.gov (United States)

    Borbolla-Pertierra, A M; Martínez-Hernández, C K; Juárez-Echenique, J C

    2014-06-01

    A 5-year-old male presented with bilateral poor vision, esotropia and a previous diagnosis of cataract since he was 1 year old. The physical examination revealed bilateral posterior paracentric capsule opacification, vitreous cavity with a permeable pulsatile blood filled hyaloid artery in both eyes. He was kept under observation. Persistent hyaloid artery is an uncommon faulty primary vitreous regression, often unilateral (although it may be bilateral) and sporadic, associated with microphthalmos. It may be complicated with glaucoma and phthisis bulbi. Vitrectomy plus lensectomy or simple observation are the accepted treatment options. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  3. Expression of p-PPARγ in the aging thoracic aorta of spontaneously hypertensive rat and inhibitory effect of rosiglitazone

    Institute of Scientific and Technical Information of China (English)

    Hai-Feng; Yuan; Xiao-Lin; Niu; Deng-Feng; Gao; Guang-Hua; Hao; An-Qi; Song; Jin; Wei

    2014-01-01

    Objective:To investigate the expression of phosphorylated peroxisome proliferators-activated receptor y(p-PPARY) in the aging thoracic aorta of spontaneously hypertensive rat(SHR) and the inhibitory effect of rosiglitazone on the phosphorylation of PPART.Methods:16,32 and 64 week-old Wistar-Kyoto rats(WKY) and SHR were randomly and respectively divided into WKY,SHR and SHR+rosiglitazone group(9 in each group).The rats in SHR+rosiglitazone group were treated with rosiglitazone(5 mg/kg,intragastrically) for 56 d,whereas normal saline was applied in WKY and SHR groups.Systolic blood pressure(SBP)of rats was measured by tail cuff method.Histopathological damage of thoracic aorta was analyzed using Hematoxylin-Eosin(HE) staining.Immunohistochemical staining and western blot were performed to test the level of p-PPARY protein in the thoracic aorta arising from each group.Results:The SBP in 16,32 and 64 week-old SHR were significantly higher as compared with those in matched WKY rats(P<0.05,respectively).HE staining showed increased content of smooth muscle cell,wrinkled lining endothelium and increased thickness of internal elastic lamina in the thoracic aorta of SHR.Immunohistochemical staining and western blot indicated that the levels of p-PPARY in the thoracic aorta arising from SHR were obviously higher than those in the thoracic aorta arising from WKY rats(P<0.05,respectively).Importantly,the high SBP,histopathological abnormalities of the thoracic aorta and elevated p-PPARY expression were prominently abrogated by rosiglitazone treatment in SHR(P<0.05,respectively).Furthermore,the SBP,histopathological abnormalities of the thoracic aorta and p-PPARY expression were positively correlated with age in SHR(P<0.05,respectively).Conclusions:The PPARY phosphorylation was observed in the thoracic aorta of SHR and its expression was increased by the increase of age.Furthermore,rosiglitazone inhibited the PPARY phosphorylation and suppressed vascular aging in SHR.

  4. November 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2014 Arizona Thoracic Society meeting was held on Wednesday, November 19, 2014 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were about 30 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. Jud Tillinghast was nominated as the Arizona Thoracic Society physician of the year. Three cases were presented: 1. George Parides presented a case of a 70-year-old woman with a 3 areas of ground glass picked up incidentally on CT scan. She had some wheezing. A needle biopsy revealed adenocarcinoma. The biopsy and radiologic pattern were consistent with adenocarcinoma in situ or minimally invasive adenocarcinoma. Discussion centered around treatment. Most felt that if the areas could be removed that surgical resection was indicated (1. 2. Lewis Wesselius presented a 60-year-old man with Marfan's syndrome and a history of an aortic valve replacement on chronic ...

  5. May 2013 Arizona Thoracic Society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-05-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on Wednesday, 5/15/2013 at Scottsdale Shea beginning at 6:30 PM. There were 13 in attendance representing the pulmonary, critical care, sleep, thoracic surgery, and radiology communities. Dr. George Parides will have served his 2 year tenure as Arizona Thoracic Society President by July, 2013. However, he will be unable to attend the June meeting and for this reason Presidential elections were held. Dr. Lewis Wesselius was nominated and unanimously elected as President. Three cases were presented:1. Dr. Gerald Schwartzberg presented the case of a 49 year old woman with a history of Valley Fever in 2009. She was a nonsmoker and had no other known medical diseases. However, she developed shortness of breath beginning earlier this year along with a cough productive of clear, jelly-like sputum. Her physical was normal. Pulmonary function testing revealed restrictive disease with significant improvements in the FEV1 and FVC …

  6. Video-Assisted Thoracic Surgery Study Group.

    Science.gov (United States)

    LoCicero, J

    1993-09-01

    Both patients and the medical profession are quick to embrace new technology, particularly when it may replace an existing surgical procedure. Unfortunately, the rapidity of acceptance is rarely associated with careful evaluation. Laparoscopy is a recent example of such widely embraced technology. Studies of laparoscopy that yielded good comparative data to more traditional methods were slow to accrue. This led to the exposure of its shortcomings through governmental reports and the lay press. To prevent this from happening in thoracoscopy, two types of studies are required so that valid conclusions about the new technology can be drawn. The first is an accounting of the new technology as procedures evolve around it. The data collected in such a study should contain basic information, including the indications for the procedure, how it was performed, procedure length, associated complications, and patient outcome. Such information provides a broad profile of the technology, emphasizing from the outset its potential strengths and weaknesses. The second type of study involves a more detailed concurrent comparison of the specific procedures utilizing this technology to the established traditional methods. Such randomized studies help to firmly establish through scientific process the place of the new technology. The Video-Assisted Thoracic Surgery Study Group was organized in early 1992 to address these concerns. From an initial four surgeons the group has grown to include more than 41 institutions. Currently the group is collecting data in a registry and has established three clinical trials to evaluate video-assisted thoracic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Surgical efficacy of minimally invasive thoracic discectomy.

    Science.gov (United States)

    Elhadi, Ali M; Zehri, Aqib H; Zaidi, Hasan A; Almefty, Kaith K; Preul, Mark C; Theodore, Nicholas; Dickman, Curtis A

    2015-11-01

    We aimed to determine the clinical indications and surgical outcomes for thoracoscopic discectomy. Thoracic disc disease is a rare degenerative process. Thoracoscopic approaches serve to minimize tissue injury during the approach, but critics argue that this comes at the cost of surgical efficacy. Current reports in the literature are limited to small institutional patient series. We systematically identified all English language articles on thoracoscopic discectomy with at least two patients, published from 1994 to 2013 on MEDLINE, Science Direct, and Google Scholar. We analyzed 12 articles that met the inclusion criteria, five prospective and seven retrospective studies comprising 545 surgical patients. The overall complication rate was 24% (n=129), with reported complications ranging from intercostal neuralgia (6.1%), atelectasis (2.8%), and pleural effusion (2.6%), to more severe complications such as pneumonia (0.8%), pneumothorax (1.3%), and venous thrombosis (0.2%). The average reported postoperative follow-up was 20.5 months. Complete resolution of symptoms was reported in 79% of patients, improvement with residual symptoms in 10.2%, no change in 9.6%, and worsening in 1.2%. The minimally invasive endoscopic approaches to the thoracic spine among selected patients demonstrate excellent clinical efficacy and acceptable complication rates, comparable to the open approaches. Disc herniations confined to a single level, with small or no calcifications, are ideal for such an approach, whereas patients with calcified discs adherent to the dura would benefit from an open approach.

  8. September 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-09-01

    Full Text Available No abstract available. Article truncated at 150 words. The September 2017 Arizona Thoracic Society meeting was held on Wednesday, September 27, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 16 in attendance representing the pulmonary, critical care, sleep, and radiology communities. There was a discussion of the Tobacco 21 bill which had been introduced the last session in the Arizona State Legislature. Since it seems likely that the bill will be reintroduced, the Arizona Thoracic Society will support the bill in the future. Dr. Rick Robbins announced that the SWJPCC has applied to be included in PubMed. In addition, Dr. Robbins was assigned the task of tracking down the campaign contributions to congressional members from the tobacco PAC before the next election. There were 7 case presentations: 1.\tAshley L. Garrett, MD, pulmonary fellow at Mayo, presented an elderly man with insulin-dependent diabetes who felt he …

  9. Thoracic Ganglioneuromas Resulting in Nonimmune Hydrops Fetalis

    Directory of Open Access Journals (Sweden)

    Paul Singh

    2014-05-01

    Full Text Available Introduction - Most often, ganglioneuromas affect older pediatric and adult patients. They are typically slow growing tumors that remain clinically silent until they become large enough to cause symptoms by compression of adjacent structures. Case - We report a case of a 22-year-old Hispanic gravida 2 para 1 female patient who was found to have massive hydrops fetalis at 20 completed gestational weeks. Fetal echocardiography revealed a narrowed distal ductal arch and proximal descending aorta. Cesarean delivery was undertaken at 29 completed gestational weeks for refractory labor and nonreassuring fetal status. The neonate expired at 47 minutes of life despite aggressive resuscitation. At autopsy, multiple thoracic masses were found adjacent to a compressed proximal descending aorta. Histological and immunohistochemical analysis confirmed the diagnosis of a ganglioneuroma, a rare type of neural crest tumor. Discussion - A variety of intrathoracic masses have previously been reported to cause hydrops fetalis including teratomas, fibrosarcomas, and lymphangiomas. To our knowledge, this case is the first description of hydrops fetalis caused by ganglioneuromas. We propose that multiple thoracic ganglioneuromas led to biventricular distal outflow tract obstruction and hydrops fetalis.

  10. Thoracic empyemas necessitating surgical management CT criteria

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Soo; Hwang, Sun Hee; Kim, Yong Hoon; Noh, Joong Kee; Lee, Byoung Ho [College of Medicine, Soonchunhyang University, Asan (Korea, Republic of)

    1991-07-15

    Thoracic empyemas are usually classified into 3 stages. Stage 1 empyemas are exudative, characterized by thin pleural fluid with a low white blood cell count. Stage 2 empyemas are fibrinopurulent, characterized by thicker, more turbid fluid with the appearance of fibrin on the pleural surfaces that begins to form a peel around the lung. Stage 2 empyemas are chronic, characterized by a thickened pleural peel with infiltration of the fibroblasts, entrapment of the lung, and restriction of lung motion. Patients with stage 1 empyemas are usually treated with antibiotics alone, while patients with stage 2 empyemas can be managed with thoracentesis, percutaneous catheter drainage (PCD), or tube thoracostomy. Multiloculation of empyemas, usually formed during the late period of stage 2 when fibrin is deposited on the pleural surface, is a major cause of failure of closed drainage including PCD and tube thoracostomy. In our previous study, we suggest that multiloculated empyemas can be treated with intracavitary instillation of urokinase. In summary, we conclude that CT can determine the surgical criteria for thoracic empyemas, and multiloculated empyemas may no longer be an indication of surgical treatment.

  11. Thoracic surgery in the real world: does surgical specialty affect outcomes in patients having general thoracic operations?

    Science.gov (United States)

    Ferraris, Victor A; Saha, Sibu P; Davenport, Daniel L; Zwischenberger, Joseph B

    2012-04-01

    Most general thoracic operations in the United States are performed by general surgeons. Results obtained by those identified as general surgeons are often compared with those identified as thoracic surgeons. We interrogated the American College of Surgeons National Surgical Quality Improvement Project database over a 5-year period to compare outcomes in patients who underwent similar operations by surgeons identified as either thoracic surgeons or general surgeons. We employed propensity-score matching to minimize confounding when estimating the effect of surgeon identity on postoperative outcomes. During the study period, thoracic surgeons performed 3,263 major pulmonary or esophageal operations, and general surgeons performed 15,057 similar operations. Compared with patients operated on by general surgeons, patients operated on by thoracic surgeons had significant excess multivariate comorbidities, including insulin-dependent diabetes mellitus, chronic obstructive pulmonary disease, concurrent pneumonia, congestive heart failure, previous cardiac surgery, dialysis-dependent renal failure, disseminated cancer, prior sepsis, and previous operation within 30 days. Likewise, patients in highest risk categories had operations performed by thoracic surgeons more commonly than by general surgeons. Unadjusted comparisons for mortality and serious morbidity showed significantly worse mortality and pulmonary complications in patients operated on by thoracic surgeons. However, with propensity matching according to surgeon type, thoracic surgeons had significantly fewer serious adverse outcomes compared with general surgeons, and this decreased morbidity occurred in a higher risk cohort. Our results show that patients operated on by thoracic surgeons have higher acuity compared with patients operated on by general surgeons. When patients are matched for comorbidities and serious preoperative risk factors, thoracic surgeons have improved outcomes, especially with regard to

  12. Thoracic sympathectomy for digital ischemia : A summary of evidence

    NARCIS (Netherlands)

    Coveliers, Hans M. E.; Hoexum, Frank; Nederhoed, Johanna H.; Wisselink, Willem; Rauwerda, Jan A.

    2011-01-01

    Background: Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of digital ischemia. Methods: We reviewed the English literature between 1980 and 2010. Our analysis included reports with the

  13. Video-Assisted Thoracic Surgery in Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Calvin SH Ng

    2002-01-01

    Full Text Available The proven safety and efficacy of minimal access video-assisted thoracic surgery has changed the way that spontaneous pneumothorax is managed. This review presents some of the experiences of the decade, discusses the controversies and reviews the current video-assisted thoracic surgical management of spontaneous pneumothorax.

  14. Thoracic sympathectomy for digital ischemia : A summary of evidence

    NARCIS (Netherlands)

    Coveliers, Hans M. E.; Hoexum, Frank; Nederhoed, Johanna H.; Wisselink, Willem; Rauwerda, Jan A.

    Background: Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of digital ischemia. Methods: We reviewed the English literature between 1980 and 2010. Our analysis included reports with the

  15. Outcomes of Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysms

    NARCIS (Netherlands)

    Jonker, Frederik H. W.; Verhagen, Hence J. M.; Lin, Peter H.; Heijmen, Robin H.; Trimarchi, Santi; Lee, W. Anthony; Moll, Frans L.; Athamneh, Husam; Muhs, Bart E.

    2010-01-01

    Background-Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and the factors t

  16. Outcomes of endovascular repair of ruptured descending thoracic aortic aneurysms

    NARCIS (Netherlands)

    F.H.W. Jonker; H.J.M. Verhagen (Hence); P.H. Lin (Peter); R.H. Heijmen (Robin); S. Trimarchi (Santi); W.A. Lee (Anthony); F.L. Moll (Frans); H. Athamneh (Husam); B.E. Muhs (Bart)

    2010-01-01

    textabstractBackground-: Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and

  17. Surface anatomy and surface landmarks for thoracic surgery: Part II.

    Science.gov (United States)

    Smith, Shona E; Darling, Gail E

    2011-05-01

    Surface anatomy is an integral part of a thoracic surgeon's armamentarium to assist with the diagnosis, staging, and treatment of thoracic pathology. As reviewed in this article, the surface landmarks of the lungs, heart, great vessels, and mediastinum are critical for appropriate patient care and should be learned in conjunction with classic anatomy.

  18. Pathology of the thoracic wall: congenital and acquired

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Pena, Pilar; Barber, Ignasi [Hospital Materno-Infantil, Pediatric Radiology, Barcelona (Spain)

    2010-06-15

    This review aims to cover the main congenital and acquired lesions that arise in the thoracic wall of infants and children. Imaging often plays an essential role in the evaluation of symptomatic and asymptomatic thoracic wall abnormalities. The use of appropriate imaging modalities for each condition will be addressed, as well as the range of benign and malignant conditions that can occur. (orig.)

  19. Lung cancer screening and video-assisted thoracic surgery

    DEFF Research Database (Denmark)

    Petersen, René Horsleben; Hansen, Henrik Jessen; Dirksen, Asger

    2012-01-01

    The objective of this study is to report the impact of computed tomography (CT) screening on the use of Video-Assisted Thoracic Surgery (VATS) in a randomized screening trial.......The objective of this study is to report the impact of computed tomography (CT) screening on the use of Video-Assisted Thoracic Surgery (VATS) in a randomized screening trial....

  20. Depth of the thoracic epidural space in children.

    NARCIS (Netherlands)

    Masir, F.; Driessen, J.J.; Thies, K.C.; Wijnen, M.H.W.A.; Egmond, J. van

    2006-01-01

    Thoracic epidural anaesthesia in anaesthetized children requires a meticulous technique and may have an increased success rate when the distance between skin and epidural space is known. The objective of this observational study was to measure the skin to epidural distance (SED) during thoracic epid

  1. The major thoracic vascular invasion of lung cancer

    Directory of Open Access Journals (Sweden)

    Soichi Oka

    2017-08-01

    Conclusion: The positive predictive value of the preoperative CT findings for tumor invasion of the thoracic vessels was low. Therefore, surgical opportunities that offer the chance of a cure shouldn't be missed in advanced lung cancer patients because the tumor is located near the major thoracic vessels on preoperative CT.

  2. Bilateral ophthalmoplegia and exophthalmos complicating central hemodialysis catheter placement.

    Science.gov (United States)

    Varelas, P N; Bertorini, T E; Halford, H

    1999-05-01

    We describe a 58-year-old woman who presented with bilateral ophthalmoplegia, exophthalmos, and headache and was found to have retrograde internal jugular vein flow secondary to a high-grade obstruction of the ipsilateral brachiocephalic vein from a previous hemodialysis catheter placement. The patient had also a high-flow dialysis graft in the ipsilateral arm. The cranial and extracranial venous system congestion resolved, and the signs disappeared soon after a balloon angioplasty and stent placement at the level of the obstruction.

  3. Microneurolysis and decompression of long thoracic nerve injury are effective in reversing scapular winging: Long-term results in 50 cases

    Directory of Open Access Journals (Sweden)

    Lyons Andrew B

    2007-03-01

    Full Text Available Abstract Background Long thoracic nerve injury leading to scapular winging is common, often caused by closed trauma through compression, stretching, traction, direct extrinsic force, penetrating injury, or neuritides such as Parsonage-Turner syndrome. We undertook the largest series of long thoracic nerve decompression and neurolysis yet reported to demonstrate the usefulness of long thoracic nerve decompression. Methods Winging was bilateral in 3 of the 47 patients (26 male, 21 female, yielding a total of 50 procedures. The mean age of the patients was 33.4 years, ranging from 24–57. Causation included heavy weight-lifting (31 patients, repetitive throwing (5 patients, deep massage (2 patients, repetitive overhead movement (1 patient, direct trauma (1 patient, motor bike accident (1 patient, and idiopathic causes (9 patients. Decompression and microneurolysis of the long thoracic nerve were performed in the supraclavicular space. Follow-up (average of 25.7 months consisted of physical examination and phone conversations. The degree of winging was measured by the operating surgeon (RKN. Patients also answered questions covering 11 quality-of-life facets spanning four domains of the World Health Organization Quality of Life questionnaire. Results Thoracic nerve decompression and neurolysis improved scapular winging in 49 (98% of the 50 cases, producing "good" or "excellent" results in 46 cases (92%. At least some improvement occurred in 98% of cases that were less than 10 years old. Pain reduction through surgery was good or excellent in 43 (86% cases. Shoulder instability affected 21 patients preoperatively and persisted in 5 of these patients after surgery, even in the 5 patients with persistent instability who experienced some relief from the winging itself. Conclusion Surgical decompression and neurolysis of the long thoracic nerve significantly improve scapular winging in appropriate patients, for whom these techniques should be considered

  4. Women in Thoracic Surgery: 30 Years of History.

    Science.gov (United States)

    Antonoff, Mara B; David, Elizabeth A; Donington, Jessica S; Colson, Yolonda L; Litle, Virginia R; Lawton, Jennifer S; Burgess, Nora L

    2016-01-01

    Women in Thoracic Surgery was founded in 1986, with 2016 marking its 30th anniversary. Reflecting back on the last 3 decades of history, accomplishments, and enormous strides in our field, we review the past, present, and future of this organization. Although women still constitute a small minority of practicing surgeons in our field today, opportunities currently abound for women in thoracic surgery. Owing much to the early female pioneers in the field and to the support of male sponsors and our national societies, Women in Thoracic Surgery has grown and prospered, as have its members and the global community of female thoracic surgeons as a whole. In celebration of our 30th anniversary, we share with the readership the rich history of Women in Thoracic Surgery and its goals for the future.

  5. Bilateral giant juvenile fibroadenoma of breasts

    Directory of Open Access Journals (Sweden)

    Mukhopadhyay Madhumita

    2009-01-01

    Full Text Available An 11-year-old girl with rapidly enlarging bilateral breast lumps is reported. It was diagnosed as a case of juvenile fibroadenoma following fine needle aspiration cytology and confirmed on histopathological examination of the excised specimens.

  6. Genetics of Infantile Bilateral Striatal Necrosis

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-09-01

    Full Text Available The gene mutation causing autosomal recessive infantile bilateral striatal necrosis (IBSN was identified in eight consanguineous Israeli Bedouin families, in a study at Schneider Children’s Medical Center, Petah Tikva, Israel, and other centers.

  7. Extensive Bilateral Naevus Comedonicus Exacerbating During Pregnancy

    Directory of Open Access Journals (Sweden)

    Rao M.V

    1999-01-01

    Full Text Available Naevus comedonicus is a rare developmental anomaly of the pilosebaceous apparatus. It occurred bilaterally in a 23 year old pregnant woman. She noted exacerbations during two pregnancies, hitherto unreported in the literature.

  8. Anaesthetic management of laparoscopic assisted bilateral ...

    African Journals Online (AJOL)

    2011-04-13

    Apr 13, 2011 ... assisted bilateral adrenalectomy in a five-year-old child with Cushing's ... and her vocal cords visualised and sprayed with 2 ml 2% lignocaine. .... crossmatched. Medical therapy of Cushing's disease includes the drugs,.

  9. FLOWING BILATERAL FILTER: DEFINITION AND IMPLEMENTATIONS

    Directory of Open Access Journals (Sweden)

    Maxime Moreaud

    2015-06-01

    Full Text Available The bilateral filter plays a key role in image processing applications due to its intuitive parameterization and its high quality filter result, smoothing homogeneous regions while preserving the edges of the objects. Considering the image as a topological relief, seeing pixel intensities as peaks and valleys, we introduce a way to control the tonal weighting coefficients, the flowing bilateral filter, reducing "halo" artifacts typically produced by the regular bilateral filter around a large peak surrounded by two valleys of lower values. In this paper we propose to investigate exact and approximated versions of CPU and parallel GPU (Graphical Processing Unit based implementations of the regular and flowing bilateral filter using the NVidia CUDA API. Fast implementations of these filters are important for the processing of large 3D volumes up to several GB acquired by x-ray or electron tomography.

  10. Bilateral areolar and periareolar pityriasis versicolor.

    Science.gov (United States)

    Sárdy, Miklós; Korting, Hans Christian; Ruzicka, Thomas; Wolff, Hans

    2010-08-01

    An adolescent boy presented with isolated, symmetrical, bilateral areolar and periareolar pityriasis versicolor. This extremely rare condition should be considered in the differential diagnosis of light brown patches on the areolae.

  11. Bilateral Shoulder Dislocations Following a Motocross Accident

    National Research Council Canada - National Science Library

    H J Schroepfer; B M Martin; P J Millett

    2017-01-01

    .... A professional motocross racer experienced a high speed traumatic accident which resulted in bilateral shoulder dislocations with a rare associated complete anterosuperior RC tear due to a posterior dislocation...

  12. BILATERAL TESSIER CLEFT 3: A CASE REPORT

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    Utpal

    2014-06-01

    Full Text Available Tessier cleft 3 is a very rare congenital anomaly, (2 especially the bilateral form. Very few cases have been reported worldwide. (1,2 I report a case of bilateral Tessier cleft 3 presenting at the age of three months with clefts extending from philtral regions, undermining the nasal alar bases to the medial canthal areas bilaterally. There were bilateral complete alveolar clefts with mild protrusion of the pre-maxilla, but the rest of the maxilla including the palate was not involved. Surgical correction was started at the age of three months and completed at the age of one and half years in three stages. There was no intra-operative or postoperative complications and the final result was satisfactory.

  13. Nuss procedure for surgical stabilization of flail chest with horizontal sternal body fracture and multiple bilateral rib fractures.

    Science.gov (United States)

    Lee, Sung Kwang; Kang, Do Kyun

    2016-06-01

    Flail chest is a life-threatening situation that paradoxical movement of the thoracic cage was caused by multiply fractured ribs in two different planes, or a sternal fracture, or a combination of the two. The methods to achieve stability of the chest wall are controversy between surgical fixation and mechanical ventilation. We report a case of a 33-year-old man who fell from a high place with fail chest due to multiple rib fractures bilaterally and horizontal sternal fracture. The conventional surgical stabilization using metal plates by access to the front of the sternum could not provide stability of the flail segment because the fracture surface was obliquely upward and there were multiple bilateral rib fractures adjacent the sternum. The Nuss procedure was performed for supporting the flail segment from the back. Flail chest was resolved immediately after the surgery. The patient was weaned from the mechanical ventilation on third postoperative day successfully and was ultimately discharged without any complications.

  14. Case of bilateral pneumolabyrinth presenting as sudden, bilateral deafness, without temporal bone fracture, after a fall.

    Science.gov (United States)

    Lee, E J; Yang, Y S; Yoon, Y J

    2012-07-01

    We report a case of bilateral pneumolabyrinth presenting as sudden, bilateral deafness, without temporal bone fracture, after a fall. A 49-year-old man presented with sudden, bilateral deafness and whirling vertigo, without any other neurological manifestations. Temporal bone computed tomography clearly demonstrated the presence of air in the vestibule and cochlea on both sides. However, there was no definite fracture line, ossicular chain anomaly or soft tissue density in the temporal bone or middle-ear cavity. The patient was treated conservatively. Unfortunately, there was no improvement in his hearing. Pneumolabyrinth is an uncommon condition in which air is present in the vestibule or cochlea. It is rarely found, even with fractures violating the otic capsule or with transverse fractures of the temporal bone. In addition, its bilateral occurrence is extremely rare. In this article, we describe a case of bilateral pneumolabyrinth presenting as sudden, bilateral deafness, without temporal bone fracture, an occurrence which has not previously been reported.

  15. Sequential presentation of bilateral Brown syndrome.

    Science.gov (United States)

    Sekeroğlu, Hande Taylan; Türkçüoğlu, Peykan; Sanaç, Ali Şefik; Sener, Emin Cumhur

    2012-04-01

    Brown syndrome, characterized by a limitation of elevation in adduction and positive forced duction testing, is usually unilateral but occurs bilaterally in 10% of all cases. It may present as a congenital condition in one eye and develop in the other eye with no apparent cause. We present a case of bilateral Brown syndrome in which the right eye became involved within 1 year of surgery on the left eye for congenital Brown syndrome.

  16. Clinical subgroups in bilateral Meniere disease

    OpenAIRE

    2016-01-01

    Meniere disease (MD) is a heterogeneous clinical condition characterized by sensorineural hearing loss, episodic vestibular symptoms and tinnitus associated with several comorbidities such as migraine or autoimmune disorders (AD). The frequency of bilateral involvement may range from 5-50% and it depends on the duration of the disease. We have performed a two-step cluster analysis in 398 patients with bilateral MD to identify the best predictors to define clinical subgroups with a potential d...

  17. Bilateral anophthalmia with septo-optic dysplasia

    Directory of Open Access Journals (Sweden)

    Manisha Jana

    2010-01-01

    Full Text Available Bilateral anophthalmia is a rare entity and association with septo-optic dysplasia is an even rare condition. The condition is characterized by absent eyeballs in the presence of eyelids, conjunctiva or lacrimal apparatus. Though anophthalmia can be diagnosed clinically, imaging plays a crucial role in delineating the associated anomalies. In addition, often clinical anophthalmia may prove to be severe microphthalmia on imaging. We describe the imaging findings in an infant with bilateral anophthalmia and septo-optic dysplasia.

  18. Bilateral Keratectasia 34 Years after Corneal Transplant

    Directory of Open Access Journals (Sweden)

    Xavier Valldeperas

    2010-07-01

    Full Text Available We report the clinical findings of a patient with severe bilateral keratectasia 34 years after a penetrating keratoplasty (PK in both eyes. An otherwise healthy 67-year-old man complained of deterioration of the eyesight in both eyes over the last 6 months. The patient was diagnosed with bilateral keratoconus at the age of 32 years, and he underwent a bilateral PK. At presentation, visual acuity was 20/200 in the right eye and light perception in the left eye. A Pentacam pachymetric map revealed a central pachymetry of 720 µm in the right eye and of 710 µm in the left eye, as well as an average paracentral pachymetry of 436 and 270 µm in the 9-mm zone in the right and the left eye, respectively. Corneal topography revealed bilateral irregular and asymmetric bowing with generalized steepening and high corneal power. We describe a case of bilateral keratectasia 34 years after PK in a patient who was originally diagnosed with bilateral keratoconus.

  19. MODERN VIEWS ON BILATERAL BREAST CANCER

    Directory of Open Access Journals (Sweden)

    Ye. A. Fesik

    2014-01-01

    Full Text Available Presented modern literature data on the features of the pathogenesis, course, clinical and morphological expression and tumor characteristics, parameters and nodal metastasis of hematogenous bilateral breast cancer. Highlight the results of domestic and foreign studies in recent years to determine the prognostic factors and recurrence of synchronous and metachronous bilateral breast cancer. It was revealed that the frequency of bilateral breast tumor lesions varies widely, ranging from 0.1 to 20%, with metachronous tumors recorded significantly higher (69.6% than the synchronous (22.7%. The probability of occurrence of metachronous breast cancer is higher in women with a family history, as well as if they have a gene mutation BRCA-1. Found that the most common histological type of breast tumor with bilateral lesions is invasive ductal. However, the incidence of invasive lobular cancer and non-invasive lobular cancer is slightly higher among synchronous bilateral cancer compared with unilateral disease. Studies have shown that in a double-sided synchronous breast cancer tumor, as a rule, has a lower degree of differentiation, and the higher the expression level of estrogen receptors and progesterone receptors. Relevance of the issue because the identification of patterns in the study of lymphatic and hematogenous features bilateral metastasis of mammary tumors provides a basis for speculation about the differences in the progression of neoplastic disease in these groups and is a cause for further detailed research in this area to identify and evaluate the prognosis and also the choice of tactics of such patients.

  20. Asia’s Bilateral Relations

    Science.gov (United States)

    2004-10-01

    Analysis Section, DFAT , using the latest data from the ABS, the IMF and various international sources. http://www.dfat.gov.au/geo/fs/jap.pdf I N V E S T...instrumental in assisting their Indonesian counterparts in dismantling the culpable Jemaah Islamiyah cells . ● For the United States, Australia’s links with...being invited. Documents released by the Australia Department of Foreign Affairs and Trade ( DFAT ) now confirm that Australian officials not only knew