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Sample records for nonaneurysmal infectious thoracic

  1. Non-aneurysmal subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Bashir, Asma; Mikkelsen, Ronni; Sørensen, Leif

    2017-01-01

    Purpose Repeat imaging in patients with non-aneurysmal subarachnoid hemorrhage (NASAH) remains controversial. We aim to report our experience with NASAH with different hemorrhage patterns, and to investigate the need for further diagnostic workup to determine the underlying cause of hemorrhage. M...... adequate with absence of hematoma and vasospasm. In contrast, a follow-up DSA should be mandatory for confirming or excluding vascular pathology in case of nPMSAH in order to prevent rebleeding....

  2. Acute hydrocephalus in nonaneurysmal perimesencephalic hemorrhage: evidence of CSF block at the tentorial hiatus

    NARCIS (Netherlands)

    Rinkel, G. J.; Wijdicks, E. F.; Vermeulen, M.; Tans, J. T.; Hasan, D.; van Gijn, J.

    1992-01-01

    The acute hydrocephalus in patients with nonaneurysmal perimesencephalic hemorrhage suggests an extraventricular obstruction of CSF flow. We studied the occurrence of acute hydrocephalus and the site of cisternal blood in 40 consecutive patients with perimesencephalic hemorrhage. In all 11 patients

  3. Nonaneurysmal subarachnoid hemorrhage in intramural hematoma of the basilar artery - a case report and literature review

    International Nuclear Information System (INIS)

    Nedevska, A.; Nakov, V.; Hristov, H.

    2012-01-01

    Pretruncal (perimesencephalic) nonaneurysmal subarachnoid hemorrhage (SAH) is a benign variant of SAH. Although angiography fails to show a source of the hemorrhage, mild basilar artery narrowing may be observed. The cause of pretruncal nonaneurysmal SAH has not been established. Recent imaging studies have demonstrated that the center of this type of SAH is not around the mesencephalon but is in the prepontine or interpeduncular cistern with the hemorrhage closely associated with the basilar artery. We review the possible sources of hemorrhage in these cisterns and hypothesize that pretruncal nonaneurysmal SAH is caused by a primary intramural hematoma of the basilar artery. Such an intramural hematoma would explain bleeding under low pressure, the location of the hemorrhage anterior to the brainstem, and the typical findings of hemorrhage adjacent to the basilar artery lumen on magnetic resonance imaging and mild basilar artery narrowing on angiography. Hemorrhage in such location is easily found in native computed tomography (CT) images. Crescent, hyperdense thickening of the basilar artery wall is also observed. We have presented this unusual case to highlight the possible mechanism of hematoma formation and underline the importance of MDCT examination in the diagnosis confirmation and also excluding other potentially serious underlying condition that could also lead to non traumatic SAH. (authors)

  4. Nonaneurysmal "Pseudo-Subarachnoid Hemorrhage" Computed Tomography Patterns: Challenges in an Acute Decision-Making Heuristics.

    Science.gov (United States)

    Hasan, Tasneem F; Duarte, Walter; Akinduro, Oluwaseun O; Goldstein, Eric D; Hurst, Rebecca; Haranhalli, Neil; Miller, David A; Wharen, Robert E; Tawk, Rabih G; Freeman, William D

    2018-06-05

    Acute aneurysmal subarachnoid hemorrhage (SAH) is a medical and neurosurgical emergency from ruptured brain aneurysm. Aneurysmal SAH is identified on brain computed tomography (CT) as increased density of basal cisterns and subarachnoid spaces from acute blood products. Aneurysmal SAH-like pattern on CT appears as an optical illusion effect of hypodense brain parenchyma and/or hyperdense surrounding cerebral cisterns and blood vessels termed as "pseudo-subarachnoid hemorrhage" (pseudo-SAH). We reviewed clinical, laboratory, and radiographic data of all SAH diagnoses between January 2013 and January 2018, and found subsets of nonaneurysmal SAH, originally suspected to be aneurysmal in origin. We performed a National Library of Medicine search methodology using terms "subarachnoid hemorrhage," "pseudo," and "non-aneurysmal subarachnoid hemorrhage" singly and in combination to understand the sensitivity, specificity, and precision of pseudo-SAH. Over 5 years, 230 SAH cases were referred to our tertiary academic center and only 7 (3%) met the definition of pseudo-SAH. Searching the National Library of Medicine using subarachnoid hemorrhage yielded 27,402 results. When subarachnoid hemorrhage and pseudo were combined, this yielded 70 results and sensitivity was 50% (n = 35). Similarly, search precision was relatively low (26%) as only 18 results fit the clinical description similar to the 7 cases discussed in our series. Aneurysmal SAH pattern on CT is distinct from nonaneurysmal and pseudo-SAH patterns. The origin of pseudo-SAH terminology appears mostly tied to comatose cardiac arrest patients with diffuse dark brain Hounsfield units and cerebral edema, and is a potential imaging pitfall in acute medical decision-making. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Validation of the Infectious Diseases Society of America/American Thoracic Society criteria to predict severe community-acquired pneumonia caused by Streptococcus pneumoniae.

    Science.gov (United States)

    Kontou, Paschalina; Kuti, Joseph L; Nicolau, David P

    2009-10-01

    Severe community-acquired pneumonia (CAP) is usually defined as pneumonia that requires intensive care unit (ICU) admission; the primary pathogen responsible for ICU admission is Streptococcus pneumoniae. In this study, the 2007 Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) consensus criteria for ICU admission were compared with other severity scores in predicting ICU admission and mortality. We retrospectively studied 158 patients with pneumococcal CAP (1999-2003). Clinical and laboratory features at the emergency department were recorded and used to calculate the 2007 IDSA/ATS rule, the 2001 ATS rule, 2 modified 2007 IDSA/ATS rules, the Pneumonia Severity Index (PSI), and the CURB (confusion, urea, respiratory rate, blood pressure) score. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were assessed for the various indices. We also determined the criteria that were independently predictive of ICU admission and of mortality in our population. The 2007 IDSA/ATS criteria performed as well as the 2001 ATS rule in predicting ICU admission both demonstrated high sensitivity (90%) and NPV (97%). For the prediction of mortality, the best tool proved to be the PSI score (sensitivity, 95%; NPV, 99%). The variables associated with ICU admission in this patient population included tachypnea, confusion, Pao(2)/Fio(2) ratio of 250 or lower, and hypotension requiring fluid resuscitation. Mechanical ventilation and PSI class V were independently associated with mortality. This study confirms the usefulness of the new criteria in predicting severe CAP. The 2001 ATS criteria seem an attractive alternative because they are simple and as effective as the 2007 IDSA/ATS criteria.

  6. Pattern not volume of bleeding predicts angiographic vasospasm in nonaneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Raya, Amanda; Zipfel, Gregory J; Diringer, Michael N; Dacey, Ralph G; Derdeyn, Colin P; Rich, Keith M; Chicoine, Michael R; Dhar, Rajat

    2014-01-01

    Spontaneous idiopathic subarachnoid hemorrhage (SAH) with a perimesencephalic bleeding pattern is usually associated with a benign course, whereas a diffuse bleeding pattern has been associated with a higher risk of vasospasm and disability. We evaluated whether volume of bleeding explains this disparity. Pattern and amount of bleeding (by Hijdra and intraventricular hemorrhage scores) were assessed in 89 patients with nonaneurysmal SAH. Outcomes included angiographic vasospasm, delayed cerebral ischemia, and functional outcome at 1 year. Diffuse bleeding was associated with significantly higher Hijdra and intraventricular hemorrhage scores than perimesencephalic SAH, P≤0.003. Angiographic vasospasm was more likely in diffuse versus perimesencephalic SAH (45% versus 27%; odds ratio, 2.9; P=0.08), but adjustment for greater blood burden only partially attenuated this trend (adjusted odds ratio, 2.2; 95% confidence interval, 0.69-7.2; P=0.18); delayed cerebral ischemia was only seen in those with diffuse bleeding. Patients with diffuse bleeding were less likely to be discharged home (68% versus 90%; P=0.01) and tended to have more residual disability (modified Rankin scale, 3-6; 20% versus 6%; P=0.18). Nonaneurysmal SAH can still result in vasospasm and residual disability, especially in those with diffuse bleeding. This disparity is only partially accounted for by greater cisternal or intraventricular blood, suggesting that the mechanism and distribution of bleeding may be as important as the amount of hemorrhage in patients with idiopathic SAH.

  7. Influence of ABO blood type on the outcome after non-aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Dubinski, Daniel; Won, Sae-Yeon; Behmanesh, Bedjan; Kashefiolasl, Sepide; Geisen, Christof; Seifert, Volker; Senft, Christian; Konczalla, Juergen

    2018-04-01

    In patients with non-aneurysmal subarachnoid hemorrhage (NA-SAH), the etiology is unknown and the bleeding source remains unidentified. However, the ABO blood type system has a profound role in patient's hemostasis and thrombosis. To date, the aspect of ABO blood type in incidence, clinical course, and outcome after NA-SAH has not been investigated. In this retrospective analysis, 81 patients with non-traumatic and non-aneurysmal subarachnoid hemorrhage treated between 2010 and 2014 at the author's institution were included. WFNS admission status, cerebral vasospasm, delayed infarction, ventriculoperitoneal shunt necessity, the Fisher grade, and the modified Rankin Scale were analyzed for their association with ABO blood type. Four hundred seventy patients with aneurysmal subarachnoid hemorrhage served as a control group. The AB blood type is more frequent in NA-SAH compared to aneurysmal patients and the German population (OR 2.45, p ≤ 0.05). Furthermore, NA-SAH with AB blood type showed a similar sequelae compared to aneurysmal patients in terms of shunt necessity (OR 2.00, p ≥ 0.05), cerebral vasospasm (OR 1.66, p ≥ 0.05), and delayed infarctions (OR 1.07, p ≥ 0.05). The clinical course of NA-SAH AB blood type patients shows similar severity as of aneurysmal subarachnoid hemorrhage. Therefore, patients with AB blood type should be under intensified observation.

  8. Thoracic CT

    Science.gov (United States)

    ... through a vein (IV) in your hand or forearm. It may be given through the rectum using ... CT scan Vertebra, thoracic (mid back) Normal lung anatomy Thoracic organs References Gotway MB, Panse PM, Gruden ...

  9. Classification of non-aneurysmal subarachnoid haemorrhage: CT correlation to the clinical outcome

    International Nuclear Information System (INIS)

    Nayak, S.; Kunz, A.B.; Kieslinger, K.; Ladurner, G.; Killer, M.

    2010-01-01

    Aim: To propose a new computed tomography (CT)-based classification system for non-aneurysmal subarachnoid haemorrhage (SAH), which predicts patients' discharge clinical outcome and helps to prioritize appropriate patient management. Methods and materials: A 5-year, retrospective, two-centre study was carried out involving 1486 patients presenting with SAH. One hundred and ninety patients with non-aneurysmal SAH were included in the study. Initial cranial CT findings at admission were correlated with the patients' discharge outcomes measured using the Modified Rankin Scale (MRS). A CT-based classification system (type 1-4) was devised based on the topography of the initial haemorrhage pattern. Results: Seventy-five percent of the patients had type 1 haemorrhage and all these patients had a good clinical outcome with a discharge MRS of ≤1. Eight percent of the patients presented with type 2 haemorrhage, 62% of which were discharged with MRS of ≤1 and 12% of patients had MRS 3 or 4. Type 3 haemorrhage was found in 10%, of which 16% had good clinical outcome, but 53% had moderate to severe disability (MRS 3 and 4) and 5% were discharged with severe disability (MRS 5). Six percent of patients presented with type 4 haemorrhage of which 42% of the patients had moderate to severe disability (MRS 3 and 4), 42% had severe disability and one-sixth of the patients died. Highly significant differences were found between type 1(1a and 1b) and type 2 (p = 0.003); type 2 and type 3 (p = 0.002); type 3 and type 4 (p = 0.001). Conclusion: Haemorrhages of the type 1 category are usually benign and do not warrant an extensive battery of clinical and radiological investigations. Type 2 haemorrhages have a varying prognosis and need to be investigated and managed along similar lines as that of an aneurysmal haemorrhage with emphasis towards radiological investigation. Type 3 and type 4 haemorrhages need to be extensively investigated to find an underlying cause.

  10. Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Disease Society and the Canadian Thoracic Society

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell

    2000-01-01

    Full Text Available Community-acquired pneumonia (CAP is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in the knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity against Streptococcus pneumoniae has been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Diseases Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

  11. Factors Associated with Acute and Chronic Hydrocephalus in Nonaneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Kang, Peter; Raya, Amanda; Zipfel, Gregory J; Dhar, Rajat

    2016-02-01

    Hydrocephalus requiring external ventricular drain (EVD) or shunt placement commonly complicates aneurysmal subarachnoid hemorrhage (SAH), but its frequency is not as well known for nonaneurysmal SAH (NA-SAH). Those with diffuse bleeding may have greater risk of hydrocephalus compared to those with a perimesencephalic pattern. We evaluated the frequency of hydrocephalus in NA-SAH and whether imaging factors could predict the need for EVD and shunting. We collected admission clinical and imaging variables for 105 NA-SAH patients, including bicaudate index (BI), Hijdra sum score (HSS), intraventricular hemorrhage (IVH) score, modified Fisher scale (mFS), and bleeding pattern. Hydrocephalus was categorized as acute (need for EVD) or chronic (shunt). We applied logistic regression to determine whether hydrocephalus risk was independently related to bleeding pattern or mediated through blood volume or ventriculomegaly. Acute hydrocephalus was seen in 26 (25%) patients but was more common with diffuse (15/28, 54%) versus perimesencephalic (10/59, 17%, p hydrocephalus had worse clinical grade and higher BI, HSS, and IVH scores. Adjusting the relationship between hydrocephalus and diffuse bleeding for HSS (but not BI) nullified this association. Nine (35%) patients requiring EVD eventually required shunting for chronic hydrocephalus, which was associated with greater blood burden but not poor clinical grade. Acute hydrocephalus occurs in one-quarter of NA-SAH patients. The greater risk in diffuse bleeding appears to be mediated by greater cisternal blood volume but not by greater ventriculomegaly. Imaging characteristics may aid in anticipatory management of hydrocephalus in NA-SAH.

  12. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

    Science.gov (United States)

    Kalil, Andre C.; Metersky, Mark L.; Klompas, Michael; Muscedere, John; Sweeney, Daniel A.; Palmer, Lucy B.; Napolitano, Lena M.; O'Grady, Naomi P.; Bartlett, John G.; Carratalà, Jordi; El Solh, Ali A.; Ewig, Santiago; Fey, Paul D.; File, Thomas M.; Restrepo, Marcos I.; Roberts, Jason A.; Waterer, Grant W.; Cruse, Peggy; Knight, Shandra L.; Brozek, Jan L.

    2016-01-01

    It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews. PMID:27418577

  13. Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis: A case report and review of literature.

    Science.gov (United States)

    Fu, Fang-Wang; Rao, Jie; Zheng, Yuan-Yuan; Song, Liang; Chen, Wei; Zhou, Qi-Hui; Yang, Jian-Guang; Ke, Jiang-Qiong; Zheng, Guo-Qing

    2017-08-01

    Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is characterized by a pattern of extravasated blood restricted to the perimesencephalic cisterns, normal angiographic findings, and an excellent prognosis with an uneventful course and low risks of complication. The precise etiology of bleeding in patients with PNSAH has not yet been established. The most common hypothesis is that PNSAH is venous in origin. Intracranial venous hypertension has been considered as the pivotal factor in the pathogenesis of PNSAH. The underlying venous pathology such as straight sinus stenosis, jugular vein occlusion may contribute to PNSAH. We describe a patient in whom transverse sinus thrombosis preceded intracranial venous hypertension and PNSAH. These findings supported that the source of the subarachnoid hemorrhage is venous in origin. A 45-year-old right-handed man was admitted to the hospital with a sudden onset of severe headache associated with nausea, vomiting, and mild photophobia for 6 hours. The patient was fully conscious and totally alert. An emergency brain computed tomography (CT) revealed an acute subarachnoid hemorrhage restricted to the perimesencephalic cisterns. CT angiography revealed no evidence of an intracranial aneurysm or underlying vascular malformation. Digital subtraction angiography of arterial and capillary phases confirmed the CT angiographic findings. Assessment of the venous phase demonstrated right transverse sinus thrombosis. Magnetic resonance imaging confirmed the diagnosis of cerebral venous sinus thrombosis (CVST). Lumbar puncture revealed an opening pressure of 360 mmH2O, suggestive of intracranial venous hypertension. Grave disease was diagnosed by endocrinological investigation. Low-molecular-weight heparin, followed by oral warfarin, was initiated immediately as the treatment for cerebral venous sinus thrombosis and PNSAH. The patient discharged without any neurologic defect after 3 weeks of hospital stay. MR venography

  14. Thoracic Trauma.

    Science.gov (United States)

    Dennis, Bradley M; Bellister, Seth A; Guillamondegui, Oscar D

    2017-10-01

    Management of chest trauma is integral to patient outcomes owing to the vital structures held within the thoracic cavity. Understanding traumatic chest injuries and appropriate management plays a pivotal role in the overall well-being of both blunt and penetrating trauma patients. Whether the injury includes rib fractures, associated pulmonary injuries, or tracheobronchial tree injuries, every facet of management may impact the short- and long-term outcomes, including mortality. This article elucidates the workup and management of the thoracic cage, pulmonary and tracheobronchial injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. MRI-detection rate and incidence of lumbar bleeding sources in 190 patients with non-aneurysmal SAH.

    Directory of Open Access Journals (Sweden)

    Sepide Kashefiolasl

    Full Text Available Up to 15% of all spontaneous subarachnoid hemorrhages (SAH have a non-aneurysmal SAH (NASAH. The evaluation of SAH patients with negative digital subtraction angiography (DSA is sometimes a diagnostic challenge. Our goal in this study was to reassess the yield of standard MR-imaging of the complete spinal axis to rule out spinal bleeding sources in patients with NASAH.We retrospectively analyzed the spinal MRI findings in 190 patients with spontaneous NASAH, containing perimesencephalic (PM and non-perimesencephalic (NPM SAH, diagnosed by computer tomography (CT and/or lumbar puncture (LP, and negative 2nd DSA.190 NASAH patients were included in the study, divided into PM-SAH (n = 87; 46% and NPM-SAH (n = 103; 54%. Overall, 23 (22% patients had a CT negative SAH, diagnosed by positive LP. MR-imaging of the spinal axis detected two patients with lumbar ependymoma (n = 2; 1,05%. Both patients complained of radicular sciatic pain. The detection rate raised up to 25%, if only patients with radicular sciatic pain received an MRI.Routine radiological investigation of the complete spinal axis in NASAH patients is expensive and can not be recommended for standard procedure. However, patients with clinical signs of low-back/sciatic pain should be worked up for a spinal pathology.

  16. Increasing numbers of nonaneurysmal subarachnoid hemorrhage in the last 15 years: antithrombotic medication as reason and prognostic factor?

    Science.gov (United States)

    Konczalla, Juergen; Kashefiolasl, Sepide; Brawanski, Nina; Senft, Christian; Seifert, Volker; Platz, Johannes

    2016-06-01

    OBJECT Subarachnoid hemorrhage (SAH) is usually caused by a ruptured intracranial aneurysm, but in some patients no source of hemorrhage can be detected. More recent data showed increasing numbers of cases of spontaneous nonaneurysmal SAH (NASAH). The aim of this study was to analyze factors, especially the use of antithrombotic medications such as systemic anticoagulation or antiplatelet agents (aCPs), influencing the increasing numbers of cases of NASAH and the clinical outcome. METHODS Between 1999 and 2013, 214 patients who were admitted to the authors' institution suffered from NASAH, 14% of all patients with SAH. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months. Risk factors were identified based on the outcome. RESULTS The number of patients with NASAH increased significantly in the last 15 years of the study period. There was a statistically significant increase in the rate of nonperimesencephalic (NPM)-SAH occurrence and aCP use, while the proportion of elderly patients remained stable. Favorable outcome (mRS 0-2) was achieved in 85% of cases, but patients treated with aCPs had a significantly higher risk for an unfavorable outcome. Further analysis showed that elderly patients, and especially the subgroup with a Fisher Grade 3 bleeding pattern, had a high risk for an unfavorable outcome, whereas the subgroup of NPM-SAH without a Fisher Grade 3 bleeding pattern had a favorable outcome, similar to perimesencephalic (PM)-SAH. CONCLUSIONS Over the years, a significant increase in the number of patients with NASAH has been observed. Also, the rate of aCP use has increased significantly. Risk factors for an unfavorable outcome were age > 65 years, Fisher Grade 3 bleeding pattern, and aCP use. Both "PM-SAH" and "NPM-SAH without a Fisher Grade 3 bleeding pattern" had excellent outcomes. Patients with NASAH and a Fisher Grade 3 bleeding pattern had a significantly higher risk for an unfavorable outcome and death. Therefore, for further

  17. Asphyxiating thoracic dysplasia

    International Nuclear Information System (INIS)

    Franzcr, J.; Kozlowski, K.

    2008-01-01

    Asphyxiating Thoracic Dysplasia is the most frequent form of Small Thorax - Short Rib Syndromes. Asphyxiating Thoracic Dysplasia in two patients with different clinical course is reported. Radiographic examination is the only method to diagnose Asphyxiating Thoracic Dysplasia with certainty. The correct diagnosis is important for prognostication and genetic counseling. It also excludes the necessity of further, often expensive investigations. (author)

  18. Infectious Diseases

    Science.gov (United States)

    ... But some of them can make you sick. Infectious diseases are diseases that are caused by germs. There ... many different ways that you can get an infectious disease: Through direct contact with a person who is ...

  19. 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. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  20. Thoracic myelopathy with alkaptonuria.

    Science.gov (United States)

    Akeda, Koji; Kasai, Yuichi; Kawakita, Eiji; Matsumura, Yoshihiro; Kono, Toshibumi; Murata, Tetsuya; Uchida, Atsumasa

    2008-01-15

    A case of thoracic myelopathy with alkaptonuria (ochronotic spondyloarthropathy) is presented. To present and review the first reported case of an alkaptonuric patient with concomitant thoracic myelopathy. Alkaptonuria, a rare hereditary metabolic disease, is characterized by accumulation of homogentistic acid, ochronosis, and destruction of connective tissue resulting in degenerative spondylosis and arthritis. Despite the high incidence of intervertebral disc diseases among patients with alkaptonuria, neurologic symptoms caused by spinal disease are rare. Thoracic myelopathy in a patient with alkaptonuria has not been previously reported. The clinical course, radiologic features, pathology, and treatment outcome of an alkaptonuria patient with thoracic myelopathy was documented. Myelopathy of the patient was caused by rupture of a thoracic intervertebral disc. The neurologic symptoms of the patient were markedly improved after surgery. We have reported for the first time, that an alkaptonuria patient showed thoracic myelopathy caused by rupture of a thoracic intervertebral disc. Decompression followed by the instrumented fusion of the thoracic spine was effective for improving the neurologic symptoms.

  1. 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.

  2. Infectious Arthritis

    Science.gov (United States)

    Most kinds of arthritis cause pain and swelling in your joints. Joints are places where two bones meet, such as your elbow or knee. Infectious arthritis is an infection in the joint. The infection ...

  3. October 2012 Arizona thoracic society notes

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    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 …

  4. November 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2017 Arizona Thoracic Society meeting was held on Wednesday, November 15, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with a lecture followed by case presentations. There were 15 in attendance representing the pulmonary, critical care, sleep, allergy, infectious disease and radiology communities. At the beginning of the meeting several issues were discussed: 1. CME offered by the Southwest Journal of Pulmonary and Critical Care Medicine (SWJPCC is currently offered to only the Southwest state thoracic societies and the Mayo Clinic. After discussion it was felt that this restriction of access was no longer appropriate and CME credits should be available to all. 2. Efforts continue to obtain CME for the Arizona Thoracic Society meetings. Our Chapter Representative, Dr. Gerry Schwartzberg, is approaching this with the American Thoracic Society. Locally, HonorHealth sent out a survey on CME needs. Members were encouraged …

  5. Thoracic and abdominopelvic actinomycosis

    African Journals Online (AJOL)

    thoracic disease.1,2,4 The chronic progressive suppurative infection ... venous Penicillin G for 4 - 6 weeks being the treatment of ... pathology was demonstrated in the liver. (Figs 7a and b ). .... ulceration (may resemble Crohn's disease).3. 2.

  6. Society of Thoracic Surgeons

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    ... Apply for Membership Membership Directory Pay Your Dues Industry Mailing List License & eBlast Communications Programs Advertise on ... Hotel Discount Copyright © 2017 The Society of Thoracic Surgeons. ...

  7. March 2014 Arizona thoracic society notes

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    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. ...

  8. [Infectious diseases].

    Science.gov (United States)

    Chapuis-Taillard, Caroline; de Vallière, Serge; Bochud, Pierre-Yves

    2009-01-07

    In 2008, several publications have highlighted the role of climate change and globalization on the epidemiology of infectious diseases. Studies have shown the extension towards Europe of diseases such as Crimea-Congo fever (Kosovo, Turkey and Bulgaria), leismaniosis (Cyprus) and chikungunya virus infection (Italy). The article also contains comments on Plasmodium knowlesi, a newly identified cause of severe malaria in humans, as well as an update on human transmission of the H5NI avian influenza virus. It also mentions new data on Bell's palsy as well as two vaccines (varicella-zoster and pneumococcus), and provides a list of recent guidelines for the treatment of common infectious diseases.

  9. Infectious Diseases,

    Science.gov (United States)

    1980-02-29

    of sufficient severity, infectious hepatitis may produce hypoglycemia or hepatic failure. Severe hypoglycemia is also a common danger in neonatal ...emergency situations geoier~3ly involve the correction of severe fluid and electrolyte or acid-base ;atbnormalities. Severe hypoglycemia or anoxia... causes widespread metabolic responses in the host and in addition, leads to nutritional deficiencies. Localized infections may also result in metabolic

  10. Imaging of thoracic trauma

    International Nuclear Information System (INIS)

    Uffmann, M.; Herold, C.J.; Fuchs, M.

    1998-01-01

    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.) [de

  11. Aneurysm-Specific miR-221 and miR-146a Participates in Human Thoracic and Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Premakumari Venkatesh

    2017-04-01

    Full Text Available Altered microRNA expression is implicated in cardiovascular diseases. Our objective was to determine microRNA signatures in thoracic aortic aneurysms (TAAs and abdominal aortic aneurysms (AAAs compared with control non-aneurysmal aortic specimens. We evaluated the expression of fifteen selected microRNA in human TAA and AAA operative specimens compared to controls. We observed significant upregulation of miR-221 and downregulation of miR-1 and -133 in TAA specimens. In contrast, upregulation of miR-146a and downregulation of miR-145 and -331-3p were found only for AAA specimens. Upregulation of miR-126 and -486-5p and downregulation of miR-30c-2*, -155, and -204 were observed in specimens of TAAs and AAAs. The data reveal microRNA expression signatures unique to aneurysm location and common to both thoracic and abdominal pathologies. Thus, changes in miR-1, -29a, -133a, and -221 are involved in TAAs and miR-145, -146, and -331-3p impact AAAs. This work validates prior studies on microRNA expression in aneurysmal diseases.

  12. Infectious Tolerance

    Science.gov (United States)

    Jonuleit, Helmut; Schmitt, Edgar; Kakirman, Hacer; Stassen, Michael; Knop, Jürgen; Enk, Alexander H.

    2002-01-01

    Regulatory CD4+CD25+ T cells (Treg) are mandatory for maintaining immunologic self-tolerance. We demonstrate that the cell-cell contact–mediated suppression of conventional CD4+ T cells by human CD25+ Treg cells is fixation resistant, independent from membrane-bound TGF-β but requires activation and protein synthesis of CD25+ Treg cells. Coactivation of CD25+ Treg cells with Treg cell–depleted CD4+ T cells results in anergized CD4+ T cells that in turn inhibit the activation of conventional, freshly isolated CD4+ T helper (Th) cells. This infectious suppressive activity, transferred from CD25+ Treg cells via cell contact, is cell contact–independent and partially mediated by soluble transforming growth factor (TGF)-β. The induction of suppressive properties in conventional CD4+ Th cells represents a mechanism underlying the phenomenon of infectious tolerance. This explains previously published conflicting data on the role of TGF-β in CD25+ Treg cell–induced immunosuppression. PMID:12119350

  13. 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.

  14. 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)

  15. One-stage posterior approaches for treatment of thoracic spinal infection

    OpenAIRE

    Kao, Fu-Cheng; Tsai, Tsung-Ting; Niu, Chi-Chien; Lai, Po-Liang; Chen, Lih-Huei; Chen, Wen-Jer

    2017-01-01

    Abstract Treating thoracic infective spondylodiscitis with anterior surgical approaches carry a relatively high risk of perioperative and postoperative complications. Posterior approaches have been reported to result in lower complication rates than anterior procedures, but more evidence is needed to demonstrate the safety and efficacy of 1-stage posterior approaches for treating infectious thoracic spondylodiscitis. Preoperative and postoperative clinical data, of 18 patients who underwent 2...

  16. Thoracic imaging in AIDS

    Energy Technology Data Exchange (ETDEWEB)

    Barneveld Binkhuysen, F H [Eemland Hospital, Dept. of Radiology, Amersfoort (Netherlands)

    1996-12-31

    The contents are infectious diseases i.e. pneumocystis carinii, mycobacterium tuberculosis, atypical mycobacteria, fungal infections, viral infections ; Malignant diseases : kaposi`s sarcoma (KS), malignant lymphoma and other disorders i.e. lymphocytic interstitial pneumonitis, hypersensitivity reactions, bullous changes, pericardial abnormalities (15 refs.).

  17. Thoracic imaging in AIDS

    International Nuclear Information System (INIS)

    Barneveld Binkhuysen, F.H.

    1995-01-01

    The contents are infectious diseases i.e. pneumocystis carinii, mycobacterium tuberculosis, atypical mycobacteria, fungal infections, viral infections ; Malignant diseases : kaposi's sarcoma (KS), malignant lymphoma and other disorders i.e. lymphocytic interstitial pneumonitis, hypersensitivity reactions, bullous changes, pericardial abnormalities (15 refs.)

  18. Thoracic organ transplantation.

    Science.gov (United States)

    Pierson, Richard N; Barr, Mark L; McCullough, Keith P; Egan, Thomas; Garrity, Edward; Jessup, Mariell; Murray, Susan

    2004-01-01

    This article presents an overview of factors associated with thoracic transplantation outcomes over the past decade and provides valuable information regarding the heart, lung, and heart-lung waiting lists and thoracic organ transplant recipients. Waiting list and post-transplant information is used to assess the importance of patient demographics, risk factors, and primary cardiopulmonary disease on outcomes. The time that the typical listed patient has been waiting for a heart, lung, or heart-lung transplant has markedly increased over the past decade, while the number of transplants performed has declined slightly and survival after transplant has plateaued. Waiting list mortality, however, appears to be declining for each organ and for most diseases and high-severity subgroups, perhaps in response to recent changes in organ allocation algorithms. Based on perceived inequity in organ access and in response to a mandate from Health Resources and Services Administration, the lung transplant community is developing a lung allocation system designed to minimize deaths on the waiting list while maximizing the benefit of transplant by incorporating post-transplant survival and quality of life into the algorithm. Areas where improved data collection could inform evolving organ allocation and candidate selection policies are emphasized.

  19. 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.

  20. Thoracic spine x-ray

    Science.gov (United States)

    Vertebral radiography; X-ray - spine; Thoracic x-ray; Spine x-ray; Thoracic spine films; Back films ... There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most ...

  1. March 2013 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-03-01

    Full Text Available No abstract available. Article truncated after 150 words. A dinner meeting was held on Wednesday, 3/20/2013 at Scottsdale Shea beginning at 6:30 PM. There were 14 in attendance representing the pulmonary, critical care, sleep, infectious disease, nursing, and radiology communities.Copies of the book “Breathing in America: Diseases, Progress, and Hope” were distributed.Three cases were presented:1.Tim Kuberski, infectious diseases from Maricopa, presented a 49 year old woman with a history of alcoholism who presented with RML pneumonia. Despite azithromycin and cephtriaxone she developed progressive respiratory failure and a right pleural effusion. A right chest tube was placed. Cultures of blood and the pleural fluid were negative. She was suspected of having an anaerobic infection. Follow-up CT scan showed abscess formation in her RML with areas of dense consolidation on the left and a left pleural effusion. Discussion focused on whether RML resection should be performed. Most favored a surgical approach. 2.Andrew Goldstein, thoracic surgery, presented a …

  2. Anosmia After Perimesencephalic Nonaneurysmal Hemorrhage

    NARCIS (Netherlands)

    Greebe, Paut; Rinkel, Gabriel J. E.; Algra, Ale

    Background and Purpose-Anosmia frequently occurs after aneurysmal subarachnoid hemorrhage not only after clipping, but also after endovascular coiling. Thus, at least in part, anosmia is caused by the hemorrhage itself and not only by surgical treatment. However, it is unknown whether anosmia is

  3. The evolution of thoracic anesthesia.

    Science.gov (United States)

    Brodsky, Jay B

    2005-02-01

    The specialty of thoracic surgery has evolved along with the modem practice of anesthesia. This close relationship began in the 1930s and continues today. Thoracic surgery has grown from a field limited almost exclusively to simple chest wall procedures to the present situation in which complex procedures, such as lung volume reduction or lung transplantation, now can be performed on the most severely compromised patient. The great advances in thoracic surgery have followed discoveries and technical innovations in many medical fields. One of the most important reasons for the rapid escalation in the number and complexity of thoracic surgical procedures now being performed has been the evolution of anesthesia for thoracic surgery. There has been so much progress in this area that numerous books and journals are devoted entirely to this subject. The author has been privileged to work with several surgeons who specialized in noncardiac thoracic surgery. As a colleague of 25 years, the noted pulmonary surgeon James B.D. Mark wrote, "Any operation is a team effort... (but) nowhere is this team effort more important than in thoracic surgery, where near-choreography of moves by all participants is essential. Exchange of information, status and plans are mandatory". This team approach between the thoracic surgeon and the anesthesiologist reflects the history of the two specialties. With new advances in technology, such as continuous blood gas monitoring and the pharmacologic management of pulmonary circulation to maximize oxygenation during one-lung ventilation, in the future even more complex procedures may be able to be performed safely on even higher risk patients.

  4. Infectious mononucleosis #3 (image)

    Science.gov (United States)

    Infectious mononucleosis is caused by the Epstein-Barr virus. It is a viral infection causing high temperature, sore throat, and swollen lymph glands. Infectious mononucleosis can be contagious if the infected person comes ...

  5. Tuberculosis a disease that created and shaped thoracic surgery

    OpenAIRE

    Inzirillo, Francesco; Giorgetta, Casimiro; Robustellini, Mario; Ravalli, Eugenio; Tiberi, Simon; Della Pona, Claudio

    2014-01-01

    Today it is incredible to think that an infectious disease, Tuberculosis (TB) as the disease that shaped Thoracic Surgery. The history of TB has so far evolved similarities with that of the mythological Phoenix, where the resurgence of this never completely eradicated “Insidious Disease” has now re-emerged and brought new challenges to modern medicine that of multi drug resistance. The probability of success, in treating complicated multi-drug resistant (MDR) TB pushing us back to the pre-ant...

  6. Thoracic complications of rheumatoid disease

    International Nuclear Information System (INIS)

    Massey, H.; Darby, M.; Edey, A.

    2013-01-01

    Rheumatoid arthritis is a relatively common multisystem disease associated with significant mortality and morbidity. Thoracic disease, both pleural and pulmonary, is a frequent extra-articular manifestation of rheumatoid arthritis and responsible for approximately 20% of rheumatoid-associated mortality. Rheumatoid disease and its associated therapies can affect all compartments of the lung inciting a range of stereotyped pathological responses and it is not infrequent for multiple disease entities to co-exist. In some instances, development of pulmonary complications may precede typical rheumatological presentation of the disease and be the first indication of an underlying connective tissue disease. The spectrum of thoracic disease related to rheumatoid arthritis is reviewed

  7. Thoracic outlet syndrome: Case report

    International Nuclear Information System (INIS)

    Marquez, Juan Camilo; Acosta, Mauricio Fernando; Uribe Jorge Ricardo

    2009-01-01

    We report a case of vascular thoracic outlet syndrome in a young man, diagnosed with upper limb arteriography, leading to repeated arterio-arterial emboli originating from a post-stenotic subclavian artery aneurysm. It is of our interest due to its low incidence and the small number of cases reported that have been diagnosed by arteriography. The thoracic outlet is the path through which vascular and neural structures goes from the neck to the axilla, and it has three anatomical strictures, that when pronounced, can compress the brachial plexus or subclavian vessels, leading to different symptoms and signs.

  8. Thoracic chordoma: CT and MR findings

    International Nuclear Information System (INIS)

    Cha, Yoo Mi; Hwang, Hee Young; Kim, Sang Joon; Chung, Hyo Sun; Han, Heon

    1993-01-01

    Chordoma arising from the notochordal remnants is a rare primary bone tumor in the cervicosacral region and is even more unusual in the thoracic region. The authors experienced a case of thoracic chordoma and reports its CT and MR findings

  9. Chondrosarcoma of a thoracic vertebra

    International Nuclear Information System (INIS)

    Abdelwahab, I.F.; Casden, A.M.; Klein, M.J.; Spollman, A.

    1991-01-01

    Central chondrosarcoma is an uncommon primary malignancy of the axial skeleton which usually affects the posterior elements or the posterior part of a vertebral body. The authors present an unusual case of chondrosarcoma involving the anterior part of a thoracic vertebra with massive extravertebral extension into the posterior mediastinum. The roles of computed tomography and magnetic resonance imaging in identifying this pathology are emphasized

  10. 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. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  11. Thoracic periaortal fibrosis and Ormond's disease

    International Nuclear Information System (INIS)

    Kacl, G.M.; Bino, M.; Salomon, F.; Risti, B.; Marincek, B.

    1995-01-01

    Two cases of thoracic periaortal fibrosis as a manifestation of retroperitoneal fibrosis (Ormond's disease) are shown on CT and MRI. Thoracic periaortal fibrosis can result in an inflammatory aneurysmo with chronic dissection. Manifestation of thoracic periaortal fibrosis may typically occur intermittently over decades. (orig.) [de

  12. Thoracic trauma in newborn foals

    International Nuclear Information System (INIS)

    Jean, D.; Laverty, S.; Halley, J.; Hannigan, D.; Leveille, R.

    1999-01-01

    In a report describing life ending fractures (255 horses) from the Livestock Disease Diagnostic Center, Kentucky (1993 and 1994), 32 foals had rib fractures. The purpose of our study was to examine the incidence of rib fractures in newborn foals on a Thoroughbred studfarm by physical and radiographic examination, to determine factors which may contribute to the problem and to document any clinical consequences. All foals (263) included were examined within 3 days of birth. The thoracic cage was palpated externally for abnormalities and all foals were placed in dorsal recumbency to evaluate thoracic cage symmetry. Radiographs were used to diagnose foals with thoraciccage asymmetry (TCA) and rib fracture (RF). A diagnosis of costochondral dislocation (CD) was made when no radiographic evidence of fracture was present but there was severe TCA, Fifty-five foals (20.1%) had TCA (9 RF), One to 5 ribs were fractured on 9 of 40 radiographic studies. No consequences of the thoracic trauma was detected clinically, radiographically or ultrasonographically in this group of foals or at a 2- and 4-week follow-up examination. The percentage of foals with a history of abnormal parturition was higher in the TCA foals (15%) compared to the normal foals (6.8%). There weremore primiparous dams in the TCA group than in the normal foal group. Fillies (56.6%) had a higher incidence of birth trauma than colts (43.4%), Thisstudy demonstrates that thoracic trauma is often present in newborn foals and may not always be of clinical significance. Dystocia foals and foals from primiparous mares should be considered high risk for thoracic trauma

  13. About Infectious Mononucleosis

    Science.gov (United States)

    ... Infectious mononucleosis, also called “mono,” is a contagious disease. Epstein-Barr virus (EBV) is the most common cause of infectious mononucleosis, but other viruses can also cause this disease. It is common among teenagers and young adults, ...

  14. [Infectious diseases research].

    Science.gov (United States)

    Carratalà, Jordi; Alcamí, José; Cordero, Elisa; Miró, José M; Ramos, José Manuel

    2008-12-01

    There has been a significant increase in research activity into infectious diseases in Spain in the last few years. The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) currently has ten study groups, with the cooperation of infectious diseases specialists and microbiologists from different centres, with significant research activity. The program of Redes Temáticas de Investigación Cooperativa en Salud (Special Topics Cooperative Health Research Networks) is an appropriate framework for the strategic coordination of research groups from the Spanish autonomous communities. The Spanish Network for Research in Infectious Diseases (REIPI) and the Network for Research in AIDS (RIS) integrate investigators in Infectious Diseases from multiple groups, which continuously perform important research projects. Research using different experimental models in infectious diseases, in numerous institutions, is an important activity in our country. The analysis of the recent scientific production in Infectious Diseases shows that Spain has a good position in the context of the European Union. The research activity in Infectious Diseases carried out in our country is a great opportunity for the training of specialists in this area of knowledge.

  15. Ultrasonographyin diagnosis of thoracic diseases

    OpenAIRE

    Stević Ruža; Jaković Radoslav; Mašulović Dragan; Nagorni-Obradović Ljudmila; Mujović Nataša; Jovanović Dragana

    2010-01-01

    Introduction. Chest sonography was used until recently mainly for diagnosis of pleural diseases. High resolution ultrasound machines enable ultrasound application not only in pleural diseases detection, but in diagnosing peripheral lung and mediastinal lesions. Ultrasonography can define the origin and structure of the lesion of thoracic wall, pleural and peripheral lung lesions and mediastinal lesions. Pleural lesions. Ultrasonography is very useful in diagnosing pleural effusion and disting...

  16. Thoracic aortic aneurysms and dissections: endovascular treatment.

    Science.gov (United States)

    Baril, Donald T; Cho, Jae S; Chaer, Rabih A; Makaroun, Michel S

    2010-01-01

    The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair was first described 15 years ago. Currently, there is a diverse array of endografts that are commercially available to treat the thoracic aorta. Multiple studies, including industry-sponsored and single-institution reports, have demonstrated excellent outcomes of thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms, with less reported perioperative morbidity and mortality in comparison with conventional open repair. Additionally, similar outcomes have been demonstrated for the treatment of type B dissections. However, the technology remains relatively novel, and larger studies with longer term outcomes are necessary to more fully evaluate the role of endovascular therapy for the treatment of thoracic aortic disease. This review examines the currently available thoracic endografts, preoperative planning for thoracic endovascular aortic repair, and outcomes of thoracic endovascular aortic repair for the treatment of both thoracic aortic aneurysms and type B aortic dissections. Mt Sinai J Med 77:256-269, 2010. (c) 2010 Mount Sinai School of Medicine.

  17. Pneumothorax in severe thoracic traumas

    International Nuclear Information System (INIS)

    Camassa, N.W.; Boccuzzi, F.; Diettorre, E.; Troilo, A.

    1988-01-01

    The authors reviewed CT scans and supine chest X-ray of 47 patients affected by severe thoracic trauma, examined in 1985-86. The sensibility of the two methodologies in the assessment of pneumothorax was compared. CT detected 25 pneumothorax, whereas supine chest X-ray allowed a diagnosis in 18 cases only. In 8 of the latter (44.4%) the diagnosis was made possible by the presence of indirect signs of pneumothorax only - the most frequent being the deep sulcus sign. The characterization of pneumothorax is important especially in the patients who need to be treated with mechanical ventilation therapy, or who are to undergo surgery in total anaesthesia

  18. Thoracic organ transplantation: laboratory methods.

    Science.gov (United States)

    Patel, Jignesh K; Kobashigawa, Jon A

    2013-01-01

    Although great progress has been achieved in thoracic organ transplantation through the development of effective immunosuppression, there is still significant risk of rejection during the early post-transplant period, creating a need for routine monitoring for both acute antibody and cellular mediated rejection. The currently available multiplexed, microbead assays utilizing solubilized HLA antigens afford the capability of sensitive detection and identification of HLA and non-HLA specific antibodies. These assays are being used to assess the relative strength of donor specific antibodies; to permit performance of virtual crossmatches which can reduce the waiting time to transplantation; to monitor antibody levels during desensitization; and for heart transplants to monitor antibodies post-transplant. For cell mediated immune responses, the recent development of gene expression profiling has allowed noninvasive monitoring of heart transplant recipients yielding predictive values for acute cellular rejection. T cell immune monitoring in heart and lung transplant recipients has allowed individual tailoring of immunosuppression, particularly to minimize risk of infection. While the current antibody and cellular laboratory techniques have enhanced the ability to manage thoracic organ transplant recipients, future developments from improved understanding of microchimerism and graft tolerance may allow more refined allograft monitoring techniques.

  19. Imaging of thoracic aortic dissection

    International Nuclear Information System (INIS)

    Vu, F.H.; Young, N.; Soo, Y.S.

    1994-01-01

    Acute thoracic aortic dissection has a high mortality rate if untreated, so the diagnosis must be rapidly made. Multiple imaging techniques are often used. This retrospective study from 1988 to 1993 assesses the usefulness in diagnosis of chest X-rays, computed tomography (CT) scanning, aortography, magnetic resonance imaging (MRI), trans-thoracic (TTE) and trans-oesophageal (TOE) echocardiography. Forty-two patients with a final clinical diagnosis of dissection were studied. The diagnosis was confirmed in 16 (13 at surgery and three at autopsy). Three died with dissection given as the only cause of death. Chest X-ray abnormalities were seen in all 19 patients with surgery or death from dissection, with a widened mediastinum and/or dilated aorta being present in 17. In the group of 16 patients with surgery or autopsy proof, CT scans found dissections in 9 out of 12 patients studied and correctly classified the type in only five. Aortography was preformed in five, with accurate depiction of dissection and type in all. TTE found dissections in three of eight patients imaged by this method. MRI and TOE were preformed each on two patients, with accurate depiction of dissection and type in each. Because of the relatively low sensitivity of CT scanning in defining aortic dissections Westmead Hospital is currently assessing the use of TOE as the prime imaging modality prior to surgical intervention. 17 refs., 4 tabs., 4 figs

  20. Evolution of thoracic surgery in Canada.

    Science.gov (United States)

    Deslauriers, Jean; Pearson, F Griffith; Nelems, Bill

    2015-01-01

    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. To describe the numerous and important achievements of Canadian thoracic surgeons in the areas of surgery for pulmonary tuberculosis, thoracic oncology, airway surgery and lung transplantation. Information was collected through reading of the numerous publications written by Canadian thoracic surgeons over the past 100 years, interviews with interested people from all thoracic surgery divisions across Canada and review of pertinent material form the archives of several Canadian hospitals and universities. Many of the developments occurred by chance. It was the early and specific focus on thoracic surgery, to the exclusion of cardiac and general surgery, that distinguishes the Canadian experience, a model that is now emerging everywhere. From lung transplantation in chimera twin calves to ex vivo organ preservation, from the removal of airways to tissue regeneration, and from intensive care research to complex science, Canadians have excelled in their commitment to research. Over the years, the influence of Canadian thoracic surgery on international practice has been significant. Canada spearheaded the development of thoracic surgery over the past 100 years to a greater degree than any other country. From research to education, from national infrastructures to the regionalization of local practices, it happened in Canada.

  1. Advancements in robotic-assisted thoracic surgery.

    Science.gov (United States)

    Steenwyk, Brad; Lyerly, Ralph

    2012-12-01

    Advancements in robotic-assisted thoracic surgery present potential advantages for patients as well as new challenges for the anesthesia and surgery teams. This article describes the major aspects of the surgical approach for the most commonly performed robotic-assisted thoracic surgical procedures as well as the pertinent preoperative, intraoperative, and postoperative anesthetic concerns. Copyright © 2012. Published by Elsevier Inc.

  2. Thoracic duct lymphography by subcutaneous contrast agent ...

    African Journals Online (AJOL)

    A second lymphography revealed a collateral thoracic duct that was not detected during the first lymphography. The collateral duct was ligated and chylothorax was resolved after the second surgery. The lymphography applied in this study was minimally-invasive and easily provided images of the thoracic duct in a dog with ...

  3. Visualization of the thoracic duct by lymphoscintigraphy

    International Nuclear Information System (INIS)

    Baulieu, F.; Baulieu, J.L.; Itti, R.; Tours Univ., 37

    1987-01-01

    Imaging of the thoracic duct is usually performed by radiological lymphography. However, this procedure, which uses an oil based dye injected directly into the lymph channels, has some adverse effects. In this paper we note that lymphoscintigraphy, a physiological and non invasive method, may visualize thoracic duct abnormalities, and might be particularly usefull when radiological lymphography is contraindicated. (orig.)

  4. Bilateral locked facets in the thoracic spine

    NARCIS (Netherlands)

    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.

  5. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; van der Zwan, Jan Maarten; Izarzugaza, Isabel; Jaal, Jana; Treasure, Tom; Foschi, Roberto; Ricardi, Umberto; Groen, Harry; Tavilla, Andrea; Ardanaz, Eva

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  6. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; Zwan, J.M.V.D.; Izarzugaza, I.; Jaal, J.; Treasure, T.; Foschi, R.; Ricardi, U.; Groen, H.; Tavilla, A.; Ardanaz, E.

    2012-01-01

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  7. Infectious waste feed system

    Science.gov (United States)

    Coulthard, E. James

    1994-01-01

    An infectious waste feed system for comminuting infectious waste and feeding the comminuted waste to a combustor automatically without the need for human intervention. The system includes a receptacle for accepting waste materials. Preferably, the receptacle includes a first and second compartment and a means for sealing the first and second compartments from the atmosphere. A shredder is disposed to comminute waste materials accepted in the receptacle to a predetermined size. A trough is disposed to receive the comminuted waste materials from the shredder. A feeding means is disposed within the trough and is movable in a first and second direction for feeding the comminuted waste materials to a combustor.

  8. 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

  9. 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...

  10. Carcinoma of the thoracic esophagus

    International Nuclear Information System (INIS)

    Herskovic, A.M.; Leichman, L.; Lattin, P.B.

    1987-01-01

    The authors analyzed all cases of thoracic esophagel carcinoma seen from 1980 to 1984 inclusive, plus an additional 22 cases from a pilot study at Wayne State University. Most patients received preoperative combination radiation and chemotherapy. Eighty-nine patients completed treatment (5-fluorouracil, cisplatin, and radiation therapy) as in both the RTOG and SWOG national studies. Of these 89, 39 refused or were not offered planned surgery. Four patients are still alive and well. Fifty patients underwent esophagectomy; 12 patients were free of tumor at esophagectomy, and four of these are alive and well. One patient with a tumor in the resected esophagus alone is still alive. Twenty-two patients were enrolled in the pilot study in which surgery was reserved for salvage, the initial radiation volume was increased, the tumor dose was increased to 5,000 rad give continuously, and chemotherapy was increased to four courses

  11. Dynamics of infectious diseases

    International Nuclear Information System (INIS)

    Rock, Kat; Brand, Sam; Moir, Jo; Keeling, Matt J

    2014-01-01

    Modern infectious disease epidemiology has a strong history of using mathematics both for prediction and to gain a deeper understanding. However the study of infectious diseases is a highly interdisciplinary subject requiring insights from multiple disciplines, in particular a biological knowledge of the pathogen, a statistical description of the available data and a mathematical framework for prediction. Here we begin with the basic building blocks of infectious disease epidemiology—the SIS and SIR type models—before considering the progress that has been made over the recent decades and the challenges that lie ahead. Throughout we focus on the understanding that can be developed from relatively simple models, although accurate prediction will inevitably require far greater complexity beyond the scope of this review. In particular, we focus on three critical aspects of infectious disease models that we feel fundamentally shape their dynamics: heterogeneously structured populations, stochasticity and spatial structure. Throughout we relate the mathematical models and their results to a variety of real-world problems. (review article)

  12. Infectious uveitis in Virginia

    Directory of Open Access Journals (Sweden)

    Engelhard SB

    2015-08-01

    Full Text Available Stephanie B Engelhard,1 Zeina Haddad,1 Asima Bajwa,1 James Patrie,2 Wenjun Xin,2 Ashvini K Reddy1 1Department of Ophthalmology, 2Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA Purpose: To report the causes, clinical features, and outcomes of infectious uveitis in patients managed in a mid-Atlantic tertiary care center.Methods: Retrospective, observational study of infectious uveitis patients seen at the University of Virginia from 1984 to 2014.Results: Seventy-seven of 491 patients (15.7% were diagnosed with infectious uveitis (mean age 58 years, 71.4% female, 76.6% Caucasian. The mean follow-up was 5 years. Anterior uveitis was the most common anatomic classification (39 patients, 50.6% followed by panuveitis (20 patients, 26.0% and posterior uveitis (18 patients, 23.4%. The most common infectious etiology was herpetic anterior uveitis (37 patients, 48.1% followed by toxoplasma uveitis (14 patients, 18.2%. The most prevalent viral pathogen was varicella-zoster virus (21 patients, 27.3% followed by herpes simplex virus (20 patients, 26.0%. Acute retinal necrosis (ARN was diagnosed in 14 patients (18.2%. Aqueous humor yielded an etiologic diagnosis in seven (50% of ARN patients, four of whom tested positive for cytomegalovirus and three for varicella-zoster virus. On presentation, 43 patients (55.8% had a visual acuity (VA better than 20/40 and 17 (22.1% had a VA worse than 20/200. VA at the final follow-up was better than 20/40 in 39 patients (50.6% and worse than 20/200 in 22 patients (28.6%. In all, 16 (20.8% and 10 (13.0% patients required cataract and vitrectomy surgery, respectively. A total of 14 patients (18.2% were on glaucoma topical treatment and four (5.2% required glaucoma surgery.Conclusion: The most common type of infectious uveitis seen over the study period was herpetic anterior uveitis secondary to varicella-zoster virus or herpes simplex virus, found to be most prevalent in patients

  13. Vasculitis and infectious diseases.

    Science.gov (United States)

    Satta, R; Biondi, G

    2015-04-01

    Vasculitis usually presents without a well-known underline cause (idiopathic vasculitis), nevertheless, it is sometimes possible to find out one or more causative agents (secondary vasculitis). Nowadays, thanks to the increasing amount of precise diagnostic tools, a piece of idiopathic vasculitis is reclassified as associated with probable etiology, which can be set off by several factors, such as infections. Infections are considered to be the most common cause of secondary vasculitis. Virtually, every infectious agent can trigger a vasculitis by different mechanisms which can be divided in two main categories: direct and indirect. In the former, infectious agents destroy directly the vascular wall leading, eventually, to a subsequent inflammatory response. In the latter, indirect form, they stimulate an immune response against blood vessels. Different infectious agents are able to directly damage the vascular wall. Among these, it is possible to recognize Staphylococcus spp, Streptococcus spp, Salmonella spp, Treponema spp, Rickettsia spp, Cytomegalovirus, Herpes Simplex Virus 1 and 2, and many others which have a peculiar tropism for endothelial cells. Conversely, another group of microbial agents, such as Mycobacterium tuberculosis, Mycobacterium leprae, Hepatits B Virus, Human Immunodeficiency Virus and others, trigger vasculitis in the indirect way. This is due to the fact that they can share epitopes with the host or modify self-antigens, thus leading to a cross-self reaction of the immune system. These mechanism, in turn, leads to immunological responses classified as type I-IV by Gell-Coombs. Nevertheless, it is difficult to strictly separate the direct and indirect forms, because most infectious agents can cause vasculitis in both ways (mixed forms). This paper will analyze the link between infectious agents and vasculitis, focusing on direct and indirect secondary vasculitis, and on a group of probable infection-related idiopathic vasculitis, and finally

  14. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp; Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp; Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp; Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp; Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp; Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp [Kansai Medical University, Department of Radiology (Japan)

    2017-01-15

    PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

  15. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

    International Nuclear Information System (INIS)

    Kariya, Shuji; Nakatani, Miyuki; Yoshida, Rie; Ueno, Yutaka; Komemushi, Atsushi; Tanigawa, Noboru

    2017-01-01

    PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

  16. Emergency Anaesthetic Management of Extensive Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    H C Chandola

    2007-01-01

    Full Text Available High speed vehicles, drug abuse, alcohol and easy availability of handguns are the main reasons of increasing number of trauma especially thoracic trauma. Anaesthesiologist plays an important role in the management of extensive thoracic trauma. Thoracic trauma, penetrating or blunt, may cause damage to organs suspended in thorax viz. pleura, lungs, heart, great vessels, trachea and oesophagus. It may lead to pneumothorax, cardiac tamponade or life threatening haemorrhage. With aggressive care and management of these factors, majority of patients can survive and return to normal life.

  17. Catamenial pneumothorax caused by thoracic endometriosis

    Directory of Open Access Journals (Sweden)

    Paolo Maniglio, MD

    2018-02-01

    Conclusion: The diagnosis of thoracic endometriosis is challenging. The first line of treatment is medical, whereas the surgical treatment is performed secondly. Moreover, surgical treatment can lead to a significant rate of recurrence, often reduced by a coadjutant medical treatment.

  18. Surgical treatment of double thoracic adolescent idiopathic scoliosis with a rigid proximal thoracic curve.

    Science.gov (United States)

    Sudo, Hideki; Abe, Yuichiro; Abumi, Kuniyoshi; Iwasaki, Norimasa; Ito, Manabu

    2016-02-01

    There is limited consensus on the optimal surgical strategy for double thoracic adolescent idiopathic scoliosis (AIS). Recent studies have reported that pedicle screw constructs to maximize scoliosis correction cause further thoracic spine lordosis. The objective of this study was to apply a new surgical technique for double thoracic AIS with rigid proximal thoracic (PT) curves and assess its clinical outcomes. Twenty one consecutive patients with Lenke 2 AIS and a rigid PT curve (Cobb angle ≥30º on side-bending radiographs, flexibility ≤30 %) treated with the simultaneous double-rod rotation technique (SDRRT) were included. In this technique, a temporary rod is placed at the concave side of the PT curve. Then, distraction force is applied to correct the PT curve, which reforms a sigmoid double thoracic curve into an approximate single thoracic curve. As a result, the PT curve is typically converted from an apex left to an apex right curve before applying the correction rod for PT and main thoracic curve. All patients were followed for at least 2 years (average 2.7 years). The average main thoracic and PT Cobb angle correction rate at the final follow-up was 74.7 and 58.0 %, respectively. The average preoperative T5-T12 thoracic kyphosis was 9.3°, which improved significantly to 19.0° (p corrected using SDRRT for Lenke 2 AIS with a rigid PT curve.

  19. A History of Thoracic Aortic Surgery.

    Science.gov (United States)

    McFadden, Paul Michael; Wiggins, Luke M; Boys, Joshua A

    2017-08-01

    Ancient historical texts describe the presence of aortic pathology conditions, although the surgical treatment of thoracic aortic disease remained insurmountable until the 19th century. Surgical treatment of thoracic aortic disease then progressed along with advances in surgical technique, conduit production, cardiopulmonary bypass, and endovascular technology. Despite radical advances in aortic surgery, principles established by surgical pioneers of the 19th century hold firm to this day. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. [Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

    Science.gov (United States)

    Saito, Hajime; Minamiya, Yoshihiro

    2016-01-01

    Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

  1. 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.

  2. MRI of thoracic outlet syndrome in children

    Energy Technology Data Exchange (ETDEWEB)

    Chavhan, Govind B.; Batmanabane, Vaishnavi [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); Muthusami, Prakash [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); The Hospital for Sick Children, Division of Image Guided Therapy, Department of Diagnostic Imaging, Toronto, ON (Canada); Towbin, Alexander J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology and Medical Imaging, Cincinnati, OH (United States); Borschel, Gregory H. [The Hospital for Sick Children and University of Toronto, Division of Plastic Surgery, Department of Pediatric Surgery, Toronto, ON (Canada)

    2017-09-15

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation. (orig.)

  3. MRI of thoracic outlet syndrome in children

    International Nuclear Information System (INIS)

    Chavhan, Govind B.; Batmanabane, Vaishnavi; Muthusami, Prakash; Towbin, Alexander J.; Borschel, Gregory H.

    2017-01-01

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation. (orig.)

  4. Initial thoracic involvement in lymphoma. CT assessment

    International Nuclear Information System (INIS)

    Bustos, A.; Corredoira, J.; Ferreiros, J.; Cabeza, B.; Jorquera, M.; Pedrosa, I.; Martinez, R.; Fernandez, C.

    2002-01-01

    To analyze the initial thoracic involvement by CT in a consecutive series of patients with lymphoma. A retrospective analysis was made of thoracic CT studies made at the time of diagnosis of 259 patients with lymphoma. Mediastinal pulmonary, pleural, pericardial and chest wall involvement was assessed by CT. Of 259 patients (129 men y 130 women), 56 had Hodgkin's disease (HD) and 203 had non-Hodgkin lymphoma (NHL). Forty-two percent (42.5%, 110/259) of the patients had chest involvement on CT: 33 of 56 patients with HD (58.9%) and 77 of 203 patients with NHL (37.9%). All the patients with thoracic HD) and 71.4% of patients with thoracic NHL, had mediastinal lymph node involvement. of the patients with thoracic involvement 12.1% (4/33) of the patient with HD and 23.3% (18/77) of the patients with NHL had pulmonary involvement. Thoracic involvement on CT was more frequent in HD. Mediastinal lymph node involvement was the most common finding fundamentally in HD. Pulmonary disease always occurred in the presence of mediastinal lymph node involvement in HD but could occur as an isolated finding in NHL. (Author) 24 refs

  5. INFECTIOUS MYXOMATOSIS OF RABBITS

    Science.gov (United States)

    Smadel, Joseph E.; Ward, S. M.; Rivers, Thomas M.

    1940-01-01

    A second soluble antigen, separable from the virus, occurs in extracts of infected skin and in the serum of rabbits acutely ill with infectious myxomatosis. Like the first antigen (A), the second (B) is heat labile and has certain characteristics of a globulin. The two antigens precipitate in different concentrations of ammonium sulfate and can be separated by this method. Neither of the antigens after being heated at 56°C. precipitates in the presence of specific antibody but each is capable of inhibiting the activity of its antibody. PMID:19871012

  6. Feline infectious peritonitis.

    Science.gov (United States)

    Goodson, Teresa; Randell, Susan; Moore, Lisa

    2009-10-01

    Feline infectious peritonitis (FIP) frequently results in death in cats. It is caused by a mutated, highly contagious coronavirus, and it is more common in indoor cats in multicat households. A complex interaction between the coronavirus and the feline immune system causes disseminated vasculitis, which is the hallmark of FIP. New tests are being developed, but the antemortem diagnosis of FIP continues to be difficult and frustrating. Current treatments are crude and involve supportive care and immunosuppression. Minimizing exposure is the best method of preventing infection.

  7. [Equine Infectious Anemia (EIA)].

    Science.gov (United States)

    Kaiser, A; Meier, H P; Straub, R; Gerber, V

    2009-04-01

    Equine Infectious Anemia (EIA) is a reportable, eradicable epizootic disease caused by the equine lentivirus of the retrovirus family which affects equids only and occurs worldwide. The virus is transmitted by blood, mainly by sanguivorous insects. The main symptoms of the disease are pyrexia, apathy, loss of body condition and weight, anemia, edema and petechia. However, infected horses can also be inapparent carriers without any overt signs. The disease is diagnosed by serological tests like the Coggins test and ELISA tests. Presently, Switzerland is offi cially free from EIA. However, Switzerland is permanently at risk of introducing the virus as cases of EIA have recently been reported in different European countries.

  8. Emergency thoracic surgery in elderly patients

    Science.gov (United States)

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants Emergency patients treated at the Department of Thoracic Surgery, University Hospital of Luebeck, Germany. Main outcome measures Co-morbidities, mortality, risk factors and hospital length of stay. Results A total of 124 thoracic procedures were performed on 114 patients. There were 79 men and 36 women (average age 72.5 ±6.4 years, range 65–94). The overall operative mortality was 25.4%. The most frequent indication was thoracic/mediastinal infection, followed by peri- or postoperative thoracic complications. Risk factors for hospital mortality were a high ASA score, pre-existing diabetes mellitus and renal insufficiency. Conclusions Our study documents a perioperative mortality rate of 25% in patients over 65 who required emergency thoracic surgery. The main indication for a surgical intervention was sepsis with a thoracic/mediastinal focus. Co-morbidities and the resulting perioperative complications were found to have a significant effect on both inpatient length of stay and outcome. Long-term systemic co-morbidities such as diabetes mellitus are difficult to equalize with respect to certain organ dysfunctions and significantly increase mortality. PMID:21369531

  9. Noncontiguous multifocal brucellar spondylitis involving the cervical, thoracic, and lumbar spine: A case report

    Directory of Open Access Journals (Sweden)

    Rong Wang

    2017-06-01

    Full Text Available Brucellosis is a zoonosis infectious disease, brucellar spondylitis primarily infects the lumbar, the cervical is uncommon. Multiple-level involvement is extremely rare. This report describes a 46-year-old man with noncontiguous multifocal brucellar spondylitis involving the cervical, thoracic, and lumbar spine. Brucellar spondylitis is difficult to diagnose. Routine laboratory findings for the disease have little diagnostic value. Manifestations and radiological features are usually nonspecific. Radiological features of brucellar spondylitis are similar to tuberculous spondylitis and pyogenic spondylitis. MRI findings have diagnostic value. Suspicious patients with unexplained fever, musculoskeletal complaints at risk of infection should be considered.

  10. 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.

  11. [Globalization and infectious diseases].

    Science.gov (United States)

    Mirski, Tomasz; Bartoszcze, Michał; Bielawska-Drózd, Agata

    2011-01-01

    Globalization is a phenomenon characteristic of present times. It can be considered in various aspects: economic, environmental changes, demographic changes, as well as the development of new technologies. All these aspects of globalization have a definite influence on the emergence and spread of infectious diseases. Economic aspects ofglobalization are mainly the trade development, including food trade, which has an impact on the spread of food-borne diseases. The environmental changes caused by intensive development of industry, as a result of globalization, which in turn affects human health. The demographic changes are mainly people migration between countries and rural and urban areas, which essentially favors the global spread of many infectious diseases. While technological advances prevents the spread of infections, for example through better access to information, it may also increase the risk, for example through to create opportunities to travel into more world regions, including the endemic regions for various diseases. The phenomenon ofglobalization is also closely associated with the threat of terrorism, including bioterrorism. It forces the governments of many countries to develop effective programs to protect and fight against this threat.

  12. Mitigating Infectious Disease Outbreaks

    Science.gov (United States)

    Davey, Victoria

    The emergence of new, transmissible infections poses a significant threat to human populations. As the 2009 novel influenza A/H1N1 pandemic and the 2014-2015 Ebola epidemic demonstrate, we have observed the effects of rapid spread of illness in non-immune populations and experienced disturbing uncertainty about future potential for human suffering and societal disruption. Clinical and epidemiologic characteristics of a newly emerged infectious organism are usually gathered in retrospect as the outbreak evolves and affects populations. Knowledge of potential effects of outbreaks and epidemics and most importantly, mitigation at community, regional, national and global levels is needed to inform policy that will prepare and protect people. Study of possible outcomes of evolving epidemics and application of mitigation strategies is not possible in observational or experimental research designs, but computational modeling allows conduct of `virtual' experiments. Results of well-designed computer simulations can aid in the selection and implementation of strategies that limit illness and death, and maintain systems of healthcare and other critical resources that are vital to public protection. Mitigating Infectious Disease Outbreaks.

  13. Thoracic surgical resident education: a costly endeavor.

    Science.gov (United States)

    Calhoon, John H; Baisden, Clint; Holler, Ben; Hicks, George L; Bove, Ed L; Wright, Cameron D; Merrill, Walter H; Fullerton, Dave A

    2014-12-01

    We sought to define an accurate measure of thoracic surgical education costs. Program directors from six distinct and differently sized and geographically located thoracic surgical training programs used a common template to provide estimates of resident educational costs. These data were reviewed, clarifying questions or discrepancies when noted and using best estimates when exact data were unavailable. Subsequently, a composite of previously published cost-estimation products was used to capture accurate cost data. Data were then compiled and averaged to provide an accurate picture of all costs associated with thoracic surgical education. Before formal accounting was performed, the estimated average for all programs was approximately $250,000 per year per resident. However, when formal evaluations by the six programs were performed, the annual cost of resident education ranged from $330,000 to $667,000 per year per resident. The average cost of $483,000 per year was almost double the initial estimates. Variability was noted by region and size of program. Faculty teaching costs varied from $208,000 to $346,000 per year. Simulation costs ranged from $0 to $80,000 per year. Resident savings to program ranged from $0 to $135,000 per year and averaged $37,000 per year per resident. Thoracic surgical education costs are considerably higher than initial estimates from program directors and probably represent an unappreciated source of financial burden for cardiothoracic surgical educational programs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Thoracic CT findings at hypovolemic shock

    International Nuclear Information System (INIS)

    Rotondo, A.; Angelelli, G.; Catalano, O.; Grassi, R.; Scialpi, M.

    1998-01-01

    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.)

  15. Enhanced Recovery in Thoracic Surgery: A Review

    Directory of Open Access Journals (Sweden)

    Vesna D. Dinic

    2018-02-01

    Full Text Available The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. Anesthetic management during preoperative, intraoperative and postoperative period is essential for the enhanced recovery. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program.

  16. Wetlands and infectious diseases

    Directory of Open Access Journals (Sweden)

    Robert H. Zimmerman

    2001-01-01

    Full Text Available There is a historical association between wetlands and infectious disease that has led to the modification of wetlands to prevent disease. At the same time there has been the development of water resources projects that increase the risk of disease. The demand for more water development projects and the increased pressure to make natural wetlands economically beneficial creates the need for an ecological approach to wetland management and health assessment. The environmental and health interactions are many. There is a need to take into account the landscape, spatial boundaries, and cross-boundary interactions in water development projects as well as alternative methods to provide water for human needs. The research challenges that need to be addressed are discussed.

  17. A Case of Fatal Pulmonary Hypoplasia with Congenital Diaphragmatic Hernia, Thoracic Myelomeningocele, and Thoracic Dysplasia.

    Science.gov (United States)

    Ito, Ai; Fujinaga, Hideshi; Matsui, Sachiko; Tago, Kumiko; Iwasaki, Yuka; Fujino, Shuhei; Nagasawa, Junko; Amari, Shoichiro; Kaneshige, Masao; Wada, Yuka; Takahashi, Shigehiro; Tsukamoto, Keiko; Miyazaki, Osamu; Yoshioka, Takako; Ishiguro, Akira; Ito, Yushi

    2017-10-01

    Background  Congenital diaphragmatic hernia (CDH) is fatal in severe cases of pulmonary hypoplasia. We experienced a fatal case of pulmonary hypoplasia due to CDH, thoracic myelomeningocele (MMC), and thoracic dysplasia. This constellation of anomalies has not been previously reported. Case Report  A male infant with a prenatal diagnosis of thoracic MMC with severe hydrocephalus and scoliosis was born at 36 weeks of gestation. CDH was found after birth and the patient died of respiratory failure due to pulmonary hypoplasia and persistent pulmonary hypertension of the newborn at 30 hours of age despite neonatal intensive care. An autopsy revealed a left CDH without herniation of the liver or stomach into the thoracic cavity, severe hydrocephalus, Chiari malformation type II, MMC with spina bifida from Th4 to Th12, hemivertebrae, fused ribs, deformities of the thoracic cage and legs, short trunk, and agenesis of the left kidney. Conclusion  We speculate that two factors may be associated with the severe pulmonary hypoplasia: decreased thoracic space due to the herniation of visceral organs caused by CDH and thoracic dysplasia due to skeletal deformity and severe scoliosis.

  18. A RARE CASE OF THORACIC ACTINOMYCOSIS

    Directory of Open Access Journals (Sweden)

    Priyanka Das

    2017-10-01

    Full Text Available PRESENTATION OF CASE Actinomycetes are branching gram-positive anaerobic bacteria belonging to Actinomycetaceae family and are commensals in human oropharynx, gastrointestinal tract and female genitalia. Thoracic or pulmonary actinomycosis is an uncommon bacterial infection. The diagnosis of pulmonary or thoracic actinomycosis is often confounding because of its shared clinical features with malignant lung diseases and chronic suppurative lung diseases. However, chest physicians should be aware of actinomycosis being a differential diagnosis in persistent shadows in lung as early diagnosis leads to good prognosis. 1

  19. Failures and complications of thoracic drainage

    Directory of Open Access Journals (Sweden)

    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

  20. 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.

  1. Idiopathic thoracic transdural intravertebral spinal cord herniation

    Directory of Open Access Journals (Sweden)

    Mazda K Turel

    2017-01-01

    Full Text Available Idiopathic spinal cord herniation is a rare and often missed cause of thoracic myelopathy. The clinical presentation and radiological appearance is inconsistent and commonly confused with a dorsal arachnoid cyst and often is a misdiagnosed entity. While ventral spinal cord herniation through a dural defect has been previously described, intravertebral herniation is a distinct entity and extremely rare. We present the case of a 70-year old man with idiopathic thoracic transdural intravertebral spinal cord herniation and discuss the clinico-radiological presentation, pathophysiology and operative management along with a review the literature of this unusual entity.

  2. Lungs, pleura, thoracal wall. 7. rev. ed.

    International Nuclear Information System (INIS)

    Stender, H.S.

    1988-01-01

    The book describes the anatomy of the lungs, as well as X-ray, computerized tomography, nuclear magnetic resonance, and nuclear-medical imaging techniques. Following a discussion of the general symptomatology of pulmonary diseases verifiable by X-ray, the individual diseases including inhalation damage from inorganic dusts and gases are dealt with. Traumatic thoracal conditions, the image of the thorax after operations, alterations of the thoracal wall, as well as pleural diseases are also discussed. (MG) With 1776 figs., 52 tabs [de

  3. 75 FR 24835 - Infectious Diseases

    Science.gov (United States)

    2010-05-06

    ... and Docket Office's normal business hours, 8:15 a.m.-4:45 p.m., EST. Instructions: All submissions... infectious agents, radiation and chemicals. The Bureau of Labor Statistics (BLS) reports that for 2008, the... infectious diseases to patients and HCWs. This fundamental approach is set forth in the guidelines of the...

  4. Infectious Diseases in Day Care.

    Science.gov (United States)

    Sleator, Esther K.

    Discussed in this publication are infectious illnesses for which children attending day care appear to be at special risk. Also covered are the common cold, some infectious disease problems receiving media attention, and some other annoying but not serious diseases, such as head lice, pinworms, and contagious skin conditions. Causes,…

  5. 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.

  6. Thoracic endometriosis syndrome: Current concept in ...

    African Journals Online (AJOL)

    Background: Thoracic endometriosis is a rare pathology. The diagnosis is often delayed or missed, however recently, there has been significant advances in the knowledge of this condition and hence, an improvement in the diagnosis and treatment. Objective: To review the current concepts in the pathophysiology and ...

  7. Thoracic Ectopia Cordis in an Ethiopian Neonate

    African Journals Online (AJOL)

    GB

    2017-03-01

    Mar 1, 2017 ... Thoracic Ectopia Cordis in an Ethiopian Neonate. Henok Tadele*. 1 ... the chest wall. Initial treatment included covering the heart with sterile-saline soaked dressing, starting systemic antibiotics and supportive care. A staged ... of thoracoabdominal EC, anterior diaphragmatic hernia, lower sternal defect and ...

  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. Thoracic trauma: presentation and management outcome

    International Nuclear Information System (INIS)

    Saaiq, M.; Shah, S. A.

    2008-01-01

    To determine the presentation and management outcome of thoracic trauma in a tertiary care setting. A total of 143 patients, who presented with chest trauma, were included in the study. All the patients were assessed by the history, physical examination and ancillary investigations. Appropriate managements were instituted as required. Data was described in percentages. out of 143 patients, 119 (83)% were males and 24 (17)% were females. Most of the patients belonged to the age group of 21-50 years. Ninety seven (66)% patients were admitted for indoor management. Blunt injury was found in 125 (87.4%) patients, while penetrating injuries in only 18 (12.6%) patients. Road Traffic Accidents (RTAs) were the commonest cause of trauma (n=103, 72%). Rib fracture was the commonest chest injury (74% patients). Head injury was the most frequently associated injury (18% of the patients). Tube thoracostomy was the commonest intervention undertaken in 65 (45%) patients. Seventeen (11.88%) patients were managed with mechanical ventilation. there were 17 deaths with a mortality rate of 11.88%. Thoracic trauma is an important cause of hospitalization, morbidity and mortality in the younger population. RTAs constitute the leading cause of thoracic trauma in our setup. Tube thoracostomy is the most frequent and at times the only invasive procedure required as a definitive measure in thoracic trauma patients. A policy of selective hospitalization helps to avoid unnecessary hospital admissions. (author)

  10. Thoracic epidural anaesthesia for major abdominal surgeries ...

    African Journals Online (AJOL)

    The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Data were obtained from the ... In a previous study, Consani et al.3 documented the feasibility of thoracic epidural ... thoracostomy and mastectomy in high-risk patients.2,6 Since TEA places less demand on drugs, ...

  11. Thoracic and abdominopelvic actinomycosis | Spiegel | SA Journal ...

    African Journals Online (AJOL)

    intervention it is worthwhile including actinomycosis infection in the differential diagnosis. We present radiological findings for 4 patients presenting with different forms of thoracic and abdominopelvic actinomycosis infection, and a short review of the documented literature findings. South African Journal of Radiology Vol.

  12. Acquired intrathoracic kidney in thoracic kyphosis

    International Nuclear Information System (INIS)

    Murayama, Sadayuki; Kawashima, Akira; Ohuchida, Toshiyuki; Russell, W.J.

    1986-12-01

    Two cases of acquired intrathoracic kidney associated with thoracic kyphosis are reported, with emphasis on the radiographic manifestations. A search of the scientific literature disclosed that the acquired type of this abnormality is rare. The importance of recognizing this entity from a differential diagnostic standpoint is underscored. (author)

  13. Peracute Infectious Canine Hepatitis

    Directory of Open Access Journals (Sweden)

    A. H. Cheema*, I. Ahmed, G. Mustafa and A. Aslam

    2012-05-01

    Full Text Available Peracute infectious canine hepatitis (ICH was diagnosed in two young male dogs out of 56 dead canines presented for necropsy examination during the period of April 2009 to June 2010. These dogs were purebred, one- month old Alsatian and 5-month old Labrador. None of the dogs had received any vaccination or deworming treatment; both had died after illness lasting for six hours and twenty four hours respectively. The dogs had shown signs of depression, anorexia and fever. At necropsy, lymph nodes were swollen, edematous and congested; livers were enlarged, bright red and mottled with numerous small white foci. Petechial hemorrhages were seen in the mucosa. Excessive serosanguinous fluid was present in the abdominal cavities. Histologically, the most significant lesion was necrohemorrhagic hepatitis with single cell necrosis of hepatocytes, lacunose dilation of sinusoids filled with blood and numerous large, solid intranuclear inclusion bodies (IIBs in the hepatocytes and macrophages. Both eosinophilic and basophilic (amphophilic inclusions were seen. It has been observed that ICH is re-emerging in some endemic countries. Pet dogs should be regularly protected by effective vaccination.

  14. What Is a Pediatric Infectious Diseases Specialist?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Infectious Diseases Specialist? Page Content Article Body If ... the teen years. What Kind of Training Do Pediatric Infectious Diseases Specialists Have? Pediatric infectious diseases specialists ...

  15. NON-INFECTIOUS DISORDERS OF WARMWATER FISHES

    Science.gov (United States)

    Compared with infectious diseases and disorders, few non-infectious diseases and disorders in cultured fish have severe biologic or economic impact. Culture practices, however, often establish environments that promote infectious disease by weakening the immune response or by pro...

  16. 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.

  17. CT morphometry of adult thoracic intervertebral discs.

    Science.gov (United States)

    Fletcher, Justin G R; Stringer, Mark D; Briggs, Christopher A; Davies, Tilman M; Woodley, Stephanie J

    2015-10-01

    Despite being commonly affected by degenerative disorders, there are few data on normal thoracic intervertebral disc dimensions. A morphometric analysis of adult thoracic intervertebral discs was, therefore, undertaken. Archival computed tomography scans of 128 recently deceased individuals (70 males, 58 females, 20-79 years) with no known spinal pathology were analysed to determine thoracic disc morphometry and variations with disc level, sex and age. Reliability was assessed by intraclass correlation coefficients (ICCs). Anterior and posterior intervertebral disc heights and axial dimensions were significantly greater in men (anterior disc height 4.0±1.4 vs 3.6±1.3 mm; posterior disc height 3.6±0.90 vs 3.4±0.93 mm; p<0.01). Disc heights and axial dimensions at T4-5 were similar or smaller than at T2-3, but thereafter increased caudally (mean anterior disc height T4-5 and T10-11, 2.7±0.7 and 5.4±1.2 mm, respectively, in men; 2.6±0.8 and 5.1±1.3 mm, respectively, in women; p<0.05). Except at T2-3, anterior disc height decreased with advancing age and anteroposterior and transverse disc dimensions increased; posterior and middle disc heights and indices of disc shape showed no consistent statistically significant changes. Most parameters showed substantial to almost perfect agreement for intra- and inter-rater reliability. Thoracic disc morphometry varies significantly and consistently with disc level, sex and age. This study provides unique reference data on adult thoracic intervertebral disc morphometry, which may be useful when interpreting pathological changes and for future biomechanical and functional studies.

  18. Infectious diseases in competitive sports.

    Science.gov (United States)

    Goodman, R A; Thacker, S B; Solomon, S L; Osterholm, M T; Hughes, J M

    1994-03-16

    Participation in competitive sports is popular and widely encouraged throughout the United States. Reports of infectious disease outbreaks among competitive athletes and recent publicity regarding infectious disease concerns in sports underscore the need to better characterize the occurrence of these problems. To identify reports of infectious diseases in sports, we performed a comprehensive search of the medical literature (MEDLINE) and newspaper databases in two on-line services (NEXIS and DIALOG PAPERS). Articles selected from the literature review included those describing cases or outbreaks of disease in which exposure to an infectious agent was likely to have occurred during training for competitive sports or during actual competition. Articles from the newspaper review included reports of outbreaks, exposures, or preventive measures that directly or indirectly involved teams or spectators. The literature review identified 38 reports of infectious disease outbreaks or other instances of transmission through person-to-person (24 reports), common-source (nine reports), or airborne (five reports) routes; the newspaper search identified 28 reports. Infectious agents included predominantly viruses but also a variety of fungi and gram-positive and gram-negative bacteria. Our findings indicate that strategies to prevent transmission of infectious diseases in sports must recognize risks at three levels: the individual athlete, the team, and spectators or others who may become exposed to infectious diseases as a result of sports-related activities. Team physicians and others who are responsible for the health of athletes should be especially familiar with the features of infectious diseases that occur in sports and measures for the prevention of these problems.

  19. Infectious Diseases in the Homeless

    Centers for Disease Control (CDC) Podcasts

    2008-08-26

    In this podcast, Ted Pestorius speaks with Dr. Marian McDonald, Associate Director for Minority and Women’s Health at CDC about an article in September 2008 issue of Emerging Infectious Diseases on infectious diseases in the homeless. There are an estimated 100 million homeless people worldwide today, and this number is likely to grow. The homeless population is vulnerable to many diseases, including HIV, hepatitis, and tuberculosis. Dr. McDonald discusses why this population is so vulnerable.  Created: 8/26/2008 by Emerging Infectious Diseases.   Date Released: 8/27/2008.

  20. Multiple Sclerosis After Infectious Mononucleosis

    DEFF Research Database (Denmark)

    Nielsen, Trine Rasmussen; Rostgaard, Klaus; Nielsen, Nete Munk

    2007-01-01

    BACKGROUND: Infectious mononucleosis caused by the Epstein-Barr virus has been associated with increased risk of multiple sclerosis. However, little is known about the characteristics of this association. OBJECTIVE: To assess the significance of sex, age at and time since infectious mononucleosis......, and attained age to the risk of developing multiple sclerosis after infectious mononucleosis. DESIGN: Cohort study using persons tested serologically for infectious mononucleosis at Statens Serum Institut, the Danish Civil Registration System, the Danish National Hospital Discharge Register, and the Danish...... Multiple Sclerosis Registry. SETTING: Statens Serum Institut. PATIENTS: A cohort of 25 234 Danish patients with mononucleosis was followed up for the occurrence of multiple sclerosis beginning on April 1, 1968, or January 1 of the year after the diagnosis of mononucleosis or after a negative Paul...

  1. The European educational platform on thoracic surgery.

    Science.gov (United States)

    Massard, Gilbert; Rocco, Gaetano; Venuta, Federico

    2014-05-01

    As the largest scientific organisation world-wide exclusively dedicated to general thoracic surgery (GTS), the European Society of Thoracic Surgeons (ESTS) recognized that one of its priorities is education. The educational platform designed ESTS addresses not only trainees, but also confirmed thoracic surgeons. The two main aims are (I) to prepare trainees to graduation and to the certification by the European Board of Thoracic Surgery and (II) to offer opportunities for continuous medical education in the perspective of life-long learning and continuous professional development to certified thoracic surgeons. It is likely that recertification will become an obligation during the coming decade. At its inception, the platform differentiated two different events. A 6-day course emphasizing on theoretic knowledge was created in Antalya in 2007. The same year, a 2-day school oriented to practical issues with hands-on in the animal lab was launched in Antalya. These two teaching tracks need further development. In the knowledge track, we intend to organize highly specialized 2-day courses to deepen insight into theoretical questions. The skill track will be implemented by specialized courses for high technology such as tracheal surgery, ECMO, robotics or chest wall reconstruction. In order to promote tomorrows' leadership, we created an academic competence track giving an insight into medical communication, methodology and management. We also had to respond to an increasing demand from the Russian speaking countries, where colleagues may face problems to attend western meetings, and where the language bareer may be a major impediment. We initiated a Russian school with three events yearly in 2012. Contemporary teaching must be completed with an e-learning platform, which is currently under development. The school activities are organized by the educational committee, which is headed by the ESTS Director of Education, assisted by coordinators of the teaching tracks and

  2. Magnetic resonance-thoracic ductography. Imaging aid for thoracic surgery and thoracic duct depiction based on embryological considerations

    International Nuclear Information System (INIS)

    Okuda, Itsuko; Udagawa, Harushi; Takahashi, Junji; Yamase, Hiromi; Kohno, Tadasu; Nakajima, Yasuo

    2009-01-01

    We describe the optimal protocol of magnetic resonance-thoracic ductography (MRTD) and provide examples of thoracic ducts (TD) and various anomalies. The anatomical pathway of the TD was analyzed based on embryological considerations. A total of 78 subjects, consisting of noncancer adults and patients with esophageal cancer and lung cancer, were enrolled. The MRTD protocol included a long echo time and was based on emphasizing signals from the liquid fraction and suppressing other signals, based on the principle that lymph flow through the TD appears hyperintense on T2-weighted images. The TD configuration was classified into nine types based on location [right and/or left side(s) of the descending aorta] and outflow [right and/or left venous angle(s)]. MRTD was conducted in 78 patients, and the three-dimensional reconstruction was considered to provide excellent view of the TD in 69 patients, segmentalization of TD in 4, and a poor view of the TD in 5. MRTD achieved a visualization rate of 94%. Most of the patients had a right-side TD that flowed into the left venous angle. Major configuration variations were noted in 14% of cases. Minor anomalies, such as divergence and meandering, were frequently seen. MRTD allows noninvasive evaluation of TD and can be used to identify TD configuration. Thus, this technique is considered to contribute positively to safer performance of thoracic surgery. (author)

  3. Endovascular repair of mycotic aneurysm of the descending thoracic aorta: diagnostic and therapeutic dilemmas-two case reports with 1-year follow-up.

    Science.gov (United States)

    Marjanovic, Ivan; Sarac, Momir; Tomic, Aleksandar; Bezmarevic, Mihailo

    2013-10-01

    A mycotic aneurysm of the thoracic aorta is a rare diagnosis with high mortality. We present two cases of endovascular reconstruction of mycotic descending thoracic aorta. Specific or nonspecific bacterial or other infectious agent in serial samples of blood, urine, cerebrospinal fluid, and pleural puncture was not detected in the first case, but we found in sputum sample Mycobacterium tuberculosis in the second patient. We empirically began by administering broad-spectrum intravenous antibiotics in the first case, with preoperative antibiotic prophylaxis and antituberculotic drugs therapy in the second case, and continued with the same medication for 4 months after endovascular repair. Control computed tomographic scans 6 months after reconstruction showed no endoleak in both patients. Repair of mycotic descending thoracic aortic aneurysms by endoluminal stent graft is reasonable alternative to open surgical intervention. A broad-spectrum antibiotic therapy has a high significance in the treatment of patients with mycotic aneurysm. Georg Thieme Verlag KG Stuttgart · New York.

  4. [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.

  5. 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.

  6. 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...

  7. 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.

  8. Thoracic endometriosis syndrome: CT and MRI features

    International Nuclear Information System (INIS)

    Rousset, P.; Rousset-Jablonski, C.; Alifano, M.; Mansuet-Lupo, A.; Buy, J.-N.; Revel, M.-P.

    2014-01-01

    Thoracic endometriosis is considered to be rare, but is the most frequent form of extra-abdominopelvic endometriosis. Thoracic endometriosis syndrome affects women of reproductive age. Diagnosis is mainly based on clinical findings, which can include catamenial pneumothorax and haemothorax, non-catamenial endometriosis-related pneumothorax, catamenial haemoptysis, lung nodules, and isolated catamenial chest pain. Symptoms are typically cyclical and recurrent, with a right-sided predominance. Computed tomography (CT) is the first-line imaging method, but is poorly specific; therefore, its main role is to rule out other pulmonary diseases. However, in women with a typical clinical history, some key CT findings may help to confirm this often under-diagnosed syndrome. MRI can also assist with the diagnosis, by showing signal changes typical of haemorrhage within diaphragmatic or pleural lesions

  9. The thoracic paraspinal shadow: normal appearances.

    Science.gov (United States)

    Lien, H H; Kolbenstvedt, A

    1982-01-01

    The width of the right and left thoracic paraspinal shadows were measured at all levels in 200 presumably normal individuals. The paraspinal shadow could be identified in nearly all cases on the left side and in approximately one-third on the right. The range of variation was greater on the left side than one the right. The left paraspinal shadow was wider at the upper levels and in individuals above 40 years of age.

  10. March 2014 Arizona thoracic society notes

    OpenAIRE

    Robbins RA

    2014-01-01

    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. T...

  11. Emergency thoracic surgery in elderly patients

    OpenAIRE

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants ...

  12. One-stage sequential bilateral thoracic expansion for asphyxiating thoracic dystrophy (Jeune syndrome).

    Science.gov (United States)

    Muthialu, Nagarajan; Mussa, Shafi; Owens, Catherine M; Bulstrode, Neil; Elliott, Martin J

    2014-10-01

    Jeune syndrome (asphyxiating thoracic dystrophy) is a rare disorder characterized by skeletal dysplasia, reduced diameter of the thoracic cage and extrathoracic organ involvement. Fatal, early respiratory insufficiency may occur. Two-stage lateral thoracic expansion has been reported, addressing each side sequentially over 3-12 months. While staged repair theoretically provides less invasive surgery in a small child with respiratory distress, we utilized a single stage, bilateral procedure aiming to rapidly maximize lung development. Combined bilateral surgery also offered the chance of rapid recovery, and reduced hospital stay. We present our early experience of this modification of existing surgical treatment for an extremely rare condition, thought to be generally fatal in early childhood. Nine children (6 males, 3 females; median age 30 months [3.5-75]) underwent thoracic expansion for Jeune syndrome in our centre. All patients required preoperative respiratory support (5 with tracheostomy, 8 requiring positive pressure ventilation regularly within each day/night cycle). Two children underwent sequential unilateral (2-month interval between stages) and 7 children bilateral thoracic expansion by means of staggered osteotomies of third to eighth ribs and plate fixation of fourth to fifth rib and sixth to seventh rib, leaving the remaining ribs floating. There was no operative mortality. There were 2 deaths within 3 months of surgery, due to pulmonary hypertension (1 following two-stage and 1 following single-stage thoracic expansion). At the median follow-up of 11 months (1-15), 3 children have been discharged home from their referring unit and 2 have significantly reduced respiratory support. One child remains on non-invasive ventilation and another is still ventilated with a high oxygen requirement. Jeune syndrome is a difficult condition to manage, but bilateral thoracic expansion offers an effective reduction in ventilator requirements in these children

  13. Epidemiology and pathogenesis of thoracic outlet syndrome

    Directory of Open Access Journals (Sweden)

    Wojcik Gustaw

    2015-03-01

    Full Text Available The superior thoracic aperture is a place particularly vulnerable to the occurrence of tissue conflict and the development of a number of neurovascular changes carrying a risk of upper limb dysfunction. The triggering factor in this case is the pressure on the nerve vascular elements brought about by too large muscles of the chest and neck, clavicle fracture and dislocation of the upper ribs, anomalies in the form of ribs, in the neck, or by apex of the lung tumors. Each anatomical anomaly may be a cause of a number of lesions and lead to the development of the disease. Due to the nature of the oppressed structures, there are two basic groups: neurogenic and vascular. The most common variant giving clinical symptoms is neurogenic thoracic outlet syndrome. In this, the compression ratio, the brachial plexus, and for this reason, the vascular surface of the upper limb dysfunction is often overlooked. However, the vascular variant, and especially arterial sub-variant, is very dangerous because it can give complications even in the form of aneurysms, and even upper limb ischemia. The aim of the study is to present the most common changes in the thoracic outlet causing functional disorders of the upper limb.

  14. CT findings in severe thoracic sarcoidosis

    International Nuclear Information System (INIS)

    Hennebicque, Anne-Sophie; Brillet, Pierre-Yves; Moulahi, Hassen; Brauner, Michel W.; Nunes, Hilario; Valeyre, Dominique

    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.)

  15. [Thoracic surgery for patients with bronchial asthma].

    Science.gov (United States)

    Iyoda, A; Satoh, Y

    2012-07-01

    Thoracic surgery poses a risk for complications in the respiratory system. In particular, for patients with bronchial asthma, we need to care for perioperative complications because it is well known that these patients frequently have respiratory complications after surgery, and they may have bronchial spasms during surgery. If we can get good control of their bronchial asthma, we can usually perform surgery for these patients without limitations. For safe postoperative care, it is desirable that these patients have stable asthma conditions that are well-controlled before surgery, as thoracic surgery requires intrabronchial intubation for anesthesia and sometimes bronchial resection. These stimulations to the bronchus do not provide for good conditions because of the risk of bronchial spasm. Therefore, we should use the same agents that are used to control bronchial asthma if it is already well controlled. If it is not, we have to administer a β₂ stimulator, aminophylline, or steroidal agents for good control. Isoflurane or sevoflurane are effective for the safe control of anesthesia during surgery, and we should use a β₂ stimulator, with or without inhalation, or steroidal agents after surgery. It is important to understand that we can perform thoracic surgery for asthma patients if we can provide perioperative control of bronchial asthma, although these patients still have severe risks.

  16. Endovascular repair of traumatic thoracic aortic tears.

    Science.gov (United States)

    Mansour, M Ashraf; Kirk, Jeffrey S; Cuff, Robert F; Banegas, Shonda L; Ambrosi, Gavin M; Liao, Timothy H; Chambers, Christopher M; Wong, Peter Y; Heiser, John C

    2012-03-01

    Patients with thoracic aorta injuries (TAI) present a unique challenge. The purpose of this study was to review the outcomes of thoracic endovascular aortic repair (TEVAR) in patients with TAI. A retrospective chart review of all patients admitted for TEVAR for trauma was performed. In a 5-year period, 19 patients (6 women and 13 men; average age, 42 y) were admitted to our trauma center with TAI. Mechanism of injury was a motor vehicle crash in 12 patients, motorcycle crash in 2 patients, automobile-pedestrian accident in 2 patients, 1 fall, 1 crush injury, and 1 stab wound to the back. A thoracic endograft was used in 6 patients and proximal aortic cuffs were used in 13 patients (68%). One patient (5%) died. There were no strokes, myocardial infarctions, paraplegia, or renal failure. TEVAR for TAI appears to be a safe option for patients with multiple injuries. TEVAR in young patients is still controversial because long-term endograft behavior is unknown. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Robotics in general thoracic surgery procedures.

    Science.gov (United States)

    Latif, M Jawad; Park, Bernard J

    2017-01-01

    The use of robotic technology in general thoracic surgical practice continues to expand across various institutions and at this point many major common thoracic surgical procedures have been successfully performed by general thoracic surgeons using the robotic technology. These procedures include lung resections, excision of mediastinal masses, esophagectomy and reconstruction for malignant and benign esophageal pathologies. The success of robotic technology can be attributed to highly magnified 3-D visualization, dexterity afforded by 7 degrees of freedom that allow difficult dissections in narrow fields and the ease of reproducibility once the initial set up and instruments become familiar to the surgeon. As the application of robotic technology trickle downs from major academic centers to community hospitals, it becomes imperative that its role, limitations, learning curve and financial impact are understood by the novice robotic surgeon. In this article, we share our experience as it relates to the setup, common pitfalls and long term results for more commonly performed robotic assisted lung and thymic resections using the 4 arm da Vinci Xi robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to help guide those who are interested in adopting this technology.

  18. Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

    Science.gov (United States)

    Nie, Hong-Fei; Liu, Kai-Xuan

    2013-01-01

    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. PMID:24455232

  19. [Common pediatric infectious diseases following natural disasters].

    Science.gov (United States)

    Yao, Kai-Hu

    2013-06-01

    Natural disasters may lead to the outbreaks of infectious diseases because they increase the risk factors for infectious diseases. This paper reviews the risk factors for infectious diseases after natural disasters, especially earthquake, and the infectious diseases following disasters reported in recent years. The infectious diseases after earthquake include diarrhea, cholera, viral hepatitis, upper respiratory tract infection, tuberculosis, measles, leptospirosis, dengue fever, tetanus, and gas gangrene, as well as some rare infections. Children are vulnerable to infectious diseases, so pediatricians should pay more attention to the research on relationship between infectious diseases and natural disasters.

  20. 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.)

  1. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

    International Nuclear Information System (INIS)

    Courtney, Malachi; Ayyagari, Raj R.

    2015-01-01

    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.)

  2. Melioidosis: An emerging infectious disease

    Directory of Open Access Journals (Sweden)

    Raja N

    2005-01-01

    Full Text Available Infectious diseases account for a third of all the deaths in the developing world. Achievements in understanding the basic microbiology, pathogenesis, host defenses and expanded epidemiology of infectious diseases have resulted in better management and reduced mortality. However, an emerging infectious disease, melioidosis, is becoming endemic in the tropical regions of the world and is spreading to non-endemic areas. This article highlights the current understanding of melioidosis including advances in diagnosis, treatment and prevention. Better understanding of melioidosis is essential, as it is life-threatening and if untreated, patients can succumb to it. Our sources include a literature review, information from international consensus meetings on melioidosis and ongoing discussions within the medical and scientific community.

  3. Infectious Disease, Endangerment, and Extinction

    Science.gov (United States)

    MacPhee, Ross D. E.; Greenwood, Alex D.

    2013-01-01

    Infectious disease, especially virulent infectious disease, is commonly regarded as a cause of fluctuation or decline in biological populations. However, it is not generally considered as a primary factor in causing the actual endangerment or extinction of species. We review here the known historical examples in which disease has, or has been assumed to have had, a major deleterious impact on animal species, including extinction, and highlight some recent cases in which disease is the chief suspect in causing the outright endangerment of particular species. We conclude that the role of disease in historical extinctions at the population or species level may have been underestimated. Recent methodological breakthroughs may lead to a better understanding of the past and present roles of infectious disease in influencing population fitness and other parameters. PMID:23401844

  4. Immunochemical studies of infectious mononucleosis

    International Nuclear Information System (INIS)

    Fletcher, M.A.; Lo, T.M.; Levey, B.A.; Graves, W.R.

    1977-01-01

    The coated-tube method of solid-phase radioimmunoassay has been adapted to the detection of heterophile antibodies and antigens of infectious mononucleosis. Disposable plastic hemagglutination trays were coated with purified glycoprotein from horse erythrocytes and the subsequent uptake of antibody from test sera was detected by radio-iodinated horse erythrocyte glycoprotein. In a preliminary survey of sera from patients with infectious mononucleosis and sera from controls, the assay proved highly sensitive and specific. The test system was also useful in a competitive binding assay for immunochemical studies of glycoproteins from other heterophile antigen-positive species

  5. Infectious Diseases in the Homeless

    Centers for Disease Control (CDC) Podcasts

    In this podcast, Ted Pestorius speaks with Dr. Marian McDonald, Associate Director for Minority and Women’s Health at CDC about an article in September 2008 issue of Emerging Infectious Diseases on infectious diseases in the homeless. There are an estimated 100 million homeless people worldwide today, and this number is likely to grow. The homeless population is vulnerable to many diseases, including HIV, hepatitis, and tuberculosis. Dr. McDonald discusses why this population is so vulnerable.

  6. 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.

  7. One-stage posterior approaches for treatment of thoracic spinal infection: Transforaminal and costotransversectomy, compared with anterior approach with posterior instrumentation.

    Science.gov (United States)

    Kao, Fu-Cheng; Tsai, Tsung-Ting; Niu, Chi-Chien; Lai, Po-Liang; Chen, Lih-Huei; Chen, Wen-Jer

    2017-10-01

    Treating thoracic infective spondylodiscitis with anterior surgical approaches carry a relatively high risk of perioperative and postoperative complications. Posterior approaches have been reported to result in lower complication rates than anterior procedures, but more evidence is needed to demonstrate the safety and efficacy of 1-stage posterior approaches for treating infectious thoracic spondylodiscitis.Preoperative and postoperative clinical data, of 18 patients who underwent 2 types of 1-stage posterior procedures, costotransversectomy and transforaminal thoracic interbody debridement and fusion and 7 patients who underwent anterior debridement and reconstruction with posterior instrumentation, were retrospectively assessed.The clinical outcomes of patients treated with 1-stage posterior approaches were generally good, with good infection control, back pain relief, kyphotic angle correction, and either partial or solid union for fusion status. Furthermore, they achieved shorter surgical time, fewer postoperative complications, and shorter hospital stay than the patients underwent anterior debridement with posterior instrumentation.The results suggested that treating thoracic spondylodiscitis with a single-stage posterior approach might prevent postoperative complications and avoid respiratory problems associated with anterior approaches. Single-stage posterior approaches would be recommended for thoracic spine infection, especially for patients with medical comorbidities.

  8. Internal Thoracic Artery Encircled by an Unusual Phrenic Nerve Loop

    Directory of Open Access Journals (Sweden)

    Robert Fu-Chean Chen

    2007-12-01

    Full Text Available We report an anatomic variation of the phrenic nerve. During a routine gross anatomical dissection course at our medical university, we found an unusual loop of the left phrenic nerve around the internal thoracic artery, about 1 cm from the take-off of the left subclavian artery. The phrenic nerve is close to the internal thoracic artery and is easily injured when dissecting the internal thoracic artery for coronary artery bypass conduit. Therefore, we suggest that the anatomic relationship of the phrenic nerve and internal thoracic artery is important in preventing incidental injury of the phrenic nerve.

  9. A reappraisal of pediatric thoracic surface anatomy.

    Science.gov (United States)

    Fischer, Nicholas J; Morreau, Jonty; Sugunesegran, Ramanen; Taghavi, Kiarash; Mirjalili, S Ali

    2017-09-01

    Accurate knowledge of surface anatomy is fundamental to safe clinical practice. A paucity of evidence in the literature regarding thoracic surface anatomy in children was identified. The associations between surface landmarks and internal structures were meticulously analyzed by reviewing high quality computed tomography (CT) images of 77 children aged from four days to 12 years. The results confirmed that the sternal angle is an accurate surface landmark for the azygos-superior vena cava junction in a plane through to the level of upper T4 from birth to age four, and to lower T4 in older children. The concavity of the aortic arch was slightly below this plane and the tracheal and pulmonary artery bifurcations were even lower. The cardiac apex was typically at the 5 th intercostal space (ICS) from birth to age four, at the 4 th ICS and 5 th rib in 4-12 year olds, and close to the midclavicular line at all ages. The lower border of the diaphragm was at the level of the 6 th or 7 th rib at the midclavicular line, the 7 th ICS and 8 th rib at the midaxillary line, and the 11 th thoracic vertebra posteriorly. The domes of the diaphragm were generally flatter and lower in children, typically only one rib level higher than its anterior level at the midclavicular line. Diaphragm apertures were most commonly around the level of T9, T10, and T11 for the IVC, esophagus and aorta, respectively. This is the first study to provide an evidence-base for thoracic surface anatomy in children. Clin. Anat. 30:788-794, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  10. The reported thoracic injuries in Homer's Iliad

    Directory of Open Access Journals (Sweden)

    Apostolaki Mary

    2010-11-01

    Full Text Available Abstract Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%, the stones (7.4%, the arrow (5.5% and the sword (5.5%. We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim, medium (those which cause the victim to abandon the battlefield, and severe (those which cause death of the victim. According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95% and the remaining 8 an Achaean (21.05%. The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield.

  11. The reported thoracic injuries in Homer's Iliad.

    Science.gov (United States)

    Apostolakis, Efstratios; Apostolaki, Georgia; Apostolaki, Mary; Chorti, Maria

    2010-11-19

    Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%), the stones (7.4%), the arrow (5.5%) and the sword (5.5%). We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim), medium (those which cause the victim to abandon the battlefield), and severe (those which cause death of the victim). According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95%) and the remaining 8 an Achaean (21.05%). The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield.

  12. Integrated diagnostic imaging of primary thoracic rhabdomyosarcoma

    International Nuclear Information System (INIS)

    Almberger, M.; Iannicelli, E.; Matrunola, M.; Schiavetti, A.; Capocaccia, P.

    2001-01-01

    We report a rare case of primary thoracic rhabdomyosarcoma in a girl who was referred with acute chest pain, hacking cough, and wheezing. A chest X-ray revealed a complete opacity of the right hemithorax. Ultrasound revealed a right-sided pleural effusion and a solid mass above the liver dome, suggesting a neoplastic disease, which quickly led to further specific examination. Use of CT and MRI together with bone scintigraphy completed the investigation. The biopsy specimen showed a pattern of alveolar rhabdomyosarcoma. This case was reported to emphasize the role of US in the evaluation of a child with hemithorax opacity. (orig.)

  13. Digital subtraction angiography of the thoracic aorta

    International Nuclear Information System (INIS)

    Grossman, L.B.; Buonocore, E.; Modic, M.T.; Meaney, T.F.

    1984-01-01

    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. Integrated diagnostic imaging of primary thoracic rhabdomyosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Almberger, M.; Iannicelli, E. [Dept. of Radiology, University ' ' La Sapienza' ' , Rome (Italy); Matrunola, M.; Schiavetti, A.; Capocaccia, P. [Dept. of Pediatric Radiology, University ' ' La Sapienza' ' , Rome (Italy)

    2001-03-01

    We report a rare case of primary thoracic rhabdomyosarcoma in a girl who was referred with acute chest pain, hacking cough, and wheezing. A chest X-ray revealed a complete opacity of the right hemithorax. Ultrasound revealed a right-sided pleural effusion and a solid mass above the liver dome, suggesting a neoplastic disease, which quickly led to further specific examination. Use of CT and MRI together with bone scintigraphy completed the investigation. The biopsy specimen showed a pattern of alveolar rhabdomyosarcoma. This case was reported to emphasize the role of US in the evaluation of a child with hemithorax opacity. (orig.)

  15. 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.

  16. Temporary quadriplegia following continuous thoracic paravertebral block.

    Science.gov (United States)

    Calenda, Emile; Baste, Jean Marc; Danielou, Eric; Michelin, Paul

    2012-05-01

    A case of temporary quadriplegia following a continuous thoracic paravertebral block in an adult patient scheduled for video-assisted thoracoscopy is presented. An 18-gauge Tuohy needle was inserted under direct vision by the surgeon but the tip of the catheter was not localized. Postoperatively, the patient developed temporary quadriplegia 90 minutes after the start of a continuous infusion of ropivacaine 0.2%. Imaging studies showed that the catheter was localized in the intrathecal space. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. [Surgical treatment of thoracic disc herniation].

    Science.gov (United States)

    Hrabálek, L; Kalita, O; Langová, K

    2010-08-01

    The aim of this study was to compare the efficiency of different surgical approaches to thoracic disc herniation, and to show the role of segmental fusion and selection of an appropriate microsurgical decompression technique for the successful outcome of surgery. A group of 27 patients, 10 men and 17 women, between 31 and 70 years (average age, 49.33 years) were included in this prospective study. They underwent surgery for thoracic degeneration disc disease in the period from June 1994 to August 2008. In all patients, the severity of myelopathy was assessed using the grading Frankel system and JOA score, axial and radicular pain intensity was evaluated with VAS and ODI rating systems. The diagnosis was established on the basis of thoracic spine radiography, thoracic spine MRI and a CT scan of the segment. A total of 30 thoracic segments, in the range of Th4/Th5 to Th12/L1, were indicated for surgery. Localisation of the hernia was medial at 19 segments, mediolateral at three and lateral at eight segments. Soft disc herniation was found in 17 cases and hard disc protrusion at the remaining 13 segments. Surgery for significant myelopathy was carried out in 23 patients and for pain in four patients. According to the surgical procedure used, the patients were allocated to two groups: group A comprised 10 patients treated without disc replacement through a laminectomy or a costotransversectomy exposure, and group B consisted of 17 patients undergo- ing intersomatic fusion via a thoracotomy. Clinical and radiographic examinations were made at regular intervals for at least 1 year of follow-up. The results of clinical assessment, including JOA scores, JOA Recovery Rate, VAS scores at rest and after exercise and ODI, were statistically analysed for each group and compared. There was a statistically significant difference in JOA evaluation of myelopathy between the groups in group A, the mean JOA score declined from 7.9 to 7.0, i.e., -0.9 point, while in group B it

  18. Operativ behandling af thoracic outlet syndrome

    DEFF Research Database (Denmark)

    Birkeland, Peter; Stiasny, Jerzy

    2012-01-01

    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......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...

  19. African Journal of Infectious Diseases

    African Journals Online (AJOL)

    The African Journal of Infectious Diseases accepts original research papers on the ... Reports of research related to any aspect of the fields of microbiology, ... Vol 12, No 1S (2018) ... oxygen treatment of HIV-1 infected on Peripheral Blood Mononuclear Cells (PBMCS) · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

  20. Emerging Infectious Diseases Cover Art

    Centers for Disease Control (CDC) Podcasts

    2017-07-26

    Byron Breedlove, managing editor of the EID Journal, discusses his approach to cover art.  Created: 7/26/2017 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 7/26/2017.

  1. Facts about Infectious Diseases (ID)

    Science.gov (United States)

    ... an ID Specialist? Facts about ID Pocketcard Infectious diseases are caused by microscopic organisms that penetrate the body’s natural ... from diseases such as AIDS or treatment of diseases such as cancer, may allow ... of contaminated food or water, bites from vectors such as ticks or mosquitoes ...

  2. Deforestation and avian infectious diseases.

    Science.gov (United States)

    Sehgal, R N M

    2010-03-15

    In this time of unprecedented global change, infectious diseases will impact humans and wildlife in novel and unknown ways. Climate change, the introduction of invasive species, urbanization, agricultural practices and the loss of biodiversity have all been implicated in increasing the spread of infectious pathogens. In many regards, deforestation supersedes these other global events in terms of its immediate potential global effects in both tropical and temperate regions. The effects of deforestation on the spread of pathogens in birds are largely unknown. Birds harbor many of the same types of pathogens as humans and in addition can spread infectious agents to humans and other wildlife. It is thought that avifauna have gone extinct due to infectious diseases and many are presently threatened, especially endemic island birds. It is clear that habitat degradation can pose a direct threat to many bird species but it is uncertain how these alterations will affect disease transmission and susceptibility to disease. The migration and dispersal of birds can also change with habitat degradation, and thus expose populations to novel pathogens. Some recent work has shown that the results of landscape transformation can have confounding effects on avian malaria, other haemosporidian parasites and viruses. Now with advances in many technologies, including mathematical and computer modeling, genomics and satellite tracking, scientists have tools to further research the disease ecology of deforestation. This research will be imperative to help predict and prevent outbreaks that could affect avifauna, humans and other wildlife worldwide.

  3. How infectious is SARS virus

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. How infectious is SARS virus. Influenza: 1 patient infects ten people. SARS: 1 patient infects 2-4 people. Incubation period 10 days. Are there `silent´ cases ? Is quarantine enough ? How will it behave if and when it returns ?

  4. 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 …

  5. October 2013 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-10-01

    Full Text Available No abstract available. Article truncated after 150 words. The October Arizona Thoracic Society meeting was held on Wednesday, 10/23/2013 at Shea Hospital beginning at 6:30 PM. There were 21 in attendance representing the pulmonary, critical care, sleep, and thoracic surgery communities. A proposal was made to decrease the number of meetings from 10 to 8 per year. After a brief discussion, this was adopted. Dr. Parides will try and coordinate these changes with Tucson. Meetings were announced for December in Tucson, January in Carmel, February in Albuquerque, and April in Phoenix. A suggestion was made to have a separate area for meetings on the SWJPCC website. There were 2 cases presented-both by Nick Sparacino, a first year fellow at Good Samaritan/VA. 1. The first case was a 48 year old man admitted to podiatry for chronic diabetic foot ulcers. His preoperative chest x-ray revealed multiple pulmonary nodules. Importantly, he had a history of working in a brake pad …

  6. 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.

  7. Multidisciplinary Treatment Approach for Prosthetic Vascular Graft Infection in the Thoracic Aortic Area

    Science.gov (United States)

    Watanabe, Yoshinori

    2015-01-01

    Prosthetic vascular graft infection in the thoracic aortic area is a rare but serious complication. Adequate management of the complication is essential to increase the chance of success of open surgery. While surgical site infection is suggested as the root cause of the complication, it is also related to decreased host tolerance, especially as found in elderly patients. The handling of prosthetic vascular graft infection has been widely discussed to date. This paper mainly provides a summary of literature reports published within the past 5 years to discuss issues related to multidisciplinary treatment approaches, including surgical site infection, timing of onset, diagnostic methods, causative pathogens, auxiliary diagnostic methods, antibiotic treatment, anti-infective structures of vascular prostheses, surgical treatment, treatment strategy against infectious aortic aneurysms, future surgical treatment, postoperative systemic therapy, and antimicrobial stewardship. A thorough understanding of these issues will enable us to prevent prosthetic vascular graft infection in the thoracic aortic area as far as possible. In the event of its occurrence, the early introduction of appropriate treatment is expected to cure the disease without worsening of the underlying pathological condition. PMID:26356686

  8. African Journal of Infectious Diseases: Journal Sponsorship

    African Journals Online (AJOL)

    African Journal of Infectious Diseases: Journal Sponsorship. Journal Home > About the Journal > African Journal of Infectious Diseases: Journal Sponsorship. Log in or Register to get access to full text downloads.

  9. Menstruation in an unusual place: A case of thoracic endometriosis ...

    African Journals Online (AJOL)

    While pelvic endometriosis is relatively common, thoracic menstruation is rare. A report of what is believed to be the first case of thoracic endometriosis in Uganda is given. A 34 year old female was complaining of on and off chest pain mainly on the right side. Clinically she had signs of pleural effusion and 500 mls of altered ...

  10. State of the art thoracic ultrasound: intervention and therapeutics

    NARCIS (Netherlands)

    Corcoran, John P.; Tazi-Mezalek, Rachid; Maldonado, Fabien; Yarmus, Lonny B.; Annema, Jouke T.; Koegelenberg, Coenraad F. N.; St Noble, Victoria; Rahman, Najib M.

    2017-01-01

    The use of thoracic ultrasound outside the radiology department and in everyday clinical practice is becoming increasingly common, having been incorporated into standards of care for many specialties. For the majority of practitioners, their experience of, and exposure to, thoracic ultrasound will

  11. Adjacent-segment disease after thoracic pedicle screw fixation.

    Science.gov (United States)

    Agarwal, Nitin; Heary, Robert F; Agarwal, Prateek

    2018-03-01

    OBJECTIVE Pedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine. METHODS Select references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors' experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined. RESULTS Definitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months. CONCLUSIONS This long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the

  12. Chemoprophylaxis of Tropical Infectious Diseases

    Directory of Open Access Journals (Sweden)

    William J. H. McBride

    2010-05-01

    Full Text Available Travelers to tropical countries are at risk for a variety of infectious diseases. In some cases effective vaccinations are available, but for other infections chemoprophylaxis can be offered. Malaria prevention has become increasingly complex as Plasmodium species become resistant to available drugs. In certain high risk settings, antibiotics can be used to prevent leptospirosis, scrub typhus and other infections. Post-exposure prophylaxis is appropriate for selected virulent infections. In this article the evidence for chemoprophylaxis will be reviewed.

  13. Emerging Infectious Diseases in Pregnancy.

    Science.gov (United States)

    Beigi, Richard H

    2017-05-01

    It has been recognized for centuries that pregnant women have unique susceptibilities to many infectious diseases that predispose them to untoward outcomes compared with the general adult population. It is thought a combination of adaptive alterations in immunity to allow for the fetal allograft combined with changes in anatomy and physiology accompanying pregnancy underlie these susceptibilities. Emerging infectious diseases are defined as those whose incidence in humans has increased in the past two decades or threaten to increase in the near future. The past decade alone has witnessed many such outbreaks, each with its own unique implications for pregnant women and their unborn fetuses as well as lessons for the health care community regarding response and mitigation. Examples of such outbreaks include, but are not limited to, severe acute respiratory syndrome, the 2009 H1N1 pandemic influenza, Ebola virus, and, most recently, the Zika virus. Although each emerging pathogen has unique features requiring specific considerations, there are many underlying principles that are shared in the recognition, communication, and mitigation of such infectious outbreaks. Some of these key principles include disease-specific delineation of transmission dynamics, understanding of pathogen-specific effects on both mothers and fetuses, and advance planning and contemporaneous management that prioritize communication among public health experts, clinicians, and patients. The productive and effective working collaboration among the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine has been a key partnership in the successful communication and management of such outbreaks for women's health care providers and patients alike. Going forward, the knowledge gained over the past decade will undoubtedly continue to inform future responses and will serve to optimize the education and care given

  14. CT evaluation of infectious colitis

    International Nuclear Information System (INIS)

    Horiki, Noriyuki; Maruyama, Masataka; Fujita, Yoshiyuki; Suzuki, Yuko; Tanaka, Tsuyoshi; Imoto, Ichiro; Adachi, Yukihiko

    2002-01-01

    Computed tomography (CT) is useful for evaluating the diagnosis of gastrointestinal disease, such as infectious colitis, in patients with severe pain and bloody diarrhea. During the 7 years between November 1993 and October 2000, 34 patients with infectious colitis (18 male, 16 female; mean age 42±19 yrs), received emergency CT and colonoscopy because of severe abdominal pain and dysentery. The following organisms were isolated: pathogenic Escherichia coli (12), 6 of which were O157: H7 (O-157), Salmonella species (11), Campylobacter species (5), Vibrio parahaemolyticus (3), Yersinia enterocolotica (2) and Shigella species (1). Thickening of the intestinal wall greater than 10 mm was seen in the ascending colon in the 6 cases with E. coli O157, in 5/11 cases with Salmonella, 4/5 with Campylobacter and 1/6 with non-O157 pathogenic E. Coli. marked intestinal wall thickening, greater than 20 mm, was seen in the ascending colon of the 4 of the patients with an O-157 infection. In all patients with O-157 colitis, slight ascites was noted in the pelvic space. In additions, ascites was also seen in 3/13 patients with Salmonella and 1/5 patients with Campylobacter colitis. The CT findings, in the patients with infectious colitis, are non-specific but knowledge and recognition of the findings will help in patient evaluation and proper treatment. (author)

  15. Acute tonsillitis at infectious patients

    Directory of Open Access Journals (Sweden)

    Y. P. Finogeev

    2011-01-01

    Full Text Available We examined 1824 patients with diphtheria treated in Clinical Infectious Diseases Hospital Botkin (St. Petersburg in 1993 – 1994, and more than 500 patients referred to the clinic with a diagnosis of «angina». Based on published data and our own research observations investigated the etiology of acute tonsillitis. Bacterial tonsillitis should be treated with antibiotics, and this is important aetiological interpretation of these diseases. Streptococcal tonsillitis should always be a sore throat syndrome as a diagnostic sign of support. For other forms of lymphoma lesion of the tonsils should not be defined as «angina», and called «tonsillitis». Аngina as β-hemolytic streptococcus group A infection is recognized as the leader in the development of rheumatic fever. On the basis of a large clinical material briefly analyzed the clinical manifestations of various forms of diphtheria with membranous tonsillitis. Also presented with a syndrome of infectious diseases as tonsillitis, therapeutic and surgical «mask» of infectious diseases.

  16. CT evaluation of infectious colitis

    Energy Technology Data Exchange (ETDEWEB)

    Horiki, Noriyuki; Maruyama, Masataka; Fujita, Yoshiyuki; Suzuki, Yuko [Saint Luke' s International Hospital, Tokyo (Japan); Tanaka, Tsuyoshi; Imoto, Ichiro [National Mie Chuo Hospital, Hisai (Japan); Adachi, Yukihiko [Mie Univ., Tsu (Japan). School of Medicine

    2002-08-01

    Computed tomography (CT) is useful for evaluating the diagnosis of gastrointestinal disease, such as infectious colitis, in patients with severe pain and bloody diarrhea. During the 7 years between November 1993 and October 2000, 34 patients with infectious colitis (18 male, 16 female; mean age 42{+-}19 yrs), received emergency CT and colonoscopy because of severe abdominal pain and dysentery. The following organisms were isolated: pathogenic Escherichia coli (12), 6 of which were O157: H7 (O-157), Salmonella species (11), Campylobacter species (5), Vibrio parahaemolyticus (3), Yersinia enterocolotica (2) and Shigella species (1). Thickening of the intestinal wall greater than 10 mm was seen in the ascending colon in the 6 cases with E. coli O157, in 5/11 cases with Salmonella, 4/5 with Campylobacter and 1/6 with non-O157 pathogenic E. Coli. marked intestinal wall thickening, greater than 20 mm, was seen in the ascending colon of the 4 of the patients with an O-157 infection. In all patients with O-157 colitis, slight ascites was noted in the pelvic space. In additions, ascites was also seen in 3/13 patients with Salmonella and 1/5 patients with Campylobacter colitis. The CT findings, in the patients with infectious colitis, are non-specific but knowledge and recognition of the findings will help in patient evaluation and proper treatment. (author)

  17. Magnetic resonance imaging of thoracic hydatid disease

    International Nuclear Information System (INIS)

    Sinner, W.N. von; Rifal, A.; Te Strake, L.; Sieck, J.; King Faisal Specialist Hospital and Research Centre, Riyadh; Michigan Univ., Ann Arbor

    1990-01-01

    Two patients with thoracic manifestations of hydatid disease (HD) are discussed; one patient had recurrent HD of the chest wall and the other, intrapulmonary HD after rupture and intrathoracic extension of an infradiaphragmatic cyst. At magnetic resonance (MR) imaging the manifestations of HD in the thorax are similar to previously reported MR findings in HD in the liver. The presence of a low signal intensity rim on T2 weighted images representing the cyst wall was confirmed. On T1 weighted images cysts with heterogeneous low and intermediate signal intensity contents and a relatively high signal intensity wall were seen. ''Folded parasitic membranes'' previously not described on MR were noted. Daughter cysts may have a low or high signal intensity depending on contents. Reactive changes in the lung may be quite marked compared with the liver, due to reaction to the parasite or simply because the lung is more easily compressed leading to secondary atelectasis. (orig.)

  18. Evaluation of registration methods on thoracic CT

    DEFF Research Database (Denmark)

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

    2011-01-01

    method and the evaluation is independent, using the same criteria for all participants. All results are published on the EMPIRE10 website (http://empire10.isi.uu.nl). The challenge remains ongoing and open to new participants. Full results from 24 algorithms have been published at the time of writing......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....... This article details the organisation of the challenge, the data and evaluation methods and the outcome of the initial launch with 20 algorithms. The gain in knowledge and future work are discussed....

  19. Motion correction in thoracic positron emission tomography

    CERN Document Server

    Gigengack, Fabian; Dawood, Mohammad; Schäfers, Klaus P

    2015-01-01

    Respiratory and cardiac motion leads to image degradation in Positron Emission Tomography (PET), which impairs quantification. In this book, the authors present approaches to motion estimation and motion correction in thoracic PET. The approaches for motion estimation are based on dual gating and mass-preserving image registration (VAMPIRE) and mass-preserving optical flow (MPOF). With mass-preservation, image intensity modulations caused by highly non-rigid cardiac motion are accounted for. Within the image registration framework different data terms, different variants of regularization and parametric and non-parametric motion models are examined. Within the optical flow framework, different data terms and further non-quadratic penalization are also discussed. The approaches for motion correction particularly focus on pipelines in dual gated PET. A quantitative evaluation of the proposed approaches is performed on software phantom data with accompanied ground-truth motion information. Further, clinical appl...

  20. 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.

  1. An Official American Thoracic Society Research Statement

    DEFF Research Database (Denmark)

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

    2015-01-01

    BACKGROUND: Pulmonary nodules are frequently detected during diagnostic chest imaging and as a result of lung cancer screening. Current guidelines for their evaluation are largely based on low-quality evidence, and patients and clinicians could benefit from more research in this area. METHODS......: 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...... demographic and nodule characteristics with patient-level outcomes. Methods to share data from registries are also necessary. CONCLUSIONS: This statement may help researchers to develop impactful and innovative research projects and enable funders to better judge research proposals. We hope...

  2. 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.

  3. Benchmarking in Thoracic Surgery. Third Edition.

    Science.gov (United States)

    Freixinet Gilart, Jorge; Varela Simó, Gonzalo; Rodríguez Suárez, Pedro; Embún Flor, Raúl; Rivas de Andrés, Juan José; de la Torre Bravos, Mercedes; Molins López-Rodó, Laureano; Pac Ferrer, Joaquín; Izquierdo Elena, José Miguel; Baschwitz, Benno; López de Castro, Pedro E; Fibla Alfara, Juan José; Hernando Trancho, Florentino; Carvajal Carrasco, Ángel; Canalís Arrayás, Emili; Salvatierra Velázquez, Ángel; Canela Cardona, Mercedes; Torres Lanzas, Juan; Moreno Mata, Nicolás

    2016-04-01

    Benchmarking entails continuous comparison of efficacy and quality among products and activities, with the primary objective of achieving excellence. To analyze the results of benchmarking performed in 2013 on clinical practices undertaken in 2012 in 17 Spanish thoracic surgery units. Study data were obtained from the basic minimum data set for hospitalization, registered in 2012. Data from hospital discharge reports were submitted by the participating groups, but staff from the corresponding departments did not intervene in data collection. Study cases all involved hospital discharges recorded in the participating sites. Episodes included were respiratory surgery (Major Diagnostic Category 04, Surgery), and those of the thoracic surgery unit. Cases were labelled using codes from the International Classification of Diseases, 9th revision, Clinical Modification. The refined diagnosis-related groups classification was used to evaluate differences in severity and complexity of cases. General parameters (number of cases, mean stay, complications, readmissions, mortality, and activity) varied widely among the participating groups. Specific interventions (lobectomy, pneumonectomy, atypical resections, and treatment of pneumothorax) also varied widely. As in previous editions, practices among participating groups varied considerably. Some areas for improvement emerge: admission processes need to be standardized to avoid urgent admissions and to improve pre-operative care; hospital discharges should be streamlined and discharge reports improved by including all procedures and complications. Some units have parameters which deviate excessively from the norm, and these sites need to review their processes in depth. Coding of diagnoses and comorbidities is another area where improvement is needed. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

  4. [Flexible endoscope in thoracic surgery: CITES or cVATS?].

    Science.gov (United States)

    Assouad, J; Fénane, H; Masmoudi, H; Giol, M; Karsenti, A; Gounant, V; Grunenwald, D

    2013-10-01

    Early pain and persistent parietal disorders remains a major unresolved problem in thoracic surgery. Thoracotomy and the use of multiple ports in most Video Assisted Thoracic Surgery (VATS) procedures are the major cause of this persistent pain. For the last decade, a few publications describing the use of either single incision VATS and cervical thoracic approaches have been reported without significant results in comparison with current used techniques. Intercostals compression during surgery and early after by intercostals chest tube placement, are probably the major cause of postoperative pain. Flexible endoscope is currently used in several surgeries and will take more and more importance in our daily use in thoracic surgery. Instrument flexibility allows its use through minimally invasive approaches and offers a very interesting intra-thoracic navigation. We describe here the first use in France of a flexible endoscope in thoracic surgery through a single cervical incision to perform simultaneous exploration and biopsies of the mediastinum and right pleura using the original approach of Cervical Incision Thoracic Endoscopic Surgery (CITES). Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  5. Robotic thoracic surgery: The state of the art

    Science.gov (United States)

    Kumar, Arvind; Asaf, Belal Bin

    2015-01-01

    Minimally invasive thoracic surgery has come a long way. It has rapidly progressed to complex procedures such as lobectomy, pneumonectomy, esophagectomy, and resection of mediastinal tumors. Video-assisted thoracic surgery (VATS) offered perceptible benefits over thoracotomy in terms of less postoperative pain and narcotic utilization, shorter ICU and hospital stay, decreased incidence of postoperative complications combined with quicker return to work, and better cosmesis. However, despite its obvious advantages, the General Thoracic Surgical Community has been relatively slow in adapting VATS more widely. The introduction of da Vinci surgical system has helped overcome certain inherent limitations of VATS such as two-dimensional (2D) vision and counter intuitive movement using long rigid instruments allowing thoracic surgeons to perform a plethora of minimally invasive thoracic procedures more efficiently. Although the cumulative experience worldwide is still limited and evolving, Robotic Thoracic Surgery is an evolution over VATS. There is however a lot of concern among established high-volume VATS centers regarding the superiority of the robotic technique. We have over 7 years experience and believe that any new technology designed to make minimal invasive surgery easier and more comfortable for the surgeon is most likely to have better and safer outcomes in the long run. Our only concern is its cost effectiveness and we believe that if the cost factor is removed more and more surgeons will use the technology and it will increase the spectrum and the reach of minimally invasive thoracic surgery. This article reviews worldwide experience with robotic thoracic surgery and addresses the potential benefits and limitations of using the robotic platform for the performance of thoracic surgical procedures. PMID:25598601

  6. Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs.

    Science.gov (United States)

    Osarogiagbon, Raymond U; Freeman, Richard K; Krasna, Mark J

    2015-08-01

    Three models of care are described, including two models of multidisciplinary care for thoracic malignancies. The pros and cons of each model are discussed, the evidence supporting each is reviewed, and the need for more (and better) research into care delivery models is highlighted. Key stakeholders in thoracic oncology care delivery outcomes are identified, and the need to consider stakeholder perspectives in designing, validating and implementing multidisciplinary programs as a vehicle for quality improvement in thoracic oncology is emphasized. The importance of reconciling stakeholder perspectives, and identify meaningful stakeholder-relevant benchmarks is also emphasized. Metrics for measuring program implementation and overall success are proposed.

  7. Right main bronchial fracture resolution by digital thoracic drainage system.

    Science.gov (United States)

    Cortés Julián, Gildardo; Mier, José M; Iñiguez, Marco A; Guzmán de Alba, Enrique

    2016-03-01

    Tracheobronchial stenosis is common in the thoracic surgery service, and iatrogenic injury of the airway after manipulation is not infrequent. When a digital thoracic drainage system came onto the market, many advantages were evident. A 24-year-old woman with critical right main bronchial stenosis underwent airway dilation that was complicated by a tear with a massive air leak, resulting in a total right pneumothorax. We employed a pleural drain connected to a digital thoracic drainage system. The drain was removed 2 days after successful resolution of the air leak. © The Author(s) 2015.

  8. Magnetic resonance in prenatal diagnosis of thoracic anomalies

    International Nuclear Information System (INIS)

    Pietrani, M.; Elias, D.; Wojakowski, A.; Fataljaef, V.; Carcano, M.; Otano, L.

    2007-01-01

    The objective of this article is to communicate the experience in the evaluation of fetal anomalies thoracic by means of magnetic resonance. Between January, 2001 - March, 2007 16 fetus were evaluated by means of magnetic resonance with echographic diagnosis of thoracic anomalies. An equipment of 1.5 TESLA was used. The thoracic anatomy was valued in general. At the presence of discovering pulmonary mass, their size, volume and intensity of sign were determined. The echographic and magnetic resonance findings were checked against the perinatal results [es

  9. Fetal magnetic resonance imaging of thoracic and abdominal malformations

    International Nuclear Information System (INIS)

    Woitek, R.; Asenbaum, U.; Furtner, J.; Prayer, D.; Brugger, P.C.

    2013-01-01

    Diagnosis and differential diagnosis of fetal thoracic and abdominal malformations. Ultrasound and magnetic resonance imaging (MRI). In cases of suspected pathologies based on fetal ultrasound MRI can be used for more detailed examinations and can be of assistance in the differential diagnostic process. Improved imaging of anatomical structures and of the composition of different tissues by the use of different MRI sequences. Fetal MRI has become a part of clinical routine in thoracic and abdominal malformations and is the basis for scientific research in this field. In cases of thoracic or abdominal malformations fetal MRI provides important information additional to ultrasound to improve diagnostic accuracy, prognostic evaluation and surgical planning. (orig.) [de

  10. Update in Infectious Diseases 2017.

    Science.gov (United States)

    Candel, F J; Peñuelas, M; Lejárraga, C; Emilov, T; Rico, C; Díaz, I; Lázaro, C; Viñuela-Prieto, J M; Matesanz, M

    2017-09-01

    Antimicrobial resistance in complex models of continuous infection is a current issue. The update 2017 course addresses about microbiological, epidemiological and clinical aspects useful for a current approach to infectious disease. During the last year, nosocomial pneumonia approach guides, recommendations for management of yeast and filamentous fungal infections, review papers on the empirical approach to peritonitis and extensive guidelines on stewardship have been published. HIV infection is being treated before and more intensively. The implementation of molecular biology, spectrometry and inmunology to traditional techniques of staining and culture achieve a better and faster microbiological diagnosis. Finally, the infection is increasingly integrated, assessing non-antibiotic aspects in the treatment.

  11. Extended replacement of the thoracic aorta.

    Science.gov (United States)

    Hino, Yutaka; Okada, Kenji; Oka, Takanori; Inoue, Takeshi; Tanaka, Akiko; Omura, Atsushi; Kano, Hiroya; Okita, Yutaka

    2013-01-01

    We present our experience of total aortic arch replacement. Twenty-nine patients (21 males and 8 females; mean age 63.3 ± 13.3 years) with extended thoracic aortic aneurysms underwent graft replacement. The pathology of the diseased aorta was non-dissecting aneurysm in 11 patients, including one aortitis and aortic dissection in 18 patients (acute type A: one, chronic type A: 11, chronic type B: six). Five patients had Marfan syndrome. In their previous operation, two patients had undergone the Bentall procedure, three had endovascular stenting, one had aortic root replacement with valve sparing and 12 had hemi-arch replacement for acute type A dissection. Approaches to the aneurysm were as follows: posterolateral thoracotomy with rib-cross incision in 16, posterolateral thoracotomy extended to the retroperitoneal abdominal aorta in seven, mid-sternotomy and left pleurotomy in three, anterolateral thoracotomy with partial lower sternotomy in two and clam-shell incision in one patient. Extension of aortic replacement was performed from the aortic root to the descending aorta in 4, from the ascending aorta to the descending aorta in 17 and from the ascending to the abdominal aorta in eight patients. Arterial inflow for cardiopulmonary bypass consisted of the femoral artery in 15 patients, ascending aorta and femoral artery in seven, descending or abdominal aorta in five and ascending aorta in two. Venous drainage site was the femoral vein in 10, pulmonary artery in eight, right atrium in five, femoral artery with right atrium/pulmonary artery in four and pulmonary artery with right atrium in two patients. The operative mortality, 30-day mortality and hospital mortality was one (cardiac arrest due to aneurysm rupture), one (rupture of infected aneurysm) and one (brain contusion), respectively. Late mortality occurred in three patients due to pneumonia, ruptured residual aneurysm and intracranial bleeding. Actuarial survival at 5 years after the operations was 80.6

  12. Thoracic splenosis as a differential diagnosis of juxtapleural nodules

    Directory of Open Access Journals (Sweden)

    B. Lopes

    2014-01-01

    Full Text Available Thoracic splenosis is rare and consists of ectopic implantation of splenic tissue into the chest after concomitant thoracic and abdominal trauma with diaphragm injury. It occurs in about 18% of cases of splenic ruptures. In almost all cases, diagnosis is given incidentally once patients are usually asymptomatic. Thoracic splenosis should be considered as a differential diagnosis in all patients with history of trauma presenting with juxtapleural nodules in chest computed tomography. However, malignant conditions should be ruled out firstly. Biopsy is not essential for the diagnosis once nuclear medicine can confirm splenosis in patients with pertinent history of trauma and suggestive tomographic image. We present a typical case of thoracic splenosis whose diagnosis was made by nuclear medicine and no invasive procedures were required.

  13. Anesthesia for thoracic surgery: A survey of middle eastern practice

    Science.gov (United States)

    Eldawlatly, Abdelazeem; Turkistani, Ahmed; Shelley, Ben; El-Tahan, Mohamed; Macfie, Alistair; Kinsella, John

    2012-01-01

    Purpose: The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern (ME) region. Methods: A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic-anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation (OLV), anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Results: Volume-controlled ventilation was favored over pressure-controlled ventilation (62% vs 38% of respondents, Panesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques (P<0.05). Conclusions: Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice. PMID:23162388

  14. Left Sided Trans-thoracic Esophagectomy for Resectable ...

    African Journals Online (AJOL)

    ADMIN

    Background: Surgery is the main stay of treatment for Esophageal Cancer but there is no .... patients and a nasogastric tube positioned in the gastric tube in all. .... infection, thorough drainage of the thoracic cavity, maintenance of nutrition and ...

  15. “Clavicular Duplication Causing Thoracic Outlet Obstruction ...

    African Journals Online (AJOL)

    and left shoulder pain radiating to hand, and associated with paresthesia and .... results in fracture instead of acromioclavicular joint sprain and a “new” clavicle ... such as anomalous cervical ribs, hypoplastic first thoracic rib, exostoses of the ...

  16. variations in dimensions and shape of thoracic cage with aging

    African Journals Online (AJOL)

    the rib cage dimensions, the shape and cross- ..... Figure 6: CT axial section of thorax, showing the internal thoracic dimensions and shape at different age .... Dean J, Koehler R, Schleien C, Michael J, Chantarojanasiri T, Rogers M, Traystman ...

  17. Sampling Efficiency and Performance of Selected Thoracic Aerosol Samplers.

    Science.gov (United States)

    Görner, Peter; Simon, Xavier; Boivin, Alexis; Bau, Sébastien

    2017-08-01

    Measurement of worker exposure to a thoracic health-related aerosol fraction is necessary in a number of occupational situations. This is the case of workplaces with atmospheres polluted by fibrous particles, such as cotton dust or asbestos, and by particles inducing irritation or bronchoconstriction such as acid mists or flour dust. Three personal and two static thoracic aerosol samplers were tested under laboratory conditions. Sampling efficiency with respect to particle aerodynamic diameter was measured in a horizontal low wind tunnel and in a vertical calm air chamber. Sampling performance was evaluated against conventional thoracic penetration. Three of the tested samplers performed well, when sampling the thoracic aerosol at nominal flow rate and two others performed well at optimized flow rate. The limit of flow rate optimization was found when using cyclone samplers. © The Author 2017. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

  18. Thoracic meningocele, non-associated with neurofibromatosis: a case report

    International Nuclear Information System (INIS)

    Abdala, N.; Nalli, D.R.; Carrete Junior, H.; Rodrigues, W.M.; Nogueira, R.G.; Carri, J.M.

    1993-01-01

    A case of thoracic meningocele, not associated with neurofibromatosis, in a 30 year-old woman is reported. The importance of imaging diagnostic methods in the differential diagnosis of posterior mediastinal masses is discussed. (author)

  19. Graft-Sparing Strategy for Thoracic Prosthetic Graft Infection.

    Science.gov (United States)

    Uchino, Gaku; Yoshida, Takeshi; Kakii, Bunpachi; Furui, Masato

    2018-04-01

    Thoracic prosthetic graft infection is a rare but serious complication with no standard management. We reported our surgical experience on graft-sparing strategy for thoracic prosthetic graft infection.  This study included patients who underwent graft-sparing surgery for thoracic prosthetic graft infection at Matsubara Tokushukai Hospital in Japan from January 2000 to October 2017.  There were 17 patients included in the analyses, with a mean age at surgery of 71.0 ± 10.5 years; 11 were men. In-hospital mortality was observed in five patients (29.4%).  Graft-sparing surgery for thoracic prosthetic graft infection is an alternative option particularly for early graft infection after hemiarch replacement. Georg Thieme Verlag KG Stuttgart · New York.

  20. Anaesthetic and critical care management of thoracic injuries.

    Science.gov (United States)

    Round, J A; Mellor, A J

    2010-09-01

    Thoracic wounding has been a relatively common presentation of military wounds throughout modern conflict. When civilian casualties are included the incidence has remained constant at around 10%, although the frequency and severity of wounds to combatants has been altered by modern body armour. Whilst thoracic injury has a high initial mortality on the battlefield, those surviving to reach hospital frequently have injuries that only require simple management. In addition to penetrating ballistic injury, blunt chest trauma frequently occurs on operations as a result of road traffic collisions or tertiary blast injury. The physiological impact of thoracic wounds, however, is often great and survivors often require intensive care management and, where available, complex strategies to ensure oxygenation and carbon dioxide removal. This review examines the incidence and patterns of thoracic trauma and looks at therapeutic options for managing these complex cases.

  1. Infectious Risks of Traveling Abroad.

    Science.gov (United States)

    Chen, Lin H; Blair, Barbra M

    2015-08-01

    A popular leisure activity, international travel can be associated with some infections. The most common travel-related illnesses appear to be gastrointestinal, dermatologic, respiratory, and systemic febrile syndromes. The pretravel medical consultation includes immunizations, malaria chemoprophylaxis, self-treatment for traveler's diarrhea, and advice on the prevention of a myriad of other infectious causes including dengue, chikungunya, rickettsiosis, leptospirosis, schistosomiasis, and strongyloidiasis. Travel to locations experiencing outbreaks such as Ebola virus disease, Middle East respiratory syndrome, avian influenza, and chikungunya call for specific alerts on preventive strategies. After travel, evaluation of an ill traveler must explore details of exposure, including destinations visited; activities; ingestion of contaminated food or drinks; contact with vectors, animals, fresh water, or blood and body fluids; and other potential exposures. Knowledge of the geographic distribution of infectious diseases is important in generating the differential diagnoses and testing accordingly. Empiric treatment is sometimes necessary when suspicion of a certain diagnosis is strong and confirmatory tests are delayed or lacking, particularly for infections that are rapidly progressive (for example, malaria) or for which timing of testing is prolonged (such as leptospirosis).

  2. External validation of the Society of Thoracic Surgeons General Thoracic Surgery Database.

    Science.gov (United States)

    Magee, Mitchell J; Wright, Cameron D; McDonald, Donna; Fernandez, Felix G; Kozower, Benjamin D

    2013-11-01

    The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) reports outstanding results for lung and esophageal cancer resection. However, a major weakness of the GTSD has been the lack of validation of this voluntary registry. The purpose of this study was to perform an external, independent audit to assess the accuracy of the data collection process and the quality of the database. An independent firm was contracted to audit 5% of sites randomly selected from the GTDB in 2011. Audits were performed remotely to maximize the number of audits performed and reduce cost. Auditors compared lobectomy cases submitted to the GTSD with the hospital operative logs to evaluate completeness of the data. In addition, 20 lobectomy records from each site were audited in detail. Agreement rates were calculated for 32 individual data elements, 7 data categories pertaining to patient status or care delivery, and an overall agreement rate for each site. Six process variables were also evaluated to assess best practice for data collection and submission. Ten sites were audited from the 222 participants. Comparison of the 559 submitted lobectomy cases with operative logs from each site identified 28 omissions, a 94.6% agreement rate (discrepancies/site range, 2 to 27). Importantly, cases not submitted had no mortality or major morbidity, indicating a lack of purposeful omission. The aggregate agreement rates for all categories were greater than 90%. The overall data accuracy was 94.9%. External audits of the GTSD validate the accuracy and completeness of the data. Careful examination of unreported cases demonstrated no purposeful omission or gaming. Although these preliminary results are quite good, it is imperative that the audit process is refined and continues to expand along with the GTSD to insure reliability of the database. The audit results are currently being incorporated into educational and quality improvement processes to add further value. Copyright

  3. Increased interleukin-11 levels in thoracic aorta and plasma from patients with acute thoracic aortic dissection.

    Science.gov (United States)

    Xu, Yao; Ye, Jing; Wang, Menglong; Wang, Yuan; Ji, Qingwei; Huang, Ying; Zeng, Tao; Wang, Zhen; Ye, Di; Jiang, Huimin; Liu, Jianfang; Lin, Yingzhong; Wan, Jun

    2018-06-01

    Interleukin (IL) 11 is closely related to tumor and hematological system diseases. Recent studies have demonstrated that IL-11 also participates in cardiovascular diseases, including ischemia-reperfusion mediated heart injury and acute myocardial infarction. This study aimed to investigate whether IL-11 is involved in acute thoracic aortic dissection (TAD). Aortic tissue samples from normal donors and acute TAD patients were collected, and the expression of IL-11 in all aortic tissue was analyzed. In addition, blood samples from patients with chest pain were collected and divided into a non-AD (NAD) group and a TAD group according to the results of computed tomography angiography of the thoracic aorta. The plasma IL-11, IL-17 and interferon (IFN) γ in all blood samples were measured. Compared with aortic tissue of normal controls, IL-11 was significantly increased in aortic tissue of acute TAD patients, especially in the torn section. The IL-11 was derived from aorta macrophages in TAD. In addition, the plasma IL-11, IL-17 and IFN-γ were significantly higher in acute TAD patients than in NAD patients, and the correlation analysis showed that IL-11 levels were positively correlated with levels of IFN-γ, IL-17, glucose, systolic blood pressure, diastolic blood pressure, white blood cells, C-reactive proteins and D-dimers. Binary logistic regression analyses showed that elevated IL11 in patients who may have diagnostic value of TAD, but less that D-dimer. IL-11 was increased in thoracic aorta and plasma of TAD patients and may be a promising biomarker for diagnosis in patients with TAD. Copyright © 2018. Published by Elsevier B.V.

  4. [Infectious diseases - a specialty of internal medicine].

    Science.gov (United States)

    Fätkenheuer, G; Jung, N; Kern, W V; Fölsch, U R; Salzberger, B

    2018-04-01

    Infectious diseases have recently gained wide public interest. Emerging infections and rising rates of antibiotic resistance are determining this trend. Both challenges will need to be addressed in international and local collaborations between different specialties in medicine and basic science. Infectious diseases as a clinical specialty in this scenario is directly responsible for the care of patients with infectious diseases. Its involvement in the care of patients with complicated infections has proved to be highly effective. Antibiotic stewardship programmes are effective measures in slowing the development of antibiotic resistance and have been widely implemented. But antibiotic stewardship specialists should not be confused with or taken as an alternative to infectious disease experts. Infectious diseases requires appropriate and specific training. It mainly uses the instrumentarium of internal medicine. With the current challenges in modern medicine, infectious diseases in Germany should thus be upgraded from a subspecialty to a clinical specialty, ideally within Internal Medicine.

  5. Cardiovascular complications following thoracic radiotherapy in patients with cancer

    DEFF Research Database (Denmark)

    Nielsen, Kirsten Melgaard; Borchsenius, Julie I Helene; Offersen, Birgitte Vrou

    2016-01-01

    Cardiovascular complications following thoracic radiotherapy in patients with cancer are well described. Advancements in surgery, radiotherapy and systemic treatments have led to an increasing number of cancer survivors and thus an increasing number of patients with long-term side effects...... of their cancer treatments. This article describes the short- and long-term cardiovascular morbidity and mortality following thoracic radiotherapy and further, optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients....

  6. Video-assisted thoracic surgery mediastinal germ cell metastasis resection.

    Science.gov (United States)

    Nardini, Marco; Jayakumar, Shruti; Migliore, Marcello; Dunning, Joel

    2017-07-01

    Thoracoscopy can be safely used for dissection of masses in the visceral mediastinum. We report the case of a 31-year-old man affected by metastatic germ cell tumour and successfully treated with a 3-port posterior approach video-assisted thoracic surgery. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  7. September 2013 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-09-01

    Full Text Available No abstract available. Article truncated at 150 words. The September Arizona Thoracic Society meeting was held on Wednesday, 9/25/2013 at Shea Hospital beginning at 6:30 PM. There were 13 in attendance representing the pulmonary, critical care, sleep, and pathology communities. After a brief discussion, Gerry Swartzberg was selected as Arizona’s 2014 nominee for Clinician of the Year. There was 1 case presented: Dr. Thomas Colby, pulmonary pathologist from Mayo Clinic Arizona, presented the case of a 67 year old woman with multiple pulmonary nodules. The largest was 1.2 cm CT scan. She had a fine needle aspiration of one of the nodules. The pathology revealed spindle-shaped cells which were synaptophysin + (also known as the major synaptic vesicle protein p38. Synaptophysin marks neuroendocrine tissue and on this basis the patient was diagnosed with multiple carcinoid tumors. Aguayo et al. (1 described six patients with diffuse hyperplasia and dysplasia of pulmonary neuroendocrine cells, multiple carcinoid tumorlets, and peribronchiolar fibrosis …

  8. November 2015 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2015 Arizona Thoracic Society meeting was held on Wednesday, November 18, 2015 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 14 in attendance representing the pulmonary, critical care, sleep, and radiology communities. There were 3 case presentations: 1. Dr. Gerald Schwartzberg presented a case of a 56-year-old man with a history of diabetes, alcoholism and tobacco abuse who has a history of Mycobacterium avium-intracellulare (MAI with a residual thin-walled cavity in his right upper lobe (RUL. After quitting drinking and smoking and years of being asymptomatic, he presented with hemoptysis. Chest x-ray showed increasing density in the RUL. CT scan showed an intracavitary density in his previous cavity presumably a fungus ball. Sputum cultures are pending. Discussion followed on management of fungus balls. Bronchoscopy was recommended to view the bronchial anatomy to exclude other diagnosis as well ...

  9. Imaging after radiation therapy of thoracic tumors

    International Nuclear Information System (INIS)

    Ghaye, B.; Wanet, M.; El Hajjam, M.

    2016-01-01

    Radiation-induced lung disease (RILD) is frequent after therapeutic irradiation of thoracic malignancies. Many technique-, treatment-, tumor- and patient-related factors influence the degree of injury sustained by the lung after irradiation. Based on the time interval after the completion of the treatment RILD presents as early and late features characterized by inflammatory and fibrotic changes, respectively. They are usually confined to the radiation port. Though the typical pattern of RILD is easily recognized after conventional two-dimensional radiation therapy (RT), RILD may present with atypical patterns after more recent types of three or four-dimensional RT treatment. Three atypical patterns are reported: the modified conventional, the mass-like and the scar-like patterns. Knowledge of the various features and patterns of RILD is important for correct diagnosis and appropriate treatment. RILD should be differentiated from recurrent tumoral disease, infection and radiation-induced tumors. Due to RILD, the follow-up after RT may be difficult as response evaluation criteria in solid tumours (RECIST) criteria may be unreliable to assess tumor control particularly after stereotactic ablation RT (SABR). Long-term follow-up should be based on clinical examination and morphological and/or functional investigations including CT, PET-CT, pulmonary functional tests, MRI and PET-MRI. (authors)

  10. Aortic dose constraints when reirradiating thoracic tumors

    International Nuclear Information System (INIS)

    Evans, Jaden D.; Gomez, Daniel R.; Amini, Arya; Rebueno, Neal; Allen, Pamela K.; Martel, Mary K.; Rineer, Justin M.; Ang, Kie Kian; McAvoy, Sarah; Cox, James D.; Komaki, Ritsuko; Welsh, James W.

    2013-01-01

    Background and purpose: Improved radiation delivery and planning has allowed, in some instances, for the retreatment of thoracic tumors. We investigated the dose limits of the aorta wherein grade 5 aortic toxicity was observed after reirradiation of lung tumors. Material and methods: In a retrospective analysis, 35 patients were identified, between 1993 and 2008, who received two rounds of external beam irradiation that included the aorta in the radiation fields of both the initial and retreatment plans. We determined the maximum cumulative dose to 1 cm 3 of the aorta (the composite dose) for each patient, normalized these doses to 1.8 Gy/fraction, and corrected them for long-term tissue recovery between treatments (NID R ). Results: The median time interval between treatments was 30 months (range, 1–185 months). The median follow-up of patients alive at analysis was 42 months (range, 14–70 months). Two of the 35 patients (6%) were identified as having grade 5 aortic toxicities. There was a 25% rate of grade 5 aortic toxicity for patients receiving composite doses ⩾120.0 Gy (vs. 0% for patients receiving R ⩾90.0 Gy) to 1 cm 3 of the aorta

  11. Radiation therapy of thoracic and abdominal tumors

    International Nuclear Information System (INIS)

    LaRue, S.M.; Gillette, S.M.; Poulson, J.M.

    1995-01-01

    Until recently, radiotherapy of thoracic and abdominal tumors in animals has been limited. However, the availability of computerized tomography and other imaging techniques to aid in determining the extent of tumor, an increase in knowledge of dose tolerance of regional organs, the availability of isocentrically mounted megavoltage machines, and the willingness of patients to pursue more aggressive treatment is making radiation therapy of tumors in these regions far more common. Tumor remission has been reported after radiation therapy of thymomas. Radiation therapy has been used to treat mediastinal lymphoma refractory to chemotherapy, and may be beneficial as part of the initial treatment regimen for this disease. Chemodectomas are responsive to radiation therapy in human patients, and favorable response has also been reported in dogs. Although primary lung tumors in dogs are rare, in some cases radiation therapy could be a useful primary or adjunctive therapy. Lung is the dose-limiting organ in the thorax. Bladder and urethral tumors in dogs have been treated using intraoperative and external-beam radiation therapy combined with chemotherapy. These tumors are difficult to control locally with surgery alone, although the optimal method of combining treatment modalities has not been established. Local control of malignant perianal tumors is also difficult to achieve with surgery alone, and radiation therapy should be used. Intraoperative radiation therapy combined with external-beam radiation therapy has been used for the management of metastatic carcinoma to the sublumbar lymph nodes. Tolerance of retroperitoneal tissues may be decreased by disease or surgical manipulation

  12. July 2016 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-07-01

    Full Text Available No abstract available. Article truncated after first 150 words. The July 2016 Arizona Thoracic Society meeting was held on Wednesday, July 27, 2016 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 14 in attendance representing the pulmonary, critical care, sleep, and radiology communities. Prior to the case presentations, a discussion was held on 4 issues. First, Dr. Rick Robbins gave a summary of ATS Hill Day. During Hill Day a presentation was given by a representative from the Campaign for Tobacco-Free Kids. Their web site lists tobacco company contributions to members of Congress on their web site. Dr. Gary Ewart from the ATS office in Washington gave a presentation on the Traditional Cigar Manufacturing and Small Business Jobs Preservation Act before Congress (aka the Cigar Bill which the ATS opposes. He noted that cosponsors for the bill included several Congressmen from Southwestern states. Dr. Robbins combined the two ...

  13. September 2012 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-09-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on 9/26//2012 at Scottsdale Shea beginning at 6:30 PM. There were 18 in attendance representing the pulmonary, critical care, sleep, pathology, and radiology communities.A discussion was held on Pending Premium Cigar Legislation HR. 1639 and S.1461, the "Traditional Cigar Manufacturing and Small Business Jobs Preservation Act of 2011”. This bill would exempt "premium cigars" from FDA oversight. The definition of premium cigars is so broad that candy flavored cigars, cigarillos and blunts would be exempted from FDA regulation. Teenage cigar smoking is increasing and this legislation may result in a further increase. The Arizona Thoracic Society is opposed to this bill. Dr. Robbins is to put a link on the Southwest Journal of Pulmonary and Critical Care website linking to the ATS website. This will enable members to contact their Congressmen opposing this legislation. A discussion was also held on a proposed combined Tucson/Phoenix …

  14. January 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Wesselius LJ

    2017-02-01

    Full Text Available No abstract available. Article truncated after 150 words. The January 2017 Arizona Thoracic Society meeting was held on Wednesday, January 25, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting (prime rib with case presentations. There was a good attendance representing the pulmonary, critical care, sleep, and radiology communities. There was a discussion of supporting the Tobacco 21 bill which has been introduced into the Arizona State Legislature. There was unanimous support for this bill. Another bill to allow school nurses to administer an albuterol inhaler without a doctor’s prescription was also discussed but the members wanted more information. The new CDC Ventilator-Associated Events (VAE criteria were also discussed. Before endorsing or opposing the this as a measure, the members wished more information. It was decided that a decision on both would be postponed until discussed at the next meeting. Three cases were presented: 1. Dr. Lewis Wesselius from the Mayo Clinic …

  15. A rare case of traumatic chylothorax after blunt thoracic trauma

    Directory of Open Access Journals (Sweden)

    Spasić Marko

    2017-01-01

    Full Text Available Introduction. Chylothorax is an accumulation of chyle in the pleural cavity due to a disruption of the thoracic duct. Traumatic chylothoraces are usually a result of a penetrating trauma and disruption of the thoracic duct, but blunt traumatic chylothorax is a rare condition. The aim of this paper is to present a rare case of traumatic chylothorax after blunt thoracic trauma. Case Outline. We present a case of traumatic chylothorax after blunt thoracic trauma in a patient injured in a motor vehicle accident. The patient had a right-sided fracture of rib XI, hydropneumothorax, lung contusion, and signs of pneumomediastinum. We performed thoracic drainage, but a few days later, according to the increase of amount of the fluid daily drained, and the confirmation of laboratory findings of the analyzed fluid, we made a diagnosis of chylothorax and the patient underwent a thoracotomy, where we sutured the thoracic duct. Conclusion. Chylothorax should be considered in patients after chest trauma if they develop a milky pleural effusion. Analysis of pleural fluid and level of triglycerides is important for the diagnosis and treatment of chylothorax. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41007

  16. Digital radiography of crush thoracic trauma in the Sichuan earthquake

    Science.gov (United States)

    Dong, Zhi-Hui; Shao, Heng; Chen, Tian-Wu; Chu, Zhi-Gang; Deng, Wen; Tang, Si-Shi; Chen, Jing; Yang, Zhi-Gang

    2011-01-01

    AIM: To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography (CDR). METHODS: We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake. Patient age ranged from 0.5 to 103 years. CDR was performed between May 12, 2008 and June 7, 2008. We looked for injury to the thoracic cage, pulmonary parenchyma and the pleura. RESULTS: Antero-posterior (AP) and lateral CDR were obtained in 349 patients, the remaining 423 patients underwent only AP CDR. Thoracic cage fractures, pulmonary contusion and pleural injuries were noted in 331 (42.9%; 95% CI: 39.4%-46.4%), 67 and 135 patients, respectively. Of the 256 patients with rib fractures, the mean number of fractured ribs per patient was 3. Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib. Rib fractures had a significant positive association with non-rib thoracic fractures, pulmonary contusion and pleural injuries (P < 0.001). The number of rib fractures and pulmonary contusions were significant factors associated with patient death. CONCLUSION: Earthquake-related crush thoracic trauma has the potential for multiple fractures. The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment. PMID:22132298

  17. Thoracic solitary pedunculated osteochondroma in a child: a case report

    Directory of Open Access Journals (Sweden)

    Wali Z

    2013-10-01

    Full Text Available Zubair Wali,1 Khalid I Khoshhal21Department of Orthopedic Surgery, King Fahd Hospital, Almadinah Almunawwarah, Saudi Arabia; 2Department of Orthopedic Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi ArabiaObjective: This case report describes the rare presentation of a thoracic pedunculated osteochondroma in a child, arising from the lamina of the fourth thoracic vertebra.Clinical features: A 7-year-old girl was referred for the evaluation of a swelling in her back. The patient was suffering from atraumatic, progressive painless back swelling, of approximately 2 years duration. The physical examination showed a healthy child, with a well-defined mass, about 4 × 6 cm, located around the midline of the upper thoracic spine. No clinical signs of hereditary multiple exostoses were detected. Plain radiographs and computerized tomography were suggestive of a pedunculated osteochondroma arising from the lamina of the fourth thoracic vertebra.Intervention and outcome: The patient underwent surgical excision of the mass. The pathologist confirmed the diagnosis. Follow up for 2 years did not show any evidence of clinical or radiological recurrence.Conclusion: The current report describes a rare case and the management of a solitary pedunculated osteochondroma arising from the lamina of the fourth thoracic vertebra in a child below the age of 10 years.Keywords: benign tumors, hereditary multiple exostoses, spine column tumors, thoracic vertebra

  18. Infectious Disease Clinical Research Program (IDCRP)

    Data.gov (United States)

    Federal Laboratory Consortium — Our mission is to conduct infectious disease clinical research of importance to the military through a unique, adaptive, and collaborative network, to inform health...

  19. Geometric Deformations of the Thoracic Aorta and Supra-Aortic Arch Branch Vessels Following Thoracic Endovascular Aortic Repair.

    Science.gov (United States)

    Ullery, Brant W; Suh, Ga-Young; Hirotsu, Kelsey; Zhu, David; Lee, Jason T; Dake, Michael D; Fleischmann, Dominik; Cheng, Christopher P

    2018-04-01

    To utilize 3-D modeling techniques to better characterize geometric deformations of the supra-aortic arch branch vessels and descending thoracic aorta after thoracic endovascular aortic repair. Eighteen patients underwent endovascular repair of either type B aortic dissection (n = 10) or thoracic aortic aneurysm (n = 8). Computed tomography angiography was obtained pre- and postprocedure, and 3-D geometric models of the aorta and supra-aortic branch vessels were constructed. Branch angle of the supra-aortic branch vessels and curvature metrics of the ascending aorta, aortic arch, and stented thoracic aortic lumen were calculated both at pre- and postintervention. The left common carotid artery branch angle was lower than the left subclavian artery angles preintervention ( P Supra-aortic branch vessel angulation remains relatively static when proximal landing zones are distal to the left common carotid artery.

  20. One-stage surgery in combination with thoracic endovascular grafting and resection of T4 lung cancer invading the thoracic aorta and spine

    OpenAIRE

    Sato, Seijiro; Goto, Tatsuya; Koike, Terumoto; Okamoto, Takeshi; Shoji, Hirokazu; Ohashi, Masayuki; Watanabe, Kei; Tsuchida, Masanori

    2017-01-01

    A novel strategy of one-stage surgery in combination with thoracic endovascular grafting and resection for T4 lung cancer invading the thoracic aorta and spine is described. A 56-year-old man with locally advanced lung cancer infiltrating the aortic wall and spine underwent neoadjuvant chemotherapy and thoracic irradiation, followed by en bloc resection of the aortic wall and spine with thoracic endovascular grafting. He developed postoperative chylothorax, but there were no stent graft-relat...

  1. Prevalence of infectious and non-infectious diseases in cattle population in Moulvibazar district of Bangladesh

    OpenAIRE

    Chowdhury, Q M Monzur Kader; Roy, Sawrab; Alam, Shahrul; Ahmed, Juned

    2018-01-01

    Infectious and non-infectious diseases of cattle cause great economic losses of farmers as well as country every year by reducing growth, production and mortality of cattle population. The objective of this research work was to find out the prevalence of infectious and non-infectious diseases of cattle at Moulvibazar, Sylhet, Bangladesh. A total of 2285 clinical cases were diagnosed at District Veterinary Hospital in Moulvibazar, Bangladesh during January to June, 2016. Disease diagnosis was ...

  2. Cardiac imaging in infectious endocarditis

    DEFF Research Database (Denmark)

    Bruun, Niels Eske; Habib, Gilbert; Thuny, Franck

    2014-01-01

    Infectious endocarditis remains both a diagnostic and a treatment challenge. A positive outcome depends on a rapid diagnosis, accurate risk stratification, and a thorough follow-up. Imaging plays a key role in each of these steps and echocardiography remains the cornerstone of the methods in use....... The technique of both transthoracic echocardiography and transoesophageal echocardiography has been markedly improved across the last decades and most recently three-dimensional real-time echocardiography has been introduced in the management of endocarditis patients. Echocardiography depicts structural changes...... with conventional CT (SPECT/CT). Of these methods, (18)F-FDG PET-CT carries the best promise for a future role in endocarditis. But there are distinct limitations with both SPECT/CT and (18)F-FDG PET-CT which should not be neglected. MRI and spiral CT are methods primarily used in the search for extra cardial...

  3. Comparison of dose distribution between 3DCRT and IMRT in middle thoracic and under thoracic esophageal carcinoma

    International Nuclear Information System (INIS)

    Li Dingjie; Liu Hailong; Mao Ronghu; Liu Ru; Guo Xiaoqi; Lei Hongchang; Wang Jianhua

    2011-01-01

    Objective: To compare the dose distribution between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in treating esophageal carcinoma (middle thoracic section and under thoracic section) and to select reasonable treatment methods for esophagus cancer. Methods: Ten cases with cancer of the middle thoracic section and under thoracic section esophagus were chosen for a retrospective treatment-planning study. 3DCRT and IMRT plans were created for each patient: Some critical indicators were evolved in evaluating the treatment plans of IMRT (5B and 7B) and 3DCRT (3B), such as, PTV coverage and dose-volumes to irradiated normal structures. Evaluation indicators: prescription of 50 Gy. total lung volume (V5, V10, V20), mean lung dose (MLD), spinal cord (Dmax), heart (V40) and conformality index (CI). Each plan was evaluated with respect to dose distribution,dose-volume histograms (DVHs), and additional dosimetric endpoints described below. Results: There is no significance of CRT and IMRT technique in protection of total lung volume,mean lung dose, spinal cord (Dmax), target, CI and heart. Conclusion: As To radiotherapy of esophagus cancer of the middle thoracic section and under thoracic section, IMRT has no advantage compared with 3DCRT, the selection of plan should be adapted to the situations of every patient. (authors)

  4. The return of infectious disease.

    Science.gov (United States)

    Garrett, L

    1996-11-01

    This article presents the history of efforts to control the spread of infectious disease from the post-antibiotic era to 1995. Since World War II, public health strategy has focused on the eradication of microbes using powerful medical weaponry. The goal was to push humanity through a ¿health transition,¿ leaving the age of infectious disease permanently behind. But recent developments have shown that this grandiose optimism was premature. As people move across international borders, unwanted microbial hitch-hikers tag along, as happened in the case of Ebola. In large cities, sex industries arise and multiple-partner sex becomes more common, prompting rapid increases in sexually transmitted disease. Moreover, the practice of sharing syringes is a ready vehicle for the transmission of microbes while unhygienic health facilities become centers for the dissemination of disease rather than its control. Black market access to antimicrobials has led to overuse or outright misuse of the drugs and the emergence of resistant bacteria and parasites. Consequently, old organisms, aided by mankind's misuse of disinfectants and drugs, may take on new and more lethal forms. Even when allegations of biological warfare are not flying, it is often difficult to obtain accurate information about outbreaks of disease, particularly in countries dependent on foreign investment or tourism or both. Unfortunately, only 6 laboratories in the world meet security and safety standards that would make them suitable sites for research on the world's deadliest microbes. National security warrants bolder steps involving focusing not only on microbes directly dangerous to humans, but also on those that could pose major threats to crops or livestock. Unfortunately, economic crises have led to budget cuts, particularly in health care, at all levels of government in the US.

  5. Thoracic radiotherapy and breath control: current prospects

    International Nuclear Information System (INIS)

    Reboul, F.; Mineur, L.; Paoli, J.B.; Bodez, V.; Oozeer, R.; Garcia, R.

    2002-01-01

    Three-dimensional conformal radiotherapy (3D CRT) is adversely affected by setup error and organ motion. In thoracic 3D CRT, breathing accounts for most of intra-fraction movements, thus impairing treatment quality. Breath control clearly exhibits dosimetric improvement compared to free breathing, leading to various techniques for gated treatments. We review benefits of different breath control methods -i.e. breath-holding or beam gating, with spirometric, isometric or X-ray respiration sensor- and argument the choice of expiration versus inspiration, with consideration to dosimetric concerns. All steps of 3D-CRT can be improved with breath control. Contouring of organs at risk (OAR) and target are easier and more accurate on breath controlled CT-scans. Inter- and intra-fraction target immobilisation allows smaller margins with better coverage. Lung outcome predictors (NTCP, Mean Dose, LV20, LV30) are improved with breath-control. In addition, inspiration breath control facilitates beam arrangement since it widens the distance between OAR and target, and leaves less lung normal tissue within the high dose region. Last, lung density, as of CT scan, is more accurate, improving dosimetry. Our institutions choice is to use spirometry driven, patient controlled high-inspiration breath-hold; this technique gives excellent immobilization results, with high reproducibility, yet it is easy to implement and costs little extra treatment time. Breath control, whatever technique is employed, proves superior to free breathing treatment when using 3D-CRT. Breath control should then be used whenever possible, and is probably mandatory for IMRT. (authors)

  6. MRI findings in thoracic outlet syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Aralasmak, Ayse; Sharifov, Rasul; Kilicarslan, Rukiye; Alkan, Alpay [Bezmialem Vakif University, Department of Radiology, Fatih/Istanbul (Turkey); Cevikol, Can; Karaali, Kamil; Senol, Utku [Akdeniz University, Department of Radiology, Antalya (Turkey)

    2012-11-15

    We discuss MRI findings in patients with thoracic outlet syndrome (TOS). A total of 100 neurovascular bundles were evaluated in the interscalene triangle (IS), costoclavicular (CC), and retropectoralis minor (RPM) spaces. To exclude neurogenic abnormality, MRIs of the cervical spine and brachial plexus (BPL) were obtained in neutral. To exclude compression on neurovascular bundles, sagittal T1W images were obtained vertical to the longitudinal axis of BPL from spinal cord to the medial part of the humerus, in abduction and neutral. To exclude vascular TOS, MR angiography (MRA) and venography (MRV) of the subclavian artery (SA) and vein (SV) in abduction were obtained. If there is compression on the vessels, MRA and MRV of the subclavian vessels were repeated in neutral. Seventy-one neurovascular bundles were found to be abnormal: 16 arterial-venous-neurogenic, 20 neurogenic, 1 arterial, 15 venous, 8 arterial-venous, 3 arterial-neurogenic, and 8 venous-neurogenic TOS. Overall, neurogenic TOS was noted in 69%, venous TOS in 66%, and arterial TOS in 39%. The neurovascular bundle was most commonly compressed in the CC, mostly secondary to position, and very rarely compressed in the RPM. The cause of TOS was congenital bone variations in 36%, congenital fibromuscular anomalies in 11%, and position in 53%. In 5%, there was unilateral brachial plexitis in addition to compression of the neurovascular bundle. Severe cervical spondylosis was noted in 14%, contributing to TOS symptoms. For evaluation of patients with TOS, visualization of the brachial plexus and cervical spine and dynamic evaluation of neurovascular bundles in the cervicothoracobrachial region are mandatory. (orig.)

  7. 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.

  8. Surgical Thoracic Transplant Training: Super Fellowship-Is It Super?

    Science.gov (United States)

    Makdisi, George; Makdisi, Tony; Caldeira, Christiano C; Wang, I-Wen

    2017-10-11

    The quality of training provided to thoracic transplant fellows is a critical step in the care of complex patients undergoing transplant. The training varies since it is not an accreditation council for graduate medical education accredited fellowship. A total of 104 heart or lung transplant program directors throughout the United States were sent a survey of 24 questions focusing on key aspects of training, fellowship training content and thoracic transplant job satisfaction. Out of the 104 programs surveyed 45 surveys (43%) were returned. In total, 26 programs offering a transplant fellowship were included in the survey. Among these programs 69% currently have fellows of which 56% are American Board of Thoracic Surgery board eligible. According to the United Network for Organ Sharing (UNOS) requirements, 46% of the programs do not meet the requirements to be qualified as a primary heart transplant surgeon. A total of 23% of lung transplant programs also perform less than the UNOS minimum requirements. Only 24% have extra-surgical curriculum. Out of the participating programs, only 38% of fellows secured a job in a hospital setting for performing transplants. An astounding 77% of replies site an unpredictable work schedule as the main reason that makes thoracic transplant a less than favorable profession among new graduates. Long hours were also a complaint of 69% of graduates who agreed that their personal life is affected by excessive work hours. Annually, almost half of all thoracic transplant programs perform fewer than the UNOS requirements to be a primary thoracic surgeon. This results in a majority of transplant fellows not finding a suitable transplant career. The current and future needs for highly qualified thoracic transplant surgeons will not be met through our existing training mechanisms. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. The Role at Rehabilitation in Treatment of Thoracic Outlet Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Hosseinian

    2003-01-01

    Full Text Available Objective: Thoracic outlet syndrome is a complex disorder caused by neurovascular irritation in the region of the thoracic outlet. The syndrome have been said to be mainly due to anomalous structures in the thoracic outlet, treatment for thoracic outlet syndrome varies among different institutions, and there has not been any standard program. In general conservative and surgical treatment can be do if necessary. Materials & Methods: The rehabilitation program consists of exercise and physiotherapy and brace designed to hold the posture in which thoracic outlet is enlarged. Exercise program was designed simple enough to be performed in the daily living or during work after minimal training and isometric exercises of Serratus anterior, Levator Scapulae and Erector Spinae muscles to be performed in one posture: flexion and elevation of scapular girdle and correction position of upper-thoracic spine. During 7 years, 131 cases of (T.O.S. were evaluated that 26 cases (20% have operated and 84 cases (64% have treated with conservative treatment and 21 cases (16% have been candidate for surgery but they didn't accepted. Results: All of the cases have treated with conservative treatment for four months. 84 cases responded well and no further treatment was needed. 47 cases were not satisfied with. The outcome of their treatment, that 26 cases have operated and 21 cases have not accepted the operation and continued the conservative treatment, they have had pain and slightly disability. 23 cases of operated group responded well and they have resumed to work, one case has had neuropraxia for about one year. Conclusion: Most cases of thoracic outlet syndrome (T.O.S. can be treated conservatively. Surgically treatment is indicated only in cases severe enough to make them disable to work. It is better all the patients undergo conservative treatment for at least four months then will decided for surgical treatment.

  10. Investigation of pulsatile flowfield in healthy thoracic aorta models.

    Science.gov (United States)

    Wen, Chih-Yung; Yang, An-Shik; Tseng, Li-Yu; Chai, Jyh-Wen

    2010-02-01

    Cardiovascular disease is the primary cause of morbidity and mortality in the western world. Complex hemodynamics plays a critical role in the development of aortic dissection and atherosclerosis, as well as many other diseases. Since fundamental fluid mechanics are important for the understanding of the blood flow in the cardiovascular circulatory system of the human body aspects, a joint experimental and numerical study was conducted in this study to determine the distributions of wall shear stress and pressure and oscillatory WSS index, and to examine their correlation with the aortic disorders, especially dissection. Experimentally, the Phase-Contrast Magnetic Resonance Imaging (PC-MRI) method was used to acquire the true geometry of a normal human thoracic aorta, which was readily converted into a transparent thoracic aorta model by the rapid prototyping (RP) technique. The thoracic aorta model was then used in the in vitro experiments and computations. Simulations were performed using the computational fluid dynamic (CFD) code ACE+((R)) to determine flow characteristics of the three-dimensional, pulsatile, incompressible, and Newtonian fluid in the thoracic aorta model. The unsteady boundary conditions at the inlet and the outlet of the aortic flow were specified from the measured flowrate and pressure results during in vitro experiments. For the code validation, the predicted axial velocity reasonably agrees with the PC-MRI experimental data in the oblique sagittal plane of the thoracic aorta model. The thorough analyses of the thoracic aorta flow, WSSs, WSS index (OSI), and wall pressures are presented. The predicted locations of the maxima of WSS and the wall pressure can be then correlated with that of the thoracic aorta dissection, and thereby may lead to a useful biological significance. The numerical results also suggest that the effects of low WSS and high OSI tend to cause wall thickening occurred along the inferior wall of the aortic arch and the

  11. Atypical Pyoderma Gangrenosum Mimicking an Infectious Process

    Directory of Open Access Journals (Sweden)

    Derek To

    2014-01-01

    Full Text Available We present a patient with atypical pyoderma gangrenosum (APG, which involved the patient’s arm and hand. Hemorrhagic bullae and progressive ulcerations were initially thought to be secondary to an infectious process, but a biopsy revealed PG. Awareness of APG by infectious disease services may prevent unnecessary use of broad-spectrum antibiotics.

  12. Atypical pyoderma gangrenosum mimicking an infectious process.

    Science.gov (United States)

    To, Derek; Wong, Aaron; Montessori, Valentina

    2014-01-01

    We present a patient with atypical pyoderma gangrenosum (APG), which involved the patient's arm and hand. Hemorrhagic bullae and progressive ulcerations were initially thought to be secondary to an infectious process, but a biopsy revealed PG. Awareness of APG by infectious disease services may prevent unnecessary use of broad-spectrum antibiotics.

  13. 25 CFR 140.26 - Infectious plants.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Infectious plants. 140.26 Section 140.26 Indians BUREAU... Infectious plants. Traders shall not introduce into, sell, or spread within Indian reservations any plant, plant product, seed, or any type of vegetation, which is infested, or infected or which might act as a...

  14. Applications of Molecular Diagnostic Techniques for Infectious ...

    African Journals Online (AJOL)

    That outcome, if accurate, would help the clinician in disease management, or the epidemiologist in identifying trends of diseases or the administrator in policy and decision making. Traditionally, infectious disease diagnosis involves identifying the causative agents of infectious diseases through the direct examination, ...

  15. Tickborne infectious diseases: diagnosis and management

    National Research Council Canada - National Science Library

    Cunha, Burke A

    2000-01-01

    ... to particular flora and fauna. The purpose of Tickborne Infectious Diseases: Diagnosis and Management is to condense in a single book different approaches and paradigms of tickborne infectious diseases. Three chapters are devoted to background information, including the natural history of ticks, the diagnostic procedures of tickborne diseases, and the new tick-transm...

  16. Breeding against infectious diseases in animals

    NARCIS (Netherlands)

    Rashidi, H.

    2016-01-01

    Infectious diseases in farm animals are of major concern because of animal welfare, production costs, and public health. Farms undergo huge economic losses due to infectious disease. The costs of infections in farm animals are mainly due to production losses, treatment of infected animals, and

  17. Emerging Infectious Disease Journal Cover Art

    Centers for Disease Control (CDC) Podcasts

    2012-04-04

    Polyxeni Potter discusses the art used on the covers of the Emerging Infectious Diseases journal.  Created: 4/4/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/5/2012.

  18. Contiguous spinal metastasis mimicking infectious spondylodiscitis

    International Nuclear Information System (INIS)

    Lee, Chul Min; Lee, Seung Hun; Bae, Ji Yoon

    2015-01-01

    Differential diagnosis between spinal metastasis and infectious spondylodiscitis is one of the occasional challenges in daily clinical practice. We encountered an unusual case of spinal metastasis in a 75-year-old female breast cancer patient that mimicked infectious spondylodiscitis. Magnetic resonance imaging (MRI) showed diffuse bone marrow infiltrations with paraspinal soft tissue infiltrative changes in 5 contiguous cervical vertebrae without significant compression fracture or cortical destruction. These MRI findings made it difficult to differentiate between spinal metastasis and infectious spondylodiscitis. Infectious spondylodiscitis such as tuberculous spondylodiscitis was regarded as the more appropriate diagnosis due to the continuous involvement of > 5 cervical vertebrae. The patient's clinical presentation also supported the presumptive diagnosis of infectious spondylodiscitis rather than spinal metastasis. Intravenous antibiotics were administered, but clinical symptoms worsened despite treatment. After pathologic confirmation by computed tomography-guided biopsy, we were able to confirm a final diagnosis of spinal metastasis

  19. Contiguous spinal metastasis mimicking infectious spondylodiscitis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chul Min; Lee, Seung Hun [Dept. of Radiology, Hanyang University Hospital, Seoul (Korea, Republic of); Bae, Ji Yoon [Dept. of Pathology, National Police Hospital, Seoul (Korea, Republic of)

    2015-12-15

    Differential diagnosis between spinal metastasis and infectious spondylodiscitis is one of the occasional challenges in daily clinical practice. We encountered an unusual case of spinal metastasis in a 75-year-old female breast cancer patient that mimicked infectious spondylodiscitis. Magnetic resonance imaging (MRI) showed diffuse bone marrow infiltrations with paraspinal soft tissue infiltrative changes in 5 contiguous cervical vertebrae without significant compression fracture or cortical destruction. These MRI findings made it difficult to differentiate between spinal metastasis and infectious spondylodiscitis. Infectious spondylodiscitis such as tuberculous spondylodiscitis was regarded as the more appropriate diagnosis due to the continuous involvement of > 5 cervical vertebrae. The patient's clinical presentation also supported the presumptive diagnosis of infectious spondylodiscitis rather than spinal metastasis. Intravenous antibiotics were administered, but clinical symptoms worsened despite treatment. After pathologic confirmation by computed tomography-guided biopsy, we were able to confirm a final diagnosis of spinal metastasis.

  20. Non-infectious complications of continuous ambulatory peritoneal dialysis: evaluation with peritoneal computed tomography

    International Nuclear Information System (INIS)

    Camsari, T.; Celik, A.; Ozaksoy, D.; Salman, S.; Cavdar, C.; Sifil, A.

    1998-01-01

    The purpose of the study was to evaluate the non-infectious complications of continuous ambulatory peritoneal dialysis (CAPD) using peritoneal computed tomography (PCT). Twenty symptomatic patients were included in the study. Initially 2000 ml of dialysate fluid was infused into the peritoneal cavity and standard peritoneal computed cavity and standard peritoneal computed tomography (SPCT) serial scans with 10 mm thickness were performed from the mid-thoracic region to the genital organs. Afterwards, 100 ml of non-ionic contrast material containing 300 mg/ml iodine was injected through the catheter and was distributed homogeneously in the intra-abdominal dialysate fluid by changing the positions of the patients; after waiting for 2-4 h, the CT scan was repeated as peritoneal contrast computed tomography (PCCT). In patients (n = 20) both SPCT and PCCT revealed 90 % (n = 18) pathological findings. But PCCT showed 60 % (n = 12) additional pathological findings. We believe that PCT is beneficial for evaluation of non-infectious complications of CAPD. But PCCT is superior to SPCT in evaluating non-infectious complications encountered in patients on CAPD treatment. (author)

  1. The thoracic aortography by Gd-DTPA enhanced ultrafast cine MR imaging. Assessment of thoracic aortic dilatation in aging and in patients with hypertension and aortic valve disease

    International Nuclear Information System (INIS)

    Matsumura, Kentaro; Nakase, Emiko; Kawai, Ichiyoshi; Saito, Takayuki; Kikkawa, Nobutada; Haiyama, Toru

    1995-01-01

    To assess the morphology of thoracic aorta, we had a trial of Gd-DTPA enhanced ultrafast cine MR imaging on the thoracic aorta. This method was provided with high quality thoracic aortogram during 15-20 seconds. In patients without hypertension and aortic valve disease, dimensions of ascending aorta and aortic arch were significantly correlated with aging. In patients with hypertension, dimensions of ascending aorta and aortic arch were significantly dilated. In patients with aortic valve disease, thoracic aorta was diffusely enlarged, especially in ascending aorta. Gd-DTPA enhanced ultrafact cine MR imaging was useful to assess the thoracic aortic anatomy and diseases. (author)

  2. The Askin tumour. Neuroactodermic tumour of the thoracic wall

    International Nuclear Information System (INIS)

    Velazquez, P.; Nicolas, A. I.; Vivas, I.; Damaso Aquerreta, J.; Martinez-Cuesta, A.

    1999-01-01

    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

  3. Predictive factors for cerebrovascular accidents after thoracic endovascular aortic repair.

    Science.gov (United States)

    Mariscalco, Giovanni; Piffaretti, Gabriele; Tozzi, Matteo; Bacuzzi, Alessandro; Carrafiello, Giampaolo; Sala, Andrea; Castelli, Patrizio

    2009-12-01

    Cerebrovascular accidents are devastating and worrisome complications after thoracic endovascular aortic repair. The aim of this study was to determine cerebrovascular accident predictors after thoracic endovascular aortic repair. Between January 2001 and June 2008, 76 patients treated with thoracic endovascular aortic repair were prospectively enrolled. The study cohort included 61 men; mean age was 65.4 +/- 16.8 years. All patients underwent a specific neurologic assessment on an hourly basis postoperatively to detect neurologic deficits. Cerebrovascular accidents were diagnosed on the basis of physical examination, tomography scan or magnetic resonance imaging, or autopsy. Cerebrovascular accidents occurred in 8 (10.5%) patients, including 4 transient ischemic attack and 4 major strokes. Four cases were observed within the first 24-hours. Multivariable analysis revealed that anatomic incompleteness of the Willis circle (odds ratio [OR] 17.19, 95% confidence interval [CI] 2.10 to 140.66), as well as the presence of coronary artery disease (OR 6.86, 95 CI% 1.18 to 40.05), were independently associated with postoperative cerebrovascular accident development. Overall hospital mortality was 9.2%, with no significant difference for patients hit by cerebrovascular accidents (25.0% vs 7.3%, p = 0.102). Preexisting coronary artery disease, reflecting a severe diseased aorta and anomalies of Willis circle are independent cerebrovascular accident predictors after thoracic endovascular aortic repair procedures. A careful evaluation of the arch vessels and cerebral vascularization should be mandatory for patients suitable for thoracic endovascular aortic repair.

  4. Regional interdependence and manual therapy directed at the thoracic spine.

    Science.gov (United States)

    McDevitt, Amy; Young, Jodi; Mintken, Paul; Cleland, Josh

    2015-07-01

    Thoracic spine manipulation is commonly used by physical therapists for the management of patients with upper quarter pain syndromes. The theoretical construct for using thoracic manipulation for upper quarter conditions is a mainstay of a regional interdependence (RI) approach. The RI concept is likely much more complex and is perhaps driven by a neurophysiological response including those related to peripheral, spinal cord and supraspinal mechanisms. Recent evidence suggests that thoracic spine manipulation results in neurophysiological changes, which may lead to improved pain and outcomes in individuals with musculoskeletal disorders. The intent of this narrative review is to describe the research supporting the RI concept and its application to the treatment of individuals with neck and/or shoulder pain. Treatment utilizing both thrust and non-thrust thoracic manipulation has been shown to result in improvements in pain, range of motion and disability in patients with upper quarter conditions. Research has yet to determine optimal dosage, techniques or patient populations to which the RI approach should be applied; however, emerging evidence supporting a neurophysiological effect for thoracic spine manipulation may negate the need to fully answer this question. Certainly, there is a need for further research examining both the clinical efficacy and effectiveness of manual therapy interventions utilized in the RI model as well as the neurophysiological effects resulting from this intervention.

  5. November 2012 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-11-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on Wednesday, 11/28/2012 at Scottsdale Shea beginning at 6:30 PM. There were 20 in attendance representing the pulmonary, critical care, sleep, infectious disease, pathology, and radiology communities. Dr. George Parides stated he was unable to find further information on treating patients begun on biologicals for RA who developed a + QuantiFERON. Four cases were presented: 1. Dr. Suresh Uppalapu, a pulmonary fellow at Good Samaritan/VA, presented a case of a 29 yo woman with a rash and a myriad of nonspecific complaints. She had recently been a contestant in a reality TV show. Just prior to admission she developed a neurologic complaints including incontinence. Her CXR was negative but CT of the chest showed scattered areas of ground glass opacities peripherally. A MRI of the brain revealed nonspecific abnormalities. CBC showed an elevated eosinophil count of 8%. Coccidioidomycosis antigen was negative. An LP was performed …

  6. Emergency thoracic ultrasound and clinical risk management

    Directory of Open Access Journals (Sweden)

    Interrigi MC

    2017-02-01

    Full Text Available Maria Concetta Interrigi,1 Francesca M Trovato,2,3 Daniela Catalano,3,4 Guglielmo M Trovato3,5 1Accident and Emergency Department, Ospedale Cannizzaro, Catania, 2Accident and Emergency Department, Ospedale Civile, Ragusa, 3Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania, 4Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania, 5Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy Purpose: Thoracic ultrasound (TUS has been proposed as an easy-option replacement for chest X-ray (CXR in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. Patients and methods: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. Results: Three hundred and seventy emergency TUS scans (excluding trauma patients were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion; in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed

  7. Noninvasive vaccination against infectious diseases.

    Science.gov (United States)

    Zheng, Zhichao; Diaz-Arévalo, Diana; Guan, Hongbing; Zeng, Mingtao

    2018-04-06

    The development of a successful vaccine, which should elicit a combination of humoral and cellular responses to control or prevent infections, is the first step in protecting against infectious diseases. A vaccine may protect against bacterial, fungal, parasitic, or viral infections in animal models, but to be effective in humans there are some issues that should be considered, such as the adjuvant, the route of vaccination, and the antigen-carrier system. While almost all licensed vaccines are injected such that inoculation is by far the most commonly used method, injection has several potential disadvantages, including pain, cross contamination, needlestick injury, under- or overdosing, and increased cost. It is also problematic for patients from rural areas of developing countries, who must travel to a hospital for vaccine administration. Noninvasive immunizations, including oral, intranasal, and transcutaneous administration of vaccines, can reduce or eliminate pain, reduce the cost of vaccinations, and increase their safety. Several preclinical and clinical studies as well as experience with licensed vaccines have demonstrated that noninvasive vaccine immunization activates cellular and humoral immunity, which protect against pathogen infections. Here we review the development of noninvasive immunization with vaccines based on live attenuated virus, recombinant adenovirus, inactivated virus, viral subunits, virus-like particles, DNA, RNA, and antigen expression in rice in preclinical and clinical studies. We predict that noninvasive vaccine administration will be more widely applied in the clinic in the near future.

  8. Common questions about infectious mononucleosis.

    Science.gov (United States)

    Womack, Jason; Jimenez, Marissa

    2015-03-15

    Epstein-Barr is a ubiquitous virus that infects 95% of the world population at some point in life. Although Epstein-Barr virus (EBV) infections are often asymptomatic, some patients present with the clinical syndrome of infectious mononucleosis (IM). The syndrome most commonly occurs between 15 and 24 years of age. It should be suspected in patients presenting with sore throat, fever, tonsillar enlargement, fatigue, lymphadenopathy, pharyngeal inflammation, and palatal petechiae. A heterophile antibody test is the best initial test for diagnosis of EBV infection, with 71% to 90% accuracy for diagnosing IM. However, the test has a 25% false-negative rate in the first week of illness. IM is unlikely if the lymphocyte count is less than 4,000 mm3. The presence of EBV-specific immunoglobulin M antibodies confirms infection, but the test is more costly and results take longer than the heterophile antibody test. Symptomatic relief is the mainstay of treatment. Glucocorticoids and antivirals do not reduce the length or severity of illness. Splenic rupture is an uncommon complication of IM. Because physical activity within the first three weeks of illness may increase the risk of splenic rupture, athletic participation is not recommended during this time. Children are at the highest risk of airway obstruction, which is the most common cause of hospitalization from IM. Patients with immunosuppression are more likely to have fulminant EBV infection.

  9. Current diagnosis and management of infectious mononucleosis.

    Science.gov (United States)

    Vouloumanou, Evridiki K; Rafailidis, Petros I; Falagas, Matthew E

    2012-01-01

    Infectious mononucleosis is a common, usually self-limited disease. However, infectious mononucleosis may present with severe manifestations. Complications may also occur. Consequently, diagnostic and treatment issues regarding infectious mononucleosis are of major importance. In this review, we focus on the evaluation of articles providing diagnosis and treatment data for infectious mononucleosis, published during the past 2 years. Twelve studies, deriving from extended search in PubMed, were included. Nine studies provided diagnosis data. The evaluated diagnostic methods were real-time PCR (RT-PCR), IgM/IgG antibodies measured with different assays [measurement of Epstein-Barr virus viral load (EBV-VL) in peripheral blood, neutrophil/lymphocyte/monocyte counts, C-reactive protein values, and monospot test]. The sensitivities reported for RT-PCR were high. The available treatment data were scarce (three studies). Two of them suggested that antivirals (mainly acyclovir and valacyclovir) may have a role in the treatment of infectious mononucleosis with complications, whereas the remaining study presented novel potential therapeutic patents including 5-substituted uracyle, azacytosine derivatives, and peptides inhibiting EBV-mediated membrane fusion. RT-PCR and measurement of EBV-VL may provide useful tools for the early diagnosis of infectious mononucleosis in cases with inconclusive serological results. Antiviral agents may provide a useful treatment option in patients with severe infectious mononucleosis.

  10. Current Evidence and Insights about Genetics in Thoracic Aorta Disease

    Science.gov (United States)

    Muneretto, Claudio

    2013-01-01

    Thoracic aortic aneurysms have been historically considered to be caused by etiologic factors similar to those implied in abdominal aortic aneurysms. However, during the past decade, there has been increasing evidence that almost 20% of thoracic aortic aneurysms may be associated with a genetic disease, often within a syndromic or familial disorder. Moreover, the presence of congenital anomalies, such as bicuspid aortic valve, may have a unique common genetic underlying cause. Finally, also sporadic forms have been found to be potentially associated with genetic disorders, as highlighted by the analysis of rare variants and expression of specific microRNAs. We therefore sought to perform a comprehensive review of the role of genetic causes in the development of thoracic aortic aneurysms, by analyzing in detail the current evidence of genetic alterations in syndromes such as Marfan, Loeys-Dietz, and Ehler-Danlos, familial or sporadic forms, or forms associated with bicuspid aortic valve. PMID:24453931

  11. Extrapleural Inner Thoracic Wall Lesions: Multidetector CT Findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Soo; Kim, Young Tong; Jou, Sung Shik [Soonchunhyang University, Cheonan Hospital, Cheonan (Korea, Republic of)

    2010-06-15

    The extrapleural space is external to the parietal pleura in the thorax. The structures within and adjacent to this region include the fat pad, endothoracic fascia, intercostal muscles, connective tissue, nerves, vessels, and ribs. Further, the space is divided into the inner and outer thoracic wall by the innermost intercostal muscle. Extrapleural lesions in the inner thoracic wall are classified as air-containing lesions, fat-containing lesions, and soft tissue-containing lesions according on their main component. Air-containing lesions include extrapleural air from direct chest trauma and extrapleural extension from pneumomediastinum. Prominent extrapleural fat is seen in decreased lung volume conditions, and can also be seen in normal individuals. Soft tissue-containing lesions include extrapleural extensions from a pleural or chest wall infection as well as tumors and extrapleural hematoma. We classify extrapleural lesions in the inner thoracic wall and illustrate their imaging findings

  12. Evaluation of magnetic resonance imaging in thoracic inlet tumors

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Eiro (Kobe Univ. (Japan). School of Medicine)

    1993-06-01

    To evaluate the detectability of tumor invasion to the thoracic inlet, MRI was performed in 57 patients with thoracic inlet tumor, and the diagnostic accuracy of MRI was compared with that of CT concerning the utility for thoracic inlet lesions. And we assessed abnormal findings in comparison with surgical or autopsy findings. In the local extent of the tumor, the accuracy for tumor invasion to the vessels such as subclavian artery and vein was 94.9% for MRI, and 83.5% for CT, and to the brachial plexus was 95.0% for MRI, and 60.0% for CT. MRI was superior to CT, but MRI was equivalent to CT with regard to invasion to the base of the neck, lateral chest wall, ribs, and vertebral bodies. However on MRI, it is easier to understand the longitudinal tumor extent than on CT. CT has superior spatial resolusion but CT has also disadvantages, such as streak artifact caused by shoulder joints, resulting in image degradation. In contrast, MRI has inherent advantages, and multiple images which facilitate the relationship between tumor and normal structures. Coronal and sagittal MR images facilitated three-dimensional observation of tumor of invasion in the thoracic inlet. Furthermore to improve image quality of MRI for the thoracic inlet, we newly devised a high molecular polyester shell for fixing a surface coil. On the high resolution MR (HR-MR) imaging using our shell, normal lymph nodes, muscles, blood vessels and the branches of the branchial plexus were clearly visualized in detail. Our shell was simple to process and facilitated immobilization of a surface coil. HR-MR technique produces images of high resolution after simple preparation. In conclusion, MRI was very useful for detecting lesions of the thoracic inlet and in deciding surgical indication and the planning for radiotherapy. (author).

  13. 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.

  14. Surgical outcome analysis of paediatric thoracic and cervical neuroblastoma.

    Science.gov (United States)

    Parikh, Dakshesh; Short, Melissa; Eshmawy, Mohamed; Brown, Rachel

    2012-03-01

    To identify factors determining the surgical outcome of primary cervical and thoracic neuroblastoma. Twenty-six children with primary thoracic neuroblastoma presented over the last 14 years were analysed for age, mode of presentation, tumour histopathology, biology and outcome. Primary thoracic neuroblastoma was presented in 16 boys and 10 girls at a median age of 2 years (range 6 weeks-15 years). The International Neuroblastoma Staging System (INSS) classified these as Stage 1 (8), Stage 2 (5), Stage 3 (6) and Stage 4 (7). Computed tomography defined the tumour location at the thoracic inlet (11), cervical (2), cervico-thoracic (3), mid-thorax (9) and thoraco-abdominal (1). Twenty-two children underwent surgery that allowed an adequate exposure and resection. Surgical resection was achieved after initial biopsy and preoperative chemotherapy in 15 children, whereas primary resection was performed in 7 children. Four patients with Stage 4 disease underwent chemotherapy alone after initial biopsy; of which, two died despite chemotherapy. Favourable outcome after surgical resection and long-term survival was seen in 19 (86.4%) of the 22 children. Three had local recurrence (14 to 21 months postoperatively), all with unfavourable histology on initial biopsy. The prognostic factors that determined the outcome were age and INSS stage at presentation. In this series, all patients under 2 years of age are still alive, while mortality was seen in five older children. Thoracic neuroblastoma in children under 2 years of age irrespective of stage and histology of the tumour results in long-term survival.

  15. Infectious spondylitis and its differential diagnosis

    International Nuclear Information System (INIS)

    Erlemann, Rainer

    2012-01-01

    Infectious spondylitis can be diagnosed early and reliably by MRI, given that the most important diagnostic criteria are present. These criteria are bone marrow edema adjacent to two contiguous vertebral end plates, disk space of high signal intensity and enhancement of bone adjacent to two contiguous vertebral end plates and of the disk space. If not all of these criteria are present, diagnostic accuracy decreases. Erosive osteochondritis, spondylarthritis, osteoporotic fractures of two contiguous vertebral end plates, active Schmorl's nodes as well as neuropathic spine may mimic an infectious spondylitis. This paper presents typical and atypical morphologic patterns of infectious spondylitis as well as the differentiation criteria from the above mentioned diseases. (orig.)

  16. Use of probiotics in pediatric infectious diseases.

    Science.gov (United States)

    Caffarelli, Carlo; Cardinale, Fabio; Povesi-Dascola, Carlotta; Dodi, Icilio; Mastrorilli, Violetta; Ricci, Giampaolo

    2015-01-01

    We summarize current evidence and recommendations for the use of probiotics in childhood infectious diseases. Probiotics may be of benefit in treating acute infectious diarrhea and reducing antibiotic-associated diarrhea. Potential benefits of probiotic on prevention of traveler's diarrhea,Clostridium difficile-associated diarrhea, side effects of triple therapy in Helicobacter pylori eradication, necrotizing enterocolitis, acute diarrhea, acute respiratory infections and recurrent urinary tract infections remain unclear. More studies are needed to investigate optimal strain, dosage, bioavailability of drops and tablets, duration of treatment and safety. Probiotics and recombinant probiotic strain represent a promising source of molecules for the development of novel anti-infectious therapy.

  17. Imaging procedures in spinal infectious diseases

    International Nuclear Information System (INIS)

    Rodiek, S.O.

    2001-01-01

    A targeted successful treatment of spinal infectious diseases requires clinical and laboratory data that are completed by the contribution of imaging procedures. Neuroimaging only provides essential informations on the correct topography, localisation, acuity and differential diagnosis of spinal infectious lesions. MRI with its sensitivity concerning soft tissue lesions is a useful tool in detecting infectious alterations of spinal bone marrow, intervertebral disks, leptomeninges and the spinal cord itself. Crucial imaging patterns of typical spinal infections are displayed and illustrated by clinical case studies. We present pyogenic, granulomatous and postoperative variants of spondylodicitis, spinal epidural abscess, spinal meningitis and spinal cord infections. The importance of intravenous contrastmedia application is pointed out. (orig.) [de

  18. Haemothorax and Thoracic Spine Fractures in the Elderly

    Directory of Open Access Journals (Sweden)

    Michael A. Masteller

    2012-01-01

    Full Text Available Both osteoporotic fractures and pleural effusions are frequently observed in medicine. However, rarely does one associate a hemorrhagic pleural effusion with a thoracic spinal fracture when the patient has not sustained massive trauma. In this paper, we discuss two cases where seemingly insignificant low-energy trauma precipitated massive haemothoraces in elderly patients with underlying osteoporosis, ultimately resulting in their immediate causes of death. This paper serves to remind health care professionals of the importance of using caution when moving elderly patients as well as to consider thoracic spinal fracture as a potential explanation for a hemorrhagic pleural effusion of undetermined etiology.

  19. Thoracic manifestations of Kaposi's sarcoma in AIDS: radiological findings

    International Nuclear Information System (INIS)

    Marchiori, Edson; Baptista, Maria Ines Garcia; Cardenas, Gloria Pamela; Costa Praxedes, Marcia da; Boechat, Lucia de Fatima; Quaresma, Patricia Souto Maior

    1995-01-01

    The radiological findings of 189 cases of Kaposi's sarcoma occurring in patients with AIDS were studied. There was also made pathological correlations in these patients. Interstitial reticular infiltrations were frequently detected on thoracic examination showing paracardiac confluent areas. There was also lymphadenopathy, gross nodules and pleural fluid accumulation. Although there was no detection of any pathognomonic aspect, the interstitial reticular infiltration finding together with the paracardiac confluent areas and associated with gross nodules, is highly indicative to thoracic involvement by the disease. (author). 32 refs., 5 figs., 2 tabs

  20. Retrospective assessment of thoracic radiographic findings in metastatic canine hemangiosarcoma

    International Nuclear Information System (INIS)

    Hammer, A.S.; Bailey, M.Q.; Sagartz, J.E.

    1994-01-01

    Twenty-one dogs with histopathologically confirmed hemangiosarcoma were evaluated by thoracic radiography for metastatic disease. All dogs had histopathologic examinations of the lungs within two weeks of thoracic radiography. Fourteen dogs had histopathologic evidence of pulmonary hemangiosarcoma; metastatic disease was detected radiographically in eleven of these dogs. The most common radiographic pattern was that of poorly defined small coalescing nodules (8 dogs); other radiographic patterns included well-circumscribed nodules (3 dogs) and alveolar infiltrates secondary to hemorrhage (2 dogs). Differential diagnoses for diffuse, poorly defined, coalescing pulmonary opacities should include hemangiosarcoma in addition to edema, lymphoma, systemic mycoses, fibrosis, allergy, toxicosis, and carcinomas

  1. Infectious mononucleosis and hepatic function

    Science.gov (United States)

    Zhang, Li; Zhou, Pingping; Meng, Zhaowei; Pang, Chongjie; Gong, Lu; Zhang, Qing; Jia, Qiyu; Song, Kun

    2018-01-01

    Abnormal hepatic function is common in infectious mononucleosis (IM). However, it remains unknown why increased transferase levels are more common than bilirubin abnormalities in IM. The current study aimed to investigate these associations in the Chinese population. A total of 95 patients with IM (47 males and 48 females) were enrolled in the current study, as well as 95 healthy controls. Patients were sorted by sex. A receiver operating characteristic (ROC) curve was used to determine cut-off values for IM diagnosis and prediction. Crude and adjusted odds ratios (OR) for IM were analyzed using binary logistic regression. It was determined that alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyl transferase (GGT) levels were significantly higher in patients with IM compared with controls; however, total bilirubin (TB) levels were significantly lower in patients with IM. ROCs demonstrated that, if ALT, AST and GGT concentrations were higher than, or if TB was lower than, cut-off values, they were predictive of IM. Binary logistic regression identified that the risk of IM in patients exhibiting high levels of transferases was significantly increased, particularly in males. Crude ORs in ALT quartile 4 were 21.667 and 10.111 for males and females, respectively and adjusted ORs were 38.054 and 9.882, respectively. A significant IM risk of IM was evident in patients with low bilirubin levels and females appeared to be particularly susceptible. For example, crude ORs in quartile 1 were 8.229 and 8.257 for males and females, respectively and adjusted ORs were 8.883 and 10.048, respectively. Therefore, the current study identified a positive association between transferase levels and IM and a negative association between TB and IM. Therefore, the results of the current study indicate that high transferases are suggestive of IM, particularly in males, whereas low TB is suggestive for IM, particularly in females. PMID:29456696

  2. Infectious Mononucleosis: Recognition and Management in Athletes.

    Science.gov (United States)

    Eichner, Edward R.

    1987-01-01

    Infectious mononucleosis strikes many young athletes. Considered here are its epidemiology, pathophysiology, diagnosis, natural course, complications, and management. The focus is on concerns of athletes with a perspective on personality, convalescence, and chronic fatigue. (Author/MT)

  3. Sibship structure and risk of infectious mononucleosis

    DEFF Research Database (Denmark)

    Rostgaard, Klaus; Nielsen, Trine Rasmussen; Wohlfahrt, Jan

    2014-01-01

    BACKGROUND: Present understanding of increased risk of Epstein-Barr virus (EBV)-related infectious mononucleosis among children of low birth order or small sibships is mainly based on old and indirect evidence. Societal changes and methodological limitations of previous studies call for new data....... METHODS: We used data from the Danish Civil Registration System and the Danish National Hospital Discharge Register to study incidence rates of inpatient hospitalizations for infectious mononucleosis before the age of 20 years in a cohort of 2,543,225 Danes born between 1971 and 2008, taking individual...... sibship structure into account. RESULTS: A total of 12,872 cases of infectious mononucleosis were observed during 35.3 million person-years of follow-up. Statistical modelling showed that increasing sibship size was associated with a reduced risk of infectious mononucleosis and that younger siblings...

  4. Infectious optic neuropathies: a clinical update

    Science.gov (United States)

    Kahloun, Rim; Abroug, Nesrine; Ksiaa, Imen; Mahmoud, Anis; Zeghidi, Hatem; Zaouali, Sonia; Khairallah, Moncef

    2015-01-01

    Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases. PMID:28539795

  5. Microbiological and therapeutic challenges in infectious spondylodiscitis

    DEFF Research Database (Denmark)

    Aagaard, Theis; Roed-Petersen, Casper; Dragsted, Casper

    2013-01-01

    The microbiological diagnosis of infectious spondylodiscitis is often difficult to establish and the disease requires prolonged antibiotic treatment. We analyzed the medical records of 100 patients admitted for infectious spondylodiscitis from 2006 to 2011 with an emphasis on (1) the diagnostic u...... utility of blood cultures and invasive biopsies in the microbiological diagnosis, (2) clinical features differentiating Staphylococcus aureus infections from those with other aetiologies, and (3) evaluation of the outcome of the antimicrobial therapy.......The microbiological diagnosis of infectious spondylodiscitis is often difficult to establish and the disease requires prolonged antibiotic treatment. We analyzed the medical records of 100 patients admitted for infectious spondylodiscitis from 2006 to 2011 with an emphasis on (1) the diagnostic...

  6. Global Climate Change and Infectious Diseases

    Directory of Open Access Journals (Sweden)

    EK Shuman

    2010-12-01

    Full Text Available Climate change is occurring as a result of warming of the earth’s atmosphere due to human activity generating excess amounts of greenhouse gases. Because of its potential impact on the hydrologic cycle and severe weather events, climate change is expected to have an enormous effect on human health, including on the burden and distribution of many infectious diseases. The infectious diseases that will be most affected by climate change include those that are spread by insect vectors and by contaminated water. The burden of adverse health effects due to these infectious diseases will fall primarily on developing countries, while it is the developed countries that are primarily responsible for climate change. It is up to governments and individuals to take the lead in halting climate change, and we must increase our understanding of the ecology of infectious diseases in order to protect vulnerable populations.

  7. Intensive Care Management of Thoracic Aortic Surgical Patients, Including Thoracic and Infradiaphragmatic Endovascular Repair (EVAR/TEVAR).

    Science.gov (United States)

    Cole, Sheela Pai

    2015-12-01

    The patient with thoracic aortic disease can present for open or endovascular repair. Thoracic endovascular aortic repair (TEVAR) has emerged as a minimally invasive option for a multitude of aortic pathology, including dissections, aneurysms, traumatic injuries, and ulcers. Postoperative management of these patients depends on the extent of procedure, whether it was open or endovascular, and, finally, on the preoperative comorbidities present. While procedural success has catapulted TEVAR to popularity, midterm results have been mixed. Additionally, periprocedural complications such as paraplegia and renal failure remain a significant morbidity in these patients. © The Author(s) 2015.

  8. A randomized clinical trial to compare the immediate effects of seated thoracic manipulation and targeted supine thoracic manipulation on cervical spine flexion range of motion and pain.

    Science.gov (United States)

    Karas, Steve; Olson Hunt, Megan J

    2014-05-01

    Randomized clinical trial. To determine the effectiveness of seated thoracic manipulation versus targeted supine thoracic manipulation on cervical spine pain and flexion range of motion (ROM). There is evidence that thoracic spine manipulation is an effective treatment for patients with cervical spine pain. This evidence includes a variety of techniques to manipulate the thoracic spine. Although each of them is effective, no research has compared techniques to determine which produces the best outcomes. A total of 39 patients with cervical spine pain were randomly assigned to either a seated thoracic manipulation or targeted supine thoracic manipulation group. Pain and flexion ROM measures were taken before and after the intervention. Pain reduction (post-treatment-pre-treatment) was significantly greater in those patients receiving the targeted supine thoracic manipulation compared to the seated thoracic manipulation (Pmanipulation group. The results of this study indicate that a targeted supine thoracic manipulation may be more effective in reducing cervical spine pain and improving cervical flexion ROM than a seated thoracic manipulation. Future studies should include a variety of patients and physical therapists (PTs) to validate our findings.

  9. A macroecological characterization of infectious disease transmission:

    DEFF Research Database (Denmark)

    Andersen-Ranberg, Emilie Ulrikka

    2017-01-01

    Presentation: Per M. Jensen*, Miguel L. Grilo, Christian B. Pipper, Emilie U. Andersen-Ranberg. A macroecological characterization of infectious disease transmission: the cases of Mycobacterium and Leptospira sp. The 2017 OIKOS meeting, 10th -11th March 2017, Copenhagen, Denmark......Presentation: Per M. Jensen*, Miguel L. Grilo, Christian B. Pipper, Emilie U. Andersen-Ranberg. A macroecological characterization of infectious disease transmission: the cases of Mycobacterium and Leptospira sp. The 2017 OIKOS meeting, 10th -11th March 2017, Copenhagen, Denmark...

  10. CISH and Susceptibility to Infectious Diseases

    OpenAIRE

    Khor, CC; Vannberg, FO; Chapman, SJ; Guo, H; Wong, SH; Walley, AJ; Vukcevic, D; Rautanen, A; Mills, TC; Chang, K-C; Kam, K-M; Crampin, AC; Ngwira, B; Leung, C-C; Tam, C-M

    2010-01-01

    BACKGROUND The interleukin-2-mediated immune response is critical for host defense against infectious pathogens. Cytokine-inducible SRC homology 2 (SH2) domain protein (CISH), a suppressor of cytokine signaling, controls interleukin-2 signaling. METHODS Using a case-control design, we tested for an association between CISH polymorphisms and susceptibility to major infectious diseases (bacteremia, tuberculosis, and severe malaria) in blood samples from 8402 persons in Gambia, Hong Kong, Kenya,...

  11. Infectious Urethritis in Men and Women

    Science.gov (United States)

    Meares, Edwin M.

    1975-01-01

    Acute and recurrent infectious urethritis in men and women is commonly seen by physicians. Since specific therapy varies widely with the type of urethritis present, the proper diagnosis must be clearly established if curative drug therapy is to be selected. It is valuable, therefore, to review the diagnosis and therapy of the various forms of infectious urethritis that are recognized today in both men and women. PMID:1199099

  12. Infectious complications in chronic renal failure

    OpenAIRE

    Kielberger, Lukáš

    2014-01-01

    INFECTIOUS COMPLICATIONS IN CHRONIC RENAL FAILURE Infections represent a serious problem in chronic kidney disease (cohort and they are) associated with signifficant morbidity and mortality. The thesis originated in the nephrology division of the Department of Internal Medicine I., Charles University Teaching Hospital and Medical Faculty in Pilsen, an institution with a long standing research activity in the field. In the theoretical part of this work, a general summary of infectious complica...

  13. Role of Ultrasound Guided Biopsy of Thoracic Lesions | Elameen ...

    African Journals Online (AJOL)

    Objective: This prospective study is to evaluate and enhance the role of ultrasound in biopsy guidance of thoracic lesions. Methods: 55 patients were subjected for fine needle aspiration (FNA) and/or core needle biopsy (CNB) from peripheral chest lesions in Ribat University Hospital during the period from April 2011 and ...

  14. Cobb Angle Changes in Thoracic and Lumbar Spine Fractures ...

    African Journals Online (AJOL)

    The annual incidence of spinal column fracture is 350 per million populations. with Motor vehicular accident being the major single cause of spine injuries. The victims are predominantly young and male. The aim of this study to evaluate the clinical outcome of conservative treatment of closed thoracic and lumbar spine ...

  15. Incidence of lower thoracic ligamentum flavum midline gaps

    NARCIS (Netherlands)

    Lirk, P.; Colvin, J.; Steger, B.; Colvin, H.-P.; Keller, C.; Rieder, J.; Kolbitsch, C.; Moriggl, B.

    2005-01-01

    Lower thoracic epidural anaesthesia and analgesia (EDA) has gained increasing importance in perioperative pain therapy. The loss-of-resistance technique used to identify the epidural space is thought to rely on the penetration of the ligamentum flavum. Investigations at the cervical and lumbar

  16. Clinical application of thoracic paravertebral anesthetic block in breast surgeries

    Directory of Open Access Journals (Sweden)

    Sara Socorro Faria

    2015-04-01

    Full Text Available INTRODUCTION: Optimum treatment for postoperative pain has been of fundamental importance in surgical patient care. Among the analgesic techniques aimed at this group of patients, thoracic paravertebral block combined with general anesthesia stands out for the good results and favorable risk-benefit ratio. Many local anesthetics and other adjuvant drugs are being investigated for use in this technique, in order to improve the quality of analgesia and reduce adverse effects. OBJECTIVE: Evaluate the effectiveness and safety of paravertebral block compared to other analgesic and anesthetic regimens in women undergoing breast cancer surgeries. METHODS: Integrative literature review from 1966 to 2012, using specific terms in computerized databases of articles investigating the clinical characteristics, adverse effects, and beneficial effects of thoracic paravertebral block. RESULTS: On the selected date, 16 randomized studies that met the selection criteria established for this literature review were identified. Thoracic paravertebral block showed a significant reduction of postoperative pain, as well as decreased pain during arm movement after surgery. CONCLUSION: Thoracic paravertebral block reduced postoperative analgesic requirement compared to placebo group, markedly within the first 24 h. The use of this technique could ensure postoperative analgesia of clinical relevance. Further studies with larger populations are necessary, as paravertebral block seems to be promising for preemptive analgesia in breast cancer surgery.

  17. Diameter of the thoracic and abdominal aorta in healthy Japanese

    International Nuclear Information System (INIS)

    Matsunaga, Wakako

    1989-01-01

    In 300 cases, diameter of thoracic and abdominal aorta in healthy Japanese is measured by computed tomography (CT) and the values are analyzed in relation to the age, sex and the level of the aorta on CT scan. Aorta becomes dilated with age. In female diameter of the aorta is correlated with age, on the other hand, diameter of those is not correlated with age in male. Diameter in male is larger than in female. Aorta tapers off and the ratio of tapering of the thoracic aorta is more prominent than that of the abdominal aorta. Therefore the calculations of the landmarks of tapering of the aorta and the ratio of diameter of the aorta to transverse diameter of the vertebral body at the levels of 10th thoracic and 3rd lumber vertebrae on CT scan are useful for judgement of normal range of diameter of the aorta. Calcifications of the wall of the aorta are seen initially at the age of 5th decade in the abdominal aorta and 6th decade in the thoracic aorta in healthy Japanese. They are noted in almost of the persons after the age of seventy years old. The presence of calcification is not correlated with diameter of the aorta at the same level on CT scan. (author)

  18. Experience of thoracic surgery performed under difficult conditions ...

    African Journals Online (AJOL)

    We did not use post-operative suction drainage but simple "under water seal" bottle drainage. Results: Thoracic surgery was performed in 32 patients in Medina Hospital. Most of these cases underwent pleural decortications for chronic empyema (18 patients), 7 patients had removal of bronchial foreign bodies, 4 patients ...

  19. Left subclavian artery revascularization as part of thoracic stent grafting

    NARCIS (Netherlands)

    Saouti, N.; Hindori, V.; Morshuis, W.J.; Heijmen, R.H.

    2015-01-01

    OBJECTIVES: Intentional covering of the left subclavian artery (LSA) as part of thoracic endovascular aortic repair (TEVAR) can cause (posterior) strokes or left arm malperfusion. LSA revascularization can be done as prophylaxis against, or as treatment of, these complications. We report our

  20. Shared Genetic Risk Factors of Intracranial, Abdominal, and Thoracic Aneurysms

    NARCIS (Netherlands)

    van 't Hof, Femke N G; Ruigrok, Ynte M; Lee, Cue Hyunkyu; Ripke, Stephan; Anderson, Graig; de Andrade, Mariza; Baas, Annette F; Blankensteijn, Jan D; Böttinger, Erwin P; Bown, Matthew J; Broderick, Joseph; Bijlenga, Philippe; Carrell, David S; Crawford, Dana C; Crosslin, David R; Ebeling, Christian; Eriksson, Johan G; Fornage, Myriam; Foroud, Tatiana; von Und Zu Fraunberg, Mikael; Friedrich, Christoph M; Gaál, Emília I; Gottesman, Omri; Guo, Dong-Chuan; Harrison, Seamus C; Hernesniemi, Juha; Hofman, Albert; Inoue, Ituro; Jääskeläinen, Juha E; Jones, Gregory T; Kiemeney, Lambertus A L M; Kivisaari, Riku; Ko, Nerissa; Koskinen, Seppo; Kubo, Michiaki; Kullo, Iftikhar J; Kuivaniemi, Helena; Kurki, Mitja I; Laakso, Aki; Lai, Dongbing; Leal, Suzanne M; Lehto, Hanna; LeMaire, Scott A; Low, Siew-Kee; Malinowski, Jennifer; McCarty, Catherine A; Milewicz, Dianna M; Mosley, Thomas H; Nakamura, Yusuke; Nakaoka, Hirofumi; Niemelä, Mika; Pacheco, Jennifer; Peissig, Peggy L; Pera, Joanna; Rasmussen-Torvik, Laura; Ritchie, Marylyn D; Rivadeneira, Fernando; van Rij, Andre M; Santos-Cortez, Regie Lyn P; Saratzis, Athanasios; Slowik, Agnieszka; Takahashi, Atsushi; Tromp, Gerard; Uitterlinden, André G; Verma, Shefali S; Vermeulen, Sita H; Wang, Gao T; Han, Buhm; Rinkel, Gabriël J E; de Bakker, Paul I W

    2016-01-01

    BACKGROUND: Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co-occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. METHODS AND

  1. Shared genetic risk factors of intracranial, abdominal, and thoracic aneurysms

    NARCIS (Netherlands)

    van 't Hof, Femke N G; Ruigrok, Ynte M; Lee, Cue Hyunkyu; Ripke, Stephan; Anderson, Graig; de Andrade, Mariza; Baas, Annette F; Blankensteijn, Jan D; Böttinger, Erwin P; Bown, Matthew J; Broderick, Joseph; Bijlenga, Philippe; Carrell, David S; Crawford, Dana C; Crosslin, David R; Ebeling, Christian; Eriksson, Johan G; Fornage, Myriam; Foroud, Tatiana; von Und Zu Fraunberg, Mikael; Friedrich, Christoph M; Gaál, Emília I; Gottesman, Omri; Guo, Dong-Chuan; Harrison, Seamus C; Hernesniemi, Juha; Hofman, Albert; Inoue, Ituro; Jääskeläinen, Juha E; Jones, Gregory T; Kiemeney, Lambertus A L M; Kivisaari, Riku; Ko, Nerissa; Koskinen, Seppo; Kubo, Michiaki; Kullo, Iftikhar J; Kuivaniemi, Helena; Kurki, Mitja I; Laakso, Aki; Lai, Dongbing; Leal, Suzanne M; Lehto, Hanna; LeMaire, Scott A; Low, Siew-Kee; Malinowski, Jennifer; McCarty, Catherine A; Milewicz, Dianna M; Mosley, Thomas H; Nakamura, Yusuke; Nakaoka, Hirofumi; Niemelä, Mika; Pacheco, Jennifer; Peissig, Peggy L; Pera, Joanna; Rasmussen-Torvik, Laura; Ritchie, Marylyn D; Rivadeneira, Fernando; van Rij, Andre M; Santos-Cortez, Regie Lyn P; Saratzis, Athanasios; Slowik, Agnieszka; Takahashi, Atsushi; Tromp, Gerard; Uitterlinden, André G; Verma, Shefali S; Vermeulen, Sita H; Wang, Gao T; Han, Buhm; Rinkel, Gabriël J E; de Bakker, Paul I W

    2016-01-01

    Background--Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co-occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. Methods and

  2. Spontaneous and complete regression of a thoracic disc herniation

    International Nuclear Information System (INIS)

    Coevoet, V.; Benoudiba, F.; Doyon, D.; Lignieres, C.; Said, G.

    1997-01-01

    Spontaneous regression of disc herniation is well known but the mechanism is not clear. Some hypotheses have been made. We present here a large thoracic disc herniation diagnosed by MRI which completely regressed one year after a medical treatment with complete amendment of symptoms. (authors)

  3. Thoracic posture, shoulder muscle activation patterns and isokinetic ...

    African Journals Online (AJOL)

    Background. Shoulder injuries are the most severe injuries in rugby union players, accounting for almost 20% of injuries related to the sport and resulting in lost playing hours. Objective. To profile the thoracic posture, scapular muscle activation patterns and rotator cuff muscle isokinetic strength of semi-professional

  4. Effect of Thoracic Surgeons on Lung Cancer Patients’ Survival

    Directory of Open Access Journals (Sweden)

    Ning LI

    2018-02-01

    Full Text Available Background and objective Surgeons are the direct decision-makers and performers in the surgical treatment of patients with lung cancer. Whether the differences among doctors affect the survival of patients is unclear. This study analyzed the five-year survival rates of different thoracic surgeries in patients undergoing surgery to assess the physician's impact and impact. Methods A retrospective analysis of five years between 2002-2007 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, for surgical treatment of lung cancer patients. According to different surgeons grouping doctors to compare the basic information of patients, surgical methods, short-term results and long-term survival differences. Results A total of 712 patients treated by 11 experienced thoracic surgeons were included in this study. The patients have nosignificant difference with gender, age, smoking, pathological type between groups. There were significant differences in clinical staging, surgery type, operation time, blood transfusion rate, number of lymph node dissection, palliative resection rate, postoperative complications and perioperative mortality. There was a significant difference in five-year survival rates among patients treated by different doctors. This difference can be seen in all clinical stage analyzes with consistency. In the multivariate analysis, it was suggested that surgeon was an independent factor influencing the prognosis of patients. Conclusion Thoracic surgeon has a significant effect on the therapeutic effect of lung cancer patients.

  5. Diagnosing thoracic venous aneurysm: A contemporary imaging perspective

    Directory of Open Access Journals (Sweden)

    Rohit Aggarwal

    2017-01-01

    Full Text Available Thoracic venous aneurysms are a rare clinical entity and contrast-enhanced computed tomography has been the cornerstone of their diagnosis. We are reporting a rare case of isolated left brachiocephalic vein aneurysm, which was surgically managed, highlighting the role of dynamic contrast-enhanced magnetic resonance imaging as a definitive diagnostic modality in this patient.

  6. Clinical Studies in Risk Stratification & Therapy of Thoracic Aortic Disease

    NARCIS (Netherlands)

    Kamman, AV

    2017-01-01

    For this thesis we aimed to summarize outcomes and optimal treatment modality for thoracic aortic disease, discuss new imaging techniques and improve the use of current imaging modalities. Furthermore, we aimed to improve risk stratification for uncomplicated type B aortic dissection (TBAD) and

  7. A Rare Case: Gastric Cancer; Involving Primery Thoracal Vertebral Metastases

    Directory of Open Access Journals (Sweden)

    Harun Arslan

    2013-06-01

    Full Text Available Primery bone metastases rarely occur in gastric cancer. Bone metastases indicate that the prognosis is bad. In that article we present a case that is diagnosed as a gastric cancer with primary bone metasteses that caused pathologic thoracal vertebral fracture seenby computer ised tomography.

  8. Congenitally absent thoracic pedicle in a child with rhabdomyosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Kaufman, R A; Poznanski, A K; Hensinger, R N

    1980-04-01

    A case of congenital absence of a thoracic pedicle is reported in a 9 year old boy with embryonal rhabdomyosarcoma of the eyelid. In this clinical setting a surgical exploration was necessary in order to differentiate a developmental anomaly from an acquired metastatic deposit.

  9. Some noticeable problems in the radiological diagnosis of thoracic sarcoidosis

    International Nuclear Information System (INIS)

    Li Tieyi; Li Hui; Ji Jingling

    2003-01-01

    Objective: To discuss the noticeable problems in the radiological diagnosis of thoracic sarcoidosis through retrospective analysis of misdiagnosis. Methods: Imaging examinations of 32 misdiagnosed cases with thoracic sarcoidosis including chest radiography, CT, and their clinical data were reviewed. The final diagnosis was made by pathology (9 cases) and clinical therapy (23 cases). Results: Enlarged thoracic lymph nodes were detected in all cases. 23 of them presented mediastinal lymph node enlargement associated with bilateral hilar lymph node enlargement, 5 of them had mediastinal lymph node enlargement and unilateral hilar lymph node enlargement, and 4 of them had mediastinal lymph node enlargement without hilar lymph node enlargement. In these cases, 24 had pulmonary abnormalities. 19 of them showed multiple pulmonary nodes, 4 of them had patchy pulmonary shadows, and another 1 had pulmonary fibrosis. Pleural lesions included 2 hydrothorax and 1 multiple pleural nodes, and all of pleural lesions were associated with multiple pulmonary nodes. Conclusion: When the radiological findings of thoracic sarcoidosis are atypical, the diagnosis is difficult and must combine with the clinical findings, or the outcome of the treatment

  10. “Clavicular duplication causing thoracic outlet obstruction”: Unique ...

    African Journals Online (AJOL)

    A 22‑year‑old female student reported with features of neurogenic thoracic outlet syndrome mainly involving C8‑T1 components of the brachial plexus, seemingly originating from involvement in costo‑clavicular space. Radiograph of the shoulder revealed clavicular duplication. Neuro‑physiological studies corroborated the ...

  11. Spontaneous herniation of the thoracic spinal cord : a case report

    International Nuclear Information System (INIS)

    Jin, Sung Chan; Lee, Seong Ro; Park, Dong Woo; Joo, Kyung Bin

    2001-01-01

    Spontaneous herniation of the spinal cord is a rare disease entity in which spinal cord substance is herniated through a previously uninjured and/or untouched dural. It is a cause of myelopathy that is treatable but difficult to diagnose. We report the CT and MR findings of a case of spontaneous thoracic spinal cord through a dural defect

  12. Vertebral scale system to measure heart size in thoracic radiographs ...

    African Journals Online (AJOL)

    In veterinary diagnostic radiology, determination of heart size is necessary in the assessment of patients with clinical signs of cardiac anomaly. In this study, heart sizes were compared with lengths of mid-thoracic vertebrae in 12 clinically normal West African Dwarf Goats (WADGs) (8 females, 4 males). The aim of the ...

  13. Video-assisted thoracoscopic surgery for acute thoracic trauma

    Directory of Open Access Journals (Sweden)

    Michael Goodman

    2013-01-01

    Full Text Available Background: Operative intervention for thoracic trauma typically requires thoracotomy. We hypothesized that thoracoscopy may be safely and effectively utilized for the acute management of thoracic injuries. Materials and Methods: The Trauma Registry of a Level I trauma center was queried from 1999 through 2010 for all video-assisted thoracic procedures within 24 h of admission. Data collected included initial vital signs, operative indication, intraoperative course, and postoperative outcome. Results: Twenty-three patients met inclusion criteria: 3 (13% following blunt injury and 20 (87% after penetrating trauma. Indications for urgent thoracoscopy included diaphragmatic/esophageal injury, retained hemothorax, ongoing hemorrhage, and open/persistent pneumothorax. No conversions to thoracotomy were required and no patient required re-operation. Mean postoperative chest tube duration was 2.9 days and mean length of stay was 5.6 days. Conclusion: Video-assisted thoracoscopic surgery is safe and effective for managing thoracic trauma in hemodynamically stable patients within the first 24 h post-injury.

  14. Endoscopic Camera Control by Head Movements for Thoracic Surgery

    NARCIS (Netherlands)

    Reilink, Rob; de Bruin, Gart; Franken, M.C.J.; Mariani, Massimo A.; Misra, Sarthak; Stramigioli, Stefano

    2010-01-01

    In current video-assisted thoracic surgery, the endoscopic camera is operated by an assistant of the surgeon, which has several disadvantages. This paper describes a system which enables the surgeon to control the endoscopic camera without the help of an assistant. The system is controlled using

  15. Transection of the inferior vena cava from blunt thoracic trauma: case reports.

    Science.gov (United States)

    Peitzman, A B; Udekwu, A O; Pevec, W; Albrink, M

    1989-04-01

    Blunt thoracic trauma is a frequent cause of death in multiple trauma victims. Myocardial rupture may occur in up to 65% of patients who die with thoracic injuries. Two cases are presented with intrapericardial transection of the inferior vena cava, pericardial rupture, and myocardial rupture from blunt thoracic trauma. Both patients died.

  16. Feline infectious peritonitis. ABCD guidelines on prevention and management.

    Science.gov (United States)

    Addie, Diane; Belák, Sándor; Boucraut-Baralon, Corine; Egberink, Herman; Frymus, Tadeusz; Gruffydd-Jones, Tim; Hartmann, Katrin; Hosie, Margaret J; Lloret, Albert; Lutz, Hans; Marsilio, Fulvio; Pennisi, Maria Grazia; Radford, Alan D; Thiry, Etienne; Truyen, Uwe; Horzinek, Marian C

    2009-07-01

    Feline coronavirus infection is ubiquitous in domestic cats, and is particularly common where conditions are crowded. While most FCoV-infected cats are healthy or display only a mild enteritis, some go on to develop feline infectious peritonitis, a disease that is especially common in young cats and multi-cat environments. Up to 12% of FCoV-infected cats may succumb to FIP, with stress predisposing to the development of disease. The 'wet' or effusive form, characterised by polyserositis (abdominal and/or thoracic effusion) and vasculitis, and the 'dry' or non-effusive form (pyogranulomatous lesions in organs) reflect clinical extremes of a continuum. The clinical picture of FIP is highly variable, depending on the distribution of the vasculitis and pyogranulomatous lesions. Fever refractory to antibiotics, lethargy, anorexia and weight loss are common non-specific signs. Ascites is the most obvious manifestation of the effusive form. The aetiological diagnosis of FIP ante-mortem may be difficult, if not impossible. The background of the cat, its history, the clinical signs, laboratory changes, antibody titres and effusion analysis should all be used to help in decision-making about further diagnostic procedures. At the time of writing, there is no non-invasive confirmatory test available for cats without effusion. In most cases FIP is fatal. Supportive treatment is aimed at suppressing the inflammatory and detrimental immune response. However, there are no controlled studies to prove any beneficial effect of corticosteroids. At present, only one (intranasal) FIP vaccine is available, which is considered as being non-core. Kittens may profit from vaccination when they have not been exposed to FCoV (eg, in an early-weaning programme), particularly if they enter a FCoV-endemic environment.

  17. Thoracic dysfunction in whiplash associated disorders: A systematic review

    Science.gov (United States)

    Smith, Richard; Tyros, Isaak; Falla, Deborah; Rushton, Alison

    2018-01-01

    Background Research investigating Whiplash Associated Disorder (WAD) has largely focused on the cervical spine yet symptoms can be widespread. Thoracic spine pain prevalence is reported ~66%; perhaps unsurprising given the forceful stretch/eccentric loading of posterior structures of the spine, and the thoracic spine’s contribution to neck mobility/function. Approximately 50% WAD patients develop chronic pain and disability resulting in high levels of societal and healthcare costs. It is time to look beyond the cervical spine to fully understand anatomical dysfunction in WAD and provide new directions for clinical practice and research. Purpose To evaluate the scope and nature of dysfunction in the thoracic region in patients with WAD. Methods A systematic review and data synthesis was conducted according to a pre-defined, registered (PROSPERO, CRD42015026983) and published protocol. All forms of observational study were included. A sensitive topic-based search strategy was designed from inception to 1/06/16. Databases, grey literature and registers were searched using a study population terms and key words derived from scoping search. Two reviewers independently searched information sources, assessed studies for inclusion, extracted data and assessed risk of bias. A third reviewer checked for consistency and clarity. Extracted data included summary data: sample size and characteristics, outcomes, and timescales to reflect disorder state. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data were tabulated to allow enabling a semi-qualitative comparison and grouped by outcome across studies. Strength of the overall body of evidence was assessed using a modified GRADE. Results Thirty eight studies (n>50,000) which were conducted across a range of countries were included. Few authors responded to requests for further data (5 of 9 contacted). Results were reported in the context of overall quality and were presented for measures of pain or dysfunction and

  18. Gamification in thoracic surgical education: Using competition to fuel performance.

    Science.gov (United States)

    Mokadam, Nahush A; Lee, Richard; Vaporciyan, Ara A; Walker, Jennifer D; Cerfolio, Robert J; Hermsen, Joshua L; Baker, Craig J; Mark, Rebecca; Aloia, Lauren; Enter, Dan H; Carpenter, Andrea J; Moon, Marc R; Verrier, Edward D; Fann, James I

    2015-11-01

    In an effort to stimulate residents and trainers to increase their use of simulation training and the Thoracic Surgery Curriculum, a gamification strategy was developed in a friendly but competitive environment. "Top Gun." Low-fidelity simulators distributed annually were used for the technical competition. Baseline and final video assessments were performed, and 5 finalists were invited to compete in a live setting from 2013 to 2015. "Jeopardy." A screening examination was devised to test knowledge contained in the Thoracic Surgery Curriculum. The top 6 2-member teams were invited to compete in a live setting structured around the popular game show Jeopardy. "Top Gun." Over 3 years, there were 43 baseline and 34 final submissions. In all areas of assessment, there was demonstrable improvement. There was increasing evidence of simulation as seen by practice and ritualistic behavior. "Jeopardy." Sixty-eight individuals completed the screening examination, and 30 teams were formed. The largest representation came from the second-year residents in traditional programs. Contestants reported an average in-training examination percentile of 72.9. Finalists reported increased use of the Thoracic Surgery Curriculum by an average of 10 hours per week in preparation. The live competition was friendly, engaging, and spirited. This gamification approach focused on technical and cognitive skills, has been successfully implemented, and has encouraged the use of simulators and the Thoracic Surgery Curriculum. This framework may capitalize on the competitive nature of our trainees and can provide recognition of their achievements. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  19. Correlation analysis between change in thoracic kyphosis and multilevel facetectomy and screw density in main thoracic adolescent idiopathic scoliosis surgery.

    Science.gov (United States)

    Sudo, Hideki; Abe, Yuichiro; Kokabu, Terufumi; Ito, Manabu; Abumi, Kuniyoshi; Ito, Yoichi M; Iwasaki, Norimasa

    2016-09-01

    Controversy exists regarding the effects of multilevel facetectomy and screw density on deformity correction, especially thoracic kyphosis (TK) restoration in adolescent idiopathic scoliosis (AIS) surgery. This study aimed to evaluate the effects of multilevel facetectomy and screw density on sagittal plane correction in patients with main thoracic (MT) AIS curve. A retrospective correlation and comparative analysis of prospectively collected, consecutive, non-randomized series of patients at a single institution was undertaken. Sixty-four consecutive patients with Lenke type 1 AIS treated with posterior correction and fusion surgery using simultaneous double-rod rotation technique were included. Patient demographics and preoperative and 2-year postoperative radiographic measurements were the outcome measures for this study. Multiple stepwise linear regression analysis was conducted between change in TK (T5-T12) and the following factors: age at surgery, Risser sign, number of facetectomy level, screw density, preoperative main thoracic curve, flexibility in main thoracic curve, coronal correction rate, preoperative TK, and preoperative lumbar lordosis. Patients were classified into two groups: TKcorrect hypokyphosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Global biogeography of human infectious diseases.

    Science.gov (United States)

    Murray, Kris A; Preston, Nicholas; Allen, Toph; Zambrana-Torrelio, Carlos; Hosseini, Parviez R; Daszak, Peter

    2015-10-13

    The distributions of most infectious agents causing disease in humans are poorly resolved or unknown. However, poorly known and unknown agents contribute to the global burden of disease and will underlie many future disease risks. Existing patterns of infectious disease co-occurrence could thus play a critical role in resolving or anticipating current and future disease threats. We analyzed the global occurrence patterns of 187 human infectious diseases across 225 countries and seven epidemiological classes (human-specific, zoonotic, vector-borne, non-vector-borne, bacterial, viral, and parasitic) to show that human infectious diseases exhibit distinct spatial grouping patterns at a global scale. We demonstrate, using outbreaks of Ebola virus as a test case, that this spatial structuring provides an untapped source of prior information that could be used to tighten the focus of a range of health-related research and management activities at early stages or in data-poor settings, including disease surveillance, outbreak responses, or optimizing pathogen discovery. In examining the correlates of these spatial patterns, among a range of geographic, epidemiological, environmental, and social factors, mammalian biodiversity was the strongest predictor of infectious disease co-occurrence overall and for six of the seven disease classes examined, giving rise to a striking congruence between global pathogeographic and "Wallacean" zoogeographic patterns. This clear biogeographic signal suggests that infectious disease assemblages remain fundamentally constrained in their distributions by ecological barriers to dispersal or establishment, despite the homogenizing forces of globalization. Pathogeography thus provides an overarching context in which other factors promoting infectious disease emergence and spread are set.

  1. Post-infectious sequelae of travelers' diarrhea.

    Science.gov (United States)

    Connor, Bradley A; Riddle, Mark S

    2013-01-01

    Travelers' diarrhea (TD) has generally been considered a self-limited disorder which resolves more quickly with expeditious and appropriate antibiotic therapy given bacteria are the most frequently identified cause. However, epidemiological, clinical, and basic science evidence identifying a number of chronic health conditions related to these infections has recently emerged which challenges this current paradigm. These include serious and potentially disabling enteric and extra-intestinal long-term complications. Among these are rheumatologic, neurologic, gastrointestinal, renal, and endocrine disorders. This review aims to examine and summarize the current literature pertaining to three of these post-infectious disorders: reactive arthritis, Guillain-Barré syndrome, and post-infectious irritable bowel syndrome and the relationship of these conditions to diarrhea associated with travel as well as to diarrhea associated with gastroenteritis which may not be specifically travel related but relevant by shared microbial pathogens. It is hoped this review will allow clinicians who see travelers to be aware of these post-infectious sequelae thus adding to our body of knowledge in travel medicine. Data for this article were identified by searches of PubMed and MEDLINE, and references from relevant articles using search terms "travelers' diarrhea" "reactive arthritis" "Guillain-Barré syndrome" "Post-Infectious Irritable Bowel Syndrome." Abstracts were included when related to previously published work. A review of the published literature reveals that potential consequences of travelers' diarrhea may extend beyond the acute illness and these post-infectious complications may be more common than currently recognized. In addition since TD is such a common occurrence it would be helpful to be able to identify those who might be at greater risk of post-infectious sequelae in order to target more aggressive prophylactic or therapeutic approaches to such individuals. It is

  2. Impact of the infectious period on epidemics

    Science.gov (United States)

    Wilkinson, Robert R.; Sharkey, Kieran J.

    2018-05-01

    The duration of the infectious period is a crucial determinant of the ability of an infectious disease to spread. We consider an epidemic model that is network based and non-Markovian, containing classic Kermack-McKendrick, pairwise, message passing, and spatial models as special cases. For this model, we prove a monotonic relationship between the variability of the infectious period (with fixed mean) and the probability that the infection will reach any given subset of the population by any given time. For certain families of distributions, this result implies that epidemic severity is decreasing with respect to the variance of the infectious period. The striking importance of this relationship is demonstrated numerically. We then prove, with a fixed basic reproductive ratio (R0), a monotonic relationship between the variability of the posterior transmission probability (which is a function of the infectious period) and the probability that the infection will reach any given subset of the population by any given time. Thus again, even when R0 is fixed, variability of the infectious period tends to dampen the epidemic. Numerical results illustrate this but indicate the relationship is weaker. We then show how our results apply to message passing, pairwise, and Kermack-McKendrick epidemic models, even when they are not exactly consistent with the stochastic dynamics. For Poissonian contact processes, and arbitrarily distributed infectious periods, we demonstrate how systems of delay differential equations and ordinary differential equations can provide upper and lower bounds, respectively, for the probability that any given individual has been infected by any given time.

  3. Chest x-ray as a screening tool for blunt thoracic trauma in children.

    Science.gov (United States)

    Yanchar, Natalie L; Woo, Kenneth; Brennan, Maureen; Palmer, Cameron S; Zs Ee, Michael; Sweeney, Brian; Crameri, Joe

    2013-10-01

    With the increasing use of thoracic computed tomography (CT) to screen for injuries in pediatric blunt thoracic trauma (BTT), we determined whether chest x-ray (CXR) and other clinical and epidemiologic variables could be used to predict significant thoracic injuries, to inform the selective use of CT in pediatric BTT. We further queried if these were discrepant from factors associated with the decision to obtain a thoracic CT. This retrospective cohort study included cases of BTT from three Level I pediatric trauma centers between April 1999 and March 2008. Pre-CT epidemiologic, clinical, and radiologic variables associated with CT findings of any thoracic injury or a significant thoracic injury as well as the decision to obtain a thoracic CT were determined using logistic regression. Of 425 patients, 40% patients had a significant thoracic injury, 49% had nonsignificant thoracic injury, and 11% had no thoracic injury at all. Presence of hydrothorax and/or pneumothorax on CXR significantly increased the likelihood of significant chest injury visualized by CT (adjusted odds ratio 10.8; 95% confidence interval, 6.5-18), as did the presence of isolated subcutaneous emphysema (adjusted odds ratio, 19.8; 95% confidence interval, 2.3-168). Although a normal CXR finding was not statistically associated with a reduced risk of significant thoracic injury, 8 of the 9 cases with normal CXR findings and significant injuries involved occult pneumothoraces or hemothoraces not requiring intervention. Converse to features suggesting increased risk of significant injury, the decision to obtain a thoracic CT was only associated with later period in the study and obtaining a CT scan of another body region. CXR can be used to screen for significant thoracic injuries and direct the selective use of thoracic CT in pediatric BTT. Prospective studies are needed to validate these findings and develop guidelines that include CXR to define indications for thoracic CT in pediatric BTT

  4. Comparison of British Thoracic Society and American Thoracic Society reintroduction guidelines for anti-tuberculous therapy induced liver injury

    International Nuclear Information System (INIS)

    Zuberi, B. F.; Alvi, H.; Zuberi, F. F.; Salahuddin, J.

    2014-01-01

    Objective: To compare the efficacy of British Thoracic Society and American Thoracic Society guidelines for re-introduction of anti-tuberculous therapy after drug-induced liver injury, and to assess the ease of administration of each guideline on a scale of 1-10. Methods: The randomised prospective interventional study was conducted at the Department of Medicine and Pulmonology, Dow University of Health Sciences, Karachi, from December 2011 to November 2013. Patients with anti-tuberculous therapy drug-induced liver injury were selected. Hepatotoxic anti-tuberculous therapy was stopped and modified anti-tuberculous therapy was started. Patients were followed weekly till clinical and biochemical parameters got stabilised. After stabilisation, the patients were randomised to one of the two groups to receive re-introduction of anti-tuberculous therapy under the guidelines of British Thoracic Society (Group I) or those of American Thoracic Society (Group II). Means of the groups were analysed by Student's t test and proportions were compared by chi-square test. Multivariate analysis was done for age, body mass index and serum albumin for recurrence of drug-induced liver injury after the re-introduction. P value <0.05 was taken as significant. Results: Of the total 325 patients, 163(50.15%) were in Group I, while 162(49.84%) were in Group II. The frequency of recurrence of drug-induced liver injury in Group I was 16 (9.8%) and in Group II it was 18 (11.1%). There was no statistically significant difference between the two groups (p<0.7). Age was positively related with drug-induced liver injury, while body mass index and serum albumin were negatively associated. Conclusion: There was no significant difference between the two major guidelines though the American Thoracic Society guideline was easier to follow. (author)

  5. Reconstruction of cervical scar contracture using axial thoracic flap based on the thoracic branch of the supraclavicular artery.

    Science.gov (United States)

    Ma, Xianjie; Li, Yang; Wang, Lu; Li, Weiyang; Dong, Liwei; Xia, Wei; Su, Yingjun

    2014-09-01

    Cervical scar contracture causes both physical and psychological distress for burn patients. Many pedicle flaps or skin grafting have been suggested for reconstruction of cervical scar contracture with variable results in the literature. The authors present the axial thoracic flap based on the thoracic branch of the supraclavicular artery (TBSA) for reconstruction of cervical scar contracture. Postburn scar contractures in anterior neck region of 66 patients had been reconstructed with the axial pattern thoracic flaps based on the TBSA, including 1 expanded and 10 nonexpanded pedicle flaps, and 9 expanded and 46 nonexpanded island pedicle flaps, during 1988 through 2012. After removing and releasing the cervical scar contracture, the flap was designed in the thoracic region. The axial artery of the flap is the TBSA bifurcating from the intersection point of sternocleidomastoid muscle and omohyoid muscle with several concomitant veins as the axial veins. The flap can be designed in a large area within the borders of the anterior border of the trapezius muscle superiorly, the middle part of the deltoid muscle laterally, the midsternal line medially, and the level 3 to 4 cm below nipples inferiorly. After incisions were made along the medial, inferior, and lateral border, dissection was performed toward the pedicle. Donor site was closed directly in expanded cases and with skin grafting in nonexpanded cases. Cervical scar contractures were repaired with good functional and cosmetic results in 64 cases among this cohort. Flap tip necrosis in other 2 cases, caused by postoperative hematoma, was repaired by skin grafting. The color and texture of all flaps were fitted with those of the surrounding skin. The donor sites all healed primarily. The flap sensation in the thoracic region regained in the early stage postoperatively and that in cervical area recovered completely after 6 months according to the report of the patients. With reliable blood supply based on the

  6. Splenic Infarction: An Under-recognized Complication of Infectious Mononucleosis?

    Science.gov (United States)

    Li, Yan; George, Ann; Arnaout, Sami; Wang, Jennifer P; Abraham, George M

    2018-03-01

    Splenic infarction is a rare complication of infectious mononucleosis. We describe 3 cases of splenic infarction attributed to infectious mononucleosis that we encountered within a 2-month period. We underscore the awareness of this potential complication of infectious mononucleosis and discuss the differential diagnosis of splenic infarction, including infectious etiologies. While symptomatic management is usually sufficient for infectious mononucleosis-associated splenic infarction, close monitoring for other complications, including splenic rupture, is mandated.

  7. Return to play after infectious mononucleosis.

    Science.gov (United States)

    Becker, Jonathan A; Smith, Julie Anne

    2014-05-01

    Infectious mononucleosis is a disease primarily of adolescence and early adulthood. The risk of splenic injury and chronic fatigue make return-to-play decisions a challenge for the clinician caring for athletes with infectious mononucleosis. Data were obtained from the PubMed and MEDLINE databases through December 2012 by searching for epidemiology, diagnosis, clinical manifestations, management, and the role of the spleen in infectious mononucleosis. Clinical review. Level 4. Infectious mononucleosis is commonly encountered in young athletes. Its disease pattern is variable and can affect multiple organ systems. Supportive care is the cornerstone, with little role for medications such as corticosteroids. Physical examination is unreliable for the spleen, and ultrasound imaging has limitations in its ability to guide return-to-play decisions. Exercise does not appear to place the young athlete at risk for chronic fatigue, but determining who is at risk for persistent symptoms is a challenge. Return-to-play decisions for the athlete with infectious mononucleosis need to be individualized because of the variable disease course and lack of evidence-based guidelines.

  8. Global Dynamics of Infectious Disease with Arbitrary Distributed Infectious Period on Complex Networks

    Directory of Open Access Journals (Sweden)

    Xiaoguang Zhang

    2014-01-01

    Full Text Available Most of the current epidemic models assume that the infectious period follows an exponential distribution. However, due to individual heterogeneity and epidemic diversity, these models fail to describe the distribution of infectious periods precisely. We establish a SIS epidemic model with multistaged progression of infectious periods on complex networks, which can be used to characterize arbitrary distributions of infectious periods of the individuals. By using mathematical analysis, the basic reproduction number R0 for the model is derived. We verify that the R0 depends on the average distributions of infection periods for different types of infective individuals, which extend the general theory obtained from the single infectious period epidemic models. It is proved that if R0<1, then the disease-free equilibrium is globally asymptotically stable; otherwise the unique endemic equilibrium exists such that it is globally asymptotically attractive. Finally numerical simulations hold for the validity of our theoretical results is given.

  9. Patient safety in thoracic surgery and European Society of Thoracic Surgeons checklist.

    Science.gov (United States)

    Novoa, Nuria M

    2015-04-01

    Improving patient safety seems to be a new interesting clinical subject but, in fact, it is no new. It has to do with one of the oldest ethical principles of our profession: curing and not harming. The important research that has been done in a short period of time has brought in new insight to this complex area that is fast developing. The creation of safety managing systems will allow coordinating efforts from very different, although complementary, areas to create real safety culture and safety climate in every organization. In the surgical settings, teamwork is basic to provide good quality of care. Safety leaders in every team have an important role in establishing priorities, summarizing proposals, coordinating efforts, launching new initiatives and transmitting that safety efforts are worth taken. Preparedness and anticipation are key points for avoiding most of the diverse types of patient harm that can occur. As has been published, a great number of errors can be avoided simply using crosscheck based on specialized checklist that reviews every important detail of the procedure. This strategy has been demonstrated very useful at other high risk industries such as aviation, nuclear or food management. The Safe Surgery Saves Lives program launched in 2002 by the WHO has taught us that improvement is possible using a simple checklist. More complex and detail checklist can be more adequate for more complex procedures and settings. The proposed ESTS checklist reviews different areas of possible error in deeper detail allowing the finest adjustment of the patient before the skin incision. It has been recently released to the general thoracic community and monitors its use and usefulness has to be warrantied.

  10. Involvement of the thoracic duct in liver cirrhosis patients with ascites. Using MR lymphography

    International Nuclear Information System (INIS)

    Kuboyama, Shin-ichi; Ishii, Kunihide; Koga, Hiroyuki

    2003-01-01

    To elucidate whether the morphological changes of the thoracic duct are observed in patients with liver cirrhosis and ascites, the thoracic duct was examined at magnetic resonance (MR) lymphography without contrast agent. In 7 healthy volunteers, the thoracic duct was clearly visualized as an intermittent or continuous straight line along the thoracic aorta (its mean diameter was 3.9 mm). In 20 liver cirrhosis without ascites, its mean diameter was 3.6 mm. In 6 liver cirrhosis with refractory ascites, the thoracic duct was visualized as straight or slightly tortuous and slender line (its mean diameter was 2.5 mm). On the other hand, 7 cases with ascites which respond well to the administration of diuretics showed tortuous and dilated thoracic duct (its mean diameter was 4.3 mm). In cases with refractory ascites, mean diameter of the thoracic duct was significantly reduced, compared with the cases without ascites and with ascites that respond well to the administration of diuretics. Thus, it was found that the morphological differences of the thoracic duct depend on the response to the diuretics in liver cirrhosis patients with ascites. To elucidate whether the morphological changes of the thoracic duct are observed in patients with liver cirrhosis and ascites, the thoracic duct was examined at magnetic resonance lymphography without contrast agent. In cases with refractory ascites, mean diameter of the thoracic duct was significantly reduced, compared with the cases without ascites and with ascites that respond well to the administration of diuretics. (author)

  11. Radiographic evaluation of obesity-caused oppression of the thoracic cavity in beagles

    International Nuclear Information System (INIS)

    Morooka, T.; Niiyama, M.; Kougo, A.; Soya, M.; Nunome, K.

    2004-01-01

    Thoracic radiographs of fifteen beagles with mild-to-moderate obesity revealed that oppression of the thoracic cavity increased with increasing degree of obesity. Oppression of the thoracic cavity was evaluated based on the length, depth, width and area of the thoracic cavity. To obtain thoracic radiographs at the terminal inspiration and expiration phases, thoracic fluororadiographs were recorded with a digital video camera. Bodyweight and the depth of the back fat layer at the seventh lumbar vertebra (DB, measured by ultrasonography) were used as indicators of the degree of obesity. The length of the thoracic cavity tended to become shorter and the depth and width of the thoracic cavity tended to increase as bodyweight increased and as DB increased. On the other hand, the area of the thoracic cavity was not clearly related to bodyweight or DB. These results suggest that oppression of the thoracic cavity due to the cranial shift of the diaphragm is compensated for by increases in the depth and width of the thoracic cavity in beagles with mild-to-moderate obesity

  12. Lower thoracic degenerative spondylithesis with concomitant lumbar spondylosis.

    Science.gov (United States)

    Hsieh, Po-Chuan; Lee, Shih-Tseng; Chen, Jyi-Feng

    2014-03-01

    Degenerative spondylolisthesis of the spine is less common in the lower thoracic region than in the lumbar and cervical regions. However, lower thoracic degenerative spondylolisthesis may develop secondary to intervertebral disc degeneration. Most of our patients are found to have concomitant lumbar spondylosis. By retrospective review of our cases, current diagnosis and treatments for this rare disease were discussed. We present a series of 5 patients who experienced low back pain, progressive numbness, weakness and even paraparesis. Initially, all of them were diagnosed with lumbar spondylosis at other clinics, and 1 patient had even received prior decompressive lumbar surgery. However, their symptoms continued to progress, even after conservative treatments or lumbar surgeries. These patients also showed wide-based gait, increased deep tendon reflex (DTR), and urinary difficulty. All these clinical presentations could not be explained solely by lumbar spondylosis. Thoracolumbar spinal magnetic resonance imaging (MRI), neurophysiologic studies such as motor evoked potential (MEP) or somatosensory evoked potential (SSEP), and dynamic thoracolumbar lateral radiography were performed, and a final diagnosis of lower thoracic degenerative spondylolisthesis was made. Bilateral facet effusions, shown by hyperintense signals in T2 MRI sequence, were observed in all patients. Neurophysiologic studies revealed conduction defect of either MEP or SSEP. One patient refused surgical management because of personal reasons. However, with the use of thoracolumbar orthosis, his symptoms/signs stabilized, although partial lower leg myelopathy was present. The other patients received surgical decompression in association with fixation/fusion procedures performed for managing the thoracolumbar lesions. Three patients became symptom-free, whereas in 1 patient, paralysis set in before the operation; this patient was able to walk with assistance 6 months after surgical decompression

  13. Thoracic posterior longitudinal ligament ossification in a fixed population; longitudinal radiological observations

    International Nuclear Information System (INIS)

    Ono, Minoru; Russell, W.J.; Kudo, Sho.

    1984-05-01

    All lateral chest radiographs of 34 persons with posterior longitudinal ligament ossification (PLLO) in the thoracic spine were reviewed for date of its onset and its progress. These observations spanned as long as 18 years. Upper mid-thoracic PLLO first appeared under the age of 40, then increased in extent in the vertical axis until the age of 50. Lower thoracic PLLO occurred later than upper mid-thoracic PLLO. In the lower thoracic and lumbar regions, degeneration of the vertebrae and discs apparently were focal factors which triggered the development of thoracic PLLO. PLLO apparently developed in a different way in the upper and mid-thoracic regions, where the vertebrae and discs were unremarkable at the time of its initial appearance, and degenerative abnormalities did not predispose to it. (author)

  14. Systems thinking in combating infectious diseases.

    Science.gov (United States)

    Xia, Shang; Zhou, Xiao-Nong; Liu, Jiming

    2017-09-11

    The transmission of infectious diseases is a dynamic process determined by multiple factors originating from disease pathogens and/or parasites, vector species, and human populations. These factors interact with each other and demonstrate the intrinsic mechanisms of the disease transmission temporally, spatially, and socially. In this article, we provide a comprehensive perspective, named as systems thinking, for investigating disease dynamics and associated impact factors, by means of emphasizing the entirety of a system's components and the complexity of their interrelated behaviors. We further develop the general steps for performing systems approach to tackling infectious diseases in the real-world settings, so as to expand our abilities to understand, predict, and mitigate infectious diseases.

  15. Infectious diseases in Greenlanders of Upernavik

    DEFF Research Database (Denmark)

    Bjerregaard, P

    1985-01-01

    During one year, 1979-80, all the contacts between the 836 inhabitants of Upernavik town and the local medical officers were recorded. In the 737 native Greenlanders 1006 contacts (41%) were caused by infectious diseases, representing 705 episodes of disease. The number of contacts per episode...... infections during winter was noted. The contact rate for all infectious diseases together was slightly higher than in Danish general practice, and infectious diseases also accounted for a larger proportion of all registered contacts. Contacts due to chronic respiratory infections, skin infections...... of disease was similar in all age groups. Of these contacts 26% were caused by acute upper respiratory tract infections, 8% by other acute respiratory infections, 10% by chronic respiratory infections, 24% by non-traumatic skin infections, 7% by post-traumatic skin infections, 8% by sexually transmitted...

  16. Agranulocytosis occurrence following recent acute infectious mononucleosis.

    Science.gov (United States)

    Massoll, Anthony F; Powers, Stanlyn C; Betten, David P

    2017-05-01

    Infectious mononucleosis secondary to Epstein-Barr virus typically follows a relatively benign and self-limited course. A small subset of individuals may develop further progression of disease including hematologic, neurologic, and cardiac abnormalities. A mild transient neutropenia occurring during the first weeks of acute infection is a common finding however in rare cases a more profound neutropenia and agranulocytosis may occur up to 6weeks following the onset of initial symptoms. We describe the case of an 18-year-old woman who presented 26days following an acute infectious mononucleosis diagnosis with agranulocytosis and fever. No source of infection was identified and the patient had rapid improvement in her symptoms and resolution of her neutropenia. The presence of fever recurrence and other non-specific symptoms in individuals 2-6weeks following acute infectious mononucleosis symptom onset may warrant further assessment for this uncommon event. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Sibship structure and risk of infectious mononucleosis

    DEFF Research Database (Denmark)

    Rostgaard, Klaus; Nielsen, Trine Rasmussen; Wohlfahrt, Jan

    2014-01-01

    BACKGROUND: Present understanding of increased risk of Epstein-Barr virus (EBV)-related infectious mononucleosis among children of low birth order or small sibships is mainly based on old and indirect evidence. Societal changes and methodological limitations of previous studies call for new data....... METHODS: We used data from the Danish Civil Registration System and the Danish National Hospital Discharge Register to study incidence rates of inpatient hospitalizations for infectious mononucleosis before the age of 20 years in a cohort of 2,543,225 Danes born between 1971 and 2008, taking individual...... of blood donors followed up retrospectively for self-reported infectious mononucleosis. CONCLUSIONS: Younger siblings, and to a lesser degree older siblings, seem to be important in the transmission of EBV within families. Apparently the dogma of low birth order in a sibship as being at the highest risk...

  18. Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage

    NARCIS (Netherlands)

    van Gijn, J.; van Dongen, K. J.; Vermeulen, M.; Hijdra, A.

    1985-01-01

    We studied 28 patients with subarachnoid hemorrhage and normal angiograms. On early CT (within 5 days) in 13 cases, blood was seen mainly or only in the cisterns around the midbrain. This pattern of hemorrhage was found in only 1 of 92 patients with a ruptured aneurysm. None of the unexplained

  19. CISH and susceptibility to infectious diseases.

    Science.gov (United States)

    Khor, Chiea C; Vannberg, Fredrik O; Chapman, Stephen J; Guo, Haiyan; Wong, Sunny H; Walley, Andrew J; Vukcevic, Damjan; Rautanen, Anna; Mills, Tara C; Chang, Kwok-Chiu; Kam, Kai-Man; Crampin, Amelia C; Ngwira, Bagrey; Leung, Chi-Chiu; Tam, Cheuk-Ming; Chan, Chiu-Yeung; Sung, Joseph J Y; Yew, Wing-Wai; Toh, Kai-Yee; Tay, Stacey K H; Kwiatkowski, Dominic; Lienhardt, Christian; Hien, Tran-Tinh; Day, Nicholas P; Peshu, Nobert; Marsh, Kevin; Maitland, Kathryn; Scott, J Anthony; Williams, Thomas N; Berkley, James A; Floyd, Sian; Tang, Nelson L S; Fine, Paul E M; Goh, Denise L M; Hill, Adrian V S

    2010-06-03

    The interleukin-2-mediated immune response is critical for host defense against infectious pathogens. Cytokine-inducible SRC homology 2 (SH2) domain protein (CISH), a suppressor of cytokine signaling, controls interleukin-2 signaling. Using a case-control design, we tested for an association between CISH polymorphisms and susceptibility to major infectious diseases (bacteremia, tuberculosis, and severe malaria) in blood samples from 8402 persons in Gambia, Hong Kong, Kenya, Malawi, and Vietnam. We had previously tested 20 other immune-related genes in one or more of these sample collections. We observed associations between variant alleles of multiple CISH polymorphisms and increased susceptibility to each infectious disease in each of the study populations. When all five single-nucleotide polymorphisms (SNPs) (at positions -639, -292, -163, +1320, and +3415 [all relative to CISH]) within the CISH-associated locus were considered together in a multiple-SNP score, we found an association between CISH genetic variants and susceptibility to bacteremia, malaria, and tuberculosis (P=3.8x10(-11) for all comparisons), with -292 accounting for most of the association signal (P=4.58x10(-7)). Peripheral-blood mononuclear cells obtained from adult subjects carrying the -292 variant, as compared with wild-type cells, showed a muted response to the stimulation of interleukin-2 production--that is, 25 to 40% less CISH expression. Variants of CISH are associated with susceptibility to diseases caused by diverse infectious pathogens, suggesting that negative regulators of cytokine signaling have a role in immunity against various infectious diseases. The overall risk of one of these infectious diseases was increased by at least 18% among persons carrying the variant CISH alleles. 2010 Massachusetts Medical Society

  20. CISH and Susceptibility to Infectious Diseases

    Science.gov (United States)

    Khor, Chiea C.; Vannberg, Fredrik O.; Chapman, Stephen J.; Guo, Haiyan; Wong, Sunny H.; Walley, Andrew J.; Vukcevic, Damjan; Rautanen, Anna; Mills, Tara C.; Chang, Kwok-Chiu; Kam, Kai-Man; Crampin, Amelia C.; Ngwira, Bagrey; Leung, Chi-Chiu; Tam, Cheuk-Ming; Chan, Chiu-Yeung; Sung, Joseph J.Y.; Yew, Wing-Wai; Toh, Kai-Yee; Tay, Stacey K.H.; Kwiatkowski, Dominic; Lienhardt, Christian; Hien, Tran-Tinh; Day, Nicholas P.; Peshu, Nobert; Marsh, Kevin; Maitland, Kathryn; Scott, J. Anthony; Williams, Thomas N.; Berkley, James A.; Floyd, Sian; Tang, Nelson L.S.; Fine, Paul E.M.; Goh, Denise L.M.; Hill, Adrian V.S.

    2013-01-01

    Background The interleukin-2 (IL2)-mediated immune response is critical for host defence against infectious pathogens. CISH, a suppressor of cytokine signalling, controls IL2 signalling. Methods We tested for association between CISH polymorphisms and susceptibility to major infectious diseases (bacteremia, tuberculosis and severe malaria) in 8402 persons from the Gambia, Hong Kong, Kenya, Malawi, and Vietnam using a case-control design. We have previously tested twenty other immune-related genes in one or more of these sample collections. Results We observed associations between variant alleles of multiple CISH polymorphisms and increased susceptibility to each infectious disease in each of the study populations. When all five SNPs (CISH −639, −292, −163, +1320 and +3415) within the CISH-associated locus were considered together in a multi-SNP score, we found substantial support for an effect of CISH genetic variants on susceptibility to bacteremia, malaria, and tuberculosis (overall P=3.8 × 10−11) with CISH −292 being “responsible” for the majority of the association signal (P=4.58×10−7). Peripheral blood mononuclear cells of adult volunteers carrying the CISH −292 variant showed a muted response to IL2 stimulation — in the form of 25-40% less CISH — when compared with “control” cells lacking the −292 variant. Conclusions Variants of CISH are associated with susceptibility to diseases caused by diverse infectious pathogens, suggesting that negative regulators of cytokine signalling may play a major role in immunity against various infectious diseases. The overall risk of having one of these infectious diseases was found to be increased by at least 18 percent in individuals carrying the variant CISH alleles. PMID:20484391

  1. Imaging methods for detection of infectious foci

    International Nuclear Information System (INIS)

    Couret, I.; Rossi, M.; Weinemann, P.; Moretti, J.L.

    1993-01-01

    Several tracers can be used for imaging infection. None is a worthwhile agent for all infectious foci, but each one has preferential applications, depending on its uptake mechanism by the infectious and/or inflammatory focus. Autologous leucocytes labeled in vitro with indium-111 (In-111) or with technetium-99-hexamethylpropyleneamine oxime (Tc-99m HMPAO) were applied with success in the detection of peripheral bone infection, focal vascular graft infection and inflammatory bowel disease. Labeling with In-111 is of interest in chronic bone infection, while labeling with Tc-99m HMPAO gets the advantage of a better dosimetry and imaging. The interest of in vivo labeled leucocytes with a Tc-99m labeled monoclonal antigranulocyte antibody anti-NCA 95 (BW 250/183) was proved in the same principal type of infectious foci than in vitro labeled leucocytes. Sites of chronic infection in the spine and the pelvis, whether active or healed, appear as photopenic defects on both in vitro labeled leucocytes and Tc-99m monoclonal antigranulocyte antibody (BW 250/183) scintigraphies. With gallium-67 results showed a high sensitivity with a low specificity. This tracer demonstrated good performance to delineate foci of infectious spondylitis. In-111 and Tc-99m labeled polyclonal human immunoglobulin (HIG) was applied with success in the assessment of various infectious foci, particularly in chronic sepsis. As labeled leucocytes, labeled HIG showed cold defects in infectious sepsis of the spine. Research in nuclear medicine is very active in the development of more specific tracers of infection, mainly involved in Tc-99m or In-111 labeled chemotactic peptides, antigranulocyte antibody fragments, antibiotic derivatives and interleukins. (authors). 70 refs

  2. Technical Note: Thoracic duct embolization for treatment of chylothorax: A novel guidance technique for puncture using combined MRI and fluoroscopy

    International Nuclear Information System (INIS)

    Praveen, Alampath; Sreekumar, Karumathil Pullara; Nazar, Puthukudiyil Kader; Moorthy, Srikanth

    2012-01-01

    Thoracic duct embolization (TDE) is an established radiological interventional procedure for thoracic duct injuries. Traditionally, it is done under fluoroscopic guidance after opacifying the thoracic duct with bipedal lymphangiography. We describe our experience in usinga heavily T2W sequence for guiding thoracic duct puncture and direct injection of glue through the puncture needle without cannulating the duct

  3. Technical Note: Thoracic duct embolization for treatment of chylothorax: A novel guidance technique for puncture using combined MRI and fluoroscopy.

    Science.gov (United States)

    Praveen, Alampath; Sreekumar, Karumathil Pullara; Nazar, Puthukudiyil Kader; Moorthy, Srikanth

    2012-04-01

    Thoracic duct embolization (TDE) is an established radiological interventional procedure for thoracic duct injuries. Traditionally, it is done under fluoroscopic guidance after opacifying the thoracic duct with bipedal lymphangiography. We describe our experience in usinga heavily T2W sequence for guiding thoracic duct puncture and direct injection of glue through the puncture needle without cannulating the duct.

  4. [Infectious burdens of reproduction of female dogs].

    Science.gov (United States)

    Wendt, K; Stellmacher, H

    1996-02-01

    The results of gynecological investigations in 142 bitches were evaluated and the complexity of infectious affections is discussed. High proportions of infectious cases were found in cases of limitation of fertility (67.5%), in vaginal discharge in the estrus (60.8%), in cases of mastitis/pseudopregnancy (61.5%) and in mortality of newborn puppies. St. aureus and E. coli were often isolated. There is a high etiological correlation in epidemiology of diseases of the reproductive tract in the single bitch and especially in kennel bitches.

  5. Bone scan in diagnosis of infectious osteoarthritis

    International Nuclear Information System (INIS)

    Marandian, M.H.; Mortazavi, H.; Behvad, A.; Haghigat, H.; Lessani, M.; Youssefian, B.

    1979-01-01

    Bone scan with Technetium 99m is harmless method of evaluation of skeletal lesions. It is safe in pediatrics age group and it can be used in early diagnosis of infectious osteoarthritis. Bone scan differentiate osteomyelitis from cellulitis, and also it may help in diagnosis of subclinical involvement of rheumatoid arthritis, benign and malignant bone tumors, stress fractures and periostitis. We report results of bone scan in 30 pediatrics patients as follow: osteomyelitis 9 cases, cellulitis 4 cases, infectious arthritis 7 cases, tuberculous osteoarthritis 2 cases, rheumatoid arthritis 2 cases, and other different diseases 9 cases [fr

  6. Geography, ecology and emerging infectious diseases.

    Science.gov (United States)

    Mayer, J D

    2000-04-01

    Emerging infectious diseases are the focus of increased attention and even alarm in the scholarly and popular literature. The emergence of new diseases and the resurgence of older and previously recognized infectious diseases both in developing and developed country poses challenges for understanding the ecological web of causation, including social, economic, environmental and biological components. This paper is a synthesis of the major characteristics of emerging diseases, in an interdisciplinary context. Political ecology is one framework for analysis that is promising in developing a modified ecology of disease.

  7. Disruptive technology in the treatment of thoracic trauma.

    Science.gov (United States)

    Smith, R Stephen

    2013-12-01

    The care of patients with thoracic injuries has undergone monumental change over the past 25 years. Advances in technology have driven improvements in care, with obvious benefits to patients. In many instances, new or "disruptive" technologies have unexpectedly displaced previously established standards for the diagnosis and treatment of these potentially devastating injuries. Examples of disruptive technology include the use of ultrasound technology for the diagnosis of cardiac tamponade and pneumothorax; thoracoscopic techniques instead of thoracotomy, pulmonary tractotomy, and stapled lung resection; endovascular repair of thoracic aortic injury; operative fixation of flail chest; and the enhanced availability of extracorporeal lung support for severe respiratory failure. Surgeons must be prepared to recognize the benefits, and limits, of novel technologies and incorporate these methods into day-to-day treatment protocols. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Local complications of hydatid disease involving thoracic cavity: Imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Turgut, A.T. [Department of Radiology, Ankara Training and Research Hospital, Ankara (Turkey)], E-mail: ahmettuncayturgut@yahoo.com; Altinok, T. [Department of Thoracic Surgery, Meram Faculty of Medicine, Selcuk University, Konya (Turkey); Topcu, S. [Department of Thoracic Surgery, Faculty of Medicine, Kocaeli University, Izmit (Turkey); Kosar, U. [Department of Radiology, Ankara Training and Research Hospital, Ankara (Turkey)

    2009-04-15

    Hydatid disease, a worldwide zoonosis, is caused by the larval stage of the Echinococcus tapeworm. Although it can involve almost every organ of the body, lung involvement follows in frequency the hepatic infestation in adults and is the predominating site in children. Radiologically, hydatidosis usually demonstrates typical findings, but many patients are at risk of developing various complications of hydatid disease with atypical imaging findings and these are rarely described in the literature. In this pictorial review, the imaging features of local complications of hydatid disease involving the thorax including intrapulmonary or pleural rupture, infection of the ruptured cysts, reactions of the adjacent tissues, thoracic wall invasion and iatrogenic involvement of pleura are described. Additionally, imaging characteristics of transdiaphragmatic thoracic involvement of hepatic hydatid disease are presented. To prevent the development of subsequent catastrophic results, all radiologists need to be aware of the atypical imaging appearances of complications of pulmonary hydatid disease.

  9. Radiation dose-reduction strategies in thoracic CT.

    Science.gov (United States)

    Moser, J B; Sheard, S L; Edyvean, S; Vlahos, I

    2017-05-01

    Modern computed tomography (CT) machines have the capability to perform thoracic CT for a range of clinical indications at increasingly low radiation doses. This article reviews several factors, both technical and patient-related, that can affect radiation dose and discusses current dose-reduction methods relevant to thoracic imaging through a review of current techniques in CT acquisition and image reconstruction. The fine balance between low radiation dose and high image quality is considered throughout, with an emphasis on obtaining diagnostic quality imaging at the lowest achievable radiation dose. The risks of excessive radiation dose reduction are also considered. Inappropriately low dose may result in suboptimal or non-diagnostic imaging that may reduce diagnostic confidence, impair diagnosis, or result in repeat examinations incurring incremental ionising radiation exposure. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  10. Thoracic lymphangiectasis presenting with chyloptysis and bronchial cast expectoration

    International Nuclear Information System (INIS)

    Orliaguet, O.; Beauclair, P.; Gavazzi, G.; Winckel, P.; Laporte, F.; Coulomb, M.; Ferretti, G.R.

    2002-01-01

    A 70-year-old man with recurrent undiagnosed episodes of bronchial cast expectoration and pulmonary infiltrates on chest radiography for 15 years is described. The diagnosis of chyloptysis was established by chemical analysis of the bronchial aspiration. We emphasize the radiological findings of this rare observation. The CT-associated lymphangiography showed mediastinal lymphangiectasis with retrograde opacification of mediastinal and hilar lymph nodes as well as submucosal lymphatic vessels protruding into the lumen of the tracheo-bronchial tree without evidence of thoracic duct obstruction as well as a ''crazy-paving appearance.'' Congenital incompetence of the valves of the lymphatic vessels originating from the thoracic duct is held to be the cause. Chyloptysis and pulmonary lymphatic disorder should be sought in cases of bronchial cast expectoration. (orig.)

  11. Surgical treatment of gross posttraumatic deformations in thoracic spine

    Directory of Open Access Journals (Sweden)

    Aleksei E. Shul’ga

    2017-10-01

    Full Text Available Rigid severe post-traumatic thoracic spine deformities result from frequent, recent high-energy trauma in children with an increasing frequency due to a variety of reasons. These types of injuries are commonly followed by spinal cord anatomic injury; therefore, the treatment of these patients warrants special attention from the ethical viewpoint. Generally, the only indication for surgical intervention is spinal dysfunction. Considering this and the patients’ ordinary severe somatic state, surgical trauma should be minimized as much as possible. However, for adequate deformity correction, effective spine stabilization and restoration of liquorodynamics is necessary. Recent studies have reported the successful use of different methods of dorsal interventions (P/VCR in cases with unstable damages in children. Here, we present the case of a 15-year-old boy who underwent surgical treatment for coarse post-traumatic thoracic spine deformity with chronic fracture-dislocation of Th7 vertebra.

  12. Local complications of hydatid disease involving thoracic cavity: Imaging findings

    International Nuclear Information System (INIS)

    Turgut, A.T.; Altinok, T.; Topcu, S.; Kosar, U.

    2009-01-01

    Hydatid disease, a worldwide zoonosis, is caused by the larval stage of the Echinococcus tapeworm. Although it can involve almost every organ of the body, lung involvement follows in frequency the hepatic infestation in adults and is the predominating site in children. Radiologically, hydatidosis usually demonstrates typical findings, but many patients are at risk of developing various complications of hydatid disease with atypical imaging findings and these are rarely described in the literature. In this pictorial review, the imaging features of local complications of hydatid disease involving the thorax including intrapulmonary or pleural rupture, infection of the ruptured cysts, reactions of the adjacent tissues, thoracic wall invasion and iatrogenic involvement of pleura are described. Additionally, imaging characteristics of transdiaphragmatic thoracic involvement of hepatic hydatid disease are presented. To prevent the development of subsequent catastrophic results, all radiologists need to be aware of the atypical imaging appearances of complications of pulmonary hydatid disease.

  13. [Thoracic aortic dissection revealed by systemic cholesterol embolism].

    Science.gov (United States)

    Braem, L; Paule, P; Héno, P; Morand, J J; Mafart, B; La Folie, T; Varlet, P; Mioulet, D; Fourcade, L

    2006-10-01

    Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

  14. [Biomedicine in thoracic surgery: state of the art].

    Science.gov (United States)

    Leistner, M; Steinke, M; Walles, T

    2013-06-01

    Biomedicine represents a new scientific field at the interface of human, molecular and cell biology and medicine. Comprising the diverse disciplines of stem cell research, tissue engineering and material sciences, biomedicine gives rise to new approaches in research and therapy for - to date - unmet medical issues. Biomedical research is currently conducted in many medical, especially surgical subspecialties, and a number of successful developments have already been brought to clinical application. Concerning thoracic surgery, biomedical approaches are pursued primarily for tissue and organ replacement of the upper airways, lung and thoracic wall. In spite of a comparatively small research foundation, five different concepts have been clinically implemented worldwide, due to a lack of established treatment options in the case of extensive disease of the greater airways. In this review, the clinical background and the tissue-specific basics of tracheobronchial biomedicine are presented. Georg Thieme Verlag KG Stuttgart · New York.

  15. Electrical impedance measured changes in thoracic fluid content during thoracentesis

    DEFF Research Database (Denmark)

    Petersen, J R; Jensen, B V; Drabaek, H

    1994-01-01

    In patients (seven females and 11 males) with pleural effusion due to pulmonary (n = 13) or cardiac disease (n = 5) the change in baseline transthoracic impedance (Z0) was measured by electrical impedance (BoMed's NCCOM-3, 70 kHz) during thoracentesis. Data were obtained before and after withdrawal...... of each 500 ml, and at the end of the thoracentesis. We found a close linear correlation (r = 0.97) between changes in Z0 and the volume of aspirated pleural effusion (y = 0.415.x+0.093). The variability of the estimated thoracic fluid volumes was analysed with a plot of the residuals from the regression...... line, and we found that changes in thoracic fluid volume estimated by impedance technique would be within +/- 302 ml (= 2 SD). However, the absolute value of Z0 before thoracentesis could not differentiate the group of patients with pleural effusion from normal subjects (n = 28)....

  16. Cardiac pacemaker dysfunction in children after thoracic drainage catheter manipulation.

    Science.gov (United States)

    Lobdell, K W; Walters, H L; Hudson, C; Hakimi, M

    1997-05-01

    Two children underwent placement of permanent, epicardial-lead, dual-chamber, unipolar pacemaker systems for complete heart block. Postoperatively, both patients demonstrated subcutaneous emphysema-in the area of their pulse generators-temporally related to thoracic catheter manipulation. Acutely, each situation was managed with manual compression of the pulse generator, ascertaining appropriate pacemaker sensing and pacing. Maintenance of compression with pressure dressings, vigilant observation/monitoring, and education of the care givers resulted in satisfactory pacemaker function without invasive intervention.

  17. Segmental thoracic spinal anesthesia in patient with Byssinosis undergoing nephrectomy.

    Science.gov (United States)

    Patel, Kiran; Salgaonkar, Sweta

    2012-01-01

    Byssinosis is an occupational disease occurring commonly in cotton mill workers; it usually presents with features of chronic obstructive pulmonary disease (COPD). The management of patients with COPD presents a significant challenges to the anesthetist. Regional anesthesia is preferred in most of these patients to avoid perioperative and postoperative complications related to general anesthesia. We report a known case of Byssinosis who underwent nephrectomy under segmental spinal anesthesia at the low thoracic level.

  18. Novel Split Chest Tube Improves Post-Surgical Thoracic Drainage

    Science.gov (United States)

    Olivencia-Yurvati, Albert H; Cherry, Brandon H; Gurji, Hunaid A; White, Daniel W; Newton, J Tyler; Scott, Gary F; Hoxha, Besim; Gourlay, Terence; Mallet, Robert T

    2014-01-01

    Objective Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. Description We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. Methods After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costo-diaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at −20 cm H2O for 30 min. Results When D5W was infused, the split drain left a residual volume of 53 ± 99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P=0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, Pdrain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. Conclusion The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications. PMID:25478289

  19. Thoracic spine disc-related abnormalities: longitudinal MR imaging assessment

    Energy Technology Data Exchange (ETDEWEB)

    Girard, Charles J.; Schweitzer, Mark E.; Morrison, William B.; Parellada, Joan A. [TJUH Radiology, Philadelphia, Pennsylvania (United States); Carrino, J.A. [Department of Radiology ASB-1, Harvard Medical School, Brigham and Women' s Hospital, L1, Room 002B, 75 Francis Street, MA 02115, Boston (United States)

    2004-04-01

    To describe and characterize the temporal changes in disc-related disorders of the thoracic spine using MR imaging. A retrospective longitudinal cohort study was carried out of 40 patients with two sequential thoracic spine MR images at variable intervals. The images were assessed for baseline presence of, new incidence of and changes in disc herniation, degenerative disc disease, endplate marrow signal alteration and Schmorl nodes. The range of follow-up was 4-149 weeks. Baseline presence was: disc herniation, 10% (49/480); degenerative disc disease, 14% (66/480); endplate marrow signal alteration, 2.3% (11/480); Schmorl nodes 9.6% (46/480). Most pre-existing lesions tended to remain unchanged. Herniations showed the most change, tending to improve in 27%. New incidence was: disc herniation, 1.5% (7/480), degenerative disc disease, 2% (10/480); endplate marrow signal alteration, 1.6% (8/480); Schmorl nodes, 2.1% (10/480). Disc degeneration was first visible at an 11-week interval and once established almost never changed over many weeks to months. Endplate signal alterations (Modic changes) were uncommon. Schmorl nodes show no change from baseline for up to 2 1/2 years. All findings predominated in the lower intervertebral levels from T6 to T10. The most prevalent thoracic spine disc-related findings are degeneration and herniation. Disc herniations predominate in the lower segments and are a dynamic phenomenon. Disc degeneration can be rapidly evolving but tends to remain unchanged after occurrence. Endplate marrow signal changes were an uncommon manifestation of thoracic disc disease. Schmorl nodes showed the least change over time. (orig.)

  20. Neurological Complications Following Endoluminal Repair of Thoracic Aortic Disease

    International Nuclear Information System (INIS)

    Morales, J. P.; Taylor, P. R.; Bell, R. E.; Chan, Y. C.; Sabharwal, T.; Carrell, T. W. G.; Reidy, J. F.

    2007-01-01

    Open surgery for thoracic aortic disease is associated with significant morbidity and the reported rates for paraplegia and stroke are 3%-19% and 6%-11%, respectively. Spinal cord ischemia and stroke have also been reported following endoluminal repair. This study reviews the incidence of paraplegia and stroke in a series of 186 patients treated with thoracic stent grafts. From July 1997 to September 2006, 186 patients (125 men) underwent endoluminal repair of thoracic aortic pathology. Mean age was 71 years (range, 17-90 years). One hundred twenty-eight patients were treated electively and 58 patients had urgent procedures. Anesthesia was epidural in 131, general in 50, and local in 5 patients. Seven patients developed paraplegia (3.8%; two urgent and five elective). All occurred in-hospital apart from one associated with severe hypotension after a myocardial infarction at 3 weeks. Four of these recovered with cerebrospinal fluid (CSF) drainage. One patient with paraplegia died and two had permanent neurological deficit. The rate of permanent paraplegia and death was 1.6%. There were seven strokes (3.8%; four urgent and three elective). Three patients made a complete recovery, one had permanent expressive dysphasia, and three died. The rate of permanent stroke and death was 2.1%. Endoluminal treatment of thoracic aortic disease is an attractive alternative to open surgery; however, there is still a risk of paraplegia and stroke. Permanent neurological deficits and death occurred in 3.7% of the patients in this series. We conclude that prompt recognition of paraplegia and immediate insertion of a CSF drain can be an effective way of recovering spinal cord function and improving the prognosis

  1. Warm fresh whole blood and thoracic traumain iraq and afghanistan.

    Science.gov (United States)

    Keneally, Ryan J; Parsons, Andrew M; Willett, Peter B

    2015-01-01

    Thoracic trauma occurred in 10% of the patients seen at US military treatment facilities in Iraq and Afghanistan and 52% of those patients were transfused. Among those transfused, 281 patients received warm fresh whole blood. A previous report documented improved survival with warm fresh whole blood in patients injured in combat without stratification by injury pattern. A later report described an increase in acute lung injuries after its administration. Survivorship and warm fresh whole blood have never been analyzed in a subpopulation at highest risk for lung injuries, such as patients with thoracic trauma. There may be a heterogeneous relationship between whole blood and survival based on likelihood of a concomitant pulmonary injury. In this report, the relationship between warm fresh whole blood and survivorship was analyzed among patients at highest risk for concomitant pulmonary injuries. Patients with thoracic trauma who received a transfusion were identified in the Joint Theater Trauma Registry. Gross mortality rates were compared between whole blood recipients and patients transfused with component therapy only. The association between each blood component and mortality was determined in a regression model. The overall mortality risk was compared between warm fresh whole blood recipients and non-recipients. Patients transfused with warm fresh whole blood in addition to component therapy had a higher mortality rate than patients transfused only separated blood components (21.3% vs. 12.8%, P warm fresh whole blood in addition to component therapy was not associated with increased mortality risk compared with the transfusion of component therapy only (OR 1.247 [95% CI 0.760-2.048], P = 0.382). Patients with combat related thoracic trauma transfused with warm fresh whole blood were not at increased risk for mortality compared to those who received component therapy alone when controlling for covariates.

  2. Haemothorax and Thoracic Spine Fractures in the Elderly

    OpenAIRE

    Michael A. Masteller; Aakash Chauhan; Harsha Musunuru; Mark M. Walsh; Bryan Boyer; Joseph A. Prahlow

    2012-01-01

    Both osteoporotic fractures and pleural effusions are frequently observed in medicine. However, rarely does one associate a hemorrhagic pleural effusion with a thoracic spinal fracture when the patient has not sustained massive trauma. In this paper, we discuss two cases where seemingly insignificant low-energy trauma precipitated massive haemothoraces in elderly patients with underlying osteoporosis, ultimately resulting in their immediate causes of death. This paper serves to remind health ...

  3. Home Mechanical Ventilation: A Canadian Thoracic Society Clinical Practice Guideline

    OpenAIRE

    McKim, Douglas A; Road, Jeremy; Avendano, Monica; Abdool, Steve; Côté, Fabien; Duguid, Nigel; Fraser, Janet; Maltais, François; Morrison, Debra L; O’Connell, Colleen; Petrof, Basil J; Rimmer, Karen; Skomro, Robert

    2011-01-01

    Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of user-friendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV) exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee ha...

  4. Association Between Thoracic Aortic Disease and Inguinal Hernia

    OpenAIRE

    Olsson, Christian; Eriksson, Per; Franco?Cereceda, Anders

    2014-01-01

    Background The study hypothesis was that thoracic aortic disease (TAD) is associated with a higher?than?expected prevalence of inguinal hernia. Such an association has been reported for abdominal aortic aneurysm (AAA) and hernia. Unlike AAA, TAD is not necessarily detectable with clinical examination or ultrasound, and there are no population?based screening programs for TAD. Therefore, conditions associated with TAD, such as inguinal hernia, are of particular clinical relevance. Methods and ...

  5. Instantaneous Respiratory Estimation from Thoracic Impedance by Empirical Mode Decomposition

    OpenAIRE

    Wang, Fu-Tai; Chan, Hsiao-Lung; Wang, Chun-Li; Jian, Hung-Ming; Lin, Sheng-Hsiung

    2015-01-01

    Impedance plethysmography provides a way to measure respiratory activity by sensing the change of thoracic impedance caused by inspiration and expiration. This measurement imposes little pressure on the body and uses the human body as the sensor, thereby reducing the need for adjustments as body position changes and making it suitable for long-term or ambulatory monitoring. The empirical mode decomposition (EMD) can decompose a signal into several intrinsic mode functions (IMFs) that disclos...

  6. The role of diagnostic VATS in penetrating thoracic injuries

    Directory of Open Access Journals (Sweden)

    Guasti Guido

    2006-10-01

    Full Text Available Abstract Background Penetrating chest injuries account for 1–13% of thoracic trauma hospital admissions and most of these are managed with a conservative approach. Nevertheless, 18–30% of cases managed only with tube thoracostomy have residual clotted blood, considered the major risk factor for the development of fibrothorax and empyema. In addition, 4–23% of chest injury patients present persistent pneumothorax and 15–59% present an injury to the diaphragm, which is missed in 30% of cases. In order to make a correct diagnosis, reduce the number of missed injuries, chronic sequelae and late mortality we propose performing surgical exploration of all patients with a penetrating injury of the pleural cavity. Methods 1270 patients who sustained thoracic trauma were admitted to our hospital between 1994 and 2004. Of these, 16 patients had penetrating injuries: thirteen were surgically explored by means of Video Assisted Thoracic Surgery (VATS, and 3 with thoracotomy due to hemodynamic instability or suspected lesion of the heart or great vessels. Results In the 13 patients who underwent VATS, 5 injuries to the diaphragm, 3 lesions to an intercostal artery, and 1 lesion to the diaphragmatic artery were detected. In 12 of these patients a laceration of the pulmonary parenchyma was also present. A conversion to thoracotomy was necessary due to a broad laceration of the diaphragm and due to hemostasis of an intercostal artery. In all but one case, which was later converted, diagnostic imaging missed the diagnosis of laceration of the diaphragm. There was no intra- or postoperative mortality, and average hospital stay was five days. Conclusion VATS is a safe and effective way to diagnose and manage penetrating thoracic injuries, and its extensive use leads to a reduction in the number of missed, potentially fatal lesions as well as in chronic sequelae.

  7. Novel Split Chest Tube Improves Post-Surgical Thoracic Drainage.

    Science.gov (United States)

    Olivencia-Yurvati, Albert H; Cherry, Brandon H; Gurji, Hunaid A; White, Daniel W; Newton, J Tyler; Scott, Gary F; Hoxha, Besim; Gourlay, Terence; Mallet, Robert T

    2014-01-01

    Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costo-diaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at -20 cm H2O for 30 min. When D5W was infused, the split drain left a residual volume of 53 ± 99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P=0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, Pdrain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications.

  8. The role of wet lab in thoracic surgery.

    Science.gov (United States)

    Bedetti, Benedetta; Schnorr, Philipp; Schmidt, Joachim; Scarci, Marco

    2017-01-01

    During the last three decades, minimally invasive surgery has become common practice in all kinds of surgical disciplines and, in Thoracic Surgery, the minimally invasive approach is recommended as the treatment of choice for early-stage non-small cell lung cancer. Nevertheless, all over the world a large number of lobectomies is still performed by conventional open thoracotomy and not as video-assisted thoracic surgery (VATS), which shows the need of a proper training for this technique. Development and improvement of surgical skills are not only challenging and time-consuming components of the training curriculum for resident or fellow surgeons, but also for more experienced consultants learning new techniques. The rapid evolution of medical technologies like VATS or robotic surgery requires an evolution of the existing educational models to improve cognitive and procedural skills before reaching the operating room in order to increase patient safety. Nowadays, in the Thoracic Surgery field, there is a wide range of simulation-based training methods for surgeons starting or wanting to improve their learning curve in VATS. Aim is to overcome the learning curve required to successfully master this new technique in a brief time. In general, the basic difference between the various learning techniques is the distinction between "dry" and "wet" lab modules, which mainly reflects the use of synthetic or animal-model-based materials. Wet lab trainings can be further sub-divided into in vivo modules, where living anaesthetized animals are used, and ex vivo modules, where only animal tissues serve as basis of the simulation-based training method. In the literature, the role of wet lab in Thoracic Surgery is still debated.

  9. [Characteristics of porcine thoracic arteries fixed with polyepoxy compound].

    Science.gov (United States)

    Yu, Xi-Xun; Chen, Huai-Qing

    2005-09-01

    To investigate the characteristics of porcine thoracic arteries fixed with ethylene glycol diglycidyl ether (EX-810) and to provide the proper scaffold materials for tissue-engineered blood vessel. The porcine thoracic arteries were respectively treated with 40 ml/L EX-810 and 6.25 g/L glutaraldehyde, and then they were examined with naked-eye, light microscope and scanning electron microscope. The fixation index determination, the amino acid analysis and the biomechanics test were also performed. The antigenicity of vascular tissues can be diminished by EX-810 through getting rid of cell in the vascular tissues or reducing the level of free amino groups in the vascular tissues. The structural integrity of vascular tissues can be preserved after treatment with EX-810. It was also found that the EX-810-fixed porcine vascular tissues appeared more similar to the natural vascular tissues in color and mechanical properties, and were more pliable than the glutaraldehyde-fixed tissues. The EX-810-fixed porcine thoracic arteries with low cytotoxicity and low antigenicity showed favorable characteristic similar to those of natural vessel, and it should be a promising material for fabricating scaffold of tissue-engineered blood vessel.

  10. Thoracic aortic aneurysm in a buck associated with caseous lymphadenitis

    Directory of Open Access Journals (Sweden)

    R.R. Pinheiro

    2013-06-01

    Full Text Available This paper reports the clinical, bacteriological and pathological findings of a thoracic aortic aneurysm in a four-year-old Anglo-Nubian goat buck, related to a framework of visceral caseous lymphadenitis. General clinical examination showed heart rate of 75 beats per minute, respiratory rate of 20 movements per minute and ruminal movements of four movements per minute. Superficial lymph nodes were normal upon palpation. Rectal temperature was slightly high (40.5°C. Blood test showed an intense leukocytosis (54,000/µL, characterized by strong neutrophil shift to the left. At necropsy, a large blood clot was detected in the thoracic cavity. The thickening of the myocardium and dilatation of the aorta in the thoracic portion, presenting a saculiform format was also observed. A large number of abscesses were disseminated in the media and intima layers of aorta. The aorta lumen obstruction by arterial plaques consisting of inflammatory infiltrate, predominantly neutrophilic was also detected. Abscesses were found spread in turbinate, rumen, reticulum, kidneys, liver, spleen, testicles and aorta wall. The microbiological exam of exudate confirmed Corynebacterium pseudotuberculosis as the causal agent.

  11. Thoracic radiography and oxidative stress indices in heartworm affected dogs

    Directory of Open Access Journals (Sweden)

    P. K. Rath

    2014-09-01

    Full Text Available Aim: The aim was to study the pathomorphological changes through thoracic radiography and status of oxidative stress parameters in heartworm affected dogs in Odisha. Materials and Methods: A total of 16 dogs with clinically established diagnosis of dirofilariasis by wet blood smear and modified Knott’s test and equal numbers of dogs as control were included in this study. The present study was conducted in heartworm affected dogs to see the pathomorphological changes through thoracic radiography. Similarly, the evaluation was undertaken for observing any alterations in oxidative stress status in affected as well as non-affected, but healthy control dogs by adopting standard procedure. Results: Thoracic radiography revealed cardiac enlargement, round heart appearance suggestive of right ventricular hypertrophy, tortuous pulmonary artery and darkening of lungs. Alterations in oxidative stress indices showed a significant rise of lipid peroxidase activity, non-significant rise of superoxide dismutase and a significant although reverse trend for catalase levels in affected dogs in comparison to Dirofilaria negative control but apparently healthy dogs. Conclusions: Radiographic changes, as well as alterations in oxidative stress parameters, may not be diagnostic for heartworm infection, but useful for detecting heartworm disease, assessing severity and evaluating cardiopulmonary parenchyma changes and gives a fair idea about the degree of severity of the disease. It aids as contributing factors in disease pathogenesis.

  12. The Effect of Chlorpyrifos on Isolated Thoracic Aorta in Rats

    Directory of Open Access Journals (Sweden)

    Ebru Yıldırım

    2013-01-01

    Full Text Available This study investigated the effect of chlorpyrifos on thoracic aorta and on the level of NO in plasma and aorta. The effect of chlorpyrifos on thoracic aorta in organ bath was determined in 10 rats. Another 45 rats were assigned to 3 groups with 15 rats each: control group 1 received distilled water, control group 2 was given corn oil, and the last group was given 13.5 mg/kg chlorpyrifos dissolved in corn oil every other day for 8 weeks orally. Chlorpyrifos (10−10 M–10−5 M showed no effect on isolated thoracic aorta. Plasma AChE activity was decreased, while LDH, ALT, GGT, and AST activities were increased in chlorpyrifos group compared to control groups. Plasma NO level was increased in chlorpyrifos group compared to control groups. iNOS expression was present in all groups in the cytoplasm of the endothelia and in the smooth muscle cells of aorta. According to semiquantitative histomorphological analysis, iNOS immunopositive reactions were seen in the decreasing order in chlorpyrifos, control 2, and control 1 groups. eNOS immunopositive reactions were observed in the endothelial cell cytoplasm, rarely in the subintimal layer, and the smooth muscle cells of aorta. There were no differences among the groups in terms of eNOS immunostaining. In conclusion, chlorpyrifos induced NO production in aorta following an increase in NOS expression.

  13. The Effect of Chlorpyrifos on Isolated Thoracic Aorta in Rats

    Science.gov (United States)

    Yıldırım, Ebru; Baydan, Emine; Kanbur, Murat; Kul, Oğuz; Çınar, Miyase; Ekici, Hüsamettin; Atmaca, Nurgül

    2013-01-01

    This study investigated the effect of chlorpyrifos on thoracic aorta and on the level of NO in plasma and aorta. The effect of chlorpyrifos on thoracic aorta in organ bath was determined in 10 rats. Another 45 rats were assigned to 3 groups with 15 rats each: control group 1 received distilled water, control group 2 was given corn oil, and the last group was given 13.5 mg/kg chlorpyrifos dissolved in corn oil every other day for 8 weeks orally. Chlorpyrifos (10−10 M–10−5 M) showed no effect on isolated thoracic aorta. Plasma AChE activity was decreased, while LDH, ALT, GGT, and AST activities were increased in chlorpyrifos group compared to control groups. Plasma NO level was increased in chlorpyrifos group compared to control groups. iNOS expression was present in all groups in the cytoplasm of the endothelia and in the smooth muscle cells of aorta. According to semiquantitative histomorphological analysis, iNOS immunopositive reactions were seen in the decreasing order in chlorpyrifos, control 2, and control 1 groups. eNOS immunopositive reactions were observed in the endothelial cell cytoplasm, rarely in the subintimal layer, and the smooth muscle cells of aorta. There were no differences among the groups in terms of eNOS immunostaining. In conclusion, chlorpyrifos induced NO production in aorta following an increase in NOS expression. PMID:23878805

  14. Rib fractures in blunt chest trauma - associated thoracic injuries

    Directory of Open Access Journals (Sweden)

    Iv. Dimitrov

    2017-09-01

    Full Text Available PURPOSE. The aim of our retrospective study was to analyze the patterns of associated thoracic injuries in patients underwent blunt chest trauma and rib fractures. METHODS. The study included 212 patients with rib fractures due to blunt thoracic trauma. The mechanism of trauma, the type of rib fracture and the type of associated injuries were analyzed. RESULTS. The patients were divided in two groups according to the number of fractured ribs-group I included the patients with up to two fractured ribs (72 patients-33,9%, and group II – with ≥3 fractured ribs (140 patients-66,1%. Associated chest injuries were present in 36 of the patients from group I (50%, and in 133 patients from group II (95%. Pulmonary contusion was the most common intrathoracicinjurie-65,6% of the cases. The mean hospital stay was 8, 7 days. The lethality rate was 16,9% -all of them due to the associated chest injuries. CONCLUSIONS. The mortality related to rib fractures is affected by the associated thoracic injuries, the advanced age, and the number of fractured ribs.

  15. Thoracic epidural steroid injection for rib fracture pain.

    Science.gov (United States)

    Rauchwerger, Jacob J; Candido, Kenneth D; Deer, Timothy R; Frogel, Jonathan K; Iadevaio, Robert; Kirschen, Neil B

    2013-06-01

    Treatment for rib fracture pain can be broadly divided into pharmacologic approaches with oral and/or parenteral medication and interventional approaches utilizing neuraxial analgesia or peripheral nerve blocks to provide pain relief. Both approaches attempt to control nociceptive and neuropathic pain secondary to osseous injury and nerve insult, respectively. Success of treatment is ultimately measured by the ability of the selected modality to decrease pain, chest splinting, and to prevent sequelae of injury, such as pneumonia. Typically, opioids and NSAIDs are the drugs of first choice for acute pain because of ease of administration, immediate onset of action, and rapid titration to effect. In contrast, neuropathic pain medications have a slower onset of action and are more difficult to titrate to therapeutic effect. Interventional approaches include interpleural catheters, intercostal nerve blocks, paravertebral nerve blocks, and thoracic and lumbar epidural catheters. Each intervention has its own inherent advantages, disadvantages, and success rates. Rib fracture pain management practice is founded on the thoracic surgical and anesthesiology literature. Articles addressing rib fracture pain are relatively scarce in the pain medicine literature. As life expectancy increases, and as healthcare system modifications are implemented, pain medicine physicians may be consulted to treat increasing number of patients suffering rib fracture pain and may need to resort to novel therapeutic measures because of financial constraints imposed by those changes. Here we present the first published case series of thoracic epidural steroid injections used for management of rib fracture pain. © 2012 The Authors Pain Practice © 2012 World Institute of Pain.

  16. Morphology of the thoracic limb bones in the giant anteater

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    Fabrício Singaretti de Oliveira

    2013-11-01

    Full Text Available The giant anteater has a grayish-brown pelage with white and black tones, its skull is elongated, cylindrical, and there are no teeth. Its tail is long, with thick and long bristles, resembling a flag. This is an endangered species, due to the constant degradation of its habitat, in addition to deaths caused by fires and roadkills. Thus, this paper aimed to describe the morphology of the thoracic limb bones in Myrmecophaga tridactyla, focusing on its main bone accidents. We used two specimens of giant anteater collected on highways in the state of Minas Gerais, Brazil, after death due to being run over. The scapula, humerus, radius, ulna, and the hand bones showed particular characteristics adapted to the species’ lifestyle and habits. In general, the scapula resembles that in human beings and the humerus is similar to that in armadillo, the radius and ulna exhibit articular surfaces which enable a wide range of rotational movements in the forearm, the carpal bones are also similar in number and shape to those in human beings, and the fingers are well developed in the giant anteater, having long, strong and sharp claws, especially in the third finger. Thus, the anatomical description of the thoracic limb bones in the giant anteater showed to be important, providing a deeper understanding both of the functional aspects of the thoracic limb and the comparative anatomy of wild animals.

  17. Bovine aortic arch: A novel association with thoracic aortic dilation

    International Nuclear Information System (INIS)

    Malone, C.D.; Urbania, T.H.; Crook, S.E.S.; Hope, M.D.

    2012-01-01

    Aim: To investigate whether there is a link between bovine arch and thoracic aortic aneurysm. Materials and methods: Computed tomography (CT) and magnetic resonance imaging (MRI) images of the thorax of 191 patients with dilated thoracic aortas and 391 consecutive, unselected patients as controls were retrospectively reviewed. Bovine arch was considered present if either a shared origin of the left common carotid and innominate arteries or an origin of the left common carotid from the innominate artery was identified. A chi-square test was used to evaluate the significance of differences between subgroups. Results: A trend towards increased prevalence of bovine arch was seen in patients with dilated aortas (26.2%) compared to controls (20.5%, p = 0.12). The association was statistically significant in patients over 70 years old (31.9%, p = 0.019) and when dilation involved the aortic arch (47.6%, p = 0.003). Conclusions: An association between bovine arch and aortic dilation is seen in older patients, and when dilation involves the aortic arch. Bovine arch should be considered a potential risk factor for thoracic aortic aneurysm.

  18. A rare malformation of urinary system: Right ectopic thoracic kidney

    Directory of Open Access Journals (Sweden)

    Musab Ilgi

    2017-01-01

    Full Text Available An ectopic kidney is a common developmental anomaly of the urinary system. However, the thoracic kidney (TK is the rarest state form of an aberrant kidney. The aim of this case report is defining the symptoms in TK diagnosis and constructing a treatment model will promote the best outcomes. These patients come to the physician with the various symptoms, and they could be diagnosed incidentally. In our case, we describe 40 years female patient with severe respiratory problems and upper back pain. In the pulmonary clinic, suspected mass was diagnosed with chest X-ray, and computerized tomography detected nontraumatic nonhernia associated, a truly ectopic TK. Moreover, the thoracic surgeon and urologist team decided to exploration and reconstructed the right ectopic kidney. The 1st month of the control of patient symptoms was disappeared. Overall, TK should be kept in mind in the differential diagnosis of thoracic tumors. Surgical exploration and reconstruction should be thought in patients who have severe respiratory symptoms.

  19. Ligamentum flavum hematomas of the cervical and thoracic spine.

    Science.gov (United States)

    Wild, Florian; Tuettenberg, Jochen; Grau, Armin; Weis, Joachim; Krauss, Joachim K

    2014-01-01

    To report extremely rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Only six cases of thoracic ligamentum flavum hematomas and three cases of cervical ligamentum flavum hematomas have been reported so far. Two patients presented with tetraparesis and one patient presented with radicular pain and paresthesias in the T3 dermatome. MRI was performed in two patients, which showed a posterior intraspinal mass, continuous with the ligamentum flavum. The mass was moderately hypointense on T2-weighted images and hyperintense on T1-weighted images with no contrast enhancement. The third patient underwent cervical myelography because of a cardiac pacemaker. The myelography showed an intraspinal posterior mass with compression of the dural sac at C3/C4. All patients underwent a hemilaminectomy to resect the ligamentum flavum hematoma and recovered completely afterwords, and did not experience a recurrence during follow-up of at least 2 years. This case series shows rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Surgery achieved complete recovery of the preoperative symptoms in all patients within days. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. Navigating the pathway to robotic competency in general thoracic surgery.

    Science.gov (United States)

    Seder, Christopher W; Cassivi, Stephen D; Wigle, Dennis A

    2013-01-01

    Although robotic technology has addressed many of the limitations of traditional videoscopic surgery, robotic surgery has not gained widespread acceptance in the general thoracic community. We report our initial robotic surgery experience and propose a structured, competency-based pathway for the development of robotic skills. Between December 2008 and February 2012, a total of 79 robot-assisted pulmonary, mediastinal, benign esophageal, or diaphragmatic procedures were performed. Data on patient characteristics and perioperative outcomes were retrospectively collected and analyzed. During the study period, one surgeon and three residents participated in a triphasic, competency-based pathway designed to teach robotic skills. The pathway consisted of individual preclinical learning followed by mentored preclinical exercises and progressive clinical responsibility. The robot-assisted procedures performed included lung resection (n = 38), mediastinal mass resection (n = 19), hiatal or paraesophageal hernia repair (n = 12), and Heller myotomy (n = 7), among others (n = 3). There were no perioperative mortalities, with a 20% complication rate and a 3% readmission rate. Conversion to a thoracoscopic or open approach was required in eight pulmonary resections to facilitate dissection (six) or to control hemorrhage (two). Fewer major perioperative complications were observed in the later half of the experience. All residents who participated in the thoracic surgery robotic pathway perform robot-assisted procedures as part of their clinical practice. Robot-assisted thoracic surgery can be safely learned when skill acquisition is guided by a structured, competency-based pathway.

  1. Instantaneous Respiratory Estimation from Thoracic Impedance by Empirical Mode Decomposition

    Directory of Open Access Journals (Sweden)

    Fu-Tai Wang

    2015-07-01

    Full Text Available Impedance plethysmography provides a way to measure respiratory activity by sensing the change of thoracic impedance caused by inspiration and expiration. This measurement imposes little pressure on the body and uses the human body as the sensor, thereby reducing the need for adjustments as body position changes and making it suitable for long-term or ambulatory monitoring. The empirical mode decomposition (EMD can decompose a signal into several intrinsic mode functions (IMFs that disclose nonstationary components as well as stationary components and, similarly, capture respiratory episodes from thoracic impedance. However, upper-body movements usually produce motion artifacts that are not easily removed by digital filtering. Moreover, large motion artifacts disable the EMD to decompose respiratory components. In this paper, motion artifacts are detected and replaced by the data mirrored from the prior and the posterior before EMD processing. A novel intrinsic respiratory reconstruction index that considers both global and local properties of IMFs is proposed to define respiration-related IMFs for respiration reconstruction and instantaneous respiratory estimation. Based on the experiments performing a series of static and dynamic physical activates, our results showed the proposed method had higher cross correlations between respiratory frequencies estimated from thoracic impedance and those from oronasal airflow based on small window size compared to the Fourier transform-based method.

  2. Instantaneous Respiratory Estimation from Thoracic Impedance by Empirical Mode Decomposition.

    Science.gov (United States)

    Wang, Fu-Tai; Chan, Hsiao-Lung; Wang, Chun-Li; Jian, Hung-Ming; Lin, Sheng-Hsiung

    2015-07-07

    Impedance plethysmography provides a way to measure respiratory activity by sensing the change of thoracic impedance caused by inspiration and expiration. This measurement imposes little pressure on the body and uses the human body as the sensor, thereby reducing the need for adjustments as body position changes and making it suitable for long-term or ambulatory monitoring. The empirical mode decomposition (EMD) can decompose a signal into several intrinsic mode functions (IMFs) that disclose nonstationary components as well as stationary components and, similarly, capture respiratory episodes from thoracic impedance. However, upper-body movements usually produce motion artifacts that are not easily removed by digital filtering. Moreover, large motion artifacts disable the EMD to decompose respiratory components. In this paper, motion artifacts are detected and replaced by the data mirrored from the prior and the posterior before EMD processing. A novel intrinsic respiratory reconstruction index that considers both global and local properties of IMFs is proposed to define respiration-related IMFs for respiration reconstruction and instantaneous respiratory estimation. Based on the experiments performing a series of static and dynamic physical activates, our results showed the proposed method had higher cross correlations between respiratory frequencies estimated from thoracic impedance and those from oronasal airflow based on small window size compared to the Fourier transform-based method.

  3. The History of the Department of Cardiovascular and Thoracic Surgery at Rush.

    Science.gov (United States)

    Faber, L Penfield; Liptay, Michael J; Seder, Christopher W

    2016-01-01

    The Rush Department of Cardiovascular and Thoracic Surgery received certification by the American Board of Thoracic Surgery (ABTS) to train thoracic surgical residents in 1962. The outstanding clinical faculty, with nationally recognized technical expertise, was eager to provide resident education. The hallmark of the program has been clinical excellence, dedication to patient care, and outstanding results in complex cardiac, vascular, and general thoracic surgical procedures. A strong commitment to resident education has been carried to the present time. Development of the sternotomy incision, thoracic and abdominal aneurysm repair, carotid endarterectomy, along with valve replacement, have been the hallmark of the section of cardiovascular surgery. Innovation in bronchoplastic lung resection, aggressive approach to thoracic malignancy, and segmental resection for lung cancer identify the section of general thoracic surgery. A total of 131 thoracic residents have been trained by the Rush Thoracic Surgery program, and many achieved their vascular certificate, as well. Their training has been vigorous and, at times, difficult. They carry the Rush thoracic surgical commitment of excellence in clinical surgery and patient care throughout the country, both in practice groups and academic centers. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Personalized Medicine and Infectious Disease Management.

    Science.gov (United States)

    Jensen, Slade O; van Hal, Sebastiaan J

    2017-11-01

    A recent study identified pathogen factors associated with an increased mortality risk in Staphylococcus aureus bacteremia, using predictive modelling and a combination of genotypic, phenotypic, and clinical data. This study conceptually validates the benefit of personalized medicine and highlights the potential use of whole genome sequencing in infectious disease management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Characteristics of Hodgkin's lymphoma after infectious mononucleosis

    DEFF Research Database (Denmark)

    Hjalgrim, Henrik; Askling, Johan; Rostgaard, Klaus

    2003-01-01

    BACKGROUND: Infectious mononucleosis-related Epstein-Barr virus (EBV) infection has been associated with an increased risk of Hodgkin's lymphoma in young adults. Whether the association is causal remains unclear. METHODS: We compared the incidence rates of Hodgkin's lymphoma in two population...

  6. Infectious Disease Risk Associated with Space Flight

    Science.gov (United States)

    Pierson, Duane L.

    2010-01-01

    This slide presentation opens with views of the shuttle in various stages of preparation for launch, a few moments after launch prior to external fuel tank separation, a few pictures of the earth,and several pictures of astronomical interest. The presentation reviews the factors effecting the risks of infectious disease during space flight, such as the crew, water, food, air, surfaces and payloads and the factors that increase disease risk, the factors affecting the risk of infectious disease during spaceflight, and the environmental factors affecting immunity, such as stress. One factor in space infectious disease is latent viral reactivation, such as herpes. There are comparisons of the incidence of viral reactivation in space, and in other analogous situations (such as bed rest, or isolation). There is discussion of shingles, and the pain and results of treatment. There is a further discussion of the changes in microbial pathogen characteristics, using salmonella as an example of the increased virulence of microbes during spaceflight. A factor involved in the risk of infectious disease is stress.

  7. Neutropenic enterocolitis (typhlitis) associated with infectious mononucleosis

    International Nuclear Information System (INIS)

    Sigirci, Ahmet; Akinci, Aysehan; Oezgen, Uensal; Oezen, Metehan

    2006-01-01

    Neutropenic enterocolitis (typhlitis) is an unusual acute complication of neutropenia, most often associated with leukaemia and lymphoma and characterized by segmental caecal and ascending colonic ulceration that may progress to necrosis, perforation, and septicaemia. We present a unique case of an 8-year-old girl with recently diagnosed infectious mononucleosis having findings consistent with typhlitis on abdominal CT. (orig.)

  8. Infectious mononucleosis presenting as bilateral acute dacryocystitis.

    Science.gov (United States)

    Atkinson, P L; Ansons, A M; Patterson, A

    1990-01-01

    A case of infectious mononucleosis presenting as bilateral acute dacryocystitis in a 7-year-old girl is reported. Acute dacryocystitis is uncommon in this age group, and an underlying systemic illness should be suspected particularly when it is bilateral. Images PMID:2275940

  9. Neutropenic enterocolitis (typhlitis) associated with infectious mononucleosis

    Energy Technology Data Exchange (ETDEWEB)

    Sigirci, Ahmet [Inonu University School of Medicine, Department of Radiology, Turgut Ozal Medical Centre, Malatya (Turkey); Akinci, Aysehan; Oezgen, Uensal; Oezen, Metehan [Inonu University School of Medicine, Department of Paediatrics, Turgut Ozal Medical Centre, Malatya (Turkey)

    2006-02-01

    Neutropenic enterocolitis (typhlitis) is an unusual acute complication of neutropenia, most often associated with leukaemia and lymphoma and characterized by segmental caecal and ascending colonic ulceration that may progress to necrosis, perforation, and septicaemia. We present a unique case of an 8-year-old girl with recently diagnosed infectious mononucleosis having findings consistent with typhlitis on abdominal CT. (orig.)

  10. Extreme weather events and infectious disease outbreaks.

    Science.gov (United States)

    McMichael, Anthony J

    2015-01-01

    Human-driven climatic changes will fundamentally influence patterns of human health, including infectious disease clusters and epidemics following extreme weather events. Extreme weather events are projected to increase further with the advance of human-driven climate change. Both recent and historical experiences indicate that infectious disease outbreaks very often follow extreme weather events, as microbes, vectors and reservoir animal hosts exploit the disrupted social and environmental conditions of extreme weather events. This review article examines infectious disease risks associated with extreme weather events; it draws on recent experiences including Hurricane Katrina in 2005 and the 2010 Pakistan mega-floods, and historical examples from previous centuries of epidemics and 'pestilence' associated with extreme weather disasters and climatic changes. A fuller understanding of climatic change, the precursors and triggers of extreme weather events and health consequences is needed in order to anticipate and respond to the infectious disease risks associated with human-driven climate change. Post-event risks to human health can be constrained, nonetheless, by reducing background rates of persistent infection, preparatory action such as coordinated disease surveillance and vaccination coverage, and strengthened disaster response. In the face of changing climate and weather conditions, it is critically important to think in ecological terms about the determinants of health, disease and death in human populations.

  11. THE PATHOLOGY OF INFECTIOUS BURSAL DISEASE IN ...

    African Journals Online (AJOL)

    An outbreak of infectious bursal disease (IBD) occurred in a flock of 11-week old crossbreeds of Harco cocks and indigenous Nigerian hens (referred to as exotic and locals respectively in the text). Clinical signs observed include depression, anorexia, ruffled feathers and diarrhoea. Haemorrhages were present in the bursa ...

  12. Population dynamics and infectious diseases in Asia

    National Research Council Canada - National Science Library

    Sleigh, Adrian

    2006-01-01

    ... such as SARS. David J BRADLEY is Ross Professor of Tropical Hygiene Emeritus at the London School of Hygiene and Tropical Medicine and Leverhulme Emeritus Fellow in the Department of Zoology, Oxford University. He has worked on the epidemiology and control of vector-borne and infectious diseases, water in relation to health, and concepts in international h...

  13. Infectious agents are associated with psychiatric diseases

    Directory of Open Access Journals (Sweden)

    Daniela Lydia Krause

    2012-01-01

    Full Text Available There are several infectious agents in the environment that can cause persistent infections in the host. They usually cause their symptoms shortly after first infection and later persist as silent viruses and bacteria within the body. However, these chronic infections may play an important role in the pathogenesis of schizophrenia and Tourette’s syndrome (TS. We investigated the distribution of different neurotrophic infectious agents in TS, schizophrenia and controls. A total of 93 individuals were included (schizophrenic patients, Tourette patients and controls. We evaluated antibodies against cytomegalovirus (CMV, herpes-simplex virus (HSV, Epstein-Barr virus, Toxoplasma, Mycoplasma and Chlamydia trachomatis/pneumoniae. By comparing schizophrenia and TS, we found a higher prevalence of HSV (P=0.017 and CMV (P=0.017 antibodies in schizophrenic patients. Considering the relationship between schizophrenia, TS and healthy controls, we showed that there are associations for Chlamydia trachomatis (P=0.007, HSV (P=0.027 and CMV (P=0.029. When all measured viruses, bacteria and protozoa were combined, schizophrenic patients had a higher rate of antibodies to infectious agents than TS patients (P=0.049. Tourette and schizophrenic patients show a different vulnerability to infectious agents. Schizophrenic patients were found to have a higher susceptibility to viral infections than individuals with TS. This finding might point to a modification in special immune parameters in these diseases.

  14. Epidemiological and antibiotic susceptibility profiles of infectious ...

    African Journals Online (AJOL)

    2011-09-28

    Sep 28, 2011 ... profiles of infectious bacterial diarrhoea in Juba, ... a Field Epidemiology and Laboratory Training Program (FELTP) resident, Jomo Kenyatta University of Agriculture and Technology, Nairobi, ... Teaching Hospital (JTH), Al Sabah children's hospital, .... Only 12 (4.2%) participants reached higher education.

  15. [Emerging infectious diseases: complex, unpredictable processes].

    Science.gov (United States)

    Guégan, Jean-François

    2016-01-01

    In the light of a double approach, at first empirical, later theoretical and comparative, illustrated by the example of the Buruli ulcer and its mycobacterial agent Mycobacterium ulcerans on which I focused my research activity these last ten years by studying determinants and factors of emerging infectious or parasitic diseases, the complexity of events explaining emerging diseases will be presented. The cascade of events occurring at various levels of spatiotemporal scales and organization of life, which lead to the numerous observed emergences, nowadays requires better taking into account the interactions between host(s), pathogen(s) and the environment by including the behavior of both individuals and the population. In numerous research studies on emerging infectious diseases, microbial hazard is described rather than infectious disease risk, the latter resulting from the confrontation between an association of threatening phenomena, or hazards, and a susceptible population. Beyond, the theme of emerging infectious diseases and its links with global environmental and societal changes leads to reconsider some well-established knowledge in infectiology and parasitology. © Société de Biologie, 2017.

  16. [Combined physiotherapy of chronic infectious prostatitis].

    Science.gov (United States)

    Churakov, A A; Popkov, V M; Zemskov, S P; Glybochko, P V; Bliumberg, B I

    2007-01-01

    Our experience with therapy of 259 outpatients with chronic infectious prostatitis (CIP) aged 16-55 years has demonstrated that combined treatment of CIP with rectal digital massage of the prostate, electrophoresis of chimotripsin solution with dimexide and local magnetotherapy (Intramag unit) significantly raises treatment efficacy, shortens treatment, prevents complications.

  17. An overview of post infectious coughs

    Directory of Open Access Journals (Sweden)

    Samrad Mehrabi

    2016-03-01

    Full Text Available Coughs lasting more than 3 weeks after airway infections are likely regarded as post-infectious coughs. A normal chest radiography unfavors possibility of pulmonary infection. These coughs are selflimited. This study reviews conducted studies in order to identify and define prevalence, pathogenesis, and cure of post-infectious constant coughs. The necessary data and guidelines are gained from English articles in PubMed website. Post-infectious and cough are searched. Post-infectious cough pathogenesis are not known; nevertheless, inflammation, epithelial damages of upper and lower airways, increased mucus secretion, and an increased reactivity of airways can cause these coughs. Despite self-limitedness of these coughs; dextromethorphan, antihistamines, ipratropium bromide, and decongestant are usually prescribed for cure of these coughs. Conversely, antibiotics play no significant role in this regard. These coughs constitutes smaller percentage of chronic coughs and are primarily classified in subacute coughs. Further studies should cover sub-acute and chronic properties of these coughs as well as their prevalence in different age groups and their determinants.

  18. Infectious disease protection for healthcare security officers.

    Science.gov (United States)

    D'Angelo, Michael S; Arias, Jean

    2015-01-01

    Healthcare Security should be considered an active component in an infectious disease event, the authors maintain, and security officers must be included in an Employee Health screening and N95 fit testing initiative to safely welcome the incoming infected patients. In this article, they spell out the different levels of precautions officers should become familiar with in order to protect themselves.

  19. Infectious Disease Transmission during Transfusion and Transplantation

    Centers for Disease Control (CDC) Podcasts

    2012-08-13

    Dr. Matthew Kuehnert, Director of the Office of Blood, Organ, and Other Tissue Safety, discusses infections in transplants.  Created: 8/13/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 8/15/2012.

  20. Thoracic and respirable particle definitions for human health risk assessment.

    Science.gov (United States)

    Brown, James S; Gordon, Terry; Price, Owen; Asgharian, Bahman

    2013-04-10

    Particle size-selective sampling refers to the collection of particles of varying sizes that potentially reach and adversely affect specific regions of the respiratory tract. Thoracic and respirable fractions are defined as the fraction of inhaled particles capable of passing beyond the larynx and ciliated airways, respectively, during inhalation. In an attempt to afford greater protection to exposed individuals, current size-selective sampling criteria overestimate the population means of particle penetration into regions of the lower respiratory tract. The purpose of our analyses was to provide estimates of the thoracic and respirable fractions for adults and children during typical activities with both nasal and oral inhalation, that may be used in the design of experimental studies and interpretation of health effects evidence. We estimated the fraction of inhaled particles (0.5-20 μm aerodynamic diameter) penetrating beyond the larynx (based on experimental data) and ciliated airways (based on a mathematical model) for an adult male, adult female, and a 10 yr old child during typical daily activities and breathing patterns. Our estimates show less penetration of coarse particulate matter into the thoracic and gas exchange regions of the respiratory tract than current size-selective criteria. Of the parameters we evaluated, particle penetration into the lower respiratory tract was most dependent on route of breathing. For typical activity levels and breathing habits, we estimated a 50% cut-size for the thoracic fraction at an aerodynamic diameter of around 3 μm in adults and 5 μm in children, whereas current ambient and occupational criteria suggest a 50% cut-size of 10 μm. By design, current size-selective sample criteria overestimate the mass of particles generally expected to penetrate into the lower respiratory tract to provide protection for individuals who may breathe orally. We provide estimates of thoracic and respirable fractions for a variety of

  1. Infectious and non-infectious neurologic complications in heart transplant recipients.

    Science.gov (United States)

    Muñoz, Patricia; Valerio, Maricela; Palomo, Jesús; Fernández-Yáñez, Juan; Fernández-Cruz, Ana; Guinea, Jesús; Bouza, Emilio

    2010-05-01

    Neurologic complications are important causes of morbidity and mortality in heart transplant (HT) recipients. New immunomodulating agents have improved survival rates, although some have been associated with a high rate of neurologic complications (infectious and non-infectious). We conducted this study to analyze the frequency of these complications, before and after the use of daclizumab induction therapy. We reviewed all neurologic complications in our HT cohort, comparing infectious with non-infectious complications over 2 periods of time in which different induction therapies were used (316 patients with OKT3 or antithymocyte globulin from 1988 to 2002, and 68 patients with daclizumab from 2003 to 2006). Neurologic complications were found in 75/384 patients (19.5%) with a total of 78 episodes. Non-infectious complications accounted for 68% of the 78 episodes of neurologic complications. A total of 51 patients and 53 episodes were detailed as follows: 25 episodes of stroke (25 of 78 total episodes, 32%; 19 ischemic, 6 hemorrhagic); 7 neuropathies; 6 seizures; 4 episodes of transient ischemic attack (TIA); 3 anoxic encephalopathy; 2 each brachial plexus palsy and metabolic encephalopathy; and 1 each myoclonia, central nervous system (CNS) lymphoma, subdural hematoma, and Cotard syndrome. Mean time to presentation of stroke, TIA, and encephalopathy was 1 day (range, 1-19 d) posttransplant. Mortality rate among non-infectious complications was 12/53 (22.6%). Infectious complications accounted for 32% of the 78 total episodes. We found 25 episodes in 24 patients: 17 herpes zoster (median, 268 d after HT), 3 CNS aspergillosis (median, 90 d after HT), 1 CNS toxoplasmosis and tuberculosis (51 d after HT), 1 pneumococcal meningitis (402 d after HT), and 2 Listeria meningitis (median, 108 d after HT). The 3 patients with CNS aspergillosis died. The mortality rate among patients with infectious neurologic complications was 12% (42.8% if the CNS was involved). When we

  2. Full-thickness thoracic laminar erosion after posterior spinal fusion associated with late-presenting infection.

    Science.gov (United States)

    Tribus, Clifford B; Garvey, Kathleen E

    2003-05-15

    A case report describes unilateral complete laminar erosion of the caudal thoracic spine and late-presenting infection in a patient 10 years after anteroposterior reconstruction for scoliosis. To present an unusual but significant complication that may occur after implantation of spinal instrumentation. The reported patient presented with a deep infection and persistent back pain 10 years after successful anteroposterior reconstruction for adult idiopathic scoliosis. Delayed onset infections after implantation of spinal instrumentation are infrequent, yet when present, often require hardware removal. The case of a 51-year-old woman who underwent irrigation and debridement for a late-presenting infection and removal of posterior hardware 10 years after her index procedure is presented. Interoperatively, it was noted that full-thickness laminar erosion was present from T4 to T12. The patient was taken to the operating room for wound irrigation, debridement, and hardware removal. It was discovered that a Cotrel-Dubousset rod placed on the convexity of the curve had completely eroded through the lamina of T7-T12. Infectious material was found along the entire length of both the convex and concave Cotrel-Dubousset rods. Intraoperative cultures grew Staphylococcus epidermidis and Propionibacterium acnes. Intravenous and oral antibiotics were administered, resulting in resolution of the infection and preoperative pain. The exact role of late-presenting infection with regard to the laminar erosion and rod migration seen in this case remains to be elucidated. However, the authors believe the primary cause of bony erosion was mechanical in origin. Regardless, most spine surgeons will treat many patients who have had posterior spinal implants and will perform hardware removal on a significant number of these patients during their careers. A full-thickness laminar erosion exposes the spinal cord to traumatic injury during hardware removal and debridement. This case is

  3. Thoracic ROM measurement system with visual bio-feedback: system design and biofeedback evaluation.

    Science.gov (United States)

    Ando, Takeshi; Kawamura, Kazuya; Fujitani, Junko; Koike, Tomokazu; Fujimoto, Masashi; Fujie, Masakatsu G

    2011-01-01

    Patients with diseases such as chronic obstructive pulmonary disease (COPD) need to improve their thorax mobility. Thoracic ROM is one of the simplest and most useful indexes to evaluate the respiratory function. In this paper, we have proposed the prototype of a simple thoracic ROM measurement system with real-time visual bio-feedback in the chest expansion test. In this system, the thoracic ROM is measured using a wire-type linear encoder whose wire is wrapped around the thorax. In this paper, firstly, the repeatability and reliability of measured thoracic ROM was confirmed as a first report of the developed prototype. Secondly, we analyzed the effect of the bio-feedback system on the respiratory function. The result of the experiment showed that it was easier to maintain a large and stable thoracic ROM during deep breathing by using the real-time visual biofeedback system of the thoracic ROM.

  4. National Infectious Diseases Surveillance data of South Korea.

    Science.gov (United States)

    Park, Sunhee; Cho, Eunhee

    2014-01-01

    The Korea Centers for Disease Control and Prevention (KCDC) operate infectious disease surveillance systems to monitor national disease incidence. Since 1954, Korea has collected data on various infectious diseases in accordance with the Infectious Disease Control and Prevention Act. All physicians (including those working in Oriental medicine) who diagnose a patient with an infectious disease or conduct a postmortem examination of an infectious disease case are obliged to report the disease to the system. These reported data are incorporated into the database of the National Infectious Disease Surveillance System, which has been providing web-based real-time surveillance data on infectious diseases since 2001. In addition, the KCDC analyzes reported data and publishes the Infectious Disease Surveillance Yearbook annually.

  5. Bilateral sixth cranial nerve palsy in infectious mononucleosis.

    Science.gov (United States)

    Neuberger, J.; Bone, I.

    1979-01-01

    A 15-year-old girl who presented with a bilateral sixth nerve palsy caused by infectious mononucleosis is described. The neurological presentation of infectious mononucleosis is discussed. PMID:225738

  6. Art in Science: Selections from Emerging Infectious Diseases

    Centers for Disease Control (CDC) Podcasts

    Polyxeni Potter, retired managing editor of the Emerging Infectious Diseases journal, discusses the history of the journal and her new book, Art in Science: Selections from Emerging Infectious Diseases.

  7. Thoracic manual therapy is not more effective than placebo thoracic manual therapy in patients with shoulder dysfunctions: A systematic review with meta-analysis.

    Science.gov (United States)

    Bizzarri, Paolo; Buzzatti, Luca; Cattrysse, Erik; Scafoglieri, Aldo

    2018-02-01

    Manual treatments targeting different regions (shoulder, cervical spine, thoracic spine, ribs) have been studied to deal with patients complaining of shoulder pain. Thoracic manual treatments seem able to produce beneficial effects on this group of patients. However, it is not clear whether the patient improvement is a consequence of thoracic manual therapy or a placebo effect. To compare the efficacy of thoracic manual therapy and placebo thoracic manual treatment for patients with shoulder dysfunction. Electronic databases (MEDLINE, CENTRAL, PEDro, CINAHL, WoS, EMBASE, ERIC) were searched through November 2016. Randomized Controlled Trials assessing pain, mobility and function were selected. The Cochrane bias estimation tool was applied. Outcome results were either extracted or computed from raw data. Meta-analysis was performed for outcomes with low heterogeneity. Four studies were included in the review. The methodology of the included studies was generally good except for one study that was rated as high risk of bias. Meta-analysis showed no significant effect for "pain at present" (SMD -0.02; 95% CI: -0.35, 0.32) and "pain during movement" (SMD -0.12; 95% CI: -0.45, 0.21). There is very low to low quality of evidence that a single session of thoracic manual therapy is not more effective than a single session of placebo thoracic manual therapy in patients with shoulder dysfunction at immediate post-treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Major morbidity after video-assisted thoracic surgery lung resections: a comparison between the European Society of Thoracic Surgeons definition and the Thoracic Morbidity and Mortality system.

    Science.gov (United States)

    Sandri, Alberto; Papagiannopoulos, Kostas; Milton, Richard; Kefaloyannis, Emmanuel; Chaudhuri, Nilanjan; Poyser, Emily; Spencer, Nicholas; Brunelli, Alessandro

    2015-07-01

    The thoracic morbidity and mortality (TM&M) classification system univocally encodes the postoperative adverse events by their management complexity. This study aims to compare the distribution of the severity of complications according to the TM&M system versus the distribution according to the classification proposed by European Society of Thoracic Surgeons (ESTS) Database in a population of patients submitted to video assisted thoracoscopic surgery (VATS) lung resection. A total of 227 consecutive patients submitted to VATS lobectomy for lung cancer were analyzed. Any complication developed postoperatively was graded from I to V according to the TM&M system, reflecting the increasing severity of its management. We verified the distribution of the different grades of complications and analyzed their frequency among those defined as "major cardiopulmonary complications" by the ESTS Database. Following the ESTS definitions, 20 were the major cardiopulmonary complications [atrial fibrillation (AF): 10, 50%; adult respiratory distress syndrome (ARDS): 1, 5%; pulmonary embolism: 2, 10%; mechanical ventilation >24 h: 1, 5%; pneumonia: 3, 15%; myocardial infarct: 1, 5%; atelectasis requiring bronchoscopy: 2, 10%] of which 9 (45%) were reclassified as minor complications (grade II) by the TM&M classification system. According to the TM&M system, 10/34 (29.4%) of all complications were considered minor (grade I or II) while 21/34 (71.4%) as major (IIIa: 8, 23.5%; IIIb: 4, 11.7%; IVa: 8, 23.5%; IVb: 1, 2.9%; V: 3, 8.8%). Other 14 surgical complications occurred and were classified as major complications according to the TM&M system. The distribution of postoperative complications differs between the two classification systems. The TM&M grading system questions the traditional classification of major complications following VATS lung resection and may be used as an additional endpoint for outcome analyses.

  9. JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

    International Nuclear Information System (INIS)

    Ricci, Carmelo; Ceccherini, Claudio; Leonini, Sara; Cini, Marco; Vigni, Francesco; Neri, Eugenio; Tucci, Enrico; Benvenuti, Antonio; Tommasino, Giulio; Sassi, Carlo

    2012-01-01

    An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

  10. Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion

    Directory of Open Access Journals (Sweden)

    Ahmed M Hasanin

    2017-01-01

    Conclusion: Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method.

  11. Uniportal video-assisted thoracic surgery course in Mexico-first experience.

    Science.gov (United States)

    Céspedes-Meneses, Erick; Echavarri-Arana, José Manuel; Tort-Martínez, Alejandro; Guzmán-de Alba, Enrique; das Neves-Pereira, Joao Carlos; González-Rivas, Diego

    2016-01-01

    "The First Minimally Invasive Thoracic Surgery Uniportal Course" in Mexico was held from July 13 th to 15 th in Mexico City, at the National Institute of Respiratory Diseases (INER). Thoracic surgeons from around Mexico assisted the course. The special guests were the Spanish doctor Diego González-Rivas and the Brasilian doctor Joao Carlos das Neves-Pereira. The course included live surgery and wet lab. Demonstration of the uniportal video-assisted thoracic surgery (VATS) technique was done. The course was a success and Mexican thoracic surgeons were ready to adopt this technique.

  12. From Diagnosis to Treatment: Clinical Applications of Nanotechnology in Thoracic Surgery.

    Science.gov (United States)

    Digesu, Christopher S; Hofferberth, Sophie C; Grinstaff, Mark W; Colson, Yolonda L

    2016-05-01

    Nanotechnology is an emerging field with potential as an adjunct to cancer therapy, particularly thoracic surgery. Therapy can be delivered to tumors in a more targeted fashion, with less systemic toxicity. Nanoparticles may aid in diagnosis, preoperative characterization, and intraoperative localization of thoracic tumors and their lymphatics. Focused research into nanotechnology's ability to deliver both diagnostics and therapeutics has led to the development of nanotheranostics, which promises to improve the treatment of thoracic malignancies through enhanced tumor targeting, controlled drug delivery, and therapeutic monitoring. This article reviews nanoplatforms, their unique properties, and the potential for clinical application in thoracic surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Supraclavicular scalenectomy for thoracic outlet syndrome--functional outcomes assessed using the DASH scoring system.

    LENUS (Irish Health Repository)

    Glynn, Ronan W

    2012-02-01

    To evaluate supraclavicular scalenectomy ± cervical rib excision for thoracic outlet syndrome (TOS), employing Disability of Arm, Shoulder, and Hand (DASH) scoring for functional assessment post-decompression.

  14. 76 FR 27070 - National Institute of Allergy and Infectious Diseases;

    Science.gov (United States)

    2011-05-10

    ... Allergy and Infectious Diseases; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... Infectious Diseases Special Emphasis Panel, NIAID Peer Review Meeting 1. Date: June 1, 2011. Time: 8 a.m. to... Institute of Allergy and Infectious Diseases Special Emphasis Panel, NIAID Peer Review Meeting 2. Date: June...

  15. 21 CFR 866.5640 - Infectious mononucleosis immunological test system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Infectious mononucleosis immunological test system....5640 Infectious mononucleosis immunological test system. (a) Identification. An infectious mononucleosis immunological test system is a device that consists of the reagents used to measure by...

  16. Art in Science: Selections from Emerging Infectious Diseases

    Centers for Disease Control (CDC) Podcasts

    2014-02-12

    Polyxeni Potter, retired managing editor of the Emerging Infectious Diseases journal, discusses the history of the journal and her new book, Art in Science: Selections from Emerging Infectious Diseases.  Created: 2/12/2014 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 2/13/2014.

  17. Treatment of traumatic rupture of the thoracic aorta

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2008-01-01

    Full Text Available INTRODUCTION Interest for traumatic thoracic aorta rupture stems from the fact that its number continually increases, and it can be rapidly lethal. OBJECTIVE The aim of this study is to present early and long term results as well as experiences of our team in surgical treatment of traumatic thoracic aorta rupture. METHOD Our retrospective study includes 12 patients with traumatic thoracic aorta rupture treated between 1985 and 2007. There were 10 male and two female patients of average age 30.75 years (18-74. RESULTS In six cases, primary diagnosis was established during the first seven days days after trauma, while in 6 more than one month later. In 11 cases, classical open surgical procedure was performed, while endovascular treatment was used in one patient. Three (25% patients died, while two (16.6% had paraplegia. Nine patients (75% were treated without complications, and are in good condition after a mean follow-up period of 9.7 years (from one month to 22 years. CONCLUSION Surgical treatment requires spinal cord protection to prevent paraplegia, using cardiopulmonary by-pass (three of our cases or external heparin-bonded shunts (five of our cases. Cardiopulmonary by-pass is followed with lower incidence of paraplegia, however it is not such a good solution for patients with polytrauma because of hemorrhage. The endovascular repair is a safe and feasible procedure in the acute phase, especially because of traumatic shock and polytrauma which contributes to higher mortality rate after open surgery. On the other hand, in chronic postrauamatic aortic rupture, open surgical treatment is connected with a lower mortality rate and good long-term results. There have been no published data about long-term results of endovascular treatment in the chronic phase.

  18. Lower thoracic rib stress fractures in baseball pitchers.

    Science.gov (United States)

    Gerrie, Brayden J; Harris, Joshua D; Lintner, David M; McCulloch, Patrick C

    2016-01-01

    Stress fractures of the first rib on the dominant throwing side are well-described in baseball pitchers; however, lower thoracic rib fractures are not commonly recognized. While common in other sports such as rowing, there is scant literature on these injuries in baseball. Intercostal muscle strains are commonly diagnosed in baseball pitchers and have a nearly identical presentation but also a highly variable healing time. The diagnosis of a rib stress fracture can predict a more protracted recovery. This case series presents two collegiate baseball pitchers on one team during the same season who were originally diagnosed with intercostal muscle strains, which following magnetic resonance imaging (MRI) were found to have actually sustained lower thoracic rib stress fractures. The first sustained a stress fracture of the posterior aspect of the right 8th rib on the dominant arm side, while the second presented with a left-sided 10th rib stress fracture on the nondominant arm side. In both cases, MRI was used to visualize the fractures as plain radiographs are insensitive and commonly negative early in patient presentation. Patients were treated with activity modification, and symptomatic management for 4-6 weeks with a graduated return to throwing and competition by 8-10 weeks. The repetitive high stresses incurred by pitching may cause either dominant or nondominant rib stress fractures and this should be included in the differential diagnosis of thoracic injuries in throwers. It is especially important that athletic trainers and team physicians consider this diagnosis, as rib fractures may have a protracted course and delayed return to play. Additionally, using the appropriate imaging techniques to establish an accurate diagnosis can help inform return-to-play decisions, which have important practical applications in baseball, such as roster management and eligibility.

  19. Eye-hand laterality and right thoracic idiopathic scoliosis.

    Science.gov (United States)

    Catanzariti, Jean-François; Guyot, Marc-Alexandre; Agnani, Olivier; Demaille, Samantha; Kolanowski, Elisabeth; Donze, Cécile

    2014-06-01

    The adolescent idiopathic scoliosis (AIS) pathogenesis remains unknown. Certain studies have shown that there is a correlation between manual laterality and scoliotic deviation. A full study of manual laterality needs to be paired with one for visual dominance. With the aim of physiopathological research, we have evaluated the manual and visual laterality in AIS. A retrospective study from prospective data collection is used to evaluate the distribution of eye-hand laterality (homogeneous or crossed) of 65 right thoracic AIS (mean age 14.8 ± 1.8 years; mean Cobb angle: 32.8°) and a control group of 65 sex and age-matched (mean age 14.6 ± 1.8 years). The manual laterality was defined by the modified Edinburgh Handedness Inventory. The evaluation of the visual laterality is done using three tests (kaleidoscope test, hole-in-the-card test, distance-hole-in-the-card test). The group of right thoracic AIS presents a significantly higher frequency of crossed eye-hand laterality (63 %) than the control group (63 vs. 29.2 %; p laterality is "right hand dominant-left eye dominant" (82.9 %). There is no relationship with the Cobb angle. Those with right thoracic AIS show a higher occurrence of crossed eye-hand laterality. This could point physiopathological research of AIS towards functional abnormality of the optic chiasma through underuse of cross visual pathways, and in particular accessory optic pathways. It would be useful to explore this by carrying out research on AISs through neuroimaging and neurofunctional exploration.

  20. Physiological Interaction of Heart and Lung in Thoracic Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Ghobadi, Ghazaleh; Veen, Sonja van der [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Department of Cell Biology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Bartelds, Beatrijs [Center for Congenital Heart Disease, Beatrix Children Hospital, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Boer, Rudolf A. de [Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Dickinson, Michael G. [Center for Congenital Heart Disease, Beatrix Children Hospital, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Jong, Johan R. de [Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Faber, Hette; Niemantsverdriet, Maarten [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Department of Cell Biology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Brandenburg, Sytze [Kernfysisch Versneller Instituut, University of Groningen, Groningen (Netherlands); Berger, Rolf M.F. [Center for Congenital Heart Disease, Beatrix Children Hospital, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Coppes, Robert P. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Department of Cell Biology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Luijk, Peter van, E-mail: p.van.luijk@umcg.nl [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)

    2012-12-01

    Introduction: The risk of early radiation-induced lung toxicity (RILT) limits the dose and efficacy of radiation therapy of thoracic tumors. In addition to lung dose, coirradiation of the heart is a known risk factor in the development RILT. The aim of this study was to identify the underlying physiology of the interaction between lung and heart in thoracic irradiation. Methods and Materials: Rat hearts, lungs, or both were irradiated to 20 Gy using high-precision proton beams. Cardiopulmonary performance was assessed using breathing rate measurements and F{sup 18}-fluorodeoxyglucose positron emission tomography ({sup 18}F-FDG-PET) scans biweekly and left- and right-sided cardiac hemodynamic measurements and histopathology analysis at 8 weeks postirradiation. Results: Two to 12 weeks after heart irradiation, a pronounced defect in the uptake of {sup 18}F-FDG in the left ventricle (LV) was observed. At 8 weeks postirradiation, this coincided with LV perivascular fibrosis, an increase in LV end-diastolic pressure, and pulmonary edema in the shielded lungs. Lung irradiation alone not only increased pulmonary artery pressure and perivascular edema but also induced an increased LV relaxation time. Combined irradiation of lung and heart induced pronounced increases in LV end-diastolic pressure and relaxation time, in addition to an increase in right ventricle end-diastolic pressure, indicative of biventricular diastolic dysfunction. Moreover, enhanced pulmonary edema, inflammation and fibrosis were also observed. Conclusions: Both lung and heart irradiation cause cardiac and pulmonary toxicity via different mechanisms. Thus, when combined, the loss of cardiopulmonary performance is intensified further, explaining the deleterious effects of heart and lung coirradiation. Our findings show for the first time the physiological mechanism underlying the development of a multiorgan complication, RILT. Reduction of dose to either of these organs offers new opportunities to

  1. [Implementation of a robotic video-assisted thoracic surgical program].

    Science.gov (United States)

    Baste, J-M; Riviera, C; Nouhaud, F-X; Rinieri, P; Melki, J; Peillon, C

    2016-03-01

    Recent publications from North America have shown the benefits of robot-assisted thoracic surgery. We report here the process of setting up such a program in a French university centre and early results in a unit with an average treatment volume. Retrospective review of a single institution database. The program was launched after a 6-month preparation period. From January 2012 to January 2013, totally endoscopic, full robot-assisted procedures were performed on 30 patients (17 males). Median age was 54 [Q1-Q3, 48-63] years and ASA score 2 [1,2]. Operative procedures included thymectomy (9 ; 30%), lobectomy with nodes resection (11 ; 38%), segmentectomy (4 ; 14%), lymphadenectomy (3 ; 10%), Bronchogenic cyst (2, 5%) and posterior mediastinal mass resection (1 ; 3%). No conversion was required. Median blood loss was 50mL [10-100]. Median operating time was 135 min (105-165) including 30 min [20-40] for docking, 90min for robot-assisted operating [70-120] and 15 min [10-15] for lesion extraction. CO2 insufflation was used in 28 cases (93%). Hospital stay was 4 days [4-6] with 6 minor complications (20%) (Grade 1 according to the Clavien-Dindo classification). After a median 4 months follow-up [2-7], all patients were alive and demonstrated a good quality of life. This series suggests that full robotic thoracic procedures are safe and effective treatment for various pathologies, with low morbidity and without a significant learning curve, even in a lower volume centre. This technology should accompany the development of minimally invasive thoracic surgery. The importance of robotic training should be emphasized to optimize procedures and costs. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  2. Profile of thoracic trauma victims submitted to chest drainage

    Directory of Open Access Journals (Sweden)

    CESAR AUGUSTO BROSKA JÚNIOR

    Full Text Available ABSTRACT Objective: to describe and compare the variables involved in trauma victims undergoing thoracic drainage. Methods: we conducted a retrospective, analytical, descriptive, cross-sectional study, with medical records of patients attended at the Trauma Service of the Curitiba Evangelical University Hospital between February 2011 and January 2014. Results: there were 488 patients undergoing chest drainage, 84.7% men and 15.3% women, with an average age of 38.2 years. Attendances usually occurred at night, without predominance between open or closed mechanism, gender or age group. The majority of patients with thoracic trauma requiring drainage were diagnosed by anamnesis and physical examination (41.1% and drained in the emergency room (80.8%. Most of the patients (66.2% had another associated lesion, mostly some abdominal viscera. Complications were present in 16.6% (81 patients, most of them due to drainage positioning error (9.2%. The mean hospital stay was 15 days and drainage lasted for an average of 8.1 days, with no statistical difference between open and closed trauma. The clinical outcome was discharge in most cases. Conclusion: the profile of patients with thoracic trauma is that of young men, attended at night, with some other associated lesion. Although diagnosis and treatment were rapid and most often without the need for complex examinations, the time of drainage, hospitalization and complications were higher than in the literature, which can be explained by the drainage being made at the Emergency Room and the presence of associated injuries.

  3. Infectious diseases in Greenlanders of Upernavik

    DEFF Research Database (Denmark)

    Bjerregaard, P

    1985-01-01

    of disease was similar in all age groups. Of these contacts 26% were caused by acute upper respiratory tract infections, 8% by other acute respiratory infections, 10% by chronic respiratory infections, 24% by non-traumatic skin infections, 7% by post-traumatic skin infections, 8% by sexually transmitted...... diseases, and 17% by other infections. Skin infections were most common in males, whereas all other infections were most common in females. The patterns of age specific contact rates were similar in males and females, except regarding "other infections". A peak of respiratory infections in July and of skin...... infections during winter was noted. The contact rate for all infectious diseases together was slightly higher than in Danish general practice, and infectious diseases also accounted for a larger proportion of all registered contacts. Contacts due to chronic respiratory infections, skin infections...

  4. Anti-Infectious Agents against MRSA

    Directory of Open Access Journals (Sweden)

    Nobuhiro Koyama

    2012-12-01

    Full Text Available Clinically useful antibiotics, β-lactams and vancomycin, are known to inhibit bacterial cell wall peptidoglycan synthesis. Methicillin-resistant Staphylococcus aureus (MRSA has a unique cell wall structure consisting of peptidoglycan and wall teichoic acid. In recent years, new anti-infectious agents (spirohexaline, tripropeptin C, DMPI, CDFI, cyslabdan, 1835F03, and BPH-652 targeting MRSA cell wall biosynthesis have been discovered using unique screening methods. These agents were found to inhibit important enzymes involved in cell wall biosynthesis such as undecaprenyl pyrophosphate (UPP synthase, FemA, flippase, or UPP phosphatase. In this review, the discovery, the mechanism of action, and the future of these anti-infectious agents are described.

  5. Discovering network behind infectious disease outbreak

    Science.gov (United States)

    Maeno, Yoshiharu

    2010-11-01

    Stochasticity and spatial heterogeneity are of great interest recently in studying the spread of an infectious disease. The presented method solves an inverse problem to discover the effectively decisive topology of a heterogeneous network and reveal the transmission parameters which govern the stochastic spreads over the network from a dataset on an infectious disease outbreak in the early growth phase. Populations in a combination of epidemiological compartment models and a meta-population network model are described by stochastic differential equations. Probability density functions are derived from the equations and used for the maximal likelihood estimation of the topology and parameters. The method is tested with computationally synthesized datasets and the WHO dataset on the SARS outbreak.

  6. Thoracic involvement in generalised lymphatic anomaly (or lymphangiomatosis

    Directory of Open Access Journals (Sweden)

    Francesca Luisi

    2016-06-01

    Full Text Available Generalised lymphatic anomaly (GLA, also known as lymphangiomatosis, is a rare disease caused by congenital abnormalities of lymphatic development. It usually presents in childhood but can also be diagnosed in adults. GLA encompasses a wide spectrum of clinical manifestations ranging from single-organ involvement to generalised disease. Given the rarity of the disease, most of the information regarding it comes from case reports. To date, no clinical trials concerning treatment are available. This review focuses on thoracic GLA and summarises possible diagnostic and therapeutic approaches.

  7. Advances in chest drain management in thoracic disease

    Science.gov (United States)

    George, Robert S.

    2016-01-01

    An adequate chest drainage system aims to drain fluid and air and restore the negative pleural pressure facilitating lung expansion. In thoracic surgery the post-operative use of the conventional underwater seal chest drainage system fulfills these requirements, however they allow great variability amongst practices. In addition they do not offer accurate data and they are often inconvenient to both patients and hospital staff. This article aims to simplify the myths surrounding the management of chest drains following chest surgery, review current experience and explore the advantages of modern digital chest drain systems and address their disease-specific use. PMID:26941971

  8. Dose effect relationships in cervical and thoracic radiation myelopathies

    International Nuclear Information System (INIS)

    Holdorff, B.

    1980-01-01

    The course and prognosis of radiation myelopathies are determined by 3 factors: the segmental (vertical) location of the lesion, the extent of the transverse syndrome (complete or incomplete) and the radiation dose. The median spinal dose in cervical radiation myelopathies with fatal outcome was higher than in survivals with an incomplete transverse syndrome. In thoracic radiation myelopathies a dose difference between complete and incomplete transverse syndromes could be found as well. Incomplete transverse syndromes as submaximum radiation injuries are more suitable for the determination of the spinal tolerance dose than complete transverse syndromes. The lowest threshold could be stated for cases following high-volume irradiation of the lymphatic system. (Auth.)

  9. Spinal CT scan, 1. Cervical and thoracic spines

    Energy Technology Data Exchange (ETDEWEB)

    Nakagawa, Hiroshi (Aichi Medical Univ. (Japan))

    1982-01-01

    Methods of CT of the cervical and thoracic spines were explained, and normal CT pictures of them were described. Spinal CT was evaluated in comparison with other methods in various spinal diseases. Plain CT revealed stenosis due to spondylosis or ossification of posterior longitudinal ligament and hernia of intervertebral disc. CT took an important role in the diagnosis of spinal cord tumors with calcification and destruction of the bone. CT scan in combination with other methods was also useful for the diagnosis of spinal injuries, congenital anomalies and infections.

  10. Chondroblastoma of thoracic vertebra in young adult causing paraparesis

    Directory of Open Access Journals (Sweden)

    Giri Pramod J.

    2017-09-01

    Full Text Available Chondroblastoma of spine is very rare condition. To best of our knowledge, fewer than 30 cases have been reported in the world literature. Almost all of them involved both anterior & posterior component of vertebra. There are only few reports with isolated posterior element involvement. Clinical presentation of paraparesis because of vertebral chondroblastoma is very rare. This case report presents 17 yr old male with chondroblastoma involving posterior thoracic vertebra presenting with quadriparesis which improved after successful treatment. Early diagnosis and complete excision with periodic follow up is necessary for treatment of this disease.

  11. Effects of thapsigargin in isolated rat thoracic aorta

    DEFF Research Database (Denmark)

    Mikkelsen, E O; Thastrup, Ole; Christensen, S B

    1988-01-01

    The effect of thapsigargin (Tg) was studied in rat thoracic aorta. Tg (10(-8)-10(-5) M) had a dual effect on rat aorta. Thus, Tg induced a concentration dependent increase in basal tone in normal physiological salt solution (PSS), while Tg in potassium (K+) precontracted aortic rings caused a con...... A 23187 had an endothelium dependent relaxant effect on rat aorta different from that of carbachol. The results indicate that Tg in vascular smooth muscle acts by stimulating the transmembranal influx of extracellular calcium....

  12. Mediastinal pancreatic pseudocyst with isolated thoracic symptoms: a case report

    Directory of Open Access Journals (Sweden)

    Drescher Robert

    2008-05-01

    Full Text Available Abstract Introduction Mediastinal pancreatic pseudocysts represent a rare complication of acute or chronic pancreatitis. Case presentation A 55-year-old man with a history of chronic pancreatitis was admitted with intermittent dyspnea, dysphagia and weight loss. Chest X-ray, computed tomography and magnetic resonance imaging revealed a large paracardial pancreatic pseudocyst causing cardiac and esophageal compression. Conclusion Mediastinal pancreatic pseudocysts are a rare complication of chronic pancreatitis. These pseudocysts may lead to isolated thoracic symptoms. For accurate diagnostic and therapy planning, a multimodal imaging approach is necessary.

  13. Aneurysm growth after late conversion of thoracic endovascular aortic repair

    Directory of Open Access Journals (Sweden)

    Hirofumi Kasahara

    2015-01-01

    Full Text Available A 69-year-old man underwent thoracic endovascular aortic repair of a descending aortic aneurysm. Three years later, he developed impending rupture due to aneurysmal expansion that included the proximal landing zone. Urgent open surgery was performed via lateral thoracotomy, and a Dacron graft was sewn to the previous stent graft distally with Teflon felt reinforcement. Postoperatively, four sequential computed tomography scans demonstrated that the aneurysm was additionally increasing in size probably due to continuous hematoma production, suggesting a possibility of endoleaks. This case demonstrates the importance of careful radiologic surveillance after endovascular repair, and also after partial open conversion.

  14. Phrenic nerve reconstruction in complete video-assisted thoracic surgery.

    Science.gov (United States)

    Kawashima, Shun; Kohno, Tadasu; Fujimori, Sakashi; Yokomakura, Naoya; Ikeda, Takeshi; Harano, Takashi; Suzuki, Souichiro; Iida, Takahiro; Sakai, Emi

    2015-01-01

    Primary or metastatic lung cancer or mediastinal tumours may at times involve the phrenic nerve and pericardium. To remove the pathology en bloc, the phrenic nerve must be resected. This results in phrenic nerve paralysis, which in turn reduces pulmonary function and quality of life. As a curative measure of this paralysis and thus a preventive measure against decreased pulmonary function and quality of life, we have performed immediate phrenic nerve reconstruction under complete video-assisted thoracic surgery, and with minimal additional stress to the patient. This study sought to ascertain the utility of this procedure from an evaluation of the cases experienced to date. We performed 6 cases of complete video-assisted thoracic surgery phrenic nerve reconstruction from October 2009 to December 2013 in patients who had undergone phrenic nerve resection or separation to remove tumours en bloc. In all cases, it was difficult to separate the phrenic nerve from the tumour. Reconstruction involved direct anastomosis in 3 cases and intercostal nerve interposition anastomosis in the remaining 3 cases. In the 6 patients (3 men, 3 women; mean age 50.8 years), we performed two right-sided and four left-sided procedures. The mean anastomosis time was 5.3 min for direct anastomosis and 35.3 min for intercostal nerve interposition anastomosis. Postoperative phrenic nerve function was measured on chest X-ray during inspiration and expiration. Direct anastomosis was effective in 2 of the 3 patients, and intercostal nerve interposition anastomosis was effective in all 3 patients. Diaphragm function was confirmed on X-ray to be improved in these 5 patients. Complete video-assisted thoracic surgery phrenic nerve reconstruction was effective for direct anastomosis as well as for intercostal nerve interposition anastomosis in a small sample of selected patients. The procedure shows promise for phrenic nerve reconstruction and further data should be accumulated over time. © The

  15. Peritonite infecciosa felina: 13 casos Feline infectious peritonitis: 13 cases

    Directory of Open Access Journals (Sweden)

    Fabiano Nunes de Oliveira

    2003-10-01

    clinical signs included loss of weight, anorexia, diarrhea, jaundice, vomiting, swollen lymph nodes, and neurological disturbances. Necropsy findings, in the wet form included excess of yellowish viscous tanslucent or slightly opaque fluid (50ml-1 liter in the peritoneal cavity and (in one case thoracic cavity. Fibrinous exudate covered the serosal surfaces of abdominal organs imparting a whitish, granular, frost-like appearance to them. In the dry form there were multiple granulomatous foci underneath the serosal surface, which extended into the parenchyma of abdominal organs; these findings were particularly prominent in the kidneys. Corneal opacity was observed in one cat. Histologically, there were variable degrees of disseminated piogranulomatous vasculitis and perivasculitis particularly in arterioles. Pyogranulomatous meningitis or meningoencephalitis were observed in three cats with the dry form of feline infectious peritonitis.

  16. INFECTIOUS MYXOMATOSIS (SANARELLI) IN PREGNANT RABBITS

    Science.gov (United States)

    Sprunt, Douglas H.

    1932-01-01

    Pregnancy in rabbits alters the reactivity of the tissues to the virus of infectious myxomatosis. The livers of pregnant animals with the myxoma have a central acidophilic necrosis. Secondary lesions in the lungs are much more numerous and larger in the pregnant than in the non-gravid animals. In like manner the lesions in the spleen are more extensive in the pregnant rabbit. On the other hand the skin lesions of the pregnant animal are decreased in size. PMID:19870088

  17. Magnetic resonance imaging of infectious myositis

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Ji Young; Kim, Jee Young; Kim, Sang Heum; Jung, Youn Ju; Cha, Eun Suk; Park, Joung Mi; Park, Young Ha [The Catholic Univ., College of Medicine, Suwon (Korea, Republic of)

    1998-09-01

    To describe the findings of magnetic resonance imaging in infectious myositis and to determine their value for differentiation between ruberculous and bacterial myositis. Magnetic resonance images of ten proven cases of infectious myositis (five tuberculous and five bacterial) were retrospectively reviewed in the light of clinical and laboratory findings. On the basis of magnetic resonance images, signal intensity of the mass, the presence or absence of an abscess, signal intensity of the peripheral wall, patterns of contrast enhancement, and associated findings were evaluated. Compared with those of bacterial myositis, the symptoms of tuberculous myositis lasted longer but there were no difinite local inflammatory signs. In three of five cases of bacterial myositis there were specific medical records;trauma in two cases and systemic lupus erythematosus in one. All tuberculous myositis cases involved a single muscle, but bacterial myositis affected multipe muscles in three cases(60%). All but one case showed a mass in the involved muscles. In one bacterial case, there was diffuse swelling in the involved muscle. On T1-weighted images, eight infectious cases showed low signal intensity;two, of the bactrerial type, showed subtle increased signal intensity. all cases demonstrated high signal intensity on t2-weighted images. The signal intensity of peripheral wall was slightly increased on T1-weighted images, but low on T2-weighted. In four cases there was associated cellulitis, and in one case each, adjacent joint effusion and deep vein thrombosis were seen. After gadolinium infusion, peripheral rim enhancement was noted in nine cases and heterogeneous enhancement in one. After magnetic resonance imaging of infectious myositis, the characteristic finding was an abscessed lesion, with the peripheral wall showing high signal intensity on T1-weighted images and low signal intensity on T2 weighted. Although we found it difficult to differentiate bacterial from tuberculous

  18. Magnetic resonance imaging of infectious myositis

    International Nuclear Information System (INIS)

    Yun, Ji Young; Kim, Jee Young; Kim, Sang Heum; Jung, Youn Ju; Cha, Eun Suk; Park, Joung Mi; Park, Young Ha

    1998-01-01

    To describe the findings of magnetic resonance imaging in infectious myositis and to determine their value for differentiation between ruberculous and bacterial myositis. Magnetic resonance images of ten proven cases of infectious myositis (five tuberculous and five bacterial) were retrospectively reviewed in the light of clinical and laboratory findings. On the basis of magnetic resonance images, signal intensity of the mass, the presence or absence of an abscess, signal intensity of the peripheral wall, patterns of contrast enhancement, and associated findings were evaluated. Compared with those of bacterial myositis, the symptoms of tuberculous myositis lasted longer but there were no difinite local inflammatory signs. In three of five cases of bacterial myositis there were specific medical records;trauma in two cases and systemic lupus erythematosus in one. All tuberculous myositis cases involved a single muscle, but bacterial myositis affected multipe muscles in three cases(60%). All but one case showed a mass in the involved muscles. In one bacterial case, there was diffuse swelling in the involved muscle. On T1-weighted images, eight infectious cases showed low signal intensity;two, of the bactrerial type, showed subtle increased signal intensity. all cases demonstrated high signal intensity on t2-weighted images. The signal intensity of peripheral wall was slightly increased on T1-weighted images, but low on T2-weighted. In four cases there was associated cellulitis, and in one case each, adjacent joint effusion and deep vein thrombosis were seen. After gadolinium infusion, peripheral rim enhancement was noted in nine cases and heterogeneous enhancement in one. After magnetic resonance imaging of infectious myositis, the characteristic finding was an abscessed lesion, with the peripheral wall showing high signal intensity on T1-weighted images and low signal intensity on T2 weighted. Although we found it difficult to differentiate bacterial from tuberculous

  19. Research Program In Tropical Infectious Diseases

    Science.gov (United States)

    1991-12-15

    Central America at the base of the Yucatan Peninsula, surrounded on the west and north by Guatemala and Mexico and on the east by the Caribbean Sea...inferred that in Belize, 2 tropical infectious diseases are common. Yellow fever has been known to occur in the Yucatan ,1 dengue and malaria are...Centro Americano) representatives in Belize City. Two ERC technologists and two CML technicians attended an INCAP (Instituto de Nutricion de Centro

  20. Emerging infectious diseases – 1970s

    Directory of Open Access Journals (Sweden)

    Robert Ferguson

    2016-10-01

    Full Text Available Forty years ago is not ancient history in the medical field. However, being an eye witness to the emergence of three new infectious diseases in the northeastern United States in the 1970s left a deep impression on this author. I will relate a small portion of the amazing events that caught the attention of the medical establishment and the general public in a roughly 5-year period of medical discovery.

  1. Timeliness of notification in infectious disease cases.

    OpenAIRE

    Domínguez, A; Coll, J J; Fuentes, M; Salleras, L

    1992-01-01

    Records of notification in cases of eight infectious diseases in the "Servei Territorial de Salut Publica" of the Province of Barcelona, Spain, between 1982 and 1986 were reviewed. Time from onset of symptoms to notification, time from notification to completion of data collection, and time from onset to completion of the case investigation were analyzed. For the period from onset to notification, the shortest mean was registered for meningococcal infection (6.31 days) and the longest was for...

  2. A lipidomic concept in infectious diseases

    Directory of Open Access Journals (Sweden)

    Khaled Mohamed Mohamed Koriem

    2017-03-01

    Full Text Available Infectious diseases resemble a great threat to the human health according to World Health Organization where about 17% of all deaths (≈9.2 million deaths in 2013 recorded are related to infectious diseases. The pathogenic microorganisms such as bacteria, viruses, fungi and parasites are the principle causes of infectious diseases. Ebola, AIDS, dengue, hepatitis, malaria, tuberculosis and schistosomiasis are among 216 infectious diseases found where the immunity represents the first line defense in infection. Lipidomic includes examination of different biological lipids in the biological cell. The lipidomic research covers all aspects of individual lipid molecule including its structure, function, connection with other cell constituents such as protein, lipid, and metabolite in both health and disease conditions. Details of cell biology obtained from different pathogens (viruses, bacteria, and parasites provide a great data on molecular structure of host-pathogen relation and consequently on infection process. The lipids here play a very important role in many processes involved in host-pathogen relations. The role of lipid in host-pathogen link includes many processes in (1 structural host constituents, (2 host recognition, (3 intracellular transferring, and (4 energy and resource homeostasis during pathogen duplication. There are many lipid phosphatases, kinases, and lipases molecules that greatly involved in these processes and controlling pathogen expression and infection progress. The cell lipid metabolism depends on an adequate energy stores that push the infection to be accelerated and disease symptoms to be appeared. Consequently, future lipidomics studies are the basic for detecting the lipid role in host-pathogen relations which help in therapy advances and biomarkers development.

  3. Infectious myocarditis (Clinic, diagnostics, principles of treatment

    Directory of Open Access Journals (Sweden)

    Yu. P. Finogeev

    2016-01-01

    Full Text Available Infective myocarditis can be considered as a case of myocardial damage caused by different infectious agents. Traditionally discusses the questions of diagnostics and treatment infectious myocarditis. The paper has repeatedly stressed the difficulty of clinical diagnosis, and the laboriousness and economic costs of laboratory tests and additional researches. Endomyocardial biopsy findings remain the gold standard for unequivocally establishing the diagnosis. However, it is technically extremely invasive test and can be performed only in specialized cardiology centers. The paper analyzes in detail not only own materials, but also results of researches published in numerous domestic and foreign sources of literature. Publication of «Infectious myocarditis» is necessary due to the fact that patients with a diagnosis of «Myocarditis » account for 11% of all cardiovascular disease in the world. Article is timely and necessary for many professionals, senior students of medical universities.

  4. Histopathology for the diagnosis of infectious diseases

    Directory of Open Access Journals (Sweden)

    Gupta E

    2009-01-01

    Full Text Available Histopathological examination of tissue biopsies for the identification of infectious organisms is a very important diagnostic tool. Conventional culture confirmation of tissue biopsies often fail to identify any pathogen as, first of all, invariably most of the tissue samples that are collected and sent for culture isolation are inappropriately collected in formalin, which prevents pathogen growth in culture media. Inadequate processing like grinding, etc. further hinders isolation. Presence of inhibitors like dead tissue debris, fibers, etc. also delays isolation. Microbiologists often lack expertise in identifying infectious pathogens directly from tissue biopsies by microscopic visualization. This review therefore acquaints microbiologists with the various methods available for detecting infectious agents by using histological stains. On histopathological examination of the tissue biopsy once, it is determined that a disease is likely to be due to an infection and has characterized the inflammatory response and hence associated microorganisms should be thoroughly looked for. Although some microorganisms or their cytopathic effects may be clearly visible on routine haematoxylin- and eosin-stained sections, additional histochemical stains are often needed for their complete characterization. Highly specific molecular techniques, such as immunohistochemistry, in situ hybridization and nucleic acid amplification, may be needed in certain instances to establish the diagnosis of infection. Through appropriate morphologic diagnoses and interlaboratory communication and collaboration, direct microscopic visualization of tissue samples can thus be very helpful in reaching a correct and rapid diagnosis.

  5. Epidemiological monitoring for emerging infectious diseases

    Science.gov (United States)

    Greene, Marjorie

    2010-04-01

    The Homeland Security News Wire has been reporting on new ways to fight epidemics using digital tools such as iPhone, social networks, Wikipedia, and other Internet sites. Instant two-way communication now gives consumers the ability to complement official reports on emerging infectious diseases from health authorities. However, there is increasing concern that these communications networks could open the door to mass panic from unreliable or false reports. There is thus an urgent need to ensure that epidemiological monitoring for emerging infectious diseases gives health authorities the capability to identify, analyze, and report disease outbreaks in as timely and efficient a manner as possible. One of the dilemmas in the global dissemination of information on infectious diseases is the possibility that information overload will create inefficiencies as the volume of Internet-based surveillance information increases. What is needed is a filtering mechanism that will retrieve relevant information for further analysis by epidemiologists, laboratories, and other health organizations so they are not overwhelmed with irrelevant information and will be able to respond quickly. This paper introduces a self-organizing ontology that could be used as a filtering mechanism to increase relevance and allow rapid analysis of disease outbreaks as they evolve in real time.

  6. Infectious diseases in atomic bomb survivors

    International Nuclear Information System (INIS)

    Hamada, Tadao; Ishida, Sadamu; Matsushita, Hiroshi.

    1976-01-01

    Incidences of various infectious diseases in 986 autopsy cases at Hiroshima Atomic Bomb Hospital and Hiroshima Red Cross Hospital from 1965 to 1975 were compared according to the distance from the explosion place, and the following results were obtained. There was not a significant difference at incidences of most infectious diseases between each exposured group and not-exposured group. Incidence of old tuberculosis focus was a little higher in exposured groups, but incidences of main lesions such as tuberculosis, active tuberculosis, and miliary tuberculosis were lower in exposured groups and effect of exposure was negative. Out of urinary tract infections, the nearer the distance to the explosion place was, the higher incidence of cistitis in female was. Incidence of cystitis of female was higher than that of male in the group exposured near to the explosion place. With respect to stomach cancer, leukemia, malignant lymphoma, and cerebrovascular disorder, the nearer the distance to the explosion place was, the higher incidences of various infectious diseases were. (Tsunoda, M.)

  7. Is irritable bowel syndrome an infectious disease?

    Science.gov (United States)

    Thompson, John Richard

    2016-01-28

    Irritable bowel syndrome (IBS) is the most common of all gastroenterological diseases. While many mechanisms have been postulated to explain its etiology, no single mechanism entirely explains the heterogeneity of symptoms seen with the various phenotypes of the disease. Recent data from both basic and clinical sciences suggest that underlying infectious disease may provide a unifying hypothesis that better explains the overall symptomatology. The presence of small intestinal bowel overgrowth (SIBO) has been documented in patients with IBS and reductions in SIBO as determined by breath testing correlate with IBS symptom improvement in clinical trials. The incidence of new onset IBS symptoms following acute infectious gastroenteritis also suggests an infectious cause. Alterations in microbiota-host interactions may compromise epithelial barrier integrity, immune function, and the development and function of both central and enteric nervous systems explaining alterations in the brain-gut axis. Clinical evidence from treatment trials with both probiotics and antibiotics also support this etiology. Probiotics appear to restore the imbalance in the microflora and improve IBS-specific quality of life. Antibiotic trials with both neomycin and rifaximin show improvement in global IBS symptoms that correlates with breath test normalization in diarrhea-predominant patients. The treatment response to two weeks of rifaximin is sustained for up to ten weeks and comparable results are seen in symptom reduction with retreatment in patients who develop recurrent symptoms.

  8. Recommended Curriculum for Training in Pediatric Transplant Infectious Diseases.

    Science.gov (United States)

    Danziger-Isakov, Lara; Allen, Upton; Englund, Janet; Herold, Betsy; Hoffman, Jill; Green, Michael; Gantt, Soren; Kumar, Deepali; Michaels, Marian G

    2015-03-01

    A working group representing the American Society of Transplantation, Pediatric Infectious Diseases Society, and International Pediatric Transplant Association has developed a collaborative effort to identify and develop core knowledge in pediatric transplant infectious diseases. Guidance for patient care environments for training and core competencies is included to help facilitate training directed at improving the experience for pediatric infectious diseases trainees and practitioners in the area of pediatric transplant infectious diseases. © The Author 2013. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  9. [Plastic surgery of the thoracic wall as a method of thoracic wall reconstruction after complete surgical wound disintegration after sternotomy].

    Science.gov (United States)

    Hájek, T; Jirásek, K; Urban, M; Straka, Z

    1998-12-01

    During the period between January 1996 and July 1998 in our department 1920 patients were operated on account of heart disease from median sternotomy. In 17 patients, i.e. in 0.9% during the early postoperative period the surgical wound disintegrated incl. dehiscence of the sternum and the development of postoperative mediastinitis. In 14 of these patients the authors reconstructed the defect of the thoracic wall by their own modification of Jurkiewicz plastic operation using the pectoral muscles. One patient from this group died, in the remaining 13 patients the wound healed without deformity of the chest and without signs of instability, without restriction of movement and function.

  10. Thoraco-laparoscopic esophagectomy: thoracic stage in prone position

    Directory of Open Access Journals (Sweden)

    Carlos Bernardo Cola

    Full Text Available ABSTRACT Objective: to analyze the National Cancer Institute Abdominopelvic Division (INCA / MS/HC I initial experience with thoraco-laparoscopic esophagectomy with thoracic stage in prone position. Methods: we studied 19 consecutive thoraco-laparoscopic esophagectomies from may 2012 to august 2014, including ten patients with squamous cells carcinoma (five of the middle third and five of the lower third and nine cases of gastroesophageal junction adenocarcinoma (six Siewert I and three Siewert II. All procedures were initiated by the prone thoracic stage. Results: There were minimal blood loss, optimal mediastinal visualization, oncological radicality and no conversions. Surgical morbidity was 42 %, most being minor complications (58% Clavien I or II, with few related to the technique. The most common complication was cervical anastomotic leak (37%, with a low anastomotic stricture rate (two stenosis: 10.53%. We had one (5.3% surgical related death, due to a gastric tube`s mediastinal leak, treated by open reoperation and neck diversion. The median Intensive Care Unit stay and hospital stay were two and 12 days, respectively. The mean thoracoscopic stage duration was 77 min. Thirteen patients received neoadjuvant treatment (five squamous cells carcinoma and eight gastroesophageal adenocarcinomas. The average lymph node sample had 16.4 lymph nodes per patient and 22.67 when separately analyzing patients without neoadjuvant treatment. Conclusion: the thoraco-laparoscopic approach was a safe technique in the surgical treatment of esophageal cancer, with a good lymph node sampling.

  11. How to get the best from robotic thoracic surgery.

    Science.gov (United States)

    Ricciardi, Sara; Zirafa, Carmelina Cristina; Davini, Federico; Melfi, Franca

    2018-04-01

    The application of Robotic technology in thoracic surgery has become widespread in the last decades. Thanks to its advanced features, the robotic system allows to perform a broad range of complex operations safely and in a comfortable way, with valuable advantages related to low invasiveness. Regarding lung tumours, several studies have shown the benefits of robotic surgery including lower blood loss and improved lymph node removal when compared with other minimally invasive techniques. Moreover, the robotic instruments allow to reach deep and narrow spaces permitting safe and precise removal of tumours located in remote areas, such as retrosternal and posterior mediastinal spaces with outstanding postoperative and oncological results. One controversial finding about the application of robotic system is its high capital and running costs. For this reason, a limited number of centres worldwide are able to employ this groundbreaking technology and there are limited possibilities for the trainees to acquire the necessary skills in robotic surgery. Therefore, a training programme based on three steps of learning, associated with a solid surgical background and a consistent operating activity, are required to obtain effective results. Putting this highest technological innovation in the hand of expert surgeons we can assure safe and effective procedures getting the best from robotic thoracic surgery.

  12. Breast internal dose measurements in a physical thoracic phantom

    Energy Technology Data Exchange (ETDEWEB)

    Silva, S.D.; Oliveira, M.A.; Castro, A.L.S.; Dias, H.G.; Nogueira, L.B.; Campos, T.P.R., E-mail: sadonatosilva@hotmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear; Hospital das Clinicas de Uberlandia, MG (Brazil). Departamento de Oncologia; Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Anatomia e Departamento de Imagem

    2017-10-01

    Radiotherapy is a cancer treatment intended to deposit the entire prescribed dose homogeneously into a target volume in order to eliminate the tumor and to spare the surrounding healthy tissues. This paper aimed to provide a dosimetric comparison between the treatment planning system (TPS) ECLIPSE from Varian Medical Systems and the internal dosimetric measurements in a breast phantom. The methodology consisted in performing a 3D conformal radiotherapy planning with two tangential opposite parallel fields applied to the synthetic breast in a thoracic phantom. The irradiation was reproduced in the Varian Linear accelerator, model SL - 20 Precise, 6 MV energy. EBT2 Radiochromic films, placed into the glandular equivalent tissue of the breast, were used to measure the spatial dose distribution. The absorbed dose was compared to those values predicted by the treatment planning system; besides, the dosimetric uncertainties were analyzed. The modal absorbed dose was in agreement with the prescribed value of 180 cGy, although few high dose points between 180 and 220 cGy were detected. The findings suggested a non-uniform dose distribution in the glandular tissue of the synthetic breast, similar to those found in the TPS, associated with the irregular anatomic breast shape and presence of inhomogeneities next to the thoracic wall generated by the low lung density. (author)

  13. An evaluation of in-plane shields during thoracic CT.

    Science.gov (United States)

    Foley, S J; McEntee, M F; Rainford, L A

    2013-08-01

    The object of this study was to compare organ dose and image quality effects of using bismuth and barium vinyl in-plane shields with standard and low tube current thoracic CT protocols. A RANDO phantom was scanned using a 64-slice CT scanner and three different thoracic protocols. Thermoluminescent dosemeters were positioned in six locations to record surface and absorbed breast and lung doses. Image quality was assessed quantitatively using region of interest measurements. Scanning was repeated using bismuth and barium vinyl in-plane shields to cover the breasts and the results were compared with standard and reduced dose protocols. Dose reductions were most evident in the breast, skin and anterior lung when shielding was used, with mean reductions of 34, 33 and 10 % for bismuth and 23, 18 and 11 % for barium, respectively. Bismuth was associated with significant increases in both noise and CT attenuation values for all the three protocols, especially anteriorly and centrally. Barium shielding had a reduced impact on image quality. Reducing the overall tube current reduced doses in all the locations by 20-27 % with similar increases in noise as shielding, without impacting on attenuation values. Reducing the overall tube current best optimises dose with minimal image quality impact. In-plane shields increase noise and attenuation values, while reducing anterior organ doses primarily. Shielding remains a useful optimisation tool in CT and barium is an effective alternative to bismuth especially when image quality is of concern.

  14. Thoracic Wall Necrotizing Fasccitiss in a Neonate: a Case Report

    Directory of Open Access Journals (Sweden)

    Serdar Onat

    2010-09-01

    Full Text Available Necrotizing fasciitis (NF is a rapidly progressive and potentially life-threatening infection of superficial fascia and subcutaneous tissue. Thoracic wall is one of the rarest locations for NF. Broadspectrum antibiotics receiving, early surgical debridement, and skin grafting are life saving in NF. We report a 7-day-old female neonate who had left sided thoracic wall NF. She had undergone extensive surgical debridement within 4 hours of hospital admission, and reconstruction of skin defect by split-thickness skin grafting later. Early diagnosis is important, as prompt surgical debridement offers the best chance for survival. Early and extensive surgical debridement is a widely accepted clinical approach and the mainstay of effective treatment. The goals of surgical intervention are to remove all necrotic tissues, and to help control the progression of NF. Reconstruction of skin defects should be performed by early split-thickness skin grafting like our patient or primary closure. Because early wound resurfacing prevents fluid, electrolyte, and protein loss from the wound site, and decreases secondary infection. Although chest wall NF is rare in neonates, it is a rapidly spreading, highly lethal infection. A high index of suspicion, early diagnosis, and aggressive approach are essential to its successful treatment.

  15. Noninvasive radiodiagnosis of aneurysms of the thoracic aorta

    International Nuclear Information System (INIS)

    Todua, F.I.; Petsko, A.P.; Arablinskij, A.V.; Kazanchyan, P.O.; Nikitaev, N.S.; Sultanaliev, T.A.

    1990-01-01

    The paper is concerned with analysis of the results of X-ray investigation of 45 patients with aneurysms of the distal part of the arch and descending part of the thoracic aorta. X-ray investigation helped to establish correct diagnosis of aneurysm of the aorta in 42 of 45 patients (93.3 %) on the basis of the detection of intense additional shadow formation in left pulmonary field, unseparable from the aortic shadow. The use of a new method of ultrasound diagnosis-duplex scanning-made it possible to establish the presence of aneurysm and to determine its sizes as well as to visualize the relation of the left subclavicular artery to aneurysm in 17 of 21 patients. CT-semiotics of aneurysms of the descending part of the thoracic aorta consisted in its dilatation over 3.5 cm, wall calcification, thrombosis of the cavity and change of the adjacent structures. Basing on the analysis of these signs correct diagnosis was established in 34 of 35 examinees (97.1 %)

  16. Thoracic radiographic findings in dogs infected with Rickettsia rickettsii

    International Nuclear Information System (INIS)

    Drost, W.T.; Berry, C.R.; Breitschwerdt, E.B.; Davidson, M.G.

    1997-01-01

    Sixteen beagle dogs were injected intradermally with Rickettsia rickettsii. The dogs were divided into four groups (n = 4): 1) infected, non-treated control; 2) infected, treated with doxycycline; 3) infected, treated with doxycycline and an anti-inflammatory dose of corticosteroid; and 4) infected, treated with doxycycline and an immunosuppressive dose of corticosteroid. Thoracic radiographs were made and ocular fluorescein angiography was performed on days 6, 10, 17 post-inoculation. A mild interstitial lung opacity was noted in 4/16 dogs on day 6, 5/16 on day 10 and 3/16 on day 17 post-inoculation. Increased retinal vascular permeability was noted in 8/16 dogs on day 6, 3/16 on day 10 and 1/16 on day 17 post-inoculation. Correlation between the presence of radiographic and retinal lesions was not significant (p = 0.08). Eleven, naturally infected, dogs with thoracic radiographs and a final diagnosis of RMSF were also evaluated. Four of the 11 dogs had an unstructured interstitial pattern. Dogs with acute, experimentally-infected or naturally-occurring RMSF may have subtle pulmonary changes characterized by an unstructured interstitial pattern

  17. Effective dose to patients from thoracic spine examinations with tomosynthesis

    International Nuclear Information System (INIS)

    Svalkvist, Angelica; Baath, Magnus; Soederman, Christina

    2016-01-01

    The purposes of the present work were to calculate the average effective dose to patients from lateral tomosynthesis examinations of the thoracic spine, compare the results with the corresponding conventional examination and to determine a conversion factor between dose-area product (DAP) and effective dose for the tomosynthesis examination. Thoracic spine examinations from 17 patients were included in the study. The registered DAP and information about the field size for each projection radiograph were, together with patient height and mass, used to calculate the effective dose for each projection radiograph. The total effective doses for the tomosynthesis examinations were obtained by adding the effective doses from the 60 projection radiographs included in the examination. The mean effective dose was 0.47 mSv (range 0.24-0.81 mSv) for the tomosynthesis examinations and 0.20 mSv (range 0.07-0.29 mSv) for the corresponding conventional examinations (anteroposterior + left lateral projection). For the tomosynthesis examinations, a conversion factor between total DAP and effective dose of 0.092 mSv Gycm -2 was obtained. (authors)

  18. EFFECTIVE DOSE TO PATIENTS FROM THORACIC SPINE EXAMINATIONS WITH TOMOSYNTHESIS.

    Science.gov (United States)

    Svalkvist, Angelica; Söderman, Christina; Båth, Magnus

    2016-06-01

    The purposes of the present work were to calculate the average effective dose to patients from lateral tomosynthesis examinations of the thoracic spine, compare the results with the corresponding conventional examination and to determine a conversion factor between dose-area product (DAP) and effective dose for the tomosynthesis examination. Thoracic spine examinations from 17 patients were included in the study. The registered DAP and information about the field size for each projection radiograph were, together with patient height and mass, used to calculate the effective dose for each projection radiograph. The total effective doses for the tomosynthesis examinations were obtained by adding the effective doses from the 60 projection radiographs included in the examination. The mean effective dose was 0.47 mSv (range 0.24-0.81 mSv) for the tomosynthesis examinations and 0.20 mSv (range 0.07-0.29 mSv) for the corresponding conventional examinations (anteroposterior + left lateral projection). For the tomosynthesis examinations, a conversion factor between total DAP and effective dose of 0.092 mSv Gycm(-2) was obtained. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Endovascular stent-graft management of thoracic aortic diseases

    International Nuclear Information System (INIS)

    Dake, Michael D.

    2001-01-01

    The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence

  20. The history of thoracic surgical instruments and instrumentation.

    Science.gov (United States)

    Hagopian, E J; Mann, C; Galibert, L A; Steichen, F M

    2000-02-01

    Thoracic surgical practice has evolved from the innovations of its pioneers. Beginning with the stethoscope discovered by Laënnec with his system of auscultation, to the tools we use in the dissection and control of the hilum of the lung for resection, our practice of thoracic surgery has been entwined with the development of instruments and instrumentation. The development of strategies to prevent death from the open pneumothorax began with manual control of the mediastinum and progressed through differential pressure to, finally, the technique of intubation and the methods of positive-pressure and insufflation anesthesia. The instruments we place in our hands are not enough to define our art. Entry into the chest would not be possible without the use of rib retractors, rib shears, and even periosteal elevators. Finally, to the present day of minimally invasive techniques and the application of thoracoscopy for therapeutic purposes, we find the efforts of our predecessors well developed. For the progression from the fear of the open pneumothorax to the present-day state of the ease of thoracotomy for lung resection we are indebted to those who gave so much of their time and, for some, their lives to death from tuberculosis, to allow the advancement of our practice of surgery. These great people should be remembered not only for their acceptance of novel ideas but also, more importantly, for their lack of fear of testing them.

  1. Muscle sparing lateral thoracotomy: the standard incision for thoracic procedures

    Directory of Open Access Journals (Sweden)

    Mihai Dumitrescu

    2017-05-01

    Full Text Available Lateral thoracotomy is a versatile approach with many variations and is currently the most widely used incision in thoracic surgery. In the current article we are presenting the muscle-sparing lateral thoracotomy in the lateral decubitus position which we consider to be the “standard” for lateral thoracotomies. Indications, surgical technique and pitfalls are described alongside our experience with thoracic drainage. Although there is no consensus regarding the name of this incision, some authors call it “axillary thoracotomy” while others call it a “modified lateral thoracotomy”, they all agree on one aspect – the importance of muscle sparing – which makes it the go-to thoracotomy for both small and large procedures involving the lung. Lateral muscle sparing thoracotomy allows for good exposure of the pulmonary hilum, fissures, apex and diaphragm. The approach is easy and quick to perform while at the same time ensuring faster postoperative recovery by sparing the latissimus dorsi muscle, better cosmetics and lower postoperative pain score when compared to the posterolateral or classical lateral thoracotomies.

  2. Early structural changes in sheep lung following thoracic irradiation

    International Nuclear Information System (INIS)

    Guerry-Force, M.L.; Perkett, E.A.; Brigham, K.L.; Meyrick, B.

    1988-01-01

    Using a large animal model of radiation lung injury--the sheep exposed to bilateral thoracic irradiation--we have recently shown the development of sustained pulmonary hypertension during the first 4 weeks following radiation. This is the period prior to the onset of pneumonitis and pulmonary fibrosis. In the present study, we have examined biopsy and autopsy lung tissue from these same sheep and assessed the sequential changes in lung morphology. Six unanesthetized sheep received bilateral thoracic irradiation (a total of 15 Gy); control sheep were sham irradiated. Lung biopsy tissue was taken prior to and at weekly or biweekly intervals during the 4 weeks immediately following radiation. The lungs were also removed at autopsy for light and electron microscopic examination. Our results show early (Week 1) interstitial and progressive intraalveolar edema accompanied by endothelial and epithelial injury. A gradual increase in number of interstitial mononuclear cells was evident from Week 1, both in the lung tissue and in perivascular cuffs. The number of peripheral lung interstitial mononuclear cells was twice baseline from Week 3 and included accumulation of lymphocytes, fibroblasts, and intravascular macrophages. The increased numbers of mononuclear cells paralleled the development of chronic pulmonary hypertension, perhaps suggesting their involvement in the pathogenesis of this disease. Alternatively, it may be that increased mononuclear cell number represents a stage of lung repair

  3. Symptomatic thoracic spinal cord herniation: case series and technical report.

    Science.gov (United States)

    Hawasli, Ammar H; Ray, Wilson Z; Wright, Neill M

    2014-09-01

    Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes. In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomatology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially because of multiple sclerosis. Finally, compared with compressive myelopathy in the thoracic spine, surgical treatment of ISCH led to rapid improvement despite a long duration of symptoms. Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.

  4. Paravertebral block catheter breakage by electrocautery during thoracic surgery.

    Science.gov (United States)

    Saeki, Noboru; Sugimoto, Yuki; Mori, Yoko; Kato, Takahiro; Miyoshi, Hirotsugu; Nakamura, Ryuji; Koga, Tomomichi

    2017-06-01

    Advantages of thoracic paravertebral analgesia (TPA) include placement of the catheter closer to the surgical field; however, the catheter can become damaged during the operation. We experienced a case of intraoperative TPA catheter breakage that prompted us to perform an experiment to investigate possible causes. A 50-year-old male underwent a thoracoscopic lower lobectomy under general anesthesia with TPA via an intercostal approach. Following surgery, it was discovered that the catheter had become occluded, as well as cut and fused, so we reopened the incision and removed the residual catheter. From that experience, we performed an experiment to examine electrocautery-induced damage in normal (Portex™, Smith's Medical), radiopaque (Perifix SoftTip™, BBraun), and reinforced (Perifix FX™, BBraun) epidural catheters (n = 8 each). Chicken meat was penetrated by each catheter and then cut by electrocautery. In the normal group, breakage occurred in 8 and occlusion in 6 of the catheters, and in the radiopaque group breakage occurred in 8 and occlusion in 7. In contrast, breakage occurred in only 3 and occlusion in none in the reinforced group, with the 5 without breakage remaining connected only by the spring coil. Furthermore, in 7 of the reinforced catheters, electric arc-induced thermal damage was observed at the tip of the catheter. A TPA catheter for thoracic surgery should be inserted via the median approach, or it should be inserted after surgery to avoid catheter damage during surgery.

  5. Thoracic radiography in the neonatal foal: a preliminary report

    International Nuclear Information System (INIS)

    Lamb, C.R.; O'Callaghan, M.W.; Paradis, M.R.

    1990-01-01

    Thoracic radiographs from 22 neonatal foals were reviewed to investigate the radiographic appearance of the thorax in normal, immature, and septicemic foals, and in foals with neonatal respiratory distress syndrome. The size and radiographic appearance of intrathoracic structures and abnormal lung opacities were evaluated. The craniocaudal and apicobasilar dimensions of the heart were 5.6–6.3 and 6.7–7.8 times the length of a midthoracic vetebral body, respectively, in normal, immature and septicemic foals. Apicobasilar measurements were greater (8.0–8.7) in the foals with respiratory distress syndrome. Normal foals had clear lung fields within 12 hours of birth. A more marked interstitial pattern was observed in immature and septicemic foals compared to normals. Diffuse air–space (alveolar) pattern with air bronchograms was seen in foals with respiratory distress syndrome. It was concluded from this series that thoracic radiographs taken 24–48 hours after birth may aid differentiation of normal foals, septicemic or immature foals, and foals with respiratory distress syndrome

  6. Diagnostic accuracy of post-mortem MRI for thoracic abnormalities in fetuses and children

    International Nuclear Information System (INIS)

    Arthurs, Owen J.; Thayyil, Sudhin; Addison, Shea; Olsen, Oystein E.; Wade, Angie; Jones, Rod; Norman, Wendy; Taylor, Andrew M.; Scott, Rosemary J.; Robertson, Nicola J.; Chitty, Lyn S.; Sebire, Neil J.; Owens, Catherine M.

    2014-01-01

    To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for non-cardiac thoracic pathology in fetuses and children, compared with conventional autopsy. Institutional ethics approval and parental consent was obtained. A total of 400 unselected fetuses and children underwent PMMR before conventional autopsy, reported blinded to the other dataset. Of 400 non-cardiac thoracic abnormalities, 113 (28 %) were found at autopsy. Overall sensitivity and specificity (95 % confidence interval) of PMMR for any thoracic pathology was poor at 39.6 % (31.0, 48.9) and 85.5 % (80.7, 89.2) respectively, with positive predictive value (PPV) 53.7 % (42.9, 64.0) and negative predictive value (NPV) 77.0 % (71.8, 81.4). Overall agreement was 71.8 % (67.1, 76.2). PMMR was most sensitive at detecting anatomical abnormalities, including pleural effusions and lung or thoracic hypoplasia, but particularly poor at detecting infection. PMMR currently has relatively poor diagnostic detection rates for the commonest intra-thoracic pathologies identified at autopsy in fetuses and children, including respiratory tract infection and diffuse alveolar haemorrhage. The reasonable NPV suggests that normal thoracic appearances at PMMR exclude the majority of important thoracic lesions at autopsy, and so could be useful in the context of minimally invasive autopsy for detecting non-cardiac thoracic abnormalities. (orig.)

  7. Pulmonary actinomycosis with thoracic soft tissue mass: a rare onset form

    Energy Technology Data Exchange (ETDEWEB)

    Zarca-diaz de la Espina, Miguel A.; Lopez-Menendez, Carlos; Ruiz-Martinez, Rafael; Molino-Trinidad, Ceferino

    2001-03-01

    Actinomycosis is unusual, and rare especially when the lung and the thoracic wall are involved. It is more frequent in immunocompromised patient. US, CT, or MRI are imaging methods of diagnosis with high sensibility to recognise the disease and are able to the management. We point out a rare case in a normal teenager with thoracic abscess.

  8. Surgical and Clinical Decision Making in Isolated Long Thoracic Nerve Palsy.

    Science.gov (United States)

    Noland, Shelley S; Krauss, Emily M; Felder, John M; Mackinnon, Susan E

    2017-10-01

    Isolated long thoracic nerve palsy results in scapular winging and destabilization. In this study, we review the surgical management of isolated long thoracic nerve palsy and suggest a surgical technique and treatment algorithm to simplify management. In total, 19 patients who required surgery for an isolated long thoracic nerve palsy were reviewed retrospectively. Preoperative demographics, electromyography (EMG), and physical examinations were reviewed. Intraoperative nerve stimulation, surgical decision making, and postoperative outcomes were reviewed. In total, 19 patients with an average age of 32 were included in the study. All patients had an isolated long thoracic nerve palsy caused by either an injury (58%), Parsonage-Turner syndrome (32%), or shoulder surgery (10%); 18 patients (95%) underwent preoperative EMG; 10 with evidence of denervation (56%); and 13 patients had motor unit potentials in the serratus anterior (72%). The preoperative EMG did not correlate with intraoperative nerve stimulation in 13 patients (72%) and did correlate in 5 patients (28%); 3 patients had a nerve transfer (3 thoracodorsal to long thoracic at lateral chest, 1 pec to long thoracic at supraclavicular incision). In the 3 patients who had a nerve transfer, there was return of full forward flexion of the shoulder at an average of 2.5 months. A treatment algorithm based on intraoperative nerve stimulation will help guide surgeons in their clinical decision making in patients with isolated long thoracic nerve palsy. Intraoperative nerve stimulation is the gold standard in the management of isolated long thoracic nerve palsy.

  9. Pulmonary actinomycosis with thoracic soft tissue mass: a rare onset form

    International Nuclear Information System (INIS)

    Zarca-diaz de la Espina, Miguel A.; Lopez-Menendez, Carlos; Ruiz-Martinez, Rafael; Molino-Trinidad, Ceferino

    2001-01-01

    Actinomycosis is unusual, and rare especially when the lung and the thoracic wall are involved. It is more frequent in immunocompromised patient. US, CT, or MRI are imaging methods of diagnosis with high sensibility to recognise the disease and are able to the management. We point out a rare case in a normal teenager with thoracic abscess

  10. Thoracic aortic aneurysm in a child due to cystic medial necrosis

    International Nuclear Information System (INIS)

    Kuribayashi, Sachio; Watabe, Tsuneya; Ohtaki, Makoto; Matsuyama, Shoya; Ogawa, Junichi

    1983-01-01

    The valuable role of computed tomography (CT) was stressed in the diagnosis of thoracic aortic aneurysm in an asymptomatic 12-year-old child. She initially presented mediastinal mass on plain chest film. A saccular thoracic aortic aneurysm was highly suspected from the CT findings, and it was confirmed on angiography. Pathological examination of the aneurysmal wall revealed cystic medial necrosis. (author)

  11. Diagnostic accuracy of post-mortem MRI for thoracic abnormalities in fetuses and children

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Thayyil, Sudhin; Addison, Shea [Imperial College London, Perinatal Neurology and Neonatology, London (United Kingdom); Olsen, Oystein E. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); Wade, Angie [UCL Institute of Child Health, Paediatric Epidemiology and Biostatistics Unit, London (United Kingdom); Jones, Rod; Norman, Wendy; Taylor, Andrew M. [UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London (United Kingdom); Great Ormond Street Hospital for Children NHS Foundation Trust, Cardiorespiratory Division, London (United Kingdom); Scott, Rosemary J. [University College London Hospital NHS Trust, Department of Histopathology, London (United Kingdom); Robertson, Nicola J. [UCL Institute for Women' s Health, Academic Neonatology, London (United Kingdom); Chitty, Lyn S. [UCL Institute of Child Health, Genetics and Genomic Medicine, London (United Kingdom); UCLH NHS Foundation Trusts, London (United Kingdom); Sebire, Neil J. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Histopathology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Owens, Catherine M. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London (United Kingdom); Great Ormond Street Hospital for Children NHS Foundation Trust, Cardiorespiratory Division, London (United Kingdom); Collaboration: Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group

    2014-11-15

    To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for non-cardiac thoracic pathology in fetuses and children, compared with conventional autopsy. Institutional ethics approval and parental consent was obtained. A total of 400 unselected fetuses and children underwent PMMR before conventional autopsy, reported blinded to the other dataset. Of 400 non-cardiac thoracic abnormalities, 113 (28 %) were found at autopsy. Overall sensitivity and specificity (95 % confidence interval) of PMMR for any thoracic pathology was poor at 39.6 % (31.0, 48.9) and 85.5 % (80.7, 89.2) respectively, with positive predictive value (PPV) 53.7 % (42.9, 64.0) and negative predictive value (NPV) 77.0 % (71.8, 81.4). Overall agreement was 71.8 % (67.1, 76.2). PMMR was most sensitive at detecting anatomical abnormalities, including pleural effusions and lung or thoracic hypoplasia, but particularly poor at detecting infection. PMMR currently has relatively poor diagnostic detection rates for the commonest intra-thoracic pathologies identified at autopsy in fetuses and children, including respiratory tract infection and diffuse alveolar haemorrhage. The reasonable NPV suggests that normal thoracic appearances at PMMR exclude the majority of important thoracic lesions at autopsy, and so could be useful in the context of minimally invasive autopsy for detecting non-cardiac thoracic abnormalities. (orig.)

  12. MRI-based anatomical landmarks for the identification of thoracic vertebral levels

    International Nuclear Information System (INIS)

    Connor, S.E.J.; Shah, A.; Latifoltojar, H.; Lung, P.

    2013-01-01

    Aim: To identify soft-tissue and bony anatomical landmarks on dedicated thoracic spine magnetic resonance imaging (MRI), and to assess their detectability, reproducibility, and accuracy in predicting specific thoracic vertebral levels. Materials and methods: One hundred dedicated thoracic MRI studies were retrospectively analysed by two radiologists independently. Ten bone and soft-tissue landmarks were localized to the adjacent vertebral level. The true numerical thoracic vertebral level was subsequently determined and recorded by cross referencing with a sagittal cervico-thoracic “counting scan”. Results: Six landmarks were defined in ≥98% cases; however, there was a low interobserver percentage agreement for the defined vertebral levels (>70% for only one landmark). The most useful landmark for defining a specific vertebral level was the most superior rib (98% detection, 95% interobserver agreement, 98% at a single vertebral level, 0.07 SD). Eight landmarks localized to a specific thoracic segment in only 16–44% of cases, with a standard deviation of >0.5 vertebral levels and with a range which was greater than four vertebral levels. Conclusion: The C2 vertebra must be identified and cross referenced to the dedicated thoracic spine MRI, as other MRI-based anatomical landmarks are unreliable in determining the correct thoracic vertebral level

  13. Ipsilateral Brachial Plexus Block and Hemidiaphragmatic Paresis as Adverse Effect of a High Thoracic Paravertebral Block

    NARCIS (Netherlands)

    Renes, Steven H.; van Geffen, Geert J.; Snoeren, Miranda M.; Gielen, Matthieu J.; Groen, Gerbrand J.

    Background: Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. Case Reports: We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral

  14. Everolimus with reduced calcineurin inhibitor in thoracic transplant recipients with renal dysfunction: a multicenter, randomized trial

    DEFF Research Database (Denmark)

    Gullestad, Lars; Iversen, Martin; Mortensen, Svend-Aage

    2010-01-01

    The proliferation signal inhibitor everolimus offers the potential to reduce calcineurin inhibitor (CNI) exposure and alleviate CNI-related nephrotoxicity. Randomized trials in maintenance thoracic transplant patients are lacking.......The proliferation signal inhibitor everolimus offers the potential to reduce calcineurin inhibitor (CNI) exposure and alleviate CNI-related nephrotoxicity. Randomized trials in maintenance thoracic transplant patients are lacking....

  15. Peculiarities of infectious diseases course accompanied by quinsy syndrome in children (data from children infectious hospital

    Directory of Open Access Journals (Sweden)

    Ovchinnikova T.A.

    2011-03-01

    Full Text Available The research goal is to study morbidity dynamics for the period of 15 years and to determine clinical signs that accompany quinsy syndrome (diphtheria, infectious mononucleosis, scarlet fever, quinsy. Retrospective study analysis of annual reports and case-histories was carried out. 323 cases of infectious diseases accompanied by quinsy syndrome were examined. Clinical and epidemic signs of diseases were determined during the period of morbidity raise. The current clinical course of diseases was characterized in detail. The significant percentage of renal complications in case of pharyngonasal cavity lesion was shown

  16. 4D computed tomography scans for conformal thoracic treatment planning: is a single scan sufficient to capture thoracic tumor motion?

    Science.gov (United States)

    Tseng, Yolanda D.; Wootton, Landon; Nyflot, Matthew; Apisarnthanarax, Smith; Rengan, Ramesh; Bloch, Charles; Sandison, George; St. James, Sara

    2018-01-01

    Four dimensional computed tomography (4DCT) scans are routinely used in radiation therapy to determine the internal treatment volume for targets that are moving (e.g. lung tumors). The use of these studies has allowed clinicians to create target volumes based upon the motion of the tumor during the imaging study. The purpose of this work is to determine if a target volume based on a single 4DCT scan at simulation is sufficient to capture thoracic motion. Phantom studies were performed to determine expected differences between volumes contoured on 4DCT scans and those on the evaluation CT scans (slow scans). Evaluation CT scans acquired during treatment of 11 patients were compared to the 4DCT scans used for treatment planning. The images were assessed to determine if the target remained within the target volume determined during the first 4DCT scan. A total of 55 slow scans were compared to the 11 planning 4DCT scans. Small differences were observed in phantom between the 4DCT volumes and the slow scan volumes, with a maximum of 2.9%, that can be attributed to minor differences in contouring and the ability of the 4DCT scan to adequately capture motion at the apex and base of the motion trajectory. Larger differences were observed in the patients studied, up to a maximum volume difference of 33.4%. These results demonstrate that a single 4DCT scan is not adequate to capture all thoracic motion throughout treatment.

  17. Morphology study of thoracic transverse processes and its significance in pedicle-rib unit screw fixation.

    Science.gov (United States)

    Cui, Xin-gang; Cai, Jin-fang; Sun, Jian-min; Jiang, Zhen-song

    2015-03-01

    Thoracic transverse process is an important anatomic structure of the spine. Several anatomic studies have investigated the adjacent structures of the thoracic transverse process. But there is still a blank on the morphology of the thoracic transverse processes. The purpose of the cadaveric study is to investigate the morphology of thoracic transverse processes and to provide morphology basis for the pedicle-rib unit (extrapedicular) screw fixation method. Forty-five adult dehydrated skeletons (T1-T10) were included in this study. The length, width, thickness, and the tilt angle (upward and backward) of the thoracic transverse process were measured. The data were then analyzed statistically. On the basis of the morphometric study, 5 fresh cadavers were used to place screws from transverse processes to the vertebral body in the thoracic spine, and then observed by the naked eye and on computed tomography scans. The lengths of thoracic transverse processes were between 16.63±1.59 and 18.10±1.95 mm; the longest was at T7, and the shortest was at T10. The widths of thoracic transverse processes were between 11.68±0.80 and 12.87±1.48 mm; the widest was at T3, and the narrowest was at T7. The thicknesses of thoracic transverse processes were between 7.86±1.24 and 10.78±1.35 mm; the thickest was at T1, and the thinnest was at T7. The upward tilt angles of thoracic transverse processes were between 24.9±3.1 and 3.0±1.56 degrees; the maximal upward tilt angle was at T1, and the minimal upward tilt angle was at T7. The upward tilt angles of T1 and T2 were obviously different from the other thoracic transverse processes (Ptransverse processes gradually increased from 24.5±2.91 degrees at T1 to 64.5±5.12 degrees at T10. The backward tilt angles were significantly different between each other, except between T5 and T6. In the validation study, screws were all placed successfully from transverse processes to the vertebrae of thoracic spine. The length, width, and

  18. Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults : a prospective cohort study

    NARCIS (Netherlands)

    van der Jagt-Willems, Hanna C.; de Groot, Maartje H.; van Campen, Jos P. C. M.; Lamoth, Claudine J. C.; Lems, Willem F.

    2015-01-01

    Background: Vertebral fractures, an increased thoracic kyphosis and a flexed posture are associated with falls. However, this was not confirmed in prospective studies. We performed a prospective cohort study to investigate the association between vertebral fractures, increased thoracic kyphosis

  19. Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study

    NARCIS (Netherlands)

    van der Jagt-Willems, H.C.; de Groot, M.H.; van Campen, J.P.C.M.; Lamoth, C.J.C.; Lems, W.F.

    2015-01-01

    Background: Vertebral fractures, an increased thoracic kyphosis and a flexed posture are associated with falls. However, this was not confirmed in prospective studies. We performed a prospective cohort study to investigate the association between vertebral fractures, increased thoracic kyphosis

  20. Uniportal video assisted thoracic surgery: summary of experience, mini-review and perspectives.

    Science.gov (United States)

    Migliore, Marcello; Calvo, Damiano; Criscione, Alessandra; Borrata, Francesco

    2015-09-01

    The uniportal-video assisted thoracic surgery (VATS) technique comprises operations which can be performed with skin incisions ranging from 2 to 8 cm and the manifest result of the introduction of the uniportal lobectomy had made possible to increase rapidly the number of published papers on this subject. Many of the large ensuing literature report incomplete historical information on uniportal VATS, and doubts exist about the indication of uniportal VATS for some thoracic oncologic pathologies. Known limitations have been overcome. On the other hand, the modern thoracic surgical team includes one surgeon, one assistant and a scrub nurse, and it is clear that the new generation of thoracic surgeons need to use the "less" used hand. The new technology which permitted the introduction of the uniportal VATS could influence the future need of thoracic surgeons worldwide.

  1. How to make epidemiological training infectious.

    Directory of Open Access Journals (Sweden)

    Steve E Bellan

    Full Text Available Modern infectious disease epidemiology builds on two independently developed fields: classical epidemiology and dynamical epidemiology. Over the past decade, integration of the two fields has increased in research practice, but training options within the fields remain distinct with few opportunities for integration in the classroom. The annual Clinic on the Meaningful Modeling of Epidemiological Data (MMED at the African Institute for Mathematical Sciences has begun to address this gap. MMED offers participants exposure to a broad range of concepts and techniques from both epidemiological traditions. During MMED 2010 we developed a pedagogical approach that bridges the traditional distinction between classical and dynamical epidemiology and can be used at multiple educational levels, from high school to graduate level courses. The approach is hands-on, consisting of a real-time simulation of a stochastic outbreak in course participants, including realistic data reporting, followed by a variety of mathematical and statistical analyses, stemming from both epidemiological traditions. During the exercise, dynamical epidemiologists developed empirical skills such as study design and learned concepts of bias while classical epidemiologists were trained in systems thinking and began to understand epidemics as dynamic nonlinear processes. We believe this type of integrated educational tool will prove extremely valuable in the training of future infectious disease epidemiologists. We also believe that such interdisciplinary training will be critical for local capacity building in analytical epidemiology as Africa continues to produce new cohorts of well-trained mathematicians, statisticians, and scientists. And because the lessons draw on skills and concepts from many fields in biology--from pathogen biology, evolutionary dynamics of host--pathogen interactions, and the ecology of infectious disease to bioinformatics, computational biology, and

  2. Infectious Disease Practice Gaps in Dermatology.

    Science.gov (United States)

    Hopp, Shelby; Quest, Tyler L; Wanat, Karolyn A

    2016-07-01

    The article highlights different educational and practice gaps in infectious diseases as they pertain to dermatology. These gaps include the use of antibiotics in relation to atopic dermatitis and acne vulgaris, treatment of skin and soft tissue infection, and diagnosis and treatment of onychomycosis. In addition, practice gaps related to use of imiquimod for molluscum contagiosum, risk of infections related to immunosuppressive medications and rates of vaccination, and the use of bedside diagnostics for diagnosing common infections were discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Radioisotopic studies on equine infectious anemia, 2

    International Nuclear Information System (INIS)

    Maliska, C.

    1973-01-01

    Red cell mass and blood volume of 16 thoroughbred horse, 11 healthy and 5 with naturally acquired equine infectious anemia, were determined by means of 51 Cr-tagged erythrocytes. The mean values obtained in healthy thoroughbred horses were as follows: red cell mass 40,64 and blood volume 102,32 ml/kg body weight. The mean red cell mass and blood volume in anemic horses were respectively 21,13 and 107,71 ml/Kg body weight. The difference in red cell mass value between the two groups was statistically significant (P [pt

  4. Unusual infectious mononucleosis complicated by vasculitis

    Directory of Open Access Journals (Sweden)

    Srimanta Kumar Sahu

    2016-01-01

    Full Text Available Infectious mononucleosis (IM is a clinical syndrome caused by Epstein-Barr virus (EBV. It manifests as fever, pharyngitis, malaise, adenopathy, and atypical lymphocytosis. Cardiovascular complications are thought to be rare in IM. There are very few case reports of EBV-associated vasculitides, like Kawasaki disease and systemic polyarteritis nodosa, however, involvement of the large caliber arteries like the aorta and its branches have been reported only scarcely. Myocarditis also is rare as an early manifestation of EBV infection. We present here a rare case of IM, presented initially with acute myocarditis and later with large-vessels arteritis.

  5. Selected emerging infectious diseases of squamata.

    Science.gov (United States)

    Latney, La'toya V; Wellehan, James

    2013-05-01

    It is important that reptile clinicians have an appreciation for the epidemiology, clinical signs, pathology, diagnostic options, and prognostic parameters for novel and emerging infectious diseases in squamates. This article provides an update on emerging squamate diseases reported in the primary literature within the past decade. Updates on adenovirus, iridovirus, rhabdovirus, arenavirus, and paramyxovirus epidemiology, divergence, and host fidelity are presented. A new emerging bacterial disease of Uromastyx species, Devriesea agamarum, is reviewed. Chrysosporium ophiodiicola-associated mortality in North American snakes is discussed. Cryptosporidium and pentastomid infections in squamates are highlighted among emerging parasitic infections. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Infectious endocarditis caused by Escherichia coli

    DEFF Research Database (Denmark)

    Lauridsen, Trine Kiilerich; Arpi, Magnus; Fritz-Hansen, Thomas

    2011-01-01

    Although Escherichia coli is among the most common causes of Gram-negative bacteraemia, infectious endocarditis (IE) due to this pathogen is rare. A 67-y-old male without a previous medical history presented with a new mitral regurgitation murmur and persisting E. coli bacteraemia in spite of broad......-spectrum intravenous antibiotics. Transthoracic and transoesophageal echocardiography revealed a severe mitral endocarditis. E. coli DNA was identified from the mitral valve and the vegetation, and no other pathogen was found. The case was further complicated by spondylodiscitis and bilateral endophthalmitis. Extra...

  7. Emerging Ranaviral Infectious Diseases and Amphibian Decline

    Directory of Open Access Journals (Sweden)

    Jacques Robert

    2010-02-01

    Full Text Available Infectious diseases caused by ranaviruses (RV, family Iridoviridae not only affect wild amphibian populations but also agriculture and international animal trade. Although, the prevalence of RV infections and die offs has markedly increased over the last decade, it is still unclear whether these viruses are direct causal agents of extinction or rather are the resulting (secondary consequences of weakened health of amphibian populations leading to increased susceptibility to viral pathogens. In either case, it is important to understand the critical role of host immune defense in controlling RV infections, pathogenicity, and transmission; this is the focus of this review.

  8. Thoracic fat volume is independently associated with coronary vasomotion

    Energy Technology Data Exchange (ETDEWEB)

    Dunet, Vincent; Allenbach, Gilles; Prior, John O. [Lausanne University Hospital, Department of Nuclear Medicine and Molecular Imaging, Lausanne (Switzerland); Feihl, Francois; Dabiri, Amin; Waeber, Bernard [Lausanne University Hospital, Department of Clinical Physiopathology, Lausanne (Switzerland); Heinzer, Raphael [Lausanne University Hospital, Center for Investigation and Research in Sleep, Lausanne (Switzerland)

    2016-02-15

    Thoracic fat has been associated with an increased risk of coronary artery disease (CAD). As endothelium-dependent vasoreactivity is a surrogate of cardiovascular events and is impaired early in atherosclerosis, we aimed at assessing the possible relationship between thoracic fat volume (TFV) and endothelium-dependent coronary vasomotion. Fifty healthy volunteers without known CAD or major cardiovascular risk factors (CRFs) prospectively underwent a {sup 82}Rb cardiac PET/CT to quantify myocardial blood flow (MBF) at rest, and MBF response to cold pressor testing (CPT-MBF) and adenosine (i.e., stress-MBF). TFV was measured by a 2D volumetric CT method and common laboratory blood tests (glucose and insulin levels, HOMA-IR, cholesterol, triglyceride, hsCRP) were performed. Relationships between CPT-MBF, TFV and other CRFs were assessed using non-parametric Spearman rank correlation testing and multivariate linear regression analysis. All of the 50 participants (58 ± 10y) had normal stress-MBF (2.7 ± 0.6 mL/min/g; 95 % CI: 2.6-2.9) and myocardial flow reserve (2.8 ± 0.8; 95 % CI: 2.6-3.0) excluding underlying CAD. Univariate analysis revealed a significant inverse relation between absolute CPT-MBF and sex (ρ = -0.47, p = 0.0006), triglyceride (ρ = -0.32, p = 0.024) and insulin levels (ρ = -0.43, p = 0.0024), HOMA-IR (ρ = -0.39, p = 0.007), BMI (ρ = -0.51, p = 0.0002) and TFV (ρ = -0.52, p = 0.0001). MBF response to adenosine was also correlated with TFV (ρ = -0.32, p = 0.026). On multivariate analysis, TFV emerged as the only significant predictor of MBF response to CPT (p = 0.014). TFV is significantly correlated with endothelium-dependent and -independent coronary vasomotion. High TF burden might negatively influence MBF response to CPT and to adenosine stress, even in persons without CAD, suggesting a link between thoracic fat and future cardiovascular events. (orig.)

  9. Intrinsic response of thoracic propriospinal neurons to axotomy

    Directory of Open Access Journals (Sweden)

    Stelzner Dennis J

    2010-06-01

    Full Text Available Abstract Background Central nervous system axons lack a robust regenerative response following spinal cord injury (SCI and regeneration is usually abortive. Supraspinal pathways, which are the most commonly studied for their regenerative potential, demonstrate a limited regenerative ability. On the other hand, propriospinal (PS neurons, with axons intrinsic to the spinal cord, have shown a greater regenerative response than their supraspinal counterparts, but remain relatively understudied in regards to spinal cord injury. Results Utilizing laser microdissection, gene-microarray, qRT-PCR, and immunohistochemistry, we focused on the intrinsic post-axotomy response of specifically labelled thoracic propriospinal neurons at periods from 3-days to 1-month following T9 spinal cord injury. We found a strong and early (3-days post injury, p.i upregulation in the expression of genes involved in the immune/inflammatory response that returned towards normal by 1-week p.i. In addition, several regeneration associated and cell survival/neuroprotective genes were significantly up-regulated at the earliest p.i. period studied. Significant upregulation of several growth factor receptor genes (GFRa1, Ret, Lifr also occurred only during the initial period examined. The expression of a number of pro-apoptotic genes up-regulated at 3-days p.i. suggest that changes in gene expression after this period may have resulted from analyzing surviving TPS neurons after the cell death of the remainder of the axotomized TPS neuronal population. Conclusions Taken collectively these data demonstrate that thoracic propriospinal (TPS neurons mount a very dynamic response following low thoracic axotomy that includes a strong regenerative response, but also results in the cell death of many axotomized TPS neurons in the first week after spinal cord injury. These data also suggest that the immune/inflammatory response may have an important role in mediating the early strong

  10. Reduction of uterus dose in clinical thoracic computed tomography

    International Nuclear Information System (INIS)

    Danova, D.; Keil, B.; Kaestner, B.; Klose, K.J.; Heverhagen, J.T.; Wulff, J.; Fiebich, M.; Zink, K.

    2010-01-01

    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 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 μGy. 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 μGy (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 μGy (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.)

  11. Automatic learning-based beam angle selection for thoracic IMRT

    International Nuclear Information System (INIS)

    Amit, Guy; Marshall, Andrea; Purdie, Thomas G.; Jaffray, David A.; Levinshtein, Alex; Hope, Andrew J.; Lindsay, Patricia; Pekar, Vladimir

    2015-01-01

    Purpose: The treatment of thoracic cancer using external beam radiation requires an optimal selection of the radiation beam directions to ensure effective coverage of the target volume and to avoid unnecessary treatment of normal healthy tissues. Intensity modulated radiation therapy (IMRT) planning is a lengthy process, which requires the planner to iterate between choosing beam angles, specifying dose–volume objectives and executing IMRT optimization. In thorax treatment planning, where there are no class solutions for beam placement, beam angle selection is performed manually, based on the planner’s clinical experience. The purpose of this work is to propose and study a computationally efficient framework that utilizes machine learning to automatically select treatment beam angles. Such a framework may be helpful for reducing the overall planning workload. Methods: The authors introduce an automated beam selection method, based on learning the relationships between beam angles and anatomical features. Using a large set of clinically approved IMRT plans, a random forest regression algorithm is trained to map a multitude of anatomical features into an individual beam score. An optimization scheme is then built to select and adjust the beam angles, considering the learned interbeam dependencies. The validity and quality of the automatically selected beams evaluated using the manually selected beams from the corresponding clinical plans as the ground truth. Results: The analysis included 149 clinically approved thoracic IMRT plans. For a randomly selected test subset of 27 plans, IMRT plans were generated using automatically selected beams and compared to the clinical plans. The comparison of the predicted and the clinical beam angles demonstrated a good average correspondence between the two (angular distance 16.8° ± 10°, correlation 0.75 ± 0.2). The dose distributions of the semiautomatic and clinical plans were equivalent in terms of primary target volume

  12. Long-term results after proximal thoracic aortic redo surgery.

    Directory of Open Access Journals (Sweden)

    Martin Czerny

    Full Text Available OBJECTIVE: To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery. METHODS: We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40 who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed. RESULTS: In hospital mortality was 13%, perioperative neurologic injury was 7%. Fifty percent of patients underwent redo surgery in an urgent or emergency setting. In 65%, partial or total arch replacement with or without conventional or frozen elephant trunk extension was performed. The preoperative logistic EuroSCORE I confirmed to be a reliable predictor of adverse outcome- (ROC 0.786, 95%CI 0.64-0.93 as did the new EuroSCORE II model: ROC 0.882 95%CI 0.78-0.98. Extensive individual logistic EuroSCORE I levels more than 67 showed an OR of 7.01, 95%CI 1.43-34.27. A EuroSCORE II larger than 28 showed an OR of 4.44 (95%CI 1.4-14.06. Multivariate logistic regression analysis identified a critical preoperative state (OR 7.96, 95%CI 1.51-38.79 but not advanced age (OR 2.46, 95%CI 0.48-12.66 as the strongest independent predictor of in-hospital mortality. Median follow-up was 23 months (1-52 months. One year and five year actuarial survival rates were 83% and 69% respectively. Freedom from reoperation during follow-up was 100%. CONCLUSIONS: Despite a substantial early attrition rate in patients presenting with a critical preoperative state, proximal thoracic aortic redo surgery provides excellent early and mid-term results. Higher EuroSCORE I and II levels and a critical preoperative state but not advanced age are independent predictors of in-hospital mortality. As a consequence, age alone should no longer be regarded as a contraindication for surgical treatment in this particular group of patients.

  13. Thoracic fat volume is independently associated with coronary vasomotion

    International Nuclear Information System (INIS)

    Dunet, Vincent; Allenbach, Gilles; Prior, John O.; Feihl, Francois; Dabiri, Amin; Waeber, Bernard; Heinzer, Raphael

    2016-01-01

    Thoracic fat has been associated with an increased risk of coronary artery disease (CAD). As endothelium-dependent vasoreactivity is a surrogate of cardiovascular events and is impaired early in atherosclerosis, we aimed at assessing the possible relationship between thoracic fat volume (TFV) and endothelium-dependent coronary vasomotion. Fifty healthy volunteers without known CAD or major cardiovascular risk factors (CRFs) prospectively underwent a 82 Rb cardiac PET/CT to quantify myocardial blood flow (MBF) at rest, and MBF response to cold pressor testing (CPT-MBF) and adenosine (i.e., stress-MBF). TFV was measured by a 2D volumetric CT method and common laboratory blood tests (glucose and insulin levels, HOMA-IR, cholesterol, triglyceride, hsCRP) were performed. Relationships between CPT-MBF, TFV and other CRFs were assessed using non-parametric Spearman rank correlation testing and multivariate linear regression analysis. All of the 50 participants (58 ± 10y) had normal stress-MBF (2.7 ± 0.6 mL/min/g; 95 % CI: 2.6-2.9) and myocardial flow reserve (2.8 ± 0.8; 95 % CI: 2.6-3.0) excluding underlying CAD. Univariate analysis revealed a significant inverse relation between absolute CPT-MBF and sex (ρ = -0.47, p = 0.0006), triglyceride (ρ = -0.32, p = 0.024) and insulin levels (ρ = -0.43, p = 0.0024), HOMA-IR (ρ = -0.39, p = 0.007), BMI (ρ = -0.51, p = 0.0002) and TFV (ρ = -0.52, p = 0.0001). MBF response to adenosine was also correlated with TFV (ρ = -0.32, p = 0.026). On multivariate analysis, TFV emerged as the only significant predictor of MBF response to CPT (p = 0.014). TFV is significantly correlated with endothelium-dependent and -independent coronary vasomotion. High TF burden might negatively influence MBF response to CPT and to adenosine stress, even in persons without CAD, suggesting a link between thoracic fat and future cardiovascular events. (orig.)

  14. Estimating Hemodynamic Responses to the Wingate Test Using Thoracic Impedance

    Directory of Open Access Journals (Sweden)

    Todd A. Astorino, Curtis Bovee, Ashley DeBoe

    2015-12-01

    Full Text Available Techniques including direct Fick and Doppler echocardiography are frequently used to assess hemodynamic responses to exercise. Thoracic impedance has been shown to be a noninvasive alternative to these methods for assessing these responses during graded exercise to exhaustion, yet its feasibility during supramaximal bouts of exercise is relatively unknown. We used thoracic impedance to estimate stroke volume (SV and cardiac output (CO during the Wingate test (WAnT and compared these values to those from graded exercise testing (GXT. Active men (n = 9 and women (n = 7 (mean age = 24.8 ± 5.9 yr completed two Wingate tests and two graded exercise tests on a cycle ergometer. During exercise, heart rate (HR, SV, and CO were continuously estimated using thoracic impedance. Repeated measures analysis of variance was used to identify potential differences in hemodynamic responses across protocols. Results: Maximal SV (138.6 ± 37.4 mL vs. 135.6 ± 26.9 mL and CO (24.5 ± 6.1 L·min-1 vs. 23.7 ± 5.1 L·min-1 were similar (p > 0.05 between repeated Wingate tests. Mean maximal HR was higher (p < 0.01 for GXT (185 ± 7 b·min-1 versus WAnT (177 ± 11 b·min-1, and mean SV was higher in response to WAnT (137.1 ± 32.1 mL versus GXT (123.0 ± 32.0 mL, leading to similar maximal cardiac output between WAnT and GXT (23.9 ± 5.6 L·min-1 vs. 22.5 ± 6.0 L·min-1. Our data show no difference in hemodynamic responses in response to repeated administrations of the Wingate test. In addition, the Wingate test elicits similar cardiac output compared to progressive cycling to VO2max.

  15. Emerging and Neglected Infectious Diseases: Insights, Advances, and Challenges.

    Science.gov (United States)

    Nii-Trebi, Nicholas Israel

    2017-01-01

    Infectious diseases are a significant burden on public health and economic stability of societies all over the world. They have for centuries been among the leading causes of death and disability and presented growing challenges to health security and human progress. The threat posed by infectious diseases is further deepened by the continued emergence of new, unrecognized, and old infectious disease epidemics of global impact. Over the past three and half decades at least 30 new infectious agents affecting humans have emerged, most of which are zoonotic and their origins have been shown to correlate significantly with socioeconomic, environmental, and ecological factors. As these factors continue to increase, putting people in increased contact with the disease causing pathogens, there is concern that infectious diseases may continue to present a formidable challenge. Constant awareness and pursuance of effective strategies for controlling infectious diseases and disease emergence thus remain crucial. This review presents current updates on emerging and neglected infectious diseases and highlights the scope, dynamics, and advances in infectious disease management with particular focus on WHO top priority emerging infectious diseases (EIDs) and neglected tropical infectious diseases.

  16. Indication for resuscitative thoracotomy in thoracic injuries-Adherence to the ATLS guidelines. A forensic autopsy based evaluation

    DEFF Research Database (Denmark)

    Ohrt-Nissen, S; Colville-Ebeling, B; Kandler, K

    2016-01-01

    of deceased patients with potentially reversible thoracic lesions (PRTL). METHODS: The database at the Department of Forensic Medicine at Copenhagen University was queried for autopsy cases with thoracic lesions indicated by the SNOMED autopsy coding system. Patients were included if thoracic lesions were...

  17. Electrophysiologic studies of the thoracic limb of the horse.

    Science.gov (United States)

    Blythe, L L; Kitchell, R L

    1982-09-01

    The cutaneous innervation of the thoracic limb was investigated in 18 barbiturate-anesthetized horses, using electrophysiologic techniques. The cutaneous area (CA) innervated by each cutaneous nerve was delineated in at least 4 horses by stroking the hairs with a small watercolor brush while recording from the nerve. Mapping of adjacent CA revealed areas of considerable overlap. The part of a CA of a given nerve supplied only by that nerve is referred to as its autonomous zone (AZ). In contrast to the standard textbook illustrations cutaneous branches of the axillary, radial, musculocutaneous, and ulnar nerves overlapped extensively in the antebrachium. Clinically testable AZ were found in the antebrachium for the caudal cutaneous antebrachial nerve of the ulnar nerve and in the carpus and manus for the cutaneous branches of the median, ulnar, and musculocutaneous nerves; AZ were not found for the cutaneous branches of the radial and axillary nerves.

  18. Bio-chemo-mechanics of thoracic aortic aneurysms.

    Science.gov (United States)

    Wagenseil, Jessica E

    2018-03-01

    Most thoracic aortic aneurysms (TAAs) occur in the ascending aorta. This review focuses on the unique bio-chemo-mechanical environment that makes the ascending aorta susceptible to TAA. The environment includes solid mechanics, fluid mechanics, cell phenotype, and extracellular matrix composition. Advances in solid mechanics include quantification of biaxial deformation and complex failure behavior of the TAA wall. Advances in fluid mechanics include imaging and modeling of hemodynamics that may lead to TAA formation. For cell phenotype, studies demonstrate changes in cell contractility that may serve to sense mechanical changes and transduce chemical signals. Studies on matrix defects highlight the multi-factorial nature of the disease. We conclude that future work should integrate the effects of bio-chemo-mechanical factors for improved TAA treatment.

  19. Traumatic thoracic injury: the role of Multidetector-row CT

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kyung Joo; Kang, Doo Kyung; Kim, Tae Hee [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2006-05-15

    The introduction of Multidetector-row CT (MDCT) has revolutionized the diagnostic strategy of multitrauma patients. The rapid acquisition of a large scanning volume with a thin slice collimation allows for motion-free images of high spatial resolution, and this enables the application of the multiplanar reformat (MPR) and 3D volume-rendering (VR) images. The MPR images more accurately demonstrate aortic rupture or dissection, diaphragmatic injuries and fracture of vertebrae, sternum and costal cartilages. Diagnosing vascular injuries can be aided by using the MIP images. Rib fracture, trachea and bronchial laceration are more easily detected by the 3D images, while airway and vascular injuries can be detected from performing virtual endoscopy. We introduce our current CT imaging protocol and we present our clinical experience with using MDCT in the assessment of patients with blunt thoracic trauma.

  20. UPPER THORACIC SPINE FRACTURE ASSOCIATED WITH FRACTURE OF THE STERNUM

    Directory of Open Access Journals (Sweden)

    JOAQUÍN VALERO

    Full Text Available ABSTRACT Objectives: The objectives of this presentation are to analyze the kinematics that causes this association, describe the impact of the injury, and evaluate the treatment performed Methods: Three cases are analyzed by quantifying the displacement and angulation of the sternum, the characteristics of the spinal injury and deformity, treatment, and complications Results: The mechanism that causes the injury is flexion-distraction, the component of the vertebral body presented is type A, and the most affected region was T5. Two patients had neurological picture E. Sternum injury was caused by direct trauma Conclusion: The association of these was observed in patients who have suffered from high-energy trauma in a car accident. There was no relationship between the angulation of the sternum and its displacement to the degree of kyphosis and displacement of the thoracic spine. It is important to carry out good radiographic studies that include the sternum when there is suspicion of this relationship.

  1. Radiologic drainage of infected and noninfected thoracic fluid collections

    International Nuclear Information System (INIS)

    Van Sonnenberg, E.; Casola, G.; Stavas, J.; Neff, C.C.; Varney, R.A.; Wittich, G.R.; Dillard, J.; Christensen, R.A.; Friedman, P.J.

    1987-01-01

    Radiologically guided drainage of 100 thoracic fluid collections is described in this paper. Collections that underwent drainage include empyemas, lung abscesses, bronchopleural fistulas (BPFs), mediastinal abscesses, paracardial collections, bronchogenic cysts, sequestrations, lymphoceles, lymphangiomas, malignant effusions, and necrotic tumors. Catheters were placed for sclerotherapy in nine patients. Guidance modalities (in descending order of frequency) were CT, US, fluoroscopy, and MR. Inadequate thoracostomy tube drainage occurred in a third of the patients prior to radiologic drainage. Drainages were effective in 85% of cases, sparing surgery or another thoracostomy tube. Complications occurred in 7% of patients, most being minor and none requiring operation. Criteria for drainage of lung abscess and BPF will be emphasized, as will techniques and methods of follow-up

  2. Multiple giant mid-thoracic esophageal diverticula in a teenager

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    Moo Cho

    2017-12-01

    Full Text Available Esophageal diverticula in the pediatric population are rare. The etiologies and presentations can vary widely which can make it difficult to diagnose without imaging or direct visualization. We are reporting a case of a 14-year-old male with history of asthma, anorexia, weight loss, and chest discomfort. CXR findings of mediastinal widening prompted a more extensive evaluation. He was found to have two esophageal diverticula, phlegmonous changes, and osteomyelitis of the T5 and T6 vertebra. He was initially treated with IV antibiotic therapy, bypassing the affected area with nasogastric enteric tube feedings, and a cervical thoracic orthosis brace for spine stability. He regained his lost weight and became asymptomatic, returning to a regular diet. The family has declined to pursue surgical intervention at present.

  3. CT quantification of pleuropulmonary lesions in severe thoracic trauma

    International Nuclear Information System (INIS)

    Kunisch-Hoppe, M.; Bachmann, G.; Weimar, B.; Bauer, T.; Rau, W.S.; Hoppe, M.; Zickmann, B.

    1997-01-01

    Purpose: Computed quantification of the extent of pleuropulmonary trauma by CT and comparison with conventional chest X-ray - Impact on therapy and correlation with mechanical ventilation support and clinical outcome. Method: In a prospective trial, 50 patients with clinically suspicious blunt chest trauma were evaluated using CT and conventional chest X-ray. The computed quantification of ventilated lung provided by CT volumetry was correlated with the consecutive artificial respiration parameters and the clinical outcome. Results: We found a high correlation between CT volumetry and artificial ventilation concerning maximal pressures and inspiratory oxygen concentration (FiO 2 , Goris-Score) (r=0.89, Pearson). The graduation of thoracic trauma correlated highly with the duration of mechanical ventilation (r=0.98, Pearson). Especially with regard to atelectases and lung contusions CT is superior compared to conventional chest X-ray; only 32% and 43%, respectively, were identified by conventional chest X-ray. (orig./AJ) [de

  4. Pleural puncture with thoracic epidural: A rare complication?

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    Rachna Wadhwa

    2011-01-01

    Full Text Available Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

  5. [Thoracic wounds. Therapeutic approach. Apropos of 77 cases].

    Science.gov (United States)

    Lamour, A; Azorin, J; Destable, M D; Hoang, P; Lapandry, C; de Saint-Florent, G

    1987-05-01

    We have led over a four year period, from 1981 to 1985, a prospective study on all cases of penetrating chest wounds (77 cases) in the intensive Care unit and the Department of Thoracic Surgery at the Avicenne Hospital. These wounds, involving young males, are fortunately mostly benign. Their seriousness is based on the abdominal or mediastinal hemorrhage as well as lesions to the vital organs which need an emergency intervention. The latter, nevertheless, with the help of the mobile reanimation service for transfering the patient, has diminished the mortality rate to 2.6 per cent. Following their experiment and after a review of the literature, the authors expose their method of management of the penetrating chest wounds.

  6. Thoracic surgery in solving enormous elevation of the left hemidiaphragm

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    Cvijanović Vlado

    2007-01-01

    Full Text Available Background. Acquired elevation of the diaphragm is mostly the result of phrenic nerve paralysis, some of thoracic and abdominal patological states, and also some of neuromuscular diseases. Surgical treatment is rarely performed and is indicated when lung compression produces disabilitating dyspnea, and includes plication of diaphragm. The goal of this case report has been to show completely documented diagnostic procedures and surgical treatment one of rare pathological condition. Case report. A 62-year-old patient was admitted to our clinic because of surgical treatment of the enormous elevation of the left hemidiaphragm. After thoracotomy and plication of the bulging diaphragm, lung compression did not exist any more and mediastinum went back in the normal position. Conclusion. Elevation of the diaphragm rarely demands surgical correction. When it is complicated with lung compression and disabilitating dyspnea, surgical treatment has extremely useful functional effect.

  7. Open pneumothorax resulting from blunt thoracic trauma: a case report.

    Science.gov (United States)

    McClintick, Colleen M

    2008-01-01

    Cases of open pneumothorax have been documented as early as 326 BC. Until the last 50 years, understanding of the epidemiology and treatment of penetrating chest trauma has arisen from military surgery. A better understanding of cardiopulmonary dynamics, advances in ventilatory support, and improvement in surgical technique have drastically improved treatment and increased the survival rate of patients with penetrating thoracic trauma. Open pneumothorax is rare in blunt chest trauma, but can occur when injury results in a substantial loss of the chest wall. This case study presents an adolescent who sustained a large open pneumothorax as a result of being run over by a car. Early and appropriate surgical intervention coupled with coordinated efforts by all members of the trauma team resulted in a positive outcome for this patient.

  8. Radiation therapy for the cervical and upper thoracic esophageal cancer

    International Nuclear Information System (INIS)

    Chatani, Masashi; Teshima, Teruki; Inoue, Toshihiko

    1990-01-01

    This is a retrospective analysis of 19 patients with carcinoma of the cervical esophagus (Ce) and 36 of the upper thoracic esophagus (Iu) treated with radiotherapy between September 1977 and December 1987. Three-year survival rates by Kaplan-Meier method were 18% in Ce cancer and 7% in Iu cancer. Two-year local tumor control was obtained in 3 Ce and 4 Iu cancer. Concerning the treatment methods for the above 7 patients, 3 patients with carcinoma of the Ce were treated with double wedged technique and 4 of Iu were treated with box-technique (2 patients), rotation technique (1) and double wedge technique (1). There were no 2-year local tumor control in patients who received less than 60 Gy of the tumor dose or whose tumor exceeded more than 10 cm in length. Double wedge technique is suitable for radiotherapy of Ce cancer, while further investigation of dose and compensation is necessary for Iu cancer. (author)

  9. A proposed radiological classification of childhood intra-thoracic tuberculosis

    International Nuclear Information System (INIS)

    Marais, Ben J.; Gie, Robert P.; Schaaf, H. Simon; Hesseling, Anneke C.; Donald, Peter R.; Beyers, Nulda; Starke, Jeff R.

    2004-01-01

    One of the obstacles in discussing childhood tuberculosis (TB) is the lack of standard descriptive terminology to classify the diverse spectrum of disease. Accurate disease classification is important, because the correct identification of the specific disease entity has definite prognostic significance. Accurate classification will also improve study outcome definitions and facilitate scientific communication. The aim of this paper is to provide practical guidelines for the accurate radiological classification of intra-thoracic TB in children less than 15 years of age. The proposed radiological classification is based on the underlying disease and the principles of pathological disease progression. The hope is that the proposed classification will clarify concepts and stimulate discussion that may lead to future consensus. (orig.)

  10. Wall stress on ascending thoracic aortic aneurysms with bicuspid compared with tricuspid aortic valve.

    Science.gov (United States)

    Xuan, Yue; Wang, Zhongjie; Liu, Raymond; Haraldsson, Henrik; Hope, Michael D; Saloner, David A; Guccione, Julius M; Ge, Liang; Tseng, Elaine

    2018-03-08

    Guidelines for repair of bicuspid aortic valve-associated ascending thoracic aortic aneurysms have been changing, most recently to the same criteria as tricuspid aortic valve-ascending thoracic aortic aneurysms. Rupture/dissection occurs when wall stress exceeds wall strength. Recent studies suggest similar strength of bicuspid aortic valve versus tricuspid aortic valve-ascending thoracic aortic aneurysms; thus, comparative wall stress may better predict dissection in bicuspid aortic valve versus tricuspid aortic valve-ascending thoracic aortic aneurysms. Our aim was to determine whether bicuspid aortic valve-ascending thoracic aortic aneurysms had higher wall stresses than their tricuspid aortic valve counterparts. Patients with bicuspid aortic valve- and tricuspid aortic valve-ascending thoracic aortic aneurysms (bicuspid aortic valve = 17, tricuspid aortic valve = 19) greater than 4.5 cm underwent electrocardiogram-gated computed tomography angiography. Patient-specific 3-dimensional geometry was reconstructed and loaded to systemic pressure after accounting for prestress geometry. Finite element analyses were performed using the LS-DYNA solver (LSTC Inc, Livermore, Calif) with user-defined fiber-embedded material model to determine ascending thoracic aortic aneurysm wall stress. Bicuspid aortic valve-ascending thoracic aortic aneurysms 99th-percentile longitudinal stresses were 280 kPa versus 242 kPa (P = .028) for tricuspid aortic valve-ascending thoracic aortic aneurysms in systole. These stresses did not correlate to diameter for bicuspid aortic valve-ascending thoracic aortic aneurysms (r = -0.004) but had better correlation to tricuspid aortic valve-ascending thoracic aortic aneurysms diameter (r = 0.677). Longitudinal stresses on sinotubular junction were significantly higher in bicuspid aortic valve-ascending thoracic aortic aneurysms than in tricuspid aortic valve-ascending thoracic aortic aneurysms (405 vs 329 kPa, P = .023). Bicuspid

  11. INFECTIOUS COMPLICATIONS IN CHRONIC LYMPHOCYTIC LEUKEMIA

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    AnnaMaria Nosari

    2012-11-01

    Full Text Available Infectious complications have been known to be a major cause of morbidity and mortality in CLL patients who are predisposed to infections because of both the humoral immunodepression inherent to hematologic disease, which is related to stage and duration of CLL, and to further immunosuppression related to therapy. The majority of infections in CLL patients treated with alkilating agents is of bacterial origin. The immunodeficiency and natural infectious history of alkylator-resistant, corticosteroid-treated patients appears to have changed with the administration of purine analogs, which has been complicated by very severe and unusual infections and also more viral infections due to sustained reduction of CD4-positive T lymphocytes. The following introduction of monoclonal antibody therapies, in particular alemtuzumab, further increased the immunodepression, increasing also infections which appeared more often in patients with recurrent neutropenia due to chemotherapy cycles. Epidemiological data regarding fungal infections in lymphoproliferative disorders are scarce. Italian SEIFEM group in a retrospective multicentre study regarding CLL patients reported an incidence of mycoses 0.5%; however, chronic lymphoproliferative disorders emerged as second haematological underlying disease after acute leukemia in a French study on aspergillosis; in particular CLL with aspergillosis accounted for a third of these chronic lymphoproliferative diseases presenting mould infection.

  12. Mathematical modeling of infectious disease dynamics

    Science.gov (United States)

    Siettos, Constantinos I.; Russo, Lucia

    2013-01-01

    Over the last years, an intensive worldwide effort is speeding up the developments in the establishment of a global surveillance network for combating pandemics of emergent and re-emergent infectious diseases. Scientists from different fields extending from medicine and molecular biology to computer science and applied mathematics have teamed up for rapid assessment of potentially urgent situations. Toward this aim mathematical modeling plays an important role in efforts that focus on predicting, assessing, and controlling potential outbreaks. To better understand and model the contagious dynamics the impact of numerous variables ranging from the micro host–pathogen level to host-to-host interactions, as well as prevailing ecological, social, economic, and demographic factors across the globe have to be analyzed and thoroughly studied. Here, we present and discuss the main approaches that are used for the surveillance and modeling of infectious disease dynamics. We present the basic concepts underpinning their implementation and practice and for each category we give an annotated list of representative works. PMID:23552814

  13. Pregnancy and Susceptibility to Infectious Diseases

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    Elisabeth Sappenfield

    2013-01-01

    Full Text Available To summarize the literature regarding susceptibility of pregnant women to infectious diseases and severity of resulting disease, we conducted a review using a PubMed search and other strategies. Studies were included if they reported information on infection risk or disease outcome in pregnant women. In all, 1454 abstracts were reviewed, and a total of 85 studies were included. Data were extracted regarding number of cases in pregnant women, rates of infection, risk factors for disease severity or complications, and maternal outcomes. The evidence indicates that pregnancy is associated with increased severity of some infectious diseases, such as influenza, malaria, hepatitis E, and herpes simplex virus (HSV infection (risk for dissemination/hepatitis; there is also some evidence for increased severity of measles and smallpox. Disease severity seems higher with advanced pregnancy. Pregnant women may be more susceptible to acquisition of malaria, HIV infection, and listeriosis, although the evidence is limited. These results reinforce the importance of infection prevention as well as of early identification and treatment of suspected influenza, malaria, hepatitis E, and HSV disease during pregnancy.

  14. Microparticles as immune regulators in infectious disease

    Directory of Open Access Journals (Sweden)

    Zheng Lung Ling

    2011-11-01

    Full Text Available Despite their clear relationship to immunology, few existing studies have examined potential role of microparticles (MP in infectious disease. Infection with pathogens usually leads to the expression of a range of inflammatory cytokines and chemokines, as well as significant stress in both infected and uninfected cells. It is thus reasonable to infer from studies to date that infection-associated inflammation also leads to MP production. MP are produced by most of the major cell types in the immune system, and appear to be involved at both the innate and adaptive levels, potentially serving different functions at each level. Thus, MP do not appear to have a universal function; instead their functions are source- or stimulus-dependent, although likely to be primarily either pro- or anti-inflammatory. Importantly, in infectious diseases MP may have the ability to deliver antigen to APC via the biological cargo acquired from their cells of origin. Another potential benefit of MP would be to transfer and/or disseminate phenotype and function to target cells. However, MP may also potentially be manipulated, particularly by intracellular pathogens for survival advantage.

  15. Splenic Infarction in Acute Infectious Mononucleosis.

    Science.gov (United States)

    Naviglio, Samuele; Abate, Maria Valentina; Chinello, Matteo; Ventura, Alessandro

    2016-01-01

    The evaluation of a febrile patient with acute abdominal pain represents a frequent yet possibly challenging situation in the emergency department (ED). Splenic infarction is an uncommon complication of infectious mononucleosis, and may have a wide range of clinical presentations, from dramatic to more subtle. Its pathogenesis is still incompletely understood, yet it may be associated with the occurrence of transient prothrombotic factors. We report the case of a 14-year-old boy who presented with fever, sore throat, left upper quadrant abdominal pain, and splenomegaly, with no history of recent trauma. Laboratory tests revealed a markedly prolonged activated partial thromboplastin time and positive lupus anticoagulant. Abdominal ultrasonography showed several hypoechoic areas in the spleen consistent with multiple infarctions. Magnetic resonance imaging eventually confirmed the diagnosis. He was admitted for observation and supportive treatment, and was discharged in good condition after 7 days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous splenic infarction should be considered in the differential list of patients presenting with left upper quadrant abdominal pain and features of infectious mononucleosis; the diagnosis, however, may not be straightforward, as clinical presentation may also be subtle, and abdominal ultrasonography, which is often used as a first-line imaging modality in pediatric EDs, has low sensitivity in this scenario and may easily miss it. Furthermore, although treatment is mainly supportive, close observation for possible complications is necessary. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Feline infectious peritonitis: still an enigma?

    Science.gov (United States)

    Kipar, A; Meli, M L

    2014-03-01

    Feline infectious peritonitis (FIP) is one of the most important fatal infectious diseases of cats, the pathogenesis of which has not yet been fully revealed. The present review focuses on the biology of feline coronavirus (FCoV) infection and the pathogenesis and pathological features of FIP. Recent studies have revealed functions of many viral proteins, differing receptor specificity for type I and type II FCoV, and genomic differences between feline enteric coronaviruses (FECVs) and FIP viruses (FIPVs). FECV and FIP also exhibit functional differences, since FECVs replicate mainly in intestinal epithelium and are shed in feces, and FIPVs replicate efficiently in monocytes and induce systemic disease. Thus, key events in the pathogenesis of FIP are systemic infection with FIPV, effective and sustainable viral replication in monocytes, and activation of infected monocytes. The host's genetics and immune system also play important roles. It is the activation of monocytes and macrophages that directly leads to the pathologic features of FIP, including vasculitis, body cavity effusions, and fibrinous and granulomatous inflammatory lesions. Advances have been made in the clinical diagnosis of FIP, based on the clinical pathologic findings, serologic testing, and detection of virus using molecular (polymerase chain reaction) or antibody-based methods. Nevertheless, the clinical diagnosis remains challenging in particular in the dry form of FIP, which is partly due to the incomplete understanding of infection biology and pathogenesis in FIP. So, while much progress has been made, many aspects of FIP pathogenesis still remain an enigma.

  17. Tackling feline infectious peritonitis via reverse genetics.

    Science.gov (United States)

    Thiel, Volker; Thiel, Heinz-Jürgen; Tekes, Gergely

    2014-01-01

    Feline infectious peritonitis (FIP) is caused by feline coronaviruses (FCoVs) and represents one of the most important lethal infectious diseases of cats. To date, there is no efficacious prevention and treatment, and our limited knowledge on FIP pathogenesis is mainly based on analysis of experiments with field isolates. In a recent study, we reported a promising approach to study FIP pathogenesis using reverse genetics. We generated a set of recombinant FCoVs and investigated their pathogenicity in vivo. The set included the type I FCoV strain Black, a type I FCoV strain Black with restored accessory gene 7b, two chimeric type I/type II FCoVs and the highly pathogenic type II FCoV strain 79-1146. All recombinant FCoVs and the reference strain isolates were found to establish productive infections in cats. While none of the type I FCoVs and chimeric FCoVs induced FIP, the recombinant type II FCoV strain 79-1146 was as pathogenic as the parental isolate. Interestingly, an intact ORF 3c was confirmed to be restored in all viruses (re)isolated from FIP-diseased animals.

  18. Photodynamic inactivation of pathogens causing infectious keratitis

    Science.gov (United States)

    Simon, Carole; Wolf, G.; Walther, M.; Winkler, K.; Finke, M.; Hüttenberger, D.; Bischoff, Markus; Seitz, B.; Cullum, J.; Foth, H.-J.

    2014-03-01

    The increasing prevalence of antibiotic resistance requires new approaches also for the treatment of infectious keratitis. Photodynamic Inactivation (PDI) using the photosensitizer (PS) Chlorin e6 (Ce6) was investigated as an alternative to antibiotic treatment. An in-vitro cornea model was established using porcine eyes. The uptake of Ce6 by bacteria and the diffusion of the PS in the individual layers of corneal tissue were investigated by fluorescence. After removal of the cornea's epithelium Ce6-concentrations tested in liquid culture against different concentrations of Ce6 (1 - 512 μM) using 10 minutes irradiation (E = 18 J/cm2 ). This demonstrated that a complete inactivation of the pathogen strains were feasible whereby SA was slightly more susceptible than PA. 3909 mutants of the Keio collection of Escherichia coli (E.coli) were screened for potential resistance factors. The sensitive mutants can be grouped into three categories: transport mutants, mutants in lipopolysaccharide synthesis and mutants in the bacterial SOS-response. In conclusion PDI is seen as a promising therapy concept for infectious keratitis.

  19. Infectious Diseases and Immunizations in International Adoption.

    Science.gov (United States)

    Obringer, Emily; Walsh, Linda

    2017-02-01

    Children who are adopted internationally have an increased risk of infectious diseases due to endemic conditions and variable access to preventive health care, such as vaccines, in their country of origin. Pediatricians and other providers who care for children should be familiar with the recommended screening for newly arrived international adoptees. Testing for gastrointestinal pathogens, tuberculosis, hepatitis, syphilis, and HIV should be routinely performed. Other endemic diseases and common skin infections may need to be assessed. Evaluation of the child's immunization record is also important, as nearly all international adoptees will require catch-up vaccines. The provider may also be asked to review medical records prior to adoption, provide travel advice, and ensure that parents and other close contacts are up-to-date on immunizations prior to the arrival of the newest family member. The pediatrician serves a unique role in facilitating the evaluation, treatment, and prevention of infectious diseases in international adoptees. [Pediatr Ann. 2017;46(2):e56-e60.]. Copyright 2017, SLACK Incorporated.

  20. Preoperative diagnosis of lymph node metastasis in thoracic esophageal cancer

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    Eguchi, Reiki; Yamada, Akiyoshi; Ueno, Keiko; Murata, Yoko [Tokyo Women`s Medical Coll. (Japan)

    1996-10-01

    From 1994 to 1995, to evaluate the utility of preoperative CT, EUS (endoscopic ultrasonography) and US in the diagnosis of lymph node metastasis in thoracic esophageal cancer, 94 patients with thoracic esophageal cancer who underwent esophagectomy were studied clinicopathologically. The sensitivity of EUS diagnosis of upper mediastinal lymph node metastasis (85%), left-sided paragastrin lymph node metastasis (73-77%), and especially lower paraesophageal lymph node metastasis (100%) were good. But due to their low-grade specificity in EUS diagnosis, their overall accuracy was not very good. On the other hand, the overall accuracy of the CT diagnosis of lymph node metastasis was fine. However, sensitivity, the most important clinical factor in the CT diagnosis of lymph node metastasis was considerably inferior to EUS. The assessment of the diagnosis of lymph node metastasis around the tracheal bifurcation and the pulmonary hilum and the left para-cardial lesion by CT or EUS was poor. It was concluded that lymph node metastasis of these area must be the pitfall in preoperative diagnosis. The average diameter of the lymph nodes and the proportion of cancerous tissue in the lymph nodes diagnosed as metastatic lymph nodes by CT was larger than that of the false negative lymph nodes. However, the lymph nodes diagnosed as true positives by EUS showed no such tendency. This must be the reason the sensitivity of the EUS diagnosis and specificity of the CT diagnosis were favorable, but the specificity of the EUS diagnosis and especially the sensitivity of the CT diagnosis were not as good. (author)