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Sample records for thoracic wall axilla

  1. 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

  2. Extrapleural Inner Thoracic Wall Lesions: Multidetector CT Findings

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    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

  3. 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

  4. 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.

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

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    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.

  6. An unusual case of isolated, serial metastases of gallbladder carcinoma involving the chest wall, axilla, breast and lung parenchyma

    Directory of Open Access Journals (Sweden)

    Matthew J. Iott

    2013-02-01

    Full Text Available In the English literature, only 9 cases of adenocarcinoma of the gallbladder with cutaneous metastasis have been reported so far. One case of multiple cutaneous metastases along with deposits in the breast tissue has been reported. We present a case of incidental metastatic gallbladder carcinoma with no intra-abdominal disease presenting as a series of four isolated cutaneous right chest wall, axillary nodal, breast and pulmonary metastases following resection and adjuvant chemoradiation for her primary tumor. In spite of the metastatic disease coupled with the aggressive nature of the cancer, this patient reported that her energy level had returned to baseline with a good appetite and a stable weight indicating a good performance status and now is alive at 25 months since diagnosis. Her serially-presented, oligometastatic diseases were well-controlled by concurrent chemoradiation and stereotactic radiation therapy. We report this case study because of its rarity and for the purpose of complementing current literature with an additional example of cutaneous metastasis from adenocarcinoma of the gallbladder.

  7. Malignant granular cell tumour on the thoracic wall: a case report and literature review

    International Nuclear Information System (INIS)

    Perez, E.; Esteban, R.; Alcalaya, R.; Albors, L.; Jimenez, C.; Ovelar, Y.; Cantera, M.G.

    1993-01-01

    A case is presented of a malignant granular cell tumour in a 52-year-old patient the initial location of which was the thoracic wall. After the tumour's removal there was recurrence in the lymph nodes, retroperitoneum, bone, lung and orbits. The important features of this case are its extraordinary rarity, the unusual location in the thoracic wall, and the tumour's infrequent malignancy. The radiological and histological findings are discussed, and the literature on the subject is reviewed. (orig.)

  8. 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

  9. Characterization of atherosclerotic disease in thoracic aorta: A 3D, multicontrast vessel wall imaging study

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    Zhou, Changwu [Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing (China); Department of Radiology, The Second Clinical Medical College, Yangzhou University, Yangzhou (China); Qiao, Huiyu; He, Le [Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing (China); Yuan, Chun [Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing (China); Department of Radiology, University of Washington, Seattle, WA (United States); Chen, Huijun; Zhang, Qiang; Li, Rui [Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing (China); Wang, Wei; Du, Fang [Department of Radiology, The Second Clinical Medical College, Yangzhou University, Yangzhou (China); Li, Cheng, E-mail: cjr.licheng@vip.163.com [Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing (China); Zhao, Xihai, E-mail: xihaizhao@tsinghua.edu.cn [Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing (China)

    2016-11-15

    Purpose: To investigate the characteristics of plaque in the thoracic aorta using three dimensional multicontrast magnetic resonance imaging. Materials and methods: Elderly subjects (≥60 years) were recruited in this study. Thoracic aorta was imaged on a 3.0T MR scanner by acquiring multicontrast sequences. The plaque burden was evaluated by measuring lumen area, wall area, wall thickness, and normalized wall index. The presence or absence of plaque and intraplaque hemorrhage (IPH)/mural thrombus (MT) were identified. The characteristics of atherosclerosis among different thoracic aorta segments (AAO: ascending aorta; AOA: aortic arch, and DOA: descending aorta) were determined. Results: Of 66 recruited subjects (mean age 72.3 ± 6.2 years, 30 males), 55 (83.3%) had plaques in the thoracic aorta. The prevalence of plaque in AAO, AOA, and DAO was 5.4%, 72.7%, and 71.2%, respectively. In addition, 21.2% of subjects were found to have lesions with IPH/MT in the thoracic aorta. The prevalence of IPH/MT in segment of AAO, AOA and DAO was 0%, 13.6%, and 12.1%, respectively. The aortic wall showed the highest NWI in DAO (34.1% ± 4.8%), followed by AOA (31.2% ± 5%), and AAO (26.8% ± 3.3%) (p < 0.001). Conclusion: Three dimensional multicontrast MR imaging is capable of characterizing atherosclerotic plaques in the thoracic aorta. The findings of high prevalence of plaques and the presence of high risk plaques in the thoracic aorta suggest early screening for aortic vulnerable lesions in the elderly.

  10. Characterization of atherosclerotic disease in thoracic aorta: A 3D, multicontrast vessel wall imaging study

    International Nuclear Information System (INIS)

    Zhou, Changwu; Qiao, Huiyu; He, Le; Yuan, Chun; Chen, Huijun; Zhang, Qiang; Li, Rui; Wang, Wei; Du, Fang; Li, Cheng; Zhao, Xihai

    2016-01-01

    Purpose: To investigate the characteristics of plaque in the thoracic aorta using three dimensional multicontrast magnetic resonance imaging. Materials and methods: Elderly subjects (≥60 years) were recruited in this study. Thoracic aorta was imaged on a 3.0T MR scanner by acquiring multicontrast sequences. The plaque burden was evaluated by measuring lumen area, wall area, wall thickness, and normalized wall index. The presence or absence of plaque and intraplaque hemorrhage (IPH)/mural thrombus (MT) were identified. The characteristics of atherosclerosis among different thoracic aorta segments (AAO: ascending aorta; AOA: aortic arch, and DOA: descending aorta) were determined. Results: Of 66 recruited subjects (mean age 72.3 ± 6.2 years, 30 males), 55 (83.3%) had plaques in the thoracic aorta. The prevalence of plaque in AAO, AOA, and DAO was 5.4%, 72.7%, and 71.2%, respectively. In addition, 21.2% of subjects were found to have lesions with IPH/MT in the thoracic aorta. The prevalence of IPH/MT in segment of AAO, AOA and DAO was 0%, 13.6%, and 12.1%, respectively. The aortic wall showed the highest NWI in DAO (34.1% ± 4.8%), followed by AOA (31.2% ± 5%), and AAO (26.8% ± 3.3%) (p < 0.001). Conclusion: Three dimensional multicontrast MR imaging is capable of characterizing atherosclerotic plaques in the thoracic aorta. The findings of high prevalence of plaques and the presence of high risk plaques in the thoracic aorta suggest early screening for aortic vulnerable lesions in the elderly.

  11. A "conservative" method of thoracic wall dissection: a proposal for teaching human anatomy.

    Science.gov (United States)

    Barberini, Fabrizio; Brunone, Francesca

    2008-01-01

    The common methods of dissection exposing the thoracic organs include crossing of the wall together with wide resection of its muscular planes. In order to preserve these structures, a little demolishing technique of the thoracic wall is proposed, entering the thoracic cavity without extensive resection of the pectoral muscles. This method is based on the fact that these muscles rise up from the wall, like a bridge connecting the costal plane with the upper limb, and that the pectoralis major shows a segmental constitution. SUPERIOR LIMIT: Resect the sternal manubrium transversely between the 1st and the 2nd rib. The incision is prolonged along the 1st intercostal space, separating the first sterno-costal segment of the pectoralis major from the second one, and involving the intercostal muscles as far as the medial margin of the pectoralis minor. This muscle must be raised up, and the transverse resection continued below its medial margin latero-medially along the 1st intercostal space, to rejoin the cut performed before. Then, the incision of the 1st intercostal space is prolonged below the lateral margin of the pectoralis minor, which must be kept raised up, medio-laterally as far as the anterior axillary line. INFERIOR LIMIT: It corresponds to the inferior border of the thoracic cage, resected from the xiphoid process to the anterior axillary line, together with the sterno-costal insertions of the diaphragm. Then, an incision of the sterno-pericardial ligaments and a median sternotomy from the xiphoid process to the transverse resection of the manubrium should be performed. LATERAL LIMIT: From the point of crossing of the anterior axillary line with the inferior limit, resect the ribs from the 10th to the 2nd one. The lateral part of the pectoralis major must be raised up, so that the costal resection may be continued below it. Then, at the lateral extremity of the superior incision, the first and the second sternocostal segment of the pectoralis major must be

  12. Traumatic funicular phlebitis of the thoracic wall resembling Mondor's disease: a case report

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    Kondo Takeshi

    2011-03-01

    Full Text Available Abstract Introduction Mondor's disease is a peculiar form of thrombophlebitis, involving a superficial vein in the subcutaneous fat of the breast or anterior chest wall. Case presentation The author presents a case of a 35-year-old male Japanese patient with cord-like induration in the right lateral thoracic wall. This lesion was diagnosed as traumatic funicular phlebitis, resembling Mondor's disease. Conclusion Traumatic funicular phlebitis, resembling Mondor's disease, is a clinical entity which may give suggestive insight to the etiology of Mondor's disease itself.

  13. Obesity Increases the Risk of Chest Wall Pain From Thoracic Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Welsh, James; Thomas, Jimmy; Shah, Deep; Allen, Pamela K.; Wei, Xiong; Mitchell, Kevin; Gao, Song; Balter, Peter; Komaki, Ritsuko; Chang, Joe Y.

    2011-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumors within 30 , or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI ≥29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

  14. Quantification of progression and regression of descending thoracic aortic wall thickness by enhanced computed tomography

    International Nuclear Information System (INIS)

    Yokoyama, Kenichi; Takasu, Junichiro; Yamamoto, Rie; Taguchi, Rie; Itani, Yasutaka; Ito, Yuichi; Watanabe, Shigeru; Masuda, Yoshiaki

    2001-01-01

    The purpose of this study is to verify the usefulness of the quantification of aortic wall involvement by enhanced computed tomography (CT). One-hundred thirteen Japanese patients underwent two enhanced CT of the descending thoracic aorta at intervals. We sliced the descending thoracic aorta continuously from the level of the tracheal bifurcation with 1 cm intervals, and we defined aortic wall volume (AWV) (cm 3 ) as the sum of a 7-slice area of aortic wall involving calcification. The average of AWV increased from 7.95±2.92 cm 3 to 8.70±2.98 cm 3 . The developmental rate of AWV (ΔAWV) was 0.270±0.281 cm 3 /year. ΔAWV did not have a significant correlation with any risk factor at the baseline. ΔAWV had significant correlation with total cholesterol, (LDL-C) low-density lipoprotein cholesterol and LDL-C/(HDL-C) high-density lipoprotein cholesterol ratio at the follow-up, and by multivariate analysis with only the LDL-C/HDL-C ratio. ΔAWV was not correlated with the intake status of hypoglycemic, antihypertensive or lipid-lowering drugs. The cut-off level of total cholesterol with the most significant odds ratio for progression of aortic wall was 190 mg/dl, and that of LDL-C was 130 mg/dl. This method proved to be useful for the non-invasive assessment of aortic wall thickness. (author)

  15. Vessel wall MRI of the thoracic aorta: correlation to histology and transesophageal ultrasound. Preliminary results

    International Nuclear Information System (INIS)

    Abolmaali, N.; Schick, C.; Thalhammer, A.; Schmitt, J.; Vogl, T.J.; Langenfeld, M.; Schaechinger, V.; Krahforst, R.; Schulze, T.

    2002-01-01

    Purpose: To visualise the vessel wall of the descending thoracic aorta using magnetic resonance imaging. To evaluate the diagnostic potential of tailored T 1 -weighted sequences with contrast enhancement to assess systemic atherosclerotic disease. Methods: This study was performed on a clinical 1.5 Tesla scanner using a gradient strength of 30 mT/m and the phased array spine coil. A cadaver was examined to optimise a magnetic resonance imaging (MRI) protocol to evaluate atherosclerotic aortic wall disease. The acquired MR images were compared to gross specimens and histology. Subsequently seven patients who had undergone transesophageal ultrasound (TEU) with detailed assessment of the descending thoracic aorta were examined with MRI. The optimised protocol included untriggered and fat suppressed T 2 -weighted turbo spin echo sequences and ECG-triggered and fat suppressed T 1 -weighted spin echo sequences before and after iv administration of Gd-DTPA. Findings of the MR images were compared to the results of TEU. Contrast enhancement measurements were performed in normal and thickened vessel wall segments. Results: For the cadaver study a good correlation of the degree of vessel wall thickening and the extent of plaque imaged with the applied MR protocol was found. Tissue characterisation was limited due to post mortem changes. In vivo ECG-triggered T 1 -weighted images showed good correlation to TEU in terms of vessel wall thickness and plaque extension as verified by means of consensus reading. Differentiation of the plaque components fat, calcium and fibrous tissue was possible. In thickened aortic wall segments and fibrous caps a mean contrast enhancement of 50.4%±23.5% was measurable while normal wall segments showed an enhancement of 6.7%±3.1%. (orig.) [de

  16. The Askin tumour. Neuroactodermic tumour of the thoracic wall; Tumor de Askin: tumor neuroectodermico de la pared toracica

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    Velazquez, P.; Nicolas, A. I.; Vivas, I.; Damaso Aquerreta, J.; Martinez-Cuesta, A. [Clinica Universitaria de Navarra. Pamplona (Spain)

    1999-07-01

    The Askin tumours is an extremely rare and malignant process in the thoracic pulmonary region during infancy and youth. The differential diagnosis has to be considered with other thoracic wall tumours that are more common in pediatrics like the undifferentiated neuroblastoma, the embionic rabdomiosarcoma, the Ewing sarcoma and the linfoma. A retrospective examination was carried out on 473 thoracic wall tumours from 1994 to 1997 at our centre, resulting in 4 patients with an anatomopathologically tested Askin tumour (ages from 13-21). All the cases were studied using simple radiography and CT. In two cases MRI was also used. The most common clinical manifestation was a palpable painful mass in the thoracic wall. In the simple radiograph the main finding was a large mass of extrapleural soft material, with costal destruction ( n=3) and a pleural effusion (n=2). In the CT study the mass was heterogeneous, with internal calcifications in one case. CT and MRI showed invasion in the mediastinum (n=1), medular channel (n=1) and phrenic and sulphrenic extension (n=1). The Askin tumour should be included in the differential diagnosis of thoracic wall masses in infant-youth ages. There are no specific morphological characteristics. Both CT and MRI are useful for the diagnosis, staging and follow up. (Author) 11 refs.

  17. Postoperative thoracic hemorrhage after right upper lobectomy with thoracic wall resection during rivaroxaban anticoagulant therapy for deep leg vein thrombosis: A case report

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    Taiji Kuwata

    Full Text Available Introduction: Postoperative pulmonary embolism (PE is the one of the most important complications after thoracic surgery. This complicatin after the surgery is often treated by new anticoaglant drug, such as rivaroxaban, which dose not need to the monitoring of blood coaglation system. We experienced postoperative bleeding case during anticoaglant therapy using rivaroxaban. Presentation of case: The patient underwent a right upper lobectomy with lung and chest wall resection for lung cancer. On postoperative day (POD 10, we started to use rivaroxaban to treat the deep vein thrombosis (DVT. Four days after starting the rivaroxaban treatment, severe surgical site hemorrhage occurred, which led to the need for the infusion of concentrated red cells (CRC. After stopping the rivaroxaban, the thoracic bleeding ceased. Because the event occurred so long after the surgery, and because the bleeding stopped after withdrawal of treatment, we believe that rivaroxaban induced the thoracic bleeding. Conclusion: Some reports in the field of orthopedics (Turpie et al., 2009 have noted that rivarxaban is effective to prevent postoperative DVT. However, there were few reports that invied the attention to postoperative bleeding be induced by rivarxaban. Thus, we describe this case in order to alert clinicians to the potential bleeding risks associated with the admistration of rivaroxaban postoperatively. Keywords: Revaroxaban, Anticoagulant, Surgical site bleeding

  18. Wall Shear Stress Estimation of Thoracic Aortic Aneurysm Using Computational Fluid Dynamics

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    J. Febina

    2018-01-01

    Full Text Available An attempt has been made to evaluate the effects of wall shear stress (WSS on thoracic aortic aneurysm (TAA using Computational Fluid Dynamics (CFD. Aneurysm is an excessive localized swelling of the arterial wall due to many physiological factors and it may rupture causing shock or sudden death. The existing imaging modalities such as MRI and CT assist in the visualization of anomalies in internal organs. However, the expected dynamic behaviour of arterial bulge under stressed condition can only be effectively evaluated through mathematical modelling. In this work, a 3D aneurysm model is reconstructed from the CT scan slices and eventually the model is imported to Star CCM+ (Siemens, USA for intensive CFD analysis. The domain is discretized using polyhedral mesh with prism layers to capture the weakening boundary more accurately. When there is flow reversal in TAA as seen in the velocity vector plot, there is a chance of cell damage causing clots. This is because of the shear created in the system due to the flow pattern. It is observed from the proposed mathematical modelling that the deteriorating WSS is an indicator for possible rupture and its value oscillates over a cardiac cycle as well as over different stress conditions. In this model, the vortex formation pattern and flow reversals are also captured. The non-Newtonian model, including a pulsatile flow instead of a steady average flow, does not overpredict the WSS (15.29 Pa compared to 16 Pa for the Newtonian model. Although in a cycle the flow behaviour is laminar-turbulent-laminar (LTL, utilizing the non-Newtonian model along with LTL model also overpredicted the WSS with a value of 20.1 Pa. The numerical study presented here provides good insight of TAA using a systematic approach to numerical modelling and analysis.

  19. Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

    International Nuclear Information System (INIS)

    Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik

    2014-01-01

    Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

  20. Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

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    Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik [St. Paul' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2014-05-15

    Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

  1. [Use and versatility of titanium for the reconstruction of the thoracic wall].

    Science.gov (United States)

    Córcoles Padilla, Juan Manuel; Bolufer Nadal, Sergio; Kurowski, Krzysztof; Gálvez Muñoz, Carlos; Rodriguez Paniagua, José Manuel

    2014-02-01

    Chest wall deformities/defects and chest wall resections, as well as complex rib fractures require reconstruction with various prosthetic materials to ensure the basic functions of the chest wall. Titanium provides many features that make it an ideal material for this surgery. The aim is to present our initial results with this material in several diseases. From 2008 to 2012, 14 patients were operated on and titanium was used for reconstruction of the chest wall. A total of 7 patients had chest wall tumors, 2 with sternal resection, 4 patients with chest wall deformities/defects and 3 patients with severe rib injury due to traffic accident. The reconstruction was successful in all cases, with early extubation without detecting problems in the functionality of the chest wall at a respiratory level. Patients with chest wall tumors including sternal resections were extubated in the operating room as well as the chest wall deformities. Chest trauma cases were extubated within 24h from internal rib fixation. There were no complications related to the material used and the method of implementation. Titanium is an ideal material for reconstruction of the chest wall in several clinical situations allowing for great versatility and adaptability in different chest wall reconstructions. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  2. Left-Sided Catamenial Pneumothorax with Thoracic Endometriosis and Bullae in the Alveolar Wall.

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    Takahashi, Ryo; Kurihara, Masatoshi; Mizobuchi, Teruaki; Ebana, Hiroki; Yamanaka, Sumitaka

    2017-04-20

    Catamenial pneumothorax (CP) is generally caused by intraperitoneal air leaking from the uterus into the thoracic cavity via a defect in the endometrial tissue of the diaphragm and is usually detected in the right thorax. We report a case of left-sided CP caused by endometriosis in the visceral pleura and with no abnormal findings in the diaphragm. A 33-year-old female patient presented at the end of a course of low-dose contraceptive pills for pelvic endometriosis, with spontaneous pneumothorax in the left chest. Chest CT revealed a bulla in the left upper lung lobe. The patient underwent partial resection of the lung. Immunohistochemistry confirmed the presence of endometrial stromal tissue in the visceral pleura and confirmed this as the cause of pneumothorax since there were no observable abnormalities in the diaphragm. This case suggests that immunohistochemical examination of patients with spontaneous pneumothorax can detect alternative endometrial lesions.

  3. CT in the evaluation of space-occupying lesions of the thoracic and abdominal wall

    International Nuclear Information System (INIS)

    Marchal, G.; Coenen, Y.; Baert, A.L.; Wilms, G.

    1979-01-01

    The progress of CT is predominantly based upon a higher densitometric resolution. Besides the bony skeleton, still more precisely studied by conventional techniques, the different soft components of the wall can now be directly and distinctly visualized. It is our experience that CT represents an important contribution in the diagnosis of wall lesions for the following reasons: 1. Correct topographic delineation of space-occupying masses, even when these cannot be visualized by conventional X-ray examination. 2. Indication of extension, with all the practical surgical and radiotherapeutic consequences. 3. It is a very valuable noninvasive method of follow-up of these soft tissue masses in radiotherapy as well as in chemotherapy. (orig.) 891 MG/orig. 892 MB [de

  4. 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.

  5. Visualization of the inferoposterior thoracic wall (VIP) and boomerang signs-novel sonographic signs of right pleural effusion.

    Science.gov (United States)

    Lau, James Siu Ki; Yuen, Chi Kit; Mok, Ka Leung; Yan, Wing Wa; Kan, Pui Gay

    2017-11-15

    This study is to present the diagnostic values of the novel sonographic visualization of the inferoposterior thoracic wall (VIP) and boomerang signs in detecting right pleural effusion by sonologists with little to no experience in ultrasound. A prospective analysis of a convenience sample of patients who were assessed by junior intensive care physicians was performed. The patients all underwent computed tomography (CT) of the chest or abdomen with lung bases as part of their care regardless of indication; the results were interpreted by radiologists and were considered the gold standard. Sonography was performed to assess for the presence of the VIP and boomerang signs. Sonographic and chest radiographic findings were compared against CT results. 73 patients were enrolled. The sensitivity and specificity for the VIP sign were 0.85 (95% confidence interval [CI], 0.67-0.94) and 0.86 (95% CI, 0.70-0.95). The sensitivity and specificity for the boomerang sign were 0.78 (95% CI, 0.60-0.90) and 0.87 (95% CI, 0.71-0.95). However, the sensitivity and specificity for the traditional approach of detecting an anechoic collection above the diaphragm to indicate pleural effusion were only 0.54 (95% CI, 0.37-0.71) and 0.86 (95% CI, 0.80-0.99). Despite inexperience in sonography, the novel VIP and boomerang signs show high diagnostic values in detecting right pleural effusion compared to the traditional methods. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. A rare presentation of an ectopic breast tissue in axilla

    Directory of Open Access Journals (Sweden)

    Radhika Vidyasagar

    2015-10-01

    Full Text Available Accessory breast tissue is rare accounting to less than 1% cases seen in females. It is usually bilateral. We report a case of 24-year-old woman with a lump in the left axilla in view of its rarity and made a differential diagnosis of fibroadenoma, which following the investigations and histopathological report was confirmed as revealed fibroadenoma in the axilla. It should also be considered as a differential diagnosis for all axillary swellings.

  7. Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park.

    Science.gov (United States)

    Sesma, Julio; Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

    2017-08-01

    Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3 rd postoperative day and patient was discharged on 14 th postoperative day. He has already recovered his normal activity 6 months after surgery.

  8. Fibroadenoma in axilla: another manifestation of ectopic breast.

    Science.gov (United States)

    Tiwary, Satyendra K; Kumar, Puneet; Khanna, Ajay Kumar

    2015-04-26

    Fibroadenoma of an accessory breast is a rare disease. The clinical significance lies in the fact that a number of cystic, inflammatory, neoplastic diseases similar to those of a normal breast have been reported in accessory breasts as well. Vigilant self-assessment and complete clinical examination are always encouraged to detect earliest malignancy in the axilla. We report two cases of ectopic breast fibroadenoma with the relevant literature. 2015 BMJ Publishing Group Ltd.

  9. 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 ...

  10. Chest-wall thickness and percent thoracic fat estimation by B-mode ultrasound: system and procedure review

    International Nuclear Information System (INIS)

    Berger, C.D.; Lane, B.H.; Dunsmore, M.R.

    1983-02-01

    Accurate measurement of chest wall thickness is necessary for estimation of lung burden of transuranic elements in humans. To achieve tis capability, the ORNL Whole Body Counter has acquired a B-mode ultrasonic imaging system for defining the structure within the thorax of the body. This report contains a review of the ultrasound system in use at the ORNL Whole Body Counter, including its theory of operation, and te procedure for use of the system. Future developmental plans are also presented

  11. Reptured Epidermal Inclusion Cyst in the Axilla: A Case Report

    International Nuclear Information System (INIS)

    Kim, Kyu Soon; Kim, Hak Hee; Shin, Hee Jeong; Yang, Hye Rin; Sohn, Jeong Hee; Kwon, Gui Young; Gong, Gyung Yub

    2006-01-01

    Epidermal inclusion cysts, the most common type of simple epithelial cyst, are typically well-encapsulated, subepidermal and mobile nodules. They may occur anywhere, but are mostly found on the scalp, face, neck, trunk, and back. Less than 10% of epidermal inclusion cysts occur on the extremities, and even fewer are found on the palms, soles, and breasts. If epidermal inclusion cysts rupture, foreign body reaction, granulomatous reaction or abscess formation could follow. We described here the sonographic findings of ruptured epidermal inclusion cyst of the right axilla in a 33-year-old woman who presented with a palpable axillary mass forming an inflammatory abscess

  12. Moulages on the thoracic wall in radiotherapy of the operated mammary carcinoma with high-speed electrons: Comparative tests of different materials

    International Nuclear Information System (INIS)

    Niewald, M.; Lehmann, W.; Tkocz, H.J.; Scharding, B.; Uhlmann, U.; Schnabel, K.; Leetz, H.K.; Universitaet des Saarlandes, Homburg/Saar

    1986-01-01

    Irradiation of the thoracic wall with high-speed electrons is one of the standard methods of prophylaxis and therapy of local recurrences and cutaneous metastases of an operated mammary carcinoma. The surface dose, however, is only 85% of the maximum dose, due to the depth dose curve of the electron beams with the preponderantly applied energy of 7 MeV. This is a poor value, since most of all recurrences appear near to the surface and so the risk of giving an insufficient dosis is involved. The dose distribution could be essentially improved by the use of moulages on the chest. The moulages were made of different materials which were tested and compared with respect to their suitability for radiotherapeutic purposes. The best materials proved to be 'Urgo-Plastan' (manufacturer: Holphar, Sulzbach) and 'Orthoplast' (manufacturer: Johnson and Johnson, Duesseldorf). Both materials are synthetic substances which after heating can easily be adapted to the body shape and which offer a good stability, little inconvenience for the patient and a relative easy handling. With these moulage materials, the surface dose is increased to 98% ('Urgo-Plastan') and 99% ('Orthoplast') of the maximum dose. (orig.) [de

  13. Effect of cannula shape on aortic wall and flow turbulence: hydrodynamic study during extracorporeal circulation in mock thoracic aorta.

    Science.gov (United States)

    Minakawa, Masahito; Fukuda, Ikuo; Yamazaki, Junichi; Fukui, Kozo; Yanaoka, Hideki; Inamura, Takao

    2007-12-01

    This study was designed to analyze flow pattern, velocity, and strain on the aortic wall of a glass aortic model during extracorporeal circulation, and to elucidate the characteristics of flow pattern in four aortic cannulas. Different patterns of large vortices and helical flow were made by each cannula. The high-velocity flow (0.6 m/s) was observed in end-hole cannula, causing high strain rate tensor (0.3~0.4 without unit) on the aortic arch. In dispersion cannula, a decreased strain rate tensor (less than 0.1) was found on the outer curvature of the aortic arch. In Soft-flow cannula (3M Cardiovascular, Ann Arbor, MI, USA), further decreased flow velocity (0.2 m/s) and strain (less than 0.2) were observed. In Select 3D cannula (Medtronic, Inc., Minneapolis, MN, USA), a high strain (0.4~0.5) was observed along the inner curvature of the aortic arch. In conclusion, end-hole cannula should not be used in atherosclerotic aorta. Particular attention should be paid both for selection of cannulas and cannulation site based on this result.

  14. 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.)

  15. 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.)

  16. Time trends in axilla management among early breast cancer patients

    DEFF Research Database (Denmark)

    Gondos, Adam; Jansen, Lina; Heil, Joerg

    2016-01-01

    Background We examined time trends in axilla management among patients with early breast cancer in European clinical settings. Material and methods EUROCANPlatform partners, including population-based and cancer center-specific registries, provided routinely available clinical cancer registry data...... for a comparative study of axillary management trends among patients with first non-metastatic breast cancer who were not selected for neoadjuvant therapy during the last decade. We used an additional short questionnaire to compare clinical care patterns in 2014. Results Patients treated in cancer centers were...... younger than population-based registry populations. Tumor size and lymph node status distributions varied little between settings or over time. In 2003, sentinel lymph node biopsy (SLNB) use varied between 26% and 81% for pT1 tumors, and between 2% and 68% for pT2 tumors. By 2010, SLNB use increased to 79...

  17. 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.

  18. 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.

  19. Fibroadenoma of ectopic breast tissue of the axilla in an adolescent ...

    African Journals Online (AJOL)

    Ectopic breast tissue (EBT) is a well-described entity in the English literature. However, fibroadenoma of the ectopic breast is a rare entity. We present a case of a 13-year-old adolescent girl with a subcutaneous mass in the right axilla that was pathologically identical to fibroadenoma seen in the EBT. To our knowledge, this ...

  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. 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...

  2. Ultrasound of the axilla: where to look for the sentinel lymph node

    International Nuclear Information System (INIS)

    Britton, P.; Moyle, P.; Benson, J.R.; Goud, A.; Sinnatamby, R.; Barter, S.; Gaskarth, M.; Provenzano, E.; Wallis, M.

    2010-01-01

    Aims: The aim of this paper is to guide the radiologist to the most likely location of the sentinel lymph node (SLN). Materials and methods: Patients with invasive breast cancer underwent axillary ultrasound examination. The position and morphological appearances of the lymph nodes were noted and core biopsy (CB) was performed of the largest or most suspicious node. Those patients whose biopsy revealed no evidence of malignancy proceeded to a surgical sentinel lymph node (SLN) biopsy (SLNB) looking for histopathological evidence of previous CB. Results: Of 121 patients who underwent axillary ultrasound and CB no malignancy was identified in 73, all of whom subsequently underwent SLNB. Histological evidence of CB in the SLN was identified in 47 (64%) patients. The position of all the lymph nodes identified on ultrasound and the 47 patients whose SLNs were identified were drawn on composite diagrams of the axilla. Of the 36 nodes identified as sentinel whose position relative to other nodes could be determined, 29 (81%) represented the lowest node identified in the axilla, four (11%) were the second lowest, and three (8%) were the third lowest node. None of the four patients whose CB was from the fourth lowest node had the CB site identified at subsequent SLNB. Conclusion: Ultrasound of the axilla should be carried out in a systematic fashion focusing on level I nodes paying particular attention to the lowest one or two lymph nodes.

  3. Ultrasound of the axilla: where to look for the sentinel lymph node

    Energy Technology Data Exchange (ETDEWEB)

    Britton, P., E-mail: peter.britton@addenbrookes.nhs.u [Cambridge Breast Unit, Addenbrooke' s Hospital, Cambridge (United Kingdom); Moyle, P.; Benson, J.R.; Goud, A.; Sinnatamby, R.; Barter, S.; Gaskarth, M.; Provenzano, E.; Wallis, M. [Cambridge Breast Unit, Addenbrooke' s Hospital, Cambridge (United Kingdom)

    2010-05-15

    Aims: The aim of this paper is to guide the radiologist to the most likely location of the sentinel lymph node (SLN). Materials and methods: Patients with invasive breast cancer underwent axillary ultrasound examination. The position and morphological appearances of the lymph nodes were noted and core biopsy (CB) was performed of the largest or most suspicious node. Those patients whose biopsy revealed no evidence of malignancy proceeded to a surgical sentinel lymph node (SLN) biopsy (SLNB) looking for histopathological evidence of previous CB. Results: Of 121 patients who underwent axillary ultrasound and CB no malignancy was identified in 73, all of whom subsequently underwent SLNB. Histological evidence of CB in the SLN was identified in 47 (64%) patients. The position of all the lymph nodes identified on ultrasound and the 47 patients whose SLNs were identified were drawn on composite diagrams of the axilla. Of the 36 nodes identified as sentinel whose position relative to other nodes could be determined, 29 (81%) represented the lowest node identified in the axilla, four (11%) were the second lowest, and three (8%) were the third lowest node. None of the four patients whose CB was from the fourth lowest node had the CB site identified at subsequent SLNB. Conclusion: Ultrasound of the axilla should be carried out in a systematic fashion focusing on level I nodes paying particular attention to the lowest one or two lymph nodes.

  4. 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)

  5. 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 ...

  6. Defining the minimum anatomical coverage required to protect the axilla and arm against penetrating ballistic projectiles.

    Science.gov (United States)

    Breeze, Johno; Fryer, R; Lewis, E A; Clasper, J

    2016-08-01

    Defining the minimum anatomical structural coverage required to protect from ballistic threats is necessary to enable objective comparisons between body armour designs. Current protection for the axilla and arm is in the form of brassards, but no evidence exists to justify the coverage that should be provided by them. A systematic review was undertaken to ascertain which anatomical components within the arm or axilla would be highly likely to lead to either death within 60 min or would cause significant long-term morbidity. Haemorrhage from vascular damage to the axillary or brachial vessels was demonstrated to be the principal cause of mortality from arm trauma on combat operations. Peripheral nerve injuries are the primary cause of long-term morbidity and functional disability following upper extremity arterial trauma. Haemorrhage is managed through direct pressure and the application of a tourniquet. It is therefore recommended that the minimum coverage should be the most proximal extent to which a tourniquet can be applied. Superimposition of OSPREY brassards over these identified anatomical structures demonstrates that current coverage provided by the brassards could potentially be reduced. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. 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

  8. 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.

  9. 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.

  10. Adjuvant radiation of the axilla for skin cancer - evolution of a technique

    International Nuclear Information System (INIS)

    Fogarty, G.; Smith, A.; Ainslie, J.

    2003-01-01

    Phase II and retrospective data show that adjuvant radiotherapy to the axilla improves local control in skin cancers such as melanoma, squamous cell carcinoma and Merkel cell carcinoma. Optimisation of the volume treated, dose and fractionation patterns are essential in order to avoid long term toxicities to nearby dose sensitive structures in survivors. Traditionally this has been planned with plain film simulation and a certain percentage of treatment toxicity has been accepted as inevitable to deliver appropriate treatment. The recent advent of CT planning has enabled a better understanding of the origin of toxicity based on the amount of normal structures actually in the treated volume. Other variables such as the differences in individual patient anatomy and the differences between the prescribing radiation oncologists' understanding of the anatomy of the axilla and volumes, such as clinical target volume and planning target volume, have also been discovered when compared with plain film simulation. Case studies are presented which suggest causes of toxicity and techniques of optimization based on CT planning which differ with other variables such as patient anatomy and dose-volume histograms of relevant structures.. Baseline parameters that outline a standard treatment plan based on CT planning are offered that should assist in minimising toxicity and maximising the treatment efficacy. This could also be offered as a template so that inter-doctor and inter-centre variations are kept to a minimum. The latter is important in ensuring there is standardisation of treatment particularly when it is imperative to maintain consistency of treatment volumes in multi-centre clinical trials

  11. Treatment morbidity associated with the management of the axilla in breast-conserving therapy

    International Nuclear Information System (INIS)

    Johansen, J.; Overgaard, J.; Blichert-Toft, M.; Overgaard, M.

    2000-01-01

    The purpose of this study was to determine the impact of surgery and radiotherapy on late morbidity associated with the management of the axilla in breast cancer patients. Two hundred and sixty-six patients from a randomized breast conservation trial (DBCG-82TM protocol) were called in for a single follow-up interview and clinical examination of several functional outcome measures after a median of 6.6 years (3.5-10.5). All the patients were treated with lumpectomy and axillary dissection, followed by external beam radiotherapy to the residual breast. High-risk patients were given additional radiation to the regional lymph nodes plus adjuvant systemic treatment. Twenty-eight patients (11%) had arm edema (> or 2 cm), which was associated with the extent of axillary node dissection as well as with age and radiotherapy (relative risk, RR 4.5 (1.8-11.2, p = 0.001)). Impaired shoulder movement of any degree (7%) was associated with radiotherapy (RR 4.0 (1.5-13.8, p = 0.007)) and advanced age (p = 0.002), while the extent of axillary dissection as described by the number of nodes retrieved was the only factor that predicted pain on logistic regression analysis (p = 0.02). A moderate to severe change in arm/shoulder strength and working ability was observed in 7% and 5% of patients, respectively, but no independent predisposing factor was discerned for these endpoints. It is concluded that the level of late functional morbidity several years after breast-conserving treatment is relatively low and clearly relates to age, extension of surgery, irradiation of the axilla or a combination of these factors, depending on the specific clinical outcome measure

  12. Short versus long-term postoperative drainage of the axilla after axillary lymph node dissection. A prospective randomized study

    NARCIS (Netherlands)

    Baas-Vrancken Peeters, Marie-Jeanne T. F. D.; Kluit, Ariane B.; Merkus, Jos W. S.; Breslau, Paul J.

    2005-01-01

    Background. Axillary lymph node dissection (ALND) is a standard procedure in the treatment of breast cancer. Current practice following ALND involves several days of drainage of the axilla to reduce the formation of seroma. The aim of this study is to investigate the feasibility of 24 h drainage.

  13. 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

  14. 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.

  15. Society of Thoracic Surgeons

    Science.gov (United States)

    ... 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. ...

  16. The strategy of therapy of the axilla in early cancer. Surgery or radiotherapy

    International Nuclear Information System (INIS)

    Izuo, Masaru

    1998-01-01

    The therapy of the axillary lymph node in early breast cancer was assessed perspectively. Recently, axillary irradiation was carried out and compared with surgery. Radiotherapy was not evaluated more successful. To carry out in accordance with the present guide line, so called ''modern technique'' or ''modern dosage schedule'', radiotherapy of the axilla is effective as well as surgery. We have many agreements that the rate of incidence of complication associated with irradiation was decreased in accordance with ''modern technique''. It is reasonable to radiate additionally after the selection by the ''node sampling'' in the sense of decreasing unnecessary irradiation. But it is not sufficient in their reliability, it is hard to expect this method getting more popular than now. We cannot find any difference in the effect of the treatment itself between present dissection and radiotherapy. However we have many agreements that axillary dissection may give the information about n-stage, and the contribution to the suitable selection to the prognosis factor and adjuvant chemotherapy was not so less even in early cancer. Some early cancers (non-invasive carcinoma or micro carcinoma) will not need the axillary therapy. It is one of the options ''to combine mastectomy under local anesthesia and radiotherapy'' in close cooperation with the skilled radiologist. (K.H.) 120 refs

  17. Primary lymphoma of the breast involving both axillae with bilateral breast carcinoma

    Directory of Open Access Journals (Sweden)

    Rubin Gary

    2008-05-01

    Full Text Available Abstract Background Primary Non-Hodgkin's Lymphoma (PHNL of the breast is a rare entity, while secondary involvement of the breast with diffuse disease of Non-Hodgkin's lymphoma (NHL is more common. However, PNHL is the most frequent haematopoietic tumour of the breast. Diagnostic criteria for PNHL of the breast are presence of technically adequate pathologic specimens, close association of mammary tissue and lymphomatous infiltrate, no prior diagnosis of an extarammamary lymphoma, and no evidence of concurrent widespread disease, except for ipsilateral axillary lymph nodes if concomitant with the primary lesion. Case presentation A 57-year-old woman was recalled because her screening mammograms revealed three separate lesions in her right breast and one in the left. Histology of the lesions confirmed lymphoma in one breast with ductal carcinoma in the other. Conclusion Most of reported cases in literature have been involving the right breast, and almost all the patients were females. NHLs of the breast typically present as unilateral mass; the frequency of bilateral disease at first presentation ranges from 5–25%. Our objective is to report a case of primary lymphoma of the breast involving both axillae with concomitant bilateral primary breast cancer which has not been reported yet to our best of knowledge in literature.

  18. Effect of Electrocautery on Endothelial Integrity of the Internal Thoracic Artery: Ultrastructural Analysis with Transmission Electron Microscopy

    OpenAIRE

    Onan, Burak; Yeniterzi, Mehmet; Onan, Ismihan Selen; Ersoy, Burak; Gonca, Suheyla; Gelenli, Elif; Solakoglu, Seyhun; Bakir, Ihsan

    2014-01-01

    The internal thoracic artery (ITA) is typically harvested from the chest wall by means of conventional electrocautery. We investigated the effects of electrocautery on endothelial-cell and vessel-wall morphology at the ultrastructural level during ITA harvesting.

  19. 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

  20. 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.

  1. 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

  2. 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)

  3. 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.)

  4. Stage III Melanoma in the Axilla: Patterns of Regional Recurrence After Surgery With and Without Adjuvant Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pinkham, Mark B., E-mail: mark.pinkham@health.qld.gov.au [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia); Foote, Matthew C. [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); Diamantina Institute, Brisbane (Australia); University of Queensland, Brisbane (Australia); Burmeister, Elizabeth [Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane (Australia); Research Centre for Clinical and Community Practice, Griffith University, Brisbane (Australia); Thomas, Janine [Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); Meakin, Janelle [Clinical Trials Research Unit, Princess Alexandra Hospital, Brisbane (Australia); Smithers, B. Mark [Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia); Burmeister, Bryan H. [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia)

    2013-07-15

    Purpose: To describe the anatomic distribution of regionally recurrent disease in patients with stage III melanoma in the axilla after curative-intent surgery with and without adjuvant radiation therapy. Methods and Materials: A single-institution, retrospective analysis of a prospective database of 277 patients undergoing curative-intent treatment for stage III melanoma in the axilla between 1992 and 2012 was completed. For patients who received radiation therapy and those who did not, patterns of regional recurrence were analyzed, and univariate analyses were performed to assess for potential factors associated with location of recurrence. Results: There were 121 patients who received adjuvant radiation therapy because their clinicopathologic features conferred a greater risk of regional recurrence. There were 156 patients who received no radiation therapy. The overall axillary control rate was 87%. There were 37 patients with regional recurrence; 17 patients had received adjuvant radiation therapy (14%), and 20 patients (13%) had not. The likelihood of in-field nodal recurrence was significantly less in the adjuvant radiation therapy group (P=.01) and significantly greater in sites adjacent to the axilla (P=.02). Patients with high-risk clinicopathologic features who did not receive adjuvant radiation therapy also tended to experience in-field failure rather than adjacent-field failure. Conclusions: Patients who received adjuvant radiation therapy were more likely to experience recurrence in the adjacent-field regions rather than in the in-field regions. This may not simply reflect higher-risk pathology. Using this data, it may be possible to improve outcomes by reducing the number of adjacent-field recurrences after adjuvant radiation therapy.

  5. Stage III Melanoma in the Axilla: Patterns of Regional Recurrence After Surgery With and Without Adjuvant Radiation Therapy

    International Nuclear Information System (INIS)

    Pinkham, Mark B.; Foote, Matthew C.; Burmeister, Elizabeth; Thomas, Janine; Meakin, Janelle; Smithers, B. Mark; Burmeister, Bryan H.

    2013-01-01

    Purpose: To describe the anatomic distribution of regionally recurrent disease in patients with stage III melanoma in the axilla after curative-intent surgery with and without adjuvant radiation therapy. Methods and Materials: A single-institution, retrospective analysis of a prospective database of 277 patients undergoing curative-intent treatment for stage III melanoma in the axilla between 1992 and 2012 was completed. For patients who received radiation therapy and those who did not, patterns of regional recurrence were analyzed, and univariate analyses were performed to assess for potential factors associated with location of recurrence. Results: There were 121 patients who received adjuvant radiation therapy because their clinicopathologic features conferred a greater risk of regional recurrence. There were 156 patients who received no radiation therapy. The overall axillary control rate was 87%. There were 37 patients with regional recurrence; 17 patients had received adjuvant radiation therapy (14%), and 20 patients (13%) had not. The likelihood of in-field nodal recurrence was significantly less in the adjuvant radiation therapy group (P=.01) and significantly greater in sites adjacent to the axilla (P=.02). Patients with high-risk clinicopathologic features who did not receive adjuvant radiation therapy also tended to experience in-field failure rather than adjacent-field failure. Conclusions: Patients who received adjuvant radiation therapy were more likely to experience recurrence in the adjacent-field regions rather than in the in-field regions. This may not simply reflect higher-risk pathology. Using this data, it may be possible to improve outcomes by reducing the number of adjacent-field recurrences after adjuvant radiation therapy

  6. Curcuma aeruginosa Roxb. essential oil slows hair-growth and lightens skin in axillae; a randomised, double blinded trial.

    Science.gov (United States)

    Srivilai, Jukkarin; Phimnuan, Preeyawass; Jaisabai, Jiraporn; Luangtoomma, Nantakarn; Waranuch, Neti; Khorana, Nantaka; Wisuitiprot, Wudtichai; Scholfield, C Norman; Champachaisri, Katechan; Ingkaninan, Kornkanok

    2017-02-15

    Androgenic hair-growth contributes to secondary gender characteristics but can be troublesome in women. Inhibiting axillary hair-growth via 5-α-reductases using the Thai medicinal plant, Curcuma aeruginosa Roxb. is an attractive treatment strategy. C. aeruginosa essential oil (CA-oil) formulated as a lotion is an efficacious and safe inhibitor of axillary hair growth. This trial was a single center, randomized, double-blind, placebo controlled 10 weeks, intervention in 60 women (18-23 years) and 2 weeks washout with axillary hair length was the primary end-point. Bioactive-enriched essential oil of C. aeruginosa was formulated with a base lotion. All participants were pre-challenged with lotions by 4-h patch irritation tests to exclude skin reactions. Participants were randomly allocated to use either 1 or 5%w/w CA-oil lotion on one axilla and base-lotion (placebo) to the other for 10 weeks followed by placebo in both axillae for 2 weeks. Every week, the axillae were photographed to measure hair lengths, shaved, and roll-on applicators containing appropriate lotion replaced. Also, skin melanin by spectrophotometry and hair density were measured. From weeks 5-11 of trial, 1 and 5%w/w CA-oil retarded growth by 13 ± 1.5% and 16 ± 0.9% respectively, while placebo was ineffective. CA-oil had no influence on hair density. Both concentrations of CA-oil rapidly and equally effectively brightened skin within 3 weeks which persisted 2 weeks after treatment ceased while placebo darkened the skin. Adherence appeared good as judged by consistency of lotion consumption and between axillae. Participants were satisfied with the treatment and reported reduced hairiness, freedom from any discomforts, but product odour attracted some negative comment. No adverse reactions ascribed to CA-oil were detected or reported. This study points to a safe and efficacious dual action on retarding hair-growth and skin lightening by CA-oil. Copyright © 2016 Elsevier GmbH. All rights

  7. 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.

  8. 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)

  9. 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.)

  10. A large and aggressive fibromatosis in the axilla: a rare case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Duan M

    2018-05-01

    Full Text Available Mingyue Duan,1 Hua Xing,1 Keren Wang,1 Chunbo Niu,2 Chengwei Jiang,2 Lijuan Zhang,1 Shereen Ezzat,3 Le Zhang1 1Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People’s Republic of China; 2Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People’s Republic of China; 3Ontario Cancer Institute and The Endocrine Oncology Site Group, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada Abstract: Aggressive fibromatosis (AF is a rare benign tumor, which occurs in the deep part of bone and muscle fibrous tissue. Clinical and pathological features can be challenging for definitive diagnosis. Here, we report a rare case of a large AF in the axilla. Interestingly, 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography showed significant increase in standard uptake value. Surgical resection yielded a spindle cell tumor likely of fibromatosis origin which was positive for β-catenin expression. Keywords: aggressive fibromatosis, desmoid-type fibromatosis, axilla, 18 F-fluorodeoxyglucose, PET/CT, β-catenin

  11. 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

  12. 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.

  13. 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.

  14. Dosimetric comparison of axilla and groin radiotherapy techniques for high-risk and locally advanced skin cancer

    International Nuclear Information System (INIS)

    Mattes, Malcolm D.; Zhou, Ying; Berry, Sean L.; Barker, Christopher A.

    2016-01-01

    Radiation therapy targeting axilla and groin lymph nodes improves regional disease control in locally advanced and high-risk skin cancers. However, trials generally used conventional two-dimensional radiotherapy (2D-RT), contributing towards relatively high rates of side effects from treatment. The goal of this study is to determine if three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or volumetric-modulated arc therapy (VMAT) may improve radiation delivery to the target while avoiding organs at risk in the clinical context of skin cancer regional nodal irradiation. Twenty patients with locally advanced/high-risk skin cancers underwent computed tomography simulation. The relevant axilla or groin planning target volumes and organs at risk were delineated using standard definitions. Paired t-tests were used to compare the mean values of several dose-volumetric parameters for each of the 4 techniques. In the axilla, the largest improvement for 3D-CRT compared to 2D-RT was for homogeneity index (13.9 vs. 54.3), at the expense of higher lung V 20 (28.0% vs. 12.6%). In the groin, the largest improvements for 3D-CRT compared to 2D-RT were for anorectum D max (13.6 vs. 38.9 Gy), bowel D 200cc (7.3 vs. 23.1 Gy), femur D 50 (34.6 vs. 57.2 Gy), and genitalia D max (37.6 vs. 51.1 Gy). IMRT had further improvements compared to 3D-CRT for humerus D mean (16.9 vs. 22.4 Gy), brachial plexus D 5 (57.4 vs. 61.3 Gy), bladder D 5 (26.8 vs. 36.5 Gy), and femur D 50 (18.7 vs. 34.6 Gy). Fewer differences were observed between IMRT and VMAT. Compared to 2D-RT and 3D-CRT, IMRT and VMAT had dosimetric advantages in the treatment of nodal regions of skin cancer patients

  15. Dosimetric comparison of axilla and groin radiotherapy techniques for high-risk and locally advanced skin cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mattes, Malcolm D.; Zhou, Ying; Berry, Sean L.; Barker, Christopher A. [Memorial Sloan Kettering Cancer Center, New York (United States)

    2016-06-15

    Radiation therapy targeting axilla and groin lymph nodes improves regional disease control in locally advanced and high-risk skin cancers. However, trials generally used conventional two-dimensional radiotherapy (2D-RT), contributing towards relatively high rates of side effects from treatment. The goal of this study is to determine if three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or volumetric-modulated arc therapy (VMAT) may improve radiation delivery to the target while avoiding organs at risk in the clinical context of skin cancer regional nodal irradiation. Twenty patients with locally advanced/high-risk skin cancers underwent computed tomography simulation. The relevant axilla or groin planning target volumes and organs at risk were delineated using standard definitions. Paired t-tests were used to compare the mean values of several dose-volumetric parameters for each of the 4 techniques. In the axilla, the largest improvement for 3D-CRT compared to 2D-RT was for homogeneity index (13.9 vs. 54.3), at the expense of higher lung V{sub 20} (28.0% vs. 12.6%). In the groin, the largest improvements for 3D-CRT compared to 2D-RT were for anorectum D{sub max} (13.6 vs. 38.9 Gy), bowel D{sub 200cc} (7.3 vs. 23.1 Gy), femur D{sub 50} (34.6 vs. 57.2 Gy), and genitalia D{sub max} (37.6 vs. 51.1 Gy). IMRT had further improvements compared to 3D-CRT for humerus D{sub mean} (16.9 vs. 22.4 Gy), brachial plexus D{sub 5} (57.4 vs. 61.3 Gy), bladder D{sub 5} (26.8 vs. 36.5 Gy), and femur D{sub 50} (18.7 vs. 34.6 Gy). Fewer differences were observed between IMRT and VMAT. Compared to 2D-RT and 3D-CRT, IMRT and VMAT had dosimetric advantages in the treatment of nodal regions of skin cancer patients.

  16. Thoracic Insufficiency Syndrome

    Science.gov (United States)

    ... properly, and the diaphragm muscle must be properly anchored at the base of the chest. With fused ... waist to help stabilize the surgically expanded chest wall constriction (expansion thoracoplasty). To accommodate later growth, the ...

  17. 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 ...

  18. Sentinel nodes identified by computed tomography-lymphography accurately stage the axilla in patients with breast cancer

    International Nuclear Information System (INIS)

    Motomura, Kazuyoshi; Sumino, Hiroshi; Noguchi, Atsushi; Horinouchi, Takashi; Nakanishi, Katsuyuki

    2013-01-01

    Sentinel node biopsy often results in the identification and removal of multiple nodes as sentinel nodes, although most of these nodes could be non-sentinel nodes. This study investigated whether computed tomography-lymphography (CT-LG) can distinguish sentinel nodes from non-sentinel nodes and whether sentinel nodes identified by CT-LG can accurately stage the axilla in patients with breast cancer. This study included 184 patients with breast cancer and clinically negative nodes. Contrast agent was injected interstitially. The location of sentinel nodes was marked on the skin surface using a CT laser light navigator system. Lymph nodes located just under the marks were first removed as sentinel nodes. Then, all dyed nodes or all hot nodes were removed. The mean number of sentinel nodes identified by CT-LG was significantly lower than that of dyed and/or hot nodes removed (1.1 vs 1.8, p <0.0001). Twenty-three (12.5%) patients had ≥2 sentinel nodes identified by CT-LG removed, whereas 94 (51.1%) of patients had ≥2 dyed and/or hot nodes removed (p <0.0001). Pathological evaluation demonstrated that 47 (25.5%) of 184 patients had metastasis to at least one node. All 47 patients demonstrated metastases to at least one of the sentinel nodes identified by CT-LG. CT-LG can distinguish sentinel nodes from non-sentinel nodes, and sentinel nodes identified by CT-LG can accurately stage the axilla in patients with breast cancer. Successful identification of sentinel nodes using CT-LG may facilitate image-based diagnosis of metastasis, possibly leading to the omission of sentinel node biopsy

  19. A broad diversity of volatile carboxylic acids, released by a bacterial aminoacylase from axilla secretions, as candidate molecules for the determination of human-body odor type.

    Science.gov (United States)

    Natsch, Andreas; Derrer, Samuel; Flachsmann, Felix; Schmid, Joachim

    2006-01-01

    Human body odor is to a large part determined by secretions of glands in the axillary regions. Two key odoriferous principles, 3-methylhex-2-enoic acid (3MH2; 4/5) and 3-hydroxy-3-methylhexanoic acid (HMHA; 6) have been shown to be released from glutamine conjugates secreted in the axilla by a specific N(alpha)-acyl-glutamine aminoacylase (N-AGA) obtained from axilla isolates of Corynebacteria sp. However, the low number of different odorants reported in humans stands in contrast to the observed high inter-individual variability in body odors. Axilla secretions of individual donors were, therefore, analyzed in detail. The secretions were treated with N-AGA, analyzed by GC/MS, and compared to undigested controls. Over 28 different carboxylic acids were released by this enzyme from odorless axilla secretions (Table 1). Many of these body odorants have not been reported before from a natural source, and they include several aliphatic 3-hydroxy acids with 4-Me branches, 3,4-unsaturated, 4-Et-branched aliphatic acids, and a variety of degradation products of amino acids. The odor threshold of some of the acids was found to be in the range of 1 ng. Most of these compounds were present in all donors tested, but in highly variable relative amounts, and they are, thus, candidate molecules as key components of a 'compound odor' determining the individual types of human body odor.

  20. Axillary local anesthetic spread after the thoracic interfacial ultrasound block – a cadaveric and radiological evaluation

    Directory of Open Access Journals (Sweden)

    Patricia Alfaro de la Torre

    2017-11-01

    Full Text Available Background: Oral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and does not have a specific regional anesthesia technique published that offers its adequate blockade. Methods: After institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane. Magnetic Resonance Imaging studies were then conducted in 15 of 34 patients scheduled for unilateral breast surgery that entailed any of the following: axillary clearance, sentinel node biopsy, axillary node biopsy, or supernumerary breasts, to ascertain the deposition and time course of spread of solution within the thoracic interfascial plane in vivo. Results: Radiological and cadaveric studies showed that the injection of local anesthetic and methylene blue via the thoracic inter-fascial plane, using ultrasound guide technique, results in reliable deposition into the axilla. In patients, the injection of the local anesthetic produced a reliable axillary sensory block. This finding was supported by Magnetic Resonance Imaging studies that showed hyper-intense signals in the axillary region. Conclusions: These findings define the anatomic characteristics of the thoracic interfascial plane nerve block in the axillary region, and underline the clinical potential of this novel nerve block. Resumo: Justificativa: Os analgésicos orais à base de opioides têm sido usados para o manejo da analgesia nos períodos peri e pós-operatório de pacientes submetidos à linfadenectomia axilar. A região axilar é uma zona difícil de bloquear e não há registro de uma técnica de anestesia regional específica que ofereça o seu bloqueio adequado. Métodos: Após a aprovação do Conselho de Ética institucional

  1. 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).

  2. Radiology of thoracic trauma

    International Nuclear Information System (INIS)

    Stark, P.

    1987-01-01

    This course provides an overview of the radiologic manifestations of trauma to the chest. The basic mechanisms of injury are discussed. The effect of trauma on the chest wall, the lung parenchyma, and the pleural space is described. Rib fractures, sternal fractures, lung contusion, lung hematoma, lung laceration, post-traumatic atelectasis, hemothorax, chylothorax, pneumothorax, and adult respiratory distress syndrome are discussed and illustrated. Injuries to the tracheobronchial tree, the aorta and brachiocephalic vessels, the esophagus, the diaphragm, and the heart are also presented. The purpose of the lecture is to familiarize the audience with common and unusual radiologic presentations of traumatic injury to the thorax

  3. Posterior axilla sling traction for shoulder dystocia: case review and a new method of shoulder rotation with the sling.

    Science.gov (United States)

    Cluver, Catherine Anne; Hofmeyr, G Justus

    2015-06-01

    The purpose of this study was to report on all cases in which posterior axilla sling traction (PAST) has been used to deliver cases of intractable shoulder dystocia and to describe a new method of shoulder rotation with the sling. A record of all published and known cases was collected that included information on preliminary obstetric techniques that were used and how the PAST technique was performed. Maternal outcomes that included maternal injury and length of hospital stay and fetal outcomes, which included birthweight, Apgar scores, nerve injuries, fractures, hospital stay, and outcome, were documented. We have recorded 19 cases where PAST has been used. In 5 cases, the babies had died in utero. Ten were assisted deliveries. PAST was successful in 18 cases. In one case, it was partially successful because it enabled delivery of the posterior shoulder with digital axillary traction. The most commonly used material was suction tubing. Once the posterior shoulder was delivered, the shoulder dystocia was resolved in all cases. Time from insertion to delivery was dystocia fail. Advantages are that it is easy to use (even by someone who has not seen it used previously), that the sling material is readily available, and that it is inserted quickly with 2 fingers. This is the first report of its use to rotate the posterior shoulder to the anterior position for delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Approach and management of primary ectopic breast carcinoma in the axilla: where are we? A comprehensive historical literature review.

    Science.gov (United States)

    Visconti, Giuseppe; Eltahir, Yassir; Van Ginkel, Robert J; Bart, Joost; Werker, Paul M N

    2011-01-01

    Primary ectopic breast carcinoma is a rare disease and, at present, no specific guidelines on its diagnosis and treatment are available. The purpose of this article is to review the world literature in English on primary ectopic breast carcinoma located in the armpit and to offer guidelines for diagnosis and treatment. Data for this review were identified by searches of MEDLINE, PubMed, The Cochrane Library, ACNP (Italian catalogue of journals) and references from relevant articles using relevant search terms and data published in the previous reviews. Primary ectopic breast carcinoma of the axilla mostly affects women of over 40 (range 28-90 yrs) years of age. The most frequent histological diagnosis is invasive ductal carcinoma not otherwise specified (NOS) (72%). Because of its rareness, in most cases, the diagnosis is delayed for on average 40.5 months. This disease is rare, but a high level of suspicion for carcinoma is mandatory when confronted with a tumour in this area. Once diagnosed, patients should undergo staging, and prognostic and adjuvant treatment procedures identical to orthotopic breast carcinoma guidelines. There are some limitations for the staging. Loco-regional treatment, on indication, combined with endocrine therapy and/or chemotherapy seems the treatment of choice. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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

    International Nuclear Information System (INIS)

    Slovis, T.L.; Meza, M.P.; Cushing, B.; Elkowitz, S.S.; Leonidas, J.C.; Festa, R.; Kogutt, M.S.; Fletcher, B.D.

    1997-01-01

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

  6. 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)

  7. 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

  8. Diagnostic radiology of thoracic diseases. Textbook and atlas. 4. compl. rev. and enl. ed.; Radiologische Diagnostik der Thoraxerkrankungen. Lehrbuch und Atlas

    Energy Technology Data Exchange (ETDEWEB)

    Lange, Sebastian

    2010-07-01

    The book on diagnostic radiology of thoracic diseases covers the following topics: diagnostic techniques and normal diagnostic findings using x-ray radiography, CT, scintigraphy, angiography, bronchography, ultrasonography and NMR imaging; malformations; infections; emphysema, chronic lung diseases and asthma; inhalation damage and pneumoconiosis; neoplasm; vascular diseases; thorax injuries, pleura diseases, heart diseases, mediastinum diseases; midriff diseases; thoracic wall diseases; pathological pattern in CT; radiological indications and differential diagnostics; thoracic interventions.

  9. 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

  10. 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

  11. 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.

  12. 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

  13. Thoracic wall lipoblastoma: a rare case with rare presentation

    African Journals Online (AJOL)

    Sama Savli Road, 390024 Vadodara, Gujarat. Tel: +919879609195; e-mail: muleyprasad@yahoo.com. Received 14 December 2011 accepted 16 January .... lipoblastoma involving the right common iliac artery and vein. Eur J Pediatr. Surg 2003; 13:268–271. 6 Lorenzen JC, Godballe C, Kerndrup GB. Lipoblastoma of the ...

  14. 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.

  15. 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.

  16. [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.

  17. 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

  18. Maximizing Use of Robot-Arm No. 3 in Da Vinci–Assisted Thoracic Surgery

    Science.gov (United States)

    Kajiwara, Naohiro; Maeda, Junichi; Yoshida, Koichi; Kato, Yasufumi; Hagiwara, Masaru; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

    2015-01-01

    We have previously reported on the importance of appropriate robot-arm settings and replacement of instrument ports in robot-assisted thoracic surgery, because the thoracic cavity requires a large space to access all lesions in various areas of the thoracic cavity from the apex to the diaphragm and mediastinum and the chest wall.1–3 Moreover, it can be difficult to manipulate the da Vinci Surgical System using only arms No. 1 and No. 2 depending on the tumor location. However, arm No. 3 is usually positioned on the same side as arm No. 2, and sometimes it is only used as an assisting-arm to avoid conflict with other arms (Fig. 1). In this report, we show how robot-arm No. 3 can be used with maximum effectiveness in da Vinci-assisted thoracic surgery. PMID:26011219

  19. [Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery].

    Science.gov (United States)

    Diéguez García, P; Fajardo Pérez, M; López Álvarez, S; Alfaro de la Torre, P; Pensado Castiñeiras, A P

    2013-01-01

    Several nerve blocks have recently been used for pain treatment in breast surgery. The main objective of our study was to determine the efficacy and safety of ultrasound-assisted blocking of the anterior and lateral cutaneous branches of the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. A prospective observational study was conducted on 30 patients scheduled for non-reconstructive breast and axilla surgery. An intercostal branches block was performed in the mid-axillary line with 0,5% levobupivacaine (3ml in each intercostal space). Clinical efficacy was assessed by standard intraoperative hemodynamic response to surgical stimulus and the need for opioids, and in the postoperative period, by assessing pain intensity as a verbal numerical scale and the need for rescue treatment. We also evaluated the quality of sleep the first night after surgery, any adverse events that occurred, and the satisfaction of patients and surgeons with the anesthetic technique. The intercostal branches block in the mid-axillary line was effective in most cases, with only 2 patients requiring intraoperative opioids, and in one case analgesic rescue was necessary in the postoperative period. The duration of postoperative analgesia was 19±4h. There were no notable adverse events or complications. The satisfaction with the chosen technique was assessed as "very good" in all patients, and by 97% of the surgeons. Intercostal branches block in the mid-axillary line provides adequate intraoperative and postoperative analgesia for non-reconstructive breast and axilla surgery. It is a simple, reproducible technique in most patients of this study, with an easy to understand ultrasound anatomy, in which adequate analgesia could be provided through a single puncture, and may be an alternative to neuroaxial blocks. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights

  20. 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.

  1. 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 ...

  2. 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.

  3. Initial thoracic involvement in lymphoma. CT assessment; Afectacion toracica inicial en el linfom. Valoracion con TC

    Energy Technology Data Exchange (ETDEWEB)

    Bustos, A.; Corredoira, J.; Ferreiros, J.; Cabeza, B.; Jorquera, M.; Pedrosa, I.; Martinez, R.; Fernandez, C. [Hospital Clinico San Carlos. Madrid (Spain)

    2002-07-01

    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.

  4. Body odour of monozygotic human twins: a common pattern of odorant carboxylic acids released by a bacterial aminoacylase from axilla secretions contributing to an inherited body odour type.

    Science.gov (United States)

    Kuhn, Fabian; Natsch, Andreas

    2009-04-06

    It is currently not fully established whether human individuals have a genetically determined, individual-specific body odour. Volatile carboxylic acids are a key class of known human body odorants. They are released from glutamine conjugates secreted in axillary skin by a specific Nalpha-acyl-glutamine-aminoacylase present in skin bacteria. Here, we report a quantitative investigation of these odorant acids in 12 pairs of monozygotic twins. Axilla secretions were sampled twice and treated with the Nalpha-acyl-glutamine-aminoacylase. The released acids were analysed as their methyl esters with comprehensive two-dimensional gas chromatography and time-of-flight mass spectrometry detection. The pattern of the analytes was compared with distance analysis. The distance was lowest between samples of the right and the left axilla taken on the same day from the same individual. It was clearly greater if the same subject was sampled on different days, but this intra-individual distance between samples was only slightly lower than the distance between samples taken from two monozygotic twins. A much greater distance was observed when comparing unrelated individuals. By applying cluster and principal component analyses, a clear clustering of samples taken from one pair of monozygotic twins was also confirmed. In conclusion, the specific pattern of precursors for volatile carboxylic acids is subject to a day-to-day variation, but there is a strong genetic contribution. Therefore, humans have a genetically determined body odour type that is at least partly composed of these odorant acids.

  5. 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

  6. 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.

  7. 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

  8. Reconstruction of the full thickness chest wall defect. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Moriguchi, T; Sano, S; Ogawa, Y; Fujimori, Y [Kyoto Univ. (Japan). Faculty of Medicine; Abe, R

    1977-03-01

    To treat the chest wall defect following the postoperative radiotherapy for breast cancer, we used an island flap prepared from the opposite mammary region preserving the perforating vessels from the internal thoracic artery.

  9. 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.

  10. 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.

  11. 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 ...

  12. 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.)

  13. 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.

  14. 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,

  15. 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,

  16. 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

  17. Analysis the findings of chest radiograph and CT scan in 217 acute thoracic trauma

    International Nuclear Information System (INIS)

    Huang Shaoying

    2005-01-01

    Objective: To evaluate chest radiograph and CT scan in assessing acute thoracic trauma. Methods: Retrospectively analyzed the findings of chest radiograph and CT scan in 217 cases of acute thoracic trauma and positive rate of each modality was compared. Results: The positive rate of rib and clavicle fracture was higher in chest radiograph than these in CT scan. But the positive rate of chest wall hematoma, mediastinum and subcutaneous emphysema, pneumothorax, hydropneumothorax, damage of lung parenchyma and traumatic pulmonary atelectasis was higher in CT scan than those in chest radiograph. Conclusion: The application of the combined imaging modalities improves assessing of acute thoracic trauma, because the imaging manifestation of the lesion is various. (authors)

  18. Thoracic cavity segmentation algorithm using multiorgan extraction and surface fitting in volumetric CT

    Energy Technology Data Exchange (ETDEWEB)

    Bae, JangPyo [Interdisciplinary Program, Bioengineering Major, Graduate School, Seoul National University, Seoul 110-744, South Korea and Department of Radiology, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736 (Korea, Republic of); Kim, Namkug, E-mail: namkugkim@gmail.com; Lee, Sang Min; Seo, Joon Beom [Department of Radiology, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736 (Korea, Republic of); Kim, Hee Chan [Department of Biomedical Engineering, College of Medicine and Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 110-744 (Korea, Republic of)

    2014-04-15

    Purpose: To develop and validate a semiautomatic segmentation method for thoracic cavity volumetry and mediastinum fat quantification of patients with chronic obstructive pulmonary disease. Methods: The thoracic cavity region was separated by segmenting multiorgans, namely, the rib, lung, heart, and diaphragm. To encompass various lung disease-induced variations, the inner thoracic wall and diaphragm were modeled by using a three-dimensional surface-fitting method. To improve the accuracy of the diaphragm surface model, the heart and its surrounding tissue were segmented by a two-stage level set method using a shape prior. To assess the accuracy of the proposed algorithm, the algorithm results of 50 patients were compared to the manual segmentation results of two experts with more than 5 years of experience (these manual results were confirmed by an expert thoracic radiologist). The proposed method was also compared to three state-of-the-art segmentation methods. The metrics used to evaluate segmentation accuracy were volumetric overlap ratio (VOR), false positive ratio on VOR (FPRV), false negative ratio on VOR (FNRV), average symmetric absolute surface distance (ASASD), average symmetric squared surface distance (ASSSD), and maximum symmetric surface distance (MSSD). Results: In terms of thoracic cavity volumetry, the mean ± SD VOR, FPRV, and FNRV of the proposed method were (98.17 ± 0.84)%, (0.49 ± 0.23)%, and (1.34 ± 0.83)%, respectively. The ASASD, ASSSD, and MSSD for the thoracic wall were 0.28 ± 0.12, 1.28 ± 0.53, and 23.91 ± 7.64 mm, respectively. The ASASD, ASSSD, and MSSD for the diaphragm surface were 1.73 ± 0.91, 3.92 ± 1.68, and 27.80 ± 10.63 mm, respectively. The proposed method performed significantly better than the other three methods in terms of VOR, ASASD, and ASSSD. Conclusions: The proposed semiautomatic thoracic cavity segmentation method, which extracts multiple organs (namely, the rib, thoracic wall, diaphragm, and heart

  19. 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...

  20. 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

  1. Successful Intra-Arterial Chemotherapy for Extramammary Paget’s Disease of the Axilla in a Patient with Parkinson’s Disease

    International Nuclear Information System (INIS)

    Damascelli, Bruno; Ticha, Vladimira

    2011-01-01

    Extramammary Paget’s disease (EMPD) is a rare intraepithelial neoplasm occurring less frequently in men and even more rarely in the axilla. A 59-year-old man with severe Parkinson’s disease presented with axillary EMPD. The neurological comorbidity made treatment of the EMPD problematical and prompted us to propose locoregional intra-arterial chemotherapy in single short sessions. Two innovative chemotherapeutic macrocomplexes were used: doxorubicin incorporated in large liposomes and the taxane paclitaxel incorporated in albumin nanoparticles. A therapeutic response was seen right from the first treatment and was macroscopically close to complete after four cycles. Five months after the end of treatment the patient had minimal visible disease and had enjoyed a distinct improvement in quality of life, with no noteworthy complications related to the intra-arterial chemotherapy with percutaneous transfemoral catheterization.

  2. Preoperative ultrasound staging of the axilla make's peroperative examination of the sentinel node redundant in breast cancer: saving tissue, time and money.

    Science.gov (United States)

    Van Berckelaer, Christophe; Huizing, Manon; Van Goethem, Mireille; Vervaecke, Andrew; Papadimitriou, Konstantinos; Verslegers, Inge; Trinh, Bich X; Van Dam, Peter; Altintas, Sevilay; Van den Wyngaert, Tim; Huyghe, Ivan; Siozopoulou, Vasiliki; Tjalma, Wiebren A A

    2016-11-01

    To evaluate the role of preoperative axillary staging with ultrasound (US) and fine needle aspiration cytology (FNAC). Can we avoid intraoperative sentinel lymph node (SLN) examination, with an acceptable revision rate by preoperative staging? This study is based on the retrospective data of 336 patients that underwent US evaluation of the axilla as part of their staging. A FNAC biopsy was performed when abnormal lymph nodes were visualized. Patients with normal appearing nodes on US or a benign diagnostic biopsy had removal of the SLNs without intraoperative pathological examination. We calculated the sensitivity, specificity and accuracy of US/FNAC in predicting the necessity of an axillary lymphadenectomy. Subsequently we looked at the total cost and the operating time of 3 models. Model A is our study protocol. Model B is a theoretical protocol based on the findings of the Z0011 trial with only clinical preoperative staging and in Model C preoperative staging and intraoperative pathological examination were both theoretically done. sentinel node, staging, ultrasound, preoperative axillary staging, FNAC, axilla RESULTS: The sensitivity, specificity and accuracy are respectively 0.75 (0.66-0.82), 1.00 (0.99-1.00) and 0.92 (0.88-0.94). Only 26 out of 317 (8.2%) patients that successfully underwent staging needed a revision. The total cost of Model A was 1.58% cheaper than Model C and resulted in a decrease in operation time by 9,46%. The benefits compared with Model B were much smaller. Preoperative US/FNAC staging of the axillary lymph nodes can avoid intraoperative examination of the sentinel node with an acceptable revision rate. It saves tissue, reduces operating time and decreases healthcare costs in general. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Axillary basal cell carcinoma in patients with Goltz-Gorlin syndrome: report of basal cell carcinoma in both axilla of a woman with basal cell nevus syndrome and literature review.

    Science.gov (United States)

    Cohen, Philip R

    2014-08-17

    Basal cell carcinoma of the axilla, an area that is not usually exposed to the sun, is rare. Individuals with basal cell nevus syndrome, a disorder associated with a mutation in the patch 1 (PTCH1) gene, develop numerous basal cell carcinomas. To describe a woman with basal cell nevus syndrome who developed a pigmented basal cell carcinoma in each of her axilla and to review the features of axillary basal cell carcinoma patients with Goltz-Gorlin syndrome. Pubmed was used to search the following terms: axillary basal cell carcinoma and basal cell nevus syndrome. The papers and their citations were evaluated. Basal cell nevus syndrome patients with basal cell carcinoma of the axilla were observed in two women; this represents 2.5% (2 of 79) of the patients with axillary basal cell carcinoma. Both women had pigmented tumors that were histologically nonaggressive. The cancers did not recur after curettage or excision. Basal cell carcinoma of the axilla has only been described in 79 individuals; two of the patients were women with pigmented tumors who had basal cell nevus syndrome. Similar to other patients with axillary basal cell carcinoma, the tumors were histologically nonaggressive and did not recur following treatment. Whether PTCH1 gene mutation predisposes basal cell nevus patients to develop axillary basal cell carcinomas remains to be determined.

  4. 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.

  5. 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.

  6. 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.

  7. Ambiguous walls

    DEFF Research Database (Denmark)

    Mody, Astrid

    2012-01-01

    The introduction of Light Emitting Diodes (LEDs) in the built environment has encouraged myriad applications, often embedded in surfaces as an integrated part of the architecture. Thus the wall as responsive luminous skin is becoming, if not common, at least familiar. Taking into account how wall...

  8. Ambiguous walls

    DEFF Research Database (Denmark)

    Mody, Astrid

    2012-01-01

    The introduction of Light Emitting Diodes (LEDs) in the built environment has encouraged myriad applications, often embedded in surfaces as an integrated part of the architecture. Thus the wall as responsive luminous skin is becoming, if not common, at least familiar. Taking into account how walls...... have encouraged architectural thinking of enclosure, materiality, construction and inhabitation in architectural history, the paper’s aim is to define new directions for the integration of LEDs in walls, challenging the thinking of inhabitation and program. This paper introduces the notion...... of “ambiguous walls” as a more “critical” approach to design [1]. The concept of ambiguous walls refers to the diffuse status a lumious and possibly responsive wall will have. Instead of confining it can open up. Instead of having a static appearance, it becomes a context over time. Instead of being hard...

  9. 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.

  10. 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.

  11. Chest wall resection for multifocal osseous haemangioma.

    Science.gov (United States)

    Weinandt, Marthe; Legras, Antoine; Mordant, Pierre; Le Pimpec Barthes, Françoise

    2016-02-01

    Intraosseous haemangioma is a rare and benign primary tumour of the bone. We report the case of a 76-year old woman who presented the exceptional condition of multifocal cavernous haemangiomas involving the spine and the ribs, requiring spinal and chest wall resections to confirm the diagnosis and treat the symptoms. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  12. 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.

  13. 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)

  14. 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 %)

  15. 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.

  16. 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.

  17. 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.

  18. Wall Turbulence.

    Science.gov (United States)

    Hanratty, Thomas J.

    1980-01-01

    This paper gives an account of research on the structure of turbulence close to a solid boundary. Included is a method to study the flow close to the wall of a pipe without interferring with it. (Author/JN)

  19. Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study.

    Science.gov (United States)

    van der Jagt-Willems, Hanna C; de Groot, Maartje H; van Campen, Jos P C M; Lamoth, Claudine J C; Lems, Willem F

    2015-03-28

    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 and/or flexed posture with future fall incidents in older adults within the next year. Patients were recruited at a geriatric outpatient clinic. Vertebral fractures were evaluated on lateral radiographs of the spine with the semi-quantitative method of Genant; the degree of thoracic kyphosis was assessed with the Cobb angle. The occiput-to-wall distance was used to determine a flexed posture. Self-reported falls were prospectively registered by monthly phone contact for the duration of 12 months. Fifty-one older adults were included; mean age was 79 years (SD = 4.8). An increased thoracic kyphosis was independently associated with future falls (OR 2.13; 95% CI 1.10-4.51). Prevalent vertebral fractures had a trend towards significancy (OR 3.67; 95% CI 0.85-15.9). A flexed posture was not significantly associated with future falls. Older adults with an increased thoracic kyphosis are more likely to fall within the next year. We suggest clinical attention for underlying causes. Because patients with increased thoracic curvature of the spine might have underlying osteoporotic vertebral fractures, clinicians should be aware of the risk of a new fracture.

  20. 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

  1. 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.

  2. 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.

  3. 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.)

  4. A comparison of oblique subcostal transversus abdominis plane block versus thoracic paravertebral block for postoperative analgesia after open cholecystectomy

    Directory of Open Access Journals (Sweden)

    Ghada Kamhawy

    2017-10-01

    effective in reducing morphine consumption. Keywords: Morphine consumption, Oblique subcostal transversus abdominis plain block, Abdominal wall blocks, Thoracic paravertebral block, Postoperative pain

  5. AIDS related thoracic lymphoma: evaluation by computed tomography; Linfoma toracico na sindrome da imunodeficiencia adquirida: avaliacao por tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Siciliano, Antonio Alexandre de Oliveira [Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ (Brazil). Servico de Radiodiagnostico; Marchiori, Edson [Universidade Federal, Rio de Janeiro, RJ (Brazil). Curso de Pos-graduacao em Radiologia

    2000-02-01

    The authors reviewed five cases of patients with acquired immunodeficiency syndrome (AIDS) related lymphoma to describe the thoracic findings on computed tomography. The patients were followed at Hospital Universitario Clementino Fraga Filho, Hospital Universitario Antonio Pedro and Hospital da Lagoa, from November, 1989 to March 1998. Epidemiological, clinical and pathological data from these patients were quiet variable and pulmonary nodules and masses, hilar and mediastinal lymphadenopathy, and thoracic wall masses were observed. AIDS related lymphomas involving the chest are pleomorphic and most commonly extranodal. (author)

  6. 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.

  7. Thoracic epidural analgesia in a child with multiple traumatic rib fractures.

    Science.gov (United States)

    Keech, Brian M

    2015-12-01

    The morbidity and mortality associated with blunt thoracic trauma are significant and can be multisystem in nature. Of these, pulmonary complications, including ventilatory impairment secondary to pain, have been recognized to be the most consequential. Although several analgesic strategies have emerged, thoracic epidural analgesia (TEA) has arguably demonstrated superior efficacy and is used frequently in adults. Unfortunately, TEA is rarely used in children after blunt thoracic trauma, but may be of considerable benefit. This low rate of use likely reflects one or more of several factors potentially encountered when considering the use of TEA in pediatric chest wall trauma. Among them are (1) uncertainty regarding safety and efficacy; (2) the technical challenges of pediatric thoracic epidural placement, including technique and equipment concerns; and (3) drug selection, dosing, and toxicity. The following case review describes the successful application of TEA in a 4-year-old boy after multiple traumatic rib fractures and associated pneumothorax and pulmonary contusion. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Chest Wall tumor: combined management

    International Nuclear Information System (INIS)

    Rao Bhaskar, N.

    1997-01-01

    Cancer is relatively rare disease among children and adolescents. The incidence of solid tumors other than CNS is less than 2/100,000. Tumors of the chest wall can arise either from the somatic tissue or ribs. These are rare, so either institutional reviews or multi institutional studies should determine optimal therapeutic management. Of the bony chest wall, Ewing's sarcoma or the family of tumor (peripheral neuro epithelioma, Askin tumor), are the most common. These lesions are lytic and have associated large extra pleural component. This large extra pleural component often necessitates major chest wall resection (3 or more ribs), and when lower ribs are involved, this entails resection of portion of diaphragm. Despite this resection, survival in the early 1970 was 10-20%. Since 1970 multi agent chemotherapy has increased survival rates. of importance, however, is these regimens have caused significant reduction of these extra pleural components so that major chest wall resections have become a rarity. With improved survival and decreased morbidity preoperative chemotherapy followed by surgery is now the accepted modality of treatment. Another major advantage of this regimen is that potential radiation therapy may be obviated. The most common chest wall lesion is rhabdomyosarcoma. In the IRS study of 1620 RMS patients, in 141 (9%) the primary lesion was in the chest wall. these are primarily alveolar histology. when lesions were superficial, wide local excision with supplemental radiation therapy was associated with low morbidity and good overall survival. however, a majority have significant intra- thoracic components. in these circumstances the resectability rate is less than 30% and the survival poor. Other lesions include non rhabdomyosarcomas, eosinophilic granuloma, chondrosarcoma, and osteomyelitis. The management of these lesions varies according to extent, histology, and patient characteristics

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

    Directory of Open Access Journals (Sweden)

    Bailey James

    2012-05-01

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

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. 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.

  15. Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients

    International Nuclear Information System (INIS)

    Lee, Kyung Soo; Kim, Tae Sung; Kim, Eun A.; Fujimoto, Kiminori; Moriya, Hiroshi; Watanabe, Hideyuki; Tateishi, Ukihide; Ashizawa, Kazuoto; Johkoh, Takeshi; Kwon, O. Jung

    2003-01-01

    Our objective was to describe the CT findings of thoracic Wegener's granulomatosis. At presentation, both conventional and thin-section CT scans were available in 30 patients with Wegener's granulomatosis. Serial CT scans (range of intervals: 1-25 months, mean 4.5 months) were available in 20 patients. The initial and follow-up CT scans were analyzed retrospectively by two observers in terms of pattern and extent of parenchymal and airway lesions. Positive CT findings were seen in 29 of 30 (97%) patients at initial presentation. The most common pattern was nodules or masses seen in 27 of 30 (90%) patients. They were multiple in 23 of 27 (85%) patients, bilateral in 18 (67%), subpleural in 24 (89%), and peribronchovascular in 11 (41%) in distribution. Bronchial wall thickening in the segmental or subsegmental bronchi was seen in 22 (73%) patients. Large airways were also abnormal in 9 (30%) patients. Patchy areas of consolidation and ground-glass opacity were seen in 7 (23%) patients, respectively. In 17 of 20 (85%) patients in whom follow-up CT scans were available, the parenchymal or airway lesion showed complete or partial improvement with treatment. The CT findings of Wegener's granulomatosis, although multiple and variable, consist mainly of bilateral subpleural or peribronchovascular nodules or masses and bronchial wall thickening in the segmental or subsegmental bronchi. Parenchymal and airway lesions improve with treatment in most patients. (orig.)

  16. Thoracic radiation therapy (RT) before autologous bone marrow transplantation (ABMT) in relapsed or refractory Hodgkin's disease (HD)

    International Nuclear Information System (INIS)

    Tsang, Richard W.; Gospodarowicz, Mary K.; Sutcliffe, Simon B.; Crump, Michael; Keating, Armand

    1997-01-01

    Purpose: To assess the relationship between peri-ABMT RT and treatment-related mortality in patients receiving high-dose chemotherapy (HDCT) and ABMT for recurrent/refractory HD. Materials and Methods: Between 12/1986 and 12/1992, 90 patients (pts) with HD were treated with HDCT (etoposide 60 mg/kg, melphalan 160 mg/m 2 ) +ABMT in Toronto. Fifty-nine of these had all or part of their treatment (RT and/or CT) at the PMH, and they form the basis of this report. HDCT + ABMT was performed for refractory (11 pts) or relapsed (48 pts) HD. The median age at ABMT was 29 (range 16-47), F:M ratio was 1:1.2. Salvage chemotherapy consisted of DHAP (36), mini-BEAM (7), both (8), other chemotherapy (5), and no chemotherapy (3). RT have been incorporated in the salvage treatment with the intent to achieve complete disease control of active disease at relapse or disease progression. RT was given pre-ABMT in 33 pts (3 mantle, 8 mantle with lung, 7 modified mantle excluding axillae, 4 involved field, 1 mantle with TBI, 1 TBI, and 9 non-thoracic), and post-ABMT in 4 pts (2 mantle, 2 modified mantle). Planned RT tumor dose was 35 Gy over 4 weeks (median 35 Gy, range 25-40 Gy), lower doses were used for lung RT (15-17.5 Gy). Treatment-related (TR) mortality was defined as any death occurring within 100 days of ABMT. Autopsies were performed for all patients with TR deaths. Results: We observed 36 deaths, and 10 of these were treatment-related (TR) deaths. With an average follow-up of 4.9 years (range 1.2-7.4 years), the actuarial overall survival was 52% ± 13% at 3 years, and 41% ± 14% at 5 years. Among the 24 patients who received thoracic RT before ABMT, there were 8 TR deaths, with 3 solely attributable to radiation pneumonitis. The remaining 5 TR deaths all had respiratory failure as a major medical problem with complicating sepsis and pancytopenia. The interval from RT to ABMT was shorter for 8 patients dying of TR death (mean 37 days; range 0-103 days), than for the 16 pts with

  17. Evolution of Thoracic Surgery in Canada

    Directory of Open Access Journals (Sweden)

    Jean Deslauriers

    2015-01-01

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

  18. 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 ...

  19. 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 ...

  20. 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 …

  1. 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)

  2. 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, ...

  3. 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.

  4. 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)

  5. Staging the Axilla with selective sentinel node biopsy in patients with previous excision of non-palpable and palpable breast cancer

    International Nuclear Information System (INIS)

    Ruano, R.; Garcia-Talavera, J.R.; Arriba, A. de; Ramos, M.; Gonzalez-Orus, J.; Iglesias, M.; Serrano, E.; Macias, M.C.

    2008-01-01

    To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer. In the period 2001-2006, 138 patients with prior diagnostic excisional biopsy (96 non-palpable and 42 palpable breast cancer) and 328 without previous surgery (32 non-palpable; 296 palpable cancer) were treated. The combined technique ( 99m Tc-colloidal rhenium and isosulfan blue dye) was the approach for sentinel lymph node (SLN) detection. Axillary lymph node dissection (ALND) was completed only when the SLN was positive for metastasis or not located. Detection rate, if there was prior surgery, was 95% for non-palpable and 98% for palpable cancer, and 99% for one-time treatment group. Metastasis rate in the SLN was 15% in non-palpable cancer (14/91), significantly smaller than in palpable breast cancer (39% if prior surgery and 37% in one-time surgery). According to tumoral size, ALND metastasis rate was similar for T1 and T2 tumors (43-44%). In the follow-up of the groups with prior diagnostic biopsy or surgery of the breast cancer we have not found any false negative in the axilla. The detection of the SLN is also feasible in patients with previous surgery of breast cancer. Because SLN metastasis rates are significantly smaller in non-palpable lesions, the effort in screening programs for early detection of breast cancer and also in improving histopathological confirmation of malignancy with ultrasound or stereotactic guided core biopsies must continue. (orig.)

  6. Variations in the management of the axilla in screen-detected ductal carcinoma in situ: evidence from the UK NHS breast screening programme audit of screen detected DCIS.

    Science.gov (United States)

    Nicholson, S; Hanby, A; Clements, K; Kearins, O; Lawrence, G; Dodwell, D; Bishop, H; Thompson, A

    2015-01-01

    The diagnosis and surgical management of screen-detected Ductal Carcinoma In Situ (DCIS) remains controversial including a range of axillary approaches and consequent morbidity. This study examined the management of the axilla in all patients with DCIS presenting through the United Kingdom National Health Service Breast Screening Programme (UK NHS BSP). Retrospective analysis of the UK NHS BSP identified 26,696 women initially diagnosed with DCIS over the 8 years 1 April 2003-31 March 2011. The final breast pathology of these women was upgraded to invasive ductal cancer in 5564 (20.8%) women or micro-invasive cancer in 1031 (3.9%) women. At first operation, 5290 (26.3%) of the 20,094 women who had a final post-operative diagnosis of DCIS only underwent axillary surgery (72.4% at the time of mastectomy, 23.8% breast conservation surgery, 3.8% axillary surgery alone). Performance of axillary surgery reflected increasing tumour size, micro-invasion or increasing nuclear grade for the final diagnosis of DCIS. More extensive nodal surgery was performed in those undergoing mastectomy; 10.8% of women had more than 8 nodes removed. Overall, 12.0% of women with invasive cancer, 1.7% with micro-invasion, and 0.2% with DCIS alone, were ultimately node positive. Improved pre-operative sampling of DCIS, axillary assessment by ultrasound with needle biopsy for suspected metastases, risk stratification for sentinel node biopsy (for high grade or extensive DCIS) and avoiding axillary clearance for a pre-operative diagnosis of DCIS alone should reduce unnecessary axillary surgery. Standards using such criteria for axillary surgery in screen-detected DCIS should be integrated into the NHS BSP. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  7. Fixed, low radiant exposure vs. incremental radiant exposure approach for diode laser hair reduction: a randomized, split axilla, comparative single-blinded trial.

    Science.gov (United States)

    Pavlović, M D; Adamič, M; Nenadić, D

    2015-12-01

    Diode lasers are the most commonly used treatment modalities for unwanted hair reduction. Only a few controlled clinical trials but not a single randomized controlled trial (RCT) compared the impact of various laser parameters, especially radiant exposure, onto efficacy, tolerability and safety of laser hair reduction. To compare the safety, tolerability and mid-term efficacy of fixed, low and incremental radiant exposures of diode lasers (800 nm) for axillary hair removal, we conducted an intrapatient, left-to-right, patient- and assessor-blinded and controlled trial. Diode laser (800 nm) treatments were evaluated in 39 study participants (skin type II-III) with unwanted axillary hairs. Randomization and allocation to split axilla treatments were carried out by a web-based randomization tool. Six treatments were performed at 4- to 6-week intervals with study subjects blinded to the type of treatment. Final assessment of hair reduction was conducted 6 months after the last treatment by means of blinded 4-point clinical scale using photographs. The primary endpoint was reduction in hair growth, and secondary endpoints were patient-rated tolerability and satisfaction with the treatment, treatment-related pain and adverse effects. Excellent reduction in axillary hairs (≥ 76%) at 6-month follow-up visit after receiving fixed, low and incremental radiant exposure diode laser treatments was obtained in 59% and 67% of study participants respectively (Z value: 1.342, P = 0.180). Patients reported lower visual analogue scale (VAS) pain score on the fixed (4.26) than on the incremental radiant exposure side (5.64) (P diode laser treatments were less painful and better tolerated. © 2015 European Academy of Dermatology and Venereology.

  8. Automated segmentation of pulmonary structures in thoracic computed tomography scans: a review

    International Nuclear Information System (INIS)

    Van Rikxoort, Eva M; Van Ginneken, Bram

    2013-01-01

    Computed tomography (CT) is the modality of choice for imaging the lungs in vivo. Sub-millimeter isotropic images of the lungs can be obtained within seconds, allowing the detection of small lesions and detailed analysis of disease processes. The high resolution of thoracic CT and the high prevalence of lung diseases require a high degree of automation in the analysis pipeline. The automated segmentation of pulmonary structures in thoracic CT has been an important research topic for over a decade now. This systematic review provides an overview of current literature. We discuss segmentation methods for the lungs, the pulmonary vasculature, the airways, including airway tree construction and airway wall segmentation, the fissures, the lobes and the pulmonary segments. For each topic, the current state of the art is summarized, and topics for future research are identified. (topical review)

  9. Latissimus-sparing thoracotomy in the pediatric patient: a valuable asset for thoracic reconstruction.

    Science.gov (United States)

    Malczewski, M C; Colony, L; Cobb, L M

    1994-03-01

    The traditional posterolateral thoracotomy involves division of the latissimus dorsi muscle (LD). While the division results in no functional disability, it does negate the potential for possible future thoracic reconstruction if required in individual cases (eg, bronchopleural fistula, empyema, etc). A latissimus-sparing thoracotomy (LST) mobilizes the muscle dorsad and does not compromise the operation. Thus, the ipsilateral LD can be used when chest wall reconstruction is required. This option has been used frequently for adults; however, its use in children has not been extensively documented. Microvascular anastomoses for a contralateral LD free-flap may be tenuous in the small vessels of the child; thus, reconstruction using the ipsilateral LD could be beneficial and safer. The feasibility of LST has not been established with regard to the chest of the child. The authors present three pediatric thoracic cases that illustrate the value of this procedure, and discuss different situations in which latissimus-sparing thoracotomy is advantageous.

  10. A case of sarcoma of the chest wall after radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Izumi, Junko; Nishi, Tsunehiro; Fukuuchi, Atsushi; Takanashi, Riichiro

    1998-01-01

    A case of radiation-induced sarcoma of the chest wall after radiation therapy for breast cancer is reported. A 69-year-old woman underwent mastectomy with axillary lymph node dissection followed by linac therapy of 50 Gy delivered to the left axilla, left supraclavicular area, and parasternal area. During therapy for bone and liver metastases, a tumor was noted in the left chest wall 15 years after radiation therapy. Incisional biopsy was performed. Histological diagnosis was spindle cell sarcoma. Radiation-induced sarcoma was suspected because the tumor developed 15 years after radiation therapy within the same area. Radiation-induced sarcoma is a rare tumor, but radiation therapy following breast-conserving therapy is widely employed. It is important to be aware of the possibility of radiation-induced sarcoma. (author)

  11. 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.

  12. 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.

  13. Magnetic resonance imaging of thoracic hydatid disease; Correlation with clinical findings, radiography, ultrasonography, CT and pathology

    Energy Technology Data Exchange (ETDEWEB)

    Sinner, W.N. von; Rifal, A.; Te Strake, L.; Sieck, J. (King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia). Dept. of Radiology King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia). Dept. of Medicine Michigan Univ., Ann Arbor (USA). Dept. of Radiology)

    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.).

  14. Clinical evaluation of atherosclerosis and mechanical properties of the thoracic aorta

    International Nuclear Information System (INIS)

    Saiki, Atsushi

    1991-01-01

    To evaluate the aortic wall atherosclerosis, X-ray CT and ECG gated radionuclide angiography were performed in 25 subjects. They were classified into 17 normotensive group (N) and 8 hypertensive group (HT). The time-activity curve was generated using radionuclide angiography in the portion of the thoracic aorta. The aortic wall distensibility was expressed as 100ΔV/V 0 / PP, where ΔV was difference between maximum and minimum (V 0 ) counts of the aorta, and PP was pulse pressure. The degree of the aortic wall atherosclerosis was evaluated by X-ray CT. The aortic wall CT-score was calculated from the CT-scores measured whithin the region of interest of the other margin of the aorta and of the background by X-ray CT. There was a significant correlation between aortic wall CT-score and systolic blood pressure (r=0.59, p<0.01) or aortic wall distensibility (r=-0.74, p<0.01)), but no correlation existed between aortic wall CT-score and diastolic blood pressure (r=0.11, p:NS). The aortic wall distensibility was higher and the aortic wall CT-score was lower in N-group than in HT-group, whereas there was no difference of the radius of the aorta between both groups. These results suggest that the aortic wall atherosclerosis advanced progressively in hypertensive patients and systolic blood pressure was a good predictor of the degree of the aortic atherosclerosis. (author)

  15. 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)

  16. Effects of Corrective Exercise for Thoracic Hyperkyphosis on Posture, Balance, and Well-Being in Older Women: A Double-Blind, Group-Matched Design.

    Science.gov (United States)

    Jang, Hyun-Jeong; Hughes, Lynne C; Oh, Duck-Won; Kim, Suhn-Yeop

    2017-09-13

    The purpose of this study was to identify the effects of a corrective exercise for thoracic hyperkyphosis on posture, balance, and well-being in Korean community-dwelling older women. Fifty women 65 years of age and older, recruited from 2 senior centers, participated in this study. Participants were assigned to either the experimental group (EG) or the control group (CG) on the basis of convenience of location, and 22 in each were analyzed. Participants in the EG underwent a thoracic corrective exercise program 1 hour each session, twice per week for 8 weeks (a total of 16 sessions), which consisted of specific exercises to enhance breathing, thoracic mobility and stability, and awareness of thoracic alignment. The CG received education on the same thoracic corrective exercise program and a booklet of the exercises. Outcome measures included the extent of postural abnormality (angle of thoracic kyphosis, kyphosis index calculated both in relaxed- and best posture using flexicurve, the ratio of the kyphosis index calculated best posture/relaxed posture, craniovertebral angle, and tragus-to-wall distance), balance (Short Physical Performance Battery and limit of stability), and well-being (Geriatric Depression Scale Short Form and the 36-Item Short Form Health Survey [SF-36]). All data were collected by 6 blinded assessors at baseline, at 8 weeks after the completion of intervention, and at 16 weeks for follow-up. For participants of the EG, means of all parameters showed significant improvements over time (P posture, balance, and well-being in older women with thoracic hyperkyphosis. We recommend the use of the therapeutic strategies utilized in this study to enhance thoracic posture, balance, and well-being of older women with thoracic hyperkyphosis. Future research is needed to apply this exercise protocol on a larger and more diverse population.

  17. [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.

  18. Comminuted fracture of the thoracic spine.

    LENUS (Irish Health Repository)

    Cashman, J P

    2012-02-03

    BACKGROUND: Road deaths fell initially after the introduction of the penalty points but despite this, the rate of spinal injuries remained unchanged. AIMS: We report a patient with a dramatic spinal injury, though without neurological deficit. We discuss the classification, management and economic impact of these injuries. METHODS: We describe the management of a patient with a comminuted thoracic spinal fracture without neurological injury. We conducted a literature review with regard to the availability of literature of the management of these injuries. RESULTS: This 17-year-old female was managed surgically and had a good functional outcome. There is no clear consensus in the published literature on the management of these injuries. CONCLUSIONS: Comminuted thoracic spinal factures are potentially devastating. Such a patient presents challenges in determining the appropriate treatment.

  19. 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...

  20. 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.

  1. March 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated after 150 words. The March 2014 Arizona Thoracic Society meeting was a special meeting. In conjunction with the Valley Fever Center for Excellence and the Arizona Respiratory Center the Eighteenth Annual Farness Lecture was held in the Sonntag Pavilion at St. Joseph's Hospital at 6 PM on Friday, April 4, 2014. The guest speaker was Antonio "Tony" Catanzaro, MD from the University of California San Diego and current president of the Cocci Study Group. There were 57 in attendance representing the pulmonary, critical care, sleep, and infectious disease communities. After opening remarks by Arizona Thoracic Society president, Lewis Wesselius (a former fellow under Dr. Catanzaro at UCSD, John Galgiani, director of the Valley Fever Center for Excellence, gave a brief history of the Farness lecture before introducing Dr. Catanzaro. The lecture is named for Orin J. Farness, a Tucson physician, who was the first to report culture positive coccidioidomycosis (cocci or Valley Fever. ...

  2. 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

  3. 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.

  4. 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.

  5. 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...

  6. 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 ...

  7. 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

  8. 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.

  9. [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.

  10. 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.

  11. October 2012 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-10-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on 10/24/2012 at Scottsdale Shea beginning at 6:30 PM. There were 23 in attendance representing the pulmonary, critical care, sleep, infectious disease, pathology, and radiology communities. An announcement was made that the Colorado Thoracic Society has accepted an invitation to partner with the Arizona and New Mexico Thoracic Societies in the Southwest Journal of Pulmonary and Critical Care Medicine. Discussions continue to be held regarding a combined Arizona Thoracic Society meeting with Tucson either in Casa Grande or electronically. Six cases were presented: Dr. Tim Kuberski, chief of Infectious Disease at Maricopa Medical Center, presented a 48 year old female who had been ill for 2 weeks. A CT of the chest revealed a left lower lobe nodule and a CT of the abdomen showed hydronephrosis and a pelvic mass. Carcinoembryonic antigen (CEA was elevated. All turned out to be coccidioidomycosis on biopsy. CEA decreased …

  12. 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.

  13. 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

  14. Laparoscopic surgery in children: abdominal wall complications

    Directory of Open Access Journals (Sweden)

    Vaccaro S.

    2017-06-01

    Full Text Available Minimal invasive surgery has become the standard of care for operations involving the thoracic and abdominal cavities for all ages. Laparoscopic complications can occur as well as more invasive surgical procedures and we can classify them into non-specific and specific. Our goal is to analyze the most influential available scientific literature and to expose important and recognized advices in order to reduce these complications. We examined the mechanism, risk factors, treatment and tried to outline how to prevent two major abdominal wall complications related to laparoscopy: bleeding and port site herniation .

  15. Towards the evaluation of the pathological state of ascending thoracic aneurysms: integration of in-vivo measurements and hemodynamic simulations

    Science.gov (United States)

    Boccadifuoco, Alessandro; Mariotti, Alessandro; Celi, Simona; Martini, Nicola; Salvetti, Maria Vittoria

    2016-11-01

    Ascending thoracic aortic aneurysms are cardiovascular diseases consisting in a dilation of the ascending thoracic aorta. Since indicating a weakness of the arterial wall, they can lead to major complications with significant mortality rate. Clinical decisions about surgery are currently based on the maximum aortic diameter, but this single index does not seem a reliable indicator of the pathological state of the aorta. Numerical simulations of the blood flow inside the aneurysm may give supplementary information by quantifying important indices that are difficult to be measured, like the wall shear stress. Our aim is to develop an efficient platform in which in-vivo measurements are used to perform the hemodynamic simulations on a patient-specific basis. In particular, we used real geometries of thoracic aorta and focused on the use of clinical information to impose accurate boundary conditions at the inlet/outlets of the computational model. Stochastic analysis was also performed, to evaluate how uncertainties in the boundary parameters affect the main hemodynamic indicators, by considering both rigid and deformable walls. Stochastic calibration of numerical parameters against clinical data is in progress and results will be possibly shown.

  16. A case of parachordoma on the chest wall and literature review

    Directory of Open Access Journals (Sweden)

    Jie Zhang

    2013-01-01

    Full Text Available Parachordoma is an extremely uncommon soft-tissue tumor, which mainly occurs in the deep soft-tissue of the distal parts of the limbs, such as deep fascia, muscle tendon, synovial or soft-tissue closed to the bone. Nevertheless, the literature reports about parachordoma on the thoracic wall were scarce. The clinical and imaging manifestation has a non-specific appearance. In this article, we reported one case of parachordoma of the thoracic wall that we met in clinical works and reviewed the literature.

  17. 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.)

  18. 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.)

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

    Directory of Open Access Journals (Sweden)

    Amir Ghafarzad

    2014-03-01

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

  20. Anatomical variation of human thoracic rib in dry bone.

    Directory of Open Access Journals (Sweden)

    Dr. Nalini Konkani

    2017-12-01

    Full Text Available Introduction: The Ribs are essential structure of osseous thorax and provide information that aids in the interpretation of radiologic images. The purpose of this study to investigate variations in thoracic rib and its morphological & clinical importance. So, In present study attempted to find out additional intercostal spaces due to bifurcation of ribs, less intercostal space due to fusion of ribs, variation of the normal ribs like, gap in the rib, fusion of one rib to another at a shaft of rib. Congenital abnormalities of the ribs are usually asymptomatic, often discovered incidentally on chest X-ray. Effects of this neuroskeletal anomaly can include respiratory difficulties and neurological limitations.Material & Method: The study was carried out in Bone Store of Department of Anatomy, B. J. Medical College, Ahmedabad, Gujarat. Study was carried out on 500 human dried ribs. And the variations in the ribs are studied. We got variation in the human ribs and studied. Result : Variations were seen like out of 500 ribs, Bifid rib having two ends 9(1.8%, rib having bifid space 2(0.4%, fusion rib at the level of shaft 1(0.2%, fusion of first rib and second rib 1(0.2%,first rib having two ends 1(0.2%. Conclusion: Bifid rib is an anatomical variant where the sternal end of the rib is cleaved into two. So we can rule out mesodermal abnormalities, parenchymal lung disease, chest wall tumor or costal fracture.

  1. Recent clinical innovations in thoracic surgery in Hong Kong.

    Science.gov (United States)

    Zhao, Ze-Rui; Li, Zheng; Situ, Dong-Rong; Ng, Calvin S H

    2016-08-01

    The concept of personalized medicine, which aims to provide patients with targeted therapies while greatly reducing surgical trauma, is gaining popularity among Asian clinicians. Single port video-assisted thoracic surgery (VATS) has rapidly gained popularity in Hong Kong for major lung resections, despite bringing new challenges such as interference between surgical instruments and insertion of the optical source through a single incision. Novel types of endocutters and thoracoscopes can help reduce the difficulties commonly encountered during single-port VATS. Our region has been the testing ground and has led the development of many of these innovations. Performing VATS, in particular single-port VATS in hybrid operating theatre helps to localise small pulmonary lesions with real-time images, thus increasing surgical accuracy and pushes the boundaries in treating subcentimeter diseases. Such approach may be assisted by use of electromagnetic navigational bronchoscopy in the same setting. In addition, sublobar resection can also be more individualised according to pathologic tumour subtype that require rapid intraoperative diagnostic test to guide appropriate surgical therapy. A focus on technology and innovation for large tumours that require chest wall resection and reconstructions have also been on going, with new materials and prostheses that may be tailored to each individual needs. The current paper reviews the literature pertaining to the above topics and discusses recent related innovations in Hong Kong, highlighting the study results and future perspectives.

  2. 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.

  3. First wall

    International Nuclear Information System (INIS)

    Omori, Junji.

    1991-01-01

    Graphite and C/C composite are used recently for the first wall of a thermonuclear device since materials with small atom number have great impurity allowable capacity for plasmas. Among them, those materials having high thermal conduction are generally anisotropic and have an upper limit for the thickness upon production. Then, anisotropic materials are used for a heat receiving plate, such that the surfaces of the heat receiving plate on the side of lower heat conductivity are brought into contact with each other, and the side of higher thermal conductivity is arranged in parallel with small radius direction and the toroidal direction of the thermonuclear device. As a result, the incident heat on an edge portion can be transferred rapidly to the heat receiving plate, which can suppress the temperature elevation at the surface to thereby reduce the amount of abrasion. Since the heat expansion coefficient of the anisotropic materials is great in the direction of the lower heat conductivity and small in the direction of the higher heat conductivity, the gradient of a thermal load distribution in the direction of the higher heat expansion coefficient is small, and occurrence of thermal stresses due to temperature difference is reduced, to improve the reliability. (N.H.)

  4. Falling walls

    CERN Multimedia

    It was 20 years ago this week that the Berlin wall was opened for the first time since its construction began in 1961. Although the signs of a thaw had been in the air for some time, few predicted the speed of the change that would ensue. As members of the scientific community, we can take a moment to reflect on the role our field played in bringing East and West together. CERN’s collaboration with the East, primarily through links with the Joint Institute for Nuclear Research, JINR, in Dubna, Russia, is well documented. Less well known, however, is the role CERN played in bringing the scientists of East and West Germany together. As the Iron curtain was going up, particle physicists on both sides were already creating the conditions that would allow it to be torn down. Cold war historian Thomas Stange tells the story in his 2002 CERN Courier article. It was my privilege to be in Berlin on Monday, the anniversary of the wall’s opening, to take part in a conference entitled &lsquo...

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.)

  10. 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

  11. 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.)

  12. 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.

  13. 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.

  14. [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

  15. 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...

  16. Dissection or irradiation of the axilla in postmenopausal patients with breast cancer? Long-term results and late effects in 655 patients; Axilladissektion oder Axillabestrahlung bei postmenopausalen Patientinnen mit Mammakarzinom?

    Energy Technology Data Exchange (ETDEWEB)

    Albrecht, M.R.; Zink, K.; Ruehl, U. [Abt. fuer Strahlentherapie, Klinikum im Friedrichshain, Standort Moabit, Berlin (Germany); Busch, W. [Abt. fuer Gynaekologie, Krankenhaus Moabit Berlin (Germany)

    2002-09-01

    Patients and methods: From 1986 to 1993 we irradiated 655 patients with breast cancer after breast conserving surgery (BET). In all 144 cN1- and all 209 premenopausal cNO-patients axillary dissection was recommended. Of 302 postmenopausal cNO-patients 129 had breast surgery in our institution. In a total of 129 patients axillary dissection was replaced by irradiation (AxRT-group). They were compared with all 173 patients referred from other hospitals for irradiation after both breast conserving surgery and axillary dissection (AxOP-group). Dissected patients with gross tumor involvement of the axilla or less than eight nodes removed had additional axillary irradiation. Patients age, tumor size, vessel-, muscle- or skin invasion and grading were similar in both groups. However, in the AxRT-group there were more patients with negative hormon receptors, multifocal and medial sited tumors. Late complications after dissection and/or irradiation of the axilla were evaluated in 502 patients free of locoregional relapse and with a minimal follow up of 3 years (media 9,5 years). Results: After 5, 10 and 15 years tumor free survival rated were 90%, 82% and 79% in the AxOP-group vs 91%, 82% and 80% in the AxRT-group, respectively (p = 0.95). Overall survival (p = 0.98) local (p = 0.47) and axillary control (p = 0.12) were equal in both groups. However, serious problems like lymphedema of the arm, pain, mobility impairment occured in 26% patients following axillary dissection but only in 1% after axillary irradiation. No difference in late sequelae after axillary dissection with or without irradiation could be detected (26 vs 27%). (orig.) [German] Patientinnen und Methoden: Von 1986 bis 1993 wurden 655 Patientinnen mit Mammakarzinom nach brusterhaltender Operation (BET) bestrahlt. Davon waren praeoperativ 144 cN1- und 511 cNO-Patientinnen. Bei allen 144 cN1- und allen 209 praemenopausalen cNO-Patientinnen war eine Axilladissektion vorgesehen. Von 302 postmenopausalen c

  17. Automated extraction of pleural effusion in three-dimensional thoracic CT images

    Science.gov (United States)

    Kido, Shoji; Tsunomori, Akinori

    2009-02-01

    It is important for diagnosis of pulmonary diseases to measure volume of accumulating pleural effusion in threedimensional thoracic CT images quantitatively. However, automated extraction of pulmonary effusion correctly is difficult. Conventional extraction algorithm using a gray-level based threshold can not extract pleural effusion from thoracic wall or mediastinum correctly, because density of pleural effusion in CT images is similar to those of thoracic wall or mediastinum. So, we have developed an automated extraction method of pulmonary effusion by use of extracting lung area with pleural effusion. Our method used a template of lung obtained from a normal lung for segmentation of lungs with pleural effusions. Registration process consisted of two steps. First step was a global matching processing between normal and abnormal lungs of organs such as bronchi, bones (ribs, sternum and vertebrae) and upper surfaces of livers which were extracted using a region-growing algorithm. Second step was a local matching processing between normal and abnormal lungs which were deformed by the parameter obtained from the global matching processing. Finally, we segmented a lung with pleural effusion by use of the template which was deformed by two parameters obtained from the global matching processing and the local matching processing. We compared our method with a conventional extraction method using a gray-level based threshold and two published methods. The extraction rates of pleural effusions obtained from our method were much higher than those obtained from other methods. Automated extraction method of pulmonary effusion by use of extracting lung area with pleural effusion is promising for diagnosis of pulmonary diseases by providing quantitative volume of accumulating pleural effusion.

  18. DIFFERENT TYPES OF INSPIRATORY MUSCLE TRAINING PROVIDES BETTERMENT IN ALTERED PULMONARY FUNCTIONS IN UPPER THORACIC SPINAL CORD INJURIES

    Directory of Open Access Journals (Sweden)

    Muruganandam Periyasamy

    2016-08-01

    Full Text Available Background: Respiratory problems are usual in upper thoracic spinal cord injuries when compared to Lower thoracic spinal cord injuries. Generally there are frequent respiratory complications in the individuals with spinal cord injuries. The complications of the respiratory system are severe and more prevalent source of morbidity and mortality after the spinal cord injury due to the inefficient breathing capacity including inspiratory and expiratory abilities. The present study represents the inspiratory muscle training especially in upper thoracic spinal cord injury patients to assess the improvement in the pulmonary functions. Methods: Twenty five patients with the age between 25 -40 years with the upper spinal cord injuries were selected in the present study in order to assess the efficacy of the training. Several types of exercises were practiced including diaphragmatic breathing exercises, incentive spirometry, active cycle of breathing technique and weight training. COPD Conditions, Chest wall deformities, Hypertensive patients, Cardio vascular problems were excluded in the study. Results: The results from the study showed that significant changes were found in the patients treated with all the above mentioned techniques. Axillary level, nipple level, Xiphisternum levels were analysed and the results found to be significant after the treatment. Incentive spirometry and peak flow meter observations were also found to be significant when compare to the pretreatment. Conclusion: The present study conclude that the combined effect of incentive spriometry, diaphragmatic breathing exercises, and active cycle of breathing technique is more effective in improving the pulmonary functions in upper thoracic spinal cord injuries than single method efficiency.

  19. 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 …

  20. 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 …

  1. 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.

  2. Giant Chest Wall Hematoma Mimicking Elastofibroma Dorsi: A Case Report

    International Nuclear Information System (INIS)

    Lee, Yeon Soo; Park, Kuhn; Kim, Jong Ok; Choi, Eun Seok; Kang, Si Won

    2011-01-01

    Hematoma on the thoracic wall is very rare. We describe here a 63-year-old man with a huge chest wall hematoma and the man had no history of trauma. The patient was found to have a large mass located subjacent to the inferior angle of the right scapula area and the CT and MRI findings were similar to those of an elastofibroma dorsi. We describe the CT and MRI findings of this hematoma and how to make the differential diagnosis from elastofibroma dorsi

  3. Giant Chest Wall Hematoma Mimicking Elastofibroma Dorsi: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yeon Soo; Park, Kuhn; Kim, Jong Ok; Choi, Eun Seok; Kang, Si Won [Daejeon St. Mary' s Hospital, The Catholic University of Korea, Daejeon (Korea, Republic of)

    2011-02-15

    Hematoma on the thoracic wall is very rare. We describe here a 63-year-old man with a huge chest wall hematoma and the man had no history of trauma. The patient was found to have a large mass located subjacent to the inferior angle of the right scapula area and the CT and MRI findings were similar to those of an elastofibroma dorsi. We describe the CT and MRI findings of this hematoma and how to make the differential diagnosis from elastofibroma dorsi

  4. Delayed chest wall hematoma caused by progressive displacement of rib fractures after blunt trauma

    Directory of Open Access Journals (Sweden)

    Nobuhiro Sato

    2016-06-01

    Full Text Available Rib fracture is a common injury resulting from blunt thoracic trauma. Although hemothorax and pneumothorax are known delayed complications of rib fracture, delayed chest wall hematoma has rarely been reported. We discuss the case of an 81-year-old woman who was not undergoing antiplatelet or anticoagulant therapy who presented to our emergency department after a traffic injury. This patient had a nondisplaced rib fracture that went undetected on the initial computed tomography scan; the development of progressive displacement led to hemorrhagic shock due to delayed chest wall hematoma. The chest wall hematoma was effectively diagnosed and treated via contrast-enhanced computed tomography and angiographic embolization. This case highlights the possibility of this potential delayed complication from a common injury such as a rib fracture. Keywords: Angiography, Chest wall, Delayed complication, Rib fracture, Thoracic injury

  5. 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 ...

  6. 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

  7. Research Status of the Skeletalre Construction of Chest Wall

    Directory of Open Access Journals (Sweden)

    Daixing ZHONG

    2018-04-01

    Full Text Available Chest wall defect may be caused by many factors such as the resection of tumor and trauma, and the reconstruction of bone-defection is still the key point of thoracic surgery. With the development of material science, more and more new materials have been used in medical practice, which makes huge progress in the surgery of chest wall. However, none of these materials satisfy all the practical needs of the reconstruction. Recently, with the development of the capacity of computer, 3D-printing technology has been gradually used in clinical work, and the idea of individual treatment has been accepted by more and more people. The weakness of these materials may be solved by the new material and the application of individual treatment, which could also make great advance in chest wall surgery. This article will make a summary of the research on the reconstruction of chest wall.

  8. 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

  9. Thoracic meningocele in lumbo-costo-vertebral syndrome in a child: possible enlargement with repeated motion by anchoring to the diaphragm.

    Science.gov (United States)

    Wataya, Takafumi; Horikawa, Kyohei; Kitagawa, Masashi; Tashiro, Yuzuru

    2016-08-01

    Lumbo-costo-vertebral syndrome (LCVS) is a rare disorder in children that is characterized by hemivertebrae, congenital absence of ribs, meningocele, and hypoplasia of the truncal and abdominal wall presenting as a congenital lumbar hernia. An otherwise healthy 12-month-old girl was referred to the authors' hospital with soft swelling on her left middle back; scoliosis had been present since birth. Imaging revealed a thoracic meningocele, ectopia of the spleen suggesting lumbar hernia, multiple anomalies of the thoracic vertebral columns, and defects of the ribs; thus, LCVS was diagnosed. Surgical observation revealed that the meningocele was firmly anchored to part of the diaphragm, which created stretching tension in the meningocele continuously with exhalation. Once detached, the meningocele shrank spontaneously and never developed again after cauterization. In this case, continuous or pulsatile pressure in the presence of a vertebral defect was thus considered to be an important factor for formation of the thoracic meningocele.

  10. Dosimetric Factors and Toxicity in Highly Conformal Thoracic Reirradiation

    Energy Technology Data Exchange (ETDEWEB)

    Binkley, Michael S.; Hiniker, Susan M.; Chaudhuri, Aadel [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Maxim, Peter G. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Diehn, Maximilian [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California (United States); Loo, Billy W., E-mail: BWLoo@Stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Shultz, David Benjamin, E-mail: David.Shultz@rmp.uhn.on.ca [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)

    2016-03-15

    Purpose: We determined cumulative dose to critical structures, rates of toxicity, and outcomes following thoracic reirradiation. Methods and Materials: We retrospectively reviewed our institutional database for patients treated between 2008 and 2014, who received thoracic reirradiation with overlap of 25% prescribed isodose lines. Patients received courses of hyperfractionated (n=5), hypofractionated (n=5), conventionally fractionated (n=21), or stereotactic ablative radiation therapy (n=51). Doses to critical structures were converted to biologically effective dose, expressed as 2 Gy per fraction equivalent dose (EQD2; α/β = 2 for spinal cord; α/β = 3 for other critical structures). Results: We identified 82 courses (44 for retreatment) in 38 patients reirradiated at a median 16 months (range: 1-71 months) following initial RT. Median follow-up was 17 months (range: 3-57 months). Twelve- and 24-month overall survival rates were 79.6% and 57.3%, respectively. Eighteen patients received reirradiation for locoregionally recurrent non-small cell lung cancer with 12-month rates of local failure and regional recurrence and distant metastases rates of 13.5%, 8.1%, and 15.6%, respectively. Critical structures receiving ≥75 Gy EQD2 included spinal cord (1 cm{sup 3}; n=1), esophagus (1 cm{sup 3}; n=10), trachea (1 cm{sup 3}; n=11), heart (1 cm{sup 3}; n=9), aorta (1 cm{sup 3}; n=16), superior vena cava (1 cm{sup 3}; n=12), brachial plexus (0.2 cm{sup 3}; n=2), vagus nerve (0.2 cm{sup 3}; n=7), sympathetic trunk (0.2 cm{sup 3}; n=4), chest wall (30 cm{sup 3}; n=12), and proximal bronchial tree (1 cm{sup 3}; n=17). Cumulative dose-volume (D cm{sup 3}) toxicity following reirradiation data included esophagitis grade ≥2 (n=3, D1 cm{sup 3} range: 41.0-100.6 Gy), chest wall grade ≥2 (n=4; D30 cm{sup 3} range: 35.0-117.2 Gy), lung grade 2 (n=7; V20{sub combined-lung} range: 4.7%-21.7%), vocal cord paralysis (n=2; vagus nerve D0.2 cm{sup 3

  11. 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....

  12. 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...

  13. 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.

  14. 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...

  15. 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.

  16. 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.

  17. The implantation of separating aortic stent-graft into the canine thoracic aorta: an experimental study

    International Nuclear Information System (INIS)

    Xia Jinguo; Shi Haibin; Yang Zhengqiang; Li Chao; Liu Sheng; Zu Qingquan; Li Linsun

    2011-01-01

    Objective: to assess the technical feasibility of implanting separating stent-graft into the canine thoracic aorta and to study its biocompatibility. Methods: Twelve adult dogs were randomly and equally divided into three groups. The right femoral artery was cut open, through which the separating stent-graft was inserted and deployed in the canine thoracic aorta, with the proximal end of the graft being quite close to the origin of the left subclavian artery. the technical feasibility of the deployment process was assessed. Angiography was performed at 4, 8 and 12 weeks after stent-graft placement to evaluate the position and patency of the stent-graft. Then the dogs were sacrificed and the specimens were collected for pathologic study. Both gross and microscopic examinations were made to evaluate the fixation of the stent-graft with the vessel wall, the endothelialization of stent-graft surface and the pathologic changes of the vascular wall. Results: A total of ten separating stent-grafts were successfully deployed in the canine thoracic aorta, no migration or deformation occurred. One dog died of massive bleeding due to the rupture of the right femoral artery which occurred when the delivery system containing the inner bare stent was inserted through the right femoral artery. Death occurred in another dog as a result of the ascending aorta rupture caused by the migration of outer-layer stent-graft. Angiography was conducted at 4, 8 and 12 weeks after stent-graft placement. No migration, deformation, rupture or stenosis of the implanted stent-grafts were observed. The formation of intima on the inner surface of the bare stent appeared at 4 weeks, which became more and more obvious with the time passing, and at 12 weeks complete endothelialization of stent-graft surface was observed. Conclusion: Technically, it is feasible to deploy the separating aortic stent-graft into the canine thoracic aorta. Moreover, the separating aortic stent-graft carries excellent

  18. The contribution of thoracic vertebral deformity and arthropathy to trunk pain in patients with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Chen, Yi-Wen; Coxson, Harvey O; Coupal, Tyler M; Lam, Stephen; Munk, Peter L; Leipsic, Jonathon; Reid, W Darlene

    2018-04-01

    Pain, commonly localized to the trunk in individuals with COPD, may be due to osteoporosis-related vertebral deformity and chest wall hyper-expansion causing misalignment of joints between the ribs and vertebrae. The purpose of this study was to determine if thoracic vertebral deformity and arthropathy were independent contributors to trunk pain in COPD patients compared to people with a significant smoking history. Participants completed the Brief Pain Inventory (BPI) on the same day as chest CT scans and spirometry. Current and ex-smokers were separated into COPD (n = 91) or non-COPD (n = 80) groups based on spirometry. Subsequently, CT images were assessed for thoracic vertebral deformity, bone attenuation values, and arthropathy of thoracic vertebral joints. The trunk area was the most common pain location in both COPD and non-COPD groups. Thoracic vertebral deformity and costotransverse joint arthropathy were independent contributors to trunk pain in COPD patients (adjusted OR = 3.55 and 1.30, respectively) whereas alcohol consumption contributed to trunk pain in the non-COPD group (adjusted OR = 0.35 in occasional alcohol drinkers; 0.08 in non-alcohol drinkers). The spinal deformity index and the number of narrowed disc spaces were significantly positively related to the BPI intensity, interference, and total scores significantly in COPD patients. Trunk pain, at least in part, is caused by thoracic vertebral deformity, and costotransverse and intervertebral arthropathy in patients living with COPD. The results of this study provided the foundation for the management of pain, which requires further exploration. Copyright © 2018 Elsevier Ltd. All rights reserved.

  19. Relation of murine thoracic aortic structural and cellular changes with aging to passive and active mechanical properties.

    Science.gov (United States)

    Wheeler, Jason B; Mukherjee, Rupak; Stroud, Robert E; Jones, Jeffrey A; Ikonomidis, John S

    2015-02-25

    Maintenance of the structure and mechanical properties of the thoracic aorta contributes to aortic function and is dependent on the composition of the extracellular matrix and the cellular content within the aortic wall. Age-related alterations in the aorta include changes in cellular content and composition of the extracellular matrix; however, the precise roles of these age-related changes in altering aortic mechanical function are not well understood. Thoracic aortic rings from the descending segment were harvested from C57BL/6 mice aged 6 and 21 months. Thoracic aortic diameter and wall thickness were higher in the old mice. Cellular density was reduced in the medial layer of aortas from the old mice; concomitantly, collagen content was higher in old mice, but elastin content was similar between young and old mice. Stress relaxation, an index of compliance, was reduced in aortas from old mice and correlated with collagen fraction. Contractility of the aortic rings following potassium stimulation was reduced in old versus young mice. Furthermore, collagen gel contraction by aortic smooth muscle cells was reduced with age. These results demonstrate that numerous age-related structural changes occurred in the thoracic aorta and were related to alterations in mechanical properties. Aortic contractility decreased with age, likely because of a reduction in medial cell number in addition to a smooth muscle contractile deficit. Together, these unique findings provide evidence that the age-related changes in structure and mechanical function coalesce to provide an aortic substrate that may be predisposed to aortopathies. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  20. [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.

  1. Dynamic autophagic activity affected the development of thoracic aortic dissection by regulating functional properties of smooth muscle cells

    International Nuclear Information System (INIS)

    Wang, Yang; Zhao, Zhi-Min; Zhang, Guan-Xin; Yang, Fan; Yan, Yan; Liu, Su-Xuan; Li, Song-Hua; Wang, Guo-Kun; Xu, Zhi-Yun

    2016-01-01

    The aortic medial degeneration is the key histopathologic feature of Thoracic aortic dissection (TAD). The aim of this study was to identify the change of autophagic activity in the aortic wall during TAD development, and to explore the roles of autophagy on regulating functional properties of smooth muscle cells (SMCs). Firstly, compared with control group (n = 11), the increased expression of autophagic markers Beclin1 and LC3 was detected in the aortic wall from TAD group (n = 23) by immunochemistry and western blot. We found that more autophagic vacuoles were present in the aortic wall of TAD patients using Transmission electron microscopy. Next, autophagic activity was examined in AD mice model established by β-aminopropionitrile fumarate (BAPN) and angiotensin II. Immunochemistry proved that autophagic activity was dynamically changed during AD development. Beclin1 and LC3 were detected up-regulated in the aortic wall in the second week after BAPN feeding, earlier than the fragmentation or loss of elastic fibers. When AD occurred in the 4th week, the expression of Beclin1 and LC3 began to decrease, but still higher than the control. Furthermore, autophagy was found to inhibit starvation-induced apoptosis of SMCs. Meanwhile, blockage of autophagy could suppress PDGF-induced phenotypic switch of SMCs. Taken together, autophagic activity was dynamically changed in the aortic wall during TAD development. The abnormal autophagy could regulate the functional properties of aortic SMCs, which might be the potential pathogenesis of TAD. - Highlights: • Autophagy is up-regulated in aorta wall from thoracic aorta dissection (TAD) patient. • Autophagic activity is dynamically changed during TAD development. • Dynamically change of autophagy is associated with pathological process of TAD. • Autophagy participate in the development of TAD by regulating function of SMCs.

  2. 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

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. [Effects of rhynchophylla alkaloids on vascular adventitial fibroblast apoptosis and proliferation in the thoracic aorta of spontaneously hypertensive rats].

    Science.gov (United States)

    Dai, Guo-Hua; Sun, Jing-Chang; Qi, Dong-Mei

    2012-09-01

    , isorhynchophylline, and rhynchophylla alkaloids might promote the VAF apoptosis in the thoracic aorta of SHR by regulating the protein expressions of Bcl-2 and Bax. They might inhibit the VAF proliferation by restraining protein expressions of c-Fos, c-Myc, and TGF-beta1 mRNA. They also might improve the thoracic aorta wall reconstruction and decrease the tail arterial systolic pressure by down-regulating the protein expressions of FN and LN, and attenuating the deposition of extracellular matrix.

  8. 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

  9. A rare case of an intercostal lung herniation with fractures of the fifth and sixth ribs after thoracic surgery.

    Science.gov (United States)

    Haro, Akira; Komiya, Kazune; Taguchi, Yoshihiro; Nishikawa, Haruka; Kouda, Takuyuki; Fujishita, Takatoshi; Yokoyama, Hideki

    2017-01-01

    Lung herniation is a rare condition defined as a protrusion of the pleural-covered lung parenchyma through an abnormal defect or weakness in the thoracic wall. Postoperative lung herniation is reported to result from a preceding operation with inadequate closure of the chest wall. A 77-year-old woman was admitted to our hospital for treatment of hemoptysis and nausea. One year previously, she had undergone wedge resection of the right lower lobe (S6) for treatment of primary lung adenocarcinoma. Upon admission, chest radiograph and chest computed tomography showed a right lung herniation through the fifth enlarged intercostal space with right fifth and sixth rib fractures. She underwent surgical closure of the intercostal hernia using synthetic materials with fixation of the fifth and sixth ribs. The patient had developed no recurrence 9 months after surgical repair. In the present case, adequate closure of the right pleural cavity was ensured by fixation of both fifth and sixth ribs during the preceding video-assisted thoracic surgery for the primary lung carcinoma. Our patient may have had some exacerbation factors for lung herniation, increased intrathoracic pressure, attenuation of chest wall by prolonged coughing and rib fracture, and high abdominal pressure due to her hunched-over posture. It is important to know some exacerbation factors for postoperative intercostal lung herniation. Addition of monofirament-suture fixation of the ribs to patch repair is very effective for lung herniation repair in patients with concurrent lung herniation and rib fractures.

  10. 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.

  11. 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

  12. 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 ...

  13. “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 ...

  14. 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 ...

  15. 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.

  16. 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)

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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....

  2. 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.

  3. 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 …

  4. 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 …

  5. 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)

  6. 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

  7. 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

  8. 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 ...

  9. 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 …

  10. 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 …

  11. In vivo hypertensive arterial wall uptake of radiolabeled liposomes

    International Nuclear Information System (INIS)

    Hodis, H.N.; Amartey, J.K.; Crawford, D.W.; Wickham, E.; Blankenhorn, D.H.

    1990-01-01

    Using five sham-operated and seven aortic coarctation-induced hypertensive New Zealand White rabbits intravenously injected with neutral small unilamellar vesicles loaded with [111In]nitrilotriacetic acid, we demonstrated in vivo that the normal aortic arterial wall participates in liposome uptake and that this uptake is increased in the hypertensive aortic wall by approximately threefold (p less than or equal to 0.0001). Among the three regions examined, aortic arch, thoracic aorta, and lower abdominal aorta, the difference in uptake between the normotensive and hypertensive arterial walls was significantly different, p less than or equal to 0.05, p less than or equal to 0.0001, and p less than 0.05, respectively. The uptake by the different regions of the hypertensive arterial wall is consistent with the pathological changes present in these areas. Furthermore, the extent of liposome uptake by the aortic wall is strongly correlated with the height of the blood pressure (r = 0.85, p = 0.001, n = 11). We conclude that neutral small unilamellar liposomes can be used to carry agents into the arterial wall in vivo in the study of hypertensive vascular disease and could be especially useful for the delivery of pharmacologically or biologically active agents that would otherwise be inactivated within the circulation or are impermeable to the arterial wall

  12. Evaluation of respiratory functions in chest trauma patients treated with thoracic wall stabilization

    Directory of Open Access Journals (Sweden)

    Karam E. Moslam

    2015-01-01

    Conclusion: Surgical stabilization of flail chest with metallic plates is a safe and effective therapy in properly selected patients. These patients had a significantly smoother course during the intensive care unit and hospital stays, had improved respiratory functions and decreased rate of complications.

  13. Sonographic determination of the irradiated pulmonary volume in case of irradiation of the thoracic wall

    International Nuclear Information System (INIS)

    Wittich, G.; Hohenberg, G.; Seitz, W.; Vienna Univ.

    1983-01-01

    In order to determine the irradiated pulmonary volume, comparative examinations by sonography and computed tomography were made in ten patients submitted to postoperative radiotherapy for mammary carcinoma. The physical and anatomical conditions of sonographic volumetry are discussed. In all cases irradiated with tangential contralateral fields, the irradiated pulmonary volume was less than 200 ccm (118 ccm on an average). The sonographic results did not differ essentially from those of computed tomography, so that the sonographic examination can be offered as a simple and sufficient precise method of documentation within the frame of an individual therapy planning. (orig.) [de

  14. Repair of extensive radionecrosis of the thoracic wall using soft tissues from the paralyzed upper limb

    Energy Technology Data Exchange (ETDEWEB)

    Delacroix, R; Wallaert, C; Soulier, A; Delepoulle, E; Francois, C; Grignet, J P

    1975-04-01

    The authors report one case of extensive radionecrosis after postoperative radiotherapy for breast cancer, with overt pyothorax, deep axillary ulceration, and brachial paralysis. The plastic use of the musculo-aponeutrotic tissues of the paralysed upper limb resulted in spectacular success, complicated only by empyema of the hemithoracic cavity, for which treatment with neomycin is recommended.

  15. Blunt thoracic trauma - an analysis of 264 patients in Rawalpindi, Pakistan

    International Nuclear Information System (INIS)

    Subhani, S.S.; Muzaffar, M.S.

    2014-01-01

    Objective: To analyse the outcome in terms of morbidity and mortality in blunt thoracic trauma patients in tertiary care hospitals, Rawalpindi. Methods: The prospective study was conducted from March 2008 to February 2012 in surgical wards of public and private sector hospitals in Rawalpindi. A total of 221 patients were included from the Combined Military Hospital during 2008-10, and 43 patients from the Heart's International during 2011-12. The patients reported to emergency department within 48 hours of trauma. All patients were subjected to detailed history and respiratory system examination to ascertain fracture of ribs, flail segment and haemopneumothorax. The diagnosis of chest wall injuries, parenchymal pulmonary injuries and pleural involvement were made on the basis of chest radiographs and computed tomography scan of the chest. The lung contusion was assessed by the number of lobes involved. SPSS 19 was used for statistical analysis. Results: Of the 264 patients in the study, 211 (80%) were males and 54 (20%) females. The overall mean age was 44.8+-17.1 years. Over all morbidity was 222 (84.2%); morbidity (minor) was 128 (48.5%), and morbidity (major) was 94 (35.7%). Mortality was 26 (9.8%) and 16 (6%) cases had normal outcome. Conclusion: Early identification and aggressive management of blunt thoracic trauma is essential to reducing significant rates of morbidity and mortality. (author)

  16. The hemiclamshell approach in thoracic surgery: indications and associated morbidity in 50 patients.

    Science.gov (United States)

    Lebreton, Guillaume; Baste, Jean-Marc; Thumerel, Matthieu; Delcambre, Frédéric; Velly, Jean-Françis; Jougon, Jacques

    2009-12-01

    This retrospective study was carried out to evaluate the indications for and outcomes of the hemiclamshell (HCS) approach (longitudinal partial sternotomy with antero-lateral thoracotomy) in patients undergoing mass resection in thoracic surgery. All patients (50) who underwent a HCS procedure in our department, between July 1996 and July 2005, were studied retrospectively, analyzing the indications, morbidity and outcome (pain, neurological or shoulder defects, mortality) at one month and one year. The main indications were apical tumours (38%), tumours of the cervicothoracic junction (46%) and chest wall (10%), and 'bulky' tumours (6%). One-month mortality was 6%. Two patients suffered from a chylothorax and one from phrenic paralysis. The postoperative analgesic requirements were similar to those after other thoracic surgery approaches. Twelve percent of patients suffered pain at one month and 6% at one year. Shoulder dysfunction was observed in 10% of patients at one month and 6% at one year. In conclusion, the HCS surgical approach was associated with an uncomplicated postoperative course. This anterior approach is suitable for apical tumours, tumours of the cervicothoracic junction and 'bulky' lung tumours, providing good access for control of the large vessels and radical mediastinal clearance.

  17. 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

  18. 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

  19. 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

  20. Expression of platelet-derived growth factor B is upregulated in patients with thoracic aortic dissection.

    Science.gov (United States)

    Meng, Weixin; Liu, Shangdian; Li, Dandan; Liu, Zonghong; Yang, Hui; Sun, Bo; Liu, Hongyu

    2018-04-20

    Thoracic aortic dissection (TAD) is a serious condition requiring urgent treatment to avoid catastrophic consequences. The inflammatory response is involved in the occurrence and development of TAD, possibly potentiated by platelet-derived growth factors (PDGFs). This study aimed to determine whether expression of PDGF-B (a subunit of PDGF-BB) was increased in TAD patients and to explore the factors responsible for its upregulation and subsequent effects on TAD. Full-thickness ascending aorta wall specimens from TAD patients (n = 15) and control patients (n = 10) were examined for expression of PDGF-B and its receptor (PDGFRB) and in terms of morphology, inflammation, and fibrosis. Blood samples from TAD and control patients were collected to detect plasma levels of PDGF-BB and soluble elastins. Expression levels of PDGF-B, PDGFRB, and collagen I were significantly enhanced in ascending aorta wall specimens from TAD patients compared with controls. Furthermore, soluble elastic fragments and PDGF-BB were significantly increased in plasma from TAD patients compared with controls, and numerous irregular elastic fibers and macrophages were seen in the ascending aorta wall in TAD patients. An increase in elastic fragments in the aorta wall might be responsible for inducing the activation and migration of macrophages to injured sites, leading to elevated expression of PDGF-B, which in turn induces deposition of collagen, disrupts extracellular matrix homeostasis, and increases the stiffness of the aorta wall, resulting in compromised aorta compliance. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  1. Possible Genetic Origin of Limb-Body Wall Complex.

    Science.gov (United States)

    Gajzer, David C; Hirzel, Alicia Cristina; Saigal, Gaurav; Rojas, Claudia Patricia; Rodriguez, Maria Matilde

    2015-01-01

    Limb body wall complex (LBWC) is characterized by multiple severe congenital malformations including an abdominal and/or thoracic wall defect covered by amnion, a short or absent umbilical cord with the placenta almost attached to the anterior fetal wall, intestinal malrotation, scoliosis, and lower extremity anomalies. There is no consensus about the etiology of LBWC and many cases with abnormal facial cleft do not meet the requirements for the true complex. We describe a series of four patients with LBWC and other malformations in an attempt to explain their etiology. There are several reports of fetuses with LBWC and absent gallbladder and one of our patients also had polysplenia. Absent gallbladder and polysplenia are associated with laterality genes including HOX, bFGF, transforming growth factor beta/activins/BMP4, WNT 1-8, and SHH. We postulate that this severe malformation may be due to abnormal genes involved in laterality and caudal development.

  2. 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.

  3. Frequency and significance of thoracic injuries detected on abdominal trauma CT scans

    International Nuclear Information System (INIS)

    Hareli, G.S.; Rhea, J.T.; Novelline, R.A.; Lawrason, N.; Sacknoff, R.; Oser, A.

    1987-01-01

    The authors have noted that in multiple trauma patients chest injuries inapparent on initial chest radiographs may be detected at abdominal CT. In an ongoing series of 112 patients to date, 50 chest injuries were detected in 33 patients (29%). The injuries included 15 bilateral hemothoraces, seven unilateral hemothoraces, seven posttraumatic atrelectasis, seven lung contusions, five pneumothoraces, four rib factures, two thoracic spine fractures, two chest wall emphysema, and one mediastinal emphysema. In 24 of the 33 patients (72%) the injury was not seen on the initial chest radiographs; in seven patients treatment of the chest injury was required. The authors have included screening cuts of the middle and upper chest as part of their abdominal CT protocol

  4. Thoracic and abdominal SPECT imaging in systemic amyloidosis in identifying multiorgan involvement

    International Nuclear Information System (INIS)

    Wellman, H.N.; Benson, M.D.; Park, H.M.; Siddiqui, A.R.; Krepshaw, J.D.

    1988-01-01

    Thirty-three patients with systemic amyloidosis have been studied. Thoracic single photon emission computed tomography (SPECT) for myocardial involvement and skeletal imaging were performed with Tc-99m PYP, and abdominal SPECT with TcS colloid. Myocardial wall involvement was easily discernible with SPECT in 17 cases, and in many with normal ultrasonography. PYP uptake was also observed in liver (five patients), kidneys (four patients), and soft tissues (two patients). Most patients had widespread degenerative joint disease. With TcS colloid, intrinsic liver abnormalities were found in four patients, hepatomegaly in seven, and splenic infiltration in two. Nuclear SPECT and planar imaging characterize the distribution of systemic amyloidosis in organs, distribution not readily identified with other diagnostic modalities

  5. 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)

  6. Transpedicular screw fixation in the thoracic and lumbar spine with a novel cannulated polyaxial screw system

    Directory of Open Access Journals (Sweden)

    Lutz Weise

    2008-10-01

    Full Text Available Lutz Weise, Olaf Suess, Thomas Picht, Theodoros KombosNeurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Berlin, GermanyObjective: Transpedicular screws are commonly and successfully used for posterior fixation in spinal instability, but their insertion remains challenging. Even using navigation techniques, there is a misplacement rate of up to 11%. The aim of this study was to assess the accuracy of a novel pedicle screw system.Methods: Thoracic and lumbar fusions were performed on 67 consecutive patients for tumor, trauma, degenerative disease or infection. A total of 326 pedicular screws were placed using a novel wire-guided, cannulated, polyaxial screw system (XIA Precision®, Stryker. The accuracy of placement was assessed post operatively by CT scan, and the patients were followed-up clinically for a mean of 16 months.Results: The total medio-caudal pedicle wall perforation rate was 9.2% (30/326. In 19 of these 30 cases a cortical breakthrough of less than 2 mm occurred. The misplacement rate (defined as a perforation of 2 mm or more was 3.37% (11/326. Three of these 11 screws needed surgical revision due to neurological symptoms or CSF leakage. There have been no screw breakages or dislocations over the follow up-period.Conclusion: We conclude that the use of this cannulated screw system for the placement of pedicle screws in the thoracic and lumbar spine is accurate and safe. The advantages of this technique include easy handling without a time-consuming set up. Considering the incidence of long-term screw breakage, further investigation with a longer follow-up period is necessary.Keywords: spinal instrumentation, pedicle screws, misplacement, pedicle wall perforation

  7. Time-resolved three-dimensional magnetic resonance velocity mapping of chronic thoracic aortic dissection. A preliminary investigation

    International Nuclear Information System (INIS)

    Amano, Yasuo; Sekine, Tetsuro; Tanaka, Keiji; Takagi, Ryo; Kumita, Shinichiro; Suzuki, Yuriko

    2011-01-01

    The blood flow patterns of chronic thoracic aortic dissection are complicated, and their clinical significance remains unknown. We evaluated the technical and clinical potentials of time-resolved 3-dimensional (3D) magnetic resonance (MR) velocity mapping for assessing these patterns. We used data collected from time-resolved 3D phase-contrast MR imaging of 16 patients with chronic thoracic aortic dissection to generate time-resolved 3D MR velocity mapping that included 3D streamline and path line. We investigated blood flow patterns of this disease in the mapping and compared them with the morphological changes of the patent false lumen. Time-resolved 3D MR velocity mapping visualized rapid flow at the entry and in the true lumen immediately distal to the entry. We observed slower helical or laminar flow in the patent false lumen. In patients with disease progression, slower helical flow following rapid entry jet collided with the outer wall of the false lumen and was also observed in a growing ulcer-like projection. We showed the potential of time-resolved 3D MR velocity mapping for visualizing pathologic flow patterns related to chronic thoracic aortic dissection. (author)

  8. Heartbeat-related displacement of the thoracic aorta in patients with chronic aortic dissection type B: Quantification by dynamic CTA

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Tim F. [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany)], E-mail: tim.weber@med.uni-heidelberg.de; Ganten, Maria-Katharina [German Cancer Research Center, Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany)], E-mail: m.ganten@dkfz.de; Boeckler, Dittmar [University of Heidelberg, Department of Vascular and Endovascular Surgery, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany)], E-mail: dittmar.boeckler@med.uni-heidelberg.de; Geisbuesch, Philipp [University of Heidelberg, Department of Vascular and Endovascular Surgery, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany)], E-mail: philipp.geisbuesch@med.uni-heidelberg.de; Kauczor, Hans-Ulrich [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany)], E-mail: hu.kauczor@med.uni-heidelberg.de; Tengg-Kobligk, Hendrik von [German Cancer Research Center, Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany)], E-mail: h.vontengg@dkfz.de

    2009-12-15

    Purpose: The purpose of this study was to characterize the heartbeat-related displacement of the thoracic aorta in patients with chronic aortic dissection type B (CADB). Materials and methods: Electrocardiogram-gated computed tomography angiography was performed during inspiratory breath-hold in 11 patients with CADB: Collimation 16 mm x 1 mm, pitch 0.2, slice thickness 1 mm, reconstruction increment 0.8 mm. Multiplanar reformations were taken for 20 equidistant time instances through both ascending (AAo) and descending aorta (true lumen, DAoT; false lumen, DAoF) and the vertex of the aortic arch (VA). In-plane vessel displacement was determined by region of interest analysis. Results: Mean displacement was 5.2 {+-} 1.7 mm (AAo), 1.6 {+-} 1.0 mm (VA), 0.9 {+-} 0.4 mm (DAoT), and 1.1 {+-} 0.4 mm (DAoF). This indicated a significant reduction of displacement from AAo to VA and DAoT (p < 0.05). The direction of displacement was anterior for AAo and cranial for VA. Conclusion: In CADB, the thoracic aorta undergoes a heartbeat-related displacement that exhibits an unbalanced distribution of magnitude and direction along the thoracic vessel course. Since consecutive traction forces on the aortic wall have to be assumed, these observations may have implications on pathogenesis of and treatment strategies for CADB.

  9. Effect of thoracic mobilization on respiratory parameters in chronic non-specific low back pain: A randomized controlled trial.

    Science.gov (United States)

    Babina, R; Mohanty, P P; Pattnaik, M

    2016-02-19

    Altered respiratory function has been found to be associated with back pain. Limited chest excursion in subjects with chronic low back pain (CLBP) may be due to co-contraction or bracing of erector spinae and abdominal muscles; their flexed spinal posture; and/or their compromised spinal stability resulting from dysfunctional transversus abdominis. To check for the effects of thoracic mobilization on respiratory parameters in subjects with chronic non-specific low back pain. Sixty-two subjects (excluding 11 dropouts) with CLBP of age group 30-60 were randomly allocated to two groups. Both groups received individualized treatment for low back pain (LBP) and HEP (home exercise program) regime of breathing exercises. In addition, group 1 received Maitland's Central postero-anterior vertebral pressure for thoracic spine (T1-T8). Total treatment duration was 10 sessions in 2 weeks (5 sessions/week). Results showed significant improvement in respiratory parameters viz. Forced Vital Capacity (FVC), Sustained Maximal Inspiratory Pressure (SMIP) and Chest Wall Expansion (CWE) and Oswestry Disability Index (ODI) in both groups (pchronic low back pain with or without radiation to lower limbs when treated with thoracic central PA mobilization, in addition to LBP specific treatment and breathing exercises, show an improvement in respiratory parameters and reduction in disability.

  10. Clinical significance of conventional rib series in patients with minor thoracic trauma

    International Nuclear Information System (INIS)

    Hoffstetter, P.; Dornia, C.; University Medical Center Regensburg; Wagner, M.; Niessen, C.; Dendl, L.M.; Stroszczynski, C.; Schreyer, A.G.; Al Suwaidi, M.H.

    2014-01-01

    Background: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. Methods: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. Results: We included 669 patients (61.4% men, 38.6% women, median age: 51 years, range: 13-92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5%) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5%) patients. Considering the 157 patients with fractured ribs, 73 (46.8%) had a single fracture, 38 (24.4%) and two fractures and 45 (28.8%) had more than two fractures. When assessing the 405 CRs, we detected 69 (17%) fractures while the corresponding RS of the same patients revealed 87 (21.5%) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1% received medical therapy, while 64.5% of those patients without a radiologically documented fracture also received therapy (p = 0.25). Conclusion: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosing rib fractures, the results from RS seem to have no significant influence on further clinical management and therapeutic measures. Minor thoracic trauma should be evaluated

  11. Clinical significance of conventional rib series in patients with minor thoracic trauma

    Energy Technology Data Exchange (ETDEWEB)

    Hoffstetter, P.; Dornia, C. [Asklepios Medical Center, Bad Abbach (Germany). Radiology; University Medical Center Regensburg (Germany). Radiology; Wagner, M.; Niessen, C.; Dendl, L.M.; Stroszczynski, C.; Schreyer, A.G. [University Medical Center Regensburg (Germany). Radiology; Al Suwaidi, M.H. [Asklepios Medical Center, Bad Abbach (Germany). Rheumatology/Clinical Immmunology

    2014-09-15

    Background: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. Methods: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. Results: We included 669 patients (61.4% men, 38.6% women, median age: 51 years, range: 13-92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5%) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5%) patients. Considering the 157 patients with fractured ribs, 73 (46.8%) had a single fracture, 38 (24.4%) and two fractures and 45 (28.8%) had more than two fractures. When assessing the 405 CRs, we detected 69 (17%) fractures while the corresponding RS of the same patients revealed 87 (21.5%) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1% received medical therapy, while 64.5% of those patients without a radiologically documented fracture also received therapy (p = 0.25). Conclusion: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosing rib fractures, the results from RS seem to have no significant influence on further clinical management and therapeutic measures. Minor thoracic trauma should be evaluated

  12. 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)

  13. 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.)

  14. Haemodynamic imaging of thoracic stent-grafts by computational fluid dynamics (CFD): presentation of a patient-specific method combining magnetic resonance imaging and numerical simulations.

    Science.gov (United States)

    Midulla, Marco; Moreno, Ramiro; Baali, Adil; Chau, Ming; Negre-Salvayre, Anne; Nicoud, Franck; Pruvo, Jean-Pierre; Haulon, Stephan; Rousseau, Hervé

    2012-10-01

    In the last decade, there was been increasing interest in finding imaging techniques able to provide a functional vascular imaging of the thoracic aorta. The purpose of this paper is to present an imaging method combining magnetic resonance imaging (MRI) and computational fluid dynamics (CFD) to obtain a patient-specific haemodynamic analysis of patients treated by thoracic endovascular aortic repair (TEVAR). MRI was used to obtain boundary conditions. MR angiography (MRA) was followed by cardiac-gated cine sequences which covered the whole thoracic aorta. Phase contrast imaging provided the inlet and outlet profiles. A CFD mesh generator was used to model the arterial morphology, and wall movements were imposed according to the cine imaging. CFD runs were processed using the finite volume (FV) method assuming blood as a homogeneous Newtonian fluid. Twenty patients (14 men; mean age 62.2 years) with different aortic lesions were evaluated. Four-dimensional mapping of velocity and wall shear stress were obtained, depicting different patterns of flow (laminar, turbulent, stenosis-like) and local alterations of parietal stress in-stent and along the native aorta. A computational method using a combined approach with MRI appears feasible and seems promising to provide detailed functional analysis of thoracic aorta after stent-graft implantation. • Functional vascular imaging of the thoracic aorta offers new diagnostic opportunities • CFD can model vascular haemodynamics for clinical aortic problems • Combining CFD with MRI offers patient specific method of aortic analysis • Haemodynamic analysis of stent-grafts could improve clinical management and follow-up.

  15. Structure of the Elastin-Contractile Units in the Thoracic Aorta and How Genes That Cause Thoracic Aortic Aneurysms and Dissections Disrupt This Structure.

    Science.gov (United States)

    Karimi, Ashkan; Milewicz, Dianna M

    2016-01-01

    The medial layer of the aorta confers elasticity and strength to the aortic wall and is composed of alternating layers of smooth muscle cells (SMCs) and elastic fibres. The SMC elastin-contractile unit is a structural unit that links the elastin fibres to the SMCs and is characterized by the following: (1) layers of elastin fibres that are surrounded by microfibrils; (2) microfibrils that bind to the integrin receptors in focal adhesions on the cell surface of the SMCs; and (3) SMC contractile filaments that are linked to the focal adhesions on the inner side of the membrane. The genes that are altered to cause thoracic aortic aneurysms and aortic dissections encode proteins involved in the structure or function of the SMC elastin-contractile unit. Included in this gene list are the genes encoding protein that are structural components of elastin fibres and microfibrils, FBN1, MFAP5, ELN, and FBLN4. Also included are genes that encode structural proteins in the SMC contractile unit, including ACTA2, which encodes SMC-specific α-actin and MYH11, which encodes SMC-specific myosin heavy chain, along with MYLK and PRKG1, which encode kinases that control SMC contraction. Finally, mutations in the gene encoding the protein linking integrin receptors to the contractile filaments, FLNA, also predispose to thoracic aortic disease. Thus, these data suggest that functional SMC elastin-contractile units are important for maintaining the structural integrity of the aorta. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. 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.

  18. 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.

  19. Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora? Intramammary lymph node sentinel metastasis without metastasis in axilla: axillary lymph node dissection or conservative surgery?

    Directory of Open Access Journals (Sweden)

    René Aloisio da Costa Vieira

    2012-01-01

    Full Text Available A pesquisa do linfonodo sentinela constitui tratamento padrão para pacientes portadoras de câncer de mama e axila clinicamente negativa. A presença do linfonodo sentinela (LS extra-axilar e intramamário (IM ocorre em até 2,6% dos casos, e na presença do LS IM metastático, a positividade axilar pode alcançar até 81%. Na associação do LS IM metastático ao LS axilar não metastático, não há conduta padronizada, visto um limitado número de casos descritos. Adicionamos dois casos à literatura, observando, em um deles, a presença de doença metastática axilar na linfadenectomia complementar. A utilização de nomograma demonstrou que o risco de doença metastática axilar era inferior a 10%, e a adição destes casos à literatura mostrou que, nesta situação, a taxa de doença metastática axilar é de 6,25%. Discutimos os prós e contras da linfadenectomia axilar complementar nesta situação.The sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM sentinel lymph node (SLN occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.

  20. Analysis of the thoracic aorta using a semi-automated post processing tool

    International Nuclear Information System (INIS)

    Entezari, Pegah; Kino, Aya; Honarmand, Amir R.; Galizia, Mauricio S.; Yang, Yan; Collins, Jeremy; Yaghmai, Vahid; Carr, James C.

    2013-01-01

    Objective: To evaluates a semi-automated method for Thoracic Aortic Aneurysm (TAA) measurement using ECG-gated Dual Source CT Angiogram (DSCTA). Methods: This retrospective HIPAA compliant study was approved by our IRB. Transaxial maximum diameters of outer wall to outer wall were studied in fifty patients at seven anatomic locations of the thoracic aorta: annulus, sinus, sinotubular junction (STJ), mid ascending aorta (MAA) at the level of right pulmonary artery, proximal aortic arch (PROX) immediately proximal to innominate artery, distal aortic arch (DIST) immediately distal to left subclavian artery, and descending aorta (DESC) at the level of diaphragm. Measurements were performed using a manual method and semi-automated software. All readers repeated their measurements. Inter-method, intra-observer and inter-observer agreements were evaluated according to intraclass correlation coefficient (ICC) and Bland–Altman plot. The number of cases with manual contouring or center line adjustment for the semi-automated method and also the post-processing time for each method were recorded. Results: The mean difference between semi-automated and manual methods was less than 1.3 mm at all seven points. Strong inter-method, inter-observer and intra-observer agreement was recorded at all levels (ICC ≥ 0.9). The maximum rate of manual adjustment of center line and contour was at the level of annulus. The average time for manual post-processing of the aorta was 19 ± 0.3 min, while it took 8.26 ± 2.1 min to do the measurements with the semi-automated tool (Vitrea version 6.0.0.1 software). The center line was edited manually at all levels, with most corrections at the level of annulus (60%), while the contour was adjusted at all levels with highest and lowest number of corrections at the levels of annulus and DESC (75% and 0.07% of the cases), respectively. Conclusion: Compared to the commonly used manual method, semi-automated measurement of vessel dimensions is

  1. Abdominal wall fat pad biopsy

    Science.gov (United States)

    Amyloidosis - abdominal wall fat pad biopsy; Abdominal wall biopsy; Biopsy - abdominal wall fat pad ... is the most common method of taking an abdominal wall fat pad biopsy . The health care provider cleans the ...

  2. Case of congenital absence of the left pericardium. In special reference to diagnostic significance of echocardiography and thoracic computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Toda, Genji; Katayama, Tomoyuki; Honda, Yukiharu; Eguchi, Keisuke [Nagasaki City Hospital (Japan); Mori, Hideki; Oku, Yasuhiko

    1983-11-01

    In a 24-year-old female patient with complete congenital absence of the left pericardium, M mode echocardiography revealed that excessive motility of the left posterior ventricular wall observed in a supine position became more conspicuous in the left lateral position. In this postural position, a systolic notch in the posterior left ventricular wall, which was attributed to a large displacement of the heart to the left posteriorly in the early systolic phase, was observed. Thoracic CT visualized an extensive defect of the left pericardium even in a supine position by combination of artificial pneumothorax. In the left lateral position, CT clearly visualized the remaining end of the left pericardium in defect on 2 slices, front and back.

  3. 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)

  4. Liquid Wall Chambers

    Energy Technology Data Exchange (ETDEWEB)

    Meier, W R

    2011-02-24

    The key feature of liquid wall chambers is the use of a renewable liquid layer to protect chamber structures from target emissions. Two primary options have been proposed and studied: wetted wall chambers and thick liquid wall (TLW) chambers. With wetted wall designs, a thin layer of liquid shields the structural first wall from short ranged target emissions (x-rays, ions and debris) but not neutrons. Various schemes have been proposed to establish and renew the liquid layer between shots including flow-guiding porous fabrics (e.g., Osiris, HIBALL), porous rigid structures (Prometheus) and thin film flows (KOYO). The thin liquid layer can be the tritium breeding material (e.g., flibe, PbLi, or Li) or another liquid metal such as Pb. TLWs use liquid jets injected by stationary or oscillating nozzles to form a neutronically thick layer (typically with an effective thickness of {approx}50 cm) of liquid between the target and first structural wall. In addition to absorbing short ranged emissions, the thick liquid layer degrades the neutron flux and energy reaching the first wall, typically by {approx}10 x x, so that steel walls can survive for the life of the plant ({approx}30-60 yrs). The thick liquid serves as the primary coolant and tritium breeding material (most recent designs use flibe, but the earliest concepts used Li). In essence, the TLW places the fusion blanket inside the first wall instead of behind the first wall.

  5. 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.

  6. 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.

  7. 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

  8. 3D printing-assisted preoperative plan of pedicle screw placement for middle-upper thoracic trauma: a cohort study.

    Science.gov (United States)

    Xu, Wei; Zhang, Xuming; Ke, Tie; Cai, Hongru; Gao, Xiang

    2017-08-11

    This study aimed to evaluate the application of 3D printing in assisting preoperative plan of pedicle screw placement for treating middle-upper thoracic trauma. A preoperative plan was implemented in seven patients suffering from middle-upper thoracic (T3-T7) trauma between March 2013 and February 2016. In the 3D printing models, entry points of 56 pedicle screws (Magerl method) and 4 important parameters of the pedicle screws were measured, including optimal diameter (ϕ, mm), length (L, mm), inclined angle (α), head-tilting angle (+β), and tail-tilting angle (-β). In the surgery, bare-hands fixation of pedicle screws was performed using 3D printing models and the measured parameters as guidance. A total of seven patients were enrolled, including five men and two women, with the age of 21-62 years (mean age of 37.7 years). The position of the pedicle screw was evaluated postoperatively using a computerized tomography scan. Totally, 56 pedicle screws were placed, including 33 pieces of level 0, 18 pieces of level 1, 4 pieces of level 2 (pierced lateral wall), and 1 piece of level 3 (pierced lateral wall, no adverse consequences), with a fine rate of 91.0%. 3D printing technique is an intuitive and effective assistive technology to pedicle screw fixation for treating middle-upper thoracic vertebrae, which improve the accuracy of bare-hands screw placement and reduce empirical errors. The trial was approved by the Ethics Committee of the Fujian Provincial Hospital. It was registered on March 1st, 2013, and the registration number was K2013-03-001.

  9. Comparison thoracic epidural and intercostal block to improve ventilation parameters and reduce pain in patients with multiple rib fractures.

    Science.gov (United States)

    Hashemzadeh, Shahryar; Hashemzadeh, Khosrov; Hosseinzadeh, Hamzeh; Aligholipour Maleki, Raheleh; Golzari, Samad E J; Golzari, Samad

    2011-01-01

    Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may require such high dose that they produce respiratory depression, especially in elderly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or intercostal block with 0.25% bupivacaine. The patients were assessed through ICU and hospital stay length, ventilation function tests. Pain score among the patients was measured with verbal rating scale, before and after administration of the analgesia. We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P pain at rest and pain caused by coughing and deep breathing in group A compared group B... ICU and hospital stay markedly reduced in Group A. thoracic epidural analgesia is superior to intercostals block regarding pain relief of rib fractures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.

  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. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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

  16. Factors influencing the mechanical behaviour of healthy human descending thoracic aorta

    International Nuclear Information System (INIS)

    Guinea, Gustavo V; Atienza, José M; Rojo, Francisco J; Yiqun, Li; Claes, Els; Elices, Manuel; García-Herrera, Claudio M; Goicolea, José M; García-Montero, Carlos; Burgos, Raúl L; Goicolea, Francisco J

    2010-01-01

    In recent times, significant effort has been made to understand the mechanical behaviour of the arterial wall and how it is affected by the different vascular pathologies. However, to be able to interpret the results correctly, it is essential that the influence of other factors, such as aging or anisotropy, be understood. Knowledge of mechanical behaviour of the aorta has been customarily constrained by lack of data on fresh aortic tissue, especially from healthy young individuals. In addition, information regarding the point of rupture is also very limited. In this study, the mechanical behaviour of the descending thoracic aorta of 28 organ donors with no apparent disease, whose ages vary from 17 to 60 years, is evaluated. Tensile tests up to rupture are carried out to evaluate the influence of age and wall anisotropy. Results reveal that the tensile strength and stretch at failure of healthy descending aortas show a significant reduction with age, falling abruptly beyond the age of 30. This fact places age as a key factor when mechanical properties of descending aorta are considered

  17. Descending aortic injury by a thoracic pedicle screw during posterior reconstructive surgery: a case report.

    Science.gov (United States)

    Watanabe, Kei; Yamazaki, Akiyoshi; Hirano, Toru; Izumi, Tomohiro; Sano, Atsuki; Morita, Osamu; Kikuchi, Ren; Ito, Takui

    2010-09-15

    Case report. To describe an iatrogenic aortic injury by pedicle screw instrumentation during posterior reconstructive surgery of spinal deformity. Iatrogenic major vascular injuries during anterior instrumentation procedures have been reported by several authors, but there have been few reports regarding iatrogenic major vascular injuries during posterior instrumentation procedures. A 57-year-old woman with thoracolumbar kyphosis due to osteoporotic T12 vertebral fracture underwent posterior correction and fusion (T10-L2), using segmental pedicle screw construct concomitant with T12 pedicle subtraction osteotomy. Postoperative routine plain radiographs and computed tomography myelography demonstrated a misplaced left T10 pedicle screw, which was in contact with the posteromedial aspect of the thoracic aorta, and suspected penetration of the aortic wall. The patient underwent removal of the pedicle screw, and repair of the penetrated aortic wall through a simultaneous anterior-posterior approach. The patient tolerated the procedure well without neurologic sequelae, and was discharged several days after removal of a left tube thoracostomy. Plain radiographs demonstrated solid fusion at the osteotomy site and no loosening of hardware. Preoperative neurologic symptoms improved completely at 18-months follow-up. Use of pedicle screw instrumentation has the potential to cause major vascular injury during posterior spinal surgery, and measures to prevent this complication must be taken. Timely diagnosis and treatment are essential to prevent both early and delayed complications and death.

  18. Wall Finishes; Carpentry: 901895.

    Science.gov (United States)

    Dade County Public Schools, Miami, FL.

    The course outline is designed to provide instruction in selecting, preparing, and installing wall finishing materials. Prerequisites for the course include mastery of building construction plans, foundations and walls, and basic mathematics. Intended for use in grades 11 and 12, the course contains five blocks of study totaling 135 hours of…

  19. Wall Construction; Carpentry: 901892.

    Science.gov (United States)

    Dade County Public Schools, Miami, FL.

    The curriculum guide outlines a course designed to provide instruction in floor and wall layout, and in the diverse methods and construction of walls. Upon completion of this course the students should have acquired a knowledge of construction plans and structural foundations in addition to a basic knowledge of mathematics. The course consists of…

  20. International Divider Walls

    NARCIS (Netherlands)

    Kruis, A.; Sneller, Lineke

    2013-01-01

    The subject of this teaching case is the Enterprise Resource Planning (ERP) system implementation at International Divider Walls, the world market leader in design, production, and sales of divider walls. The implementation in one of the divisions of this multinational company had been successful,

  1. Supersymmetric domain walls

    NARCIS (Netherlands)

    Bergshoeff, Eric A.; Kleinschmidt, Axel; Riccioni, Fabio

    2012-01-01

    We classify the half-supersymmetric "domain walls," i.e., branes of codimension one, in toroidally compactified IIA/IIB string theory and show to which gauged supergravity theory each of these domain walls belong. We use as input the requirement of supersymmetric Wess-Zumino terms, the properties of

  2. 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.

  3. An unusual case of grass inflorescence aspiration presenting as a chest wall tumour

    Energy Technology Data Exchange (ETDEWEB)

    Karagoez, Beguel; Koeksal, Yavuz; Varan, Ali; Bueyuekpamukcu, Muenevver [Hacettepe University, Department of Paediatric Oncology, Institute of Oncology, Ankara (Turkey); Haliloglu, Mithat [Hacettepe University, Department of Radiology, Faculty of Medicine, Ankara (Turkey); Ekinci, Saniye [Hacettepe University, Department of Paediatric Surgery, Faculty of Medicine, Ankara (Turkey)

    2006-05-15

    A 9-year-old boy was referred to the Oncology Department because of a thoracic soft-tissue mass thought to be a chest wall tumour. He had a history of grass inflorescence (Hordeum murinum) aspiration 2 weeks prior to this admission. On physical examination a tender soft-tissue mass under the right scapula and diminished breath sounds from the right lower lobe were detected. Thoracic CT confirmed soft-tissue swelling of the right posterior chest wall. There was a hypodense area within the soft-tissue mass suggesting a foreign body and also focal consolidation of the right lower lobe adjacent to the soft-tissue swelling. We report here unique CT findings of grass inflorescence aspiration before and after its migration through the airways. (orig.)

  4. An unusual case of grass inflorescence aspiration presenting as a chest wall tumour

    International Nuclear Information System (INIS)

    Karagoez, Beguel; Koeksal, Yavuz; Varan, Ali; Bueyuekpamukcu, Muenevver; Haliloglu, Mithat; Ekinci, Saniye

    2006-01-01

    A 9-year-old boy was referred to the Oncology Department because of a thoracic soft-tissue mass thought to be a chest wall tumour. He had a history of grass inflorescence (Hordeum murinum) aspiration 2 weeks prior to this admission. On physical examination a tender soft-tissue mass under the right scapula and diminished breath sounds from the right lower lobe were detected. Thoracic CT confirmed soft-tissue swelling of the right posterior chest wall. There was a hypodense area within the soft-tissue mass suggesting a foreign body and also focal consolidation of the right lower lobe adjacent to the soft-tissue swelling. We report here unique CT findings of grass inflorescence aspiration before and after its migration through the airways. (orig.)

  5. 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.

  6. 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 ...

  7. 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 ...

  8. 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

  9. 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.

  10. 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 ...

  11. 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

  12. 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

  13. 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

  14. 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)

  15. 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

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. “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 ...

  3. 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

  4. 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 ...

  5. 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.

  6. 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

  7. Bilateral Multifocal Hamartoma of the Chest Wall in an Infant

    Science.gov (United States)

    Yilmaz, Erdem; Erol, Oguz Bulent; Pekcan, Melih; Gundogdu, Gokcen; Bilgic, Bilge; Gun, Feryal; Yekeler, Ensar

    2015-01-01

    Summary Background Hamartoma of the thoracic wall is a rare benign tumor that occurs in infancy and can be mistaken for a malignancy due to its clinical and imaging features. Hamartomas are extrapleural soft tissue lesions that cause rib expansion and destruction and appear on imaging as cystic areas with fluid levels and calcification. They can cause scoliosis, pressure on the neighboring lung parenchyma and mediastinal displacement. While conservative treatment is recommended in asymptomatic cases, growing lesions require surgical excision. Case Report In this report, we present the imaging findings in a 3-month-old infant that presented with a firm swelling in the chest wall and was histopathologically confirmed to have a bilateral multifocal hamartoma. Conclusions Radiological imaging methods are important for accurate diagnosis of this very rare condition that can be confused with a malignancy. PMID:26082822

  8. Solar Walls in tsbi3

    DEFF Research Database (Denmark)

    Wittchen, Kim Bjarne

    tsbi3 is a user-friendly and flexible computer program, which provides support to the design team in the analysis of the indoor climate and the energy performance of buildings. The solar wall module gives tsbi3 the capability of simulating solar walls and their interaction with the building....... This version, C, of tsbi3 is capable of simulating five types of solar walls say: mass-walls, Trombe-walls, double Trombe-walls, internally ventilated walls and solar walls for preheating ventilation air. The user's guide gives a description of the capabilities and how to simulate solar walls in tsbi3....

  9. 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.

  10. 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

  11. Health-related quality of life in children with thoracic insufficiency syndrome.

    Science.gov (United States)

    Vitale, Michael G; Matsumoto, Hiroko; Roye, David P; Gomez, Jaime A; Betz, Randal R; Emans, John B; Skaggs, David L; Smith, John T; Song, Kit M; Campbell, Robert M

    2008-03-01

    The traditional techniques to treat thoracic insufficiency syndrome (TIS) are not able to stabilize or improve chest wall size or pulmonary function while allowing spine growth. To this end, vertical expandable prosthetic titanium rib (VEPTR) was specifically designed to treat TIS by allowing growth of the thoracic cavity and control/correction of spine deformity. The purpose of this study was to determine quality of life (QOL) of children with TIS and its impact on their parents before and after implantation of the VEPTR and also compare these results to those of healthy children. As part of the original multicenter evaluation of the VEPTR, a Child Health Questionnaire (CHQ) was collected preoperatively on 45 patients who were subsequently treated with expansion thoracoplasty using the VEPTR. The average age was 8.2 +/- 2.6 years, and the parent form of the CHQ was filled out by the primary caretaker. Patients were divided into 3 diagnostic categories: rib fusion (n = 15), hypoplastic thorax syndromes (n = 17), and progressive spinal deformity (n = 13). There were significant differences between the study patients and healthy children in physical domains. Compared with parents of healthy children, parents of children with TIS experienced more limitations on their time and emotional lives due to their children's health problems. There were no significant differences in CHQ before and after the surgery except for a significant decrease in the self-esteem among a subgroup of patients with hypoplastic thorax syndromes. There were no significant differences in postoperative QOL between patients who had VEPTR-related complications and patients who did not have the complications. The children with TIS had lower physical scores and higher caregiver burden scores than healthy children. However, the scores in psychosocial domains were similar to those in healthy children. Our study demonstrated that QOL of children and burden of care in their parents remained the same after

  12. Computed tomographic-guided iodine-125 interstitial implants for malignant thoracic tumors

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Qiming [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China); The Department of Radiology, Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan Bei Road, Quanzhou 362000 (China); Chen, Jin; Chen, Qunlin [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China); Lai, Qingquan; Cai, Siqing [The Department of Radiology, Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan Bei Road, Quanzhou 362000 (China); Luo, Kaidong [The Department of Radiology, Longyan Hosptial of Traditional Chinese Medical, 59 Longteng Middle Road, Longyan 364000 (China); Lin, Zhengyu, E-mail: linsinlan@yahoo.com.cn [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China)

    2013-11-01

    Purpose: To evaluate the feasibility and efficacy of percutaneous interstitial brachytherapy using iodine-125 ({sup 125}I) radioactive seeds under computed tomographic (CT) guidance for malignant thoracic tumors. Materials and methods: Forty-one patients (34 males, 7 females; 18–90 years; mean, 63.7 years) with 77 lesions (3 in the mediastinum, 7 in the chest wall, 67 in the lung) underwent percutaneous interstitial implantation of {sup 125}I radioactive seeds under CT guidance. A treatment planning system (TPS) was employed to calculate the number and distribution of seeds preoperatively. An 18-G needle was inserted into the lesions under CT guidance and send the seeds according to TPS. Two patients with mediastinal lesions undergoing seed implantation received an artificial pneumothorax. One patient with lung carcinoma adjacent to the anterior mediastinum underwent seed implantation through the sternum. Follow-up CT was done every 2 months postoperatively. Results: The procedure was successful in all patients. No major procedure-associated death occurred. The mean duration of follow-up was 19.4 ± 1.3 months (3–49 months). A complete response (CR) was seen in 49 lesions (63.6%), partial response (PR) in 9 lesions (11.7%), stable disease (SD) in 12 lesions (12.8%), and progressive disease (PD) in 7 lesions (7.4%). The overall response rate (CR + PR) was 75.3%; the local control rate (CR + PR + SD) was 90.9%. The 1-, 2- and 3-year progression-free rates for local tumors were 91%, 88% and 88%, respectively. The 1-, 2- and 3-year survival rates were 87%, 74% and 68%, respectively. Conclusion: Implantation of CT-guided {sup 125}I seeds is feasible and effective for patients with malignant thoracic tumors.

  13. Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature.

    Science.gov (United States)

    Uno, Kaname; Koike, Tomoyuki; Takahashi, Seiichi; Komazawa, Daisuke; Shimosegawa, Tooru

    2017-10-01

    Aorto-esophageal fistula (AEF) is a rare and lethal entity, and the difficulty of making diagnosis of AEF is well-known. As promising results in the short-term effectiveness of thoracic endovascular aortic repair (TEVAR) promote its usage, the occurrence of AEF after TEVAR (post-TEVAR AEF) increases as one of the major complications. Therefore, we provide a review concerning the management strategy of post-TEVAR AEF. Although its representative symptom was reported as the triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis, the symptom-free interval between sentinel hemorrhage and massive exsanguination is unpredictable. However, the physiological condition represents a surgical contraindication. Accordingly, early diagnosis is important, but either CT or esophago-gastro-duodenoscopy rarely depicts a typical image. The formation of post-TEVAR AEF might be associated with the infection of micro-organisms, which is uncontrollable with anti-biotic administration. The current first-line strategy is combination therapy as follows, (1) to control bleeding by TEVAR in the urgent phase, and (2) radical debridement and aortic/esophageal re-construction in the semi-urgent phase. In view of the high mortality and morbidity rate, it is proposed that the choice in treatment strategies might be affected by patient`s condition, size of the wall defects and the etiology of AEF. Practically, we should keep in mind the importance of making an early diagnosis and, once a suspicious symptom has occurred in a patient with a history of TEVAR, the existence of post-TEVAR AEF should be suspected. A prospective registry together with more developed technologies will be needed to establish a future strategy.

  14. Case of sudden death following rupture of thoracic aortic aneurysm during “a manual therapy” procedure in the spinal area

    Directory of Open Access Journals (Sweden)

    Aleksandra Kaczorowska

    2015-03-01

    Full Text Available The reported case concerns the rupture of an aneurysm located in the descending part of the thoracic aorta during the procedure of the so-called “spinal adjustment” performed by a chiropractor. A 45-year-old patient with no significant medical history of cardiovascular diseases visited, along with his wife, one of “manual therapy” practices because of back pain. During the procedure, the patient suddenly lost consciousness. Despite cardiopulmonary resuscitation and emergency assistance given by an ambulance team, the patient died. An autopsy revealed that the cause of death was increasing cardiorespiratory failure secondary to bleeding into the lumen of the left pleural cavity following the rupture of pathologically altered thoracic aortic wall.

  15. An unusual case of thoracic ectopia cordis in a Toggenburg Goat and its three-dimensional images constructed with X-ray computed tomography.

    Science.gov (United States)

    Lai, Jyh-Mirn; Wu, Jui-Te; Yang, Wei-Cheng; Chao, Ming-Hsin; Nagahata, Hajime

    2016-05-01

    A two-day-old female Toggenburg goat with thoracic ectopia cordis (EC) was diagnosed via radiography and computed tomography. The goat was born with EC, defects of the sternum and a supra-umbilical abdominal wall, but without the presence of Cantrell's syndrome. Necropsy and histopathological findings indicated the affected kid had malformation of the heart with an enlarged left ventricle. The findings showed the heart (9 x 5 x 5 cm) stayed outside the thorax, and was covered by a semitransparent membrane. This report is the first to describe a case of thoracic EC in a goat whose sternum was not developed fully and was not connected to the ribs. It is also the first paper to describe three-dimensional images of this condition constructed from computed tomography scans.

  16. 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.

  17. Randomized Control Trial: Evaluating Aluminum-Based Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for Treatment of Stage 0, I, and II Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Watson, Linda C., E-mail: Linda.watson@albertahealthservices.ca [Department of Interdisciplinary Practice, Community Oncology, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Gies, Donna [Department of Radiation Oncology Nursing, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Thompson, Emmanuel [Department of Mathematics and Statistics, University of Calgary Faculty of Science, Calgary, AB (Canada); Thomas, Bejoy [Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Department of Psychosocial Oncology, University of Calgary Faculty of Medicine, Calgary, AB (Canada)

    2012-05-01

    Purpose: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. Methods: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy's questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. Results: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Conclusions: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from

  18. Randomized Control Trial: Evaluating Aluminum-Based Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for Treatment of Stage 0, I, and II Breast Cancer

    International Nuclear Information System (INIS)

    Watson, Linda C.; Gies, Donna; Thompson, Emmanuel; Thomas, Bejoy

    2012-01-01

    Purpose: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. Methods: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy’s questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. Results: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Conclusions: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from using

  19. Evaluation of thoracic abnormalities on 64-row multi-detector row CT: Comparison between axial images versus coronal reformations

    Energy Technology Data Exchange (ETDEWEB)

    Nishino, Mizuki [Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 (United States)]. E-mail: mnishino@bidmc.harvard.edu; Kubo, Takeshi [Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 (United States); Kataoka, Milliam L. [Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 (United States); Gautam, Shiva [Department of General Clinical Research Center and Biometrics, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 (United States); Raptopoulos, Vassilios [Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 (United States); Hatabu, Hiroto [Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 (United States)

    2006-07-15

    Purpose: To evaluate the capability of coronal reformations of chest on 64-row MDCT in demonstrating thoracic abnormalities in comparison with axial images. Materials and methods: Thirty-eight consecutive patients who underwent pulmonary CTA on 64-row MDCT were retrospectively studied with institutional review board (IRB) approval. Contiguous 2 mm axial and coronal images were reviewed independently with a 1-week interval, by consensus reading of two board-certified radiologists. Overall image quality was graded using a five-point scale. Abnormalities in mediastinum, hilum, pulmonary vessels, aorta, heart, esophagus, pleura, chest wall, and lung parenchyma were scored: 1 = definitely absent, 2 = probably absent, 3 = equivocal, 4 probably present, 5 = definitely present. Scores on axial and coronal images were compared using weighted {kappa} analysis. Results: Overall image quality was not different with statistical relevance between axial and coronal images (mean/median scores; 3.7/4; 3.6/4, respectively, P = 0.286, Wilcoxon signed-rank test). Significant agreement was observed between axial and coronal scores (mean weighted {kappa}, 0.661; range, 0.362-1). Agreement was almost perfect for pneumothorax, lung and pleural mass, effusion and consolidation (weighted {kappa} = 0.833-1); substantial for pulmonary embolism, trachea, mediastinal lymphadenopathy and non-skeletal chest wall lesion, heart, esophagus, and emphysema (weighted {kappa}, 0.618-0.799); moderate for atelectasis, mediastinum, hilar nodes, aorta, other lung lesions, skeletal chest wall lesions, linear scarring, nodules >1 cm, pulmonary artery abnormalities and pleural thickening (weighted {kappa}, 0.405-0.592); and fair for nodules <1 cm (weighted {kappa} = 0.362). Conclusion: Coronal reformations on 64-row MDCT had substantial agreement with axial images for evaluation of the majority of thoracic abnormalities.

  20. Evaluation of thoracic abnormalities on 64-row multi-detector row CT: Comparison between axial images versus coronal reformations

    International Nuclear Information System (INIS)

    Nishino, Mizuki; Kubo, Takeshi; Kataoka, Milliam L.; Gautam, Shiva; Raptopoulos, Vassilios; Hatabu, Hiroto

    2006-01-01

    Purpose: To evaluate the capability of coronal reformations of chest on 64-row MDCT in demonstrating thoracic abnormalities in comparison with axial images. Materials and methods: Thirty-eight consecutive patients who underwent pulmonary CTA on 64-row MDCT were retrospectively studied with institutional review board (IRB) approval. Contiguous 2 mm axial and coronal images were reviewed independently with a 1-week interval, by consensus reading of two board-certified radiologists. Overall image quality was graded using a five-point scale. Abnormalities in mediastinum, hilum, pulmonary vessels, aorta, heart, esophagus, pleura, chest wall, and lung parenchyma were scored: 1 = definitely absent, 2 = probably absent, 3 = equivocal, 4 probably present, 5 = definitely present. Scores on axial and coronal images were compared using weighted κ analysis. Results: Overall image quality was not different with statistical relevance between axial and coronal images (mean/median scores; 3.7/4; 3.6/4, respectively, P = 0.286, Wilcoxon signed-rank test). Significant agreement was observed between axial and coronal scores (mean weighted κ, 0.661; range, 0.362-1). Agreement was almost perfect for pneumothorax, lung and pleural mass, effusion and consolidation (weighted κ = 0.833-1); substantial for pulmonary embolism, trachea, mediastinal lymphadenopathy and non-skeletal chest wall lesion, heart, esophagus, and emphysema (weighted κ, 0.618-0.799); moderate for atelectasis, mediastinum, hilar nodes, aorta, other lung lesions, skeletal chest wall lesions, linear scarring, nodules >1 cm, pulmonary artery abnormalities and pleural thickening (weighted κ, 0.405-0.592); and fair for nodules <1 cm (weighted κ = 0.362). Conclusion: Coronal reformations on 64-row MDCT had substantial agreement with axial images for evaluation of the majority of thoracic abnormalities

  1. Effect of electrocautery on endothelial integrity of the internal thoracic artery: ultrastructural analysis with transmission electron microscopy.

    Science.gov (United States)

    Onan, Burak; Yeniterzi, Mehmet; Onan, Ismihan Selen; Ersoy, Burak; Gonca, Suheyla; Gelenli, Elif; Solakoglu, Seyhun; Bakir, Ihsan

    2014-10-01

    The internal thoracic artery (ITA) is typically harvested from the chest wall by means of conventional electrocautery. We investigated the effects of electrocautery on endothelial-cell and vessel-wall morphology at the ultrastructural level during ITA harvesting. Internal thoracic artery specimens from 20 patients who underwent elective coronary artery bypass grafting were investigated in 2 groups. The ITA grafts were sharply dissected with use of a scalpel and clips in the control group (n=10) and were harvested by means of electrocautery in the study group (n=10). Each sample was evaluated for intimal, elastic-tissue, muscular-layer, and adventitial changes. Free flow was measured intraoperatively. Light microscopic examinations were performed after hematoxylin-eosin and Masson's trichrome staining. Transmission electron microscopy was used to evaluate ultrastructural changes in the endothelial cells and vessel walls of each ITA. In the sharp-dissection group, the endothelial surfaces were lined with normal amounts of original endothelium, endothelial cells were distinctly attached to the basal lamina, cytoplasmic organelles were evident, and intercellular junctional complexes were intact. Conversely, in the electrocautery group, the morphologic integrity of endothelial cells was distorted, with some cell separations and splits, contracted cells, numerous large cytoplasmic vacuoles, and no visible cytoplasmic organelles. The subendothelial layer exhibited disintegration. Free ITA flow was higher in the sharp-dissection group (P=0.04). The integrity of endothelial cells can be better preserved when the ITA is mobilized by means of sharp dissection, rather than solely by electrocautery; we recommend a combined approach.

  2. Chest wall – underappreciated structure in sonography. Part II: Non-cancerous lesions

    Directory of Open Access Journals (Sweden)

    Andrzej Smereczyński

    2017-12-01

    Full Text Available The chest wall is a vast and complex structure, hence the wide range of pathological conditions that may affect it. The aim of this publication is to discuss the usefulness of ultrasound for the diagnosis of benign lesions involving the thoracic wall. The most commonly encountered conditions include sternal and costal injuries and thoracic lymphadenopathy. Ultrasound is very efficient in identifying the etiology of pain experienced in the anterior chest wall following CPR interventions. Both available literature and the authors’ own experience prompt us to propose ultrasound evaluation as the first step in the diagnostic workup of chest trauma, as it permits far superior visualization of the examined structures compared with conventional radiography. Sonographic evaluation allows correct diagnosis in the case of various costal and chondral defects suspicious for cancer. It also facilitates diagnosis of such conditions as degenerative lesions, subluxation of sternoclavicular joints (SCJs and inflammatory lesions of various etiology and location. US may be used as the diagnostic modality of choice in conditions following thoracoscopy or thoracotomy. It may also visualize the fairly common sternal wound infection, including bone inflammation. Slipping rib syndrome, relatively little known among clinicians, has also been discussed in the study. A whole gamut of benign lesions of thoracic soft tissues, such as enlarged lymph nodes, torn muscles, hematomas, abscesses, fissures, scars or foreign bodies, are all easily identified on ultrasound, just like in other superficially located organs.

  3. 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.

  4. Plasma-wall interactions

    International Nuclear Information System (INIS)

    Behrisch, Rainer

    1978-01-01

    The plasma wall interactions for two extreme cases, the 'vacuum model' and the 'cold gas blanket' are outlined. As a first step for understanding the plasma wall interactions the elementary interaction processes at the first wall are identified. These are energetic ion and neutral particle trapping and release, ion and neutral backscattering, ion sputtering, desorption by ions, photons and electrons and evaporation. These processes have only recently been started to be investigated in the parameter range of interest for fusion research. The few measured data and their extrapolation into regions not yet investigated are reviewed

  5. 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

  6. Bioactive nanocomposite for chest-wall replacement: Cellular response in a murine model.

    Science.gov (United States)

    Jungraithmayr, Wolfgang; Laube, Isabelle; Hild, Nora; Stark, Wendelin J; Mihic-Probst, Daniela; Weder, Walter; Buschmann, Johanna

    2014-07-01

    Chest-wall invading malignancies usually necessitate the resection of the respective part of the thoracic wall. Gore-Tex® is the material of choice that is traditionally used to repair thoracic defects. This material is well accepted by the recipient; however, though not rejected, it is an inert material and behaves like a 'foreign body' within the thoracic wall. By contrast, there are materials that have the potential to physiologically integrate into the host, and these materials are currently under in vitro and also in vivo investigation. These materials offer a gradual but complete biodegradation over time, and severe adverse inflammatory responses can be avoided. Here, we present a novel material that is a biodegradable nanocomposite based on poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles in comparison to the traditionally employed Gore-Tex® being the standard for chest-wall replacement. On a mouse model of thoracic wall resection, that resembles the technique and localization applied in humans, poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles and Gore-Tex® were implanted subcutaneously and additionally tested in a separate series as a chest-wall graft. After 1, 2, 4 and 8 weeks cell infiltration into the respective materials, inflammatory reactions as well as neo-vascularization (endothelial cells) were determined in six different zones. While Gore-Tex® allowed for cell infiltration only at the outer surface, electrospun poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles were completely penetrated by infiltrating cells. These cells were composed mainly by macrophages, with only 4% of giant cells and lymphocytes. Total macrophage count increased by time while the number of IL1-β-expressing macrophages decreased, indicating a protective state towards the graft. As such, poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles seem to develop ideal

  7. 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)

  8. 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

  9. Advanced walling systems

    CSIR Research Space (South Africa)

    De Villiers, A

    2010-01-01

    Full Text Available The question addressed by this chapter is: How should advanced walling systems be planned, designed, built, refurbished, and end their useful lives, to classify as smart, sustainable, green or eco-building environments?...

  10. Fusion: first wall problems

    International Nuclear Information System (INIS)

    Behrisch, R.

    1976-01-01

    Some of the relevant elementary atomic processes which are expected to be of significance to the first wall of a fusion reactor are reviewed. Up to the present, most investigations have been performed at relatively high ion energies, typically E greater than 5 keV, and even in this range the available data are very poor. If the plasma wall interaction takes place at energies of E greater than 1 keV the impurity introduction and first wall erosion which will take place predominantly by sputtering, will be large and may severely limit the burning time of the plasma. The wall bombardment and surface erosion will presumably not decrease substantially by introducing a divertor. The erosion can only be kept low if the energy of the bombarding ions and neutrals can be kept below the threshold for sputtering of 1 to 10 eV. 93 refs

  11. Plasma-wall interaction

    International Nuclear Information System (INIS)

    Reichle, R.

    2004-01-01

    This document gathers the 43 slides presented in the framework of the week long lecture 'hot plasmas 2004' and dedicated to plasma-wall interaction in a tokamak. This document is divided into 4 parts: 1) thermal load on the wall, power extraction and particle recovery, 2) basic edge plasma physics, 3) processes that drive the plasma-solid interaction, and 4) material conditioning (surface treatment...) for ITER

  12. Dynamic wall demonstration project

    Energy Technology Data Exchange (ETDEWEB)

    Nakatsui, L.; Mayhew, W.

    1990-12-01

    The dynamic wall concept is a ventilation strategy that can be applied to a single family dwelling. With suitable construction, outside air can be admitted through the exterior walls of the house to the interior space to function as ventilation air. The construction and performance monitoring of a demonstration house built to test the dynamic wall concept in Sherwood Park, Alberta, is described. The project had the objectives of demonstrating and assessing the construction methods; determining the cost-effectiveness of the concept in Alberta; analyzing the operation of the dynamic wall system; and determining how other components and systems in the house interact with the dynamic wall. The exterior wall construction consisted of vinyl siding, spun-bonded polyolefin-backed (SBPO) rigid fiberglass sheathing, 38 mm by 89 mm framing, fiberglass batt insulation and 12.7 mm drywall. The mechanical system was designed to operate in the dynamic (negative pressure) mode, however flexibility was provided to allow operation in the static (balanced pressure) mode to permit monitoring of the walls as if they were in a conventional house. The house was monitored by an extensive computerized monitoring system. Dynamic wall operation was dependent on pressure and temperature differentials between indoor and outdoor as well as wind speed and direction. The degree of heat gain was found to be ca 74% of the indoor-outdoor temperature differential. Temperature of incoming dynamic air was significantly affected by solar radiation and measurement of indoor air pollutants found no significant levels. 4 refs., 34 figs., 11 tabs.

  13. 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.

  14. Orbital wall fractures

    International Nuclear Information System (INIS)

    Iinuma, Toshitaka; Ishio, Ken-ichirou; Yoshinami, Hiroyoshi; Kuriyama, Jun-ichi; Hirota, Yoshiharu.

    1993-01-01

    A total of 59 cases of mild facial fractures (simple orbital wall fractures, 34 cases, other facial fractures, 25 cases) with the clinical suspects of orbital wall fractures were evaluated both by conventional views (Waters' and Caldwell views) and coronal CT scans. Conventional views were obtained, as an average, after 4 days and CT after 7 days of injuries. Both the medial wall and the floor were evaluated at two sites, i.e., anterior and posterior. The ethmoid-maxillary plate was also included in the study. The degree of fractures was classified as, no fractures, fractures of discontinuity, dislocation and fragmentation. The coronal CT images in bone window condition was used as reference and the findings were compared between conventional views and CT. The correct diagnosis was obtained as follows: orbital floor (anterior, 78%, posterior, 73%), medial orbital wall (anterior, 72%, posterior, 72%) and ethmoid-maxillary plate (64%). The false positive diagnosis was as follows: orbital floor (anterior only, 13%), medial orbital wall (anterior only, 7%) and ethmoid-maxillary plate (11%). The false negative diagnosis was as follows: orbital floor (anterior, 9%, posterior, 10%), medial orbital wall (anterior, 21%, posterior, 28%) and ethmoid-maxillary plate (21%). The results were compared with those of others in the past. (author)

  15. 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)

  16. 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

  17. 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

  18. 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)

  19. KETERASINGAN DALAM FILM WALL-E

    Directory of Open Access Journals (Sweden)

    Rahmadya Putra Nugraha

    2017-05-01

    Full Text Available Modern society nowadays technological advances at first create efficiency in human life. Further development of the technology thus drown human in a routine and automation of work created. The State is to be one of the causes of man separated from fellow or the outside world and eventually experiencing alienation. The movie as a mass media function to obtain the movie and entertainment can be informative or educative function is contained, even persuasive. The purpose of this research was conducted to find out the alienation in the movie Wall E. The concepts used to analyze the movie Wall E this is communication, movie, and alienation. The concept of alienation of human alienation from covering its own products of human alienation from its activities, the human alienation from nature of his humanity and human alienation from each other. Paradigm used is a critical paradigm with type a descriptive research with qualitative approach. The method used is the analysis of semiotics Roland Barthes to interpretation the scope of social alienation and fellow humans in the movie.This writing research results found that alienation of humans with other humans influenced the development of the technology and how the human it self represented of technology, not from our fellow human beings. Masyarakat modern saat ini kemajuan teknologi pada awalnya membuat efisiensi dalam kehidupan manusia. Perkembangan selanjutnya teknologi justru menenggelamkan manusia dalam suatu rutinitas dan otomatisasi kerja yang diciptakan. Keadaan itulah yang menjadi salah satu penyebab manusia terpisah dari sesama atau dunia luar dan akhirnya mengalami keterasingan. Film sebagai media massa berfungsi untuk memperoleh hiburan dan dalam film dapat terkandung fungsi informatif maupun edukatif, bahkan persuasif. Tujuan Penelitian ini dilakukan untuk mengetahui Keterasingan dalam film Wall E. Konsep-konsep yang digunakan untuk menganalisis film Wall E ini adalah komunikasi, film, dan

  20. 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

  1. 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.

  2. 3D-black-blood 3T-MRI for the diagnosis of thoracic large vessel vasculitis: A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Treitl, Karla Maria; Saam, Tobias [Institute for Clinical Radiology, LMU Munich, Munich (Germany); German Center for Cardiovascular Disease Research (DZHK e.V.), Munich (Germany); Maurus, Stefan; Sommer, Nora Narvina; Coppenrath, Eva; Treitl, Marcus [Institute for Clinical Radiology, LMU Munich, Munich (Germany); Kooijman-Kurfuerst, Hendrik [Philips Healthcare, Hamburg (Germany); Czihal, Michael; Hoffmann, Ulrich [LMU Munich, Division of Vascular Medicine, Medical Clinic and Policlinic IV, Munich (Germany); Dechant, Claudia; Schulze-Koops, Hendrik [LMU Munich, Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, Munich (Germany)

    2017-05-15

    To evaluate the feasibility of T1w-3D black-blood turbo spin echo (TSE) sequence with variable flip angles for the diagnosis of thoracic large vessel vasculitis (LVV). Thirty-five patients with LVV, diagnosed according to the current standard of reference, and 35 controls were imaged at 3.0T using 1.2 x 1.3 x 2.0 mm{sup 3} fat-suppressed, T1w-3D, modified Volumetric Isotropic TSE Acquisition (mVISTA) pre- and post-contrast. Applying a navigator and peripheral pulse unit triggering (PPU), the total scan time was 10-12 min. Thoracic aorta and subclavian and pulmonary arteries were evaluated for image quality (IQ), flow artefact intensity, diagnostic confidence, concentric wall thickening and contrast enhancement (CWT, CCE) using a 4-point scale. IQ was good in all examinations (3.25 ± 0.72) and good to excellent in 342 of 408 evaluated segments (83.8 %), while 84.1 % showed no or minor flow artefacts. The interobserver reproducibility for the identification of CCE and CWT was 0.969 and 0.971 (p < 0.001) with an average diagnostic confidence of 3.47 ± 0.64. CCE and CWT were strongly correlated (Cohen's k = 0.87; P < 0.001) and significantly more frequent in the LVV-group (52.8 % vs. 1.0 %; 59.8 % vs. 2.4 %; P < 0.001). Navigated fat-suppressed T1w-3D black-blood MRI with PPU-triggering allows diagnosis of thoracic LVV. (orig.)

  3. Transient long thoracic nerve injury during posterior spinal fusion for adolescent idiopathic scoliosis: A report of two cases

    Directory of Open Access Journals (Sweden)

    Athanasios I Tsirikos

    2013-01-01

    Full Text Available We present the transient long thoracic nerve (LTN injury during instrumented posterior spinal arthrodesis for idiopathic scoliosis. The suspected mechanism of injury, postoperative course and final outcome is discussed. The LTN is susceptible to injury due to its long and relatively superficial course across the thoracic wall through direct trauma or tension. Radical mastectomies with resection of axillary lymph nodes, first rib resection to treat thoracic outlet syndrome and cardiac surgery can be complicated with LTN injury. LTN injury producing scapular winging has not been reported in association with spinal deformity surgery. We reviewed the medical notes and spinal radiographs of two adolescent patients with idiopathic scoliosis who underwent posterior spinal arthrodesis and developed LTN neuropraxia. Scoliosis surgery was uneventful and intraoperative spinal cord monitoring was stable throughout the procedure. Postoperative neurological examination was otherwise normal, but both patients developed winging of the scapula at 4 and 6 days after spinal arthrodesis, which did not affect shoulder function. Both patients made a good recovery and the scapular winging resolved spontaneously 8 and 11 months following surgery with no residual morbidity. We believe that this LTN was due to positioning of our patients with their head flexed, tilted and rotated toward the contralateral side while the arm was abducted and extended. The use of heavy retractors may have also applied compression or tension to the nerve in one of our patients contributing to the development of neuropraxia. This is an important consideration during spinal deformity surgery to prevent potentially permanent injury to the nerve, which can produce severe shoulder dysfunction and persistent pain.

  4. 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.

  5. 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.

  6. 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.)

  7. 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.

  8. [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.

  9. 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)....

  10. 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.

  11. 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.

  12. 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

  13. 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.)

  14. 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

  15. 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.

  16. 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 ...

  17. 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...

  18. 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 ...

  19. 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...

  20. 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.

  1. 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.

  2. 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.

  3. Spaceflight Affects Postnatal Development of the Aortic Wall in Rats

    Directory of Open Access Journals (Sweden)

    Shin-ichiro Katsuda

    2014-01-01

    Full Text Available We investigated effect of microgravity environment during spaceflight on postnatal development of the rheological properties of the aorta in rats. The neonate rats were randomly divided at 7 days of age into the spaceflight, asynchronous ground control, and vivarium control groups (8 pups for one dam. The spaceflight group rats at 9 days of age were exposed to microgravity environment for 16 days. A longitudinal wall strip of the proximal descending thoracic aorta was subjected to stress-strain and stress-relaxation tests. Wall tensile force was significantly smaller in the spaceflight group than in the two control groups, whereas there were no significant differences in wall stress or incremental elastic modulus at each strain among the three groups. Wall thickness and number of smooth muscle fibers were significantly smaller in the spaceflight group than in the two control groups, but there were no significant differences in amounts of either the elastin or collagen fibers among the three groups. The decreased thickness was mainly caused by the decreased number of smooth muscle cells. Plastic deformation was observed only in the spaceflight group in the stress-strain test. A microgravity environment during spaceflight could affect postnatal development of the morphological and rheological properties of the aorta.

  4. [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.

  5. 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.

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

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    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.

  7. 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

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

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    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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Hydatid cyst of axilla masquerading as scrofuloderma

    Directory of Open Access Journals (Sweden)

    Shantilal M Sisodia

    2013-01-01

    Full Text Available Hydatid disease is an ancient endemic parasitic infestation caused by Echinococcus granulosus, which results in the formation of hydatid cysts in various parts of the body, the liver, and lungs being the most common sites. However, in 15% to 20% of the cases it may occur in unusual sites. We report a 25-year-old male patient who presented with clinical features similar to scrofuloderma in the axillary region but confirmed from histological examination to have hydatid cyst. This case highlights the uncommon site of hydatid cyst and unusual clinical and histopathological features along with the fact that it should be kept in differential diagnosis of nodules and sinuses in the axillary region. The treatment of choice is excision along with combination of albendazole and praziquantel.

  18. Commentary on “Inhibition of interleukin-1beta decreases aneurysm formation and progression in a novel model of thoracic aortic aneurysms”

    Directory of Open Access Journals (Sweden)

    Yonghua Bi

    2015-09-01

    Full Text Available Aortic aneurysm is a silent but life-threatening disease, whose pathogenesis remains poorly understood. Aneurysm models have been induced in small animals to study its pathogenesis, Johnston WF et al. successfully induced a novel model of thoracic aortic aneurysms (TAA by periadventitial application of elastase in mice. We comment on this model according to our experiment. We hypothesize that endogenous MMPs, especially MMP2, play a vital role in complex repair process of aneurysmal wall, which should be a key target in the investigation and treatment of aortic aneurysms.

  19. 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.

  20. Kinetic wall from Israel

    Energy Technology Data Exchange (ETDEWEB)

    Godolphin, D.

    1985-05-01

    An unusual solar mass wall is described. At the turn of a handle it can change from a solar energy collector to a heat-blocker. An appropriate name for it might be the rotating prism wall. An example of the moving wall is at work in an adobe test home in Sede Boqer. Behind a large south-facing window stand four large adobe columns that are triangular in plan. One face of each of them is painted black to absorb sunlight, a second is covered with panels of polystyrene insulation, and a third is painted to match the room decor. These columns can rotate. On winter nights, the insulated side faces the glass, keeping heat losses down. The same scheme works in summer to keep heat out of the house. Small windows provide ventilation.

  1. Etonogestrel implant migration to the vasculature, chest wall, and distant body sites: cases from a pharmacovigilance database.

    Science.gov (United States)

    Kang, Sarah; Niak, Ali; Gada, Neha; Brinker, Allen; Jones, S Christopher

    2017-12-01

    To describe clinical outcomes of etonogestrel implant patients with migration to the vasculature, chest wall and other distant body sites spontaneously reported to the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. We performed a standardized Medical Dictionary for Regulatory Activities (MedDRA) query in the FAERS database (through November 15, 2015), with reports coded with one or more MedDRA preferred terms that indicate complications with device placement or migration of the device from the original site of insertion to the vasculature, chest wall and other distant body sites. We excluded any cases previously described in the medical literature. We identified 38 cases of pronounced etonogestrel implant migration. Migration locations included the lung/pulmonary artery (n=9), chest wall (n=1), vasculature at locations other than the lung/pulmonary artery (n=14) and extravascular migrations (n=14) to other body sites (e.g., the axilla and clavicle/neck line/shoulder). The majority of cases were asymptomatic and detected when the patient desired implant removal; however, seven cases reported symptoms such as pain, discomfort and dyspnea in association with implant migration. Three cases also describe pulmonary fibrosis and skin reactions as a result of implant migration to the vasculature, chest wall and other distant body sites. Sixteen cases reported surgical removal in an operating room setting. Our FAERS case series demonstrates etonogestrel implant migration to the vasculature, chest wall and other body sites distant from the site of original insertion. As noted by the sponsor in current prescribing information, a key determinant in the risk for etonogestrel contraceptive implant migration appears to be improper insertion technique. Although migration of etonogestrel implants to the vasculature is rare, awareness of migration and education on proper insertion technique may reduce the risk. Published by Elsevier Inc.

  2. 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

  3. Thoracic heteropagus conjoined twins associated to an omphalocele: Report of a case and complete review of the literature

    Directory of Open Access Journals (Sweden)

    Kotti Ahmed

    2016-01-01

    Full Text Available Heteropagus twins are an extremely rare event with an incidence of 1–2 million live births that represents, sometimes, a real challenge for paediatric surgeons. The majority of cases have complete or partial duplication of the pelvis and/or lower extremities. Thoracic heteropagus conjoined twins is a rare condition in which a grossly defective foetus (the parasite is attached to the thorax of the main foetus (the autosite. We describe a case of a parasitic heteropagus attached at the chest wall with a rare presentation of giant exomphalos on the autosite. In this situation, the separation procedure was simple after a well-done anatomic study using X-ray, ultrasonography, magnetic resonance and echocardiogram are performed.

  4. Timber frame walls

    DEFF Research Database (Denmark)

    Hansen, Ernst Jan de Place; Brandt, Erik

    2010-01-01

    A ventilated cavity is usually considered good practice for removing moisture behind the cladding of timber framed walls. Timber frame walls with no cavity are a logical alternative as they are slimmer and less expensive to produce and besides the risk of a two-sided fire behind the cladding....... It was found that the specific damages made to the vapour barrier as part of the test did not have any provable effect on the moisture content. In general elements with an intact vapour barrier did not show a critical moisture content at the wind barrier after four years of exposure....

  5. Transport of 125I-albumin across normal and deendothelialized rabbit thoracic aorta in vivo

    International Nuclear Information System (INIS)

    Ramirez, C.A.; Colton, C.K.; Smith, K.A.; Stemerman, M.B.; Lees, R.S.

    1984-01-01

    Transmural concentration profiles of 125 I-albumin in vivo were measured across the normal and balloon catheter-deendothelialized rabbit descending thoracic aorta as a function of time following intravenous injection. A tracer was injected 5 or 60 minutes after deendothelialization, and the animals were sacrificed after circulation times of 10, 30 or 60 minutes. The aorta was immediately excised and frozen flat between glass slides. Samples were serially sectioned parallel to the intimal surface in a refrigerated microtome, washed with trichloroacetic acid (TCA), and counted. Relative tissue concentration profiles of TCA-precipitable radioactivity from the media of control animals showed entry from both luminal and adventitial sides, as previously found with conscious normal rabbits, but spatial gradients at both luminal and medial-adventitial borders were less steep. Relative concentration levels in ballooned animals were 10- to 40-fold higher than in controls, and the profiles were flatter. Uptake rates at equivalent circulation times were greater in experiments initiated 60 minutes, as compared with 5 minutes, after deendothelialization, suggesting that progressive medial edema may have occurred following balloon injury. These results show that the intact endothelium is the dominant mass transfer resistance for 125 I-albumin transport across the aortic wall. The data also suggest that the incomplete monolayer of platelets adherent to the subendothelium after balloon deendothelialization is not a substantial resistance to transport, as compared to that of the media, and that convection plays a more important role than diffusion for 125 I-albumin transport across the deendothelialized aortic wall

  6. Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair.

    Science.gov (United States)

    Mayberry, John C; Ham, L Bruce; Schipper, Paul H; Ellis, Thomas J; Mullins, Richard J

    2009-03-01

    Rib and sternal fracture repair are controversial. The opinion of surgeons regarding those patients who would benefit from repair is unknown. Members of the Eastern Association for the Surgery of Trauma, the Orthopedic Trauma Association, and thoracic surgeons (THS) affiliated with teaching hospitals in the United States were recruited to complete an electronic survey regarding rib and sternal fracture repair. Two hundred thirty-eight trauma surgeons (TRS), 97 orthopedic trauma surgeons (OTS), and 70 THS completed the survey. Eighty-two percent of TRS, 66% of OTS, and 71% of THS thought that rib fracture repair was indicated in selected patients. A greater proportion of surgeons thought that sternal fracture repair was indicated in selected patients (89% of TRS, 85% of OTS, and 95% of THS). Chest wall defect/pulmonary hernia (58%) and sternal fracture nonunion (>6 weeks) (68%) were the only two indications accepted by a majority of respondents. Twenty-six percent of surgeons reported that they had performed or assisted on a chest wall fracture repair, whereas 22% of surgeons were familiar with published randomized trials of the surgical repair of flail chest. Of surgeons who thought rib fracture or sternal fracture repair was rarely, if ever, indicated, 91% and 95%, respectively, specified that a randomized trial confirming efficacy would be necessary to change their negative opinion. A majority of surveyed surgeons reported that rib and sternal fracture repair is indicated in selected patients; however, a much smaller proportion indicated that they had performed the procedures. The published literature on surgical repair is sparse and unfamiliar to most surgeons. Barriers to surgical repair of rib and sternal fracture include a lack of expertise among TRS, lack of research of optimal techniques, and a dearth of randomized trials.

  7. Thoracic aorta 3D hemodynamics in pediatric and young adult patients with bicuspid aortic valve.

    Science.gov (United States)

    Allen, Bradley D; van Ooij, Pim; Barker, Alex J; Carr, Maria; Gabbour, Maya; Schnell, Susanne; Jarvis, Kelly B; Carr, James C; Markl, Michael; Rigsby, Cynthia; Robinson, Joshua D

    2015-10-01

    To evaluate the 3D hemodynamics in the thoracic aorta of pediatric and young adult bicuspid aortic valve (BAV) patients. 4D flow MRI was performed in 30 pediatric and young adult BAV patients (age: 13.9 ± 4.4 (range: [3.4, 20.7]) years old, M:F = 17:13) as part of this Institutional Review Board-approved study. Nomogram-based aortic root Z-scores were calculated to assess aortic dilatation and degree of aortic stenosis (AS) severity was assessed on MRI. Data analysis included calculation of time-averaged systolic 3D wall shear stress (WSSsys ) along the entire aorta wall, and regional quantification of maximum and mean WSSsys and peak systolic velocity (velsys ) in the ascending aorta (AAo), arch, and descending aorta (DAo). The 4D flow MRI AAo velsys was also compared with echocardiography peak velocity measurements. There was a positive correlation with both mean and max AAo WSSsys and peak AAo velsys (mean: r = 0.84, P max: r = 0.94, P max: rS  = 0.70, P < 0.001). AAo peak velocity was significantly higher when measured with echo compared with 4D flow MRI (2.1 ± 0.98 m/s versus 1.27 ± 0.49 m/s, P < 0.001). In pediatric and young adult patients with BAV, AS and peak ascending aorta velocity are associated with increased AAo WSS, while aortic dilation, age, and body surface area do not significantly impact AAo hemodynamics. Prospective studies are required to establish the role of WSS as a risk-stratification tool in these patients. © 2015 Wiley Periodicals, Inc.

  8. Massive aggrecan and versican accumulation in thoracic aortic aneurysm and dissection.

    Science.gov (United States)

    Cikach, Frank S; Koch, Christopher D; Mead, Timothy J; Galatioto, Josephine; Willard, Belinda B; Emerton, Kelly B; Eagleton, Matthew J; Blackstone, Eugene H; Ramirez, Francesco; Roselli, Eric E; Apte, Suneel S

    2018-03-08

    Proteoglycan accumulation is a hallmark of medial degeneration in thoracic aortic aneurysm and dissection (TAAD). Here, we defined the aortic proteoglycanome using mass spectrometry, and based on the findings, investigated the large aggregating proteoglycans aggrecan and versican in human ascending TAAD and a mouse model of severe Marfan syndrome. The aortic proteoglycanome comprises 20 proteoglycans including aggrecan and versican. Antibodies against these proteoglycans intensely stained medial degeneration lesions in TAAD, contrasting with modest intralamellar staining in controls. Aggrecan, but not versican, was increased in longitudinal analysis of Fbn1mgR/mgR aortas. TAAD and Fbn1mgR/mgR aortas had increased aggrecan and versican mRNAs, and reduced expression of a key proteoglycanase gene, ADAMTS5, was seen in TAAD. Fbn1mgR/mgR mice with ascending aortic dissection and/or rupture had dramatically increased aggrecan staining compared with mice without these complications. Thus, aggrecan and versican accumulation in ascending TAAD occurs via increased synthesis and/or reduced proteolytic turnover, and correlates with aortic dissection/rupture in Fbn1mgR/mgR mice. Tissue swelling imposed by aggrecan and versican is proposed to be profoundly deleterious to aortic wall mechanics and smooth muscle cell homeostasis, predisposing to type-A dissections. These proteoglycans provide potential biomarkers for refined risk stratification and timing of elective aortic aneurysm repair.

  9. Cognitive and Affective Uses of a Thoracic Outlet Syndrome Facebook Support Group.

    Science.gov (United States)

    Walker, Kimberly K

    2014-09-01

    There are currently many disease-specific groups on Facebook in which patients may take an active part (Greene, Choudhry, Kilabuk, & Shrank, 2011). Although uses and gratifications of patient-disease groups have begun to be identified for chronic diseases, rare diseases have been omitted, even though they collectively affect roughly 30 million people in the United States and 350 million people worldwide. This study is a content analysis of one Facebook rare disease patient group, the Thoracic Outlet Syndrome (TOS) Awareness group. All wall posts were recorded and content analyzed for cognitive and affective categories and subcategories between October 9, 2011 (date of site origin), and May 1, 2012. Analysis of cognitive needs indicated TOS patients used the site more to share information about their own TOS symptoms and journey with diagnosis than to seek information. Analysis of affective needs found patients were more likely to use the site to give support and encouragement to others than to express concerns and complaints. The complaints they did express were primarily related to their frustration with the general medical community's perceived inability to diagnose and understand their disease or to question a specific doctor's diagnosis/recommendation. Results point to needs specific to TOS patients that uses and gratifications research can help clarify.

  10. Assessment of thoracic aortic elasticity: a preliminary study using electrocardiographically gated dual-source CT

    International Nuclear Information System (INIS)

    Li, Ning; Guo, Lijun; Sun, Haitao; Gao, Fei; Liu, Cheng; Beck, Thomas; Chen, Jiuhong; Biermann, Christina

    2011-01-01

    To gain a new insight into the elastic properties of the thoracic aorta in patients without aortic diseases using electrocardiographically (ECG)-gated dual-source (DS) CT. 56 subjects with no cardiovascular disease, selected from 2,700 people undergoing ECG-gated DSCT examination, were divided into three groups according to their age. CT data were reconstructed in 5% step throughout the RR interval. Diameter and area were measured at the curve of the ascending aorta (AA) and at the same level of the descending aorta (DA). The pulsation and elasticity of the aorta were evaluated. Aortic diameter changes were noted throughout the cardiac cycle. The maximum average diameter was seen at an RR interval of 24.02 ± 4.99% for the AA and 25.63 ± 4.77% for the DA. The minimum was at 93.5 ± 4.04% for the AA and 96.6 ± 4.58% for the DA. There was an age-dependent decrease in elasticity, while different correlation coefficients were found between various age groups and different elastic parameters. The properties of aortic pulsation and wall elasticity could be well shown by ECG-gated DSCT. The new findings regarding segment difference and age relevance were significant and should be taken into account in clinical trials and treatments for the elasticity related cardiovascular diseases. (orig.)

  11. Comparison Thoracic Epidural and Intercostal Block to Improve Ventilation Parameters and Reduce Pain in Patients with Multiple Rib Fractures

    Directory of Open Access Journals (Sweden)

    Raheleh Aligholipour Maleki

    2011-08-01

    Full Text Available Introduction: Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may re-quire such high dose that they produce respiratory depression, especially in el-derly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. Methods: sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or inter-costal block with %0.25 bupivacaine. The patients were assessed through ICU and hos-pital stay length, ventilation function tests. Pain score among the patients was meas-ured with verbal rating scale, before and after administration of the analgesia. Results: We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P < 0.004. Changes in the visual Analogue Scale were associated with marked improvement re-garding pain at rest and pain caused by coughing and deep breathing in group A com-pared group B... ICU and hospital stay markedly reduced in Group A. Conclusion: tho-racic epidural analgesia is superior to intercostals block regarding pain relief of rib frac-tures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.

  12. eWALL

    DEFF Research Database (Denmark)

    Kyriazakos, Sofoklis; Mihaylov, Mihail; Anggorojati, Bayu

    2016-01-01

    challenge with impact in multiple sectors. In this paper we present an innovative ICT solution, named eWALL, that aims to address these challenges by means of an advanced ICT infrastructure and home sensing environment; thus differentiating from existing eHealth and eCare solutions. The system of e...

  13. Abdominal wall surgery

    Science.gov (United States)

    ... as liposuction , which is another way to remove fat. But, abdominal wall surgery is sometimes combined with liposuction. ... from the middle and lower sections of your abdomen to make it firmer ... removes excess fat and skin (love handles) from the sides of ...

  14. Occupy Wall Street

    DEFF Research Database (Denmark)

    Jensen, Michael J.; Bang, Henrik

    2013-01-01

    This article analyzes the political form of Occupy Wall Street on Twitter. Drawing on evidence contained within the profiles of over 50,000 Twitter users, political identities of participants are characterized using natural language processing. The results find evidence of a traditional...

  15. Endometriosis Abdominal wall

    International Nuclear Information System (INIS)

    Alvarez, M.; Carriquiry, L.

    2003-01-01

    Endometriosis of abdominal wall is a rare entity wi ch frequently appears after gynecological surgery. Case history includes three cases of parietal endometriosis wi ch were treated in Maciel Hospital of Montevideo. The report refers to etiological diagnostic aspects and highlights the importance of total resection in order to achieve definitive healing

  16. 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.

  17. Chronic Abdominal Wall Pain.

    Science.gov (United States)

    Koop, Herbert; Koprdova, Simona; Schürmann, Christine

    2016-01-29

    Chronic abdominal wall pain is a poorly recognized clinical problem despite being an important element in the differential diagnosis of abdominal pain. This review is based on pertinent articles that were retrieved by a selective search in PubMed and EMBASE employing the terms "abdominal wall pain" and "cutaneous nerve entrapment syndrome," as well as on the authors' clinical experience. In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall; in patients with previously diagnosed chronic abdominal pain who have no demonstrable pathological abnormality, this likelihood can rise as high as 30% . There have only been a small number of clinical trials of treatment for this condition. The diagnosis is made on clinical grounds, with the aid of Carnett's test. The characteristic clinical feature is strictly localized pain in the anterior abdominal wall, which is often mischaracterized as a "functional" complaint. In one study, injection of local anesthesia combined with steroids into the painful area was found to relieve pain for 4 weeks in 95% of patients. The injection of lidocaine alone brought about improvement in 83-91% of patients. Long-term pain relief ensued after a single lidocaine injection in 20-30% of patients, after repeated injections in 40-50% , and after combined lidocaine and steroid injections in up to 80% . Pain that persists despite these treatments can be treated with surgery (neurectomy). Chronic abdominal wall pain is easily diagnosed on physical examination and can often be rapidly treated. Any physician treating patients with abdominal pain should be aware of this condition. Further comparative treatment trials will be needed before a validated treatment algorithm can be established.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. [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.

  10. 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.

  11. Wind tunnels with adapted walls for reducing wall interference

    Science.gov (United States)

    Ganzer, U.

    1979-01-01

    The basic principle of adaptable wind tunnel walls is explained. First results of an investigation carried out at the Aero-Space Institute of Berlin Technical University are presented for two dimensional flexible walls and a NACA 0012 airfoil. With five examples exhibiting very different flow conditions it is demonstrated that it is possible to reduce wall interference and to avoid blockage at transonic speeds by wall adaptation.

  12. Rising damp in building walls: the wall base ventilation system

    Energy Technology Data Exchange (ETDEWEB)

    Guimaraes, A.S.; Delgado, J.M.P.Q.; Freitas, V.P. de [Faculdade de Engenharia da Universidade do Porto, Laboratorio de Fisica das Construcoes (LFC), Departamento de Engenharia Civil, Porto (Portugal)

    2012-12-15

    This work intends to validate a new system for treating rising damp in historic buildings walls. The results of laboratory experiments show that an efficient way of treating rising damp is by ventilating the wall base, using the HUMIVENT technique. The analytical model presented describes very well the observed features of rising damp in walls, verified by laboratory tests, who contributed for a simple sizing of the wall base ventilation system that will be implemented in historic buildings. (orig.)

  13. 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.

  14. 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

  15. 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.)

  16. 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.

  17. 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.

  18. 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....

  19. 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.

  20. 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...

  1. 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.

  2. 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

  3. High-R Walls for Remodeling: Wall Cavity Moisture Monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Wiehagen, J.; Kochkin, V.

    2012-12-01

    The focus of the study is on the performance of wall systems, and in particular, the moisture characteristics inside the wall cavity and in the wood sheathing. Furthermore, while this research will initially address new home construction, the goal is to address potential moisture issues in wall cavities of existing homes when insulation and air sealing improvements are made.

  4. High-R Walls for Remodeling. Wall Cavity Moisture Monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Wiehagen, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Kochkin, V. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States)

    2012-12-01

    The focus of the study is on the performance of wall systems, and in particular, the moisture characteristics inside the wall cavity and in the wood sheathing. Furthermore, while this research will initially address new home construction, the goal is to address potential moisture issues in wall cavities of existing homes when insulation and air sealing improvements are made.

  5. A lipomatous chest wall lesion: hibernoma

    International Nuclear Information System (INIS)

    Incedayi, M.; Sivrioglu, A.; Saglam, M.; Sonmez, G.; Tekin, L.

    2012-01-01

    Full text: A hibernoma is a rare benign soft tissue tumor derived from brown fat. The tumor is also known as 'fetal' lipoma, lipoma of embriogenic fat and lipoma of immature adipose tissue. Hibernomas are slow growing, painless soft tissue tumors which do not recur after surgical resection. Preferred locations are brown fat containing sites as thigh, inter scapular region, shoulder, axilla and mediastinum. The tumor occurs most commonly in adults, with a mean age of 38 years (age range, 2-75 years). We present a rare case of hibernoma with radiological and pathological findings

  6. Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

    Science.gov (United States)

    Turna, Akif; Kavakli, Kuthan; Sapmaz, Ersin; Arslan, Hakan; Caylak, Hasan; Gokce, Hasan Suat; Demirkaya, Ahmet

    2014-01-01

    The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours. PMID:24227881

  7. Wall insulation system

    Energy Technology Data Exchange (ETDEWEB)

    Kostek, P.T.

    1987-08-11

    In a channel specially designed to fasten semi-rigid mineral fibre insulation to masonry walls, it is known to be constructed from 20 gauge galvanized steel or other suitable material. The channel is designed to have pre-punched holes along its length for fastening of the channel to the drywall screw. The unique feature of the channel is the teeth running along its length which are pressed into the surface of the butted together sections of the insulation providing a strong grip between the two adjacent pieces of insulation. Of prime importance to the success of this system is the recent technological advancements of the mineral fibre itself which allow the teeth of the channel to engage the insulation fully and hold without mechanical support, rather than be repelled or pushed back by the inherent nature of the insulation material. After the insulation is secured to the masonry wall by concrete nail fastening systems, the drywall is screwed to the channel.

  8. Shadows on the wall

    International Nuclear Information System (INIS)

    Swift, Diana.

    1984-01-01

    Canadian antinuclear groups, because of their shifting stances and fluid overlapping membership, are compared with shadows on a wall. They can be roughly classified as environmental, pacifist, concerned with energy, religious, or dedicated to nuclear responsibility. The author considers that such groups, despite their arguably unrealistic attitudes, have raised public awareness of the ethical, practical and financial aspects of power development in Canada and the world

  9. Scalable Resolution Display Walls

    KAUST Repository

    Leigh, Jason; Johnson, Andrew; Renambot, Luc; Peterka, Tom; Jeong, Byungil; Sandin, Daniel J.; Talandis, Jonas; Jagodic, Ratko; Nam, Sungwon; Hur, Hyejung; Sun, Yiwen

    2013-01-01

    This article will describe the progress since 2000 on research and development in 2-D and 3-D scalable resolution display walls that are built from tiling individual lower resolution flat panel displays. The article will describe approaches and trends in display hardware construction, middleware architecture, and user-interaction design. The article will also highlight examples of use cases and the benefits the technology has brought to their respective disciplines. © 1963-2012 IEEE.

  10. Plastic surgery in chest wall reconstruction: relevant aspects - case series

    Directory of Open Access Journals (Sweden)

    Diogo Franco

    Full Text Available Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

  11. Airway wall thickening and emphysema show independent familial aggregation in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Patel, Bipen D; Coxson, Harvey O; Pillai, Sreekumar G

    2008-01-01

    RATIONALE: It is unclear whether airway wall thickening and emphysema make independent contributions to airflow limitation in chronic obstructive pulmonary disease (COPD) and whether these phenotypes cluster within families. OBJECTIVES: To determine whether airway wall thickening and emphysema (1...... to airflow obstruction in COPD. These phenotypes show independent aggregation within families of individuals with COPD, suggesting that different genetic factors influence these disease processes....... the severity of airway wall thickening and emphysema. MEASUREMENTS AND MAIN RESULTS: A total of 3,096 individuals were recruited to the study, of whom 1,159 (519 probands and 640 siblings) had technically adequate high-resolution computed tomography scans without significant non-COPD-related thoracic disease...

  12. Light shining through walls

    International Nuclear Information System (INIS)

    Redondo, Javier; Ringwald, Andreas

    2010-11-01

    Shining light through walls? At first glance this sounds crazy. However, very feeble gravitational and electroweak effects allow for this exotic possibility. Unfortunately, with present and near future technologies the opportunity to observe light shining through walls via these effects is completely out of question. Nevertheless there are quite a number of experimental collaborations around the globe involved in this quest. Why are they doing it? Are there additional ways of sending photons through opaque matter? Indeed, various extensions of the standard model of particle physics predict the existence of new particles called WISPs - extremely weakly interacting slim particles. Photons can convert into these hypothetical particles, which have no problems to penetrate very dense materials, and these can reconvert into photons after their passage - as if light was effectively traversing walls. We review this exciting field of research, describing the most important WISPs, the present and future experiments, the indirect hints from astrophysics and cosmology pointing to the existence of WISPs, and finally outlining the consequences that the discovery of WISPs would have. (orig.)

  13. Light shining through walls

    Energy Technology Data Exchange (ETDEWEB)

    Redondo, Javier [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); Max-Planck-Institut fuer Physik, Muenchen (Germany); Ringwald, Andreas [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany)

    2010-11-15

    Shining light through walls? At first glance this sounds crazy. However, very feeble gravitational and electroweak effects allow for this exotic possibility. Unfortunately, with present and near future technologies the opportunity to observe light shining through walls via these effects is completely out of question. Nevertheless there are quite a number of experimental collaborations around the globe involved in this quest. Why are they doing it? Are there additional ways of sending photons through opaque matter? Indeed, various extensions of the standard model of particle physics predict the existence of new particles called WISPs - extremely weakly interacting slim particles. Photons can convert into these hypothetical particles, which have no problems to penetrate very dense materials, and these can reconvert into photons after their passage - as if light was effectively traversing walls. We review this exciting field of research, describing the most important WISPs, the present and future experiments, the indirect hints from astrophysics and cosmology pointing to the existence of WISPs, and finally outlining the consequences that the discovery of WISPs would have. (orig.)

  14. Microfluidics with fluid walls.

    Science.gov (United States)

    Walsh, Edmond J; Feuerborn, Alexander; Wheeler, James H R; Tan, Ann Na; Durham, William M; Foster, Kevin R; Cook, Peter R

    2017-10-10

    Microfluidics has great potential, but the complexity of fabricating and operating devices has limited its use. Here we describe a method - Freestyle Fluidics - that overcomes many key limitations. In this method, liquids are confined by fluid (not solid) walls. Aqueous circuits with any 2D shape are printed in seconds on plastic or glass Petri dishes; then, interfacial forces pin liquids to substrates, and overlaying an immiscible liquid prevents evaporation. Confining fluid walls are pliant and resilient; they self-heal when liquids are pipetted through them. We drive flow through a wide range of circuits passively by manipulating surface tension and hydrostatic pressure, and actively using external pumps. Finally, we validate the technology with two challenging applications - triggering an inflammatory response in human cells and chemotaxis in bacterial biofilms. This approach provides a powerful and versatile alternative to traditional microfluidics.The complexity of fabricating and operating microfluidic devices limits their use. Walsh et al. describe a method in which circuits are printed as quickly and simply as writing with a pen, and liquids in them are confined by fluid instead of solid walls.

  15. Wall Street som kreationistisk forkynder

    DEFF Research Database (Denmark)

    Ekman, Susanne

    2016-01-01

    Artiklen gennemgår Karen Hos etnografi om Wall Street: "Liquidated: An ethnography of Wall Street" set i lyset af den offentlige debat vedrørende Goldman Sachs opkøb af Dong......Artiklen gennemgår Karen Hos etnografi om Wall Street: "Liquidated: An ethnography of Wall Street" set i lyset af den offentlige debat vedrørende Goldman Sachs opkøb af Dong...

  16. Tumors on chest wall, breast cancer in men. A case

    International Nuclear Information System (INIS)

    Najera, Carlos; Guerra, Diego; Sotomayor, Sonia; Poveda, Sergio; Bucheli, Carlos

    2004-01-01

    A 75 years old man went to the Carlos Andrade Marin Hospital due to the appearance of a mass on his chest wall, initially diagnosed as a lypoma. During his preoperative preparation we had a suspicion of a malignant process. Finally and after a surgical procedure the diagnose was made, breast cancer. Considered this way the practice of medicine is as simple as having a suspicion. In fact it is, actually what determines the final diagnose of a pathology is the suspicion that we as physicians have about a problem. However, to generate an hypothesis we required knowledge, study and curiosity. The present work is a bibliographic review about a non so frequent problem as the thoracic mass is. The author)

  17. Build an Interactive Word Wall

    Science.gov (United States)

    Jackson, Julie

    2018-01-01

    Word walls visually display important vocabulary covered during class. Although teachers have often been encouraged to post word walls in their classrooms, little information is available to guide them. This article describes steps science teachers can follow to transform traditional word walls into interactive teaching tools. It also describes a…

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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)

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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

  11. Elastofibroma dorsi – differential diagnosis in chest wall tumours

    Directory of Open Access Journals (Sweden)

    Steinau Hans-Ulrich

    2007-02-01

    Full Text Available Abstract Background Elastofibromas are benign soft tissue tumours mostly of the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle with a prevalence of up to 24% in the elderly. The pathogenesis of the lesion is still unclear, but repetitive microtrauma by friction between the scapula and the thoracic wall may cause the reactive hyperproliferation of fibroelastic tissue. Methods We present a series of seven cases with elastofibroma dorsi with reference to clinical findings, further clinical course and functional results after resection, as well as recurrence. Data were obtained retrospectively by clinical examination, phone calls to the patients' general practitioners and charts review. Follow-up time ranged from four months to nine years and averaged 53 months. Results The patients presented with swelling of the infrascapular region or snapping scapula. In three cases, the lesion was painful. The ratio men/women was 2/5 with a mean age of 64 years. The tumor sizes ranged from 3 to 13 cm. The typical macroscopic aspect was characterized as poorly defined fibroelastic soft tissue lesion with a white and yellow cut surface caused by intermingled remnants of fatty tissue. Microscopically, the lesions consisted of broad collagenous strands and densely packed enlarged and fragmented elastic fibres with mostly round shapes. In all patients but one, postoperative seroma (which had to be punctuated occurred after resection; however, at follow-up time, no patient reported any decrease of function or sensation at the shoulder or the arm of the operated side. None of the patients experienced a relapse. Conclusion In differential diagnosis of soft tissue tumors located at this specific site, elastofibroma should be considered as likely diagnosis. Due to its benign behaviour, the tumor should be resected only in symptomatic patients.

  12. 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.)

  13. 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.

  14. 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.)

  15. 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

  16. 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

  17. 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....

  18. 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.

  19. Regulation of cell wall biosynthesis.

    Science.gov (United States)

    Zhong, Ruiqin; Ye, Zheng-Hua

    2007-12-01

    Plant cell walls differ in their amount and composition among various cell types and even in different microdomains of the wall of a given cell. Plants must have evolved regulatory mechanisms controlling biosynthesis, targeted secretion, and assembly of wall components to achieve the heterogeneity in cell walls. A number of factors, including hormones, the cytoskeleton, glycosylphosphatidylinositol-anchored proteins, phosphoinositides, and sugar nucleotide supply, have been implicated in the regulation of cell wall biosynthesis or deposition. In the past two years, there have been important discoveries in transcriptional regulation of secondary wall biosynthesis. Several transcription factors in the NAC and MYB families have been shown to be the key switches for activation of secondary wall biosynthesis. These studies suggest a transcriptional network comprised of a hierarchy of transcription factors is involved in regulating secondary wall biosynthesis. Further investigation and integration of the regulatory players participating in the making of cell walls will certainly lead to our understanding of how wall amounts and composition are controlled in a given cell type. This may eventually allow custom design of plant cell walls on the basis of our needs.

  20. Electroweak bubble wall speed limit

    Energy Technology Data Exchange (ETDEWEB)

    Bödeker, Dietrich [Fakultät für Physik, Universität Bielefeld, 33501 Bielefeld (Germany); Moore, Guy D., E-mail: bodeker@physik.uni-bielefeld.de, E-mail: guymoore@ikp.physik.tu-darmstadt.de [Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 2, 64289 Darmstadt (Germany)

    2017-05-01

    In extensions of the Standard Model with extra scalars, the electroweak phase transition can be very strong, and the bubble walls can be highly relativistic. We revisit our previous argument that electroweak bubble walls can 'run away,' that is, achieve extreme ultrarelativistic velocities γ ∼ 10{sup 14}. We show that, when particles cross the bubble wall, they can emit transition radiation. Wall-frame soft processes, though suppressed by a power of the coupling α, have a significance enhanced by the γ-factor of the wall, limiting wall velocities to γ ∼ 1/α. Though the bubble walls can move at almost the speed of light, they carry an infinitesimal share of the plasma's energy.