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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute aortic dissection is a life-threatening condition. Aggressive hypotensive drug therapy is the initial treatment of choice, although emergent surgical intervention is often warranted. We evaluated the efficacy of a balloon-expandable intravascular stent for the internal obliteration of aortic dissection. It is a flexible, continuous, complex coil cut to the length needed at the time of insertion. It can be positioned in curved vessels, including the aortic arch. The stent was inserted in the thoracic and abdominal aorta of 12 dogs (group I). Six weeks after implantation the dogs underwent angiography and the stents were explanted for light and scanning electron microscopy. There were no instances of stent migration or change in configuration. The aortas did not rupture. All branch vessels remained patent. Light and scanning electron microscopy illustrated neointimal incorporation into the vascular wall except at orifices. Thoracic dissections were created surgically in an additional 24 mongrel dogs. Twelve dogs received stents immediately after creation of the dissection (group II). All 12 dissections were obliterated. Twelve dogs were allowed to recover after creation of the dissection to observe the natural history of that lesion (group III). Within 1 week, in group III, there were three deaths because of aortic rupture; eight dissections persisted, and one resealed spontaneously. Stents were placed in the eight persistent dissections. All eight dissections were obliterated. In both groups, after 6 weeks of stent placement, aortography was repeated, and stents were explanted for light and scanning electron microscopy. There were no instances of rupture. All branch vessels remained patent with no evidence of thrombosis. We conclude that because of its unique characteristics, the stent effectively obliterates the false lumen of experimental acute aortic dissections without occlusing side branches, damaging the aorta, or inducing thrombosis.
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PMID:A balloon-expandable intravascular stent for obliterating experimental aortic dissection. 233 37

Chronic granulomatous disease of childhood is an inheritable disorder of phagocytic cell respiratory burst resulting in recurrent, life-threatening, catalase-positive infections. The lung is the most common site of infection, and pulmonary disease is the primary cause of death in greater than 50% of children with chronic granulomatous disease. Still, the role of surgery in management of this disease remains undefined. Between 1974 and 1990, 19 patients with chronic granulomatous disease required 31 thoracic interventions at our institution. Patients ranged in age from 2.5 to 27 years (mean age, 15 years). Seventeen of 19 patients (89%) had had previous pulmonary infections. Patients presented as toxic (temperature > 38.5 degrees C, chest pain, and cough) in 22 instances before the 31 procedures. Aggressive surgical intervention for diagnosis and extirpation of localized infections was undertaken with lobectomy/pneumonectomy with or without other procedures (5), bisegmentectomy (2), segmentectomy with or without other procedures (5), or wedge with or without other procedures (13). In five instances, an empyema was drained; a chest tube for a sterile collection was placed in one instance. There was one intraoperative death, and 3 patients died 22 to 600 days postoperatively with overwhelming sepsis. The mean hospitalization was 101 days (range, 24 to 600 days). Wound complications occurred in 5 patients, requiring 17 separate anesthetic debridements. A change in therapy was dictated by the results of the procedure in 23 of 31 instances (74%). Thoracic surgeons must be aware of this rare cause of immunosuppression in these children and, due to the unusual nature of the pulmonary infections, should follow an aggressive approach in their diagnosis and management.
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PMID:Surgical management of pulmonary infections in chronic granulomatous disease of childhood. 846 36

A 44-year-old woman presented with a thoracic chordoma with intrathoracic extension manifesting as complaints of lower extremity weakness, hypesthesia below the levels of T5-6, and sphincter incontinence. Almost total resection combined with anterior interbody fusion and stabilization was possible through a left transpleural transthoracic approach. She suffered recurrence after 2 years and was considered inoperable. Biopsy revealed a malignant chordoma with no sarcomatous differentiation. Chordoma is an uncommon malignant bone tumor originating from remnants of the embryonal notochord, occurring mostly along the axial skeleton, at the extremity of the vertebral spine, and is least common in the thoracic region. Differential diagnosis is problematic and biopsy is helpful particularly if considered inoperable. Thoracic chordomas of the malignant type manifest as cord or root compression. Classical malignant chordomas must be distinguished from chondroid, benign, or other types of chordomas, since the biological behavior and clinical features are distinct. However, the differential diagnosis cannot be based on histological examination, but long-term follow up is required. Most patients have extradural and intraspinal tissue extension at the time of diagnosis, which makes complete resection impossible. Aggressive surgery without violation of surgical borders is the best choice in the treatment of thoracic chordoma. Thoracic chordoma is a recurring neoplasm and is prone to dissemination and sarcomatous differentiation despite its slow-growing nature.
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PMID:Chordoma of the thoracic spine--case report. 1201 71

We present a patient who was referred to our thoracic surgical service with a massive, loculated right pleural effusion accompanied by significant ascites. Thoracotomy and decortication were required and pleural biopsy led to a diagnosis of endometriosis. Aggressive medical therapy was subsequently initiated but hysterectomy with bilateral oophorectomy was required due to poor symptom control and the inability to rule out a neoplastic process. There are less than 15 reported cases of endometriosis presenting with both pleural effusion and ascites. Thoracic surgeons presented with such a scenario should be cognizant of this pathological entity.
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PMID:Massive pleural endometriosis. 1214 12

Development of treatment modalities for chest wounds and traumatic empyema thoracis is reviewed in the light of war experience. Mortality from thoracic injury was more than 50% before World War I and was about 25% during World War I. It came down to 10% in World War II and was about 5% during the Korean War. It improved further during the Vietnam War, until it ranged at 2% to 4%, where no further improvement could be imagined. Thoracic surgery was born in the field hospitals of World War I. Established drainage methods and standardized anesthesia made thoracotomy a standard procedure in World War II. As experience increased in chest trauma, surgical aggression diminished. Drainage ruled primary chest trauma treatment algorithms during the Vietnam War and coexisted with the full arsenal of cardiothoracic surgery when it was needed. Optimization of thoracic surgical aggression includes a case-tailored approach when major chest surgery with or without interventions on the central cardiovascular system is needed. This is where we are now, provided a proper logistic, Medevac system exists. If we let the past fade away, the danger of committing the mistakes of our predecessors increases without having their excuses. Our present is only the past of the future.
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PMID:Changing dogmas: history of development in treatment modalities of traumatic pneumothorax, hemothorax, and posttraumatic empyema thoracis. 1472 6