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

A number of unusual or uncommon thoracoscopic indications have developed over the years. Pleural tuberculosis and blastomycosis, HIV infections, histoplasmosis, presenting as a nodular process have been diagnosed and treated. Fistulae or tube tract endoscopy may delineate whether a patient has persistence or recurrent carcinoma or tuberculosis through biopsy and culture techniques especially in the post pneumonectomy patient with an air leak. Thoracic diseases, including carcinoma, and mediastinal adenopathy and undiagnosed masses, are amenable to biopsy and possible resection. Foreign bodies may be removed with this technique. The utilization of thoracoscopy for diagnosis and treatment of pericardial processes has been utilized as well for placement of pacemakers. More recently, internal mammary artery to coronary artery bypass grafting has been performed by a few same surgeons with the endoscopic or VATS technique. Neurogenic indications include resection of the posterior sympathetic ganglia and vagectomy. Chylothorax therapy utilizing fibrin glue and liver and kidney biopsy may be performed.
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PMID:Unusual and infrequent indications for thoracoscopy. 970 9

Human herpes virus-8 (HHV-8)-associated primary effusion lymphoma (PEL) is an unusual lymphoma confined to the body cavities, which primarily affects human immunodeficiency virus (HIV)-positive men at high risk for Kaposi's sarcoma (KS). We describe two HIV-negative elderly Italian men, who developed pleural HHV-8-positive PEL in association with other diseases (systemic hypertension, colonic carcinoma, chronic obstructive airways disease, dilated cardiomyopathy), but without KS. Thoracic computed tomography revealed unilateral pleural effusion and pleural thickening. Thoracentesis disclosed large lymphoma cells, with no T- or B-cell associated antigens, clonal rearrangement of the immunoglobulin heavy chain gene and the presence of HHV-8 but not Epstein-Barr virus deoxyribonucleic acid sequences. Our cases differ from most pleural effusion lymphomas, in that they are non-acquired immunodeficiency syndrome-related. This highlights the possible human herpes virus-8-associated primary effusion lymphoma risk among elderly human immunodeficiency virus-negative patients, particularly Italians, in whom human herpes virus-8 seroprevalence rates and incidence of classic Kaposi's sarcoma are high.
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PMID:Human herpes virus-8 associated primary effusion lymphoma of the pleural cavity in HIV-negative elderly men. 1059 17

A 74-year-old man with primary lung cancer developed preoperative empyema but was successfully managed surgically. The patient was given a diagnosis of c-T2N1M0, stage IIB, moderately differentiated squamous cell carcinoma, but before surgery pneumothorax and empyema developed, resulting from rupture of the carcinoma. Thoracic drainage, lavage and systemic administration of antibiotics improved his empyema. As there were no malignant cells in the drainage fluid, right middle-lower bilobectomy, empyemal cavity resection and lymph node dissection were performed. The bronchial stump was covered with an intercostal muscle flap. Thoracic drainage, lavage and systemic administration of antibiotics were performed for 6 days following the operation. The patient was discharged on the 27th postoperative day without any complications having developed. The pathological diagnosis of the tumor was p-T4N2(#7)M0, stage IIIB, br(-), ly(+), v(+), p3(pleura), pm1 and d0. He died of recurrence at home 18 months after the operation. We believe the following to be the minimum requirements for surgical management of such patients: (1) immediate thoracic cavity drainage and lavage with systemic antibiotic therapy, aiming at infection control before surgery; (2) prophylactic lavage of the thoracic cavity during and after surgery and (3) coverage of the bronchial stump with an adequate flap. Six reported cases of primary lung cancer with preoperative empyema are also discussed.
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PMID:Surgical management of primary lung cancer in an elderly patient with preoperative empyema. 1067 61

A case of advanced cryptogenic fibrosing alveolitis (CFA) with multiple bullae and extensive pulmonary fibrosis, scheduled for modified radical mastectomy for carcinoma of breast, is presented. This patient had ischemic heart disease, corticosteroid-induced hypertension, diabetes mellitus, and a difficult airway. Thoracic epidural segmental anesthesia was successfully given to this patient. Preoperative problems, perioperative management, and alternative anesthetic techniques are discussed.
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PMID:Thoracic epidural anesthesia for modified radical mastectomy in a patient with cryptogenic fibrosing alveolitis: a case report. 1077 15

Limited information is available in the medical literature on thoracic reirradiation for patients with recurrent/persistent lung carcinoma or new primary lung tumors. Controversy exists regarding the retreatment because of concerns regarding the risk of radiation toxicity. The medical and radiotherapeutic records of more than 1,500 patients with lung cancer seen in the Department of Radiation Oncology at Thomas Jefferson University Hospital from 1982 through 1997 were searched. Twenty-three patients with history of previous thoracic radiation therapy underwent thoracic reirradiation for either biopsy-proven and/or radiographically evident tumor recurrence, metastasis, or second lung primary. Most patients were reirradiated because of progressive dyspnea, cough, thoracic pain, or hemoptysis. Each of these symptoms was evaluated separately with regard to the subjective response to reirradiation. The median follow-up time from completion of reirradiation to last correspondence with the patient and/or family was 3.2 months, with a range of 0 to 17.5 months. In six patients with hemoptysis, a decrease or resolution of this symptom was noted. Of five patients with thoracic pain attributed to carcinoma, four noted an improvement in pain after reirradiation. Of 15 patients with cough, 9 had an improvement in cough, and of 15 patients with dyspnea, 11 had an improvement. Thoracic reirradiation is an effective modality in patients with hemoptysis, thoracic pain, cough, and dyspnea attributed to a radiographically defined recurrence and/or progression of lung cancer.
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PMID:Thoracic reirradiation for symptomatic relief after prior radiotherapeutic management for lung cancer. 1077 77

The authors set out to determine how histologic variability in bronchioloalveolar cell carcinoma impacts dominant radiographic patterns shown by computed tomography (CT). Thoracic CT's of all patients with pathologically confirmed bronchioloalveolar cell carcinoma diagnosed over a 36-month period were reviewed without knowledge of underlying histologic type. The dominant CT pattern was recorded as 1) air space consolidation; 2) focal nodule or mass; and 3) multicentric nodules or masses. Nodules and masses were further characterized according to borders, distribution, and associated findings, including spiculations and air bronchograms. Histology was independently reviewed. Twenty-seven patients, 16 women and 11 men, mean age 60 years, were diagnosed with bronchioloalveolar cell carcinoma. In 6 (22%) of the 27 cases, the histology was mucinous, with malignant goblet cells identified. Five (83%) of the six mucinous neoplasms manifested as air space consolidation and three (50%) of the six presented with multiple nodules, in which two had coexisting air space consolidation. Of the remaining 21 cases (78%) with nonmucinous histology, the primary malignant cells of origin included Clara cells (n = 8), tall columnar epithelial cells (n = 7) and alveolar type II pneumocytes (n = 6). Sclerosis was a dominant histologic feature in 14 (67%) of the 21 cases. Seventeen (81%) of the nonmucinous neoplasms presented as isolated nodules or masses and four (19%) presented as multiple nodules or masses. Of these four patients with multifocal disease and nonmucinous histology, multiple bronchioloalveolar adenomas accounted for multicentricity in two of the patients. Significant correlations included air space consolidation with mucinous histology (p = 0.001) and focal nodule or mass with nonmucinous histology (p = 0.001). At CT of bronchioloalveolar cell carcinoma, the patterns of air-space consolidation correlate with mucinous histology and isolated nodules or masses with nonmucinous histology. The pattern of multiple nodules or masses, however, did not correlate with histology. Coexisting bronchioloalveolar adenomas can contribute to apparent multicentric disease in patients with nonmucinous histology.
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PMID:Bronchioloalveolar cell carcinoma: impact of histology on dominant CT pattern. 1092 10

In the period 1993-1998, digital carcinomas in 64 cats were examined. In all animals primary complaints were painful digit(s). Eight cats had a primary squamous cell carcinoma which involved one digit or two adjacent digits of one leg. Fifty-six cats had metastases of a pulmonary carcinoma in the digits, and in general multiple digits of different legs were involved. In many of these cats metastases also occurred in other organs, including the skin and muscles. No primary sweat gland carcinomas of the digits were seen. Primary squamous cell carcinomas of the digits were characterized by cornification and the absence of PAS-positive cells, PAS-positive secretory material. Immunohistochemically, these neoplasms stained negative with the monoclonal antibody CAM 5.2 directed against Keratin 8 (K 8). The metastases of pulmonary carcinomas to the digits showed one or more of the following histological features: goblet cells, ciliated epithelial cells, PAS-positive cells or lakes, and/or a PAS-positive lining of luminal membranes and no cornification. Immunohistochemically, they showed positive staining for CAM 5.2 (K8). Thoracic radiographs from three cats with a primary squamous cell carcinoma showed no abnormalities, whereas all cases of metastases from a pulmonary carcinoma to the digits available for follow-up showed evidence of a primary pulmonary carcinoma on radiography and/or postmortem examination (25 out of 56). The conclusion of this study was that most carcinomas in the digits of cats were metastases of a primary pulmonary carcinoma (87.5%). Primary squamous cell carcinomas occurred infrequently. The prognosis of metastases of a pulmonary carcinoma in the digits is poor with an average survival time of 4.9 weeks, in contrast to 29.5 weeks in cats with a squamous cell carcinoma. These data stress the importance of taking thoracic radiographs of cats with digital tumours before surgical intervention.
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PMID:Primary and metastatic carcinomas in the digits of cats. 1095 43

The authors describe their experience with the surgical treatment of metachronous homolateral lung cancer by completion pneumonectomy. In the Department of Thoracic Surgery of the National Cancer Institute of Milan, over a period ranging from 1982 to 1996, 30 completion pneumonectomies were performed for local relapses or second primary tumors. The patients submitted to this intervention had a lobectomy as their first operation in 23 cases (77%), a bilobectomy in 4 (13%) and a typical segmentectomy in 3 (10%). Associated with these interventions we performed 2 en bloc chest wall resections and a contralateral wedge resection. Two subjects received neoadjuvant chemo-therapy. Histology revealed squamous carcinoma in 14 cases (47%) and adenocarcinoma in 16 (53%). Seventeen patients (57%) were classified as stage I, 8 as stage II (26%), 4 as stage III (13%) and 1 as stage IV (4%). Four patients received adjuvant chemotherapy and/or radiotherapy. Lung cancer relapse occurred as a single lesion in 27 cases (90%) and as multiple lesions in 3 (10%). We performed 18 right (60%) and 12 left (40%) completion pneumonectomies. In 1 case (4%) a sleeve pneumonectomy was necessary. Associated with these interventions we performed 5 en bloc chest wall resections. The perioperative mortality was 10% and the postoperative morbidity 40%. Histological tests showed 12 squamous carcinomas (40%) and 18 adenocarcinomas (60%). Two patients (7%) had a different histology. Disease was classified as stage I in 13 cases (44%), as stage II in 9 (30%) and as stage III in 8 (26%). Four patients received adjuvant chemotherapy and/or radiotherapy. Two subjects developed a metachronous contralateral tumor (7%). The disease-free interval was 22.70 +/- 14.69 months, with a median value of 17 months (range: 7-53 months). Mean survival after completion pneumonectomy was 49.77 +/- 49.29 months, with a median value of 26.5 months (range: 4-190 months). The 5-year actuarial survival rate, calculated using the Kaplan-Meier method, was 30%. Completion pneumonectomy is a technically very demanding intervention carrying a high risk of morbidity. On the basis of the analysis of our data, we can affirm that mean postoperative survival seems to be satisfactory and to justify this aggressive attitude towards recurrent tumor. We should stress the importance of careful evaluation of indications and precise selection of patients.
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PMID:[Surgery in the treatment of metachronous homolateral non-small cell lung cancer]. 1119 May 46

Over a 10-year period, a total of 403 patients with mammary gland carcinoma--398 women (98.8%) and five men (1.2%)--are operated in the Clinic of Thoracic Surgery & Oncology at the Military Medical Academy. The mean age in men, as compared to that in women, is nearly 12 years older. In one patient tumorectomy is done for "cleanliness" on account of the seriously impaired general condition. In the remainder the operative intervention is radical mastectomy after Patey or Pirogov, with meticulous axillary lymph dissection. In all men operated on, gynecomastia concurrent to the underlying disease is found. The histological patterns of mammary gland cancer in male patients is identical to the histological picture in women.
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PMID:[Mammary gland carcinoma in men]. 1119 27

Bronchoplastic and reconstructive operations (BPRO) are a major issue in the broad methodological spectrum of thoracic surgery. It is the aim of the study to analyze the indications, operative technique and results of such operations on the basis of experience gained in the Clinic of Thoracic Surgery over a 5-year period. A total of 19 patients (14 men and 5 women) at mean age 50.7 y (range 16 to 70 y) are operated. By histological variant of the tumor operated on, the patients are distributed as follows: carcinoid--4 cases, fibromas--1, squamous cell carcinoma--10, adenocarcinoma--1, bronchoalveolar carcinoma--1, small-cell carcinoma--1 and leiomyosarcoma--one. The reconstructive operations performed include: isolated bronchus resection--2, right upper lobectomy with cuff resection--7, right upper bilobectomy with cuff resection--2, left upper lobectomy with cuff resection--7 (in two instances in conjunction with angioplasty), and left lower lobectomy with cuff resection and angioplasty--one. No intraoperative and perioperative lethality (within 30 days) is recorded. An overweight female patient with diabetes hardly lending itself to compensation develops severe suppuration. In two instances serious concurrent complications necessitate reoperation. Overall postoperative hospital stay--20 days; without the 3 severe complications--12.8 days. One patient dies of brain metastases within 6 months of the intervention. The survivorship term in the remainder varies from 1 year to 4 years 9 months, averaging 31 months. There are no stenoses or granulations of the anastomoses requiring endoscopic treatment. Presumably, BPRO are an adequate therapeutic approach to patients presenting centrally located malignant and benign tumors. The results of their application in the series being examined are estimated as very good.
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PMID:[Plastic and reconstructive surgery of the bronchial tree]. 1148 51


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