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

Malignant tumors are a frequent problem in gerontologic medicine; moreover, the number of geriatric patients is increasing. Surgical treatment is often proposed for solid tumors, even in patients over 80 years of age. 183 cases observed over the last 15 years in the Digestive and Thoracic Clinics of the University Hospital, Geneva, are reviewed. The affected organs were, in order of frequency, 1. large bowel, 2. breast, 3. stomach, and, more rarely, biliary tract, pancreas, esophagus and liver. Postoperative survival was satisfactory in this series. Analysis by organ shows that, in the case of the large bowel, one-stage resection-anastomosis provides the best results. For the breast, the classic procedures under general anesthesia are recommended. For the stomach, resection of the tumor prolongs survival. Postoperative mortality within 30 days is not increased by this type of intervention. Classification of evaluation of operative risk, as proposed by the American Society of Anesthesiologists, corresponds favourably with the postoperative mortality rate. For nearly 60% of our patients the quality of life is the same postoperatively as before. In this group, 78% have a Karnofsky index of 100%. It can therefore be stated that surgery for solid tumors is well tolerated by geriatric patients.
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PMID:[Cancer surgery in patients over 80 years old]. 730 34

We began using the fiberoptic bronchoscope March 1, 1971, and after more than 2,800 examinations are convinced it is a highly useful diagnostic tool. We pass the open-end straight bonchoscope into the upper trachea under local anesthesia. Then, the fiberoptic bronchoscope is passed through this conduit. The advantages of the technique are discussed. The greatest advantage of fiberoptic bronchoscopy is the extended visibility it provides of peripheral lesions in the tracheobronchial tree. In this series, which includes more than 700 patients with primary bonchogenic carcinoma, the tumor was visible in one-third of the patients when only the straight bronchoscope was used while in two-thirds it was visible with the flexible bronchoscope. There were no deaths, and complications were rare and of little consequence. Thoracic surgeons are urged to use this instrument.
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PMID:The flexible fiberoptic bronchoscope: diagnostic tool or medical toy? 738 48

Neuroblastoma, Hirschsprung's disease, and central hypoventilation (Ondine's curse) are considered aberrations of neural crest cell growth, migration, or differentiation, and as such are considered to be under the general heading of neurocristopathy. Their combined occurrence in a newborn infant presenting with total colonic aganglionosis, central hypoventilation, and multifocal neuroblastoma had not been reported previously. A 2.3-kg white full-term girl required endotracheal intubation because of persistent apnea in the first hours of life. She had progressive abdominal distension and failure to pass meconium; a barium enema was performed, which showed microcolon with meconium pellets at the distal ileum. During laparotomy the distal ileum was found to be obstructed with inspissated meconium; an ileostomy and appendectomy were performed. The resected specimens were aganglionic. An additional 20 cm of aganglionic ileum was removed, and a normally innervated ileostomy was constructed. Numerous attempts at extubation failed because of apnea. The results of an extensive apnea workup, including electroencephalogram, magnetic resonance imaging (MRI), bronchoscopy, and pH probe study, were normal. Sleep studies showed congenital central hypoventilation syndrome, and the patient underwent a tracheostomy. At 3 months, an abdominal ultrasound examination performed within a septic workup showed a right suprarenal mass extending across the midline. Thoracic and abdominal MRI scans showed large bilateral adrenal and posterior mediastinal masses. The serum catecholamines and ferritin level were markedly elevated, suggestive of neuroblastoma. In light of the child's multiple problems, the family chose to forgo further workup (including a tissue biopsy) and therapy. In the following 2 months her tumor load rapidly progressed, and she died of respiratory insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The complete spectrum of neurocristopathy in an infant with congenital hypoventilation, Hirschsprung's disease, and neuroblastoma. 747 88

The authors describe 694 patients who underwent operation in 1985-1993 for carcinoma of the proximal part of the stomach with various degree of involvement of the adjacent parts of the stomach and esophagus. The tumors differed in histological structure. The main principles of classification of the groups of regional lymph nodes, taking into account the localization of the tumor in the stomach, are shown. These Principles are applied by Japanese surgeons in performing lymph node dissection and were modified in the Clinic od Thoracic Oncology of the Scientific Research Institute, Oncological Center, Russian Academy of medical Sciences. The localization and incidence of metastases in disseminated carcinoma of the proximal stomach with involvement of the esophagus were studied. The sequence of the stages of intraabdominal lymph node dissection in proximal gastric resection and gastrectomy is discussed. The tendency towards improvement on the indices of 3-year survival after expanded operations is noted. Expanded operations with scrupulous morphologic examination of the removed lymph nodes is very important for more precise determination of the stage and individual prognostication of the choice of the postoperative methods of treatment. In palliative interventions the operation is cytoreductive in essence and may create to a certain measure better conditions for chemotherapy.
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PMID:[Lymph node dissection in patients with cancer of the proximal part of the stomach]. 747 4

Primary small-cell cancer of the esophagus is a rare tumor that disseminates early with a uniformly poor prognosis if untreated. Sixteen patients with malignant dysphagia referred to the Thoracic Surgical Unit, City Hospital, Edinburgh, within a 10-year period had a diagnosis of primary small-cell cancer of the esophagus. Seven patients underwent subtotal esophagectomy or esophagogastrectomy, either alone or with adjuvant chemotherapy or radiotherapy, with a mean survival of 20 months (standard deviation 35.4 months, range 2 weeks to 96 months). The remaining nine patients had disseminated disease when they were first seen and were treated symptomatically by intubation alone (1 patient), intubation and palliative chemotherapy or radiotherapy (3 patients), palliative chemotherapy (2 patients), palliative radiotherapy (1 patient), or no therapy (2 patients), with a mean survival of 4.8 months (standard deviation 2.6 months, range 2 to 9 months). Patients seen with this aggressive tumor should be assessed urgently for evidence of metastatic spread and then offered resection in combination with chemotherapy if they are otherwise fit for operation. This treatment regimen has given us one long-term survivor (96 months) who, we believe, is the only patient to have been cured of this condition. Patients seen with disseminated disease should have symptomatic treatment of the dysphagia combined with palliative chemotherapy.
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PMID:Primary small-cell cancer of the esophagus. 753 97

Chylothorax is a rare but complex disorder in domestic animals. Etiologies include neoplasia, fungal infections, heartworm infestation, cardiac disease, thrombosis of the cranial vena cava, and congenital anomaly of the thoracic duct. Most cases of chylothorax in dogs and cats are idiopathic. Positive contrast lymphangiography on dogs and cats with chylothorax consistently reveals extensive lymphangiectasia of mediastinal and pleural lymphatics. Reported treatment modalities for chylothorax in animals include removal of the etiologic agent, such as a mediastinal tumor, thoracic duct ligation, and implantation of active or passive drainage devices such as a pleuroperitoneal shunt. Thoracic duct ligation has been most successful in our experience, but continued study is needed since treatment failures are common.
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PMID:Chylothorax in the dog and cat: a review. 756 93

All of these approaches are valuable and worthwhile, depending on the site of the apical tumor (anterior or posterior). When using an anterior approach, however, if significant posterior chest wall involvement is also present, a combined approach may be necessary, turning the patient after closure of the anterior wound, and completing the excision from the posterior approach. Thoracic surgeons involved in the management of these tumors should have all of these approaches available in their armamentarium. The overall 5-year cure rate following surgical resection of superior sulcus tumors is about 30%. In our experience, when a complete resection is performed, including a lobectomy, the 5-year cure rate is doubled. The results of en bloc resection of adjacent involved organs (subclavian vessels, vertebral body) are less optimistic in most reported series, which may reflect inadequate resections.
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PMID:Resection of a superior sulcus tumor. 761 67

The recent twenty years have brought major advances in reconstruction of pharyngoesophageal defects. Early dependence on multiple staged procedures initially were replaced by colon interposition and gastric pull-up. Subsequent elucidation of the musculocutaneous concept has added useful techniques such as the sternocleidomastoid and pectoralis major musculocutaneous flaps. Increasing experience with microsurgical reconstruction and a larger number of flaps available have made free tissue transfer a common and reliable method of reconstruction of significant defects. The choice of reconstruction depends to greatest degree on the oncologic needs of the situation. If the entire esophagus or significant part of the thoracic esophagus is involved by tumor then total esophagectomy and gastric pull-up or colon interposition is indicated. For most hypopharyngeal and laryngopharyngeal tumors, and a significant number of cervical esophageal tumors, segmental resection of the area with the appropriate node dissection and replacement with a jejunal free autograft or radial forearm free flap gives a high likelihood of success. Thoracic musculocutaneous flaps may be useful if proper precautions are observed in the reconstructive technique. This article presents the accumulated experience with these techniques and management of the subsequent problems.
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PMID:Reconstruction of the pharynx and cervical esophagus. 763 8

An adult male Muscovy (Cairina moschata) X Peking (Anas platyrhynchos) duck had a primary malignant uveal melanoma with periocular extension involving the left eye. The periocular mass displaced the globe 1.5 cm laterally. Thoracic metastasis of the ocular neoplasm infiltrated the pectoral muscles, rib cage, and cranial lung lobe on the left side, causing diminished voluntary motion of the left wing. The left orbit was exenterated, but tumor regrowth was evident within 2 weeks. This case was unusual because melanocytic neoplasms are rare in birds.
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PMID:Uveal malignant melanoma in a duck. 777 38

We present a patient with hepatocellular carcinoma with systemic hematogenous metastases, but without parenchymal pulmonary involvement. Thoracic imaging revealed prominent mediastinal involvement. This pattern of hepatocellular tumor spread is unique.
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PMID:Hepatocellular carcinoma presenting as a mediastinal mass. 806


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