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

Results in 23 patients operated upon for the repair of aneurysms of the descending thoracic aorta with a TDMAC-heparin-bonded shunt are reported. The results with particular reference to paraplegia are compared with those in 365 patients operated upon by members of The Samson Thoracic Surgical Society utilizing this and other techniques. No technique completely prevented paraplegia.
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PMID:Results of the use of the TDMAC-heparin shung in the surgery of aneurysms of the descending thoracic aorta. 32 Mar 95

Rats were subjected to 3,500 r of X-irradiation in a single dose while breathing oxygen at 1 ATM pressure. Comparison was made between the delayed effects of irradiating thoracic, lumbar, and the cauda equina fields. The lumbar field involved the alpha-motoneurons and spinal roots supplying the sciatic nerve, while the cauda equina field involved these spinal roots but spared the alpha-motoneurons in the spinal cord. Thoracic irradiation produced paraplegia after an interval of 127-150 days. In the irradiated zone, the spinal cord was severely damaged, but the thoracic spinal roots were spared. Lumbar irradiation produced paraplegia after an interval of 83-211 days. In the irradiated zone, the alpha-motoneurons were largely spared, the spinal cord showed mild to moderate white matter damage, but the most severe damage was of the lumbosacral spinal roots. The posterior roots were more affected than the anterior. In longer interval cases the degeneration of the roots appeared to be due to focal devitalization. Evidence is advanced that root degeneration had been progressing for at least 4 weeks before the onset of paraplegia. In the cauda equina series the lumbosacral spinal root changes were similar to those in the lumbar series. This study indicates that different levels of the neuraxis have different degrees of susceptibility to X-irradiation. The thoracic cord appears more susceptible than the lumbosacral; the lumbosacral roots appear more susceptible than the thoracic; the posterior roots are more susceptible than the anterior. These findings may have relevance to the study of radiation damage in man, even though the dose schedule used in this experimental study differs greatly from that used for radiotherapy.
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PMID:Delayed myeloradiculopathy produced by spinal X-irradiation in the rat. 83 11

Paraplegia from spinal cord ischemia during thoracoabdominal aneurysm repair remains an unpredictable and unpreventable complication. In an effort to prevent spinal cord ischemia during aortic cross-clamping, preoperative angiographic localization of the blood supply to the spinal cord was performed in dogs. Sixteen animals underwent 60 minutes of thoracoabdominal aortic cross-clamping either without (control, n = 8) or with (shunted, n = 8) a selective shunt. Shunting was performed from the aortic arch to that isolated aortic segment angiographically shown to supply the thoracolumbar anterior spinal artery. Spinal cord blood flow was measured with microspheres just prior to cross-clamping, at 5 and 60 minutes after cross-clamping and at 5 minutes after restoration of aortic blood flow. Functional neurologic outcome was evaluated in animals at 24 hours postoperatively. Shunting did not decrease spinal cord injury. Seven of the 8 animals in the control group and 7 of the 8 in the shunted group developed paraplegia or paraparesis. Thoracic, but not lumbar spinal cord blood flow, was significantly increased in shunted animals. Spinal cord blood supply in dogs may be more segmental than previously believed. Technical problems in angiographic localization, spinal artery spasm, loss of spinal cord autoregulation or poor collateral circulation from the distal thoracic to the lumbar cord may also account for these results. Although shunting to aortic segments supplying the anterior spinal artery during thoracoabdominal aortic clamping may be attractive in humans, no benefit could be shown in this experimental model.
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PMID:Failure of selective shunting to intercostal arteries to prevent spinal cord ischemia during experimental thoracoabdominal aortic occlusion. 129 34

A 63 year old male complained of persistent backache and productive cough. The chest X-ray revealed the fungus ball at the left apical-posterior segment and Aspergillus fumigatus was cultured from the sputum. He was treated on fulconazole and miconazole. Six months later, motor and sensory paralysis below the mamillary level and urinary and stool incontinence developed. A magnetic resonance image disclosed the destruction of the second thoracic spinal vertebra involved by the cavitated fungus ball of the left lung. Continuous peroral administration of antifungal drugs was not successful, and he expired with severe dyspnea. The autopsy revealed an extensive granulomatous and purulent change of the epidural and subdural spaces of the second to fifth thoracic spinal cord. Subdural inflammation extended to the lower thoracic and lower cervical level. Thoracic spinal cord revealed an extensive myelomalacia predominantly involving the left lateral white column, and also anterior and posterior columns. Small areas of the white matter were cystic. The left anterior horn cells revealed severe central chromatolysis. Moderate lymphocytic and plasma cell infiltration was found around the vessels within the cord. A few thrombi were found in the vein near the anterior nerve root. Central nervous system involvement of pulmonary aspergillosis is quite uncommon. However, there are a few reports of patients with paraplegia secondary to the spinal extension by aspergillus infection. Sheth et al. described that epidural and subdural granulomatous change with aspergillus abscesses and spinal cord myelomalacia is comparable to metastatic carcinoma. However, the aspergillus infection in the spinal cord is more extensive and destructive.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Aspergillosis involving the thoracic spinal cord--an autopsy case]. 129 15

From November 1984 to May 1991, descending thoracic aorta to femoral artery bypass was used to revascularise 51 lower limbs in 27 patients. There were 25 men and 2 women with a mean age of 60.2 years. There were four primary indications because of inability to use the abdominal aorta, and 23 secondary indications for late failure of a previous lower limb revascularisation: two aorto-prosthetic false aneurysms, nine infected aorto-bifemoral bypasses and 12 occluded grafts. Three deaths and one paraplegia occurred during the postoperative period, and three prosthetic occlusions and one popliteal embolism were successfully treated. During follow up (6-72 months) five deaths and three graft occlusions were observed; at 5 years, the cumulative life expectancy was 61.8 +/- 26.8%, and the cumulative secondary graft patency was 72.6 +/- 24.7%. One prosthetic infection and one ureteric fistula occurred and both were successfully treated. Thoracic aorta to femoral artery bypass is a simple extra-anatomic technique which can be used in cases of failure of a previous aorta to lower limb reconstruction. The haemodynamic results are good, and late results are better than axillo-femoral or bifemoral bypass.
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PMID:Use of descending thoracic aorta for lower limb revascularisation. 159 29

Severe multiple trauma raises difficult problems of rehabilitation. In the most usual cases, other injuries are associated with head injuries and coma, and they must be systematically screened by a very complete radiological assessment and a thorough clinical examination. Rehabilitation will be passive as long as the injured person is comatose; however, it is very important as it allows preventing bedsores and the reduction of joint amplitude that may have serious consequences later on. The associated fracture of the limbs require orthopedic or surgical solutions. External fixation devices, which are sometimes used, complicate the rest of rehabilitation. Fractures of the spine are fortunately rare, even more so when associated with lesions of the cord causing paraplegia and tetraplegia. Thoracic complications are frequent and sometime produce a complicated postoperative period so that the removal of the tracheal tube, and sometimes the suppression of feeding through a nasogastric tube or gastrostomy, will be delayed. The management of head injuries is complex. First of all the injured person, whose consciousness often is fluctuant for some times, must be reassured, pampered, then progressively helped to cooperate and to take care of himself again. The disorders, including disorders of speech, of vision, deficiencies, disorders of balance, of coordination, will be as completely assessed as possible through a complete examination. The existence of frequent orthopedic disorders will hinder the progress towards self-reliance. Simultaneously, the cognitive functions will be restored: the memory is often severely disturbed, and disorders of attentiveness and reasoning must also be dealt with. As far as possible, attempts will be made to treat the very
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PMID:[Rehabilitation of multiple injured patients]. 212 79

Spinal cord hypoperfusion injury is a devastating complication of cross-clamping the proximal thoracic aorta. The collateral circulation around the cross-clamp is generally poorly developed, and the run-off is immense, resulting in extremely low thoracic aortic and spinal cord perfusion pressures. The authors postulated that balloon occlusion of the abdominal aorta might confine this reduced collateral flow around the cross-clamp to the thoracic aorta. In 8 of 16 dogs subjected to aortic cross-clamping of the aorta just beyond the arch vessels, the abdominal aorta was also occluded by a balloon. Thoracic aortic pressure and spinal cord perfusion pressure were significantly higher in the animals with aortic balloon occlusion than in those without balloon occlusion (77 +/- 8 mm Hg versus 26 +/- 1 mm Hg, p less than 0.01, and 67 +/- 8 mm Hg versus 18 +/- 2 mm Hg, p less than 0.01, at 10 minutes after cross-clamping). Abdominal aortic balloon occlusion increases thoracic aortic pressure after the aorta is cross-clamped proximally. Further studies are necessary in primates to assess the effect of this procedure in spinal cord perfusion and the rate of paraplegia.
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PMID:Improvement in thoracic aortic pressure after proximal aortic cross-clamping by balloon occlusion of the distal aorta. 225 26

Recent clinical reports have suggested that drainage of cerebrospinal fluid lowers the incidence of perioperative paraplegia in patients with thoracoabdominal aneurysms. Unfortunately, the precise mechanisms for both the neurologic deficits and the beneficial effects of cerebrospinal fluid drainage remain unclear. To better understand the relationship between cerebrospinal fluid pressure, central venous pressure, and the compliance of the cerebrospinal fluid compartment, we studied 12 anesthetized dogs subjected to thoracic aortic occlusion. Pericardia were opened in six (group I), and left intact in six (group II). Systemic hemodynamics and cerebrospinal fluid pressure (mm Hg) were measured before and after thoracic aortic occlusion. In group II, intravenous volume loading (15 ml/kg) was superimposed on aortic occlusion. Compliance of the cerebrospinal fluid space (ml/mm Hg) was measured at each interval by use of sequential injection and withdrawal of small aliquots of fluid. Results are expressed as mean +/- SE; *p less than 0.05. Thoracic aortic occlusion resulted in predictable changes in mean arterial pressure (group I 95.8 +/- 7.1 to 123.3 +/- 7.1*, group II 82.5 +/- 6.9 to 98.3 +/- 9.5*) and central venous pressure (1.9 +/- 0.7 to 3.8 +/- 0.6*, 3.0 +/- 0.8 to 4.0 +/- 0.9*). Although cerebrospinal fluid pressure was increased by thoracic aortic occlusion in both groups (8.0 +/- 1.2 to 12.6 +/- 1.9*; 5.8 +/- 0.9 to 8.5 +/- 1.1*), compliance of the dural space was was not changed (0.61 +/- 0.19 to 0.60 +/- 0.18; 0.54 +/- 0.14 to 0.62 +/- 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mechanism of increased cerebrospinal fluid pressure with thoracic aortic occlusion. 233 35

The relationship between the evoked spinal cord potential (ESP) and the histological findings of the spinal cord after thoracic aortic cross-clamp was studied. Thoracic aorta was cross-clamped in 23 dogs and ESP was monitored before, during, and after cross-clamping. Incidence of paraplegia and histological findings were studied after the dogs recovered from the procedure. Aortic cross-clamp was maintained for 60 minutes in 20 dogs (Group A). And cross-clamp was released 10 minutes after the amplitude of ESP became lower than 20% of control in 3 dogs. (Group B). In group A, three types of ESP changes were detected; ESP became lower or lost during cross-clamping in type 1 response, ESP remained unchanged in type 2 response, and ESP returned after transient loss during cross-clamping in type 3 response. Four of five dogs with type 1, none of nine with type 2, two of five with type 3 response showed paraplegia. One of the dogs with type 2 response showed paraparesis. ESP could not detected in one dog, in which traumatic spinal cord injury during laminectomy caused paraplegia. In Group B, all dogs showed type 1 response and paraplegia. Characteristic histological finding of the spinal cords of the dogs with paraplegia was the ischemic necrosis mainly in the gray matter. Necrotic foci were limited in the posterior horn in mild, in the anterior and posterior horn in moderate changes. And neurons were lost in entire gray matter in severe histological changes. In the spinal cords of the dogs with spastic paraplegia, severe histological changes were limited in the lower lumbar region.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A study of spinal cord ischemia during aortic cross-clamp--evoked spinal cord potential and histological analysis of the spinal cord]. 234 4

We report a case of acute spinal epidural hematoma diagnosed by MRI-CT. A 76-year-old woman was admitted in our hospital for the purpose of the gastrectomy against her early cancer of stomach. Thoracic epidural anesthesia (Th8/9) was attempted for the operation and soft tube was continuously remained in the epidural space after successful gastrectomy. On the second day after operation, the tube was pulled out from the epidural space safely. However, the patient complained severe thoracic-back pain and complete paraplegia of legs with sensory loss beneath Th10 level of dermatoma. X-ray CT and MRI-CT showed spinal epidural hematoma, especially MRI-CT made clear the relationship between spine and hematoma and the level of longitudinal expansion. The hematoma was recognized in MRI-CT as high signal intensity spindle-shape area (spine echo Tr/Te 1800/100). The spinal epidural hematoma existed from 4th to 12th thoracic vertebra level on sagittal slice. Her symptom recovered completely about three hours and a half after the onset spontaneously, and there is no recurrence of paraplegia. The mechanism of spontaneous recovery from paraplegia is assumed that the spreading of the hematoma in epidural space up- and downwards to the rostro-caudal direction results in decompression. Acute spinal epidural hematoma occurred by continuous epidural anesthesia, and with spontaneous recovery is very rare. The hematoma disappeared in MRI-CT on the 26th day after the onset. MRI-CT is useful to detect spinal epidural hematoma safely and accurately for its diagnosis.
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PMID:[Acute spinal epidural hematoma in MRI-CT, following continuous epidural anesthesia with spontaneous recovery]. 275 53


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