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

Between 1974 and 1984, 1,188 patients with esophageal malignancies were treated in the Division of Thoracic Surgery of Veterans General Hospital, Taipei. The rate of resectability was 42.6%. Since 1974, the stomach has been used as esophageal substitute, and through 1984, a total of 368 patients were collected. The routes of reconstruction included retrosternal (77.2%), posteromediastinal (7.1%), and intrathoracic (15.7%). The rates of postoperative complications and surgical mortality in these 368 patients were 26.3% and 6.5%, respectively. Leakage of anastomosis was the most frequent complication. The incidence of stricture of esophagogastrostomy was 25.5%. All strictures were relieved by esophageal dilations. An average of 3.9 esophageal dilations were performed per patient (range, 1 to 15). Radical lymph node dissection was not routinely performed in our series. The actuarial 2-year and 5-year survival rates were 26.4% and 7.6%, respectively. Among 76 patients undergoing cervical esophagogastrostomy and surviving for more than 1 year, late complications occurred as follows: acid/bile regurgitation, 46.1%; postprandial fullness of abdomen, 38.2%; dumping syndrome, 13.2%; distended stomach with dyspnea, 11.8%; aspiration pneumonia, 6.6%; and gastric ulcer, 6.6%. Moreover, compared with patients without pyloroplasty, those with pyloroplasty were found to have a higher incidence of bile regurgitation (55.5% versus 8.6%), dumping syndrome (33.3% versus 6.9%), aspiration pneumonia (16.7% versus 3.4%), and gastric ulcer (22.2% versus 1.7%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Gastric substitution for resectable carcinoma of the esophagus: an analysis of 368 cases. 173 71

The Infectious Diseases Society of America (IDSA) has published guidelines for the treatment of community-acquired pneumonia (CAP). Although Streptococcus pneumoniae remains the most common etiologic agent, Chlamydia pneumoniae and Legionella pneumophila are also important causes. For all suspected CAP patients, particularly those requiring hospitalization, chest radiographs are strongly recommended to confirm the diagnosis. The IDSA guidelines, in contrast to those published by the American Thoracic Society, emphasize the use of sputum Gram's stain and culture in all patients, whenever possible, to establish etiology. This information can be used not only to guide therapy but also to track trends in the etiologic pathogens for CAP and their antibiotic susceptibility. In light of the better outcomes with the earliest possible interventions, the IDSA recommends initial empiric antimicrobial therapy until laboratory results can be obtained to guide more specific therapy. Macrolides, doxycycline, and fluoroquinolones are suggested for primary empiric therapy, since each has activity against common bacterial pathogens and atypical agents. Detailed antibiotic recommendations are made for various pathogens. For inpatients, attempts should be made to cover Legionella and other common pathogenic bacteria. Alternative antibiotics are recommended for patients with structural diseases of the lung, penicillin allergy, or suspected aspiration pneumonia. Switch to an appropriate oral antibiotic is recommended as soon as the patient's condition is stable and he or she can tolerate oral therapy, often within 72 h.
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PMID:Treatment of community-acquired pneumonia--IDSA guidelines. Infectious Diseases Society of America. 1008 53

The systemic autoimmune diseases include collagen vascular diseases, the systemic vasculitides, Wegener granulomatosis, and Churg-Strauss syndrome. They can cause a variety of thoracic abnormalities that are influenced by the pathophysiologic characteristics of the underlying disease process. Although many of the abnormalities can be detected at chest radiography, high-resolution computed tomography (CT) has been shown to be superior in depicting parenchymal, airway, and pleural abnormalities. Thoracic manifestations of collagen vascular diseases include pleural disease, pulmonary fibrosis, diaphragm weakness, aspiration pneumonia, bronchiolitis obliterans organizing pneumonia, bronchiolitis obliterans, and bronchiectasis. Wegener granulomatosis may be associated with multiple nodules or masses with irregular margins that are frequently cavitated. Patients with Churg-Strauss syndrome often have consolidation or ground-glass attenuation at chest radiography and CT. Goodpasture syndrome is associated with extensive bilateral air-space consolidation.
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PMID:Thoracic manifestations of systemic autoimmune diseases: radiographic and high-resolution CT findings. 1111 17

Illicit drug use constitutes a major health problem and may be associated with various thoracic complications. These complications vary depending on the specific drug used and the route of administration. Commonly abused drugs that may play a role in causing thoracic disease include cocaine, opiates, and methamphetamine derivatives. Intravenously abused oral medications may contain filler agents that may be responsible for disease. Thoracic complications may be categorized as pulmonary, pleural, mediastinal, cardiovascular, and chest wall complications. Pulmonary complications of drug abuse include pneumonia, cardiogenic edema, acute lung injury, pulmonary hemorrhage, and aspiration pneumonia. Filler agents such as talc may result in panacinar emphysema or high-attenuation upper-lobe conglomerate masses. The primary pleural complication of illicit drug use is pneumothorax. Mediastinal and cardiovascular complications of illicit drug use include pneumomediastinum, cardiomyopathy, myocardial infarction, aortic dissection, and injection-related pseudoaneurysms. Chest wall complications include diskitis and vertebral osteomyelitis, epidural abscess, necrotizing fasciitis, costochondritis, and septic arthritis. Categorization of thoracic complications of illicit drug use may facilitate understanding of these disorders and allow accurate diagnosis.
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PMID:Thoracic complications of illicit drug use: an organ system approach. 1237 6

Thoracic infections due to Trichomonas species often go unrecognised as they are seldom described in the literature. We describe a case that, to our knowledge, is the first reported case of empyema caused by this organism. A 59 year old man with metastatic adenocarcinoma of the lung developed a right pyopneumothorax following treatment with corticosteroids and radiotherapy. The pleural fluid was purulent and fetid, and contained large numbers of Trichomonas tenax amongst a mixed bacterial flora. Pleural drainage and antibiotic therapy with metronidazole, ciprofloxacin and gentalline were instituted immediately, but the patient died 4 days later. Trichomonas tenax is part of the normal oral floral and may on occasions colonize the airways. It can thus become involved during aspiration pneumonia or cause pleural infection following the rupture of a pulmonary abscess. Such infection tends to be associated with concurrent respiratory pathology or with immunodepression. The significance Trichomonas tenax when found in the airways is unclear and their pathogenic role is discussed.
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PMID:[Pleural trichomoniasis due to trichomonas tenax]. 1754 21

A two-year-old male entire border collie dog was evaluated for a short history of mixed bowel diarrhoea, coughing, vomiting and stranguria. Physical examination revealed dyspnoea with increased ventral lung sounds and a flaccidly distended bladder. Neurological examination revealed poor pupillary light reflexes, an absent gag reflex and a poor anal tone. Thoracic radiography was consistent with megaoesophagus and aspiration pneumonia. Clinicopathological testing revealed an elevated muscular nicotinic acetylcholine receptor antibody titre. The dog was euthanased because of clinical deterioration. Cerebrospinal fluid (CSF) collected immediately post-mortem revealed macrophagic pleocytosis. Post-mortem histopathological examination was consistent with dysautonomia. This is the first report of coexisting autoimmune myasthenia gravis and dysautonomia in a non-human species. The concomitant diseases may suggest a common immunopathological aetiology.
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PMID:Autoimmune myasthenia gravis and dysautonomia in a dog. 1868 49

An 81-year-old man was admitted to our hospital with aspiration pneumonia and thereafter suddenly died of massive hemoptysis. An autopsy revealed an aortic arch aneurysm which had ruptured into the left lung. This case showed that acute infectious lung diseases, such as aspiration pneumonia, could cause a rupture of thoracic aortic aneurysms. Thoracic aortic aneuysms are uncommom causes of hemoptysis. Their rupture into the left lung is rarer than that into other organs and not many such cases have been previously reported in the literature. Making an accurate diagnosis is also difficult if an aneurysm is not suspected. Delay in surgical treatment could result in a lethal hemorrhage. In conclusion, we suggest that thoracic aortic aneurysms should always be considered and carefully ruled out in patients who present with either massive or minor hemoptysis.
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PMID:[An autopsy case of massive hemoptysis due to a rupture of the thoracic aortic aneurysm into the left lung]. 1919 38

A 7-week-old, female Siberian husky was presented to Murdoch University Veterinary Hospital with an acute onset of respiratory distress and regurgitation. Thoracic imaging identified an intraluminal esophageal mass with concurrent aspiration pneumonia. Esophagoscopy identified the mass as stomach, and a diagnosis of gastroesophageal intussusception was made. The intussusception was reduced endoscopically, and fixation of the stomach to the abdominal wall was performed using a tube gastropexy. Gastroesophageal intussusception is an uncommon disease in small animals and traditionally has been managed surgically. This case report describes an alternative method of treatment associated with a good outcome in this puppy.
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PMID:Nonsurgical treatment of gastroesophageal intussusception in a puppy. 1957 Sep 2

An 11-year-old, spayed female, teacup poodle was evaluated for a chronic cough, lethargy, hindlimb weakness, and reluctance to exercise. Thoracic radiographs revealed megaesophagus and aspiration pneumonia. Serum antibodies against acetylcholine receptors confirmed the diagnosis of myasthenia gravis. The unusual clinical history and case outcome are discussed.
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PMID:Acquired myasthenia gravis in a poodle. 2153 24

Healthcare-associated pneumonia (HCAP) is a new concept of pneumonia proposed by the American Thoracic Society/Infectious Diseases Society of America in 2005. This category is located between community-acquired pneumonia and hospital-acquired pneumonia with respect to the characteristics of the causative pathogens and mortality, and primarily targets elderly patients in healthcare facilities. Aspiration among such patients is recognized to be a primary mechanism for the development of pneumonia, particularly since the HCAP guidelines were published. However, it is difficult to manage patients with aspiration pneumonia because the definition of the condition is unclear, and the treatment is associated with ethical aspects. This review focused on the definition, prevalence and role of aspiration pneumonia as a prognostic factor in published studies of HCAP and attempted to identify problems associated with the concept of aspiration pneumonia.
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PMID:Healthcare-associated Pneumonia and Aspiration Pneumonia. 2565 50


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