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

Sympathetic nerve disorders of the upper extremities can be treated by neurosurgeons using upper thoracic sympathectomy via a posterior approach. Descriptions have been published of alternative endoscopic procedures involving thermocoagulation, laser coagulation, or nonvideo-assisted ganglionectomy using equipment not widely available, with low morbidity and excellent results. The authors describe the use of an endoscopic approach to the thoracic sympathetic ganglia with systems designed for laparoscopic cholecystectomy. Thoracic ganglionectomy is reported in 22 patients with primary palmar hyperhidrosis and eight patients with reflex sympathetic dystrophy. The patients underwent double-lumen endotracheal intubation, after which 11- and 5.5-mm trocars were introduced into the chest cavity. Pneumothorax was produced with CO2 insufflation. Fiberoptic closed-circuit television was used to visualize the structures to be dissected. The parietal pleura over the heads of the first and second ribs was excised using 5-mm blunt and sharp insulated coagulating microscissors. The stellate and upper thoracic ganglia were clearly identified and dissected. The T-2 and T-3 ganglia were grasped with forceps and excised. A No. 16 French chest tube was introduced through a trocar, placed under water seal after the lungs were reinflated, and removed in the recovery room. The average hospital stay was 15.4 hours. There were no intraoperative complications. The average operating time was 30 minutes per side. Five patients had mild pleuritic pain which resolved within 2 weeks after surgery. Six (75%) of the eight patients with reflex sympathetic dystrophy had complete or partial relief of their symptoms (average follow-up period 5 months), and all patients had complete relief of hyperhidrosis (average follow-up period 8 months). Endoscopic ganglionectomy requires readily available and easily used instrumentation and provides a well-tolerated, cost-effective alternative to posterior thoracic sympathectomy for primary palmar hyperhidrosis and reflex sympathetic dystrophy.
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PMID:Video-assisted endoscopic thoracic ganglionectomy. 833 7

Thoracic procedures once requiring open thoracotomy are now being performed with video-assisted thoracoscopy. To visualize adequately the intrathoracic structures, creation of an artificial pneumothorax by carbon dioxide insufflation under positive pressures has been advocated. We hypothesized that positive-pressure insufflation during thorascopy would cause significant hemodynamic compromise. Eight healthy female pigs underwent general endotracheal anesthesia and placement of monitoring lines. After placement of a thorascope, baseline hemodynamic measurements were obtained at 0 mm Hg (atmospheric pressure). Measurements were taken randomly at 5, 10, and 15 mm Hg using carbon dioxide insufflation after stabilization at each pressure. Data were analyzed using Page's test for noparametric variables. Insufflation pressures of 5 mm Hg or greater resulted in significant decreases in cardiac index, mean arterial pressure, stroke volume, and left ventricular stroke work index, whereas central venous pressure increased (p < 0.001). Changes in heart rate were not significant. We do not recommend routine positive-pressure insufflation during thorascopy because of the significant hemodynamic compromise in our experimental model.
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PMID:Effects of insufflation on hemodynamics during thoracoscopy. 851 84

Videothoracoscopic and Videoassisted thoracic surgery makes diagnostic and therapeutic operation in the pleural cavity possible with minimal injury of the thoracic wall. The basic prerequisite is a free pleural cavity and selective pulmonary ventilation. VTS is a great asset in pulmonary biopsy, final treatment of a spontaneous pneumothorax, surgery of the thoracic sympathetic nerve and splanchnic nerves. VATS makes even such operations as lobectomy or pneumonectomy possible. According to the authors experience and views of the European Society of Thoracic Surgeons pulmonary carcinoma should be however operated by classical thoracotomy. The authors discuss the problem of indications and analyze operations implemented at the Third Surgical Clinic in Prague during the last three years.
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PMID:[The first 300 videothorascopic (VTS) and video-assisted (VATS) operations]. 876 9

Thoracic trauma victims commonly sustain visceral pleural injury with resultant pneumothorax. These injuries usually respond to standard tube thoracostomy decompression and drainage. However, a subset of these patients develop recurrent and/or loculated pneumothoraces or pneumatoceles that are not readily accessible by tube thoracostomy. Percutaneous catheter drainage of these collections provides a safe and reliable method of management in critically ill patients.
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PMID:Percutaneous drainage of recurrent pneumothoraces and pneumatoceles. 897 May 69

From December 1991 to June 1995, video-assisted thoracic surgery (VATS) was performed on 207 patients at the Medical Center of Delaware with minimal complications and no mortality. A definitive diagnosis was made in all patients. Results with VATS procedures appear to be comparable to those with the standard open technique. Operating time was comparable to that with the open technique. Length of stay and pain and suffering were dramatically reduced compared with the open technique. We now consider VATS to be the preferred procedure in the following conditions: 1. Undiagnosed pulmonary infiltrate in the non-ventilator-dependent patient. 2. Indeterminate pulmonary nodule. 3. Undiagnosed disease of the pleural space. 4. Recurrent or persistent pneumothorax. 5. Mediastinal or pericardial cystic tumors. 6. Thoracic sympathectomy. 7. Selected patients requiring esophagocardiomyotomy. The utilization of VATS for resection of a pulmonary mass in patients with compromised pulmonary status (i.e., FEV < 1) is being studied.
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PMID:The current role of video-assisted thoracic surgery (VATS) in the overall practice of thoracic surgery. A review of 207 cases. 937 64

This survey addressed common methods of video-assisted thoracoscopic pleurodesis for spontaneous pneumothorax. A questionnaire asking for frequency, recurrence rate and complications of the different methods of pleurodesis was sent to all hospitals that belong to the German Society for Thoracic Surgery. 19 hospitals reported on a total of 1365 operations. 88 recurrences (6.5%), 26 severe bleeding complications (1.9%), 39 persisting air leaks (2.9%) and two hospital deaths (0.1%) had been observed. Pleurectomy and pleural abrasion were the most common procedures but induced significant (p = 0.01) more bleeding complications (3.1% and 2.6%) than all other methods of pleurodesis (0.4%). Overall recurrence rates depended significantly on the chosen procedure (p = 0.0013). Pleurectomy (4.4%) and coagulation of the pleura (2.7%) showed better results than the average. Due to smaller numbers of operations and the widely differing results this significance cannot be shown for the individual recurrence rates of the different clinics. This survey demonstrated a trend towards lower rates of recurrence and complications after coagulation of the pleura parietalis. The retrospective character of the investigation and extremely different recurrence rates for different hospitals demand cautious interpretation of these results.
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PMID:[Assessment of current pleurodesis procedures exemplified by pneumothorax]. 941 91

Pleural and pleural-based intrathoracic masses lead to a real sound transmission, thus allowing a sonomorphological diagnostic approach. Thoracic sonography is particularly helpful to evaluate the nature of pleural-based radiographic opacities. Moreover, fine needle biopsies guided by sonography permit cyto-histological diagnoses of intrathoracic masses. Ultrasound-guided fine needle biopsy was performed in 15 patients with pleural-based space-occupying pulmonary lesions. True positive results were obtained in 12 of the 15 patients with two true negative results and one false negative aspiration. The overall accuracy of aspiration cytology was 14 out of 15 (93.3%). In one patient a small pneumothorax occurred as a complication of the transthoracic needle approach.
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PMID:[Ultrasound tomography and guided fine needle biopsy of intrathoracic space occupying lesions]. 941 25

The length of incision for the thoracotomy has been shorten relatively to the past. Para-scapular bow incision was over 30 cm in length but the axillary incision is a half of it. Now we have the minithoracotomy in 3 cm and the thoracoscopic treatment in 1 cm. Spontaneous pneumothorax is the best indication of thoracoscopic treatment because of the followings: 1. Pneumothorax is a benign disease. 2. Cause of air leak is rupture of the bulla which is located on visceral pleura. 3. Thoracic cavity is already opened in patients with pneumothorax. In our Center we have over 2,800 cases of spontaneous pneumothorax and we have treated thoracoscopically over 2,000. Electro-coagulation and/or YAG-LASER were used to destroy bullae within 1 cm in diameter. Looping and/or ENDO-AUTO-SUTURE devices has been used for bullae over 1 cm in diameter. Today recurrence rate is under a few% and no complications. Thoracoscopic treatment is the best way to cure the spontaneous pneumothorax and now it is the finest choice to manage of it.
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PMID:[Thoracoscopic surgery]. 942 70

Tachykinin-containing sensory axons originating from the cervical vagal nerves and the first several pairs of thoracic spinal nerves are involved in neurogenic inflammation evoked by capsaicin in the bronchial tree. Unilateral degeneration of the cervical vagal trunk by surgical lesion inhibits neurogenic inflammation in the ipsilateral bronchial airways. The vagal trunk has two main branches, the thoracic vagus nerve and recurrent laryngeal nerve in the thorax. The main purpose of this study was to determine whether the thoracic vagus nerve or recurrent laryngeal nerve was significantly involved in the neural control of bronchial inflammation in the rat. A novel and safe surgical procedure was used for selectively cutting the right thoracic vagal trunk, thoracic vagus nerve, or recurrent laryngeal nerve by introducing the surgical instrument through an aperture between the first and second ribs in the ventral wall of the rostral mediastinum. This surgical operation could be completed without causing a pneumothorax. After 2 postoperative weeks, the effects of denervation on capsaicin-induced plasma extravasation in the respiratory tract were tested. Either right thoracic vagal trunk transection or thoracic vagus section significantly decreased plasma extravasation in the right bronchial tree. Thoracic vagus section was obviously more effective. Evans blue extravasation in the right lobar bronchi was reduced by 44-78% after thoracic vagal trunk transection, while that in the right mainstem and lobar bronchi was reduced by 58-81% after thoracic vagus section. Area densities of India ink-labeled leaky blood vessels in the right lobar bronchi were reduced by 40-65% after thoracic vagal trunk transection, and those in the right mainstem and lobar bronchi were reduced by 83-88% after thoracic vagus neurectomy. Recurrent laryngeal neurectomy did not change the plasma extravasation induced by capsaicin in the trachea and bronchi. These results suggest that capsaicin-sensitive fibers running in the vagal trunk, which largely mediated neurogenic inflammation in the bronchial tree, were projected into the thoracic vagus nerve which, in turn, sent these nerve fibers to the ipsilateral bronchial tree. For the trachea, the remaining sensory fibers surviving denervation might provide sufficient tachykinins to trigger neurogenic inflammation.
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PMID:A novel procedure for mediastinal vagotomy inhibits neurogenic inflammation in rat bronchial tree. 947 Jan 47

The authors present a group of 67 patients where, using videothoracoscopy or the V.A.T.S. method (Video Assisted Thoracic Surgery), a wedge-shaped rsection of the lungs was made. The patients were divided into three groups with regard to the basic characteristic of the disease-disseminated pulmonary processes, peripheral pulmonary lesions and bullous pulmonary emphysema and spontaneous pneumothorax resp. The diagnostic and therapeutic contribution of the mentioned method, its good tolerance and short postoperative hospitalization is clearly in favour of this mininvasive method.
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PMID:[Videothoracoscopy and pulmonary wedge resection]. 947 8


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