Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thoracic spine (T1-T10) fractures can be considered a specific entity owing to the anatomic features of the rib cage and the spinal canal. During a nine year period, the authors treated 105 such fractures. The thoracic spine fractures included 57 (54.2 per cent) compression fractures, 21 (20 per cent) comminuted (burst) fractures, 3 (2.8 per cent) flexion-distraction fractures, and 24 (23 per cent) fracture-dislocations. Five lesions, termed "fracture-dislocations by an oblique shearing force", were characterized by considerable displacement and the absence of neurologic injury. 35.2 per cent of the patients had injuries at multiple levels. The frequency of associated thoracic (26.5 per cent) and scapular injuries (20 per cent) reflected involvement of the entire thoracic cage. The frequency of neurologic impairment (30.4 per cent including 20 per cent complete paraplegia) reflects the particular vulnerability of the dorsal spinal cord. 32 per cent of the patients presented one or more thoracic effusions (hemomediastinum, hemothorax) related to parietal hematoma and/or hematoma at the fracture site. Functional management of 47 patients led to recovery of a painless spine without kyphotic deformity. Conservative treatment was often difficult because of associated parietal lesions; the 10 patients treated in this manner had only moderate reductions that maintained poorly in time, but had no major painful sequellae. A posterior approach was used for 42 patients with unstable or neurotoxic fractures because this permitted a complete decompression down to the posterior wall, when necessary by a "wide laminectomy". The anterior approach was reserved for purely anterior compression (3 cases) or residual compression after an initial posterior procedure (2 cases). Cotrel-Dubousset instrumentation (used in 7 cases) was particularly indicated because it offers the advantages of Harrington rods (31 cases) while providing better stabilization. This prevented later loss of reduction and obviated the need for a postoperative brace.
 ...
PMID:[Fractures of the thoracic spine (T1-T10). Apropos of 105 cases]. 259 50

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.
 ...
PMID:[Acute spinal epidural hematoma in MRI-CT, following continuous epidural anesthesia with spontaneous recovery]. 275 53

Thoracic injury following a major trauma can be life threatening. Veno-venous extracorporeal membrane oxygenation (vv-ECMO) can be used as a support to mechanical ventilation when acute respiratory distress syndrome is present. We report the case of an 18-year-old male driver who strayed from the road and fell 15 m into a backyard by landing on the roof of its car. The injury severity score was 51 for his pattern of injuries (hemopneumothorax left, sternum fracture, pneumothorax right, pneumomediastinum, intracerebral bleeding, scalping injury occipital, fracture of the ninth thoracic vertebral body, and complete paraplegia). The patient was transferred to our hospital 12 hours after the accident. As we started the secondary survey, the patient was cannulated for vv-ECMO due to deterioration in his oxygenation status. We implanted a double-lumen cannula (Avalon31F catheter, right internal jugular vein) during fluoroscopy. The patient developed posttraumatic systemic inflammatory response syndrome, which began to resolve after 72 hours, and he started breathing spontaneously. After 7 days, he was weaned from vv-ECMO and recovered in a rehabilitation facility. The use of vv-ECMO therapy in cases of major trauma has become a rescue strategy. The use of vv-ECMO was performed without anticoagulation because of his traumatic brain injury and severe spinal cord injury.
 ...
PMID:Veno-venous extracorporeal membrane oxygenation therapy of a severely injured patient after secondary survey. 2484 16

Thoracic and lumbar fractures represent approximately 50% of neurologic spinal trauma. They lead to paraplegia or cauda equina syndrome depending on the level injured. In the acute phase, the extension of spinal cord lesions should be limited by immediately treating secondary systemic injury factors. Quick recovery of hemodynamic stability, with mean arterial blood pressure>85 mm Hg, appears essential. There is no clinical evidence in favor of high-dose corticosteroid protocols. Their effect on neurologic recovery is unproven, whereas they lead to a higher rate of secondary septic and pulmonary complications. Incomplete deficits (ASIA B-D) require urgent surgery. There is no consensus with regard to complete paraplegia (ASIA A), but early surgery can enable neurologic recovery in some cases. The principle of surgical treatment is based on spinal cord decompression, instrumentation and fracture reduction. Early stabilization of the spine improves respiratory function and shortens the duration of mechanical ventilation and thus intensive care unit stay. Depending on the severity of associated lesions, early surgery within 48 hours is beneficial in polytrauma patients. Percutaneous instrumentation combined with mini-open posterior decompression stabilizes the spine, limiting approach-related morbidity.
 ...
PMID:Management of thoracolumbar spine fractures with neurologic disorder. 2557 99

Thoracic vertebral fractures are very unusual complications of cardiopulmonary resuscitation (CPR). A 78-year-old man developed cardiac arrest after aspirating and conventional CPR was performed. After recovery, the patient had complete paraplegia (Frankel grade A). Magnetic resonance image of spine showed a dislocation fracture with hematoma at T6 thoracic level. Computed tomography scan of chest revealed the fracture of sternum. After the patient's condition became stable with subsequent medical treatment, posterior decompression and pedicle screw fixation was performed. The patient had uneventful postoperative course with continued rehabilitation. Thus, this report emphasizes that care should be taken especially in elderly patients with fragile bone to recognize such rare complication of chest compression; however, adequate compressions to ensure circulation should be maintained.
 ...
PMID:Cardiopulmonary Resuscitation-induced Thoracic Vertebral Fracture: A Case Report. 2866 77