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

A 68-year-old man with reactive thrombocytemia (platelet count: 97.2 x 10(4).mm-3) underwent liver subsegmentectomy for hepatocellular carcinoma. Thoracic epidural combined with general anesthesia was carried out for the surgery. Platelet aggregability was monitored during the operation. At the beginning of the operation, platelet aggregability to aggregating factor ADP showed an abnormal pattern without dose dependency. In spite of continuous administration of gabexate mesilate for inhibition of thrombosis, the patient developed hypercapnia with low end tidal CO2 pressure (PETCO2) and hypoxia, suggesting pulmonary embolism. PETCO2 and SPO2 recovered soon after heparin administration. The patient recovered without any neurologic complications. This case demonstrated that hyperaggregability is possible in patients with thrombocytemia and suggests that monitoring of platelet function in patients with thrombocytemia is difficult.
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PMID:[A case of suspected pulmonary thrombosis in a patient with reactive thrombocytemia who underwent liver subsegmentectomy]. 1473 84

Two patients, aged 73 and 58 years, with diffuse pulmonary fibrosis underwent emergency open cholecystectomies (subcostal approach) under thoracic epidural anesthesia with 0.5% ropivacaine and fentanyl in spontaneous ventilation. Pulmonary fibrosis was due to amiodarone administration in the first patient and of unknowon cause in the second. Both developed arterial hypotension without bradycardia in spite of optimal preloading. Inotropoic support with low doses of norepinephrine was requiered for recovery in both cases with no adverse events after reversion of the sympathetic blocks. Postoperative epidural analgesia was very satisfactory. Thoracic epidural anesthesia is a useful alternative to general anesthesia for subcostal cholecystectomy in patients with diffuse interstitial lung disease in advanced stages.
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PMID:[Open cholecystectomy under thoracic epidural anesthesia in diffuse interstitial lung disease]. 1520 Jan 90

Thoracic epidural analgesia can effectively relieve post-thoracotomy pain but may also adversely affect pulmonary function. This randomised, prospective study compared the effects on pulmonary function of three different epidural analgesics (clonidine, bupivacaine and methadone). Forty-seven patients undergoing thoracotomy were treated postoperatively for 72 h with one of the study drugs. Doses were titrated to maintain visual analogue pain scale values below 4 out of 10. Throughout the postoperative period, reductions of up to 70% of the pre-operative value were observed in forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow rate. Patients who received clonidine showed significantly faster recovery rates of forced expiratory variables compared to other patients, and by the third postoperative day significantly higher spirometry values (10-15%) were recorded in this group. As clonidine was the most effective drug in terms of preservation of pre-operative lung function, it may be clinically advantageous in post-thoracotomy patients.
Anaesthesia 2004 Sep
PMID:Epidural clonidine, bupivacaine and methadone as the sole analgesic agent after thoracotomy for lung resection. 1531 Mar 47

The purpose of this study was to evaluate the overall outcome of repair of thoracic aortic lesions with endoluminal grafts. Patients were studied prospectively following the implantation of a thoracic endovascular device. Preoperative imaging was performed by helical computed tomography (CT), angiography, transesophageal ultrasonography, or magnetic resonance imaging. Procedures were performed in an endovascular surgical suite under general anesthesia. All patients were evaluated with CT and chest radiography at discharge and at 1, 6, and 12 months. From December 1999 to November 2001, thirty-two patients were enrolled in the study (mean age 62 years; 20 male and 12 female patients). Seventeen patients had dissections, five patients had ruptured aortic ulcer, five patients had traumatic ruptures, three patients had atherosclerotic aneurysms, and two patients had pseudoaneurysms. An American Society of Anesthesiology score of III or IV was evaluated in 22 (69%) patients. The procedure was performed under emergency conditions in 11 cases. All prostheses were implanted successfully. There were no conversions. Three patients (9%) presented with a neurologic event following the implantation procedure, which was lethal in one case (hemorrhagic stroke). Two other patients died during early follow-up of myocardial infarction and multiorgan failure. The early death rate was 9%. The mean follow-up was 13.5 months. During follow-up, the maximal diameter of the aorta shrunk (> or = 5 mm) in 9 (28%) patients, remained stable in 17 (53%) patients, and increased (> or = 5 mm) in 6 (19%) patients. All patients presenting with an increased diameter were initially treated for dissections. A type 1 endoleak was diagnosed on the discharge CT scan in one patient. It sealed spontaneously thereafter. A type 3 endoleak was diagnosed 3 months after the procedure in one patient. A complementary stent graft was implanted in two patients presenting with a dissection with persistent patent false lumen and aortic enlargement. Three patients died during follow-up (two aneurysm-related and one aneurysm-unrelated death). The morbidity and mortality rates reported in our series related to the preoperative morbid conditions of the patients treated. Thoracic aorta endografting is an alternative to open surgery in this subset of patients.
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PMID:Midterm results of endoluminal stent grafting of the thoracic aorta. 1558 26

Thoracic epidural anesthesia (TEA) is used increasingly in critical care, especially for cardiac and intestinal sympathetic block. In this study we evaluated cardiorespiratory function and sympathetic activity in a new model of continuous TEA in awake rats. Thirteen rats received epidural saline control (CON) or bupivacaine 0.5% epidural infusion (EPI) at 15 microl/h for 2 h on day 1 and day 3. Mean arterial blood pressure, heart rate, respiration rate, arterial PCO2, and motor score were recorded at baseline and after 30, 60, 90, and 120 min. Skin temperature was measured at front paws, high-thoracic, mid-thoracic, and low-thoracic, hind paws, and the proximal and distal tail. Changes in sympathetic activity were assessed by skin temperature changes from baseline (DeltaT). In the EPI group, hemodynamics and respiration remained unchanged and only mild motor deficits occurred. DeltaT in thoracic segments was higher in the EPI than in the CON group (P <0.001 at all times at high-thoracic, mid-thoracic, and low-thoracic segments). Skin temperature decreased in the distal tail in the EPI group, e.g., after 90 min DeltaT=-0.86 +/- 0.25 degrees C (EPI) versus 0.4 +/- 0.12 degrees C (CON) (P <0.05 at 60, 90, and 120 min). DeltaT on day 3 was comparable to day 1. TEA induced stable segmental sympathetic block without cardiorespiratory and motor side effects in awake rats. This new technique may be applied in prolonged models of critical illness.
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PMID:Continuous thoracic epidural anesthesia induces segmental sympathetic block in the awake rat. 1561 87

The specialty of thoracic surgery has evolved along with the modem practice of anesthesia. This close relationship began in the 1930s and continues today. Thoracic surgery has grown from a field limited almost exclusively to simple chest wall procedures to the present situation in which complex procedures, such as lung volume reduction or lung transplantation, now can be performed on the most severely compromised patient. The great advances in thoracic surgery have followed discoveries and technical innovations in many medical fields. One of the most important reasons for the rapid escalation in the number and complexity of thoracic surgical procedures now being performed has been the evolution of anesthesia for thoracic surgery. There has been so much progress in this area that numerous books and journals are devoted entirely to this subject. The author has been privileged to work with several surgeons who specialized in noncardiac thoracic surgery. As a colleague of 25 years, the noted pulmonary surgeon James B.D. Mark wrote, "Any operation is a team effort... (but) nowhere is this team effort more important than in thoracic surgery, where near-choreography of moves by all participants is essential. Exchange of information, status and plans are mandatory". This team approach between the thoracic surgeon and the anesthesiologist reflects the history of the two specialties. With new advances in technology, such as continuous blood gas monitoring and the pharmacologic management of pulmonary circulation to maximize oxygenation during one-lung ventilation, in the future even more complex procedures may be able to be performed safely on even higher risk patients.
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PMID:The evolution of thoracic anesthesia. 1570 42

Efaproxiral [RSR 13, GSJ 61, JP 4, KDD 86, RS 4] is a synthetic, small-molecule, radiation-sensitising agent being developed by Allos Therapeutics primarily for the treatment of cancer. It works by binding and allosterically stabilising deoxyhaemoglobin in hypoxic regions of tumour tissue. This increases oxygen uptake of the tumour tissue and restores its sensitivity to radiation therapy, making therapy potentially more successful. This first-of-its-class compound is particularly applicable for the treatment of certain tumour types that lack oxygen, such as brain metastases. In contrast to conventional chemotherapeutic agents or radiation sensitisers, there is no requirement for efaproxiral to be administered directly into tumours or to cross the blood-brain barrier for it to display efficacy. Efaproxiral is under review for approval in the US and EU as an adjunct to whole-brain radiation therapy (WBRT) for the treatment of brain metastases originating from breast cancer. It is also under clinical evaluation for a variety of other cancers, including glioblastoma, non-small cell lung cancer (NSCLC) and cervical cancer. Allos is seeking partnership opportunities for efaproxiral's development and marketing. The company has indicated that the development of efaproxiral would be in cooperation with a corporate partner, according to its 2003 Annual Report. In 1994, Allos Therapeutics acquired exclusive worldwide rights to intellectual property relating to efaproxiral from the Center for Innovative Technology (CIT). Allos has entered into arrangements with two contract manufacturers for the supply of efaproxiral, and a third manufacturer for the supply of the formulated drug product. Hovione FarmaCiencia is the primary supplier of efaproxiral, and is contracted to manufacture sufficient quantities on a commercial scale. In addition, a second manufacturer, Raylo Chemicals, is also producing quantities of efaproxiral. In December 2003, Allos entered into a long-term development and supply agreement with Baxter Healthcare who will formulate the efaproxiral into an injection. Allos is also seeking to establish an alternate supplier of efaproxiral injection. Allos submitted a rolling NDA to the US FDA consisting of three data components. Submission began in the third quarter of 2003 and was completed by the fourth quarter of 2003. The first part of the application containing non-clinical information was submitted on 5 August 2003. The second part of the NDA containing information about efaproxiral's chemistry, manufacture and controls (CMC) was submitted in October 2003. Allos submitted its final component of the rolling NDA in December 2003. In February 2004, Allos announced that the FDA had accepted the company's NDA under priority review status. The FDA granted efaproxiral orphan drug status in August 2004 as an adjunct to WBRT for the treatment of brain metastases among breast cancer patients. Efaproxiral also received fast-track status in November 2000 for the same indication in the US. In February 2004, Allos initiated a phase III trial, called ENRICH (Enhancing Whole Brain Radiation Therapy In Patients with Breast Cancer and Hypoxic Brain Metastases) to investigate efaproxiral as an adjunct to WBRT for the treatment of brain metastases. Median survival time is the primary endpoint of the study. The National Breast Cancer Coalition (NBCC) is collaborating with the company to support trial enrolment and to gain additional insight about ways to improve radiation treatment in this patient population. The ENRICH trial protocol was approved by the FDA under a Special Protocol Assessment process; as part of the protocol, two interim analyses for safety and efficacy will be performed.This multicentre, randomised, open-label study has a target enrolment of approximately 360 patients at >100 medical centres across the US, Canada, Europe and South America. Allos announced in September 2004 that recruitment of clinical sites for the trial is ongoing across the US and Canada. Completion of trial enrolment in North America is anticipated in December 2005. Subsequently, Allos announced in January 2005 that recruitment into the ENRICH trial has commenced and is ongoing in Europe; enrolment at European sites is expected to conclude by the third quarter of 2006. Allos Therapeutics announced in June 2004 that it had filed an MAA with the EMEA for marketing of exaproxiral as an adjunct to WBRT for treatment of patients with brain metastases originating from breast cancer. The application is based on positive data from a pivotal phase III (REACH, RT-009) trial in this indication. The completed REACH trial investigated efaproxiral among patients with brain metastases undergoing WBRT. The trial was conducted at multiple sites in 11 countries, including the US, Canada, Europe and Australia. In August 2002 Allos completed the enrolment of 538 patients in the study. Initially only 408 patients were to be enrolled, but the company increased the size of the trial to conduct an appropriately powered subgroup analysis in patients with brain metastases from breast and NSCLC. The study was designed to demonstrate a 35% increase in median survival in the subgroup of patients compared with standard WBRT alone. The primary endpoint was survival. Allos began screening US patients for a phase III trial in NSCLC in early 2003. However, in May 2003, the company announced that as part of its revised operating plan it had suspended the screening of patients for this trial. The trial, which was known as ELITE (Enhanced Lung cancer treatment with Induction chemotherapy and Thoracic radiation and Efaproxiral), was comparing induction chemotherapy followed by thoracic radiation therapy with supplemental oxygen, with or without efaproxiral. The trial was enrolling patients with locally advanced, unresectable NSCLC. ELITE was planned to enrol up to 600 patients across North America and Western and Eastern Europe. Phase II trials in patients with inoperable NSCLC have been conducted in the US and Canada. Patient enrolment in one of these studies was completed in August 2000, with a total of 52 patients enrolled. This was an open-label, multicentre study of induction therapy with paclitaxel plus carboplatin followed by chest irradiation and efaproxiral in patients with locally advanced NSCLC. Positive results from this study were reported at the annual meeting of the European Society for Therapeutics Radiology and Oncology in September 2002. Efaproxiral has completed phase I trials as a treatment of surgical hypoxia in elective surgery patients receiving general anaesthesia. However, no recent development has been reported for these indications. In 1994, Allos signed an agreement with CIT for the exclusive worldwide rights to 17 US patents, a European patent covering the UK, France, Italy and Germany plus two pending patents in these territories, two issued patents in Japan, and a pending patent in Canada. These patents cover methods of allosterically modifying haemoglobin with efaproxiral and other compounds, the binding site of efaproxiral and therapy in certain indications including cancer, ischaemia and hypoxia. In addition to the licensed patents from CIT, Allos exclusively owns two patent families with pending applications directed to a formulation of efaproxiral and to methods of its use in BLOD MRI (blood oxygenation level-dependent magnetic resonance imaging) applications. These patents are pending in the US, Canada and Europe, and include an international patent application. In a May 2002 interview with the Wall Street Transcript, the CEO of Allos estimated the overall market for radiation therapy to be approximately 750 000 patients/year. Of this, brain metastases, NSCLC and glioblastoma therapy accounts for about 170 000, 140 000 and 6000 patients, respectively. Allos intend to use a speciality sales force to market efaproxiral directly to radiation therapists in North America. To penetrate the non-oncology market in the US, the company will seek partnership with one or more pharmaceutical companies with direct sales forces and with established distribution systems. Allos is also hoping to secure an oncology marketing partner for non-North American territories. At the time, the company had been issued 21 patents in the US, Canada, Europe and Japan.
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PMID:Efaproxiral: GSJ 61, JP 4, KDD 86, RS 4, RSR 13. 1586 22

Thoracic epidural analgesia (TEA) provides optimal perioperative anaesthesia and analgesia after thoracic and major abdominal surgery and decreases postoperative morbidity and mortality, mainly by blocking sympathetic nerve fibres. Surgery leads to a stress response characterized by sympathetic arousal, altered balance of catabolic and anabolic hormones, hypermetabolism, negative protein economy, and altered carbohydrate metabolism and immune function. A threefold increase of the plasma level of norepinephrine (noradrenaline) was detected up to 24 hours after surgery. These elevated catecholamine plasma levels are a risk, especially to patients with coronary artery disease, because unlike healthy coronary arteries, the stress response causes a vasoconstriction in arteriosclerotic coronary arteries. TEA results in a vasodilation in stenotic coronary arteries. In patients with instable angina pectoris, TEA reduced the number as well as the duration of episodes of cardiac ischaemia. Furthermore, TEA improves myocardial structure and function after coronary artery bypass grafting. Plasma levels of troponin T and I, as well as of atrial natriuretic peptides, were reduced and echocardiographic parameters of the ventricular wall motion were improved by TEA. Patients showed fewer arrhythmic episodes and postoperative myocardial infarction, and could be extubated earlier. The positive effects of TEA after coronary artery bypass grafting are not limited to a short postoperative period, the 2-year mortality rate also seems to be reduced. Optimized pain control and early mobilization decrease the riskof pulmonary complications, resulting in a shortened stay in intensive care units. In combination with early enteral nutrition, TEA leads to an earlier return of gastrointestinal function. Patients treated with thoracic epidural anaesthesia and analgesia have a better health-related quality of life.
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PMID:Update in thoracic epidural anaesthesia. 1596 93

Gastric dilatation-volvulus (GDV) is a disease in which there is gross distension of the stomach with fluid or gas and gastric malpositioning. It causes pathology of multiple organ systems and is rapidly fatal. It is common in large- and giant-breed dogs. The disease appears to have a familial predisposition. Thoracic depth/width ratio also appears to predispose dogs to GDV. Implicated dietary factors include dietary particle size, frequency of feeding, speed of eating, aerophagia and an elevated feed bowl. A fearful temperament and stressful events may also predispose dogs to GDV. Abdominal distension, non-productive retching, restlessness, signs of shock, tachypnoea and dyspnoea are possible clinical signs. Initial treatment includes treatment of shock and gastric decompression. Surgical treatment should be performed promptly. There are no studies comparing the use of different anaesthetic agents in the anaesthetic management of GDV. Pre-medication with an opioid/benzodiazepine combination has been recommended. Induction agents that cause minimal cardiovascular changes such as opioids, neuroactive steroidal agents and etomidate are recommended. Anaesthesia should be maintained with an inhalational agent. Surgical therapy involves decompression, correction of gastric malpositioning, debridement of necrotic tissue, and gastropexy. Options for gastropexy include incisional, tube, circumcostal, belt-loop, incorporating, and laparoscopic gastropexy. Expected mortality with surgical therapy is 15-24%. Prognostic factors include mental status on presentation, presence of gastric necrosis, presence of cardiac arrhythmia and plasma lactate levels. Prophylactic gastropexy should be considered in dogs identified as being at high risk.
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PMID:Gastric dilatation-volvulus in dogs. 1603 41

Thoracic surgery in mice is challenging due to difficult intubation and ventilation, lack of intravenous access, and the risk of hemorrhage. We developed a rapid and safe technique for murine unilateral pneumonectomy in order to study compensatory lung growth. Under general anesthesia, 81 mice were intubated with an angiocatheter using a 2.7-mm, 0-degree endoscope. A left thoracotomy was performed. The lung was gently extracted from the thoracic cavity, ligated at the hilum, and resected. Postoperatively, warming lights and subcutaneous saline injections were used to ensure minimal morbidity. The survival rate for the scope-assisted intubation and pneumonectomy was 88%. Perioperative mortality was due to technical error. Minimal long-term morbidity was appreciated. This general operative technique and perioperative management may be applied to all types of murine thoracic procedures used for surgical research.
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PMID:Pneumonectomy in the mouse: technique and perioperative management. 1612 31


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