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

Thoracic surgery creates a different environment from abdominal surgery in respect to the surgical procedure with pulmonary collapse under unilateral ventilation. Definitive evidence whether surgical trauma during thoracotomy is involved in postoperative pulmonary infections has not been clearly demonstrated. The objectives of this study were to evaluate the influence of surgical trauma during thoracotomy on postoperative infections and to investigate the clinical significance of postoperative humoral mediators in pulmonary infections after surgery. We measured serum interleukin-6 (IL-6), IL-8, hepatocyte growth factor (HGF), and nitric oxide (NO) levels in 27 patients undergoing thoracic surgery; the measurements were before and during thoracotomy, 60 minutes after reinflation, and after surgery. The patients were divided into three groups: lobectomy patients (group A), and esophagectomy patients without (group B) or with (group C) postoperative infections. The serum IL-6 and IL-8 levels in group C were markedly elevated 60 minutes after reinflation and were significantly higher than those in group A. The serum IL-8 levels during that period in group C were significantly higher than those in group B. The postoperative serum IL-6, IL-8, HGF, and NO levels were significantly higher in group c than in group B. Taken together, intraoperative hypercytokinemia, especially IL-8, following the thoracic procedure and subsequent reinflation preceded the clinical onset of postoperative infections. Hence postoperative serum IL-6, IL-8, and HGF levels may be useful predictors of infection after esophagectomy.
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PMID:Serum interleukin-6, interleukin-8, hepatocyte growth factor, and nitric oxide changes during thoracic surgery. 967 47

The Thoracic Research Scholarship 1996 of the German Society for Thoracic and Cardiovascular Surgery enabled me to visit Barnes Hospital at the Washington University of St. Louis, USA, from May to July 1996. At that center Prof. J. D. Cooper has established lung-volume reduction surgery as a successful surgical treatment for patients with endstage pulmonary emphysema. The operation is performed using left-sided double-lumen intubation. After opening of the chest and pleura and starting single-lung ventilation the less diseased parts of the second lung collapse due to absorption atelectasis whereas the more diseased portion of the lung stays hyperinflated. Linear staplers buttressed with bovine pericardium are used to resect the diseased parts of the lungs. Approximately 20-30% of the total lung volume can be resected by this way on each side. After inspection of the lungs for air leaks and preparation of pleural tents the pleura is closed bilaterally. Postoperative analgesia is performed via epidural catheter and patients are extubated postoperatively as soon as possible, usually in the operating theatre. 150 bilateral lung-volume reduction procedures for patients with severe emphysema were performed between January 1993 and February 1996 in St. Louis. 6 months postoperatively the 1-second forced expiratory volume had increased by up to 51% and residual volume was reduced by 28%. 70% of patients who required continuous oxygen supply prior to the operation no longer required this measure: the PaO2 had increased by an average of 8 mmHg. These data demonstrate that bilateral lung-volume reduction surgery is a suitable treatment for patients with terminal pulmonary emphysema. Most important for the success of this procedure are clear selection and specific perioperative treatment of the patients.
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PMID:German Thoracic Research Scholarship 1996: lung volume reduction for endstage pulmonary emphysema at the Washington University of St. Louis. 971 99

The authors sought to determine to what degree current practice by hospital physicians and accident and emergency (A&E) departments in Wales conformed to the British Thoracic Society's guidelines for the management of spontaneous pneumothorax. Questionnaires were posted to all consultants involved in emergency medical admissions in Wales (149 consultant physicians and 23 A&E consultants) of whom 101 (59%) replied. Only 45% used the classification, "small, moderate, or complete" to describe the size of pneumothorax. Just 44% would do as recommended by the British Thoracic Society and discharge an asymptomatic patient with a primary pneumothorax and 34% would discharge a patient with a primary pneumothorax after successful aspiration. Only 20% were prepared to try aspiration initially for a secondary pneumothorax with a complete lung collapse. Thirty four per cent would follow the recommendation to remove a chest drain without prior clamping of the tube 24 hours after bubbling had stopped. In the event of a persistent air leak 69% would refer patients or seek a specialist opinion. Physicians with an interest in respiratory medicine tolerated persistent air leaks for significantly longer than did non-respiratory physicians (median of 7 v 5 days, p=0.001). The survey indicates that fewer than expected consultant physicians and A&E consultants in Wales manage spontaneous pneumothoraces in the way recommended by the guidelines. Physicians with an interest in respiratory medicine tended to comply with these guidelines more than general physicians with interests other than respiratory medicine or A&E consultants but the trend was not significant at the 5% level. It is felt that the guidelines should be disseminated more widely, ensuring that emergency admissions units and A&E departments have copies on display or easily accessible, and that they could be expanded to cover other aspects such as timing for surgery.
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PMID:Management of spontaneous pneumothorax-a Welsh survey. 1129 98

The British Thoracic Society (BTS) guidelines for the detection and management of spontaneous pneumothorax have been published for over eight years. The condition continues to be managed by surgical and medical staff, especially in DGH settings. This study evaluates any recognition and initial management discrepancies in a uncomplicated pneumothorax case and documents any deviancies from guidelines A study involving 112 staff was performed in a DGH. Results showed poor overall recognition of any published guidelines (32%) with only six staff correctly identifying BTS guidelines. There was no difference between medical and surgical or consultant and junior staff in the management strategy. A tendency to initially over-treat the condition with invasive chest drainage rather than aspiration was noted. Also, there was a tendency to underestimate the size of collapse using percentages. The need for greater appreciation of detection and management of this common condition remains extant and must be addressed aggressively.
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PMID:Discrepancies in the detection and management of spontaneous pneumothorax: eight years after publication of guidelines. 1167 40

A 10-year-old male cross-breed dog was referred for investigation of oral malignant melanoma. Fine-needle aspirates were taken from the draining submandibular lymph node. The presence of metastatic melanoma cells was confirmed by cytological examination and reverse transcription polymerase chain reaction (RT-PCR) using primers for the melanoma-associated antigens: tyrosinase and mart-1/melan A. Cytokine expression in the lymph node was evaluated by multiplex RT-PCR, which demonstrated the presence of mRNA for IL-10 and TGF-beta1. However, IL-2, IL-4 and IFNgamma mRNA could not be detected, suggesting a lack of immune activation. Thoracic radiographs showed a lesion within the caudal lung fields suggestive of pulmonary metastasis. The dog developed signs of dyspnoea and collapse and was euthanased four days later. This case illustrates that molecular techniques can be used to aid clinical staging of canine oral malignant melanoma, and suggests that immunosuppressive cytokines could be involved in the pathogenesis of disease.
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PMID:Immunosuppressive cytokines in the regional lymph node of a dog suffering from oral malignant melanoma. 1240 Jun 46

This report describes an unusual case of a mucoepidermoid carcinoma developing in a patient with congenital left upper lobe agenesis. Mucoepidermoid tumours most often develop in major bronchi and present as lobar collapse, post-obstructive pneumonia or as a mass lesion on chest radiography. On CT, the tumour is smooth, well defined, homogeneous and may enhance with intravenous contrast. Tumour calcification has been reported. Lobar agenesis often presents as a co-incidental finding on chest radiography as total or almost complete absence of aeration of the affected lung. Thoracic CT confirms the presence of the underdeveloped lung, pulmonary artery and bronchus and associated mediastinal shift and herniation of the contralateral lung. A literature review of these two conditions is presented.
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PMID:Case report: Mucoepidermoid carcinoma in a patient with congenital agenesis of the left upper lobe. 1276 51

Blastomycosis was diagnosed in six nondomestic felids from eastern Tennessee, including two Asian lions (Panthera leo persicus), one African lion (Panthera leo), one Siberian tiger (Panthera tigris), one cheetah (Acinonyx jubatus), and one snow leopard (Panthera uncia). Clinical signs included lethargy, anorexia, weight loss, dyspnea, sneezing. ataxia, and paresis. Variable nonspecific changes included leukocytosis, monocytosis, moderate left shift of neutrophils, moderate hypercalcemia, hyperproteinemia, and hyperglobulinemia. Thoracic radiographs revealed interstitial and alveolar changes, consolidation or collapse of a lung lobe, bullae formation, and a pulmonary mass. Agar gel immunodiffusion (AGID) serology for Blastomyces dermatitidis was performed in five felids and was positive in three. The tiger had cerebral blastomycosis and was positive for AGID serologic tests of both cerebrospinal fluid and serum. One percutaneous lung aspirate in the snow leopard and one bronchial aspirate in an Asian lion demonstrated B. dermatitidis organisms. whereas tracheal wash samples and a nasal discharge were nondiagnostic in others. Treatment with itraconazole was attempted in four cats. The tiger improved before euthanasia, whereas the others did not survive beyond initial treatments. In four felids, B. dermatitidis was found in the lungs and tracheobronchial lymph nodes associated with a florid pyogranulomatous reaction; the tiger had a pyogranulomatous encephalomyelitis, and the cheetah had a single pulmonary granuloma. Thoracic radiography, cytologic examination of lung lesion aspirates, and B. dermatitidis AGID serology should be performed on clinically ill zoo felids in endemic areas to rule out blastomycosis.
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PMID:Blastomycosis in nondomestic felids. 1458 83

A 7-year-old, female spayed rottweiler was referred with a history of an acute onset of collapse attributable to cardiac tamponade. Thoracic radiographs revealed an enlarged cardiac silhouette compatible with pericardial effusion, sternal osteomyelitis, and an unusual mineralized lesion determined later to be within the aortic wall. The pericardial effusion was a septic exudate secondary to infection with Staphylococcus species and hemorrhage into the pericardium through a mineralized aortic lesion. The case demonstrates the importance of complete evaluation of thoracic radiographs in a patient with cardiac disease and the potential value of cytopathological evaluation of pericardial fluid.
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PMID:Septic pericarditis, aortic endarteritis, and osteomyelitis in a dog. 1473 16

Angiostrongylosis was diagnosed in 23 dogs presenting to the Queen Mother Hospital for Animals between June 1999 and August 2002. The animals' clinical records were reviewed retrospectively and certain risk factors were compared with a control population of 3407 dogs. Twenty-two of the 23 dogs were from south-east England and dogs from Surrey (n=8) were significantly overrepresented. There were also significantly more Cavalier King Charles spaniels (n=5) and Staffordshire bull terriers (n=5) among the affected dogs than in the control group. The median age of affected dogs was 10 months (range five to 90 months). The most common presenting signs were cough (65 per cent), dyspnoea (43 per cent), haemorrhagic diathesis (35 per cent) and collapse (26 per cent). Four dogs were thrombocytopenic and eight had significant prolongations in prothrombin time and/or activated partial thromboplastin time. Thoracic radiographs were abnormal in 18 of 19 dogs. A variety of changes were observed, the most typical being a patchy alveolar-interstitial pattern affecting the dorsocaudal lung fields. Angiostrongylus vasorum larvae were found in seven of 10 bronchoalveolar lavage specimens and 19 of 19 faecal samples. Three dogs died shortly after admission to the hospital. The remainder were successfully treated with fenbendazole at a dose of 50 mg/kg for five to 21 days. A vasorum should now be considered endemic to south-east England.
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PMID:Angiostrongylus vasorum infection in 23 dogs (1999-2002). 1546 Feb 1

A six-month-old, entire female, Irish setter was presented with a two-month history of progressive hindlimb weakness and collapse on exercise. Thoracic auscultation revealed a soft systolic murmur and a split second heart sound. Differential cyanosis and polycythaemia were not observed. Right-to-left shunting patent ductus arteriosus (r-PDA) was confirmed on contrast echocardiography ("bubble study") and selective right ventricular angiography. Comparison of blood gases from the metatarsal and auricular artery confirmed the presence of differential hypoxia. This technique is not known to have been described previously in the diagnostic investigation of r-PDA in dogs.
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PMID:Original investigation of right-to-left shunting patent ductus arteriosus in an Irish setter puppy. 1644 21


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