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

A case of right thoracic kidney with simple renal cyst is reported. A 67-year-old man was pointed out to have an abnormal shadow in the right lower lung field of chest X-ray film. He was asymptomatic. Laboratory test was normal. Computed tomography and excretory urography confirmed the right thoracic kidney with a simple cyst. Adrenal scintigraphy revealed a high ectopic adrenal gland with right thoracic kidney. Since he was asymptomatic, treatment was not required. High ectopic kidney is extremely rare and 74 cases have been reported in the domestic literature in Japan. Thoracic kidney should be considered as one of differential diagnoses of abnormal mediastinal shadow.
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PMID:[Right thoracic kidney with simple renal cyst: report of a case]. 228 12

This study was performed on chloralosed rats in order to examine the influence of a minor blood loss on duodenal HCO3- secretion. The HCO3- output was measured by in situ titration in a duodenal segment. Blood loss of 0.3 ml per 100 g body wt (approximately 5% of total blood volume) and 0.6 ml per 100 g body wt (approximately 10% of total body volume) reduced duodenal HCO3- secretion by about 18 and 31%, respectively. Adrenal ligation increased basal output of HCO3- but did not affect the bleeding-induced response. Thoracic epidural anaesthesia or splanchnicotomy did not affect the basal secretion but markedly reduced the depression of duodenal HCO3- secretion due to blood loss. Vagotomy lowered basal duodenal HCO3- secretion and blood loss did not reduce alkaline output in these animals. However, electric stimulation of the cut vagal nerves raised the duodenal HCO3- secretion to a similar level as in rats with intact vagal nerves. In this group blood loss reduced the duodenal HCO3- output as in rats with intact nerves. It is suggested that a small blood loss, via an activation of the sympathetic nervous system, reduces the vagally controlled part of the duodenal HCO3- secretion and that this effect is conveyed in the splanchnic nerves.
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PMID:Bleeding inhibits vagally induced duodenal HCO3- secretion via activation of the splanchnic nerves in anaesthetized rats. 360 15

Thoracic epidural analgesia (TEA) may offer haemodynamic benefits for patients with coronary heart disease going through major surgery. This may-in part-be secondary to an effect on the endocrine and metabolic response to surgery. We therefore investigated the effect of TEA on the endocrine metabolic response to aortocoronary bypass surgery (ACBS). Thirty male patients (age < 65 years, ejection fraction > 0.5) were randomized into 3 groups; the HF group receiving a high dose fentanyl (55 micrograms.kg-1) anaesthesia, the HF+TEA group with the same fentanyl dose+TEA with 10 ml bupivacain 5 mg.ml-1, followed by 4 ml every hour, and the LF+TEA group receiving fentanyl 15 micrograms.kg-1 + TEA. Adrenalin, noradrenalin, systemic vascular resistance (SVR), glucose, cortisol, lactate and free fatty acids were followed during the operation and for 20 h postoperatively. A significant increase in adrenalin, noradrenalin and SVR was found in the HF group whereas this increase was blocked in both epidural groups. An increase in glucose and cortisol was noticed in all groups, but the increase was delayed in the epidural groups. Our results suggest that a more effective blockade of the stress response during ACBS is obtained when TEA is added to general anaesthesia than with high dose fentanyl anaesthesia alone.
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PMID:Thoracic epidural analgesia in aortocoronary bypass surgery. II: Effects on the endocrine metabolic response. 788 7

In order to simplify and to standardize procedures during cardiac arrest in patients after cardiac surgery and for professional medical staff education, working group of the European Association for Cardio-Thoracic Surgery issued in 2009 "Guideline for resuscitation in cardiac arest after cardiac surgery". There are several differences between these guidelines and guidelines for general population: in ventricular fibrillation, three sequential attempts at defibrillation should precede external cardiac massage; in asystole or extreme bradycardia, pacing should precede external cardiac massage. Where the above measures fail, and in pulseless electrical activity, early resternotomy is advocated. Adrenaline should not be routinely given. Also protocols for excluding reversible airway and breathing complications and for safe emergency resternotomy are given. These guidelines in very simple and professional way define rules for resuscitation of patients after cardiac surgery. It is a useful manual which will certainly find its place in daily work of professional medical staff involved in healthcare of these patients.
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PMID:[News in hemodynamic monitoring, resuscitation and intensive care of patients after cardiac surgery: "Guidelines for resuscitation in cardiac arrest after cardiac surgery" of the European Association for Cardio-Thoracic Surgery]. 2071 19

BACKGROUND Aortoesophageal fistula is a rare etiology of serious gastrointestinal bleeding. Most aortoesophageal fistulas resulted from thoracic aortic aneurysms, foreign bodies, or esophageal malignancy. To our knowledge, spontaneous aortoesophageal fistula due to dermatomyositis and high dose steroid therapy has not been reported. CASE REPORT A 46-year-old Asian female with a history of dermatomyositis and duodenal ulcers presented with black stool for one day. She was initially admitted for dermatomyositis flare-up and received high dose steroid therapy. Four weeks after discharge, she experienced gastrointestinal bleeding from multiple duodenal ulcers. Due to a continuous fall in hemoglobin level, she received angiography and embolization to the gastroduodenal artery. After the procedure, the patient developed another episode of dermatomyositis flare-up and required endotracheal intubation. During ventilator weaning, she developed recurrent gastrointestinal bleeding. Repeated esophagogastroduodenoscopy showed one esophageal ulcer with active bleeding. Epinephrine hemostasis therapy was performed but with poor therapeutic response. Angiography showed no visible extravasation. Chest computed tomography with intravenous contrast revealed contrast extravasation in esophageal lumen with blood clots consistent with an aortoesophageal fistula. Despite our attempt to arrange an emergent endovascular stent, the patient went into cardiac arrest from circulatory collapse. CONCLUSIONS Dermatomyositis leads to esophageal structural abnormalities through various mechanisms. Aortoesophageal fistula is a life-threatening etiology of gastrointestinal bleeding and should be suspected if bleeding from an esophageal ulcer responds poorly to hemostatic treatment. Abdomen computed tomography with intravenous contrast is the preferred image modality for diagnosing aortoesophageal fistula. Thoracic endovascular aortic repair is a reasonable procedure to stop bleeding in patients with unstable hemodynamic profiles.
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PMID:Aortoesophageal Fistula Causing Massive Gastrointestinal Bleeding and Death in a Patient with Dermatomyositis: A Case Report. 3015 Jun 7