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

The effects of thoracic epidural anesthesia on the performance of the parasternal intercostal muscles were investigated by measuring electromyographic activity and length changes of the parasternals (EMG activities and length, respectively, of the parasternals) in seven pentobarbital anesthetized, spontaneously breathing dogs. Epidural injection of 0.1 mL/kg of 2% lidocaine decreased tidal volume and minute ventilation during unstimulated breathing. These changes were accompanied by complete abolishment of EMG activities of the parasternals and passive elongation of the parasternals during inspiration. At equivalent end-tidal PCO2 values (70 and 80 mm Hg) during CO2 rebreathing, tidal volume and minute ventilation were lower after epidural block compared to the corresponding values before the block. Thoracic epidural anesthesia impaired contraction of the parasternals and conceivably other respiratory muscles in the rib cage as well and could induce a distortion of the rib cage. The authors conclude that respiratory muscles in the rib cage contribute considerably to the maintenance of ventilation in anesthetized dogs.
Anesth Analg 1993 Sep
PMID:Thoracic epidural anesthesia causes rib cage distortion in anesthetized, spontaneously breathing dogs. 836 50

Thoracic surgeons have recently pursued innovative techniques that can help minimize postoperative pain. These have taken two basic directions. The first consists of a modification of the operative procedure itself, such that the surgical insult and hence the resulting pain are minimized. Modifications of the conventional thoracotomy technique have led to the development of the muscle-sparing thoracotomy and the linear or small transaxillary thoracotomy. The ultimate modification has been video-assisted thoracic surgery techniques, which are associated with a marked reduction in postoperative pain. The second approach centers on techniques that improve postoperative pain control. The recently published Agency Health Care Policy and Research guidelines provide a comprehensive review of the therapeutic options for postoperative pain control. These guidelines emphasize the value of nonsteroidal antiinflammatory drugs in conjunction with opioids as the preferred form of analgesia. Many authors have advocated the induction of spinal analgesia after thoracotomy, using either epidural opioids or local anesthesia, or both. Patient-controlled analgesia and multiple intercostal nerve blocks are other methods for managing postthoracotomy pain. The potential benefits conferred by aggressive pain control after thoracotomy are enormous for the patients, the surgeons, and the entire health-care system.
Ann Thorac Surg 1993 Sep
PMID:Pain management principles and anesthesia techniques for thoracoscopy. 837 56

The recent advancements in diagnosis and treatment of thoracic disease have been made mostly in line with advancements in endoscopic equipment design and refinement of thoracoscopic surgery techniques. Between March 1992 and February 1993, video thoracoscopic procedures were performed in 50 patients. Twelve of the 50 patients were diagnosed with lung cancer. Thoracic staging was performed in 6 patients (clinical diagnosis of suspicious intrapulmonary metastasis, 3 patients; intrapulmonary metastasis and/or lymph node metastasis, 1 patient; interlobar pleural effusion, 1 patient; and pleural dissemination, 1 patient). There were no complications or mortality associated with these procedures. Our initial experience has indicated that thoracoscopic staging for lung cancer is a safe and effective procedure.
Ann Thorac Surg 1993 Sep
PMID:Thoracoscopy for staging of lung cancer. 837 66

Thoracoscopy allows evaluation of the mediastinum and assessment of the local spread of malignancy. Adjuvant therapy trials have shown some increased survival for esophageal cancer although morbidity is high. Preoperative staging may allow appropriate allocation of adjuvant therapy. Patients with esophageal cancer underwent computed tomographic scan, magnetic resonance imaging, and endoesophageal ultrasonography. Thoracoscopic staging was performed through the left chest with biopsy of American Thoracic Society level 5 and 6 and 8 and 9 lymph nodes. Resection at a separate sitting with complete intraoperative lymph node sampling was done. Fourteen patients underwent thoracoscopic lymph node staging. One procedure could not be completed because of adhesions. Of the 13 patients undergoing successful staging, all had correct thoracic lymph node staging confirmed at surgical exploration. Two patients with adenocarcinoma of the distal third/gastroesophageal junction were found at laparotomy to have positive celiac lymph nodes. Two patients who had lymph nodes positive at computed tomographic scan and magnetic resonance imaging were found to have negative lymph nodes at thoracoscopy and subsequent resection. Two patients were found to have pulmonary metastasis at thoracoscopy. Lymph node stage in esophageal carcinoma is an important prognostic indicator. Thoracoscopic lymph node staging provides accurate pre-resection staging information.
Ann Thorac Surg 1993 Sep
PMID:Thoracoscopic lymph node staging for esophageal cancer. 837 68

Both patients and the medical profession are quick to embrace new technology, particularly when it may replace an existing surgical procedure. Unfortunately, the rapidity of acceptance is rarely associated with careful evaluation. Laparoscopy is a recent example of such widely embraced technology. Studies of laparoscopy that yielded good comparative data to more traditional methods were slow to accrue. This led to the exposure of its shortcomings through governmental reports and the lay press. To prevent this from happening in thoracoscopy, two types of studies are required so that valid conclusions about the new technology can be drawn. The first is an accounting of the new technology as procedures evolve around it. The data collected in such a study should contain basic information, including the indications for the procedure, how it was performed, procedure length, associated complications, and patient outcome. Such information provides a broad profile of the technology, emphasizing from the outset its potential strengths and weaknesses. The second type of study involves a more detailed concurrent comparison of the specific procedures utilizing this technology to the established traditional methods. Such randomized studies help to firmly establish through scientific process the place of the new technology. The Video-Assisted Thoracic Surgery Study Group was organized in early 1992 to address these concerns. From an initial four surgeons the group has grown to include more than 41 institutions. Currently the group is collecting data in a registry and has established three clinical trials to evaluate video-assisted thoracic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Ann Thorac Surg 1993 Sep
PMID:Video-Assisted Thoracic Surgery Study Group. 837 82

In order to assess the nature of spatial cues in determining the characteristic projection sites of sensory neurons in the CNS, we have transplanted sensory neurons of the cricket Acheta domesticus to ectopic locations. Thoracic campaniform sensilla (CS) function as proprioceptors and project to an intermediate layer of neuropil in thoracic ganglia while cercal CS transduce tactile information and project into a ventral layer in the terminal abdominal ganglion (TAG). When transplanted to ectopic locations, these afferents retain their modality-specific projection in the host ganglion and terminate in the layer of neuropil homologous to that of their ganglion of origin. Thus, thoracic CS neurons project to intermediate neuropil when transplanted to the abdomen and cercal CS neurons project to a ventral layer of neuropil when transplanted to the thorax. We conclude that CS can be separated into two classes based on their characteristic axonal projections within each segmental ganglion. We also found that the sensory neurons innervating tactile hairs project to ventral neuropil in any ganglion they encounter after transplantation. Ectopic sensory neurons can form functional synaptic connections with identified interneurons located within the host ganglia. The new contacts formed by these ectopic sensory neurons can be with normal targets, which arborize within the same layer of neuropil in each segmental ganglion, or with novel targets, which lack dendrites in the normal ganglion and are thus normally unavailable for synaptogenesis. These observations suggest that a limited set of molecular markers are utilized for cell-cell recognition in each segmentally homologous ganglion. Regenerating sensory neurons can recognize novel postsynaptic neurons if they have dendrites in the appropriate layer of neuropil. We suggest that spatial constraints produced by the segmentation and the modality-specific layering of the nervous system have a pivotal role in determining synaptic specificity.
J Neurobiol 1993 Sep
PMID:Transplantation of neurons reveals processing areas and rules for synaptic connectivity in the cricket nervous system. 840 77

The clinical significance of nontuberculous mycobacterial isolates and presentation of mycobacteriosis was compared in HIV-negative patients with or without preceding immunosuppression. Patients with nontuberculous mycobacterial isolates (n = 139), mainly from the respiratory system, were divided into three groups: those who had had previous immunosuppressive treatment (24%), those with other underlying diseases (54%) and those without predisposing factors (22%). The distribution of mycobacterial species among the various patient groups was similar. The immunosuppressed patients fulfilled the criteria of the American Thoracic Society for clinical mycobacteriosis less frequently (18%) than those with other underlying diseases (32%) or without predisposing factors (45%), p = 0.07, the difference being more striking for patients with Mycobacterium avium complex isolates. This was partly due to the difficulty in distinguishing the relevant symptoms from those caused by the underlying disease. The proportion of patients receiving antimycobacterial therapy differed similarly (18%, 21%, 45%, respectively). Among the immunosuppressed patients, positive acid-fast smears were significantly less common and polymicrobial infections, initial lymphocytopenia, fever and fatal outcome significantly more common. About half of the immunosuppressed patients died within one year. In order to better define patients requiring treatment, the criteria for localized mycobacteriosis among immunosuppressed patients should be reevaluated.
Eur J Clin Microbiol Infect Dis 1995 Sep
PMID:Nontuberculous mycobacterial infection in HIV-negative patients receiving immunosuppressive therapy. 853 22

A 65-year-old man with Rendu-Osler-Weber syndrome was admitted to the department of brain surgery at our hospital because of left hemiplegia and a right cerebral mass seen on a computerized tomogram of the brain. A brain abscess was found during surgery. Then the patient had pneumonia. He received antibiotics and recovered, but his PaO2 remained low. He was transferred to our department for evaluation of hypoxia. Thoracic computerized tomography showed a nodular lesion connected to a vascular shadow. Angiographic examination showed a pulmonary arteriovenous fistula and other vascular abnormalities. He was not dyspneic or cyanotic, but his hypoxia, low diffusing capacity, and brain abscess were thought to be caused by the pulmonary arteriovenous fistula. The fistula was embolized with coils via a percutaneous catheter, after which oxygenation and diffusing capacity improved.
Nihon Kyobu Shikkan Gakkai Zasshi 1995 Sep
PMID:[A case of Rendu-Osler-Weber syndrome and pulmonary arteriovenous fistula]. 853 81

We retrospectively reviewed all patients with a final diagnosis of spontaneous thoracic aortic dissection treated at Linkou Chang Gung Memorial Hospital between January 1989 and December 1994. There were a total of 109 patients with a mean age of 55 +/- 11 years ranging from 19 to 88 years. The male-to-female ratio was 2 to 1 (73 to 36). There was a predilection to present during the colder months, with 69% seen between September 1 and February 28 and only 31% during the warmer half of the year. In most patients, hypertension (85%) was the major predisposing factor with another 7% having Marfan syndrome. The remaining 8% had no obvious underlying disease except for one patient who had an atrial septum defect. Presenting chief complaints in order of frequency included: anterior chest pain 58.7% (64/109), back pain 19.2% (21/109), abdominal pain 10.1% (11/109), consciousness change 3.7% (4/109), neck pain 2.7% (3/109), paraparesis 2.7% (3/109), dyspnea 1.8% (2/109), and hemoptysis 0.9% (1/109). The diagnostic breakdown revealed 46% to be type A (50/109) and 54% type B (59/109). A total of 26 (24%) patients died in hospital (16% were type A and 8% were type B). (Type A included all proximal dissections and those distal dissections that extend retrograde to involve the arch and ascending aorta; Type B refers to the other distal dissections without proximal extension; proposed by Daily et al.) Thoracic aortic dissection remains an important concern in patients with a history of hypertension. Patients seem particularly susceptible during cold weather months. The average age of our patients was only 55 years and 24% of them died during hospitalization. Earlier identification and more aggressive antihypertensive treatment is required.
Jpn Heart J 1995 Sep
PMID:Aortic dissection in Taiwan. 855 68

Malignant non-Hodgkin's lymphomas are rare in the absence of human immunodeficiency virus infection and it is exceptional for a cardiac site to be the prominent feature. In our case, the malignant lymphoma was revealed by pericardial effusion in a context of alteration of the general state. Echocardiography revealed a heterogeneous mass in the right atrium and an abundant circumferential pericardial effusion. Thoracic computed tomography allowed local staging and magnetic resonance imaging (MRI) allowed a better definition, than CT scan, of the extension of the tumour into the various cardiac structures. The histological diagnosis was established on biopsy of a mediastinal lymph node. The patient died 7 months after the diagnosis, despite chemotherapy. The authors emphasize the contribution of echocardiography in the diagnosis of cardiac tumours, computed tomography in local staging, and MRI in the analysis of the various cardiac structures.
Ann Cardiol Angeiol (Paris) 1995 Sep
PMID:[Malignant non-Hodgkin lymphoma of cardiac localization. Apropos of a case]. 856 38


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