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

The authors report the case of an eleven year old child with aneurysmal dilatation of the left atrial appendage and underline the diagnostic value of Doppler echocardiography in this affectation. The two signs which led to investigation of the patient and the diagnosis of this rare congenital abnormality were bulging of the left heart border on chest X-ray and atrial fibrillation. In addition to visualising a left para-cardiac chamber communicating with the left atrium on transthoracic and transoesophageal echocardiography, colour Doppler confirmed an exchange of blood between the two chambers. This aneurysm was particularly voluminous and contained echos of spontaneous contrast, a possible source of thrombosis. Thoracic CT scan and angiocardiography did not provide any further useful information. The surgical findings confirmed the presence of a large aneurysm of the left atrial appendage and excluded partial agenesis of the pericardium, the main differential diagnosis. The aneurysm was excised under cardiopulmonary bypass, and, in particular, atrial fibrillation did not recur after surgery.
Arch Mal Coeur Vaiss 1994 Dec
PMID:[Severe aneurysmal dilatation of the left atrium. Apropos of a case]. 778 18

We compared arterial growth to hemodynamic changes in the perinatal period in lambs. Blood pressure did not change significantly from 120 days gestation to 3 days postpartum, when it was 45.4 +/- 1.9 mmHg; however, pressure rose to 64.8 +/- 2.5 mmHg at 21 days postpartum. Thoracic and abdominal aortic and iliac and carotid arterial blood flows fell > 50% after birth but returned to fetal levels except in the abdominal aorta by 21 days postpartum. Blood flows in mesenteric (BFm) and renal (BFr) arteries increased between 120 days gestation (BFr = 13.4 +/- 1.4; BFm = 41.8 +/- 3.5 ml/min) and 140 days gestation (BFr = 25.9 +/- 1.8; BFm = 189 +/- 18 ml/min) and between 3 and 21 days postpartum (to BFr = 71.1 +/- 14.3; BFm = 334 +/- 59 ml/min). Elastin accumulation accelerated at 140 days gestation in all arteries except the thoracic aorta, in which elastin accumulation was always rapid. Collagen but not DNA accumulation also accelerated in most arteries. Postpartum dexamethasone (0.1 mg/kg twice a day) did not affect abdominal aortic elastin by 10 days of age (23.9 +/- 2.7 vs. 26.4 +/- 4.1 mg for controls); however, dexamethasone upregulated tropoelastin mRNA in fetuses. We hypothesize that cortisol stimulates elastin accumulation in late gestation. Postnatal elastin but neither collagen nor DNA correlated with blood flow changes at birth (r = 0.855, P < 0.05). We infer that accumulation of elastin is sensitive to blood flow rates during perinatal development.
Am J Physiol 1994 Dec
PMID:Perinatal accumulation of arterial wall constituents: relation to hemodynamic changes at birth. 781 Jul 27

Thoracic empyema and appendicitis rarely are concomitant. This is the first report of ultrasonography and computed tomography being used preoperatively to establish the diagnosis of ruptured appendicitis in a child with thoracic empyema. The perforated appendicitis was identified after gastrointestinal flora were cultured from the thoracostomy drainage of the empyema.
J Pediatr Surg 1994 Dec
PMID:Thoracic empyema in a patient with acute appendicitis: a rare association. 787 55

The serial homology of arthropods, together with our ability to identify individual neurons from segment to segment, and from animal to animal, provides opportunities for studying the changes wrought by natural selection on specific neural elements when functional requirements change in different parts of the trunk. Using this concept as a guide, we studied the morphology and physiology of the thoracic N-cells and muscle receptor organs (MROs) of the crayfish Cherax destructor for evidence of serial homology and functional plasticity. Methylene blue staining, together with anterograde and retrograde filling with cobalt through cut axons, revealed the morphology of the receptors, disposition of their endings, and the pathways of their axons from receptor to ganglion. The seventh thoracic segment has tonic and phasic MROs with receptor muscles in parallel with different heads of the deep thoraco-abdominal extensor muscle. The sixth segment has a tonic MRO with a receptor muscle in parallel with one head of the abdominal abductor. These three receptors are typical MROs complete with accessory nerves. Thoracic segments 1-5 each give rise to one mechanosensory N-cell with a small cell body and long processes ramifying in a target muscle. N-cell 5 is associated with the abdominal-thoracic abductor muscle, and the other four are associated with parts of the epimeral attractor. The responses of N-cells 1-4 range from tonic to phasico-tonic and show a range of thresholds to passive muscle stretch and active contraction. Cobalt introduced into bundles of nerve fibers known to include N-cell axons reveals projections with branching patterns and morphology similar to abdominal MROs. The present findings, together with information on thoracic MROs and N-cells from other species, were tabulated according to neurotome. The clear pattern revealed leads us to propose that N-cells are derivatives of segmentally repeating MROs modified to monitor postural and locomotory movements in the less mobile thorax.
J Comp Neurol 1994 Dec 22
PMID:Morphology, physiology, and homology of the N-cell and muscle receptor organs in the thorax of the crayfish Cherax destructor. 789 Aug 31

Large multiinstitutional databases are excellent sources of information that provide clinically useful insight into the practice of cardiac surgery. Fully informed subscribers should be aware of the practical concerns associated with the management and interpretation of database results. During development of The Society of Thoracic Surgeons National Database, three such areas have become particularly important: the database population, the database quality, and the significance of results. Appreciation of the real and philosophical problems associated with these issues will allow for greater appreciation of the intricacies of the database and will enhance the users' ability to interpret information gained from the database.
Ann Thorac Surg 1994 Dec
PMID:Practical considerations in the management of large multiinstitutional databases. 797 79

The Society of Thoracic Surgeons' National Cardiac Database was used to determine the changes in preoperative characteristics and the predicted and observed risk of operative mortality of patients undergoing coronary artery bypass grafting during the decade of 1984 to 1993. During this period, the data show an increase of 2.5 years in age and decreases of 3% both in incidence of male patients and in incidence of first operation. There was little change in the percentages of urgent/emergent procedures or mean left ventricular ejection fraction. There was a significant 17.5% decrease in the proportion of lowest risk patients (0% to 2.5% predicted mortality) from 61.1% to 43.6%. Although no change in the next higher risk group (> 2.5% to 5.0% predicted mortality) occurred, the higher risk groups showed increases of 6.2%, 9.1%, 1.4%, and 1.1% for the > 5% to 10%, > 10% to 20%, > 20% to 30%, and > 30% to 50% risk groups, respectively. Over the past 2 years, there have been no significant changes in the distribution of the risk groups. These data will provide a base for comparison of future endeavors to lower complication rates and cost of coronary artery bypass graft operations.
Ann Thorac Surg 1994 Dec
PMID:Profile of preoperative characteristics of patients having CABG over the past decade. 797 83

There have been no major breakthroughs in surgical management for primary lung cancer during the past 40 years. Improved 5-year survival relates primarily to improved preoperative staging and appropriate selection of patients for resection. Perioperative morbidity and mortality, however, has been significantly reduced. Certain principles pertain to current surgical management: resection remains the best treatment for patients with localized, non-small cell primary lung cancer. Accurate preoperative diagnosis and staging: whenever possible, it is desirable to establish the diagnosis and cell type before operation. Accurate evaluation of the N status warrants wide application of invasive staging with mediastinoscopy or a variant. Indications for resection: only patients in whom a complete resection is anticipated should be selected for surgery. Such cases included T1 to T4 stages, N0 and N1 tumors, and selected N2 cases. The indication for resection in patients with hematogenous metastases are anecdotal. Intraoperative staging: accurate and deliberate intraoperative staging with evaluation of nodes using the American Thoracic Society map is highly desirable. The nature of nodal metastases exerts a critical influence on prognosis and in the selection of patients for surgical resection. At present, there is no clear indication for adjuvant therapy in surgically resected cases other than for evaluation and clinical trials.
Chest 1994 Dec
PMID:Current status of surgical resection for lung cancer. 798 59

Forty-six patients, known to suffer from asthma, attending an inner-city accident and emergency (A&E) department, were screened for the presence of chronic symptoms and their current treatment documented. The patients were asked if they knew their optimum peak expiratory flow rate (PEFR) or if they possessed a peak flow meter. The treatment being used by each of the 26 patients with evidence of chronic persistent asthma was compared to that as advised by the British Thoracic Society (B.T.S.) and it was found that only three patients were receiving adequate treatment. Most often the treatment regimes were suboptimal due to the absence of an inhaled anti-inflammatory agent. Patient awareness of their own PEFR or possession of a peak flow meter was uniformly low in both the well-controlled patients and those with chronic persistent asthma.
Arch Emerg Med 1993 Dec
PMID:Chronic persistent asthma presenting to an accident and emergency department--compliance with B.T.S. guidelines. 811 Mar 31

Thoracic injuries can always involve cardiac structures. If the heart is affected, penetrating or blunt injuries need urgent treatment. An unstable cardiac situation with shock symptoms is life-threatening. The diagnostic method of choice is ultrasound examination. This can show pericardial effusion, enlargement of cardiac chambers, wall motion changes and intracardiac defects. Pathologic ultrasound and ECG findings or abnormal enzyme values arising after blunt traumas need intensive care monitoring. Surgical interventions should be done immediately by the first surgeon involved: time should not be wasted by sending patients to special units, as extracorporal circulation is seldom needed. If it is necessary treatment should be carried out by a cardiac surgeon. Between 1989 and 1990 seven patients with thoracic trauma and heart involvement were operated on at the University of Ulm. The indications applied and results achieved are discussed with reference to the literature.
Unfallchirurg 1993 Dec
PMID:[Heart injury. Description of a traumatologic heart surgery patient sample]. 812 54

Thoracic and lumbar fracture-dislocations with 100% spinal column displacement are uncommon injuries that usually have associated neurologic injury. Severe spinal malalignment and instability can result in blood loss, tenting of skin and, severe pain. Four patients with thoracic or lumbar fracture-dislocations were initially treated and reduced with halo-bifemoral traction. Fracture reduction with halo-bifemoral traction decreased pain, controlled instability, relieved skin pressure, and prevented the need for acute surgical intervention. In addition, use of halo-bifemoral traction allowed for the resolution of spinal shock, allowed time for complete presurgical planning, and simplified the reduction portion of the operative procedure, thereby reducing operative time and blood loss.
J Spinal Disord 1993 Dec
PMID:Fracture-dislocation of the thoracic and lumbar spine: advantages of halo-bifemoral traction. 813 Mar 97


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