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

Japanese Society of Cryopreserved Thoracic Tissue Implantation was recently set up. Cryopreserved allograft valves are about to pervade in Japan. To clarify the interest, demands and supply of cryopreserved allograft valve in the area of Kyushu and Yamaguchi, we performed questionnaire investigation regarding this issue. Collection rate of this questionnaire was 87.5% (35/40 hospitals). Ninety-seven percent of the hospitals answered that they were interested in cryopreserved allograft. Ninety-four percent of the hospitals answered that they did not ethically hesitate to use cryopreserved allograft. Ninety-one percent of the hospitals hoped to perform cardiac surgery using allograft aortic valve if allograft is available. With respect to securing donors of allograft, two-third of the hospitals did not decide whether they could be involved in obtaining donors of allograft. As the number of the cadaver kidney donors is about 20 per year in the area of Kyushu and Yamaguchi, shortage of donors of allograft valve is anticipated.
Kyobu Geka 1996 Dec
PMID:[Questionnaire of cryopreserved allograft valves in Kyushu and Yamaguchi area]. 895 78

Patients with latent tuberculosis characterized by a positive tuberculin (purified protein derivative) skin test and radiographic evidence of fibronodular changes or silicosis are at increased risk for the development of active tuberculosis. Before preventive therapy is initiated, the radiographic abnormalities must be differentiated from those representing active disease. According to recommendations from the American Thoracic Society and the Centers for Disease Control and Prevention, patients with latent tuberculosis who exhibit fibronodular changes or silicosis on chest radiographs should be given either isoniazid alone for one year or the combination of isoniazid and rifampin for four months, preferably with pyrazinamide for the first two months. Patients with similar radiographic findings and sputum or culture evidence of active tuberculosis require full multidrug therapy.
Am Fam Physician 1996 Dec
PMID:Patients with an abnormal chest radiograph and latent tuberculosis. 896 48

Thoracic trauma victims commonly sustain visceral pleural injury with resultant pneumothorax. These injuries usually respond to standard tube thoracostomy decompression and drainage. However, a subset of these patients develop recurrent and/or loculated pneumothoraces or pneumatoceles that are not readily accessible by tube thoracostomy. Percutaneous catheter drainage of these collections provides a safe and reliable method of management in critically ill patients.
J Trauma 1996 Dec
PMID:Percutaneous drainage of recurrent pneumothoraces and pneumatoceles. 897 May 69

The field of sleep disorders medicine is facing enormous challenges as it strives to gain recognition from the medical profession, the public and government. One of these challenges is to ensure that limited resources for diagnosis are used wisely. The authors argue that the standards for polysomnography developed by the Canadian Sleep Society and the Canadian Thoracic Society (see pages 1673 to 1678 of this issue) will go a long way toward ensuring that this expensive resource is used prudently. In the mean-time, more research is needed to determine valid measures of the impact of sleep disorders and to establish the reliability of different diagnostic methods.
CMAJ 1996 Dec 15
PMID:Polysomnography: addressing the need for standards. 922 Sep 20

A case of acid-fast bacillus smear-positive cavitary tuberculosis (TB) was diagnosed in a high school senior (Student A) who lived in a community with a low prevalence for TB. A broad TB investigation was conducted in July 1994 among persons who attended the high school graduation with Student A. Follow-up investigations three months later focused on close contacts at highest risk. A positive tuberculin skin test (TST) was defined as induration of > or = 5 mm after placement of purified protein derivative. We determined the TST results and the estimated costs incurred by the local health department for the broad screening that was conducted. TST results were available for 122/161 (75%) close contacts, and for 1804 persons with nonclose contact with Student A. Her family members were known to have had prior positive TSTs. Positive TSTs were found among 3/122 (2.5%) close contacts, versus 34/1804 (1.9%) persons with nonclose contact. Only one close contact had conversion of TST from negative to positive, and no other active TB case was identified. We estimate the broad TST screening cost the local health department $36,507. Broad TST screening was costly and diverted staff from their customary public health service priorities. Local health departments and clinicians should follow the recommendations of the American Thoracic Society and the Centers for Disease Control and Prevention regarding TB contact investigations.
Md Med J 1996 Dec
PMID:Pulmonary tuberculosis in a high school student and a broad contact investigation: lessons relearned. 898 50

Pulmonary function was assessed by spirometry in 497 black and 2,980 white ambulatory elderly male and female participants of the Cardiovascular Health Study. The quality assurance program prompted technicians to exceed American Thoracic Society recommendations for spirometry. A "healthy" subgroup of 235 black and 1,227 white participants age 65 years and older was identified by excluding current and former smoker, and those with self-reported asthma or emphysema, congestive heart failure, and poor-quality results of spirometry tests, since those factors were associated with a lower FEV1. Reference equations and normal ranges for elderly blacks for measurements of FEV1, FVC, and the FEV1/FVC ratio were then determined from the healthy group. These elderly blacks had an FVC about 6% lower than elderly whites, even after correcting for standing height, sitting height (trunk length), and age. The popular use of spirometry reference values from studies of middle-aged white subjects by applying a 12% race correction factor for black patients appears to overestimate predicted values.
Chest 1996 Dec
PMID:Spirometry reference values for healthy elderly blacks. The Cardiovascular Health Study Research Group. 898 54

We report the case of a patient who was admitted in hospital for evaluation of a superior vena cava thrombosis. The patient exhibited an activated protein C resistance due to an arginine-506 mutation in factor V. Thoracic CT-scan showed a non-compressive complete superior vena cava thrombosis. Other investigations revealed a pleural effusion associated with an ovarian tumor. Pathological data of pleural biopsies showed a papillar carcinoma. Ovarian neoplasia revealed by a paraneoplasic syndrome was diagnosed. Treatment associated cyclophosphamide and carboplatin with anti-K-vitamin was administrated, with a complete remission and disappearance of superior vena cava thrombosis at 27 months of evolution. At this date, we observed a local pelvis recurrence which was treated with paclitaxel associated with surgery.
Rev Mal Respir 1996 Dec
PMID:[Paraneoplastic superior vena cava thrombosis disclosing an ovarian tumor]. 903 6

In a multicenter pilot study and with the support of the German Federal Ministry of Research and Technology, a commission of the German Association for Thoracic, Cardiac and Vascular Surgery developed a procedure for cardiosurgical quality assurance. After concluding the pilot phase, the data were reduced for general practicability to the essential characteristics and now comprise 205 items. After a cooperation contract between funding agents, the German Hospital Association, The German Federal Hospital Association and the German Association for Thoracic, Cardiac and Vascular Surgery, The Federal Working Group on Cardiosurgical Quality Assurance was founded. Under supervision of a federal board, the practical work is performed in a project office, which works closely together with a board of cardio-surgeons. The quality assurance comprises almost all cardiac surgery performed on adults. The data collected in the hospitals are drawn by the office into comparative statistics that allow judgement of the quality.
Herz 1996 Dec
PMID:[Quality assurance in heart surgery in Germany. Development, current status and outlook]. 908 5

In the era of managed health care quality assurance has become more and more important. In cardiac surgery immense costs have to be justified. Some of the patients might be treated alternatively with drugs or by cardiological interventions. Additionally, the operative risk is still not neglectable in cases with substantial comorbidities and advanced age. Therefore in Germany, a nationwide quality assurance system was established in 1992 covering more than 90% of the cases in more than 90% of the centers. The goals of quality assurance have to address the needs of the patients, insurance companies, and surgeons, and thereby define the primary endpoints for analysis: mortality, quality of life, and therapy costs including reinterventions. A precondition for a sufficient quality assurance system is the isolation of quality relevant data by multivariate analysis and its documentation. Weighing the different factors allows a risk stratification in order to compare the results of various centers with different patient populations. For every center an expected mortality is calculated, and compared with the observed mortality. By taking the average mortality into account a risk adjusted mortality is derived for every center, which is independent from the patient population. An automated continuous follow-up of the patients is essential and allows assessment of 30-day mortality, reinterventions and quality of life. In 1986, the German Society of Cardio-thoracic-surgery initiated the development of a multicentric method of quality assurance (Quadra). In 1992 the insurance companies agreed to cover the costs for the reduced documentation of 205 parameters for every patient undergoing CABG, valve surgery or repair of an aneurysm with the help of cardio-pulmonary bypass; a 30-day follow up is included. Isolation of risk factors has not been performed because the quality of the data was not considered valid due to incomplete documentation and non-rigorous data control. For the first time in 1990, New York State Department of Health published data on risk adjusted mortality in CABG separate for every hospital. Due to a lawsuit brought on by the journal "Newsday" the department was forced to publish the results of every surgeon. Each clinic reports 41 different patient parameters, which are controlled for completeness and accuracy by an independent committee. The efficacy of this system has been proved by a 41% reduction in mortality from 1989 to 1992 mainly due to changes in patient management. Raw mortality rates to different hospitals in CABG were published by the administration of the insurance companies in 1986 leading to misinterpretations by the public. In response, the Society of Thoracic Surgeons initiated a database to calculate risk adjusted data. Today, more than 50% of all US-American centers participate and more than 700,000 patients have been reported. The data is not controlled and the majority of participating hospitals are small community centers. We have developed a methodology of quality assurance which estimates the operative risks of an individual patient by calculating the survival curve of all patients with the same risk profile who have already been operated on in our center. An automated long-term follow-up at one and five years after surgery provides the data for the calculation. The development of an effective quality assurance in the US was forced by media and insurance companies. Presentation of incorrect or misleading data in Germany has already damaged the image of cardiac surgery and surgeons. Therefore, there are no alternatives to public presentation of risk-adjusted mortalities in order to regain trust. Fears of surgeons and hospitals with results below the average are serious and patients with a high mortality risk may be afraid of not being operated on, although the New York System shows that these fears have not become real...
Herz 1996 Dec
PMID:[Quality assurance in heart surgery. General and personal concepts]. 908 7

The aim of the study was first to evaluate whether mobility in the cervico-thoracic motion segment is an indicative factor of musculo-skeletal neck-shoulder pain and secondly to compare differences in individual factors between cases and controls for female and male subjects. One-hundred-and-forty-two male electricians and 139 female laundry workers participated in a cross-sectional study. An examination of the Cervico-Thoracic Ratio and a classification of mobility at level C7-T1 was done. All subjects answered a questionnaire about musculo-skeletal complaints. The analysis of relationship between relative flexion mobility in motion segments C7-T5 and neck-shoulder pain showed significant relationships between mobility in specific motion segments and neck-shoulder pain. The overall fit of the multiple regression analysis explained 10% of the variation in neck index (N1) for subjects classified as hypomobile at level C7-T1 and 18% for subjects classified as having an inverse C7-T1 function. Both female and male subjects classified as hypomobile at level C7-T1 showed elevated odds ratios of 2.7 and 2.2, respectively, to have had more than 7 days of neck pain during the previous 12 months, compared to subjects classified as having ordinary mobility at level C7-T1. The factor age showed that young subjects with hypoar hypermobility at level C7-T1 showed elevated odds ratios for neck pain compared to subjects with ordinary mobility in the same age group. In old subjects hypermobility at level C7-T1 was protective compared to subjects with ordinary mobility in the same age group. The factor number of working years showed significant difference between cases and controls among female subjects in the ordinary and hypermobile classes. The factor height showed no significant differences between female or male cases and controls; it did show significant correlation to C7-T1 mobility among female subjects, but not among male subjects. The factors exercise and smoking showed significant differences between cases and controls among female subjects in the ordinary mobility class. The conclusion was that relative flexion mobility is a factor related to the development of neck-shoulder pain rather than the cause of pain.
Scand J Rehabil Med 1996 Dec
PMID:Mobility in the cervico-thoracic motion segment: an indicative factor of musculo-skeletal neck-shoulder pain. 912 45


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