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PubMed2000

9. Assessment of Intrathoracic Metastatic Lung Cancer using FDG-PET and CT of the Thorax.

Purpose: The purpose of this study was to assess the accuracy in localizing mediastinal, hilar and intraparenchymal lymphadenopathy in patients with primary lung carcinomas, using FDG-PET and CT of the thorax and to correlate with surgical pathology.Method: Thirty-five patients with primary lung carcinomas and minimal metastatic lymph node involvement, (either N solidus in circle or N1 disease) underwent FDG-PET and CT of the thorax prior to surgical intervention. Both FDG-PET and CT of the thorax were blindly read independent of one another.Results: Histologically, 23 patients had negative lymph nodes (N solidus in circle) and 12 patients had N1 disease. The imaging performance characteristics for FDG-PET and CT of the thorax in N solidus in circle/N1 disease was evaluated and reported in Table 1.Conclusion: This study demonstrates the higher specificity, accuracy, PPV, and NPV of FDG-PET over CT of the thorax in patients with minimal lymph node disease.

Journal Article↗
PubMed1999

The role of thorax imaging in staging head and neck squamous cell carcinoma.

The overall survival rate for patients with head neck squamous cell carcinoma remains disappointingly static despite improved locoregional control. This has been attributed to the development of distant metastases and second primary malignancies in these patients, a large proportion of which occur in the thorax. We retrospectively analysed the incidence of thoracic malignancies in 138 patients presenting with newly diagnosed (n = 107) or recurrent (n = 31) cancer of the head and neck over a 4-year period. All 138 patients had undergone both computerised tomography of the thorax (CT) and conventional chest radiography within one month of presenting with biopsy proven squamous cell carcinoma. Seventeen percent of these were found to have simultaneous thoracic malignancies. CT thorax was more sensitive in detecting simultaneous thoracic malignancies compared with standard chest X-ray (24/138 versus 9/138, odds ratio of 3:1 in favour of CT). All thoracic malignancies detected by chest X-ray were also detected by CT thorax. Patients presenting with recurrent tumors were significantly more likely to have simultaneous thoracic malignancies than those with newly diagnosed cancer (11/31 versus 13/107, chi2 test with Yates correction, chi2 = 4.66, p = 0.03). The primary site (laryngeal, oral or pharyngeal) or presence of nodal disease did not have an effect on the incidence of simultaneous thoracic malignancies. The presence of distant metastases and second primary malignancies has major implications in the management and prognosis of patients presenting with head and neck squamous cell carcinoma, with a large proportion of such patients succumbing to their disease within one year of diagnosis. As CT scanning of the thorax was a more effective screening investigation than standard chest X-ray in the detection of simultaneous thoracic malignancy, we recommend it for use in the staging of patients presenting with cancer of the head and neck.

Adult↗
PubMed1989

Analytical studies of injury criteria for the thorax.

The viscous criterion is a recently developed criterion to assess injury severity of the human thorax. In the viscous criterion, the peak viscous response, which is defined as the maximum product of deformation velocity and compression of an object, is proposed as a predictor of injury risk. However, the physical meaning of the criterion is not very clear. In this paper, the mathematical properties of the viscous criterion are analyzed. A mechanical thorax model is then used to relate the criterion to the physical quantities of the model using energy concepts. It is found that the so-called peak viscous response is strongly related to the peak energy storing rate of the thorax which is not related to the viscosity of the thorax. It is also shown that the viscous response of the thorax is given by the integral of the velocity squared with respect to time. The analysis is further expanded to a more general case to result in four criteria based upon the energy concepts. A hypothesis for injury assessment is proposed by using the four criteria.

Biomechanical Phenomena↗
PubMed1999

Blowfly flight and optic flow. I. Thorax kinematics and flight dynamics

The motion of the thorax of the blowfly Calliphora vicina was measured during cruising flight inside a cage measuring 40 cmx40 cmx40 cm. Sensor coils mounted on the thorax picked up externally generated magnetic fields and yielded measurements of the position and orientation of the thorax with a resolution of 1 ms, 0.3 degrees and 1 mm. Flight velocities inside the cage were up to 1.2 m s-1, and accelerations were up to 1 g ( approximately 10 m s-2) vertically and 2 g horizontally. During flight, blowflies performed a series of short (approximately 20-30 ms) saccade-like turns at a rate of approximately 10 s-1. The saccades consisted of a succession of rotations around all axes, occurring in a fixed order. First, a roll was started. Second, the rolled thorax pitched (pulling the nose up) and yawed, resulting in a turn relative to the outside world. Finally, the thorax rolled back to a level position. Saccades had yaw amplitudes of up to 90 degrees, but 90 % were smaller than 50 degrees. Maximum angular velocities were 2000 degrees s-1, and maximum accelerations were 10(5 ) degrees s-2. The latter correspond to torques consistent with the maximal force (2x10(-3 )N) that can be generated by the flight motor as inferred from the maximal linear acceleration. Furthermore, the sequence of energy investment in consecutive rotations around different axes appears to be optimized during a saccade.

Journal Article↗
PubMed1996

[Treatment outcome of surgical thoracic wall stabilization of the unstable thorax with and without lung contusion].

Between 1988 and 1994, 295 patients with blunt chest trauma were treated. Forty-two patients had flail chest, requiring mechanical ventilation. Open reduction and osteosynthesis (ASIF reconstruction plates or isoelastic rip clamps) of the chest wall were performed in 20 patients. For the purpose of analysis we separated the patients into five groups: group I (n = 10) had chest wall stabilization in flail chest without pulmonary contusion (average ISS 31.0, AIS-thorax 4.1); group II (n = 10) had chest wall stabilization in flail chest with pulmonary contusion (average ISS 37.0, AIS-thorax 4.3); group III (n = 18) had fail chest without pulmonary contusion (average ISS 36.3, AIS-thorax 4.2); group IV (n = 4) had flail chest with pulmonary contusion (average ISS 37.8, AIS-thorax 4.0); group V (n = 29) had pulmonary contusion without flail chest (average ISS 34.5. AIS-thorax 4.1). With open reduction and internal fixation of unstable chest wall segments, the duration of ventilatory support, mortality and pneumonia were significantly reduced to 6.5 (1-25) days in group I (mortality rate 0%, incidence of pneumonia 10%) compared to group III (duration of ventilatory support 26.7 days, mortality rate 39%, incidence of pneumonia 16%). Eighty percent of the patients in group I were extubated within 5 days postoperatively. In group II 4 patients underwent emergency thoracotomy for intrathoracic injuries (3 of them died between 4 h and 31 days) and 2 patients for laceration of the lung. In all these cases the chest wall was stabilized after thoracotomy. One patient was stabilized for a deformation of the chest wall and two for paradoxical movement of the chest wall during weaning from the respirator. The mean duration of ventilation in group II was 30.8 (10-112) days (mortality rate 30%, incidence of pneumonia 30%). No complications related to the osteosynthesis arose during the follow-up. In conclusion, the best indication for early operative chest wall stabilization is flail chest without pulmonary contusion, leading to a significant reduction in the duration of ventilatory support. Secondary stabilization is recommended in patients with pulmonary contusion showing paradoxical movement of the chest wall during weaning from the respirator.

Adult↗
PubMed1996

[Penetrating wounds of the thorax].

From January 1989 to December 1993 at the Institute of Clinical Surgery of the University of Perugia, 5 patients were under observation for penetrating chest injuries. Two of them had show-wounds, one a slash, one a stabbing and slash and one a cutting blow. One of the patients with shot-wounds died on the operating table from a haemorrhage while the other was saved by surgery. One patient successfully underwent surgery for loss of tissue in the thorax walls. Another had a mini-thoracotomy plus lung suture which were successful. Finally, in the patient with a slash in the front region of the thorax and a slight pneumothorax, we inserted a chest thorax tube and so obtained a complete re-expansion of the lung. Total mortality was 20%. Surgical exploration of the thorax we believe is necessary wherever there is a risk of haemorrhage or possible lung damage requiring only surgery. According to many authors, video-thoracoscopy has the advantage of a reliable diagnosis and above all, enable us to repair lung wounds without opening the thorax. In one of our patients we could have avoided the mini-thoracotomy and used thoracoscopy to repair the lung damage.

Adult↗
PubMed1987

Localisation of cardiac related impedance changes in the thorax.

The existence of variations of normal human thoracic impedance, during the cardiac cycle to high frequency electrical current is well known. Since the impedance variations within the thorax are synchronous with the electrocardiogram (ECG), they are attributed to cardiac activity. They can arise from the change of either the rate of blood flow or the blood volume in the heart chambers, the great blood vessels and the lungs. However, their relative contribution is not known. Many investigators have worked on the non-invasive determination of some cardiac parameters using surface electrode impedance measurements on the thorax. Since the relationships between the measurement results and the pulsatile circulation of blood in various organs inside the chest are not well known, the information determined by surface impedance measurements is not as accurate as the results of invasive techniques. Recent advances in the clinical use of applied potential tomography (APT), or electrical impedance imaging, showed that the APT system gives a good soft-tissue contrast and has good sensitivity to resistivity changes. It is therefore concluded that the origin of thoracic impedance changes related to cardiac activity can be deduced from APT images. Our initial studies of ECG gated dynamic APT images of the thorax show that cardiac related thoracic impedance variations originating from different organs can be separated. Sequential APT images of the thorax during the cardiac cycle are presented. The movement of blood from the ventricles to the lungs and vascular system and back to the ventricles is observable in these images.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1976

Heat exchange in relation to blood flow between thorax and abdomen in bumblebees.

1. The narrow passage within the petiole between thorax and abdomen is anatomically constructed so that counter-current exchange should retain heat in the thorax despite blood flow to and from the cool abdomen. 2. However, the counter-current heat exchanger can be physiologically circumvented. Exogenously heated bumblebees prevented overheating of the thorax by shunting heat into the abdomen. They also regurgitated fluid, which helped to reduce head temperature but had little effect on thoracic temperature. 3. Temperature increases in the ventrum of the abdomen occurred in steps exactly coinciding with the beats of the ventral diaphragm, and with the abdominal 'ventilatory' pumping movements when these were present. The ability to prevent overheating of the thorax by transport of heat to the abdomen was abolished when the heart was made inoprative. 4. At low thoracic temperatures the ventral diaphragm beat at a wide range or rates and with varying interbeat intervals, while the heart beat at a high frequency relative to the ventral diaphragm, but at a very low amplitude. However, when thoracic temperature exceeded 43 degrees C the amplitudes of both were high, and the interbeat intervals as well as the beating frequencies of the two pulsatile organs became identical in any one bee. Furthermore, heated bees engaged in vigorous abdominal pumping at the same frequency as that of their heart and ventral diaphragm pulsations. 5. The results indicate that the anatomical counter-current heat exchanger is reduced or eliminated during heat stress by 'chopping' the blood flow into pulses, and the blood pulses are shunted through the petiole alternately by way of a switch mechanism.

Abdomen↗
PubMed1981

Pulmonary, chest wall, and lung-thorax elastances in acute respiratory failure.

The usefulness of lung-thorax compliance (or elastance) as an index of pulmonary compliance (or elastance) was examined in 15 patients being ventilated for acute respiratory failure. Mean lung-thorax elastance (ELT) was 27.9 +/- 2.6 cm H2O/L, and the chest wall accounted for 34 +/- 2 percent of the mean total value. Changes in ELT caused by increments of positive end-expiratory pressure correlated only with changes in pulmonary elastance (r = 0.96; P less than 0.001) and not with chest wall elastance, although individual patients varied as to the contribution of the chest wall component. Lung-thorax elastance increased in direct proportion (1:1) to increases in pulmonary elastance, whereas the changes in lung-thorax compliance were only half those in pulmonary compliance. We conclude that elastance is a more useful clinical index than compliance.

Acute Disease↗
PubMed1979

[Architectonics of the thorax (author's transl)].

Blunt traumata cause injury to the thorax and intrathoracic organs by deforming the chest wall and the enclosed structures. Neither examination of the dead person and re-enactment of the accident nor experimental studies on the living or dead person can fully elucidate the course of events. A more satisfactory approach is to use biomechanic models to simulate the structure of the thorax and the type of deformation it undergoes when subjected to various traumata. Such an elasto-static analysis presupposes knowledge of (1) the global geometry of the thorax; (2) the cross sectional geometry of the individual components; (3) the mechanical properties of the material; (4) the force of the impact; (5) concomitant conditions. The results obtained with the models are reviewed. They make it possible to predict the deformation of the thorax in response to the force of the impact, the location and type of fracture of the ribs and the deformation of the intrathoracic organs.

Anthropometry↗
PubMed2000

Staging computed tomography of the thorax for nasopharyngeal carcinoma.

BACKGROUND: To assess the role of staging CT of the thorax in advanced nodal stage nasopharyngeal carcinoma and to examine the hypothesis that contiguous spread of nodal metastases from the supraclavicular region to the upper mediastinal region occurs in this cancer. METHODS: Forty-four patients with newly diagnosed nasopharyngeal carcinoma with neck node metastases to the supraclavicular region (ie, AJCC N3b stage) underwent contrast-enhanced CT (CECT) thorax for staging. CT findings and clinical outcome were analyzed. RESULTS: No patient was found to have intrathoracic metastasis, although 1 had hepatic metastases on CECT of the thorax, resulting in upstaging in 1 of 44 (2%) of patients. With a median follow-up time of 21 months, 3 patients had lung metastases and 2 had axillary nodal metastases develop without evidence of upper mediastinal nodal metastases. CONCLUSION: Staging CECT of the thorax has a very low yield in nasopharyngeal carcinoma, even in advanced nodal disease. The hypothesis that contiguous spread of nodal metastases from the supraclavicular region to the upper mediastinum is not substantiated, and no evidence suggests that radiation therapy for N3b-stage disease needs to encompass the upper mediastinum.

Adult↗
PubMed1978

[Traffic accidents and seat belts: thorax injuries (author's transl)].

The types of injuries to 313 automobile accident victims, especially thorax injuries, are compared. Independent of seat belt use (42%), there was in general a higher degree of injury. Those wearing seat belts had a markedly less severe AISm (median degree of injury of body region) and less severe thorax injury. Severe thorax injury was first found at speeds greater than 24 km/h above average. Severer thorax injury is to be expected with defective seat belts (AISm = 1.25) than with properly functioning belts (AISm = 0.32).

Accidents, Traffic↗
PubMed1996

[Calculated organ doses and effective dosage for computerized tomography examination of the thorax and abdomen: are these doses realistic?].

PURPOSE: To analyse how far dose calculations for the CT examination of the thorax and abdomen can lead to faulty estimations of organ doses and effective dose due to differences in the topographic anatomy between mathematical phantom and man. METHODS: For the CT examination of the thorax, upper abdomen, pancreas, pelvis and the entire abdomen, organ doses were calculated with conversion factors, first with regard to the topographic relation within the phantom, then with additional regard to the real anatomy of the man. RESULTS: In the phantom, the abdomen lies outside the scan volume in case of CT-examination of the thorax and the whole intestine outside the scan volume in case of CT-examination of the upper abdomen and the pancreas, whereas the entire intestine is directly exposed in case of CT-examination of the pelvis. Dependent on whether dose calculations take real anatomy into account, doses of special organs can differ by a factor greater than 15. The calculated effective doses differ by a factor less than 1.5. CONCLUSIONS: Calculations of organ doses for the CT examination of the thorax and abdomen can lead to considerable errors due to different topographic relations between phantom and man. In contrast the calculated effective dose is realistic. Hence, dose calculations with the help of mathematical phantom is an efficient method to estimate the total radiogenic risk.

Female↗
PubMed1995

[Normal ultrasound curves of the fetal osseous thorax and fetal lung].

Over and above the evaluation of fetal standard data, chest and lung measurements were performed in a prospective cross-sectional study with real-time ultrasound. The study group consisted of 610 patients between 12 and 41 weeks' gestation. Only uncomplicated pregnancies with carefully documented gestational age were included. Patients with multiple pregnancy, fetal anomalies, intrauterine growth retardation or macrosomia and patients with oligohydramnios were excluded. Transversal (BTTD) and sagittal (BTSD) diameter of the bony fetal thorax were measured as an outer-outer-measurement at the level of the atrioventricular valves; the thorax should be as circular as possible and at right angles to the fetal spine. Lung measurements (LD) were performed in the same plane in the direct extension of the long axis of the fetal heart. The circumference of the bony thorax (BTC) was calculated from the two thoracic diameters according to the formula BTC = (BTTD+BTSD)/2 x 3.142. For all parameters growth curves with 5., 50. and 95. percentiles were established. Growth of the bony thorax as well as the lung diameter was shown in a nonlinear function. Lung diameter and thoracic circumference were used to calculate the ratio of these two parameters with reference to the gestational age.

Anthropometry↗
PubMedDate not supplied

Electric field plethysmography signals of the human thorax as determined by a 2-D FE-model.

Electric field plethysmography (EFPG) signals of the human thorax consist of a baseline component, a respiratory component and a cardiac component. This paper investigates to what extent a two-dimensional finite-element model of the human thorax can serve as a tool for signal prediction allowing for both optimisation of electrode position and effective signal interpretation. In the model inspiration is taken into account by decreasing lung conductivity. Modelling of cardiac activity involves heart geometry changes and lung conductivity increase. Comparison with experiments shows that the model is more effective for strip than spot electrodes for current injection. Modelling results suggest that the thorax behaves approximately as a homogeneous structure with an inspiratory conductivity increase of about 5%. Two electrode pairs are preferable for monitoring respiration in general. As cardiac activity involves two counter-acting signal sources in the thorax, optimum electrode position is obtained using four separated electrodes. However, recommendable positions for two electrode pairs are on the left sternal and right parasternal line. The investigation shows that in providing a proper modelling of respiration and cardiac activity, a 2-D model provides a practical tool for modelling EFPG signals with the cost of a few structural and systematical restrictions.

Cardiography, Impedance↗
PubMed1993

The evolutionary history of Drosophila buzzatii. XXVII. Thorax length is positively correlated with longevity in a natural population from Argentina.

The correlation between body size and longevity was tested in an Argentinian natural population of Drosophila buzzatii. Mean thorax length of flies newly emerging from rotting cladodes of Opuntia vulgaris was significantly smaller than that of two samples of flies caught at baits. The present results which might be interpreted as directional selection for longevity favoring larger flies are in agreement with previous results achieved in a Spanish natural population of D. buzzatii. Flies emerging from different substrates showed significant differences in thorax length, suggesting that an important fraction of phenotypic variance can be attributed to environmental variability. However, laboratory and field work in different populations of D. buzzatii showed a significant genetic component for thorax length variation.

Animals↗
PubMed1987

Acute and chronic effects of xanthine oxidase on lung thorax-compliance in guinea pigs.

Xanthine oxidase was given intratracheally in a single dose to guinea pigs. Lung compliance was measured after 4 h and 14 days respectively. Lung-thorax compliance was significantly lower compared with saline-treated controls both 4 h and 14 days after application of fluid. At 14 days there was a dose-related response between lung-thorax compliance and xanthine oxidase administered in the range 0-1.0 U. Superoxide dismutase (SOD) had a protective effect on xanthine oxidase action at 4 h, but not after 14 days. We suggest that the decreased lung-thorax compliance was caused by superoxide radicals, produced by the hypoxanthine-xanthine oxidase system, damaging lung tissue. We speculate that free oxygen radicals produced by the hypoxanthine-xanthine oxidase system could be an important contributory pathogenetic factor in producing both acute and chronic lung damage in, for instance, premature babies or adults, with respiratory distress syndrome.

Animals↗
PubMed1975

Localization of hyperfunctioning parathyroid tissue. Radioimmunoassay of parathyroid hormone on samples from the large veins of the neck and thorax and selectively catheterized thyroid veins.

Radioimmunoassay of parathyroid hormone on samples obtained from the large veins of the neck and thorax was utilized for localization in twenty-one patients with hyperparathyroidism. In seventeen of these patients, as many of the thyroid and mediastinal veins as possible were also sampled. This study reveals that sampling of the large veins of the neck and thorax is an insensitive means of adenoma from hyperplasia. Anatomic variations in the drainage of the inferior thyroid veins and dilution of the parathyroid venous effluent by the large veins of the neck and thorax seem to explain this insensitivity and the occasionally misleading results of large vein sampling. Sampling of the small thyroid veins, however, is a sensitive and specific means of localization and permitted preoperative differentiation of adenoma from hyperplasia in fourteen of our seventeen patients. Communications between the inferior thyroid and thymic veins and the fact that mediastinal adenomas frequently bring their blood supply down from the cerevical area suggest that sampling of the small thyroid veins may be of only limited value in identifying a mediastinal adenoma.

Adenoma↗