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PubMed1999

Video-assisted thoracoscopic surgery in the diagnosis and treatment of chest diseases.

Video-assisted thoracoscopic surgery (VATS) has been used recently in the diagnosis and management of thoracic diseases. In this report, VATS experience with 95 cases, focusing on indications, surgical procedures, complications, and failure rates, are reviewed. Over the past 5 years, 95 VATS procedures for diagnostic and therapeutic purposes were performed in 59 men and 36 women. The specific indications for VATS were lung biopsy for undiagnosed diffuse lung disease (48), mediastinal biopsy (12) and cyst (2), pleural effusion (10), empyema (5), pneumothorax and bullous lung disease (6), pericardial effusion (2) and cyst (2), paravertebral abscess (2), solitary pulmonary nodules (3), and thoracic trauma (3). In all patients, postoperative pain was controlled with non-narcotic analgesics and was measured according to the visual analogue scale (VAS). There was no surgical mortality. Postoperative nonfatal complications were seen in seven cases (7.5%). The overall median duration of chest tube drainage was 2.7 days and the mean postoperative hospital stay was 3 days. For diffuse lung disease, a tissue diagnosis was obtained in all the cases. Definitive diagnosis in the patients with undiagnosed pleural effusion was obtained in 90% of cases, and the overall diagnostic rate was 98.5%. The success rate of the therapeutic procedures was 100% after a mean follow-up of 12 months (range, 6-30 months). Conversion to thoracotomy was needed in six cases (6.6%). All patients scored postoperative pain <50% according to the VAS. Video-assisted thoracoscopic surgery should be considered as a procedure of choice, with exceptional results in the following chest diseases: (a) undiagnosed pleural effusions; (b) recurrent, post-traumatic, or complicated spontaneous pneumothorax; (c) stage II empyema; (d) accurate staging of lung cancer; (e) emergency traumatic injuries of the chest; (f) peripheral solitary pulmonary nodule <3 cm; and (g) lung biopsy for pulmonary diffuse disease.

Adult↗
PubMedDate not supplied

Radiographic diagnosis of lung lobe torsion.

Clinical data, thoracic radiographs, ultrasonographic exams, and histopathologic reports in 13 dogs and two cats with confirmed lung lobe torsion were reviewed. Age of dogs ranged from 4 months to 11.5 years, (mean of 6.4 years) and several breeds of large and small dogs were represented. Right middle lobe torsion was predominant in large dogs (five of eight large breed dogs) and left cranial lobe torsion was more commonly seen in small dogs (three of five small-breed dogs). Two domestic short-hair cats, 10 and 14 years of age, had right cranial and right middle lobe torsion, respectively. Underlying thoracic disease was found in only five of 15 patients. On thoracic radiographs, increased lobar opacity and pleural effusion were found in all patients (100%). Small dispersed air bubbles were found within the affected lobe of 13 patients (87%). This pattern, which was the result of vesicular emphysema, was variably extensive, and became more evident on follow-up radiographs in five of six dogs. The lobar bronchi could be seen in only eight of 15 patients (54%), and appeared irregular, focally narrowed or blunted in six of the eight patients, and displaced in five of the eight. Other common radiographic findings included mediastinal shift (nine), curved and dorsally displaced trachea (seven), and axial rotation of the carina (seven). Ultrasonography was used in seven patients and considered generally useful, although variable signs were observed.

Animals↗
PubMed2006

[Clinical application of video-assisted thoracoscopic surgery].

OBJECTIVE: To explore the clinical application of video-assisted thoracoscopic surgery (VATS). METHODS: We retrospectively analyzed the clinical data of 672 cases of VATS. There were 17 thoracic diseases such as emphysema, bullectomy for spontaneous pneumothorax, massive bullae, benign tumor of mediastinum, cyst of mediastinum, pulmonary benign tumors, hydropericardium, malignant pleural fluid, etc. RESULTS: The mean operation time was 57 minutes and there were no intraoperative complications. The bleeding during the operation was less than 100 mL. Postoperative pneumothorax occurred in 4 patients and among them 2 patients were of relapse after 1 month. The intrathoracic drain in most patients was removed with an average of 2. 5 days. A supplementary incision was needed in 10 cases: Six were due to the adhesion of full pleural cavity and 4 were found with the malignant tumor during the operation. CONCLUSION: VATS is an alternative approach that provides a safe, less invasive, and effective operation for treating spontaneous pneumothorax, benign tumor of mediastinum, cyst of mediastinum, pulmonary benign tumors, pericardial perfusion, and acute chest trauma patients.

Adolescent↗
PubMed2006

The spectrum of disease in children treated for tuberculosis in a highly endemic area.

BACKGROUND: Children contribute a substantial proportion of the global tuberculosis (TB) caseload, particularly in endemic areas, where little is known about their spectrum of disease. OBJECTIVE: To document the complete disease spectrum, with relevant age- and HIV-related differences, in children treated for TB in a highly endemic community. METHODS: A prospective descriptive study was conducted from February 2003 to October 2004 at five primary health care clinics in Cape Town, South Africa, including all children (< 13 years of age) treated for TB. RESULTS: In total, 439 children received anti-tuberculosis treatment. The spectrum of disease included 85 (19.4%) 'not TB', 307 (86.7%) intra-thoracic TB and 72 (20.3%) extra-thoracic TB (25 [5.7%] with co-existing intra- and extra-thoracic disease were included in both groups). In non-HIV-infected children, disseminated (miliary) disease (9/11, 81.8%) and tuberculous meningitis (TBM) (10/13, 76.9%) were predominantly documented in children < 3 years of age. In HIV-infected children, complicated Ghon focus and disseminated (miliary) disease were significantly more common (6/25, 24.0%) than in non-HIV-infected children (12/414, 2.9%) (OR 10.9, 95% CI 3.2-35.9). CONCLUSION: This study describes the complete disease spectrum observed in children treated for TB in a highly endemic area. Children suffered significant morbidity, with most severe disease recorded in very young and/or HIV-infected children.

AIDS Serodiagnosis↗
PubMed2000

Video-assisted thoracoscopic surgery in the diagnosis of lung disease. The Cretan experience.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has been recently utilised in the diagnosis and management of thoracic diseases. In this report we reviewed our VATS experience for biopsy of diffuse or localised lung diseases in 51 cases focusing on indications, operative procedures, complications or failures rates. PATIENTS AND METHODS: Over the last 5 years we performed 51 VATS procedures for diagnostic purposes in 32 men and 19 women. The specific indications for VATS were lung biopsy for undiagnosed diffuse or localised lung disease. In all patients the postoperative pain was controlled with the use of non-narcotic analgesics and was measured according the visual analogue scale (VAS). RESULTS: There was no operative mortality. Postoperative non-fatal complications were seen in 3 cases (6%). The overall median duration of chest tube drainage was 2 days and the mean postoperative stay 3 days. In the diffuse lung disease a tissue diagnosis was obtained in all the cases. Conversion to thoracotomy was needed in 1 case (2%), owing to extensive adhesions. All patients expressed a postoperative pain control effect of less than 50% of VAS. CONCLUSIONS: VATS should be considered as a safe and effective procedure, with low postoperative pain and morbidity. Should be recommended in patients who require a histological diagnosis of diffuse or localised lung diseases.

Adult↗
PubMedDate not supplied

Nerves of the thorax: atlas of normal and pathologic findings.

An anatomic and imaging atlas was created to provide detailed information about the six pairs of thoracic nerves (phrenic nerves, vagus nerves, recurrent laryngeal nerves, sympathetic trunks, costal nerves, long thoracic nerves). Serial axial computed tomographic (CT) scans of the normal thorax were obtained and included in the atlas, along with drawings showing the proper location of each nerve relative to adjacent anatomic structures. CT scans obtained in both symptomatic and asymptomatic patients with various thoracic diseases were paired with appropriate drawings and normal CT scans in the atlas. This format was designed to help determine the presence and severity of related disease, including injury from surgery, trauma, or penetrating injury, metastatic disease involvement, and, rarely, primary tumor. Although the nerves of the thorax are rarely identified at cross-sectional imaging, their location can be inferred by localizing easily identified anatomic landmarks. Familiarity with the functional anatomy and clinical significance of the nerves of the thorax is important for the correct interpretation of thoracic images.

Cadaver↗
PubMed1985

Segmental pulmonary resection for cancer.

Segmental pulmonary resection was employed in 61 patients with cancer whose ages ranged from 44 to 82 years (average 62 years). There were 39 patients in the curative group with disease staged T1N0M0, 9 patients in the limited group with residual thoracic disease, 8 patients in the palliative group with severe chronic obstructive pulmonary disease, and 5 patients in the metastatic group. Two patients died within 30 days after operation. Significant palliation was obtained in the limited and metastatic groups. Most patients in the palliative group died from emphysema within 1 to 2 years after resection. Early survival rates (64 percent after an average of 16 months) in the curative group were not as good as had been anticipated because small peripheral, asymptomatic, and predominantly scar adenocarcinoma spread systemically more than similar bronchogenic cancer. Furthermore, about half the deaths were related to the many other diseases of smoking. However, the local recurrence rate of 5 percent was low. Segmentectomy was well tolerated, even in patients with compromised pulmonary function.

Adenocarcinoma↗
PubMed1993

Extending the limits of lung cancer resection.

Patients with locally advanced bronchogenic carcinoma are often considered to have unresectable disease because of invasion into vital structures, or they undergo resection with questionable or involved margins, which results in local recurrence later. Brachytherapy (direct application of radioactive sources to the tumor bed) offers the potential to provide tumoricidal doses of radiation to the target area with minimal toxicity to surrounding structures. In this study, one of two different techniques of brachytherapy was utilized to treat 15 highly selected patients with histologically positive (n = 8) or suspicious (n = 7) margins after resection. The techniques were easy to apply and were not associated with any complications directly related to their use. One postoperative death resulted from a perforated peptic ulcer. In the remaining 14 patients, at a mean follow-up of 38 months, local control was complete in 12 (86%) patients, and 8 patients are alive, with 7 free of disease. Thoracic brachytherapy may offer the potential for cure to patients whose disease would otherwise be considered inoperable.

Brachytherapy↗
PubMed2001

[Pain characteristics in disease of heart and aorta].

Chest pain or discomfort is one of the cardinal manifestations of thoracic diseases. Fast, accurate diagnosis is essential for patients with angina pectoris, acute myocardial infarction, aortic dissection, ruptured aortic aneurysms, and pulmonary embolisms, which have a high mortality if not treated immediately. In patients with ischemic heart diseases and aortic dissection, an accurate history and a chest roentgenogram can serve as helpful guides to their diagnosis, and ultrasound, computed tomography, and electrocardiography can establish the diagnosis. It is important to suspect cardiovascular emergencies based on quality, duration, and location of pain as well as the presents of hypotension or hypertension, and to start these conditions as soon as possible. Then it is necessary to assess the degree of cardiovascular disability and, if necessary, to introduce patients to cardiovascular specialists.

Cardiovascular Diseases↗
PubMed2003

Efficacy and safety of single-trocar technique for minimally invasive surgery of the chest in the treatment of noncomplex pleural disease.

OBJECTIVE: To assess the efficacy and the safety of a single-trocar technique for minimally invasive surgery of the chest in the management of multiple noncomplex thoracic diseases, a prospective study was performed and the results are presented. METHODS: Between October 1998 and December 2001, 100 patients underwent video-assisted thoracic surgery through a single trocar. The patients were divided into 4 groups as follows: (1) benign, (2) malignant, (3) pleural effusion, and (4) empyema. The following data were analyzed: age, sex, forced vital capacity, forced expiratory volume in 1 second, percentage of the predicted forced expiratory volume in 1 second, type of anesthesia, anesthesia time, surgery time, intraoperative complications, morbidity, chest tube removal, hospital stay, and follow-up. RESULTS: The patient population consisted of 64 men and 36 women with a mean age of 62 years (range 31-92 years). General anesthesia was used in 53 patients (25 double-lumen and 28 single-lumen tube) and local anesthesia and sedation in 47 patients. Talc pleurodesis was performed in 55 patients. Mean operative time was 65 +/- 37 minutes, 48 +/- 18 minutes for simple and 67 +/- 37 minutes (P =.004) for complex pleural effusion. Mean anesthesia time was 102 +/- 85 minutes. Chest tubes were removed after 5 +/- 2 days. Mean overall hospital stay was 6 +/- 3 days, 5 +/- 2 days for benign diseases, 7 +/- 3 days for malignant diseases, and 8 +/- 3 for empyema. Morbidity was present in 19 patients. Two patients had intraoperative bleeding; 1 required a mini-thoracotomy to control it. There was no hospital mortality. Three patients had wound infection, and no patient with malignant diseases had port site metastasis. CONCLUSION: Video-assisted thoracic surgery through a single trocar is simple, effective, and beneficial for all patients in the diagnosis and treatment of noncomplex diseases of the chest. Furthermore, with this newest type of technologically advanced instrumentation it is possible to carry out simple intrathoracic procedures without using additional ports.

Adult↗
PubMed2004

Atheromatous disease of the thoracic aorta and systemic embolism. Clinical picture and therapeutic challenge.

Systemic embolism is a frequent cause of stroke. At the beginning of the last decade by introduction of transesophageal echocardiography and other imaging techniques atheromatosis of the aortic arch has been recognized as an important source of embolism. Formerly in the pre-TEE era, this entity was included into cryptogenic strokes. Aortic atheromas are found in about one quarter of patients presenting with embolic events. The severity of atherosclerosis graded by TEE correlates with the risk for future embolism, especially if mobile lesions or superimposed thrombi are present. Independent of plaque extension, patients with unstable plaques characterized by echo-lucency, inhomogenity, lacking of calcifications, ulceration, mobile parts and concomitant spontaneous echo contrast within the aorta have a higher risk for embolic events. However, the diagnosis of aortic atheromatosis is mostly established if an embolic event has already occurred. Therefore, it is important to identify patients at risk, especially before they undergo interventions with manipulation at the aorta like coronary bypass surgery. Risk factors are age above 70, diabetes mellitus, hyperlipidemia, arterial hypertension, aortic calcifications on standard chest X-ray, elevated serum levels of C-reactive protein, other inflammatory markers, and an activated coagulation. Randomized studies for treatment of patients with severe aortic atheromatosis are not yet existing. Warfarin has been shown to prevent stroke in patients with mobile atheromas and superimposed thrombi, but there are case reports about aggravation of cholesterol embolism under warfarin treatment. It is concluded from other atherosclerotic manifestations that plaque stabilizing treatment with statins and ACE inhibitors is also beneficial.

Aorta, Thoracic↗
PubMed2001

Abdominal and thoracic radiography in the neonate.

Plain and contrast radiographic techniques are used infrequently in the diagnostic evaluation of abdominal or thoracic disease in the adult horse because of the animal's large body size and the limited availability and expense of suitable equipment. The importance of radiography as a critical tool has also been lessened through the accessibility of ultrasound, although this technique is limited by depth and offers only a superficial window. Traditional radiographic techniques can be readily used in young foals because of their small body size, and radiography frequently provides critical information that aids in decision making. The ability to physically restrain a foal allows not only standing lateral images, but laterally recumbent and ventrodorsal views without the necessity for general anesthesia.

Animals↗