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At least 487 records · Page 27Linked to original sources
PubMed1992

The role of MR imaging in the evaluation of acquired diseases of the thoracic aorta.

Because MR imaging combines the major attributes of angiography, echocardiography, and CT, its role in the evaluation of the thoracic aorta is steadily increasing. When standard spin-echo techniques are used, flowing blood produces a signal void that allows excellent depiction of the anatomy and simultaneous evaluation of the lumen, vessel wall, and periaortic structures. On dynamic or cine MR, flowing blood generates a signal that allows visualization of the blood as it pulsates through the aorta. Turbulent blood generates a signal void, thereby allowing the detection and qualitative assessment of the pathophysiologic consequences of anatomic abnormalities. With phase-mapping techniques, blood velocity can be measured and used to calculate pressure gradients. Recent advances in the field of MR angiography will greatly enhance the overall role of MR in the evaluation of the thoracic vasculature by allowing detection and assessment of the branch vessels. Although the technique is still evolving, it has shown extraordinary potential as a tool for studying the thoracic aorta. The exact role of MR in patient care will depend on advances in transesophageal echocardiography. However, it is not unreasonable to think that someday MR imaging will be the primary technique for evaluation of the thoracic aorta.

Aorta, Thoracic↗
PubMedDate not supplied

[Hodgkin's disease in small children (author's transl)].

17 cases of Hodgkin's disease are reported, seen in a ten year period. Age of patients oscillated between three and seven years. There was a predominance of mixed cellularity type in histologic pattern. Most of patients were diagnosed in advanced clinical stages. Primary sign of disease was presence of cervical adenopathies and there were few cases of thoracic disease. Treatment consisted in radiotherapy and chemotherapy, according to histological type and clinical stage. Survival in our serie is of 53.3% with periods of observation from six months to seven years.

Child, Preschool↗
PubMedDate not supplied

Thoracic aortic stent-grafting.

The surgical management of thoracic disease has improved steadily over the past 20 years due to advances in diagnostic and surgical techniques. Despite this progress, a less invasive approach to treatment is desirable. Patients with coexisting cardiovascular or pulmonary diseases may not tolerate aortic replacement under general anesthesia, particularly combined with extracorporeal bypass. Endovascularly placed stent-grafts offer an alternative therapy, which is less invasive and associated with a shorter hospital recuperation time than with traditional operative therapy. The authors discuss the development of stent-grafts for use in the thoracic aorta, along with the various techniques utilized during these complex procedures.

Aortic Dissection↗
PubMed1981

VAB-4 combination chemotherapy in the treatment of metastatic testis tumors.

Forty-two patients with advanced testis carcinoma without previous chemotherapy were treated with VAB-4, and 41 were evaluable. The program consisted of three in-hospital inductions 16 weeks apart, and outpatient treatments every three weeks. Of the patients, 80% achieved complete remissions (CR). Chemotherapy alone induced CR in 61%, partial remissions (PR), in 24% and minor response (MR), in 15%. An additional 20% of patients (six PRs and 2 MRs) achieved CR following resection of residual tumor deposits. With a median follow-up of 27 months, the median duration of CR has not been reached. Of those achieving CR to chemotherapy alone, 12% had relapses. Bulk and extent of metastatic disease, histology of primary tumor, and tumor markers at the beginning of therapy influenced the frequency of CR. Of those with minimal disease, 90% achieved CR. The CR rate was 67% for those with advanced thoracic disease and 29% for those with advanced abdominal disease. Patients who had embryonal carcinoma and those who had no elevation of alpha-fetoprotein had a higher frequency of CRs. Myelosuppression with a leukocyte count drop less than 1000/mm3 occurred in three patients, and no patient had chronic renal failure or pulmonary fibrosis. One patient died from sepsis while in complete remission.

Adolescent↗
PubMed1988

Survival analysis of patients with small cell lung cancer.

The effects of different chemotherapy protocols on survival were evaluated in 197 small cell lung cancer patients followed-up between 1974 and 1987 in our unit. Of these, 170 patients had Stage IV disease and 24 had Stage III disease. Thoracic radiotherapy was given to 73 patients of whom 63 had Stage IV disease. Cytotoxic chemotherapy was given in four main protocols consisting of cyclophosphamide (CYC): CYC + vincristine (VCR); CYC + VCR + adriamycin (ADM) and CYC + VCR + ADM + lomustine (CCNU). The latter protocol was associated with the highest survival rates and differed significantly (p less than 0.05) from the others. In patients with extensive disease, both radiotherapy to the primary site and adjuvant immunomodulation in conjunction with the above chemotherapy regimens lacked any beneficial effect on survival.

Adult↗
PubMed1995

Percutaneous needle biopsy of localized pulmonary, mediastinal, and pleural diseased tissue with an automatic disposable guillotine soft-tissue needle. Preliminary results.

Percutaneous needle biopsy (PNB) of localized thoracic disease has become a widespread procedure in many institutions. The development of special small caliber needles has increased the diagnostic yield of PNB partly by increasing the amount of tissue from biopsy, often enabling histologic examination. Nevertheless, in a significant number of patients only cytopathologic examination is possible on the retrieved biopsy fragments, necessitating the presence of a trained cytopathologist in the biopsy room. Furthermore multiple biopsy needle passages often are required, increasing the risk for complications such as pneumothorax. We have evaluated the use of a small-caliber tissue biopsy cutting needle, consistently yielding sufficient biopsy tissue for histologic examination. In 25 pleural and mediastinal lesions, which could be biopsied without passage through aerated lung, there was a 93% sensitivity (7% false-negative results) for neoplasm and a 100% accuracy for benign disease. There were no complications. In 32 patients with lesions of 1 cm in diameter or more surrounded with aerated lung tissue, adequate histologic examination was feasible on every biopsy specimen after only one needle passage. There was an 87% sensitivity of PNB in neoplastic disease (13% false-negatives). In the patients with benign disease, there was a 100% accuracy. There was a 15.6% risk for pneumothorax. In only one patient (3%), however, was chest drainage necessary. One patient (3%) had mild hemoptysis. We conclude that percutaneous biopsy of localized pulmonary, pleural, and mediastinal lesions with a new small-caliber automatic guillotine cutting needle is safe and efficient, enabling recovery of sufficient tissue for histologic examination with a single-pass procedure, thus minimizing the risk for pneumothorax, eliminating the need for a cytopathologist in the biopsy room, and shortening the duration of the procedure.

Adult↗
PubMed2000

Percutaneous image-guided biopsy of lung nodules in the assessment of disease activity in Wegener's granulomatosis.

OBJECTIVE: In patients with known Wegener's granulomatosis (WG) and persistent chest radiographic abnormalities, assessment for disease activity is often difficult, prompting the need for histological diagnosis to determine appropriate treatment. Here we report the use of automated image-guided core needle biopsy of pulmonary lesions for the assessment of disease activity in WG, rather than for primary diagnosis. METHODS: Image-guided percutaneous core needle biopsy was performed on five occasions in four patients with thoracic WG and persistent radiographic abnormalities of the chest. Clinical features, indication for biopsy, radiographic abnormalities and pathological findings were recorded. RESULTS: Adequate pathological specimens were obtained, allowing exclusion of infection and tumour. Active chronic inflammation with or without vasculitis was demonstrated in each case, indicating the need for further immunosuppressive therapy. A small pneumothorax following biopsy in one case required no treatment. Follow-up chest imaging revealed a reduction in the extent of thoracic disease following therapy in all cases. CONCLUSIONS: The safety and diagnostic accuracy of image-guided core biopsy of thoracic lesions makes it a useful tool in the assessment of disease activity in WG patients with persistent chest radiographic lesions.

Adult↗
PubMed1994

Contribution of videothoracoscopy to the management of the cancer patient.

BACKGROUND: Videothoracoscopy has rapidly become a popular procedure, but its technical feasibility has been emphasized without critically evaluating its role in the management of thoracic disease. To assess the value of videothoracoscopy in the diagnosis and staging of the cancer patient and to determine if it has added to our previous standard approach of thoracoscopy performed with a mediastinoscope without video, we established a prospective database when we initiated videothoracoscopy in January 1992. METHODS: Patients were offered videothoracoscopy as an alternative to thoracotomy only if other standard approaches (e.g., needle biopsy, mediastinoscopy) were inadequate to diagnose or stage cancer or to restage patients after therapy. Parameters entered and analyzed in a prospective database were patient name; age; sex; past history; indications for videothoracoscopy; procedure type; surgical technique; whether conversion to thoracotomy was necessary, and if so, why; complications; and pathology. A complete case list of thoracoscopies performed in 1991 before videothoracoscopy was available provided historical comparison. RESULTS: From January 1 to December 31, 1991, 82 patients underwent thoracoscopy using a mediastinoscope for diagnosis and therapy of pleural disease. From January 1 to July 31, 1992, 160 patients (male:female = 81:79; mean age 56 years) had videothoracoscopy; 72 of 160 patients (44%) had procedures that previously would have required thoracotomy: 69 lung wedge resections, one pericardial window, one pleurectomy, one mediastinal node sampling. No major resectional procedures (e.g., lobectomy, esophagectomy) were performed by videothoracoscopy. Twenty-two percent of all patients (35 of 160), and 23% of wedge resection patients (16 of 69) required conversion to thoracotomy because videothoracoscopy was inadequate for diagnosis or staging. Reasons for conversion (multiple reasons in five patients) included further resection required in 23 patients; inability to evaluate lesion in 11; adhesions in five; and inability to tolerate one lung ventilation in two. The chest tube was in place postoperatively for a mean of 2.3 days. Thirty-day postoperative complications included ventilation for > 48 h in one patient; prolonged air leak in one; pneumonia in one; arrhythmia in one; and death from progressive disease in two. CONCLUSIONS: Although the role of videothoracoscopy in the treatment of primary thoracic malignancies and pulmonary metastases is still undefined, this early experience indicates that videothoracoscopy often enhances the ability to diagnose and stage patients by obviating thoracotomy.

Adult↗
PubMed1998

The role of computed tomography in the diagnosis and management of human immunodeficiency virus (HIV)-related pulmonary diseases.

This review summarizes the current role of CT in the diagnosis and management of respiratory disease in human immunodeficiency virus (HIV)-positive patients. Recommendations are made concerning optimum technique for diagnostic CT as well as practical considerations concerning the use of CT in biopsy and thoracic interventional procedures in acquired immune deficiency syndrome (AIDS)-related thoracic disease. Clinical scenarios discussed include the use of CT when the chest radiograph is normal in a patient with a high clinical suspicion of pulmonary disease, utility of CT in the differential diagnosis of parenchymal abnormalities and in the assessment of patients with airways disease, hemoptysis, progressive lung disease, and intrathoracic complications. Finally, the use of thoracic CT in the staging of AIDS-related neoplastic conditions involving the chest is discussed.

AIDS-Related Opportunistic Infections↗
PubMed2000

The impact of three-dimensional radiation on the treatment of non-small cell lung cancer.

PURPOSE: Non-small cell lung cancer (NSCLC) patients with locally advanced unresectable disease have a grim prognosis. Radiotherapeutic strategies are necessary to improve the permanent eradication of thoracic disease. The poor results achieved with conventional external beam radiation therapy reflect in part, the inadequacy of such therapy in achieving its primary objective of achieving local control. The impact of three-dimensional conformal radiation therapy (3-DCRT) on local disease eradication and its potential role in improving survival is assessed. DESIGN: This review addresses aspects of the software and hardware technology of 3-DCRT, the clinical and technical aspects of target volume definition, the use of 3-DCRT to predict radiation pneumonitis, strategies for dose escalation in NSCLC, and analyses the clinical results to date. RESULTS: Initially investigators compared the best treatment techniques devised with conventional planning techniques to those devised with 3-DCRT. These analyses showed that 3-DCRT had the potential to deliver high dose radiation (>70 Gy) with minimal underdosing and with a concomitant relative sparing of normal tissues. This technical demonstration of enhanced therapeutic ratio is the basis for the evolving clinical utilization of 3-DCRT for NSCLC. Software and hardware developments continue to develop and have the potential to solve evolving clinical issues. Dose-volume-histograms have been used to accurately quantify lung dose and derived parameters have the potential to predict the risk of pneumonitis for individual patients before treatment. Initial clinical results have been promising and strategies for further dose escalation are emerging. CONCLUSION: Preliminary experience has resulted in promising survival following three-dimensional conformal radiation therapy alone for locally advanced NSCLC. More follow-up and experience will determine late toxicity, maximum dose, and efficacy of dose escalation with three-dimensional conformal radiation therapy. Strategies should be developed to integrate this modality into the combined treatment of locally advanced non-small cell lung cancer.

Carcinoma, Non-Small-Cell Lung↗
PubMed1996

Combined thoracoscopic/laparoscopic staging of esophageal cancer.

Unlike mediastinoscopy in lung cancer, there exists no standard minimally invasive test to stage esophageal cancer. If it were possible to obtain exact preoperative staging in esophageal cancer, patients could be separated prospectively to receive neoadjuvant therapy appropriately. We studied the feasibility and efficacy of thoracoscopic and laparoscopic lymph node staging in esophageal cancer. Thoracoscopic staging was performed in 45 patients with biopsy-proven carcinoma of the esophagus. Laparoscopic staging was done in the last 19 patients. Thoracoscopic staging was aborted in three patients because of adhesions. Thoracic lymph node stage was N0 in 39 patients and N1 in three; celiac lymph nodes were normal in 13 and diseased in six. Esophageal resection was performed in 30 patients after thoracoscopic staging; 17 of these underwent laparoscopic staging. Thoracoscopic staging showed N0 lymph node status in 28 patients and N1 in two patients. Two of the 28 patients (7%) with N0 disease were found at resection to have paraesophageal lymph node involvement (N1); thus the disease was understaged by thoracoscopic staging. Thoracoscopic staging was accurate in detecting the presence of diseased thoracic lymph nodes in 28 of 30 cases (93%). Laparoscopic staging detected normal celiac nodes in 12 patients and diseased lymph nodes in five patients. After esophagectomy, the final pathology report in the 12 patients with N0 disease was N0 in 11 and diseased lymph nodes in one patient. Thus laparoscopic staging was accurate in detecting lymph node metastases in 16 of 17 patients (94%). Thoracoscopic and laparoscopic staging are more accurate than existing staging methods. Six of 19 patients in whom laparoscopic staging was used had unsuspected celiac axis lymph node involvement that had been missed by standard noninvasive techniques. One of three patients with thoracic lymph nodes and three of six with celiac lymph nodes were downstaged after preoperative chemotherapy/radiotherapy. The role of thoracoscopy and laparoscopy in staging esophageal cancer should be further evaluated in a multiinstitutional trial.

Adenocarcinoma↗
PubMed1999

Cardiopulmonary limitations to exercise in restrictive lung disease.

Cardiopulmonary limitations to exercise in restrictive lung disease. Med. Sci. Sports Exerc., Vol. 31, No. 1 (Suppl.), pp. S28-S32, 1999. Restrictive lung disease encompasses a large and diverse group of disorders characterized by a diminished lung volume. These disorders exhibit common pathophysiologic features including abnormal gas exchange caused by loss of functioning alveolar-capillary unit, abnormal respiratory muscle energetics caused by altered mechanical ventilatory function, and secondary hemodynamic and cardiac dysfunction. Impaired gas exchange is the most prominent exercise abnormality in interstitial lung disease and eventually develops in other causes of lung restriction as well. Measurements of diffusing capacity (DLCO) and alveolar-arterial oxygen tension gradient during exercise are more sensitive detectors of disease than measurements at rest. Excessive dead space ventilation is common in pulmonary parenchymal, pleural, and thoracic diseases, leading to a higher minute ventilation and ventilatory work during exercise. The associated increase in the metabolic energy requirement of respiratory muscles may exceed 50% of available total body oxygen delivery and result in insufficient energy delivery to nonrespiratory muscles that sustain locomotion. Pulmonary arterial hypertension develops secondarily to an increased pulmonary vascular resistance. In addition, diastolic filling of the ventricles during exercise may be restricted by pulmonary fibrosis or anatomical restriction of the pleura and thorax, contributing to secondary cardiac dysfunction. Examples of heart-lung interaction are illustrated by the patient after unilateral pneumonectomy. These pathophysiologic changes help explain why functional disability in these patients is often out proportion to the impairment in lung function.

Animals↗