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PubMed1984

Water-path ultrasound of chest disease in childhood.

While contact ultrasound has been used to assess the pleural space, pulmonary parenchyma, and mediastinum, there have been many difficulties owing to attenuation by bone and air interfaces. The authors have obtained excellent results using water-path ultrasound in 82 children with benign and malignant thoracic disease. The physical characteristics of the water path and the ability to scan dependent portions of the chest in various planes facilitated identification and characterization of lesions involving the chest wall, pleura, parenchyma, and mediastinum.

Adolescent↗
PubMed1997

[Surgical treatment of thoracic aorta for elderly patient].

From 1986 to 1996, 237 patients underwent surgical treatment of thoracic aorta in our institute. We classified them as follows: group 1 is 41 patients older than 75: group 2 is 196 patients younger than 74. The number of patients of elective surgery, emergent surgery for acute dissection type A and emergent surgery for rupture or impending rupture were 28, 9, 4 in group 1 and 123, 47, 26 in group 2. Operative death (within 30 days) of elective surgery, emergent surgery for acute dissection type A and emergent surgery for rupture or impending rupture were 1 (3.6%, MOF), 1 (11%, liver failure), 2 (50%, brain damage) in group 1 and 8 (6.5), 3 (6.4%), 9 (35%) in group 2, respectively. Hospital deaths (after 30 days and cannot discharge) were 3 (11%), 0.1 (25%) in group 1 and 3 (2.4%), 1 (2.1%), 1 (3.8%) in group 2. There was no significant difference between two groups. Survival rate of each group were 48% and 80% for five-year survival rate. Complications in elderly patients were common (88%). Respiratory insufficiency is the most frequent (51%). Otherwise survival rate of patients who had no surgical treatment of diseased thoracic aorta was reported poor by several researches. We will perform operation for elderly patients positively if we can get agreement of patients.

Acute Disease↗
PubMed1982

Experience of the National Cancer Institute (USA) in the treatment and biology of small cell lung cancer.

This retrospective study deals with 168 patients with small cell lung cancer (SCLC) who were treated at the NCI March 1973 and July 1977 with intensive chemotherapy. Results showed that 12 per cent of all the patients were disease-free for more than 40 months (25% of the limited disease and 3% of the extended stage disease patients which were treated. Complete remission was essential to prolonged survival. The development of a complete remission was favored by a satisfactory initial general condition, localised disease or presence of only one site of metastatic disease. Initial treatment included the following combinations: cyclophosphamide, methotrexate and CCNU. High doses are necessary. However, above a certain level, the toxicity increased without a corresponding increment in activity. Addition of another association without cross-resistance (vincristine-adriamycine-natulan or VP-16 and isophosphamide) may induce a complete remission in cases where only a partial remission was obtained initially. In limited disease, radiotherapy seemed to prolong disease-free survival. This lead the authors to study the use of initial radiotherapy, at the rate of 40 grays in 3 weeks in 15 fractions, at the same time as chemotherapy. The radiotherapist must take certain precautions in the use of this double treatment: reshaped fields and insertion of a spinal cord block above 2 000 rads. In extended disease, thoracic irradiation seemed to be of no benefit. Pilot studies are not underway using intensive chemotherapy with multiple tumor site irradiation and autologous marrow implants 48 per cent of all patients with SCLC will develop cerebral metastatic disease (44% intracranial, 13% leptomeningeal, 9% epidural). At 30 months, 75 percent of those who did not receive prophylactic irradiation developed cerebral disease whereas only 40 per cent of the patients who received a prophylactic dose of 30 grays developed cerebral disease. Inspite of the indisputable but incomplete local benefit of prophylactic brain irradiation, it did not prolong survival. Important biological studies are underway at the NCI. - Cell clone cultures have been established. These were enhanced by the addition of arginine vasopressive (AVP) and bombesine. These two substances may be considered as markers of APUD system and are secreted by the SCLC. Bombesine has been isolated in all the cultures tested. This possible marker was perhaps responsible for the anorexia and cachexia in these patients. - These cultures have allowed for identification of deletion 3p (14-23) chromosome anomalies in all the samples examined. - In vitro chemotherapy studies of these cultures have been carried out. Their correlation with clinical results were encouraging (100% negative p/n; 75% positive p/n). - Lastly, monoclonal AC have been prepared. Inspite of their imperfect specificity and heterogeneity with regard to tumor cells, their potential advantages were considerable.

Antineoplastic Agents↗
PubMed1994

[Thoracoscopic observation and diagnosis in cases of pleural, mediastinal, and pulmonary lesions].

Thoracoscopy was performed in a total of 424 patients at our institute from January 1970 to December 1993. The indications for thoracoscopy were pneumothorax (121 cases), primary lung cancer (98 cases), mediastinal tumor (45 cases), metastatic lung tumor (23 cases), pleuritis (35 cases), diffuse lung disease (38 cases), tuberculosis (20 cases), benign lung tumor (10 cases), and other (34 cases). By 1990, diagnostic thoracoscopy had been performed in 383 patients. Since 1991, thoracoscopy has been used therapeutically for spontaneous pneumothorax (24 cases), mediastinal and chest wall tumors (9 cases), pulmonary nodules (2 cases), and others (8 cases). Findings useful for diagnosis were obtained in 326 cases and biopsy was performed in 173 cases. Thoracoscopy was especially useful in the diagnosis of diffuse lung disease, pleuritis, and small pulmonary nodules. Recent advances in endoscopic equipment and refinement of thoracoscopic techniques have expanded the application of this procedure. Our experience indicates a markedly expanded role for thoracoscopy in the diagnosis and treatment of thoracic diseases, with less postoperative morbidity.

Humans↗
PubMed2005

[Contemporary trends in the thoracic surgery view to the history, perspective].

The development of thoracic surgery in Czechoslovakia is very closely connected with the 1st Medical Faculty of the Charles University in Prague. The first Czech surgical clinic was established in Prague at this medical faculty in 1882. Professor Vilém Weiss was the first Head of the clinic. The Second Surgical Clinic in Prague was established in 1922 and Docent, later Professor, Academic Jirí Divis was the second head of this clinic. Jirí Divis is rightfully considered the founder of the Czechoslovak School of Thoracic Surgery. Whereas pulmonary tuberculosis was the main problem thoracic surgery faced in the first half of the 20th century, pulmonary carcinoma is the main issue addressed in thoracic surgery in the second half of the 20th century and currently. What new treatments can we currently offer our patients? Bronchoplastic procedures (so-called sleeve resections) have developed and carcinomas of the tracheobronchial tree-carina- can be treated in a similar manner. Development in the technology has brought staplers--machines for surgical suture. Staplers allow performing volume reductive pulmonary resections as one of the treatment options for advanced pulmonary emphysema. Introduction of the pulmonary transplantation method in practice on 22.12.1997, when Professor Pafko and his team performed the first pulmonary transplantation in Czech republic, was a major breakthrough in pulmonary surgery. The minimal invasive technique for thoracic surgery has developed further. Video-assisted thoracoscopy is now an integral part of thoracic surgery. Introduction of PET-CT examination brought great benefit to a wide range of medical disciplines, including thoracic surgery. Where may the future development in surgery and thoracic surgery take us? We are finding that specialisation is vital in the development of all surgical disciplines. In certain borderline or technically complex operations, thoracic and mediastinal surgery requires cooperation with cardiac surgeons. Thoracic diseases should therefore be centralised in centres with sufficient experience and resources for further development of the discipline.

Czech Republic↗
PubMed1987

Thoracic needle biopsy. Improved results utilizing a team approach.

Transthoracic needle aspiration biopsy (TNAB) is a useful diagnostic technique in the evaluation of thoracic disease. Previous reports have shown that this technique has a high positive but a low negative predictive value. The latter has limited the clinical usefulness of a negative biopsy. To improve the reliability of a negative TNAB, a series of thoracic needle biopsies was done using a team approach, having a cytopathologist, with the necessary equipment to examine the biopsy specimens, in attendance at the biopsy. As biopsy specimens were obtained, they were reviewed to ensure an adequate and representative sampling. The positive predictive value was 98.6 percent and the negative predictive value was 96.7 percent. The high negative predictive value obtained using this approach allows clinical decisions to be based on the results of a negative TNAB.

Adult↗
PubMed2001

Cost analysis and estimation of thoracic surgical patients with lung cancer in Greece: the case of Sotiria ICU.

This study aimed to estimate the hospitalization cost of thoracic surgical patients with lung cancer, treated in the intensive care unit (ICU) of Sotiria Hospital in Athens. This is the largest specialist thoracic disease hospital in the greater region of Central and Southern Greece. Methodology was based on the prospective study of patients' medical records, from which clinical and economic data were derived for a six-month period. The study sample consisted of 95 thoracic surgical patients. Economic analysis and cost estimation were based on the differentiation between nominal and real prices, occurring in the public hospital sector in Greece. Real ICU cost per patient is estimated at US$ 2,011 in 1998, while the total patients hospitalization cost was US$ 6,958. The patient's ICU cost represents about 29% of his total hospitalization cost, while the price deviation in the amounts covered by social insurance compared to the real hospitalization cost is also confirmed. It is believed that the use of economic analysis techniques could substantially contribute to the assessment of resource consumption, initially at a microeconomic and later at a macroeconomic level, and thus to the adoption of prospective payment systems, as these are encountered on an international level.

Adult↗
PubMed1985

Magnetic resonance imaging of constrictive pericardial disease.

Gated magnetic resonance imaging of 5 patients with suspected constrictive pericardial disease was performed using a superconducting magnet operating at 0.35 Tesla. Results were compared with those of echocardiography and hemodynamic measurements in all patients, with chest films in 5, computerized tomography in 2 and with histologic findings in 3. Pericardial thickness exceeded 5 mm in 4 patients and was 5 mm in 1 patient. Absence of magnetic resonance signal from the thickened pericardium was observed with extensive calcific deposits, and increased intensity of the thickened pericardium was associated with inflammatory disease. Dilatation of the right atrium, venae cavae and hepatic veins, and right ventricular narrowing was observed in all patients. The ventricular septum was straight in all patients. Magnetic resonance imaging allows both measurement of pericardial thickness and depicts internal cardiac anatomy without exposure to radiation or use of contrast medium. Satisfactory imaging with a large field of view can be performed in the presence of lung disease, thoracic deformity or surgical "hardware"--conditions that limit echocardiography and computerized tomography. The inherently 3-dimensional data permit imaging in any plane without loss of resolution. Thus, magnetic resonance appears to be the noninvasive method of choice for the diagnosis of constrictive pericardial disease.

Calcinosis↗
PubMed1993

Thoracoscopy for staging of lung cancer.

The recent advancements in diagnosis and treatment of thoracic disease have been made mostly in line with advancements in endoscopic equipment design and refinement of thoracoscopic surgery techniques. Between March 1992 and February 1993, video thoracoscopic procedures were performed in 50 patients. Twelve of the 50 patients were diagnosed with lung cancer. Thoracic staging was performed in 6 patients (clinical diagnosis of suspicious intrapulmonary metastasis, 3 patients; intrapulmonary metastasis and/or lymph node metastasis, 1 patient; interlobar pleural effusion, 1 patient; and pleural dissemination, 1 patient). There were no complications or mortality associated with these procedures. Our initial experience has indicated that thoracoscopic staging for lung cancer is a safe and effective procedure.

Adenocarcinoma↗
PubMed2002

Chest wall resection in general thoracic surgery.

To clarify the incidence, indications, and efficacy of chest wall resection, a comprehensive review is needed. Chest wall resection was performed in 23 of 162 operations for thoracic disease over a nine-year period. Eight surgeries requiring chest wall resection for benign disease (8/79) were classified as fenestration or thoracoplasty for empyema, or resection of a benign neoplasm. Fifteen patients who underwent chest wall resections for malignant disease (15/83) were classified as contiguous extension of neoplasms of neighboring organs, primary tumor, or local recurrence. The most common procedure in the malignant disease group was resection for contiguous spread of primary lung cancer (n = 7). The survival rate was 50% at 4 years. There were no serious postoperative complications. In some malignant diseases, complete local control with such a procedure may even lead to a long-term survival. This is a safe and an effective procedure for a variety of diseases.

Adolescent↗
PubMed1997

[Diagnostic accuracy of teleradiology in thoracic and abdominal diseases].

For one year now, teleradiology has linked the "S. Marcello" Hospital to the Department of Radiology of "Del Ceppo." Hospital in Pistoia, 30 kilometers away. Plain films are digitized (Lumiscan 50, Philips), transmitted over a dedicated standard telephone line and displayed at 1024 x 1024 x 8 bits. To study the diagnostic accuracy of teleradiology in chest and abdominal conditions, we digitized and transmitted to the Pistoia Dept. of Radiology, a sample of 156 (96 chest and 60 abdominal) emergency examinations made in "S. Marcello" Hospital from January through November, 1995. The patients were 81 women (mean age: 69 years) and 75 men (mean age: 66 years); the age range was 17-93 years. Three radiologists independently reviewed the images in the Pistoia Dept. of Radiology on a digital workstation enabled to manipulate images. They filled in some given forms specific for chest and abdominal radiography, which were compared with the same forms filled in by the radiologist in "S. Marcello" Hospital who reviewed plain films. The differences were never clinically important; they concerned emphysema (4 false positives and 2 false negatives), congestion of the hila (2 false positives and 2 false negatives) and abnormal air in small bowel and colon (2 false positives and 2 false negatives). We believe these differences to be related to interobserver variability. The diagnostic accuracy of monitor image interpretation by the three radiologists who reviewed digitized radiographs exceeded 96% for both chest and abdominal examinations, which figure compares with literature data on high resolution workstations.

Adolescent↗
PubMed1993

Video-assisted thoracic surgery. Manipulation without trocar in 112 consecutive procedures.

Since learning of the video-assisted thoracoscopic techniques in the treatment of thoracic diseases, we have encountered many problems and difficulties because of the limited trocar space and lack of suitable instrumentations. Since March 1992, we have found a simple and easier way to perform this procedure, that is, manipulating through the extended incisional wound without using a trocar. Endoscopic and conventional thoracic instruments are able to pass through the incisional channel freely and manipulate similarly to the technique used in open thoracotomy. All the patients had less postoperative pain, reduced operative time, and prompt return to employment. The technique is effective and is herein described.

Humans↗
PubMed2005

Congenital diseases of the thoracic aorta. Role of MRI and MRA.

Aortic malformations may be associated with other congenital heart abnormalities or may present independently, as incidental findings in asymptomatic patients. For more than 30 years, conventional imaging techniques for detection and assessment of congenital anomalies of the aorta have been chest X-ray, echocardiography and angiography. In recent times, considerable interest in congenital aortic diseases has been shown, due to technical progresses of noninvasive imaging modalities. Among them, magnetic resonance imaging (MRI) almost certainly offers the greatest advantages, especially in young patients in which a radiation exposure must be avoided as much as possible. MRI provides an excellent visualization of vascular structures with a wide field of view, well suited for evaluation of the thoracic aorta malformations. With the implementation of magnetic resonance angiography (MRA) it is also possible to depict any relationship with supra-aortic or mediastinal vessels. Phase contrast technique allows identification of the hemodynamic significance of the aortic alteration. Some technical considerations, which include fast spin-echo, gradient-echo and, especially, MRA techniques with phase-contrast and contrast enhanced methods, are discussed and applied in the evaluation of congenital thoracic aorta diseases.

Aorta, Thoracic↗
PubMed1999

[Effect of intermittent ventilation on pulmonary hypertension in chronic respiratory failure].

Intermittent non-invasive (or nocturnal mechanical ventilation) eliminates symptoms of hypoventilation and improves gas exchange in patients with chronic respiratory failure. Performing right heart catheterisation we studied the influence of nocturnal mechanical ventilation on pulmonary hemodynamics. We investigated 20 patients with restrictive thoracic diseases (Post-TBC: n = 9, scoliosis: n = 11, PaCO2: 59.8 +/- 7.6 mmHg) and 13 patients with COPD (n = 13, PaCO2: 58.5 +/- 7.8 mmHg). All patients were mechanically ventilated in controlled mode. During the study the medication was not changed; COPD patients with long-term oxygen maintained this therapy. Right-heart catheterisation was performed immediately before and after 1 year nocturnal mechanical ventilation. In patients with thoracic restriction NMV induced a marked reduction of pulmonary artery pressure (PAP) from 33.2 +/- 10.0 mmHg before to 24.8 +/- 6.2 mmHg after 1 year nocturnal mechanical ventilation. In the COPD group PAP increased from 25.3 +/- 6.0 mmHg before to 27.5 +/- 6.0 mmHg after 1 year nocturnal mechanical ventilation. In contrast to the COPD group in patients with chronic respiratory failure due to thoracic restriction nocturnal mechanical ventilation causes substantial reduction in pulmonary artery pressure after a one year application.

Carbon Dioxide↗
PubMed2006

Malignant pleural effusion treatment outcomes: pleurodesis via video-assisted thoracic surgery (VATS) versus tube thoracostomy.

STUDY OBJECTIVES: Video-assisted thoracic surgery (VATS) has been widely used in the diagnosis and management of various thoracic diseases. The objective of this retrospective study was to compare the effectiveness of patients undergoing pleurodesis through VATS versus tube thoracostomy for malignant pleural effusion (MPE). Study design was a retrospective review of patients treated in medical centers and hospitals in Taiwan. PATIENTS: One hundred and forty-eight patients with MPE resistant to systemic therapy resulting from various types of carcinomas were retrospectively reviewed. VATS pleurodesis was carried out in 82 and tube thoracostomy with pleurodesis in 66 patients. RESULTS: There were no intraoperative deaths and 4 (2.7 %) in-hospital deaths. One hundred and eighteen (79.7 %) patients were available for follow-up. There were no statistically significant differences in the preoperative characteristics of the two treatment groups, except that the amount of effusion and the percentage of patients with dyspnea were both higher in the VATS treatment group. The duration of chest tube drainage was significantly longer ( P < 0.01) in the tube thoracostomy treatment group (9.1 +/- 3.3 vs. 6.2 +/- 2.3 days). There were no significant differences between the treatment groups with regard to the incidence of surgical complications and perioperative mortality. Median survival was similar in both treatment groups; however, the VATS treatment group had a significantly longer median recurrence-free survival than the tube thoracostomy treatment group. CONCLUSIONS: VATS treatment for MPE appears to be superior to tube thoracostomy for diagnostic accuracy and effectiveness in preventing effusion recurrence; however, the role of these treatments for MPE is palliative, and does not significantly prolong survival time.

Adult↗
PubMed2005

Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001.

STUDY OBJECTIVES: COPD is one of the leading causes of mortality and morbidity in the United States, yet little is known about the prevalence of comorbid conditions and mortality in hospitalized patients with COPD. DESIGN: From the National Hospital Discharge Survey, 1979 to 2001, we evaluated whether or not COPD in adults > or = 25 years old is associated with increased prevalence and in-hospital mortality of several comorbidities. RESULTS: During 1979 to 2001, there were an estimated total of 47,404,700 hospital discharges (8.5% of all hospitalizations in adults > 25 years old) of patients with COPD; 37,540,374 discharges (79.2%) were made with COPD as a secondary diagnosis, and 9,864,278 discharges (20.8%) were made with COPD as the primary diagnosis. The prevalence and in-hospital mortality for pneumonia, congestive heart failure, ischemic heart disease, thoracic malignancies, and respiratory failure were larger in hospital discharges with any mention of COPD. CONCLUSIONS: In a nationally representative sample of hospitalizations, any mention of COPD in the discharge diagnosis is associated with higher hospitalization prevalence and in-hospital mortality from other comorbidities. These results highlight the fact that the burden of disease associated with COPD is likely underestimated.

Adult↗
PubMed1993

[Video-assisted thoracoscopy and thoracic surgery: the first 50 patients].

We report our first full year of clinical experience with video assisted thoracic surgery. From September 1991 to October 1992, 50 patients were treated using endoscopic surgical techniques. There were 29 men and 21 women with a mean age of 48 years, ranging from 17 to 76 years. Drainage and talc poudrage of pleural effusions, with or without pleurodesis, was done in 18 patients (36%), blebectomies with pleurectomy or pleural abrasion was done in 11 patients (22%), and 7 patients (14%) underwent wedge resections of pulmonary lesions. Four other patients (8%) underwent resections or biopsies of mediastinal tumors, and 3 (6%) pericardial windows were done for cardiac tamponade. Finally, one chest wall biopsy and one empyema drainage were carried out, and 5 thoracoscopies were limited to the exploration of the chest. Complications occurred in 5 patients (10%). There was one mortality. Video-assisted thoracic surgery is efficacious in the treatment of various thoracic diseases and associated with satisfactory results in selected patients.

Adolescent↗