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At least 577 records · Page 32Linked to original sources
PubMed1995

Concentration of soluble vascular cell adhesion molecule-1 (VCAM-1) correlated with expression of VCAM-1 mRNA in the human atherosclerotic aorta.

BACKGROUND: Adherence of circulating monocytes and lymphocytes to arterial endothelium is detectable early in experimental and human atherosclerotic plaque formation. The purpose of the present study was to assess vascular cell adhesion molecule-1 (VCAM-1) mRNA expression and the properties of soluble VCAM-1 in patients with atherosclerotic aortic disease. METHODS: Thirteen patients with aortic disease (mean age 64 years) and 40 healthy volunteers (mean age 32 years) were included in the study. We investigated the expression of VCAM-1 mRNA in eight human aortic specimens obtained during surgery. Of these, two showed no evidence of atherosclerotic plaque formation [aortic dissection (n = 1) and annuloaortic ectasia (n = 1)], whereas six had demonstrable complex atherosclerotic formation [abdominal aneurysm (n = 5) and aortic dissection (n = 1)]. The RNase protection assay was performed using an alpha 32P-labeled 121 base pair VCAM-1 cRNA probe. We also measured concentrations of the soluble VCAM-1 using two-site enzyme immunoassays in 40 healthy volunteers and in 13 patients with abdominal and thoracic aortic aneurysms. RESULTS: In human samples, VCAM-1 mRNA expression was found to be higher in the six patients with complex atherosclerotic formation [optical density (OD), 0.71 +/- 0.14] than in the two patients with no evidence of atherosclerotic plaque formation (OD, 0.53 and 0.49). The concentration of serum soluble VCAM-1 was higher (850 +/- 298 ng/ml) in patients with aortic or thoracic disease than in the healthy volunteers (494 +/- 94 ng/ml). In addition, there was a relationship between VCAM-1 mRNA expression and the concentration of soluble VCAM-1 (y = 2088x-554, r2 = 0.73). CONCLUSION: VCAM-1 expression is higher in the human aorta in patients with atheromatous changes. Furthermore, concentrations of soluble VCAM-1 may provide important information about endothelial activation or in-vivo damage.

Adult↗
PubMed1997

Video assisted thoracoscopic surgery (VATS) in Asia--its impact and implications.

BACKGROUND: Within a short period of time, video assisted thoracoscopic surgery (VATS) has revolutionised the practice of thoracic surgery. Most of the existing literature, however, is concentrated on the technical aspects. AIMS: We examined the impact of VATS on our practice and its implications. METHODS: We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital. RESULTS: We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases. CONCLUSIONS: The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area.

Asia↗
PubMedDate not supplied

Medical devices of the chest.

Chest devices are encountered on a daily basis by almost all radiologists. A multitude of extrathoracic materials, from intravenous catheters to oxygen tubing and electrocardiographic leads, frequently overlie the chest, neck, and abdomen. Chest tubes, central venous catheters, endotracheal tubes, and feeding tubes are very common. Cardiac surgery involves the use of many sophisticated devices and procedures, ranging from valve replacement to repair of complex congenital anomalies. Coronary artery bypass surgery is no longer considered unusual, and in many large medical centers, ventricular assist devices and total artificial hearts are frequently encountered. Breast implants are visible at standard chest radiography, and many ancillary devices not intended for treatment of cardiac or thoracic diseases are visible on chest radiographs. New devices are constantly being introduced, but most of them are variations on a previous theme. Knowing the specific name of a device is not important. It is important to recognize the presence of a device and to have an understanding of its function, as well as to recognize the complications associated with its use.

Equipment and Supplies↗
PubMed2003

Spontaneous pneumomediastinum: a rare benign entity.

OBJECTIVE: Spontaneous pneumomediastinum usually occurs in young people without an apparent precipitating factor or disease. Thoracic surgeons are involved in the diagnosis and management of this entity because of the potentially life-threatening conditions that either must be treated as an emergency or excluded, such as esophageal perforation or necrotizing mediastinitis. We present our modest experience in treating spontaneous pneumomediastinum. MATERIALS: Between 1988 and 1998 we treated 22 cases of spontaneous pneumomediastinum in 18 male patients and 4 female patients, ranging in age between 12 and 32 years. All traumatic cases were excluded. Retrosternal chest pain was the main symptom the patients presented. In only 11 cases was subcutaneous emphysema present. Chest radiography was diagnostic in all our cases. Computed tomographic scan, when performed, confirmed the diagnosis. An esophagogram was essential to exclude an esophageal rupture. Last, a cardiologic examination especially focusing on pericarditis excluded cardiac disease. RESULTS: Conservative treatment consisted of bed rest, oxygen therapy, and analgesics, which led to rapid resolution of the spontaneous pneumomediastinum. The mean hospital stay ranged between 3 and 10 days. In a follow-up of 3 to 12 years only 1 recurrence was observed. CONCLUSION: Spontaneous pneumomediastinum is usually an undiagnosed benign entity that responds very well to conservative treatment. It should be considered in the differential diagnosis of chest pain, especially in healthy adolescents and young adults.

Adolescent↗
PubMedDate not supplied

[Cardiotoxicity of 5-fluorouracil: report of 6 cases].

5-fluorouracil (5-FU), a fluoropyrimidine antimetabolite, is widely used in the treatment of cancers of the digestive tract and breast. The clinical cardiotoxicity of 5-FU was first reported in 1975. Adverse cardiac effects include coronary disorders, heart failure and sudden death of suspected cardiac origin. Six new cases are reported, including 5 cases of angina and one of heart failure. The patients, 4 males and 2 females, were 26 to 71 years of age (mean: 56.2). They had no medical history of heart failure, myocardial ischemia or electrocardiographic anomalies prior to 5-FU treatment. Three patients had hypertension of whom one had had type-II diabetes mellitus for the past 20 years. Clinical symptoms included chest pain in 4 patients and heart failure in one, whereas the last patient had ECG changes with no associated clinical symptoms. Clinical symptoms of angina totally disappeared after the cessation of 5-FU administration, but heart failure was alleviated only after the introduction of digitalis, a converting-enzyme inhibitor and a diuretic. It has been estimated that 1.6% of patients treated with 5-FU develop adverse cardiac effects. Patients at greater risk are those with a history of ischemic cardiac disease, thoracic radiotherapy or high-dose 5-FU therapy. The mechanism involved is not clearly elucidated. Spasms of the coronary arteries or toxic inflammation of the myocardium have been suspected. These 6 new cases confirm the potential for cardiotoxicity of 5-FU and the need for careful cardiac monitoring of treated patients.

Adult↗
PubMed2003

The role of thoracoscopy in the management of lung cancer.

The use of video-assisted thoracic surgery (VATS) has allowed surgeons to perform complex procedures that previously required a thoracotomy. While VATS is well accepted in the management of benign thoracic disease, its role in the management of lung cancer continues to evolve. VATS is utilized in many aspects of the management of lung cancer including the evaluation of indeterminate pulmonary nodules and pleural effusions, staging of mediastinal lymph nodes, and the resection of primary and metastatic tumors. However, concerns regarding cost, training issues, and adherence to oncological principles have caused some surgeons to proceed more slowly. This review discusses the current role of thoracoscopy in the management of lung cancer.

Humans↗
PubMedDate not supplied

Combined modality therapy for stage III non-small cell lung cancer.

Lung cancer remains the leading cause of cancer death in the U.S. among both men and women. Approximately 45% of patients present with stage III disease. A proportion of these patients is amenable to surgical resection; however, the majority are "unresectable." For patients with unresectable stage IIIA/B disease, thoracic radiation therapy (TRT) was considered the standard of care until the late 1980s despite a very poor 5-year survival rate. Several clinical trials demonstrated that the combination of chemotherapy and TRT was superior to TRT alone. Based on these data, combined modality therapy became the standard of care for patients with good performance status. Recent trials have shown that concurrent chemoradiotherapy offers a significant survival advantage over sequential chemoradiotherapy. Despite a substantial number of clinical trials, important questions on the optimal treatment paradigm remain. The most effective chemotherapy combination, the use of induction or consolidation chemotherapy in addition to the concurrent portion of therapy, and the optimal dose of chemotherapy with concurrent TRT have yet to be determined. The optimal total dose, fractionation, acceleration, treatment volume, and tumor targeting remain questions related to the TRT portion of therapy. Although significant progress has been made, the majority of patients experience locoregional or distant progression of their disease and die within 5 years of diagnosis. Thus, continued development and participation in clinical trials is crucial to further improvements in the treatment of patients with stage III disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

A systematic approach to spinal reconstruction after anterior decompression for neoplastic disease of the thoracic and lumbar spine.

The anterior approach to the thoracic and lumbar spine for neoplastic disease is now a well-accepted procedure, with results, for the most part, superior to those achieved with laminectomy. However, the specific indications for anterior decompression and the selection of reconstruction techniques based on the location and extent of bony destruction have received surprisingly little attention. The authors report their experience with the operative management of 33 patients with benign and malignant tumors of the thoracic and lumbar spine, using the anterior transthoracic or retroperitoneal approach. The role of stabilization and the relative indications for anterior or posterior instrumentation are emphasized. The mean age of patients was 58 years. Twenty-three patients were male. Five patients had benign tumors, and the remainder had a variety of metastatic lesions. Twenty-nine patients had lower extremity motor deficits, although 25 were ambulatory preoperatively. Thirty-seven noncontiguous resections were performed in 33 patients. In 13 patients, the resected vertebral body was replaced with acrylic or bone without instrumentation; in 18, the acrylic was supplemented with anterior instrumentation; and in 6, both anterior and posterior instrumentation were used. Above T11, vertebral reconstruction techniques were used to restore stability after decompression. Between T11 and L4, anterior instrumentation was used to supplement vertebral reconstruction in all patients. Supplemental posterior instrumentation was used for three-column involvement. Motor function was stabilized or improved in 94% of patients, and 88% of patients were ambulatory postoperatively. Of 28 patients with malignant disease, 23 died after a mean survival of 10.2 months (range, 2-51 mo) and 5 are alive a mean of 34.4 months since their operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

The chest in profile.

SUMMARY: Radiology has been abounding with technological advances since the chest film first became the mainstay in diagnosing thoracic disease, and yet the conventional chest examination has endured as a front-line tool. The ability to perceive structural alterations is facilitated by a solid foundation in anatomy, which should be easy to achieve in a practice environment in which CT has become so commonplace. Not only is knowledge of anatomic nuances important for analysis of conventional radiographs, but it can only be an asset as multiplanar imaging is increasingly utilized and new modalities are developed over time. Some fundamental anatomic variations are revisited here through correlating the perspective provided by the lateral radiograph with the equally common one provided by routine axial CT images.

Azygos Vein↗
PubMed2005

Congenital paraesophageal hiatal hernia: pitfalls in the diagnosis and treatment.

PURPOSE: The aim of this study was to analyze pitfalls in the diagnosis and treatment of congenital paraesophageal hiatal hernia (PEHH). METHODS: Between 1992 and 2004, the records of 5 infants with PEHH were retrospectively reviewed for age, sex, presenting symptoms, radiological studies, operative findings and approaches, and outcomes. RESULTS: All cases (3 male, 2 female) had right-sided hernias. They had clinical features of recurrent chest infections and intermittent vomiting that were present since birth in 3. Three presented acutely ill with findings of respiratory distress and vomiting. Three were referred with misdiagnoses of reflux disease, thoracic mass, and bronchopneumonia. On the chest x-rays of 3 cases, there were paracardiac opacities suggesting a mass lesion. According to the upper gastrointestinal series and/or computed tomography findings, 4 cases had a combination of sliding and paraesophageal hernia, and the remainder one had pure rolling hiatus hernia. Three had obstruction owing to organoaxial volvulus and required an emergency operation. All cases had a large hernia orifice. Four had gastroesophageal junction (GEJ) displaced into the thorax, and in 3, the stomach was found to be twisted, and transverse colon with omentum was also in the thorax in 2. In the remainder, the GEJ was in its normal position with herniated stomach. None of the cases had normal gastrosplenic and gastrocolic ligaments. Surgical repair included resection of the sac, closure of the hiatal defect, and Thal procedure. Two had intestinal malrotation, with right ovarian torsion and ventricular septal defect, respectively. Postoperative ventilation was required in one who later died. At a mean follow-up of 2 years, the other 4 had no symptoms related to the disease, and no evidence of recurrence or reflux was noted on control upper gastrointestinal series. CONCLUSION: Congenital PEHH may be difficult to diagnose. It is frequently complicated and associated with morbidity and even mortality. If the defect is large and associated with displacement of GEJ into the thorax, adding an antireflux procedure to the repair is appropriate.

Diagnosis, Differential↗
PubMed2006

Minimal access spinal surgery (MASS) in treating thoracic spine metastasis.

STUDY DESIGN: A retrospective study was conducted. OBJECTIVE: This study aims to analyze the feasibility and efficacy of using minimal access spinal surgery (MASS) for managing thoracic spine metastasis. SUMMARY OF BACKGROUND DATA: Literature regarding minimally invasive surgical treatment for thoracic spine metastasis is sparse. In the past decade, the role of minimally invasive or endoscopic technique in managing metastatic thoracic disease has evolved. METHODS: From February 1997 to March 2003, 46 patients with spine metastases, from T3-T12, were enrolled in this study. There were 29 patients undergoing MASS. Seventeen patients received standard thoracotomy (ST) in the early study period served as the control group. The indications for MASS include intractable back pain and/or neurologic deficits or neurologic deterioration during or after radiotherapy. Inclusion criteria for this study included tumor limited to one or two vertebral segments. RESULTS: In the MASS and ST groups, no patient died as a result of an immediate intraoperative event. The mean operative blood loss was 1,110 versus 1,162 mL (P = 0.63), and the mean operative length was 179 versus 180 minutes (P = 0.54). Complication rates and 1-year, 2-year, and overall survival rates were comparable and the mean grade of neurologic recovery was 1.2 on the Frankel scale in both groups. Only 6.9% of MASS patients required a 2-day postoperative ICU stay compared with 88% of ST patients (P < 0.0001). CONCLUSIONS: The MASS technique is safe and effective and has proved to be an excellent alternative in managing thoracic spine metastasis. Surgeons may use progressively smaller incisions (5-6 cm in length) for the procedure. The learning curve for performing MASS procedures was not steep.

Adult↗
PubMed1987

Thoracic CT in detecting occult disease in critically ill patients.

Bedside chest radiography is important in the detection of thoracic disease in critically ill patients. Unfortunately these studies are often of poor technical quality and are frequently difficult to interpret. Eighty-seven bedside chest radiographs and concurrent thoracic CT scans obtained in 56 critically ill patients over a 20-month period were interpreted retrospectively and independently. In most cases, the studies were obtained to search for a source of sepsis, fever, or unexplained clinical deterioration. In this series, thoracic CT added significantly more diagnostic information in 61 (70%) of these studies than was available from the corresponding bedside radiographs. Despite the difficulties of transporting critically ill patients for CT and the significant cost, our results suggest that the improved rate of detection of unsuspected thoracic disease justifies the use of CT when bedside radiographic examinations fail to adequately explain the clinical findings.

Adolescent↗
PubMed2000

Short-course palliative radiotherapy in non-small-cell lung cancer: results of a prospective study.

From February 1993 to October 1997, 91 consecutive patients with inoperable (stage IIIB-IV) histologically confirmed non-small-cell lung cancer underwent palliative hypofractionated radiotherapy. Recently, the Medical Research Council studies on hypofractionated short-course radiotherapy (8.5 Gy x 2) have reported high control of symptoms caused by thoracic disease without toxicity. Based on these experiences and our previous positive trial on short-course radiotherapy (8 Gy x 2) in metastatic spinal cord compression, a prospective study of short-course palliative radiotherapy in non-small-cell lung cancer was carried out. The regimen was 16 Gy given in two 8-Gy fractions, 1 week apart. Eighty-one patients were evaluable for response to treatment. Forty-eight (59%) patients were 65 years or older. Forty (49%) patients were naive to radiotherapy, whereas 41 (51%) had previous cisplatin-based chemotherapy. All but four stage IV patients (95%) had poor Eastern Cooperative Oncology Group performance status (i.e., 2-3). Clinical palliation was achieved in 62 (77%) patients. Performance status improved in 59 (73%) patients. The median palliation time ranged from 28% to 57% of patient survival. The median survival from the beginning of treatment was 148 days (range, 5-681 days). No difference in overall survival according to stage and previous chemotherapy was observed. Only performance status conditioned survival (performance status 1-2 vs. performance status 3; p = 0.0289). Short-course radiotherapy gave good results in terms of clinical palliation for thoracic symptoms, even in patients with poor performance status and pretreated with chemotherapy. The median palliation time was approximately 50% of patient survival time. Treatment was generally well tolerated-only 4 (5%) patients experienced World Health Organization grade III dysphagia. No late toxicity was recorded. The two-fraction regimen had social and economic advantages compared with the conventional ones.

Aged↗
PubMedDate not supplied

Role of video-assisted thoracic surgery (VATS) in staging, diagnosis and treatment of lung cancer.

VATS, video-assisted thoracic surgery, is presently used for a variety of thoracic disorders and represents a new approach to thoracic disease. It plays a specific role in staging, diagnosis and treatment of lung cancer. For precise mediastinal lymph node staging, cervical mediastinoscopy remains the gold standard. VATS can replace anterior mediastinoscopy and is useful to take biopsies of lymph nodes not accessible by cervical mediastinoscopy and to judge resectability of the primary tumour. Precise diagnosis of solitary pulmonary nodules is possible by VATS but protective measures should be taken to prevent spillage of tumour cells. Positron emission tomography has recently proven to be valuable in staging and diagnosis of lung cancer but its precise role remains to be determined. VATS is presently not advocated for definite treatment of lung cancer. The only possible exceptions are peripheral T1N0 squamous cell carcinomas smaller than 2 cm., but resections less than lobectomy are oncologically not adequate.

Biopsy, Needle↗
PubMed1999

Lung function abnormalities and respiratory muscle weakness in children with juvenile chronic arthritis.

In contrast to adult rheumatoid arthritis (RA) little is known about the prevalence, nature and cause of lung function abnormalities in children with juvenile chronic arthritis (JCA). The aim of this study was to determine whether children with polyarticular and systemic onset JCA have lung function abnormalities and if so, whether they are related to pulmonary disease, thoracic and/or muscular involvement. We determined lung function and disability in 31 children with polyarticular and systemic JCA. Respiratory muscle function, thorax expansion and spine mobility were determined in the same patients, as well as in 32 matched healthy children. Peak expiratory flow (PEF) and forced vital capacity (FVC) were significantly reduced in JCA patients, when compared to reference values. Thorax expansion and spine mobility were normal, compared to paired controls. Maximum inspiratory (PI,max) and expiratory (PE,max) pressures were significantly reduced in patients compared to paired control subjects. A positive correlation was found between PE,max and FVC and PEF, an inverse correlation between expiratory pressure and disability. In conclusion, children with polyarticular and systemic juvenile chronic arthritis show a pronounced impairment in respiratory muscle strength, severe enough to cause mild lung function abnormalities and an increase in disability-scores.

Adolescent↗
PubMedDate not supplied

Osteo-articular, mammographic and thoracic films: clinical evaluation of digital view box versus conventional view box.

PURPOSE: To compare in a clinical setting a conventional view box with a digital view box (Smart Light 2000 Digital Film Viewer System, Smart Light, Israel) in the identification of osteo-articular, mammographic and thoracic lesions. MATERIALS AND METHODS: Six radiologists (two for each imaging procedure), experts in osteo-articular, mammographic and thoracic diseases, independently, compared 600 plain films (100 patient with two projections for each imaging procedure). The radiologists evaluated the films by filling-out a multiple choice questionnaire containing questions concerning the type of pathology seen and the technical quality of the radiography in terms of exposure along with specific questions concerning each of the imaging procedures. RESULTS: We observed a higher sensitivity of the digital view box for lesion identification (p<0.05); furthermore, we analyzed a greater number of radiographs, recovering technically unsuitable films, because of over or under-exposure (high or low optical density). The interreader agreement was also good (> 0.75). The better lesion perception derived from the increase luminance of the digital view box in the evaluation of higher film densities, such as in overexposed films. DISCUSSION. The technical characteristics of the digital view box reduce or eliminate negative factors that reduce perceptional performance, and often permit the recovery of films that would have otherwise been considered technically unreadable.

Arthrography↗
PubMed1987

"Pigtail" catheter drainage in thoracic surgery.

Small-bore percutaneous drainage catheters have been used extensively in the management of abdominal disorders and are gaining acceptance in thoracic problems. The records have been reviewed in 44 consecutive patients in whom 53 small-bore catheters were placed for thoracic disease, including empyema, 20; effusion, 9; pneumothorax, 10; lung abscess, 4; and mediastinal cyst, 1. Insertion was performed under fluoroscopy in 88%, computed tomography in 6%, and ultrasonography in 6%. Catheters ranged in size from 6.5F to 12F, but catheter size did not seem to influence outcome (p = 0.6). There was complete resolution of the problem in 75% (33 of 44) of the patients, although 20% of them required more than one catheter. Treatment was successful in all cases of lung abscess. These patients had been previously treated with standard medical therapy for 12 to 53 days without significant improvement in their clinical condition. Patients with empyema composed the largest group treated. Eighty percent (16 of 20) of them had a loculated (LOC) process. The LOC group appeared to have a slightly better success rate than did the non-LOC group (75 versus 50%, p = 0.33). When the catheters failed to resolve the problem (empyema, 6; chylous effusion, 1; malignant effusion, 3; and spontaneous pneumothorax, 1, either operation (9.1%) or a standard thoracostomy tube (13.6%) was required. The complications rate was 20%, but most of these were minor problems including pneumothorax, 5; catheter occlusion 3; fractured catheter, 1; infection, 1; and significant subcutaneous emphysema, 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗