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Thoracic disorders in the immunocompromised child.

Immunodeficiencies in children may be caused by primary immunodeficiency syndromes or can result from secondary disorders of immune regulation. Thoracic complications in immunocompromised children are frequent and may vary according to the type of the immunodeficiency. Imaging plays a pivotal role in detection and distinction of the variety of sequelae. It is important for the radiologist to understand both the spectrum of pediatric immune disorders, and the mechanisms underlying these disorders.

Child↗

Chest wall/diaphragmatic complications.

This article discusses the prevention and management of chest wall and diaphragmatic complications after extrapleural pneumonectomy, the prevention of thoracoplasty scoliosis, the complications after chest wall resection, and the presentation, prevention, and management of chest wall hernia. Appropriate preoperative assessment and patient selection, meticulous attention to detail intraoperatively, and diligent postoperative observation and care are needed to prevent these events.

Flail Chest↗

Computed tomography in small animals--basic principles and state of the art applications.

Since its clinical introduction, computed tomography (CT) has revolutionized veterinary medicine and is considered to be one of the most valuable tools for the imaging work-up of neurological, oncological and orthopaedic canine and feline patients. In small animals with acute trauma, particularly those involving complex anatomic areas such as the head, spine or pelvis, CT has been established as a standard imaging method. With the increasing availability of radiation therapy in veterinary medicine, CT has also become the principal tool to stage a tumour, assess response, and guide radiation therapy. The increasing availability of helical CT in veterinary medicine has allowed novel techniques such as spiral CT angiography and high-resolution CT. This review provides a brief overview of the historical and technical development of CT and literature reviews of the major clinical CT applications in small animals such as intracranial and extracranial lesions, the spine, the appendicular skeleton, and abdominal and thoracic diseases.

Animals↗

Myositis ossificans of the chest wall simulating malignant neoplasm.

Myositis ossificans originating from the chest wall is extremely rare. We report a case of myositis ossificans occurring in a young woman with progressive painful swelling in the chest wall. Preoperative examination suggested a malignant neoplasm originating from soft tissue. Although rare, myositis ossificans is one of the potential causes of painful swelling in the chest wall, and can be mistaken for a malignant neoplasm.

Adolescent↗

Stent placement in superior vena cava syndrome.

BACKGROUND: Superior vena cava syndrome (SVCS) is often seen in the natural history of malignant thoracic diseases. SVCS is characterized by unpleasant symptoms that usually lead to death. The purpose of our study is to show the efficiency of percutaneous stenting in the superior vena cava for relieving SVCS and the possibility of repeated stenting after recurrence. METHODS: Twenty patients with SVCS caused by malignant diseases who had one or more stents placed in the superior vena cava or its main tributaries were evaluated. RESULTS: Out of 20 patients, 1 died of myocardial infarction 24 hours after the procedure without any signs of pulmonary embolus, hemorrhage, or malposition of the stent. SVCS was successfully controlled in 94% of patients until death or completion of the study. In 3 patients the procedure was repeated (3 to 20 weeks later) because of the recurrence of symptoms. CONCLUSIONS: Percutaneous venous stent placement in the superior vena cava is a simple and effective technique to relieve rapid SVCS caused by malignancies. When recurrence occurs, repeated stenting can be performed successfully.

Adult↗

Aspiration needle biopsy of thoracic lesions.

We reviewed our experience with 2,114 percutaneous aspiration needle biopsies of intrathoracic lesions. Aspiration was performed for cytological diagnosis employing biplane fluoroscopy and a 20 gauge needle, 0.9 mm in outside diameter. A satisfactory specimen was obtained in 88% of biopsies, and the chance of obtaining a correct diagnosis of a malignant lesion was 81.5%. The false positive rate was 2.3%, and the cytologists could always distinguish between primary and secondary neoplasms. A false negative rare of 13.6% (36 patients) resulted in only three delayed thoracotomies and two instances of interval metastases discovered at mediastinoscopy. Cellular specificity in primary tumors was not sufficiently accurate to affect therapy. Pneumothoraces occurred frequently (31.9% of patients) but wee generally small; 10.4% of patients required chest drainage. There were no recorded instances of tumor implantation in needle tracts. We conclude that a rapid and accurate diagnosis of intrathoracic pathology can be obtained by this technique. It is associated with an acceptable morbidity and may greatly expedite both patient care and investigation.

Biopsy, Needle↗

Aggressive surgical management of testicular carcinoma metastatic to lungs and mediastinum.

During the past six years, more than 200 patients were treated with chemotherapy for disseminated testicular cancer with a 70% complete remission rate. In 22 patients who were 17 to 46 years old, there was persistent thoracic disease, which was treated surgically. Six required a median sternotomy for bilateral pulmonary involvement or mediastinal metastasis. In 8 patients, chemotherapy had altered the histological appearance of the metastases from that of an undifferentiated primary tumor to a mature cystic teratoma. Five patients had nodules in the lungs, which were necrotic and fibrosed with no evidence of tumor. Nine showed embryonal cell carcinoma metastases in the lungs. All who had cystic teratoma are alive and free from disease. Three of the 5 with nodules and 1 of the 9 with metastases are currently free from disease. Agressive surgical intervention is important in this unique group of patients in order to determine the precise pathological category of the lesions, to remove intrathoracic malignancy, and to assess the need for additional chemotherapy. An operative mortality of zero and a low morbidity justify this approach.

Adolescent↗

The infected chest wall prosthesis: management by excision and contralateral transverse rectus abdominis musculocutaneous flap.

A patient with a chest wall sarcoma whose original prosthetic reconstruction became infected after a course of radiation therapy is described. After removal of the prosthesis, salvage reconstruction was performed using a transverse rectus abdominis musculocutaneous flap. Management of the infected chest wall prosthesis, with emphasis on the indications for use of the transverse rectus abdominis musculocutaneous flap, is discussed.

Combined Modality Therapy↗

Tracheobronchial ruptures due to cuffed Carlens tubes.

At our institution in the past 22 years, more than 3,000 patients have undergone chest procedures, and 2,700 of them were intubated with a cuffed Carlens endotracheal tube. In this paper we report on 5 patients with tracheobronchial ruptures caused by intubation with these tubes. We believe this hazard should be brought to the attention of physicians.

Adult↗

Prophylactic antibiotics in noncardiac thoracic operations.

A high incidence of thoracotomy wound infection and empyema in 1972 was associated with inadequate and irregular administration of prophylactic antibiotics. Beginning with 1973, a strict regimen was adopted that combined systemic cephalosporins and two topical antibiotics (cephalothin and kanamycin). Emphasis was placed on preoperative administration of the systemic agent and on use of the topical drugs before the operative field was contaminated. The patient groups for 1972 and 1973 were similar in most respects, but the wound complication rate was 18.4% in 1972 and 4.8% in 1973.

Administration, Oral↗

Simplified lateral chest incision for most thoracotomies other than sternotomy.

Our experience using the lateral simplified thoracotomy incision for most chest work other than operations requiring median sternotomy is reported. The incision provides adequate exposure, yet preserves major muscle masses and decreases the postoperative morbidity. Return of normal ipsilateral arm function appears to be hastened in the postoperative period. In addition, the incision is easier to open and close than the standard incision.

Humans↗

Vertical axillary thoracotomy: a functional and cosmetically appealing incision.

Vertical axillary thoracotomy offers the specific advantages of minimum trauma and maximum preservation of chest wall function. A cosmetically acceptable scar results. The vertical axillary thoracotomy is specifically indicated in patients requiring less than the maximum intrathoracic exposure provided by the most traumatic posterolateral or anterolateral thoracotomy. The surgical technique is presented.

Axilla↗

[A new surgical technique for thoracic parathyroid glands: video-assisted thoracoscopy with intraoperative Tc-MIBI scintigraphy].

Ectopic mediastinal parathyroid glands are uncommon (1-11% of all cases of hyperparathyroidism). Median sternotomy used to be performed to resect them, with large and painful incisions that prolonged the length of hospital stay. Current imaging techniques (thoracic computed tomography and Tc-mibi scan) can accurately locate the ectopic glands, allowing minimally invasive exploration. We report a new surgical technique: video-assisted thoracoscopic resection associated with intraoperative Tc-mibi scintigraphy for ectopic mediastinal parathyroid glands. This technique allows minimally invasive access and reduces complications and length of hospital stay. Therefore we believe that video-assisted thoracoscopy could become the technique of choice in patients with high surgical risk and a fifth ectopic parathyroid gland. We report the case of a 49-year-old man in whom surgery was successful.

Choristoma↗

Percutaneous needle biopsy of thoracic lesions--an evaluation of 300 biopsies.

The results of 300 consecutive thoracic needle biopsies have been evaluated. It is concluded that this is a safe procedure for the investigation of peripheral intrathoracic masses. It should not be performed unless excellent facilities for cytopathology are available. Under these conditions there is a high degree of accuracy in differentiating between malignant and non-malignant lesions, particularly if repeated biopsies are performed when the initial results are unrewarding, equivocal or at variance with the radiographic appearances. In this series there was an imperfect correlation between the cytological and subsequent histological cell type except with squamous carcinomas. The indications are changing with the advent of flexible bronchoscopy and the increasing use of chemotherapeutic regimes. Misleading results may be obtained from biopsy of cavitating lesions and necrotic tumours.

Adolescent↗