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Endometriotic growth may appear in any structure in the body. As well as affecting the internal genitalia, lesions are not uncommon in the bowel, urinary tract and thorax and reports of a number of cases at rarer sites have been published. This review is based on more than 1000 publications on the subject, that allows an overview of the appearance of the disease in different organs.
In 78 patients a total of 89 chest wall tumours were considered for surgery between 1960 and 1982. There were 63 neoplasms (12 benign, 51 malignant) and 26 pseudotumours (1 chest wall deformity, 6 inflammatory tumours and 19 hydatid cysts of the chest wall). Radical resection of some kind was possible for 67 tumours and 2 patients underwent palliative resection. Exploratory thoracotomy and biopsy were performed in 9 patients and thoracoscopy and biopsy in 10. One hydatid cyst was managed with mebendazole. There were 11 postoperative complications and three hospital deaths. Chest wall prostheses were used in 13 patients. There was no operative mortality. The mean survival time for the patients with malignant tumour was 12.3 months in pleural mesothelioma and in metastatic pleural tumours, 15.2 months in primary rib tumours and 6.4 months in metastatic rib tumours. There was one death in the benign tumour group and one in the pseudotumour group.
Primary tuberculosis of the chest wall is rare and its clinical presentation may resemble pyogenic abscess or tumour. The diagnosis is difficult, since smears or cultures of aspirate frequently fail to show tubercle bacilli. Seven cases of primary chest-wall tuberculosis treated between 1973 and 1992 are described. All presented with a progressively enlarging mass. The diagnosis was based on bacteriologic and histologic findings, but definitive diagnosis was obtained before treatment in only two cases. Satisfactory results were obtained with surgical debridement and specific chemotherapy in six cases and with chemotherapy alone in one case. From this limited experience, we suggest that primary chest-wall tuberculosis should initially be treated with a combination regimen of antituberculous chemotherapy, which should take more than 9 months. If the lesion progressively enlarges or secondary infection occurs, however, adequate surgical debridement is also required.
The authors present a case of a rare cutaneous lesion resembling a human finger that protruded from the posterior thoracic region of a 7-month-old girl who was examined after the fingerlike protrusion was noted at birth. The protrusion measured 3 cm in length and 1 cm in diameter. It was located at the level of T-12 and was surrounded by angiomatous and lipomatous tissue. A computerized tomography scan demonstrated three bones in the protrusion. including deformities of the T-9 and T-10 and T-11 dysraphism. Magnetic resonance imaging revealed a hyperintense signal on the T1-weighted sequence and a hypointense signal on the T2-weighted sequence, which was visualized at the attachment to the spinal cord from T9-11. After removal of the fingerlike structure and subcutaneous mass, a T10-11 laminectomy and removal of the intradural mass were performed. Histological examination showed that the appendage was composed of nail, three bones, cartilage, and normal skin. This appendage can be recognized not only as a variant type of caudal appendage but as an ectopic finger and fingernail. The authors discuss the developmental differences among the protrusion in the present case and ordinary caudal appendages.
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Thoracoscopy has been utilized in a number of patients with unusual or difficult problems which were not resolved with standard thoracic techniques. These problems have been grouped in: infectious, tumour, iatrogenic and others. Personal experience and a survey of the literature on the subject show that thoracoscopy may be an ideal approach in many cases.
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SETTING: A referral centre for thoracic diseases in Izmir, Turkey, 1992-1995. OBJECTIVE: To appraise the adjunctive role of prednisolone (PN) in pulmonary tuberculosis (PTB) with toxic reactions. DESIGN: After excluding other febrile causes, and 2 weeks of four/five-drug antituberculosis therapy insufficient to resolve toxic reactions, 178 human immunodeficiency virus (HIV) negative patients with advanced PTB causing persistent high-grade fever (> or =38 degrees C), weight loss (> or =2 kg/week) and/or low serum albumin levels (<3 g/dL) were randomly allocated to receive either a 12-month course of antituberculosis treatment using four first-line drugs and PN (20 mg b.i.d. IV/IM initially, decreasing over 40 days) (91 patients-PN group), or 12 months of antituberculosis treatment only (87 patients-CO group). Twice-weekly sputum bacillary count, temperature recorded every 6 hours, weekly weight, serial albumin level and liver function measurements and chest roentgenograms were used to assess the effects of PN on PTB. RESULTS: Temperature decreased from 39.1+/-0.9 degrees C to 37.9+/-0.7 degrees C (P = 0.0030) within the first 72 (+/-9) hours in those patients on PN treatment, whereas a gradual decline occurred over 22 (+/-3) days in the CO group. In the PN group, patients' weight increased from 49.7+/-4.8 kg to 56.9+/-8.3 kg, compared to 47.1 +/- 6.4 kg to 51.31+/-5.9 kg in the CO group (P = 0.0022). Increases in serum albumin levels in the PN and CO groups were from 2.26+/-0.8 g/dL to 3.32+/-0.6 g/dL and from 2.31+/-0.5 g/dL to 2.90+/-0.7 g/dL, respectively (P = 0.0035). The radiographic regression and drop in bacillary count were more rapid, and the hospital stay shorter (53.4+/-3.1 days vs 71.3+/-5.6 days) in the PN group, although there were no differences in the acid-fast bacilli conversion rates. There were no detrimental side effects and relapses attributable to PN during the 1-3 year follow-up, even in 18 cases with drug resistance. CONCLUSION: Prednosolone is a beneficial and safe adjunct to 12-month antituberculosis treatment in advanced PTB causing toxic reactions, provided that close clinical, radiographic and bacillary monitoring is exercised.
We performed thoracoscopic pericardiectomy to an 86-year-old patient with recurrent pericardial effusion of unknown origin. Etiology of pericardial effusion was established by this procedure. Postoperative course was uneventful. She was discharged within two weeks and has been well 8 months postoperatively. Thoracoscopic surgery is superior to thoracotomy in terms of less invasion and postoperative pain. Thoracoscopic surgery is replacing standard thoracotomy in the management of many thoracic diseases.
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Hydatid cyst is not mentioned among the chest wall tumours in areas not known to harbour echinococcosis. One of the uncommon sites for echinococcosis even in endemic countries is the chest wall. The striking resemblance between neoplasm and hydatid cysts forms a diagnostic dilemma and makes the correct diagnosis essential before surgery.
The results of treatment of 131 victims with penetrating wounds of the thorax complicated by profuse bleeding, are presented. 36 of them after surgery to prevent pyogenous complications received 5 injections of leukinferon (test group); 95 patients who were not treated by leukinferon made up control group comparable with the test group by sex, age and character of wounds. Comparative analysis of the results showed that treatment with leukinferon has resulted in decrease of postoperative complications. In the test group the number of complications made up 47.2%, in control group--61%. Al the same time in the former group there was only one pyogenous complication (2.9%), while in control group--10 (10.6%). After the course of leukinferon leucocytic formula of the blood has become normal, the number of patients with immunodeficiency and imbalance of proteins markers of the acuteness of inflammatory process has decreased.
OBJECTIVES: To present our experience in video thoracoscopy and video-assisted thoracic surgery from November of 1991 until November of 1997. PATIENTS AND METHODS: 303 endoscopic thoracic surgery procedures (210 males and 93 females with a mean age of 42.2 years) with the following indications: 151 spontaneous pneumothorax, 51 pulmonary biopsies, 50 pulmonary nodules, 15 mediastinal tumors, 13 pleuroparietal tumors, 8 pericardial windows and 15 thoracic sympathectomies. RESULTS: Mean postoperative stay was of 5.5 days. The thoracotomy conversion was necessary in 32 cases (10.9%). The morbimortality has been: one parietal recidive of a tumor in the way of one of the trocars and one death of a patient to who was accomplished a pulmonary biopsy by diffuse pneumopathy. CONCLUSIONS: The video thoracoscopy and thoracic surgery are effective and sure technical options for diagnosis and treatment of various thoracic affections.
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OBJECTIVE: To describe a nosocomial infection surveillance in a cardiology and thoracic diseases hospital in Northern Mexico during its initial months of activity. MATERIAL AND METHODS: Retrospective report of nosocomial infection surveillance performed by the infection control team with patient visits, clinical records, microbiology reports, and direct information obtained by health personnel. General and specific infection rates were analyzed by the chi 2 test and the Student t test. RESULTS: General infection rate was 4.99 during the 17 month period. Monthly infection rates changed significantly during infection control team vacations. By site of infection, surgical wound infection were the most common (1.14), followed by urinary tract infections (1.08), and bacteremia (0.72). However, when we grouped bacteremias and other catheter related infections, this intravascular access related infections were the most frequent (1.73). Gram positive organisms were most commonly isolated in nosocomial infections, except in pneumonias (gram negative organism) and urinary tract infections (Candida spp.). Mortality related to nosocomial infection was high (21.7%), and at least one third of those deaths was directly related to the infection. In hospital stay and cost were also increase with nosocomial infections. CONCLUSIONS: Nosocomial infection is common in interventional cardiology hospitals, producing high mortality and rising costs and length of stay. We need a more effective nosocomial infections surveillance system to eliminate changes in monthly case detection produced by the infection control team vacations, since this under-registry could result in lost of control of nosocomial infections and epidemic outbreak emergence.
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