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This article presents specific uses of the portable chest film. The specific utility, borderline utility, and pitfalls in interpretation of films that are often taken to investigate a number of diagnostic problems common to the practice of emergency medicine are discussed.
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One hundred cases surgically intervened due to thoracic pathology between 1977 and 1986 were studied. The ages were equal to or higher than 70 years. Mean age was 73.13 years (70-91). In 70 cases a neoplastic aetiology existed (78.57% of primary bronchial carcinoma), while in the other 30 cases the cause was not neoplastic. In these cases with a high operative risk, a detailed systematic study before surgery is recommended, which should be treated in the most conservative possible way. Although the complication rate was higher than the average in other groups (p less than 0.05), mortality was only 4%, being related, to a greater or lesser extent--, to the surgery (p less than 0.05). In the cases diagnosed as bronchial carcinoma, a 2-year survival was obtained in 66.4%, 3 years in 49.8% and 5 years in 25.7%, concluding that an age equal to, or higher than, 70 years does not represent any contraindication for thoracic surgery.
Within the framework of a national multi-centre study the spectrum of application and the ranking of magnetic resonance tomography were investigated. Although scans of the brain and vertebral column still dominate the scene, it has become evident that whole body scanning via MR can be very accurate for certain indications. This is particularly true for examinations of gynaecological diseases (95%) and for lesions of the liver (97%). However, the number of problems in which MR can provide answers to diseases in the whole body range is still limited, and hence it would be most desirable to achieve further instrumental and methodical improvements.
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Echo guided percutaneous needle biopsy was performed in 32 cases with thoracic lesions. A definitive diagnosis was made histopathologically in 11 (100%) of 11 malignancies, 4 (67%) of 6 benign tumors and 7 (47%) of 15 inflammatory lesions. Furthermore, using cytological specimens, definitive diagnosis was successfully made in 10 (91%) of 11 malignancies and 1 (17%) of 6 benign tumors. Such highly accurate diagnostic rates were due to 1) the accurate puncture of the lesions under real time sonographic guidance, 2) repeated biopsy in case in which sample was inadequate for cytological diagnosis, and 3) aggressive application of needle biopsy for histopathological diagnosis. Following this procedure, three patients suffered from a minor pneumothorax. To prevent pneumothorax, great care is necessary, especially in high risk cases, such as with a pneumatic pattern and thin lesion. One patient suffered from minor hemoptysis but recovered without any medication. No complications were noticed in cases of extrapulmonary lesions. We conclude that echo guided percutaneous needle biopsy is not only a complementary method for biopsy of mediastinal, peripheral pulmonary and chest wall lesions, but due to its simplicity and convenience, it should be a routine method for biopsy of thoracic lesions.
Intrathoracic infections associated with infection, leakage, or bleeding of the airway, lung parenchyma, esophagus, heart or great vessels is a life-threatening situation that luckily is infrequently seen. Failure to control these infections with the usual techniques can often be attributed to the presence of persistent pleural space, continuing empyema or bronchopleural fistula. Intrathoracic transposition of extrathoracic skeletal muscle in these situations offers an effective of management. Our experience has been possible because of the continued integrated effort with our thoracic surgical colleagues. We have found the team approach to work best and will continue to use it.
Mediastinal anatomy is well depicted by MRI. This article discusses the role of thoracic MRI in evaluating mediastinal, parenchymal, and pleural abnormalities in children. It is particularly useful in the evaluation of vascular anomalies and assessment of extension of neuroblastoma and can obviate other, more invasive, studies.
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9 cases of thoracic actinomycosis are analysed with regard to their antibiotic therapy. On account of sensibility of the bacteria and the pharmaco-kinetics of the antibiotics the therapy with Ampicillin in high doses is recommended for relatively short time. This therapy should be performed in any case before surgical measures.
Authors report on their experience about ceftriaxone in surgical prophylaxis in childhood. 30 patients have been treated, suffering from surgical diseases, either thoracic or abdominal ones, including malignancies. Ceftriaxone was administered once a day; patients received ceftriaxone only once preoperatively: Results have been very satisfactory, the only two complications having been found in two severely immunocompromised patients.
FNAC was performed in 186 cases. Inadequate material was obtained in 41 cases. A definite diagnosis of malignancy could be made in 120 cases. In five cases a diagnosis "suspicious" of malignancy could be made. No serious complication was encountered with the technique. FNAC is of definite help in diagnosing the intra thoracic lesion whether malignant or inflammatory in nature. It also avoids unnecessary thoracotomy for diagnostic purposes.
A clinicopathological analysis of 70 cases of sarcoidosis was reported. Among the 70 cases, 4 were intrathoracic, 42 were extrathoracic and 24 were both intrathoracic and extrathoracic lesions. Definite diagnosis was made with biopsy in 69 cases and autopsy in one. It is shown that sarcoidosis might involve the skin, mucosa, muscle, lymph nodes of all sites, eyes, lacrymal glands, parotid and submaxillary glands, tonsils, heart, lungs, liver, spleen, brain, bones etc. It is also worthy to note that most cases with extrathoracic sarcoidosis were either wrongly diagnosed or missed.
This survey is a comprehensive review of the diagnostic and therapeutic indications for thoracoscopy.
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Extrapelvic endometriosis has been reported in nearly every organ system of the human female body. The etiology of this disease may well be due to one or more factors. Though less common than pelvic disease, extrapelvic endometriosis is often difficult to diagnose and more difficult to treat. Our experience combined with a review of world literature is presented focusing on diagnosis and management.
The AIDS epidemic continues to spread in Georgia. Almost every medical specialty is affected in some manner by the increased number of patients being diagnosed and treated with AIDS or the AIDS-related complex. Radiology has a pivotal role in documenting various opportunistic complications so that further testing and therapy may be instituted. Because of the large number of AIDS patients that develop thoracic disease, we have reviewed many of the potential pulmonary complications and their radiographic findings. Certain patterns of disease may suggest etiologies, though admittedly the chest radiograph is nonspecific. Diagnosis must be confirmed with sputum culture, bronchial lavage, and biopsy or open lung biopsy. There are key features that should be kept in mind. P. carinii, the most common pathogen, and several other opportunistic agents usually present with a fine bilateral interstitial or ground glass appearance. The presence of mediastinal adenopathy and/or pleural effusion suggests an etiology other than PCP. These findings are indicative of mycobacterial infection, KS, or lymphoma. PCP can present as a focal pulmonary consolidation, but this is unusual, and bacterial pneumonia must be considered. Finally, a small percentage of persons will present with a normal chest x-ray despite the presence of pulmonary infection or neoplasm. In those cases gallium lung scanning can help identify the affected individuals.