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PubMed1989

Heart and unilateral lung transplantation in patients with end-stage cardiopulmonary disease and previous thoracic operations.

Orthotopic en bloc transplantation of the heart and one lung has been done in two patients with end-stage cardiopulmonary disease and a prior thoracic operation. The first patient had undergone right pulmonary thromboembolectomy with caval ligation 5 years earlier, and the second had had left lower lobectomy for bronchiectasis 15 years before the heart and contralateral lung transplantation. Surgical procedures followed the techniques that had been developed in animals. Transplantation of the unoperated contralateral lung made it possible to avoid dissection in the obliterated pleural space and to minimize bleeding, which simplified the procedure considerably. Dramatic reduction in pulmonary artery pressure and improved respiratory function allowed both patients to be weaned from cardiopulmonary bypass without problems. Although the first patient died of liver and renal failure soon after the operation, an intact cough reflex facilitated recovery in the second patient, who has been discharged with essentially normal respiratory function. This report describes heart and unilateral lung transplantation as a procedure of choice for patients with extensive pleural adhesions that made total cardiopulmonary replacement unfeasible.

Adult↗
PubMed1999

Significance of Epstein-Barr virus status and post-transplant lymphoproliferative disease in pediatric thoracic transplantation.

Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disease (PTLD) is a serious complication of organ and bone marrow transplantation. The importance of EBV matching between recipient and donor remains unclear. Between October 1987 and December 1997, 64 pediatric cardio-pulmonary transplants were performed at this center (58 hearts, two heart/lungs, four sequential single lungs). The EBV viral capsid antigen (VCA) immunoglobulin G (IgG) status of both donor and recipient was determined at the time of transplant. Of 56 patients from whom paired sera was available for analysis, 27 (50%) were recipient and donor EBV IgG positive, four (7%) were recipient EBV IgG positive and donor EBV IgG negative, and 12 (20%) were recipient EBV IgG negative and donor EBV IgG negative. The remaining 13 (23%) patients were EBV IgG negative but received organs from EBV IgG-positive donors. The EBV immunoglobulin M (IgM) status was determined from 6 weeks post-transplant in the 11 mismatches who survived for longer than 28 d. Seven became EBV IgM positive, two remained EBV IgM negative; the status of the remaining two remains unknown. The EBV IgM status was also determined retrospectively in patients who were EBV IgG negative pretransplant and received organs from EBV IgG-negative donors. Nine became EBV IgM positive; the rest remained negative. PTLD was diagnosed in two of 56 patients from whom paired sera was available; one was donor and recipient EBV IgG negative; the other was donor and recipient EBV IgG positive. No cases of PTLD were diagnosed in the remaining eight patients from whom paired sera was not available. Our experience suggests that PTLD does not occur with any greater frequency in the 'mismatch' group, and does not justify EBV matching in pediatric thoracic transplantation where there is a higher proportion of EBV-negative recipients than in adults.

Adolescent↗
PubMed1991

[Study of high-resolution thoracic computerized tomography and bronchoalveolar lavage in 36 patients presenting with systemic disease and a normal thoracic radiography].

Systemic diseases such as scleroderma (ScI), rheumatoid polyarthritis (PR), Gougerot-Sjögren Syndrome (GS) have a well known propensity for the lungs. Previous studies have shown evidence of disturbed alveolar cell repair as evidence of a sub-clinical alveolitis. The significance of such cases of latent alveolitis remains to be specified. To determine if latent alveolitis was associated with interstitial chest disease which was undetectable by chest X-ray, 36 consecutive patients had an BAL and a high resolution computered tomographic examination (HRTC) (Scl: n = 21; PR: n = 9; GS: n = 6). The patients had normal respiratory function and chest X-ray was normal. Our results showed 17 out of 36 (47%) with a latent alveolitis (the percentage of lymphocytes and of alveolar polymorpho-nuclear neutrophils was superior or equal to 18 and 4% respectively) (Scl: 12/21; PR: 1/9; GS: 4/6). In the cases of scleroderma a neutrophil alveolitis was predominant (9/12) and was associated in 2 cases with a honeycomb lung and evidence of fibrotic lesions using TDM-HR. Those examinations using HRTC which were normal were equally associated with a latent alveolitis (Scl: 6/12; PR: 1/6; GR: 4/5). These results suggest that the alveolitis can preceed the anatomical damages. These results need to be confirmed in a larger series and the value of early treatment should be evaluated.

Adolescent↗
PubMed1993

[Treatment of thoracic malignancy accompanied with cardiovascular disease].

We treated 10 cases of thoracic malignancy accompanied with cardiovascular disease. Among thoracic malignancy, 7 cases were lung cancer and 3 were esophageal cancer. Accompanied cardiovascular diseases were ischemic heart disease (2 cases), valvular disease (3 cases), WPW syndrome (1 case), aortic aneurysm (4 cases). The mean age was 66, ranged from 51 to 79. The simultaneous occurrence of the two lesions were observed in 6 cases and thoracic malignancy was diagnosed after a varying interval of time following surgery of cardiovascular disease in 4 cases. In cases of thoracic malignancy accompanied with heart disease, the treatment of heart disease should precede the operation of malignant disease to reduce the risk of surgery. For the patient with esophageal cancer, posterior mediastinal esophagostomy should be applied who may have heart surgery in future. In cases of coexisting malignancy and aortic aneurysm, the priority of treatment should be determined considering the size of aneurysm. If the transverse diameter of aneurysm is larger than 7 cm, there is a high risk of rupture, so surgery for the aneurysm precedes operation of malignant diseases. It is desirable to avoid concomitant operation of malignancy and cardiovascular disease.

Aged↗
PubMed2001

Endovascular stent-graft treatment for diseases of the descending thoracic aorta.

OBJECTIVE: Assessment of endovascular stent-graft treatment for diseases of the descending thoracic aorta as a valid and effective alternative to surgery. METHODS: From March 1999 to August 2000, a total of 16 patients underwent deployment of endovascular stent-grafts in the descending thoracic aorta. Patients were divided into three groups according to the type of lesion. Group A (n=8) included five patients with atherosclerotic aneurysm and three with chronic post-traumatic pseudoaneurysm. Patients with acute post-traumatic pseudoaneurysm (n=3) and type B aortic dissection (n=5) were included in Groups B and C, respectively. All patients underwent 5-mm chest spiral angio-computerized tomography (CT) scan and angiography as preoperative assessment. The deployed stent-graft systems were Talent-Medtronic and Excluder-Gore. RESULTS: A total of 20 stent-grafts were placed. Two patients required deployment of two grafts, while three grafts were juxtaposed in a third patient in order to treat larger lesions. There was no mortality related to the procedure, although one patient (6.2%) died because of multiorgan failure 24h post-operatively. The placement of the graft was successful in all cases except one affected with type B dissection and characterized by a very large intimal flap, which was eventually fenestrated by graft guidewire. Therefore, an optimal sealing of the grafts was achieved in 15 patients. However, in one patient the descending aorta had to be surgically replaced because of the calcified pseudoaneurysm still compressing the trachea and left bronchus. Two patients required a left carotid-subclavian by-pass in order to achieve a sufficient neck for the proximal placement of the graft. No spinal cord injuries were observed. At the follow-up, performed with chest spiral angio-CT scan within 72 h and scheduled at 6 and 12 months and once a year, no stent-graft related complications have been detected. CONCLUSIONS: Endoluminal stent-graft treatment may represent a valid option in well-selected cases of descending thoracic aorta diseases. A longer follow-up in a larger series of patients is desirable to confirm these initial positive results.

Adolescent↗
PubMed1999

Endovascular solutions for diseases of the thoracic aorta.

Technology is proceeding at a very brisk pace. Harnessing that technology for clinical use is both a challenge and an opportunity. This combination of surgical and interventional methods has allowed for improved clinical outcomes in certain complex aortic problems. This article explores and discusses new techniques used in detection and treatment of diseases of the thoracic aorta.

Aged↗
PubMed1982

Long-term cardiovascular evaluation of patients with Hodgkin's disease treated by thoracic mantle radiation therapy.

The long-term cardiac effects of anterior-weighted thoracic mantle field radiotherapy were assessed in 25 patients treated for Hodgkin's disease. These patients underwent an evaluation that included a careful history and physical examination, ECG, M-mode echocardiogram, exercise ECG-gated radionuclide ventriculography, and cardiac catheterization. In these 25 patients evaluated 37-144 months (median, 96) after completion of thoracic mantle radiotherapy, eight had constrictive pericarditis; eight had occult constrictive pericarditis; three had an abnormal response to fluid challenge; three had suspected or proven occlusive coronary artery disease; and one each had a cardiomyopathy and diminished functional capacity on exercise testing. Only one patient appears to be normal after evaluation. The clinical spectrum of delayed-appearing radiation-induced cardiac disease in patients treated by anterior-weighted thoracic mantle fields and our suggestions for its treatment are discussed.

Adolescent↗
PubMed1997

Anterior thoracic corpectomy without sternotomy: a strategy for malignant disease of the upper thoracic spine.

BACKGROUND: With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal metastases. While no region of the spine is easily treated, the upper thoracic spine is perhaps the least accessible. Traditional approaches to this region involve either thoracotomy or at least limited sternotomy. The authors present an approach to anterior pathology of the upper thoracic spine that obviates the need for sternotomy. METHODS: Within the past two years, two patients with cervicothoracic metastases underwent anterior decompression and fusion without sternotomy. In both patients, the bodies of C7, T1, and T2 were removed. While both patients were prepared and draped for sternotomy, each required a neck dissection only. In both patients, left-sided incisions were made along the leading edge of the sternocleidomastoid. The platysma was divided with the overlying skin. With further dissection, the strap muscles were tagged and divided approximately one centimeter above their sternal attachments. The loose areolar tissue of the superior mediastinum was then bluntly dissected. Along the entire length of the incision, the vascular plane medial to the carotid sheath was developed to facilitate exposure of the anterior spine. A Farley-Thompson retractor system was then employed to retract and protect the superior mediastinal structures. With this exposure, corpectomies were carried out using a high speed drill. Fusion was accomplished through insertion of Steinmann pins into the adjacent intact bodies above and below. This was followed by application of methyl methacrylate. Both patients had immediate postoperative stability with preservation of spinal cord function. Both patients subsequently underwent removal of dorsally located tumor with posterior fusion. CONCLUSIONS: The goal of cancer surgery is to provide for increased functional survival without undue morbidity. The authors feel that when possible, the pain of sternal and clavicular osteotomies should be avoided. The described approach works well in conjunction with a methyl methacrylate/Steinmann pin construct. Because of the intact sternum, the surgeon has a downward angle to access the superior endplate of T3. With adequate soft tissue dissection and retraction as described, however, T3 and perhaps even T4 are easily accessible. While this downward angle would likely not permit an anterior plating procedure, it lends itself nicely to Steinmann pin/methyl methacrylate fusion and spares the patient the pain and potential morbidity of sternotomy.

Breast Neoplasms↗
PubMed1965

MONDOR'S DISEASE.

Explore the source record for details and available documents.

Breast Diseases↗
PubMed1992

[Surgical treatment of ischemic heart disease using internal thoracic artery and partial ileal bypass].

The authors recommend complex two-stage treatment of ischemic heart disease, including a reconstructive operation on the coronary arteries and an operation for correcting the disturbed plasma lipid spectrum (partial ileal bypass). The results of operative treatment of 150 patients with the use of the internal thoracic artery were studied. The authors emphasize the advantages of this operation over one using an autovein graft. Complex operative treatment was conducted in the clinic in 60 patients with a good clinical effect. The authors also recommend operation for partial ileal bypass as an independent intervention in dyslipoproteinemia and diffuse affection of the coronary arteries.

Adult↗