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At least 1,117 records · Page 62Linked to original sources
PubMed1994

Noninvasive prediction of coronary artery disease by transesophageal echocardiographic detection of thoracic aortic plaque in valvular heart disease.

Clinical and angiographic features and transesophageal echocardiographic (TEE) findings were retrospectively analyzed in 105 consecutive patients with valvular heart disease to assess the value of TEE detection of thoracic aortic plaque for predicting coronary artery disease. In 19 patients with significant coronary artery stenosis (> or = 70% narrowing of the luminal diameter in the left anterior descending, left circumflex, or right coronary arteries, or > or = 50% stenosis of the left main coronary artery), 18 had thoracic aortic plaque on TEE study. In contrast, aortic plaque existed in only 10 of the remaining 86 patients with normal coronary arteries or mildly atherosclerotic coronary lesions. The presence of aortic plaque on TEE study had a sensitivity of 95% and a specificity study had a sensitivity of 95% and a specificity of 88% for significant coronary stenosis at angiography. The positive and negative predictive values were 64% and 99%, respectively. There was a close relation between the degree of aortic intimal changes and the severity of coronary artery disease (r = 0.65; p < 0.001). Multivariate stepwise regression analysis of patient age, sex, risk factors of cardiovascular disease, angina, and TEE findings revealed that atherosclerotic aortic plaque was the most significant independent predictor of coronary artery disease. This study indicates that TEE detection of atherosclerotic plaque in the thoracic aorta is useful in the noninvasive prediction of the presence and severity of coronary artery disease in patients with valvular heart disease.

Aged↗
PubMed2002

[Surgical treatment of intervertebral disk herniation and spondylosis in degenerative diseases of the thoracic vertebrae--basic approach. Review of the literature and a group of 12 patients].

Prolapse of an intervertebral disc and neurologically important spondylosis of the thoracic vertebrae are not a frequent finding--in the wide spectrum of surgical treatment of degenerative diseases of the spine the numbers of operations in the thoracic section account only for a few percent. The authors give an account of 12 patients treated surgically during the 5-year period 1997-2001 at the Neurosurgical Department of the First Medical Faculty Charles University and Institute for Postgraduate Training in Prague-Stresovice. They describe the establishment of the neurological finding from the differential diagnostic aspect, the algorithm of radiological examination and selected treatment. In the group of surgically treated patients were two with spinal and radicular symptoms, 8 patients had only spinal and 2 patients had only root symptoms. Laminectomy was performed in one female patient, in 9 patients discectomy was performed from a transpedicular approach and in two patients discectomy from costotransversectomy. Complete normalization of clinical complaints was recorded in 2 patients, in 8 the condition improved and 2 patients did not improve. In 2 patients a revision was made and extension of the approach on account of persisting clinical complaints, in one patient after revision complete normalization of the clinical finding occurred, the second patient did not improve after revision. Selection and results of the surgical approach--in all instances different types of posterior approach were involved--are discussed. In the discussion also a brief review, indications and illustrations of posterior approaches are given. The discussion deals also with the advantages and disadvantages of the method as compared with the anterior approach or endoscopic technique. The authors emphasize the advantages of the microsurgical technique--the open posterior approach still holds an irreplaceable place in the spectrum of surgical therapeutic methods despite the onset of endoscopic methods.

Adult↗
PubMed2005

Single center experience with a new commercially available thoracic endovascular graft.

PURPOSE: To evaluate the intra-operative performance and clinical outcome of a new commercially available stent-graft for the treatment of thoracic aortic diseases. METHODS AND PATIENTS: From January 2003 to October 2004, 45 consecutive patients received endovascular treatment with the Zenith TX1 device for diseases of the thoracic aorta at a single center in northern Italy. Indications included disease of the descending thoracic aorta in 26 cases, of the aortic arch in 17 cases and of the thoraco-abdominal aorta in two cases. We treated 38 atherosclerotic aneurysms, two post-traumatic aortic ruptures, two penetrating ulcers, two chronic dissections and one case was treated for aortic bleeding after voluntary acid ingestion for attempted suicide. General anesthesia was used in 20 cases. Combined or hybrid endovascular and open surgical repair was performed in 11 patients. Mean follow-up was 7 months (range 1-22 months). RESULTS: Technical success was obtained in 44 patients (98%). One primary type I endoleak occurred (2%). ICU was used in 12 cases with a mean stay of 1 day. The mean hospital stay was 6 days (range 4-13 days). There were no hospital deaths or strokes but one transient paraplegia (2%). A type II endoleak was observed in one case and resolved spontaneously 1 month later. No aneurysm enlargement, endograft migration or structural failures were observed during follow-up. Two late unrelated-deaths were observed. CONCLUSIONS: This stent-graft does not fulfill all the characteristics of the ideal graft, however, it proved to be safe and allowed satisfactory short term results in this group of patients treated at a single center.

Adolescent↗
PubMed2001

Multifocal extensive spinal tuberculosis (Pott's disease) involving cervical, thoracic and lumbar vertebrae.

An unusual case is reported of a 53-year-old woman presenting with spinal tuberculosis involving cervical, thoracic and lumbar vertebrae. The patient originally presented with progressive quadriparesis, fever, night sweats and weight loss. Imaging studies demonstrated vertebral body destruction with and without paraspinal and/or intraspinal abscess in cervical, thoracic and lumbar regions. The laboratory studies confirmed the diagnosis of Pott's disease and the patient was placed on anti-tuberculosis chemotherapy. The anterior approach was used for removal of the infected necrotic material, bone grafting and instrumentation, in both cervical and thoracic vertebrae. The postoperative course was uneventful and the patient made an excellent neurological recovery. The present report is of the first published case of an extensive spinal tuberculosis involving cervical, thoracic and lumbar spine.

Antitubercular Agents↗
PubMed2005

American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: controlling tuberculosis in the United States.

During 1993-2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003). The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal. In this statement, the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) propose recommendations to improve the control and prevention of TB in the United States and to progress toward its elimination. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB. This statement supersedes the previous statement by ATS and CDC, which was also supported by IDSA and the American Academy of Pediatrics (AAP). This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. AAP, the National Tuberculosis Controllers Association, and the Canadian Thoracic Society were also represented on the panel. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States. Although drafted to apply to TB-control activities in the United States, this statement might be of use in other countries in which persons with TB generally have access to medical and public health services and resources necessary to make a precise diagnosis of the disease; achieve curative medical treatment; and otherwise provide substantial science-based protection of the population against TB. This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB. The audience also includes the full range of medical practitioners, organizations, and institutions involved in the health care of persons in the United States who are at risk for TB.

Adolescent↗
PubMed1988

Thoracic CT-scanning follow-up of residual mediastinal masses after treatment of Hodgkin's disease.

Sequential thoracic CT-scanning was performed for 14 patients presenting with residual mediastinal masses on chest X-ray after treatment of stage I and II Hodgkin's disease (HD). Eleven patients initially presented with bulky mediastinal involvement. No mediastinal biopsy was performed. No local recurrence was detected at a 48 month median follow-up. Early evaluation by CT-scanning showed cystic degeneration in three cases. Sequential CT-scans on longer follow-up demonstrated continuous regression of residual masses in six cases and no or limited volume reduction in six other cases. In two patients, part of the residual mass remained stable and the other part showed reduction in size. In addition, late calcifications developed in four cases. The results of sequential CT-scanning suggest that residual mediastinal masses do not generally represent active disease. Hence additional, potentially toxic, therapy can be avoided.

Follow-Up Studies↗
PubMed2004

Mild to moderate atheromatous disease of the thoracic aorta and new ischemic brain lesions after conventional coronary artery bypass graft surgery.

BACKGROUND AND PURPOSE: The presence of new ischemic brain infarcts, detected by diffusion-weighted magnetic resonance imaging (DW-MRI), have been reported in considerable number of patients after cardiac surgery. We sought to determine the role of proximal thoracic aortic atheroma in predicting embolic events and new ischemic brain lesions in patients undergoing conventional coronary revascularization surgery. METHODS: Transesophageal echocardiography and epiaortic scanning was performed to assess the severity of aortic atherosclerosis in the ascending aorta and the aortic arch. Patients were allocated to either low-risk group, (intimal thickness < or =2mm), or high-risk group (intimal thickness >2mm). Transcranial Doppler was used to monitor the middle cerebral artery. DW-MRI was performed 3-7 days after surgery. The NEECHAM Confusion Scale was used for assessment and monitoring patient consciousness level. RESULTS: Patients in the high-risk group were considerably older; 71+/-6 (n=38) versus 67+/-6 (n=72) years, P=0.004 and were more likely to have impaired left ventricular function. Confusion was present in 6 (16%) patients in the high-risk group and 5 (7%) patients in the low-risk group. Patients in the high-risk group had a three-fold increase in median embolic count, 223.5 versus 70.0, P=0.0003. DW-MRI detected brain lesions were only present in patients from high-risk group, 61.5 versus 0%, P<0.0001. There was significant correlation between the NEECHAM scores and embolic count in the high-risk group; r=0.63, P<0.001. CONCLUSIONS: The findings of this investigation suggest that mild to moderate atheromatous disease of the ascending aorta and the aortic arch (intimal thickness >2mm) is a major contributor to ischemic brain injury after cardiac surgery.

Aged↗