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PubMedDate not supplied

Interleukin-8: an important neutrophil chemotaxin in some cases of exudative pleural effusions.

It was hypothesized that IL-8, a neutrophil chemotaxin, contributes to the influx of neutrophils into the pleural cavity of patients with pleural effusions. Pleural fluids were collected from 57 patients including 13 with effusions due to congestive heart failure, 28 with pleural involvement by carcinoma, 5 with empyema, 4 with parapneumonic effusions complicating bacterial pneumonia, 3 with hemothorax, 3 with tuberculosis, and 1 with rheumatoid arthritis. All exudate groups had significantly higher IL-8 concentrations than the CHF group (p < .001). In 18 of the exudate fluids, the concentrations of IL-8 was equal to or in excess of the optimal concentration of IL-8 which causes neutrophil chemotaxis in vitro. Between 20 and 90% of the chemotactic activity in the fluids was removed by absorbing the IL-8 with an IL-8 affinity column. These data showed that IL-8 is a major chemotaxin in the fluid. The percentage of neutrophils in the fluids was not correlated with the IL-8 concentration. Although TNF alpha, a potent stimulator of IL-8 production, is present in some pleural effusions, no correlation was found between the concentrations of IL-8 and TNF alpha in the fluids. The data suggest that IL-8 contributes to the neutrophil influx into the pleural space of patients with pleural exudates in conjunction with other chemoattractants. It is unlikely that TNF alpha is the sole stimulus for the IL-8 production in pleural disease states.

Chemotaxis, Leukocyte↗
PubMed2006

Perthes syndrome associated with bilateral optic disc edema.

CASE REPORT: Perthes syndrome, or traumatic asphyxia syndrome, results from a severe crush injury of the thorax. It manifests itself with facial and upper chest petechiae, subconjunctival hemorrhages, cervical cyanosis, and occasionally neurological symptoms. A patient who had been incarcerated under a block of marble presented with severe traumatic asphyxia syndrome complicated by pulmonary contusion, fractures of the right clavicle and the 8th and 9th ribs, minimal right hemothorax, liver contusion, and bilateral optic disc edema. COMMENTS: To our knowledge, we present the first case of Perthes syndrome with bilateral optic disc edema.

Adult↗
PubMed2002

Traumatic thoracic spinal fracture dislocation with minimal or no cord injury. Report of four cases and review of the literature.

OBJECT: Thoracic fracture dislocations reportedly lead to complete paraplegia in 80% of cases. It is rare for these dislocations not to cause neurological deficits, as evidenced by the mere 11 well-documented neurologically intact cases in the English-language literature. METHODS: The authors report four cases of thoracic fracture dislocation that remained neurologically intact and discuss 11 other previously published well-documented cases. Overall there were 10 men and five women with a mean age of 34 years (range 17-66 years). Mechanisms of injury included car crash in six, motorcycle crash in seven, plane crash in one, and fall from a horse in one. On admission, neurological deficits were absent in 11 patients, intercostal neuralgia was present in two, and mild lower-extremity weakness/numbness was demonstrated in two. All suffered significant thoracic pain, with 14 patients having sustained rib fractures and eight a hemothorax. The levels of dislocation were T3-4 in two, T5-6 in four, T6-7 in four, T7-8 in two, T8-9 in one, and T9-10 in two. All suffered some degree of lateral translation (mean 12 mm, range 3-27 mm). There were six cases of well-documented anterior subluxation in addition to translation (mean 12 mm, range 4-23 mm), and all involved some degree of fracture imploding of one vertebral body (VB) into an adjacent VB. There were six cases of burst fracture with translation (mean kyphotic angle 38 degrees, range 28-50 degrees). Bilateral pedicle shear fractures were present in all 15 cases at the site of subluxation, thus separating the anterior from the posterior elements and preserving the spinal canal. Only two of the 15 patients suffered complete spondylolisthesis. Five patients underwent successful nonoperative management with prolonged bed rest; at follow-up examination, neurological status remained normal in all five, lesions were radiographically unchanged in three, and there was less subluxation but not anatomical alignment in two. Ten patients underwent successful internal fixation via anterior approaches (two cases), posterior approaches (five cases), and combined approaches (three cases). Neurological status either improved to normal or remained normal except in one case with persistent intercostal neuralgia. Surgery resulted in no change in alignment in three, improved but not anatomical alignment in 11, and normal alignment in one patient. All patients ambulated unassisted by 6 months. CONCLUSIONS: In cases in which bilateral pedicle fractures occur at the site of significant thoracic subluxation and/or translation, preservation of the spinal canal and spinal cord neurological function can rarely occur when both the lamina and spinal cord do not dislocate along with the anterior VBs. In these instances, perfect anatomical reduction may require forces that unnecessarily put neurological function at risk and the results appear to justify internal fixation with some or no reduction of deformity.

Adult↗
PubMedDate not supplied

Saline-enhanced radiofrequency thermal ablation of the lung: a feasibility study in rabbits.

OBJECTIVE: To assess the feasibility and safety of CT-guided percutaneous transthoracic radiofrequency ablation (RFA) with saline infusion of pulmonary tissue in rabbits. MATERIALS AND METHODS: Twenty-eight New Zealand White rabbits were divided into two groups: an RFA group (n=10) and a saline-enhanced RFA (SRFA) group (n=18). In the RFA group, percutaneous RFA of the lung was performed under CT guidance and using a 17-gauge internally cooled electrode. In the SRFA group, 1.5 ml of 0.9% saline was infused slowly through a 21-gauge, polyteflon- coated Chiba needle prior to and during RFA. Lesion size and the healing process were studied in rabbits sacrificed at times from the day following treatment to three weeks after, and any complications were noted. RESULTS: In the SRFA group, the mean diameter (12.5+/-1.6 mm) of acute RF lesions was greater than that of RFA lesions (8.5+/-1.4 mm) (p < .05). The complications arising in 12 cases were pneumothorax (n=8), thermal injury to the chest wall (n=2), hemothorax (n=1), and lung abscess (n=1). Although procedure-related complications tended to occur more frequently in the SRFA group (55.6%) than in the RFA group (20%), the difference was not statistically significant (p = .11). CONCLUSION: Saline-enhanced RFA of pulmonary tissue in rabbits produces more extensive coagulation necrosis than conventional RFA procedures, without adding substantial risk of serious complications.

Animals↗
PubMed1995

Extramedullary hematopoiesis manifesting as a symptomatic pleural effusion.

The occurrence of extramedullary hematopoiesis in the pleura is rare and is usually asymptomatic. It is generally diagnosed on postmortem examination. Herein we describe a 61-year-old woman with agnogenic myeloid metaplasia who sought medical assessment because of progressive dyspnea. Thoracentesis yielded sanguineous fluid with 10% myeloblasts. A 99mTc bone marrow scan demonstrated increased tracer activity throughout both lungs, an outcome consistent with extramedullary hematopoiesis. Fine-needle aspiration and video-assisted thoracoscopy were considered but deferred because of the potential risk of profuse bleeding. Treatment with low-dose external beam irradiation to the left posterior pleura was successful. To date, no hemothorax has recurred.

Female↗
PubMed1999

Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997.

OBJECTIVE: To describe the results of analysis of clinical, physiologic, diagnostic, and therapeutic aspects and complications in patients with pulmonary arteriovenous fistulas (PAVFs). PATIENTS AND METHODS: Retrospective review of medical records of all patients with the diagnosis of PAVF evaluated at Mayo Clinic Rochester from 1982 through 1997. Demographic characteristics, presence or absence of hereditary hemorrhagic telangiectasia, clinical features, and results of imaging studies and blood gas analyses, treatments, and complications related to PAVFs were reviewed. RESULTS: Among the 93 patients, 44 were male and 49 female. The mean age at the time of evaluation was 40 years (range, 5-83 years). Fifteen patients (16%) were asymptomatic. History of hereditary hemorrhagic telangiectasia was present in 52 patients (56%). Notable clinical findings included epistaxis in 46 (49%), hemoptysis in 14 (15%), cyanosis in 27 (29%), clubbing in 18 (19%), dyspnea in 53 (57%), and pulmonary bruits/murmurs in 32 (34%). Chest x-ray films with or without tomograms showed abnormal findings in 87 (94%), of which 68 (73%) suggested PAVF. Polycythemia was detected in 12 (13%). Pretherapy arterial PO2 measured on room air averaged 56 mm Hg (range, 32-95 mm Hg), and the posttherapy PO2 averaged 77 mm Hg (range, 46-110 mm Hg). Echocardiography with indocyanine green dye was diagnostic of extracardiac right-to-left shunt in 26 (90%) of 29 patients tested. Diagnostic studies revealed single lesions in 32 patients (34%) and multiple lesions in 61 (66%). The most prominent complications of the disease were neurologic events in 34 patients (37%). These complications included transient ischemic attacks, hemiplegia, brain abscesses, and seizures. Surgical resection alone was carried out in 18 patients (19%), embolization therapy alone in 41 (44%), and both therapies in 7 (8%). The 48 patients treated with embolization required 78 embolization sessions with more than 200 lesions occluded. Complications of treatment included postembolization hemothorax in 1 patient and right-sided hemiparesis in another patient. Follow-up disclosed that 1 patient died from PAVF-related complications. CONCLUSIONS: Among our patients with PAVFs, hereditary hemorrhagic telangiectasia was observed in more than half and neurologic complications in more than one third. Because of the considerable risk of neurologic and other complications, definitive treatment should be considered in patients with PAVFs. Embolization is currently the preferred treatment in most patients. Frequent follow-up of treated patients is necessary because PAVFs tend to increase both in number and in size over time.

Adolescent↗
PubMed2000

Position-dependent ventricular tachycardia related to a peripherally inserted central catheter.

Recently, peripherally inserted central venous catheters (PICCs) have been widely used for venous access. Advantages of a PICC over centrally inserted central catheters include the virtual elimination of the risk of pneumothorax, hemothorax, and arterial puncture, along with a reduced risk of bleeding. However, the PICC has associated risks. We present 2 cases of body position-dependent ventricular tachycardia related to PICCs. These events occurred in patients with no prior history of cardiac arrhythmia and were corrected by repositioning of the PICC. They serve to identify a potentially serious cardiac complication of the PICC that, to our knowledge, has not been described previously.

Adult↗
PubMed2006

[Endovascular treatment of superior vena cava syndrome].

BACKGROUND: Superior vena cava syndrome (SVCS) is caused by the obstruction of venous drainage from the upper portion of the body. Common clinical findings are headache and cervical, facial and upper limb edema. Occasionally, clouding of consciousness appears. AIM: to report our experience with endovascular treatment of SVCS. MATERIAL AND METHODS: Retrospective review of all patients with SVCS subjected to endovascular treatment between 1999 and 2005. RESULTS: Eight patients were treated, all of them with malignancies. Six had a benign obstruction due to the presence of a chemotherapy catheter located in the superior vena cava, one had obstruction secondary to radiation therapy and one a tumor compression of the superior vena cava. Two patients underwent thrombolytic therapy. Angioplasty and stenting was performed in all patients. The chemotherapy catheter was removed to all patients and installed again in one. One patient had a hemothorax secondary to a simultaneous needle lung biopsy under video thoracoscopy. No patient died in relation to the procedure. Congestive signs and symptoms subsided in all patients within 24 hours after the procedure. During follow up, only one patient had symptoms related to vena cava obstruction and three died due to their malignant tumor. CONCLUSIONS: Endovascular treatment of SVCS has a low rate of complications and provides immediate and mid-term symptom relief.

Adult↗
PubMedDate not supplied

Primary angiosarcoma of the lung and pleura.

A 46 year old male smoker was admitted for severe continuing hemoptysis. Chest-X-rays and chest computed tomography revealed nodular infiltrates and bilateral hemothorax. Fiberoptic bronchoscopy resulted to non-diagnostic cytological and microbiological findings. Open lung and pleural biopsies after right thoracotomy revealed epithelioid angiosarcoma and further staging assessment showed secondary brain and liver foci. The patient received several courses of chemotherapy but he died one month later. The clinical, radiological, pathological, histochemical and therapeutic aspects of the disease are discussed. Angiosarcoma, a rare tumour with poor prognosis should be taken into consideration in the differential diagnosis of hemoptysis.

Antineoplastic Agents↗
PubMed1978

Foreign body perforation of the esophagus initiating traumatic pericarditis in an Australian fur seal.

Postmortem examination of a juvenile Australian fur seal, Arctocephalus pusillus doriferus, washed ashore on Philip Island, Victoria, revealed traumatic fibrinous pericarditis and hemothorax. A foreign body lodged in the right ventricle was identified as the barbed spine of the ray Urolophus paucimaculatus. A small puncture wound through the esophagus indicated the initial perforation site.

Animals↗
PubMed2006

Classification and management of chest trauma.

OBJECTIVE: To classify the predominant pattern of injuries following blunt and penetrating chest trauma and to assess the adequacy of treatment strategies, complications and mortality associated with such injuries. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Surgical Unit I, Holy Family Hospital, Rawalpindi, from December 2000 to December 2003. PATIENTS AND METHODS: One hundred consecutive patients with thoracic trauma either blunt or penetrating, admitted in the ward were evaluated. Their injuries were classified, treatment strategies outlined and complications and mortality were documented on a specially-designed proforma. RESULTS: Out of the 100 patients presenting in emergency, 44% presented with blunt and 56% with penetrating trauma. Pneumothorax was detected in 39% of the patients, hemopneumothorax in 29%, hemothorax in 12%, flail chest in 9 %. Two had involvement of the heart and major vessels, 4 % had injury to the diaphragm and 5 % had multiple trauma. During treatment, 3% of all the patients were managed conservatively, 83% of patients required chest intubations, 6% needed ventilatory support and 8 % required thoracotomy. Complications were experienced in 28% of the patients of which 9% had pneumonias, 14% empyema and 5 % suffered from wound infections. The overall mortality was 7 %. CONCLUSION: This series showed the pattern of injuries following blunt and penetrating chest trauma. Furthermore, it was found that chest intubation and simple resuscitation was adequate for majority of the cases.

Adolescent↗
PubMed1996

Thoracoscopic surgery in Brazil. An overview.

The Video Assisted Thoracic Surgery (VATS) was introduced in Brazil in 1992 by Losso, Ghefter and Imaeda. Since its advent up to November 1994, 488 patients have been submitted to 497 VATS procedures in four Medical Centers of São Paulo city. The indications for the procedures were: lung diseases in 244 patients (50%), pleural disease in 155 patients (31.7%), thoracic traumas in 42 patients (8.6%), mediastinal diseases in 35 patients (7.1%), cardiovascular diseases in 7 patients (1.4%), chest wall diseases in 3 patients (0.6%) and esophageal diseases in 2 patients (0.4%). In the group of lung disease the most commonly used procedures were the lung biopsy in order to diagnose diffuse pulmonary disease and the indeterminate solitary nodule resection. Among the occurrences of pleural diseases, the most commonly used procedures were the pleurodesis with talc (talc poudrage) for the treatment of recurrent pleural effusion, the driven pleura biopsy and debridment or decortication of trapped lung in cases of pleural empyema. Concerning the mediastinal diseases, the pathology which was most frequently treated by VATS was the recurrent pericardic effusion through partial pericardiectomy. Among the patients presenting chest traumatic diseases, the VATS was used to explore thoracoabdominal penetrating injuries, to control bleeding, to remove clotted hemothorax, to suture diaphragm lesions and to remove intrapleural foreign bodies. Out of 497 procedures, there were 28 convertions to thoracotomy (5.7%) and two deaths occurred all over the cases. The complications, limitations and growth related to this method as well as a future overview of the VATS in Brazil will be presented.

Brazil↗
PubMed1999

Early results with the Carbo-seal composite valve conduit for aortic root replacement.

BACKGROUND AND AIMS OF THE STUDY: Composite graft replacement of the aortic root is still a complex operation, transgraft hemorrhage being one of the most severe complications. The aim of the study was to evaluate early results with the Carbo-seal composite conduit for aortic root replacement. METHODS: A retrospective review of 21 patients operated on for ascending aortic aneurysm and/or dissection with the open technique between August 1993 and February 1998 is presented; 12 patients had Marfan syndrome and nine were non-Marfan. RESULTS: There were two operative deaths (9.5%) due to low cardiac output. Two patients were re-explored for bleeding which was not due to transgraft hemorrhage. Postoperative complications were one hemothorax, one pneumothorax and two pericardial effusions. During the follow up, one patient died of rupture of a descending aortic aneurysm, and one patient in atrial fibrillation had a transient ischemic attack. At the closing of the follow up, the remaining patients were well and free of complications. CONCLUSIONS: Carbo-seal may be considered a reliable device for use in aortic root replacement, though a longer follow up and a larger patient population are necessary to confirm these positive early results.

Adolescent↗
PubMed1976

[Surgical indications and results of thoracic sympathectomy].

Between the 1st of July 1971 and the 31st of December 1974, among 1,459 operations on vascular surgery, we carried out 77 thoracic sympathectomies in 46 patients. In most patients there was an oblitering angiopathie of digital type, stage II to IV, confirmed by angiography. Two patients had mixed type obstructions, two others had hyperhidrosis, one patient suffered from cleroderma, another had a thoracic outlet syndrome with digital arterial obstruction. In all cases, the transaxillary approach was that which caused the least complications and which permitted satisfactory exposure of the sympathetic nerve. The cosmetic results were good. The second and third thoracic ganglia were resected and the planes of cleavage marked with silver clips. In advanced stage III and stage IV, we noted 92 p. 100 improvements i.e. return to stages I or II. The operative mortality was nil. The most serious complication was a case of hemothorax which required later pulmonary decortication. We noted in two cases, a Horner's syndrome.

Adult↗
PubMed1999

Type III dissection according to DeBakey. Comments on 45 cases treated.

BACKGROUND: There is uncertainty regarding the most suitable form of treatment for both chronic and even more so the acute forms of DeBakey's type III aortic dissections. This retrospective study analyses the indications and methods used in 20 acute cases and 25 chronic cases of type III dissection. METHOD: The 45 patients included in this study presented a high index of operability given that they were selected from more than one coronary unit and referred to our service for this purpose. This study also confirmed a clear indication for medical treatment in uncomplicated acute forms, whereas it is necessary to opt for surgery in the case of ongoing or threatened complications. In chronic forms aorta diameter and/or thrombosis of the false lumen are a valid parameter. RESULTS: The incidence of mortality was 33.3% in the 12 acute forms undergoing surgery, with 4 deaths; in the case of chronic forms undergoing surgery, the incidence was 15% with 3 deaths. Of the 8 patients with acute pathology who were not operated, 87.5% died; whereas of the 5 non-operated chronic patients, 60% died (3 cases). During the post-operative period rethoracotomy was only necessary in 1 case following hemothorax on day 5, whereas at a respiratory level only 50% of patients were extubated within 48 hours, and in 12 cases it was necessary to continue until day 5-7, whereas tracheostomy was performed in 5 cases. CONCLUSIONS: The modern tendency in the treatment of DeBakey's type III acute dissections is to opt for surgery not only in the presence of manifest complications, but also when faced with threatened complications or the failure of medical treatment. Chronic forms present the two key indications for surgery, namely aneurysmatic evolution of the wall (> 5-6 cm) and absent thrombosis of the false lumen.

Acute Disease↗
PubMed1999

[Complete disruption of thoracic descending aorta without widening of the pseudoaneurysm].

A 41-year-old male was transported to our emergency room 25 minutes after blunt chest trauma. The chest X-ray film and CT scanning demonstrated left pulmonary atelectasis, hemothorax, and widening of mediastinum possibly due to hematoma. Hundred and fifty minutes after arrival to the hospital, we were rush to bring him to the operation theater suspecting serious injury of the thoracic organs in association with bleeding from left thoracic drainage tube without detection of the aortic rupture. The left standard thoracotomy disclosed no injury of the left lung, good continuity and no dilatation of the thoracic descending aorta. But visual blood flow observed through the adventitia of the aortic isthmus led us to the final diagnosis of the aortic rupture. After aortic clamping, the intima of the injured aorta was found to be completely disrupted for a length of 6 cm and was repaired with a vascular prosthesis under the partial cardiopulmonary bypass using a centrifugal pump. His postoperative course was uneventful. We reported a case of complete circumferential aortic rupture without widening of the pseudoaneurysm in the acute stage of the disease.

Adult↗
PubMed1999

Thoracoscopic retrieval of foreign body after penetrating chest injury: report of two cases.

Video-assisted thoracic surgery has proved to be valuable in many settings in thoracic surgery. The use of video-assisted thoracic surgery in trauma has recently rapidly increased. It is useful in acute or delayed management of patients with blunt and penetrating chest trauma. It is safe for removal of clotted hemothorax, treatment of thoracic empyema, treatment of persistent pneumothorax, treatment of chylothorax, and for diagnosis of diaphragmatic injury. We report two cases using thoracoscopy to remove intrathoracic metal fragments and avert the need for thoracotomy. In the first patient, a metal fragment injury was sustained via a penetrating wound from the supraclavicular notch to the right upper lung. The metal fragment was retrieved and the lung was repaired thoracoscopically using conventional suturing techniques. A second patient sustained a broken pin injury to the left upper mediastinum via a low neck wound. The pin was successfully removed under videothoracoscopy. Both patients recovered uneventfully and had shortened hospital stays. We feel that thoracoscopy offers a therapeutic as well as diagnostic benefit in stable patients with penetrating chest trauma.

Adult↗
PubMedDate not supplied

Suction curettage for removal of retained intrathoracic blood clots and pleural lesions.

OBJECTIVE: To develop a thoracoscopic technique for correcting and/or removing an intrathoracic disease process using our existing operating room equipment and without a "small thoracotomy." METHODS AND PROCEDURES: Fifty-eight patients from October 1994 to April 1998 were prospectively studied. All were undergoing procedures involving the removal of a suspected benign (or infectious) pleural process or a retained blood clot. Three or four thoracic ports were used in all cases. Straight and curved suction curettage cannulae (with finger valve attachment) ranging from 8 to 16 French were available for use. Intermittent variable suction (between zero and 60 mm Hg) was used in all cases. Dependent upon the size and adherence of the lesion to be removed, the pressure was determined by the surgeon and regulated by the circulating nurse in the room. In each case, a trap system was used for retrieval of the specimen. One lung ventilation was used in every case, and when suction was used one of the ports was kept "open" to allow room air to enter the chest cavity. RESULTS: All patients in our series had their procedures completed without the need for any kind of open thoracotomy. Pre and postoperative diagnosis concurred in all 10 patients, and no complications occurred (specifically, no injury to the lung tissue or chest wall structures). Operative time ranged from 45 minutes to 180 minutes with a mean of 75 minutes. In all cases of a hemothorax, a cell saver system was used for an average of one unit of blood autotransfused per case. CONCLUSIONS: New techniques do not always require the purchase of new equipment. Tight hospital budgets are forcing surgeons to rely on redefining uses of instrumentation already available in solving surgical problems. We believe that the use of this instrumentation will provide another avenue for surgeons to successfully complete a procedure thoracoscopically without the need for a thoracotomy. It is through multidisciplinary conferences such as the Society of Laparoendoscopic Surgeons that ideas such as this are propagated.

Adolescent↗