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[Thoracoscopy in children].
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Thoracic manifestations of neurocutaneous diseases.
Classic neurofibromatosis, tuberous sclerosis, and ataxia-telangiectasia can affect the chest and respiratory system. These diseases are reviewed with particular emphasis on their thoracic and radiographic manifestations.
[Fiberoptic bronchoscopy in intensive care units].
The authors have retrospectively analysed 161 bedside fiberoptic bronchoscopies performed at intensive care units and demonstrate its' main indications, results and influences on the patients' condition. In 35.4% of cases immediate improvement was observed, in 31.6% the examination contributed to choose the proper treatment. Due to the safe method only one serious complication occurred because of bronchoscopy. The results justify-according to the literature-that fiberoptic bronchoscopy is an indispensable method to check airways and for diagnostical and therapeutic interventions of critically ill patients.
Disappointing results with a new commercially available thoracic endograft.
INTRODUCTION: New devices for endovascular treatment of thoracic aortic diseases were recently approved for clinical use by European authorities, obtaining the Conformité Européenne (CE) mark. In all patients who underwent endovascular treatment of a thoracic aortic disease in 2002, we used a new CE-marked device, the Endofit stent graft. The device is constituted of nitinol stents and polytetrafluoroethylene fabric, and has a simple design and delivery system. METHODS: During 2002, 11 patients (mean age, 75 years; range, 66-85 years) underwent treatment of atherosclerotic aneurysm (n = 9), chronic type B dissection (n = 1), and intramural hematoma (n = 1). Disease involved the descending thoracic aorta in 7 patients and the distal aortic arch in 4 patients. RESULTS: In all cases the Endofit stent grafts were successfully deployed in the intended position. No postoperative paraplegia or paraparesis was recorded. There were two in-hospital deaths: 1 patient died in the operating room (postmortem examination showed a kinked graft); and the other patient died in the intensive care unit on postoperative day 30, after an intraoperative stroke. One surgical conversion was performed 2 weeks after the procedure, because of total collapse of the graft due to rupture of three stents. Other graft-related complications included type I endoleak (n = 2), type II endoleak (n = 1), and incomplete opening of the device (n = 1). CONCLUSION: Endovascular treatment of thoracic disease with the Endofit graft in this small heterogeneous group of patients resulted in several complications, which may arise from both the delivery system and the graft itself. At present, other commercially available endografts may be safer for endovascular treatment of thoracic aortic diseases.
Interobserver variability in the detection of cervical-thoracic Hodgkin's disease by computed tomography.
PURPOSE: Computed tomography (CT) scans of the neck and chest are obtained at diagnosis of Hodgkin's disease to establish disease extent, plan radiotherapy, and serve as baseline studies for subsequent evaluation of response to therapy. However, differences in interpretation may occur even among experienced radiologists. This study was designed to test the extent of variation among expert radiologists' interpretations and to assess how their interpretations differed from that of the primary (institutional) radiologists. MATERIALS AND METHODS: Five radiologists independently reviewed randomly selected CT scans of 59 patients enrolled onto two Pediatric Oncology Group Hodgkin's disease treatment protocols. For each patient, 31 potential disease sites were scored as positive, negative, uncertain, or unassessable. Agreement among the reviewers and between the reviewers and the primary readers was analyzed. RESULTS: For 58% of the sites, at least four of the five reviewers agreed in >/= 80% of the cases. Kappa analysis showed moderate agreement in approximately two thirds of the sites and poor agreement in the remainder. There was moderate agreement between a majority of the expert readers and the primary radiologist reports for approximately one third of the sites, and agreement was poor in two thirds. CONCLUSION: There are disparities among radiologists' interpretations of cervical-thoracic CT imaging of patients with Hodgkin's disease. This variability may affect patient care and the performance and results of multi-institutional clinical trials. We propose that a standardized method of reporting might improve the consistency of interpretation of CT scans in these patients.
Long term follow-up of ventilated patients with thoracic restrictive or neuromuscular disease.
OBJECTIVE: To evaluate the long term effects of home mechanical ventilation (HMV) on pulmonary function, nighttime gas exchange, daytime arterial blood gases, sleep architecture and functional exercise capacity (6 min walk). Patients with respiratory failure attributable to thoracic restrictive disease (TRD) (kyphoscoliosis) or neuromuscular disease (NMD) were assessed, ventilated, trained and followed in a dedicated unit for the care of patients requiring long term ventilation. DESIGN: All patients admitted for home ventilation training since 1988 were reviewed. Measurements of lung function, gas exchange during wakefulness and sleep, as well as functional exercise capacity, were recorded before and immediately after the establishment of HMV. Measurements were repeated one to two years, five years and eight to 10 years later. PATIENTS: Seventy-four individuals with TRD or NMD who completed the home ventilation training program and continued with HMV during all or part of the day for at least one year were studied. RESULTS: Forty patients had TRD. The characteristics of these patients were (mean SE) as follows: age 58 2.4 years; vital capacity (VC) 27% 1.6% predicted, forced expiratory volume in 1 s (FEV1) 25% 1.5% predicted; FEV1/forced VC (FVC) 78% 1.8%. Thirty-four patients had NMD. The characteristics of these patients were as follows: age 44 3.1 years; VC 41% 4.9% predicted, FEV1 44 5.3% predicted; FEV1/FVC 83% 4.2%. There was a significant improvement in distance walked in 6 min (maximum change 51.2 m in patients with NMD and 93.0 m in patients with TRD), daytime partial pressure of arterial carbon dioxide (maximum change 12.9 mmHg in patients with NMD and 10.4 mmHg in patients with TRD) and nighttime partial pressure of arterial carbon dioxide (maximum change 11.7 mmHg in patients with NMD and 18.0 mmHg in patients with TRD) over time (P 0.004). Ventilation resulted in an improvement in partial pressure of arterial oxygen in patients with TRD (68.1 2.8 mmHg to 80.1 3.5 mmHg) and in patients with NMD (52.9 1.7 mmHg to 65.3 2.1 mmHg), although the change was not statistically significant in patients with NMD (P=0.001 in patients with TRD; P=0.105 in patients with NMD). The improvement after ventilation was maintained over several years. Sleep efficiency (75% 18%, 79% 2.2%), the arousal index (13.4 13 events/h, 28.2 17 events/h) and the apnea-hypopnea index (10.1 11.3 events/h, 13.9 9.5 events/h) did not change with time in either patients with TRD or patients with NMD, respectively (P 0.5). CONCLUSIONS: HMV was associated with sustained, long term improvements in nighttime and daytime gas exchange in patients with TRD and NMD. Function exercise capacity increased in patients with TRD and in a subgroup of ambulatory patients with NMD. In patients with TRD, these improvements were maintained for up to 10 years after HMV was established.
[Late results of thoracic sympathectomy in various diseases].
The late results of 171 thoracal sympathectomies performed on 142 patients in the 20-year period 1952 to 1971 are described. Favourable results were achieved in Raynaud's disease, obliterating endarteritis and other occlusive vascular diseases, and also in hyperhidrosis.
[The retrograde roentgen contrast demonstration of the thoracic duct in patients with surgical diseases of the thorax].
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[Endovascular treatment of diseases of the descending thoracic aorta].
INTRODUCTION: Endovascular repair as treatment of aortic diseases seems promising. We report the first Danish results of endografting of the descending thoracic aorta. MATERIALS AND METHODS: Nineteen patients (median age 68 years, range 22-78 years) underwent endovascular treatment of diseases in the descending thoracic aorta: atherosclerotic aneurysm (n = 7), ruptured aneurysm (n = 3), Type B dissection (n = 3), traumatic rupture (n = 3), pseudoaneurysm (n = 2) and a defective aortic prosthesis (n = 1). The patients were followed with chest CT scans and clinically. RESULTS: In all cases the endograft was successfully deployed in the intended positions. Median total hospital stay was 5 days, range 2-21 days. Eight patients had post-implantation syndrome. No deaths occurred within the first post-operative month. During the follow-up period (median 12 months, range 1-56 months) five deaths were observed. One of the patients died from aortobronchial fistula related to the endograft. One patient had an endoleak, and two had expanded aneurysm. None of these patients was treated. CONCLUSION: In selected patients, endoluminal grafting of the descending thoracic aortic is a safe and successful alternative to open graft repair in treating aneurysm, ruptured aneurysm, traumatic rupture and dissection. However, long-term evaluation is still required.
A large calcification in the thoracic wall.
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Pitfalls in the diagnosis of chest diseases.
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Endovascular treatment in diseases of the descending thoracic aorta: 6-year results of a single center.
OBJECTIVE: The purpose of this study was to evaluate endovascular treatment in diseases of the descending thoracic aorta. MATERIAL AND METHODS: This study was designed as a single center's (university hospital) experience. Over a 6-year period (1995 to 2001), thoracic endografts were placed in 74 patients with a diseased descending thoracic aorta who were at high risk for conventional open surgical repair: 34 had atherosclerotic aneurysms, six had posttraumatic aneurysms, 14 had type B dissection with aneurysmal dilatation of the false lumen, 12 had isthmic transections from blunt trauma, five had thoracoabdominal aneurysms (treated with a combined procedure), two had aortic coarctation, and one had an aortobronchial fistula. Twenty-six procedures (35.1%) were conducted as emergencies, and 48 (64.9%) were elective. The feasibility of endovascular treatment and sizing of stent grafts were determined with preoperative spiral computed tomography and intraoperative angiography. RESULTS: Endovascular operations were completed successfully in all 74 patients; postprocedural conversion to open repair was necessary in three cases. The overall 30-day mortality rate was 9.5% (seven deaths). Temporary neurologic deficits developed in two patients; not one patient had permanent paraplegia. The primary endoleak rate was 20.3% (15 patients). The mean follow-up period was 22 months (range, 3 to 72 months). Five deaths occurred in the follow-up period, and three patients needed secondary conversion to open repair 2, 3, and 14 months after initial endografting. CONCLUSION: Endoluminal treatment in diseases of the thoracic descending aorta is feasible and may offer results as good as the open method.
Thoracic surgery for hydatid disease.
This paper summarizes the place of thoracic surgery in the management of hydatid disease. Although based on the author's 31-year personal experience, it draws on the experience of others where that of the author is deficient. The treatment of pulmonary, pleural, liver, and cardiac cysts is discussed. The importance of avoiding spillage, adequate sterilization of cavities, preservation of lung, and drainage are emphasized.
The role of video-assisted thoracic surgery in esophageal disease.
Numerous applications of video-assisted thoracic surgery (VATS) in the management of diseases of the esophagus for structural, functional, benign, and malignant conditions have been reported. Indications and techniques for the use of VATS in the assessment and treatment of esophageal disease are discussed in this article. The need for careful evaluation of the safety, efficacy, and cost-effectiveness of these techniques is emphasized.
[Calcifying obstructive disease of the descending thoracic aorta].
The authors present the first surgically treated case of calcifying obstructive disease of the descending thoracic aorta. The diagnosis was based upon the coexistence of an aortic isthmus coarctation syndrome together with massive calcifications seen by chest X-ray. The aetiology remains uncertain but the authors tend in favour of an atheromatous aetiology. Cure was obtained by simple surgical treatment.
Spinal intermittent claudication due to cervical and thoracic degenerative spine disease.
STUDY DESIGN: Neurogenic intermittent claudication can be caused by spinal cord compression. In this study, 20 patients with spinal intermittent claudication due to degenerative spine diseases were evaluated. OBJECTIVES: This study clarified the clinical features and pathomechanism of spinal intermittent claudication due to degenerative spine diseases. SUMMARY OF BACKGROUND DATA: Spinal intermittent claudication may either be produced by intrinsic or extrinsic lesions. Little is known about spinal intermittent claudication due to extrinsic lesions such as spinal cord compression. Twenty patients with spinal intermittent claudication, caused by cervical or thoracic lesions, who were given surgical treatment except for one, were studied. Their main subjective symptoms were tightness, weakness, and numbness in the lower limbs and a strangulated sensation in the trunk to lower limbs. The objective findings were occurrence and/or aggravation of spinothalamic signs. METHODS: The gait loading test was performed on these 20 patients. Selective spinal angiography was performed on the patients with thoracic myelopathy and its therapeutic effects were evaluated. A radiographic assessment was made in all patients. RESULTS: The subjective symptoms and objective findings were reproduced by the gait loading test. Selective spinal angiography temporarily relieved or improved the spinal intermittent claudication due to the thoracic myelopathy. Spinal intermittent claudication disappeared immediately after surgical treatment. CONCLUSIONS: Circulatory impairment of the spinal cord seems to be closely related to the etiology of spinal intermittent claudication. Besides providing diagnostic information, selective spinal angiography may also have a temporary therapeutic effect.
Chest wall thrombophlebitis (Mondor's disease).
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