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At least 1,225 records · Page 68Linked to original sources
PubMed2004

[Outcome of tunneled hemodialysis catheters as permanent vascular access].

UNLABELLED: Tunneled cuffed hemodialysis catheters (THC) are developed as a means of short hemodialysis access while a more permanent form of access are maturing. The aim of this study is to investigate the effectiveness, survival and complications of the THC used for long-term vascular access. METHODS: In a retrospective study we looked at 42 THC inserted between November 2000 and October 2003, in 40 elderly patients, with systemic disease or when other vascular access was not possible. RESULTS: Procedural complications occurred in 5 cases (11.9%), which included: local haemorrhage (3), hemothorax (1) and one fatal venous tear. 6 catheters (14.2%) were removed due to complications (non-function 3 and bacteraemia 3). The total incidence of THC related infections was 0.18 episodes/1,000 catheters-days. Patients were followed up for a mean 379 days (range 1-1,140) and a total of 15,946 catheter-days. Qb and KT/V achieved at one month were 278.3 +/- 34.1 ml/min and 1.48 +/- 0.27 respectively. At the end of the follow-up, 23 patients (54.7%) were alive with catheter functioning. One, three and twelve months survival was 90.4%, 73.1% and 59.5% respectively. CONCLUSION: The THC may be a useful alternative permanent vascular access for hemodialysis patients when others vascular access are not possible.

Aged↗
PubMed2005

[Penetrating chest trauma in which thoracoscopy was helpful; report of a case].

A 32-year-old builder suffered from a chest trauma in a construction area. A ratchet penetrated his right chest wall posterolaterally, and he was transferred to our hospital. A chest X-ray and a computed tomography (CT) revealed that the tip of the instrument remained in the thoracic cavity and there were no other obvious damages including pneumothorax, hemothorax, and liver damage. We thought the simple removal of the instrument from his body was dangerous so he was transferred to the operating room and his chest was opened under general anesthesia. However, it was difficult to confirm the inside of penetrating point from the thoracotomy wound; therefore we used a thoracoscope. The thoracoscopy disclosed a penetration in the lung and a contusion on the diaphragm. The application of thoracoscopy in the operation of thoracic trauma is very promising in exploration of the thoracic cavity, especially in the area which is out of vision from the open thoracotomy.

Accidents, Occupational↗
PubMed2005

[Right delayed traumatic diaphragmatic hernia; report of a case].

An 80-year-old woman was admitted to our hospital with abnormal shadow on chest X-ray 8 years after a chest trauma during which multiple ribs on the right side were fractured causing hemothorax. A diagnosis of right delayed traumatic diaphragmatic hernia was based on the findings on plain X-ray and multislice computed tomography. We performed surgery via thoracic approach with thoracoscopic assist. The transverse colon, liver, and omentum were dislocated into the right thoracic cavity and hardly adhered to the lung. We successfully repaired the ruptured diaphragm. The postoperative course was uneventful and the patient was discharged on the 33rd postoperative day.

Aged↗
PubMed1992

[A successful surgical case of thoracoabdominal aortic aneurysm ruptured into the right pleural cavity].

A 55-year-old man was transferred to our cardiovascular center because of right hemothorax and hemorrhagic shock. Emergency CT scan revealed a thoracoabdominal aortic aneurysm (Crawford's type I-A) ruptured into the right thorax. The aneurysm was exposed by Stoney's spiral opening approach. A 24 mm Cooley Dacron graft was implanted in end-to-end fashion between the descending thoracic aorta and the abdominal aorta just above the celiac artery. The use of aortic artery cannula, femoral artery cannula and flexible polyvinyl tube provided safe and simple means as a temporary bypass during this graft replacement. Postoperative course was uneventful.

Aorta, Abdominal↗
PubMed2005

Electroanatomical systems to guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the Ensite/NavX and CARTO system.

BACKGROUND: The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) treatment and is becoming more widely accepted and practiced. This study aims to evaluate the characteristics of the CARTO and the Ensite/NavX system and draw a comparison between them on the aspects of procedural parameters and clinical effectiveness. METHODS: Seventy-five cases with paroxysmal or chronic symptomatic AF were randomly assigned to CPVA procedure guided by the Ensite/NavX system (group I, n = 40) and by the CARTO system (group II, n = 35). After successful transseptal procedure, the geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferentially ablate tissues out of pulmonary veins' (PVs') ostia. In cases with chronic AF, linear ablation was applied to modify the substrate of left atrium (LA). The endpoint of the procedure was complete PVs isolation. RESULTS: Seventy-five cases underwent the procedure successfully. The total procedure and fluoroscopic durations in group II were significantly shorter than in group I [(150 +/- 23) min and (18 +/- 17) min versus (170 +/- 34) min and (25 +/- 16) min, P = 0.03 and 0.04, respectively]. There was no significant difference in the fluoroscopic and procedure durations for geometry creation between group I and group II [(8 +/- 4) min and (16 +/- 11) min versus (5 +/- 4) min and (14 +/- 8) min, respectively]. The fluoroscopic durations for CPVA were (15 +/- 5) min in group I versus (10 +/- 6) min in group II (P = 0.05), and the CPVA procedural durations were significantly shorter in group II than in group I [(18 +/- 11) min versus (25 +/- 10) min, P = 0.04]. AF was terminated by radio frequency delivery in 14 cases (35%) in group I versus 5 cases (14%) in group II (P = 0.035). After CPVA complete PV isolation was attained in 26 cases (65%) in group I versus 11 cases (31%) in group II (P = 0.004). During a mean follow-up of 7 months, 32 (80%) cases in group I and 24 (69%) cases in group II were arrhythmia-free (P = 0.06). One case developed pericardium effusion and another one case was found to have intestinal artery thrombosis in group II. One case had moderate hemothorax in group I. All the complications were cured by proper treatment. No PV stenosis was observed. CONCLUSIONS: The CPVA procedure for atrial fibrillation is effective and safe. Although there is difference between the CARTO and the Ensite/NavX system, the CPVA procedure guided by either of them yields similar clinical results.

Adult↗
PubMed2005

[Penetrating right ventricular trauma by stab injury; report of a case].

A 52-year-old woman, who had attempted to commit suicide with a kitchen knife, was admitted. Upon arrival, conscious level was II-30 and blood pressure was 76/46 mmHg. The knife with a blade 20 cm long penetrated the thorax from the 7th left intercostal space beside sternum toward the heart and synchronously moved with pulsation of the heart. The chest X-ray showed the left hemothorax and a computed tomography (CT) revealed the tip of the knife reached the right ventricle. After draining the pleural effusion from the left thorax, the median sternotomy and pericardiotomy were made. The knife was shown to be stuck in right ventricle as it grazed the left anterior descending artery and the right posterior descending artery through pericardium from the apex. The ST segments in II, III, aVF and chests leads were elevated in the preoperative electrocardiography (ECG), but any damage was not recognized in coronary arteries. Under the total bypass on extracorporeal circulation, the knife was removed. The wound at the right ventricle reached about 12 cm length from the apex to the inferior wall. Fortunately, papillary muscles, chorda, septum in the right ventricle and also the left lung were not injured. The wound of the right ventricle was closed with reinforced using felt-strips. The postoperative course was uneventful. This case suggested that the most important factor for survival in cardiac trauma would be to make the hemodynamics stable with the urgent treatment just after arrival and to perform the surgical repair immediately.

Electrocardiography↗
PubMed2005

Diagnostic yield of closed pleural brushing.

The aim of this study was to assess the diagnostic yield of closed pleural brushing (CPBR) in the diagnosis of malignant pleural effusion. Twenty-one adult patients (20 men and 1 woman); aged 62.9 +/- 8.6 were participated to this prospective study. Thoracentesis, CPBR and closed pleural biopsy (CPB) following the brushing were applied to every patient. While CPBR provided diagnosis in 12 (57.1%) of 21 cases, in 3 of these 12 cases, pleural fluid cytology (PFC) and CPB were negative. The sensitivities of PFC, CPBR and CPB in the diagnosis of malignant effusions were 33%, 57% and 52%, respectively. When three procedures were used in combination, the sensitivity increased to 67%. When CPBR is performed in addition to PFC and CPB, the yield of the diagnosis increased 14% additionally. There was no mortality due to these interventions. Complications were chest pain in 3 (14.2%) cases, hypotension in 2 (9.5%) cases, cough in 1 (4.8%) case, pneumothorax in 1 (4.8%) case, and hemothorax in 1 (4.8%) case. In conclusion, CPBR as a safe, simple and well tolerated procedure provides high diagnostic yield in diagnosis of patients with malignant pleural effusion.

Adult↗
PubMed2005

[Traumatic aortic regurgitation complicating chronic bronchitis; report of a case].

A 61-year-old man with diabetes mellitus and chronic bronchitis was brought to the hospital after falling from a roof accidentally. He received blunt trauma to the left chest wall including left rib fractures, pneumothorax, hemothorax and a fracture of left scapula. After endotracheal intubation and chest drainage, he was transferred to the intensive care unit. Sixteen days later, congestive heart failure appeared. Echocardiography showed a severe aortic valve regurgitation with a prolapse of non-coronary cusp. Eight months after the injury, his heart failure deteriorated. He underwent aortic valve replacement with a mechanical prosthesis. Upon examining the aortic valve, we noted 2 perforations in the non-coronary cusp of the aortic valve. Postoperative course was uneventful.

Accidents, Home↗
PubMed2005

[Long term (5 years) outcome of radiofrequency ablation for hepatocellular carcinoma in 256 cases].

A total of 267 patients with hepatocellular carcinoma underwent ultrasound-guided radiofrequency ablation (RFA) in Peking University School of Oncology between 1999 and 2005 (421 RFA sessions). Among them, 254 patients were candidates for RFA treatment and the selective criteria were: (1) the greatest diameter of tumor 5 cm, respectively. According to tumor size, shape and location, we adopted a defined treatment strategy, which consisted of a mathematical protocol, an individualized protocol and adjunctive measures. And several methods were also used to prevent and deal with complications in tumors with different features. In this series the tumor complete necrosis rate (CR)was 95.2% (356/374 tumors). It was higher in 3.5 cm tumors with a CR of 91.3% (156/171 tumors). CR were 95.6% (44/46 tumors) for tumors near the gallbladder, 92.9%(79/85 tumors) for tumors near the diaphragm, 90.9%(40/44 tumors) for tumors near the gastrointestinal tract, 91.2% (31/34 tumors) for tumors near large vessel. In a follow-up period of 2-69 months, the local recurrence rates were 11.7% for HCC and 12.5% for recurrent HCC. The incidence of complications was 2.4% (10/409 sessions), including intraperitoneal hemorrhage (n=2), biliary duct stricture (n=1), hemothorax (n=1), bowel perforation (n=1) and needle tract seeding (n=5). Of these cases, only 3 required operation and the mortality related to RFA was zero in this series. We used Kaplain-Meier method and log-rank test to estimate and compare the survival rate. The 1-, 3-, and 5-year survival rates after RFA were 83.3%, 66.9%, 41.2%, respectively for all HCC patients and 74.6%, 41.3%, 33.6%, respectively for recurrent HCC. Survivals based on TNM stage, Child-Pugh grade, tumor number and tumor size are shown in Table 1. In conclusion, RFA with standard protocol has evolved as a minimally invasive local treatment that could achieve satisfactory outcomes for small liver tumors, and has become an effective and relatively safe alternative for the treatment of advanced tumors and recurrent tumors, which are not suitable for traditional therapy. RFA has broaded the treatment threshold for hepatic malignancies and might become one of the regular treatment methods in focal liver tumor and find wide application.

Adult↗
PubMedDate not supplied

Pleural abrasion in the treatment of recurrent or persistent spontaneous pneumothorax. Results of 94 consecutive cases.

In the ten-year period 1982 to 1991, 94 patients underwent pleural abrasion as definite treatment for spontaneous pneumothorax. Surgical indications included: 1) third recurrence of homolateral pneumothorax, 2) second recurrence of homolateral pneumothorax in the presence of alternating pneumothorax, and 3) persistent air leak with incomplete lung re-expansion in the presence of spontaneous pneumothorax treated with pleural drainage for more than 10 days. No deaths were observed in the present series. Post-operative complications were minimal and all reversible, including two cases of pleural effusion, one case of hemothorax, and one case of Horner's syndrome. Eighty cases were followed up from 7 to 91 months. No recurrences occurred during the follow-up period. Clinical, radiological and functional results appear satisfactory. Pleural abrasion seems to represent a valid surgical option in the treatment of recurrent or persistent spontaneous pneumothorax.

Adolescent↗
PubMed2005

[Electroanatomical systems guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the EnSite-NavX and CARTO system].

OBJECTIVE: The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) and is becoming more widely accepted. This study aims to evaluate the effectiveness of the CARTO and the EnSite-NavX system and to compare between them on procedural parameters and clinical characteristics. METHODS: Seventy-five patients with paroxysmal or persistent symptomatic AF were randomly assigned to CPVA procedure guided by either the EnSite-NavX system (group I, n = 40) or the CARTO system (group II, n = 35). After successful transseptal procedure, a geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferential tissues out of pulmonary veins (PVs) ostia. In cases with persistent AF, linear ablation was applied to modify the substrate of LA. The endpoint of the procedure was complete PVs isolation. RESULTS: Seventy-four cases underwent a successful procedure. The total procedure and fluoroscopic time in group II was significantly shorter than those in group I (150 min +/- 23 min and 18 min +/- 17 min vs 170 min +/- 34 min and 25 min +/- 16 min, P = 0.03 and 0.04, respectively). There was no significant difference in the fluoroscopic and procedure durations for geometry creation between the groups I and II (8 min +/- 4 min and 16 min +/- 11 min vs 5 min +/- 4 min and 14 min +/- 8 min, respectively). The fluoroscopic time for CPVA was 15 min +/- 5 min in group I vs 10 min +/- 6 min in group II (P = 0.05), and the CPVA procedural durations were significantly shorter in group II than those in group (86 min +/- 11 min vs 110 min +/- 15 min, P = 0.04). AF was terminated by RF delivery in 14 cases (35%) in group Ivs 5 cases (14%) in group II (P = 0.04). Complete PV isolation was obtained in 26 cases (65%) in group Ivs 11 cases (31%) in group II (P = 0.004). During a mean follow-up of 7 months, 32 (80%) cases in group I and 24 (69%) cases in group II were arrhythmia-free (P = 0.06). One case developed pericardial tamponade and 1 case was found to have intestinal artery thrombosis in group II. One case had moderate hemothorax in group I. All the complications were cured and no PV stenosis was observed. CONCLUSIONS: The CPVA procedure for atrial fibrillation is effective and safe. Although there is a difference between the CARTO and the EnSite-NavX system, the CPVA procedure guided by either of them yields similar clinical results.

Adult↗
PubMed2006

Serosal membranes (pleura, pericardium, peritoneum). Normal structure, development and experimental pathology.

This monograph offers a comprehensive review of the present knowledge of the structure of the serosal coverings of the pleural, pericardial, and peritoneal cavities in humans and laboratory animals. The authors provide data from their own research--with transmission and scanning electron microscopy--on the structure of the main components of the serosal membranes: mesothelial cells, underlying basal lamina, and submesothelial connective tissue layer. Two main types of mesothelial cells (flat and cubic) are distinguished and their distribution on the parietal serosal sheets and on the visceral coverings of various organs is described. The openings between mesothelial cells (stomata) and their relations with lymphatic lacunae are described thoroughly. Special reference is made to the serosal accumulations of lymphoid tissue (milky spots). The transcellular and intercellular transport to and from serosal cavities is studied by means of horseradish peroxidase tracing experiments. The prenatal and postnatal developmental studies are focused on human and rat pleura. The alterations of serosal membranes after experimental hemothorax, pneumonectomy, and peritonitis caused by Pseudomonas aeruginosa application suggest the existence of early, reversible, and late, definite periods.

Animals↗
PubMed1991

[Uni- and ipsilateral pulmonary edema after surgery on the lung].

Unilateral pulmonary edema can develop after evacuation of pleural liquid and pneumothorax, after pneumonectomy at the contralateral side and as a special form in left ventricular failure. Unilateral ipsilateral pulmonary edema in the remaining parenchyma after operations of the lung has been described very rarely. Eight patients are here described, once after a decortication and seven times after a pulmonary resection. Radiologic signs occurred generally 12-24 h after the operation and persisted for three to seven days. The first postoperative X-ray was always more or less normal. We believe that the cause of the edema is a mechanical traumatisation of the remaining parenchyma of the lung at the time of the operation which results to a capillary leak. Left ventricular failure and excessive fluid application after the operation can be a risk factor. Generally no clinical signs are present during the edema, but respiratory insufficiency, as with patient 8 can occur. Therefore it is important to distinguish unilateral pulmonary edema from other diagnosis like pneumonitis, hemothorax and atelectasis.

Aged↗
PubMed1991

[Rethoracotomies in the postoperative period].

The authors have performed 22 rethoracotomies. The causes of rethoracotomies were as follows: intrapleural bleedings, coagulated hemothorax, hermetic lung tissue, gangrene of the lung, bronchial fistula, atelectasis of the middle lobe and an error in diagnosis. Of great significance is the diagnosing of the postoperative complication and establishment of indications for rethoracotomy. Errors and problems in it show that the indication for reoperation should be established as early as possible.

Adult↗
PubMed2006

Surgeon-performed ultrasound in the diagnosis and management of pericardial tamponade in a 20-month-old blunt injured toddler.

The contents of the thorax, although less frequently injured in children than in adults, remain a source of substantial potential morbidity and mortality in traumatized children. Disparate problems such as rib fractures, lung injury, hemothorax, pneumothorax, mediastinal injuries and others may present in isolation or in combination with one another. Knowledge of the manner in which pediatric anatomy, physiology and injury patterns change with age may expedite evaluating pediatric chest after trauma. We present the case of a 20-month-old toddler with blunt myocardial injury and pericardial tamponade diagnosed with surgeon-performed Focused Abdominal Sonography for Trauma (FAST).

Cardiac Tamponade↗
PubMed2006

[Low dose whole lung irradiation for intractable pleural effusion due to idiopathic myelofibrosis].

A 63-year-old man with idiopathic myelofibrosis, diagnosed on Sept. 2004 and treated with hydroxyurea (HU), was admitted to our hospital on March 2005 because of dyspnea and pleural effusion on the right side. Effusion analysis revealed hemothorax due to extramedullary hematopoiesis or bleeding. We performed a thoracoscopic pleural lung biopsy and pleurodesis with minocycline after surgical evacuation. However, bilateral pleural effusion appeared only 2 weeks later, which was thought to be extramedullary hematopoiesis or acute transformation. We adopted a treatment strategy with low dose whole lung irradiation (4.25 Gy/5 fractions) which was followed by complete disappearance of the bilateral pleural effusion. Our present case suggests that low dose whole lung irradiation may be an effective and safe therapy for intractable pleural effusion due to extramedullary hematopoiesis.

Hematopoiesis, Extramedullary↗
PubMed2006

Scapulothoracic arthrodesis for winged scapula due to facioscapulohumeral dystrophy (a new technique).

We introduced a new scapulothoracic arthrodesis technique in 6 patients (2 bilaterally) with winging of the scapula due to facioscapulohumeral muscular dystrophy from 1984 to 2000. The procedure involved a combination of plating and wiring techniques. The indications were symptomatic winging, limitation of active shoulder motion, pain, and impaired daily living activity. Our objective was to improve motion, strength, and performance of activities of daily living, as well as to provide pain relief. As a result of the technique, active motion improved in all patients, flexion improved from 64 degrees to 104 degrees, and abduction improved from 67.5 degrees to 112.5 degrees. The only complication was a hemothorax in a bilateral case that was easily treated. The length of follow-up averaged 32.5 months (14-55 months), and results did not change with time.

Adult↗
PubMed2006

[Surgical fixation for flail chest].

Flail chest occurs by blunt chest trauma and is associated with pulmonary contusion, atelectasis, pneumothorax, hemothorax, and respiratory failure. Because of its severity, it may need internal pneumatic stabilization or surgical fixation. Some patients do not need the internal stabilization and are observed conservatively. Some of these patients, however, increase the flail after palliating the pain and getting up. These patients show inefficient ventilation and surgical fixation is needed. The operation should be performed after the improvement of pulmonary contusion. In this paper, we presented 2 patients who showed such course and clarified the surgical methodology.

Aged↗