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[EMBRYONIC POLYTOPIC OSTEOCHONDROPATHY WITH RESPIRATORY INSUFFICIENCY, "OF JEUNE"].
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Hydatid disease of the liver with thoracic involvement.
Hydatidosis, caused by Echinococcus granulosus, is an endemic parasitic disease in Mediterranean countries. The most frequent anatomic locations are liver and lung. Intrathoracic rupture of hydatid cysts situated in the hepatic dome is a serious complication resulting in damage to the pleura, pulmonary parenchyma, and bronchi. From January 1984 to December 1997 we operated on 40 patients with intrathoracic rupture of a hepatic hydatid cyst. Chest roentgenograms showed a shadow of varying size at the base of the hemithorax. Hepatic and thoracic ultrasonography was performed in all cases. The diagnosis of intrathoracic rupture of a liver cyst was confirmed preoperatively in 30 of the 40 cases. Posterolateral thoracotomy was performed in all patients. This transthoracic approach allowed adhesiolysis and treatment of the pleural lesions, pulmonary lesions, and hepatic cyst. Treatment of the diaphragmatic gap is easily done. We performed 15 lobectomies, 10 wedge resections, 16 decortications, and in one patient simple drainage of a voluminous pleuropulmonary and hepatic purulent hydatic collection. The postoperative course was uneventful in 26 cases, but 14 patients had complications, from which 3 patients died. The therapeutic approach depends on ultrasonographic findings. We believe ultrasonography to be the best examination for assessing biliary, hepatic, diaphragmatic, and pleuropulmonary lesions. When an intrathoracic collection is present, thoracotomy must be performed and is sufficient if the biliary tract is safe. An abdominal approach is necessary when biliary duct drainage is required, and it may be sufficient in cases of direct rupture into the bronchi.
Overview of MR of the heart--1986.
Experience in the first few years of using MR for evaluation of cardiovascular disease indicates that it can provide information about cardiovascular anatomy, cardiovascular function, myocardial tissue characterization, and myocardial metabolism. Only the first capability is now being used for clinical diagnosis. MR imaging is evolving as a technique for the definitive diagnosis of pericardial disease, paracardiac and intracardiac masses, and thoracic aortic disease. It also shows considerable promise for the evaluation of congenital and ischemic heart disease and cardiomyopathies. The capabilities of MR displayed in animal studies extend beyond anatomic observations. Considerably more research and optimism for early progress are justified in the effort to harness its multiple capabilities for the evaluation of cardiovascular disease.
[CLINICAL AND THERAPEUTIC ASPECTS OF FUNNEL CHEST AND PIGEON BREAST].
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[CONGENITAL GENERALIZED MUSCULAR HYPOPLASIA WITH PIGEON BREAST].
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[OBSERVATIONS ON MONDOR'S DISEASE].
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Stent-graft repair of thoracic aortic aneurysms.
Aneurysmal disease of the thoracic aorta continues to be a very challenging management problem for physicians because of the many comorbidities harbored by these patients, as well as the morbidity of the conventional open repair via left thoracotomy. In a combined effort between interventional radiology and cardiovascular surgery, an endovascular stent graft repair has been devised for these patients in an effort to reduce morbidity. This report documents the results in the first 108 patients so treated. The graft itself, custom-made for each individual, is composed of interlocked, self-expanding "Z" stents covered with a woven Dacron graft. Compressed in a loading capsule, the graft can then be advanced through a 27-French (outside diameter; OD) sheath, which is positioned within the aneurysm under fluoroscopic guidance. Relatively normal 2- to 3-cm segments of proximal and distal aorta allow an adequate friction seal to prevent stent graft dislodgement and also provide a hemostatic seal to obliterate aneurysm filling. Complete aneurysm thrombosis was achieved primarily in 103 patients. There were 10 deaths (9.25%) within the first 30 days, four of which were directly attributable to the stent graft procedure. Perioperative strokes occurred in four patients, and there were four instances of paraplegia. There have been two documented stent graft failures in a mean follow-up of 21.8 months (range, 1 to 57 months). Although the long-term durability of this procedure remains unknown, we believe this less invasive endovascular approach will prove to be an effective and less morbid treatment for aneurysmal disease of the descending thoracic aorta.
Thoracic, abdominal, and vertebral actinomycosis. Diagnosis and long-term therapy in three dogs.
The clinical, laboratory, radiographic, and histologic features and the response to therapy in three dogs with actinomycosis are reported. One dog (dog 1) had a 12-cm nonresectable mass extending from the ventrolateral chest wall into the left ventricular myocardium. Another dog (dog 2) had a diffuse peritonitis with "sulfur granules" and two large masses. One of these masses was nonresectable involving adjacent abdominal structures. A third dog (dog 3) had a subvertebral mass at T1-3 producing quadraplegia. Two dogs had periosteal reactions involving adjacent sternebrae (dog 1) or ribs and vertebral bodies (dog 3) that are characteristic of Actinomyces spp infections. In dogs 1 and 2 the diagnosis was based on the morphologic and tinctorial properties of free sulfur granules and/or tissue granules. Culture results were variable. Tissue from dog 1 yielded no growth, while polymicrobial infections, which included Actinomyces spp, were identified in dogs 2 and 3. Actinomyces odontolyticus was isolated from dog 3. Although the actinomycotic granulomas were either not excised or only partially excised from dogs 1 and 2, both animals were cured by the oral administration of high doses of penicillin G for 19 and 6 months, respectively. Dog 3 responded dramatically to the same antibiotic therapy given for 5 months. However, within 4 months of discontinuing treatment an abscess and draining fistulous tracts developed in the left axillary region. Two surgical fistulectomies and additional penicillin therapy were required to cure this animal. These cases and the current veterinary and human literature on actinomycosis are used to propose a rational approach to the treatment of actinomycosis in the dog.
The thoracic asphyxiant dystrophy and renal disease.
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Etiology and mechanism of Harrison's grooves.
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Fifty thoracic hydatid cysts.
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Second trimester prenatal diagnosis of the Jarcho-Levin syndrome.
The Jarcho-Levin syndrome (spondylothoracic dysostosis) is a rare autosomal recessive disorder characterized by a short neck, short trunk and a constricted thorax due to multiple rib and vertebral defects; other visceral malformations are occasionally present. Most cases die in infancy due to respiratory failure. In this report we describe two cases in one family from the United Kingdom. Prenatal diagnosis by ultrasound examination during the second trimester was successfully accomplished in the second case.
A case of spontaneous spreading gangrene on the chest wall.
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HIV-associated (non-thymic) intrathoracic lymphoepithelial cyst in a child.
An unusual case of a juxtabronchial lymphoepithelial cyst in an HIV-positive child with post-obstructive pneumonia is presented. The pathogenesis and similarity with parotid lymphoepithelial cysts is discussed.
Mesenchymal hamartoma of the chest wall.
Mesenchymal hamartoma of the chest wall is an unusual lesion remarkable for its occurrence in early infancy and alarming clinical presentation, which often suggests malignancy. Despite its aggressive appearance and propensity to attain massive size, the lesion behaves biologically in a benign fashion, and may be treated conservatively, provided that there is no respiratory compromise secondary to mass effect. The case of an incompletely resected mesenchymal hamartoma that has behaved in a benign fashion after more than 4 years of follow-up is discussed here. We present this case to provide insight and raise clinicians' awareness of the behavior of an extremely rare tumor.