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At least 1,387 records · Page 77Linked to original sources
PubMed1999

[Lateral view of the thorax: the profile].

The lateral view of the chest is a complementary incidence performed less frequently nowadays with the great frequency of chest CT. In fact, this lateral radiograph has important potential and can even give some exclusive information. With the 3-dimensional visualization provided by CT, the lateral radiograph of the chest is even easier to understand. Following in the footsteps of our great predecessors (Felson, Heitzman, Proto) we propose the left lateral view and offer our opinion about indications, techniques and results. The left lateral view can be performed with perfect perpendicular orientation or with a slight lateral shift that can be chosen with the right shoulder forwards (shifted right anterior lateral) or the contrary (shifted left anterior lateral). The left lateral view, like the antero-posterior view must be interpreted in a circular-concentric fashion.

Heart Diseases↗
PubMed1998

The pathophysiology of primary blast injury and its implications for treatment. Part I: The thorax.

There is insufficient evidence to support a definitive approach to the clinical management of primary pulmonary blast injury. Post-blast cardiovascular and pulmonary changes are reviewed in this paper in order to highlight important aspects in the immediate management of the blast injured casualty. Blast profiles and theoretical mechanisms of injury vary widely but all result in mechanical disruption and cause similar pathological, physiological and biochemical responses. Some patients may present acutely, while others appear unharmed and develop respiratory failure 12-24 hours later. Treatment outcome may depend on the judicious use of resuscitative fluids and respiratory support. The roles of supplementary oxygen and assisted ventilation remain controversial although administration of high inspired oxygen concentrations and respiratory support may be unavoidable. The advantage of pharmacological manipulation of reflex mechanisms is as yet unproven. Hyperbaric therapy may improve survival in pulmonary blast injury.

Blast Injuries↗
PubMed1999

[Empyema of the thorax].

The authors evaluated the therapeutic procedure and results in patients with empyema of the chest. From December 1996 till June 1998 at the Surgical Clinic of the Third Medical Faculty, Charles University Prague 21 patients with empyema of the chest were hospitalized. The most frequent cause of empyema of the chest was pneumonia in 13 patients (62%). In 16 patients (in 76%) the empyema was classified as the third stage of the disease. Decortication, the most frequent procedure, was performed in 16 patients, incl. three where it was done using videothoracoscopy. Surgical treatment was supplemented by antimicrobial treatment, either monotherapy or a combination of antimicrobial preparations. From the total number one patient died 25 days after thoracotomy and partial decortication with a mesiotheloma of the pleura. The other patients have no signs of relapse of empyema. According to the authors experience the selection of the surgical procedure depends on the stage of the disease. In the authors group decortication by the thoracotomic route was used most frequently.

Adult↗
PubMed2000

[Acute abdomen: consider also the thorax].

Three patients, 2 men aged 22 and 62 years en 1 woman aged 49, presented with symptoms of an acute abdomen. While infiltrative signs were described on radiodiagnostic images two patients underwent laparotomies. In all three subsequently the diagnosis of pneumonia was established and the patients made full recovery after antibiotic therapy. When a patient presents with symptoms of an acute abdomen, the possibility of an existing pneumonia should always be borne in mind. It is therefore recommended to make a chest radiograph with frontal and lateral view. In the presence of infiltrative signs the existence of pneumonia as the cause of abdominal symptoms should be considered in order to avoid unnecessary laparotomy.

Abdomen, Acute↗
PubMedDate not supplied

[Magnetic resonance tomography in the diagnosis of lung metastases in the mediastinum and thorax].

The results of MRI in 81 patients with morphologically verified lung cancer, mainly Stages IIIA and IIIB, were analyzed. They were compared with CT data in 37 cases and surgical findings in 28. MRI was performed by using Magnaview 0.04 T and Vectra 0.5 T apparatus in the T1- and T2-weighted SE and PC sequences as well in the fat-suppression mode. Thoracic metastases were evaluated from the direct signs tumor spread into the adjacent tissue and vessels. The criteria for the involvement of lymph nodes were their over 1-cm enlargement and characteristic changes in the intensity of signals from them. CT was found to yield less information on pleural, pericardial, and vascular invasion (66-75% sensitivity). MRI detected this type of cancer spread (88-94% sensitivity). Both techniques have nearly equal sensitivities in revealing intrathoracic lymphadenopathy. The interpretation of MRI data did not depend on the voltage of a magnetic field. It is recommended that MRI should be made after CT when there is a need for assessing large vessels or for making clear the data that remain open to question following CT.

Bronchial Neoplasms↗
PubMedDate not supplied

Stop-flow in mediastinum and thorax for resistant lymphoma.

BACKGROUND/AIMS: Management of patients with heavily pretreated malignant lymphoma failing frontline treatment and salvage high-dose chemotherapy and autologous peripheral stem cell rescue, is problematic. A pilot study was conducted to evaluate isolated thoracic perfusion of drugs by means of stopflow technique. METHODOLOGY: Six patients were enrolled in the study; diagnoses included 4 advanced Hodgkin's disease, 1 primary mediastinal B-cell lymphoma, and 1 anaplastic large cell lymphoma. Patients were aged 18-37 years; 4 presented with bulky mediastinum. They had never achieved a complete response since all had progressed from front-line treatment, and 3 had even failed salvage high-dose chemotherapy with autologous peripheral stem cell rescue. Cisplatin (100 mg/m2) and melphalan (35 mg/m2) were used. Carmustine (100 mg/m2) were added to these 2 drugs and cytarabine (2000 mg/m2) in patients not previously treated by carmustine, etoposide, cytarabine, and melphalan. Epidoxorubicin (70 mg/m2) was added in patients who previously received a suboptimal dosage of antracycline. Drugs were delivered monthly via aortic perfusion performed by means of Aigner's stop-flow technique. RESULTS: Overall 13 cycles of perfusional chemotherapy were administered with a median number of 2 cycles. During the procedures there were no technical, hemodynamic, or vascular complications, and no deaths occurred during surgery. After 1 month, 6 (100%) objective responses after isolated thoracic perfusion were recorded, 3 (50%) of which were complete. Tolerance to therapy was excellent. Hematological toxicity was mild and transfusional support was needed only in one course. At the last follow-up, 2 patients are alive (1 complete response and 1 very good partial response, maintained). CONCLUSIONS: This new therapeutical approach seems very active in recurrent/refractory malignant lymphoma and may play an important role in this setting.

Adolescent↗
PubMed2000

[Magnetic resonance angiography of the thorax in 2000].

Over the last five years, magnetic resonance imaging (MRI) has been the scene of explosive developments in many fields. MRI exploration of thoracic vessels, perfusion imaging of the pulmonary parenchyma, cine-MR, and apnea sequences have all seen impressive advances. This improvement has been made possible by progress in data processing and surface coil technology for a better signal-noise ratio. In 2000, indications for thoracic MRI remain limited due to the small number of machines available and the fact that the CT scan can provide superior quality images for the pulmonary parenchyma and for visualizing calcifications. MRI can be a complementary exam for lung cancer work-up in case of suspected invasion of the thoracic cavity or the mediastinum. It is the first intention exam in cases involving the greater vessels, with the exception of emergency situations, the posterior mediastinum, and the heart. We review here the current contribution of MRI in diseases of the chest and discuss perspectives for the future.

Humans↗
PubMedDate not supplied

[Synergic effects of intra-aortic counterpulsation and dopamine in experimental cardiogenic shock with closed thorax].

Having established an easily reproducible, stable, technique for producing cardiogenic shock in dogs, and for applying the intraaortic balloon pump (IABP), a complementary study was carried out in six dogs that were treated for cardiogenic shock with the IABP associated with 8 micrograms/kg/min. of continuous intravenous dopamine. The results were compared with those obtained using only the IABP. It was found that dopamine associated with the IABP reduced the left ventricular end-diastolic pressure by 75.3% and increased the dP/dt and Vmax by 90% and 41.6% respectively. The heart rate rose from 134 (+/- 2.45) to 153.5 (+/- 14.13) beats per minute two hours after treatment. There were no changes in the mean aortic pressure and left ventricular systolic pressure, and diuresis was decreased. It is concluded that the IABP alone produces a significant decrease in the preload and increase in the afterload, but when associated with dopamine, no changes are observed in the afterload, but the preload falls considerably. Moreover, myocardial contractility is increased. Therefore dopamine and the IABP used together have synergic beneficial effects.

Animals↗
PubMedDate not supplied

[Acute coronary oclussion and cardiogenic shock. Experimental study with closed thorax].

UNLABELLED: Nineteen dogs in whom an intent to produce cardiogenic shock due to acute myocardial infarction are studied. The dogs are maintained with closed chest and acute myocardial infarction is produced by injecting a bolus of metalic mercury in the left circumflex coronary artery using two different methods. Comparatively, the results show that a more selective embolism is obtained with the double catheter technique than by the introduction of a single coronary arteriograph catheter. Eight of the 19 dogs died. Six due to accidental introduction of mercury in the anterior interventricular artery together with the left circumflex artery, and 2 due to rupture of the ascending aorta during the maneuvre of placing the coronary arteriograph catheter. In the eleven dogs that survived the following parameters were taken every hour during a period of four to six hours. a) Hemodynamic: Left ventricle pressure, cardiac output by thermodilution, maximum dp/dt and Vmax, central venous pressure, cardiac rate and diuresis; b) Metabolic: Gases and lactate in arterial, venous and coronary sinus blood. Cortisol blood levels. All dogs were anaesthetized with thiobarbital during the venous cutdown and later sedated with morfine. They were maintained breathing atmospheric air. Cardiogenic shock was established when the diuresis fell from 170 cc/hour to an average of 43 cc/hour, the mean arterial pressure fell by 20%, the cardiac output by 58%, Vmax descending 20%, the telediastolic pressure of the left ventricle rose from 2.8 mm. Hg to 19.6 mm. Hg and the presence of acidoses was demonstrated by metabolic studies. CONCLUSION: Since the dog is maintained with a closed chest and breathing atmospheric air, this is an excellent method for the production of cardiogenic shock in conditions similar to the humain without the influence of other variables. In this way a better knowledge of shock is obtained and different terapeutic measures can be studied.

Acute Disease↗